820389_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental Qual

► 5 1 i 4,4 A l I k -tax
Type of Visit: 4D Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance I
Reason for Visit: Routine O Complaint O�Follo.�w-up O Referral O Emergency O Other Q Denied Access
Date of Visit: Arrival Time: l/ Departure Time: [j r County:
Farm Name: t 0� a " sr �u"S Owner Email:
Owner Name:Phone:
Mailing Address:
<:Aw Region:r V i
Physical Address:
Facility Contact: 6Vy4t lSOOtcx Title: Phone:
Onsite Representative: Integrator: # re —e—
Certified Operator:
Back-up Operator:
Location of Farm: Latitude:
Certification Number:
Certification Number:
Longitude:
Design Cnrrent
Design
Cnrrent
Design Current
Swine Capacity Pop.
Wetoultry P
Capacity
Pop.
C*attle
Capacity Pop.
Wean to Finish
Layer
Dairy Cow
Wean to Feeder
Non -Layer
Daia Calf
Feeder to Finish d
Dairy Heifer
Farrow to Wean
Design
Current
IDry Cow
Farrow to Feeder
D , P,oul
Ca aci
$o .
Non -Daily
Farrow to Finish
ILavers
Beef Stocker
Gilts
Non -Layers
Pullets
Turkeys
Beef Feeder
Beef Brood Cow
Boars
Other
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes [DNo ❑ NA ❑ NE
[—]Yes
[—]No
[�rNA
❑ NE
[]Yes
[:]No
CNA
❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes ❑ No
❑ Yes P
No
❑ Yes 10 No
dNA
❑ N E
❑ NA
❑ NE
❑ NA
❑ NE
Page 1 of 3 21412015 Continued

n
Facili Number: Date of inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [�.Pd�-❑ NA ❑ NE
a. if yes, is waste level into the structural freeboard? ❑ Yes ❑ No Q- lA ❑ 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?
(i.e., large trees, severe erosion, seepage, etc.)
❑ Yes[`No ❑ NA ❑ NE
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
[3 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
[DINo
❑ 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
�o
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
0 Yes
n No
❑ NA
❑ NE
maintenance or improvement?
1 I . is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes DN ❑ 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 e'l-1�G& 5Zt 0 %t
13. Soil Type(s): !T l u.;: Al
_p
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
/❑-Nb
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
E/ .l'dzi
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
[&,1Go
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
TT'Vo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[D-5o
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
_,,�
1 ,_Q l�o
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? if yes, check the appropriate box below. ❑ Yes No ❑ 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 ❑ 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

Facility Number: jDate of Inspection: x
24. Did the facility fail to calibrate waste application equipment as required by the permit? [—]Yes io
25. is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes E' 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 EKo
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes eNo
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?
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes
C3"No
❑ NA
❑ NE
[:]Yes
EfNo
❑ NA
❑ NE
❑ Yes
E ,emu
❑ NA
❑ NE
❑ Yes
ETo
❑ NA
❑ NE
❑ Yes
Q No
❑ NA
❑ NE
❑ Yes
21 N
❑ NA
❑ NE
❑ Yes
[2 No
❑ NA
❑ NE
Counts {refer togoestton #) E%plaut anyFYEStan)a d/Olrtany'additonal recarnmendateons oi'jl�atiy otheir'conmerits. �..i� a"`
Useidrav ngs;,oflfac ty toybetter eaplaEn.srtuaaons (ase addtttanai pages as necessary)::
C1U -ll�l
iur
c -CL[ Ctl o- 3 o i�_67 S[
Reviewer/Inspector Name: r L t1
Reviewer/Inspector Signature:
Page 3 of 3
Phone. j 'Q'_ 3)`J��`
Date: 1 /
21412015

Type of Visit: G�" mpliance Inspection O Operation Review O Structure Evaluation p Technical Assistance
Reason for Visit: 1fRoutine 0 Complaint 0 Follow-up O Referral 0 Emergency 0 Other 0 Denied Access
r rt
Date of Visit: LL. Arrival Time: eparture Time: t County:^ Region:
Farm Name: ek K Owner Email:
Owner Name: t r Phone:
Mailing Address:
Physical Address: f'
Facility Contact: r f
-eK4.4.
Onsite Representative:
�i
Certified Operator: <
Back-up Operator:
Location of Farm:
Latitude:
Phon�e:
Integrator:
Certification Number:
Certification Number:
Longitude:
Design Current Destgn a tC Design C•nrrent
Swine
Ca aci Po Wet Poul Ca aci Po
p ty p. try p ty p attle Capacity Pop.
Wean to Finish
Layer DaiTyCow
I INon-Layer I EET. Dai Calf
$ri "' _ = ` . Dairy Heifer
Wean to Feeder
Feeder to Finish
Destgn�Cui ren# D Cow
Farrow to Wean
Farrow to Feeder
D , 1P,oult . Ca aci ` Po V Nan -Dairy
µ=
Farrow to Finish
La ers ""'' Beef Stocker
Non -La ers xF1 Beef Feeder
Gilts
Pullets = 113eefBroudCow
Boars
Turkeys
Other,TurkeX
Poults '
Other
Other f
Discharzes and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes [2'1Vo ❑ NA ❑ NE
❑ Yes ❑ No E2KA ❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWR)
[:]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 DWR)
[:]Yes [:]No
NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes o
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes gNo
D NA
❑ NE
of the State other than from a discharge?
Page I of 3
\
21412015 Continued

Facili Number: - Date of Ins ection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure 1 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_)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
[1�"No ❑ NA ❑ NE
❑ No 21qT_0 NE
Structure 6
❑ Yes e'I�o ❑ NA ❑ NE
❑ Yes ffNo ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
©N
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
CIONo
❑ 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
�N o
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
F:; o
❑ NA
❑ NE
maintenance or im rovement9
P
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes rjoNo ❑ 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): P
Sao A
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
Ej-No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
Ef No
❑ 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
E2"No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
ff—No
[] NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[e['No
❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes. check
❑ Yes
❑ No
❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21, Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
❑'No
❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
E;rNo
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment'?
❑ Yes
2No
❑ NA ❑ NE
Page 2 of 3
21412015 Continued

Facili Number: - Date of Ins ection:. (L
24, Did the facility fail to calibrate waste application equipment as required by the permit? [:)Yes [B'<o ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [TNo ❑ 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 B No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [D No ❑ NA 0 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?
rplain any.:
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
❑ Yes ZrNo ❑ NA ❑ NE
0 Yes ff'Ro ❑ NA ❑ NE
❑ Yes [:1Qo ❑ NA ❑ NE
❑ Yes [/7'No ❑ NA ❑ NE
❑ Yes E No
❑ Yes CNo
❑ Yes [J"No
recommendations
;sary)....
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
10-3 - L K,'� I I
Phone: 43 -1-33 V
Date: (�� kc
-1 -7
21412015

Rr NS � I I ts-b
�a'iDiv`i`sian of Water Resources
Facility Number - ® Division of Sail and ffater Conservation
® Other AgencyjplllllllllllllEllllllll
Type of Visit: Com fiance Inspection Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit: (Routine O Complaint Follow-up Referral Emergency O Other Denied Access
Date of Visit:Arrival Time: ' ' S Departure Time: f p County: S -4nj Regionf:'�
Farm Name: ,el,J s'L.Tza"M Owner Email:
Owner Name: _ythgA PlAhtWS Phone: -
Mailing Address:
Physical Address:
Facility Contact: xe%4 A rA A$ D yew s Title: Phone:
Onsite Representative: + Integrator: ( f r4
Certified Operator: Certification Number: 17e.ET
Back-up Operator:
Location of Farm:
Certification Number:
Latitude: Longitude:
Swine
Design Current
Capacity Pop. Wet Poultry
Layer
Non -La er
D " ��
�D roult
Design
Capacity
'
Design
Ca aci
Current
Pop.
Current
Po
Design Current
Cattle Capacity Pop.
DairyCow
DairyCalf
DairyHeifer
D Cow
Non -Dairy
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Lavers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
OeRM
0-
Pullets
Turkeys
Turkey Poults
Beef Brood Cow
Other
Oiher
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 [31- ❑ NA ❑ NE
❑ Yes
[-]No
dNA
❑ NE
[:]Yes
[-]No
O-1QA
❑ NE
❑ Yes
[::]No
YNA
❑ NE
❑ Yes
[] No
❑ NA
❑ NE
❑ Yes
ff No
❑ NA
❑ NE
Page I of 3 21412014 Continued

Facili Number: - $ Date of Inspection:
ay
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
EjNa- ❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No E 'ice
❑ 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
ED M ❑ 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
Ole- 0 NA
❑ NE
waste management or closure plan?
If any of questions 4fi 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
LA, ❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[ZLNe- ❑ 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
EG N—oo ❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
[] Yes
[-1 o ❑ NA
❑ NE
maintenance or improvement?
1 1. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes �No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): ~ & - em aA I1/nY z ,e s 6 D
13. Soil Type(s): 1 Ut) , p -0
14. Do the receiving craps differ from those designated in the CAWMP? ❑Yes [ ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes Qcr ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes d ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
[:]Yes
❑L .ko
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
[:]Yes
[a-M
D NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
[:]Yes
[8
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
[:]Yes
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 Cg-'m
❑ 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 LJ 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 21412014 Continued

Facili Number: Oak, - Date of Inspection: 61 IF
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes MC1V1' ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes Ljjl o ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? [:]Yes 6�Ko ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ER -No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
[:]Yes
2301�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
Q'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
[311go
❑ 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
2-lTo
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
2-ITo
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
[7No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
allo
❑ NA
❑ NE
Comments (refer to question 9): 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). ^'
T{ �r
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 4 3
4
Date: 'I of
21412014

13ivvi-(
i ype 01 visit: V2,%eMpliance ]inspection V Operation Review U Structure Evaluation () 'Technical Assistance
Reason for Visit: 011i outine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: Departure Time: County: Region:
Farm Name: �rdlr lA 4,e v [ Owner Email:
Owner Name: t Phone:
Mailing Address:
Physical Address:
Facility Contact: Al" f-Title: Phone:
Onsite Representative: l {
Certified Operator: C 94'44
Back-up Operator:
Location of Farm:
Latitude:
Integrator:
Certification Number:
Certification Number:
Longitude:
Design Current b�;4 Desrgn"'Current
Swine Capacity Pop. Wet l'nultryCapacity Pop.
Wean to Finish
Wean to Feeder
Design Current
Cattle Capacity Pop.
airy Cow
aia Calf
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
y�Des>ign.
D . _foul Ea aci
La ers
Current
.P,o ,
Dairy Heifer
Dry Cow
Nan-Dai
Beef Stocker
Beef Feeder
Gilts
-Layers
Boars
jPullets
LjBmf
Brood Cow
Other ,,
Other
Turkeys
Turke Poults
Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
Q_Nff--❑ 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
[3-NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
[ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
[Q-Ko
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
e No
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 2/4/2011 Continued

Facili Number: wz jDate of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [3.AlV�__❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? [—]Yes [—]No [ A ❑ 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
M.`b
❑ 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
E°
❑ 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
G3 1Vo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
2<0
❑ 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
❑. - o
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
Q3>a--
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes FAI, ❑ NA ❑ NE
❑ Excessive Ponding 0 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 0 Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): ,,4 cj G D
13. Soil Type(s): _ p AA
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes ED No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable [:]Yes [9-i-o ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
[:]Yes
E No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
C o
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[g<o
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
LEJ Ko
❑ 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�-Po ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Sail 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 2�(N��Z
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: 61 Ll - S5 k 77 1 Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? [:]Yes Ml<o
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑' o
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structurc(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes L_�Ko
27, Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [D'K6
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface file drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
[—]Yes [DXb ❑ NA ❑ NE
[—]Yes E:fNo ❑ NA ❑ NE
[:]Yes [:fNo ❑ NA ❑ NE
❑ Yes E!rN. ❑ NA ❑ NE
❑ Yes U No
❑ Yes [fNo
❑ Yes ErNo
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question #): Explain. any YES answers and/or any.additional reeommendationsmr.any other commend.
Use drawings of facility to better explain situations (use. additional pages as necessary) u, _
At �j-e I ?-s.3
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
A-'2- 0 ' 3 (:) - �C,, -a
Phone:
Date: !�
21412011

(Type of Visit: (E'Comp ' ce Inspection p Operation Review Q Structure Evaluation O Technical Assistance I
Reason for Visit: outine O Complaint O Follow-up O Referral O Emergency Q Other Q Denied Access
Date of Visit: tl
�jA_rrival Time:® Departure Time:
Farm Name: K Aq Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: L t
Certified Operator:
Back-up Operator: �e
Location of Farm:
CountyRegion:/:--7�
Title: Phone:
Latitude:
Integrator: f t-S
Certification Number: 1 6 4y II
I
Certification Number: To SC `�-'
Longitude:
.Design Current
�;�A r - DesignCurrent�
Design Current
Capacity .Pop.
Wit Poultry Capaci Pop
Cat#le Capacity Pap.
Wean to Finish
Wean to Feeder
La er
-Layer
Dairy Cow V
Dairy Calf
Feeder to Finish
rJ
�� :'_ -
DairyHeifer
Farrow to Wean
u
DesignCerrent
Dry Cow
Farrow to Feeder
D .;I'onl
Ca cy Po
Non-Dai
Farrow to Finish
I I Beef Stocker
Gilts
Non -La ers
I I Beef Feeder
Boars
IPUIlets
I lBppf Brood Cow
Turkeys
Other
Turkey Poults
Other
Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
To ❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No ffNA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ NoFD--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
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
❑ NA
�7No
❑ NE
of the State other than from a discharge?
Page I of 3
21412011 Continued

It � Yn
Facili Number: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [tR-4f6— ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes [] No E3-+4*— ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): s3�
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
9'N`5`_
❑ 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
L- "o
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
©"No
[] NA
❑ NE
8. Do any of the structures lack adequate markers as required by the pen -nit?
[:]Yes
C2'N-6-
❑ 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
[],Ko�
❑ 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 21No ❑ 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): � e,(41k k s l) 0
13. Soil Type(s): 44, 92 D l�
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
ffCo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
Q
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
1114Z
❑ 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
Co❑
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 - o
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑Yes No
[DNA
❑ NE
Page 2 of 3 21412011 Continued

Facility Number: - Date of Ins ection. -w
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes EfNo ❑ NA ❑ NE
25. Is The facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes (2NTo ❑ 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 [2"ONo ❑ NA ONE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [31�o ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes [3 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 0�1No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the ❑ Yes No ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. [:]Yes Ta ❑ NA ❑ NE
❑ 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
❑ Yes
❑ Yes
0C ❑ NA ❑ NE
C3 No ❑ NA ❑ NE
[� No ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recornmendatJons or.any other comments:`
Use drawings of facility to better explain situations (use additional pages.as necessary).
Ge-JI-b
57-c�-O- 1'( 0- 77
r -s.3
Reviewer/inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: R w
Date:
5— c
21412011

6 C,- Xo 3
- ivision of Water Quality
Facility Number -Do a I =1111111O Division of Soil and Water Conservation
© Other Agency
Type of Visit: Otompliance Inspection 0 Operation Review p Structure Evaluation O Technical Assistance
Reason for Visit: 9-f outine Q Complaint 0 Follow-up Q Referral O Emergency 0 Other O Denied Access
Date of Visit: jkrrival Time: Departure Time: County: c IuP Region:r �
Farm Name: r \ C+Ai� 4 �' Owner Email:
Owner Name: etmk kmAc.ls Phone: G, d `s4 4-1
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
C(A �� A-evf Title: ` ._ %4_: ` Phone: D -
Latitude:
Integrator: --G
Certification Number:
Certification Number:
Longitude:
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation? [:]Yes Lf-"" ❑ NA ❑ NE
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)
Z. 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?
Page I of 3
❑ Yes
❑ No
[B l�A
❑ NE
❑ Yes
[-]No
[3'-5A
❑ NE
❑ Yes ❑ No Z}- q'A ❑ NE
[:]Yes j l o ❑ NA ❑ NE
[:)Yes �o ❑ NA ❑ NE
21412011 Continued

Facili Number: - Date of Ins action:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes . io ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? [:]Yes E<O ❑ 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 o ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes E g, Ko— ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes ER4 ❑ 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 E34o ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes U],W16_ ❑ NA ❑ NE
maintenance or improvement?
11. is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes I__LX ❑ 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
IL],Ko_
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
do
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
[ZL>o
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
L ?<o
❑ NA
❑ NE
19. Is there a lack of properly operating waste application equipment?
❑ Yes
fo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[P o
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
E o
❑ NA
❑ NE
the appropriate box. 1
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
[] Yes
E3<o
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections [:]Monthly and I" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
U o
DNA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
[:]Yes
[f/No
❑ NA
❑ NE
Page 2 of 3 21412011 Continued

Facili N—u-m b er IDate of Ins ectiow 3
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 EJ-Ko- ❑ 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 Lg�"U [DNA ❑ NE
27, Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [—]Yes uL.+'a"' ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? 0 Yes [! No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes EP oI ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? [:]Yes fo ❑ NA ❑ NE
rioj;�M_
ments (refer to question =#) Explain any YES answers and/or any additional recommendations or any other comments.-
g,
r&
drawiii 6f.facility to, better:exQlii n situations (use additional paves as necessary).
, &q 4(CA--1 — 1
slwPo r- _s'rv-y I-- (( - [3
c
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
❑ Yes [.41.,Alo ❑ NA ❑ NE
[:]Yes 015-o ❑ NA ❑ NE
[—]Yes D,hio ❑ NA ❑ NE
❑ Yes 04-o ❑ NA ❑ NE
Phone: L V ' 93
Date: t [jq1.2,,v
141201

qr�/a+ I I
li�a
Type of Visit: &7Routine
pliance Inspection O Operation Review 0 Structure Evaluation O Technical Assistance
Reason for Visit: O Complaint O Follow-up 0 Referral 0 Emergency 0 Other O Denied Access
Date of Visit: q 1 Arrival Time: Departure Time:® County Region: f_
Farm Name: U 3S N Owner Email:
Owner Name: �Egr\y, V1 mA4L_Ws Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: DL,3I\Z_J; Phone:
[
Onsite Representative: p, fr1 Integrator: 1" R nl-�r
Certified Operator: 1, 0 Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design Current
Design Current
Design Current
Swine @ape .'Y' Pop.
W,et Poultry Capacity Pop.
Cattle Capacity Pop.
Wean to Finish
I 11-ayer
Da' Cow
Calf
Wean to Feeder
I jNon-Layer I
Feeder to Finish
q
Dai Heifer
Farrow to Wean
Design
Dry Cow
Farrow to Feeder
D . Poul - a aei P,o
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
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 j[ �No ❑ NA ❑ NE
❑ Yes [—]No
❑ Yes [—]No
❑ NA ❑ NE
❑NA ❑NE
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 dNo ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters [—]Yes FR/No ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

Facili Number: %: SBI Date of Inspection: 9
1
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
I gol<)
❑ 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): L�
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
d 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
C�No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes]
No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
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!fNo
❑ 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?
1 I. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
&/ No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals
(Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): q A 0 M V 55
O
13. Soil Type(s): AUb N 1 A a?1 g e,
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
E2 f 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 [6 No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ WUP [—]Checklists ❑ Design ❑ Maps ❑ Lease Agreements
[] Yes
[4 No
❑ NA
❑ NE
❑ Yes
E�No
❑ NA
❑ NE
❑ Yes
E�No
❑ NA
❑ NE
❑ Yes
g No
❑ NA
❑ NE
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes E7 No ❑ NA ❑ NE
[:]Yes S�'No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facili Number: a - 3 g jDate of Inspection: Q
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes E f No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [] Yes dNo
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 dNo
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [:]Yes dNo
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?
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA []NE
❑ Yes
[�No
❑ NA
❑ NE
❑ Yes
dNo
❑ NA
❑ NE
❑ Yes
allo
❑ NA
❑ NE
❑ Yes
[dNo
❑ NA
❑ NE
❑ Yes [A No
❑ Yes dNo
[] Yes E/No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Reviewer/Inspector Signature: Date: 1 qjj -x
Page 3 of 3 21412011

i m�
Type of Visit: ompliance Inspection 0 Operation Review p Structure Evaluation Q Technical Assistance
Reason for Visit: outine O Complaint O Follow-up O Referral O Emergency O Other Q Denied Access
Date of Visit: ��yy�� Arrival Time: ,' Departure Time: County• Region: ICJ
Farm Name: 10441� /7 1q Owner Email:
Owner Name: — roNV/ !!�d �; ur�� iCGCI� Phone:
Mailing Address:
Physical Address:
Facility Contact: Phone:
Onsite Representative: Integrator:j"rc_
Certified Operator: Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design CurrentIll!
©.sign
Current
- Design Eurre4t
Swine Capacity Pop.•
Wet Poultry
Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
La er
Dai Cow
Wean to Feeder
Non -Layer
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
Dry P,oul#
Ca aei
P,o ,
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turk. s
Other
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes 52LNo ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes [:]No
❑ Yes ❑ No
❑ Yes F�SLNo
❑ Yes RNo
❑ NA ❑ NE
[DNA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 21412011 Continued

Facility Number: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
[3 No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
allo
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): — f ?-
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
ELNo
❑ 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
� No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
Pn 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
[2 No
❑ NA
❑ NE
maintenance or improvement?
I I. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes S 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): r�c%Sr---/
13. Soil Type(s): J �� f Z
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [S No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ZI 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?
17. Does the facility lack adequate acreage for land application?
❑ Yes
0 No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
� No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
®No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[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
❑ 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 ELNo
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes 0 No
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

r.
Facili Number: - Date of Inspection: 1
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes R No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [0 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 ® 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 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 Eg No ❑ NA ❑ NE
❑ Yes S No ❑ NA ❑ NE
[-]Yes 2jNo ❑ NA ❑ NE
❑ Yes RNo ❑ NA ❑ NE
❑ Yes Eg No
❑ Yes ® No
❑ Yes 4 No
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
Comments (refer to question ft Explain any YES=answers and/or any additional recommendations oi�an ;other -co
Use drawuigs of facility to better explain situations ;(use ;additional pages as necessary) r.n
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 24Y!Z'D —_3_30p
Date: f!`r,�
21412011

r
Type of Visit Q8 ffipliance inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit outine 0 Complaint 0 Follow up 0 Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: ` — �� Arrival Time: Departure Time: CountyRegion:
Farm Name: -nw6 Owner Email:
Owner Name: _ Ke-r7e?r4L ®!f t!r/` r Phone:
Mailing Address:
Physical Address:
Facility Contact: T l-+ ]h Title: Y �_ Phone No:
Onsite Representative: _ rL"� Integrator:
Certified Operator: �1j,.s.t�� Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: F--I o = 6 = Longitude: = o =1 = «
Design
Current
Design Current
Design Current
Swine
Capacity
Population
Wet Poultry Capacity Population
Cattle Capacity Population
❑ Wean to Finish
❑ Layer
❑Dairy Cow
❑ Wean to Feeder
on -Layer
❑Dai Calf
eder to Finish
50 1 3
❑Dairy Heifer
❑ Farrow to Wean
❑ Farrow to Feeder
El Farrow to Finish
❑ Gilts
❑ Boars
Dry Poultry
El Layers
❑ Non -Layers
❑ Pullets
❑ Turke s
❑ Dry Cow
ElNon-Dairy
❑Beef Stocker
El Feeder
❑Beef Brood Co
Other
❑ Other
❑ Turkey Poults
❑ Other
Number of Structures:
Discharees & Stream Impacts
1 _ Is any discharge observed from any part of the operation?
❑ Yes
4.No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
LkNo
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
RJNo
❑ NA
❑ NE
other than from a discharge?
12128104
Continued

Facility Number: 3 Date of Inspection
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ONo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): _ / 9
Observed Freeboard (in): :3'e 3 L
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes C.No ❑ NA ❑ NE
(icl large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes RNo ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes LgNo ❑ NA ❑ NE
8. Do any of the stuctures 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
KNo
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks. or compliance alternatives that need
❑ Yes
uNo
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? if yes, check the appropriate box below.
❑ Yes
&No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) r
13. Soil type(s)
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
9No
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
0 No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
'R No
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
PI -No
❑ NA ❑ NE
Comments (refer to question`:#) Explain any YES answers and/or any f omttiendattons or any other commena
:_ . - tIF
Use..dt awip s:of faciL.. to better ex�' lain situations. use additional a es as necessa
g P ( P g. ry}. t
Reviewerllnspector Name �' �.Phone: p3a�
Reviewer/Inspector Signature: Date: %9 A— D
12128104 Continued

Facility Number: — Date of Inspection
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 CKNo ❑ NA ❑ NE
the appropriate box.
❑ WUP El Checklists ❑Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ISNo ❑ 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
.9 No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
Ej No
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
19No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
(RNo
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
ESNo
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
allo
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
QNo
❑ NA
El NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
&No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
0-No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
0,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
ANo
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
J]No
❑ NA
❑ NE
12128104

M
Type of Visit (r-C76—mpliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Stine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: 1Arrival Time: f OE75 Departure Time: � County:
Farm Name: v� /+ r_,�� s no- AiZeJO - Owner Email:
Owner Name: 7\ 1�1104 011 -0l [�Jl �[1� Phone:
Mailing Address:
Region: /cR7
Physical Address:
Facility Contact: f� 6'/1 N elk / / al_t�rkf Title: 0",Pr-- __ Phone No:
Onsite Representative: Ste- Integrator:
Certified Operator: 4 Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = e = ` [= Longitude: 0 0 = 6 =
ds
Design
Curren-
Design
r nj
nt
Swine Capacity
Population
Vet Poultry
Capacity
Population
Cattle Capacity
Population
❑ Wean to Finish
❑ La er
❑ Dairy Cow
❑ Wean to Feeder
on -Layer
❑ Dai Calf
RF'eeder to Finish
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ Layers
❑ Farrow to Finish
❑ Non -Layers
❑ Beef Stocker
❑ Gilts
❑ Beef Feeder
❑ Boars
❑ Pullets
❑ Beef Brood Co
❑ Turkeys
Outer
❑ Other
❑ Turkey Poults
❑
Number of Structures:
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)
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 01No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
El Yes
❑No
❑NA
El NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes RNo ❑ NA ❑ NE
❑ Yes CANo ❑ NA ❑ NE
12128104 Continued

Facility Number:
Date of Inspection
Waste Collection. & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure ? Structure 4
Identifier: I r�
❑ Yes 29No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure � Structure 6
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes C.No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes 0,No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes V+No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes XNo ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks) ,,��{{
9. Does any part of the waste management system other than the waste structures require El Yes t-No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 9No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes XNo ❑ 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 types)
13. Soil type(s) ,�,11l% -
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes 0 No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes
iRNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination' ❑ Yes
Z No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes
2.No
❑ NA
❑ NE
19. Is there a lack of properly operating waste application equipment? ❑ Yes
h?S1Vo
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
a
Reviewer/Inspector Name Phone:
Reviewer/Inspector Signature: Date: 911`4p7 —1;2�
� / 1212 U4 Conanuea

' Facility Number: Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes C8 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes (9No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [K No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and l" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
(&No
❑ NA .
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[%-No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
Eallo
❑ 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
RNo
❑ 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
IgNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
9 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
NNo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
[ No
❑ NA
❑ NE
General Permit? (iel discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
2!�No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
�No
❑ NA
❑ NE
Comments and/or Drawings:
12128104

N
Type of Visit ®'Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit outine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: i Departure Time: ' p0 County: Region:
Farm Name: & uj� 4b el. Owner Email:
Owner Name: Lennef7k! / to r- fl-iS Phone:
Mailing Address:
Physical Address: / ,����%j
Facility Contact: i✓►1 ✓i P %%T�r�The itle:
Phone No:
Onsite Representative: E913v Integrator: !/
Certified Operator: Operator Certification Number:
Back-up Operator: I -- n rtek 0� eW5 1r, Back-up Certification Number: g R�3—/ y T
Location of Farm: Latitude: = f = 1
1 Longitude: = ° = 6 =
di
Design rDesignk Current Designwine GapacttVPopulahoi Wet Poultacity 1?opulat�on- Cattle Capacity Population
EQ
to Finish ❑ Layer El Dairy Caw
to Feeder ❑ Non -Layer ❑ DairyCalf
er to Finish �tj`D D D 1, "�^ * t" Dairy Heifer
A x �' ❑
w to Wean D Cow
ltry �svr 4 rm w ❑w to Feeder
❑Non-Daiw to Finish ❑ La ersBeef Stocker
❑Non -La ers ❑Beef Feeder
❑ Pullets❑Beef Brood CaEl Turke s
❑ Turke Points
❑ Other Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
allo
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
CK No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
R1 No
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
12128104
Continued

Facility Number: — Date of Inspection — c7
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? []Yes [SNo ❑ 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): $�
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
® No
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
ZI No
❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
Yes
❑ No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
[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
MNo
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
LKNo
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
ZNo
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
(:]PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) '3 nY j' It)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
§d No
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
®.No
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
M No
❑ NA ❑ NE
17. Does the facility tack adequate acreage for land application?
❑ Yes
[A No
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
® No
❑ NA ❑ NE
f edPu; r bal-r- c2l-e-a- 0-k.. L i-- 1
Reviewer/Inspector Name ! Phone: 91-f 0—i.(3�
Reviewer/Inspector Signature: Date:
rage _- of 3 JrL/zo/uY 4w499jrs"C"

Facility Number: Date of Inspection I fg l-D
i
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes C&No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check ❑ Yes 19 No ❑ NA ❑ NE
the appropiate box. ❑ W-Up ❑ Checklists Design ❑ Maps ❑ Desi p [I Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ® No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
J&No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
29 No
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
JR No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
L4 No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
,Q No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
54 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
allo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
® No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
ANO
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
P&No
❑ NA
❑ NE
Additionai'Cammeats and/orWF
a
ILI
Page 3 of 3 12128104

c
ivision of Water Quality
Facility Number 0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit 0<ompuance 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:Arrival Time: g,'/,j Departure Time: ' (7 County: Region: ! �
b.
100,
Farm Name: ��'—_CL�'11 m� _ Owner Email:
Owner [Name: ��'n/2 �� r� i V �/" Phone:
Mailing Address:
Physical Address:
Facility Contact: eP7*1> ''t- Title: Phone No:
Onsite Representative: Integrator: _
Certified Operator: Operator Certification Number: ZU.5�
Back-up Operator: Back-up Certification Number:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Latitude: =] o =' = « Longitude: 0 e = ' ❑
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Laver
❑ Non -Layer I EEEI
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turke s
❑ 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
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Ca
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 29,No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
[9 No
❑ NA
❑ NE
❑ Yes
RNo
❑ NA
❑ NE
12128104 Continued

Facility Number: 3 Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes LKNo ❑ 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):. /9 1.9
Observed Freeboard (in): j
5. Are there any immediate threats to the integrity of any of the structures observed?
❑Yes No ❑ NA ❑ NE
(iel large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes J4 No ❑ NA ❑ NE
through a waste management or closure plan'?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes ® No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes 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 RNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10_ Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes 2[No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes JK 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 ❑ Evideence 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 ZNo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes
(,No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
0 No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes
RNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes
RNo
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Revi.ewerllnspector Name ��.� Phone:
Reviewer/Inspector Signature: Date:
12128104 Continued

Facility Number:B:;7- 3 99 Date of Inspection r;77�97-4.
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 CHNo ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ 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 ❑ Annual Certification
❑ Rainfall [:]Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Cade
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes allo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes DI No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
K No
❑ NA
❑ NE
25_ Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
RNo
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
® No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
J&No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
N No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
VK[No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
[� No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
[21 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
ELNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
N No
❑ NA
❑ NE
Comments and/or Drawings:
12128104

Type of Visit [compliance Inspection O Operation Review O Structure Evaluation Q Technical Assistance
Reason for Visit Routine O Complaint O Follow up Q Referral Q Emergency O Other ❑ Denied Access
Date of Visit: —3%`Q Arrival Time: ,�'.3 O Departure Time: County- Region: 745;�'Z)
Farm Name: e w Owner Email:
Owner Name: Hen r-L C Phone:
Mailing Address:
Physical Address:)
Facility Contact: C-& ��a itle: Phone No:
Onsite Representative: Integrator: �
Certified Operator: Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: 0 0 1--] « Longitude: = ° = 4 0 «
Design Current
Design Current Design Current
Swine Capacity Population
Wet Poultry
Capacity Population Cattle Capacity Population
❑ Wean to Finish
❑ La er=:4
❑ Dairy Cow
❑ Wean to Feeder
❑Non -La er
❑Dai Calf
151 Feeder to Finish g
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
❑ La ers
❑ Non -Dairy
❑ Farrow to Finish
❑ Beef Stocker
❑ Gilts
❑ Non -Layers
El Beef Feeder
❑ Boars
El Pullets
❑ Beef Brood Ca
❑ Turkeys
Uther
❑ Turkey Poults
(umber of Structures:
❑ Other
❑ I
Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
[9No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
[4 No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
[Q No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
❑ Yes
E(No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
Z[No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
®.No
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
12128104
Continued

Facility Number:42,-,3971Date of Inspection 2 7'D6
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 P9-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 q
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes [Z 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 0 No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes %No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes Q, No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes 0 No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10_ Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 0 No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop
13. Soil t,
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
RNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination' ❑ Yes
N No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
KNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
[:]Yes
XNo
❑ NA
❑ NE
&Wd 6rn"-'
Reviewer/Inspector Name ,� , Phone: &14
Reviewer/Inspector Signature: Date: T__ 3. —2Ql7(e
12128104 Continued

Facility Number: 3 Date of inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ONo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes JZNo ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ 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 ❑ 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
0,No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
No
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
DLNo
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
J4 No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
PQ No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
,ZNo
❑ NA
❑ NE
Other issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
kNo
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
;.No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
CK 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
ER 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
gLNo
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
RNo
❑ NA
❑ NE
Addlt:onal'Commen tsandlor=Drawings: .` '"•
.�
12128104

Type of Visit ® Compliance Inspection 0 Operation Review 0 Lagoon Evaluation
Reason for Visit ® Routine O Complaint O Follow up 0 Emergency Notification 0 Other ❑ Denied Access
Date of Visit: -1_ 7_16_7 Time: %O . -��
Facilitr� lumber $off 3
.. not O erational 0 Below Threshold
® Permitted ® Certified © Conditionally Certified 0 Registered Date Last Operated or above Threshold:
Farm lame: Q'I 4-+ b c"-3; 1-10-9 F�ky .Y, County: son lr iQt3
Ow•nrr Name: h jV1 y'cwJ T'hnnr Nn- 1 !v} $�• - °�c4�a
Mailing address: _ y 5 7. Gam- - IC,'Q • N C e?8 3&>
FaCility Contact: kefix"_ in�l a+-k-4--)-_ Title: Phone No:
Onsite Representative: �r. Integrator: _pr e s-4 c!1 nas
Certified Operator: kn.,,,r6� Operator Certification Number: ����•S�
Location of Farm:
tSwine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' ' " Longitude a �• ��
Design Current
Swine ('anacity Ponulation
❑ Wean to Feeder
1,0 q".,
© Feeder to Finish
AQ-5"o
>Id2ft-5
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
Gilts
❑ Boars
Design Current Design Current
Poultry Capacity Population Cattle Ca achy Population
❑ Laver I ❑ Dairy
❑ Non -Laver I I❑Non-Dairy
❑ Other
Total Design Capacity
Total SSLW
Number of Lagoons _� 1❑ Subsurface Drains Present 11❑ Lagoon Area JU Spray Field Area
Holding Ponds I Solid Traps E::� ID No Liquid Waste Management Svstem _
Discharges & Stream Impacts
1. Is anv discharge observed from any part of the operation? ❑Yes No
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 ealimin? hi /A
d. Does discharge b�Tass a lagoon system? (If yes, notifi- DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste llection S Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate?
Strucaire 1 Structure 2 Structure 3
Identifier: / 1
Freeboard (inches): 33 .�� 33 `'
❑Yes EDNo
❑ Yes [51 No
❑ Spillway ❑ Yes YP No
Structure 4 Structure ; Structure 6
05/03/01 Confinued

Facility Number: So_,? Date of Inspection 5I/a 1oY
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes ® No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑ Yes ® No
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenancelimprovement? ❑ Yes No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes © No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes r7l No
elevation markings?
Waste_ Application
10. Are there any buffers that need maintenanceltmprovement? ❑ Yes I No
11. Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes No
❑ Excessive Pon/d�ing ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
('
12. Crop type 911 in ,�r�4_ / .5 nn a / i :� r d= jAj O -5 c-,/ '(, — —
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes j No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes No
b) Does the facility need a wettable acre determination? ❑ Yes No
c) This facility is pended for a wettable acre determination? ❑ Yes No
15. Does the receiving crop need improvement? ❑ Yes ® No
16. Is there a lack of adequate waste application equipment? ❑ Yes ® No
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge atlor below ❑ Yes []No
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes © No
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes ® No
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional ❑ Yes No
Air Quality representative immediately.
Field Copy ❑ Final Notes
L7C _S 't'o C• CA IQ90Uw Q.102- G+.- ��G WG.��G .� `� 5 t �
� �a"� ►+ C It
0.t�Gr CGLC.L- ral. a+ O� r.,u G� DDCLA� 1CV%4 'th
1~;1^op JQ rGpUr I �Dr+,.3 �o �aQ'�ca�� �rc�oQkc to, cx_A"Lm.�i�t
D� 4-ID�Sitd�La.l7-c
Reviewer/Inspector Name y r
i.A
Reviewer/Inspector Signature:,, 40---a— Date
ifIn7in:2

Facility Number: ya _ 3 3 Date of Inspection
Required Records & Documents
21. Fail to have Certificate of Coverage &. General Permit or other Permit readily available? ❑ Yes ❑ No
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 ® No
23. Does record keeping need improvement? If yes, check the appropriate box below- ❑ Yes No
❑ 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
0 No
25. Did the facility fail to have a actively certified operator in charge?
❑ Yes
❑ No
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(iel discharge, freeboard problems, over application)
❑ Yes
Q No
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
[4 No
i
28. Does facility require a follow-up visit by same agency?
❑ Yes
ED No
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
❑ No
NPDES Permitted Facilities
30. is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
Yes
❑ No
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
EQ No
32. Did the facility fail to install and maintain a rain gauge?
❑ Yes
Q No
33_ Did the facility fail to conduct an annual sludge survey?
❑ Yes
P 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 PgCrap Yield Form ❑ Rainfall ® Inspection After 1" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
12112103

Site Requires Immediate Attention:
Facility No. 92 ).7
DMSION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
Farm Name/Owner:
Mailing Address:_
County: GN
Integrator: E.
On Site Representative: & I7
Physical Address/Location:j
'd+ 11 fTa. e;,t j4^-%3'7-3 pf- NAP
DATE: 1— / � , 1995
Time:
M AA A /- a W <
5t- 9 -'Z- 3'4 4eM hkrq , NG
Phone:
,%r S Phone:
Type of Operation: 'Swine Poultry Cattle
Design Capacity: Number of Animals on Site: d
DEM Certification Number: ACE DEM Certification Number: ACNEW
]Latitude: v' 0" Longitude:
Circle Yes or No
Does the Animal Waste Lagoon h
(approximately I Foot + 7 inches)
Was any seepage observed from the
Is adequate land available for spray?
Crop(s) being utilized: i
sufficient freeboard of 1 Foot + 25 year 24 hour storm event
,or No Freeboard:_QFt. d Inches �► 1
oon(s)? Yes orWas any erosion ob ed? Yes or tNn�
e or No Is the cover crop ad uate. or No
Does the facility meet SCS minimum setback criteria?
Feet from Dwellings? jiye's or No
100 Feet from Wells? es or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or 6) �-�
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line: Yes or �J
Is animal waste discharged into water of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes or 6) If Yes, Please Explain.
Does the facility maintain adequate waste management recurs (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? a or No
Additional Comments:
Inspector Name
cc: Facility Assessment Unit
Signature
Use Attachments if Needed.
I

1'4� e, 70
oRTa CAROL334A DEPARTMENT OF � ®aLTN' & MATM L ASSODCES
DIVISION OF ENVIRONMENTAL ilARliGII%r-Mr
Fayetteville Regional Office
Animal Operation Compliance inspection Form
yAr�=IOi,DA3'E,M"I+i.;
.a�^'�-..n,--
..mw���. �y�. .„�'�, x�a}•.���yxa�...��,.;t �r
-�ey, �� <�,- y�1:i'tL^. w`•i::�^</'�._'>�'.'i.:ma�_�_p�'p r
...�.�..
t. z93S5
Cc? to 5454-
All questions answered negatively will be discussed in sufficient detail in
the -Comments Section to enable the deemed Permittee to perform the appropriate
corrections:
SECTIDN I
Animal Operation . Tym: f" J n i Sh
Horses, cattle, swine poultry, or sheep
SECTION _II
Y I N i CDME NTS
S. Does the number and type of animal meat or exceed
the (.0237) criteria? [Cattle (100 head),
horses (75), swine (250), sheep (1,000),.and
poultry (30,000 birds with liquid Waste
system)) .
2. Does this facility meet criteria for
Animal operation R=ISMATION?
3. Are animals confined fed or maintained
in this facility for a 12-month period?
4. Does this facility have a CERTn IF.D SAL
WASTE IS MGEM NT PLAA?
5. Does this facility maintain Waste management
records (volumes of manure, land applied,
spray irrigated on specific acreage with
specific cover crop)?
6. Does this facility meet the SCS minimum
setback criteria for neighboring houses,
wells, etc?
9

ff
$M=W I=I
kield Sits _Xanaama=
1. Ya animal wasLu aLMkpilad Or Lagoon
construction within 100 ft. of a DSGS
Map Blue Line Stream?
Z. Is animal waste land applied or spray
irrigataA w4*1-k4n 25 ft. of a UCGD Map
Blue Line Stream?
3. Does this facility have mdaquate acreage
on which to apply the waste's
4. noes the land application'sits have a
cover crop in accordance with the
M—TIFIGTION PLAN?
5. Is animal Waste discharged into waters of
the state by man-made ditch, flushing system,
or other similar man-made devices?
6. Does the animal Waste management at this
farm adhere to Best Management Practices
(BMP) of the approved C1A=CaTIDR7
T. does animal waste lagoon have sufficient
freeboard? How much? (Approximately )
8. Is the general condition of this CArO facility,
including management and operation,
satisfactory?
&$I CH IV
CgWents
Fame 4' gis#ere� �ti�cured b� CEf i"S�iCLL

2=sane rsC•,L� th* eamp? ated forte to t ze Zi-r sion of ��.�r'�o*... - Law Xa_-Aq8 &A1t at
t,!!a ad: -Gas on t.�L* =eve=as side of thip fan.
Name of :a_= (?!ease pr__^.t) : M4r, NBws 0G FARPK
I -; esz: T I Bo 9
Ccunc•-r : SAM PSo --
a_� _=caawcr. :act=,;do and Long --'zude:� j- ��� 1W AA� ZH(=-=a •--aC} e�,15G.
pease a=tat a Cccy of a county _mac =a.L ::It,h locac_cn dent_=-Yd.
7e _4 oFe,atlost (zr4—me, laYe_T, da;yy, etc.) : 5wf•7c'
Cesign ...Spat_=y or ani=ais) *70 XEC - Af
Average sz.re Cz c=eraC.or.pLi;3C:Cr. dvs.) ¢70 ]GE _Fi r
:;rerage ac_aace neecec for laac ap;.iicat;or. of waste (aaces) I Z.2
aaaa�aa asaaaaa3asaaa:�aasa asssaasasaaoaaasasaasaaaaasayaaasasa�aa=:aa�aaaaaa:s
TOC��C3� S~p*Cialist �� _��Gat�o�
Ns a tec•;mica? specia.lisc desiy ated by the North Carol'_=.a Sew_ ar_� avatar
ursuawt tc _SA NCAC or .0005, _ cs =_r t"-ac =e =ew or
e=P_r.dec aal= ; ;rasta manage anz syscam as i:iscal_e-r for the =a = class= move
::as an an=al wastes mar-agemenc plan, that meets the designt, cc:sc,.:c_ian.
operazicri and; = tern-_cs starca= s and spec_yic3c_ors of the Di•r_sion of
_=ar�.eatai `_";.^ague_^= and the Ccr:se=vatian Sew rri a -&calla the Ncc'-
Soil and: pacer C:.r_serration Yr.^ iss;zm pursuant to w5A NCAC Z».02_7 and
15A NCAC 57 .0001,0005. The fol_ewing e_eme_^_ts and their con=aspc :cizg a�^imp
?c��i�ha:s�been verified ::y me or ocher designar- tac:-s•.'_,� specialists ar:d
a a i.:c'uded in the plan as applicable: separations or
eguivaiert fcr lagoons or waste storage ponds; waste storage capaci.tl ade�:ate
g,.:antity and amount of land _or vasta uzi_;_acion (or use of thi_d parw-y) ; ac=ass
c= cw-ne_-s:Lip of. grope_ wasta application equipment; sczedule for timi ig of
a=pl;c_=ions; application rates; loaZi:.g races; and tie ccnt_ol of the discharge
of pollutants `scut stor=-ratsr runoff events less severe than time 23-year, 24-hour
storm. -
3amo of 'f'se..aic:l S�ec3sLpt (Please Print) (y_ GLrcnn Cc ��7'on — -
=illation: �RE3TAG8 FAAM51—
;wd��ess m. 30�, 43jS Ct /iJ?bn t7G Phone No . 177
si�..at•.:=e: __ �_ �(.4.--, CG.,�I'•- ..... Date:. t3/z3�q�
:a aaaaaasasasaaaaaasssassaaaaaraa�aassssaaaesssasasaasssasaasassaaassaa�r
i (we) understand the cperaticr. and mai.Zte-trance procedures establ:s'red in the
aonrover animal waste managersert plan for the farm manned move and will i=iemer_t
ese :rocedures. 7. (:re) know that any additional expansion to the existing
desist: capacimy of the .,caste t,eaa=enc and storage system or cnrsc=-action of new
=acil_t_es will a now get ----cation to be su!:=i_ted to _-ha Division of
Zavizorrental Y--aragemeram before file new an.= -Is a=9 sc:cited- _ (we) also
­ nde=stand that t ;ere ust be ,o d_s��arse of ani=al waste __cm ,his system to
zuzface rat?rs of the states ei_: er c.=c:ug.n a man-,tar-e ==nl-re` arce or
__- .:f =rcm a sc:z= event less severe than the 25-1--ru ear, 24- :or story. ':!�e
aLprssed slam will be filed ac the farce and at the of_,ce of t e -ccal Soil and
Wa,ar Conse= ration Oiscyict.
:ra=* o; :.and C-W-_ar (Please P=4_mt) e K n e � - -- Q� �L4-A e-
.1a=s of L=Agft=, i_` d; sre= ent :_ cm o.me= (Please pri..11t) :
5 ;=ac_=e- date:
a. ange - !andownership Cequi;es ncc_ficacion or a mess csrnficacior.
(;= thea^;:roved plan is c:.anged) co _e subraittad to ___e Di.vis_:r, or
..- "-__= e__ntal Management :+ir-h—i , 50 days of a trarsJ.
OZ:! USE CNLY; AC:rEW

.dlIgr VI IVV{II I `.L...ILjtII Ill
DePc ent c4i Environment,
hecfitl and Ncturc! Resources
Civis;cn cf Einvircr men+c! Mcncsemenr
.lcn les I Hurt, Jr- Gcvemcr
JCnCthcn ;LJcwes. Secretory
A. Prestcn Hcwcrd, Jr., P.E. ❑itectcr
ymg- *;_"r7 QR ?,ti -� `t. '- �LC'^S
zrST_IUC=';CNS :nz'.4 ;=C�'y'T_^.N CF nP'?RCG-=- AN=.ff_3I. PLANS FOP.
NtY;r CR S :+a1IL s,.r i. 'r77�S:'= y__;+�I:�►.C�^���": 5'fS S S V tG _�'-.- .Lo_rS
7= order tz :e dee=ed
pe�.ttad Sly the %-risi;= of
Zav-i onmental Management
(C;`I) , the awT:Br oY
ary new or eX-arced anz ;
waste asap-agement
system
af=az ua=LLa=f ?, 1994 whit.. is desig=ec
to sez,re greatar than
Cr
to the ar.i.:a_ Yaculacions listed below is required to suk=it a
signed
cerCif_cat iern fora to
0E_ kgt2y tie new animals are scccked on the
fa=.
;asc::r% operations are
exe=pC f-om the ;eiqsi=ement to
he cez--m=fled.
+00 'send a.� catwe
75 $crsae .
2S0 aa+'�� , ••
1, 000 ah�p
3 0, 0 0 0 bi�--'a �r3t..� a iigaid sraata syaearar
The ce-r_yfication must be signed by the owner of the feedlot (and manager if
d:_==rer_t fram the owner) a--d by any tac- = cal specialist desisaated by the Sail
and -1aCer Corsser-raCiorz CnTmni_,zzi= ;,•;«.wl t to 25A NCAC 57 .0001-.0005. A
tecr.ical sF.ecialist mast verigy by an on -site inspect --cm that all applicable
design and ccnscrsct-vn scanda-~-.s and specif_catiorzs are mee as installed and
:hat all applicable ojer_atZon. and mmintQnanre standards .and specifications can"_.._
ce met.
A-1-hougZ the actual after of animals at the facility may s ,rom t m is time,
the design capacity of the waste handli=g system, should be used to dec—i=a if
a faL= is subject to the certification r%guirememt. For exaasple, if the waste -
sfszzm `or a feedlot is desigaed to handle 300 hags but the average population
will he 200 hogs, then the waste management system requi_-es a cez--ification.
This cerr_ficaeion is =-_c aired by regulations governing animal waste martagemena
systa adopted by the=Gvirormental M-amagemenc Commission (EMC) on 0ecember 10,
1492 (TiCle ISA NC;C 2H _0217) .
�:Rw�ti�.'^Tr7N 7r1Si:f
Cn the -%verse side of --his page is the c%rti=icaticm for? which =st be
s .itt to Dmm before new ani=ls are stocked on. the faz-s. Assistance in
c= ,let,:9 the = = cmz. :e obta,zed :: ., one of --*--a local- a�=c-�=t'ual agencies
zucy as tt a sail and ::a=ar carservaciam disc_ict, t`:e CS�,�,-3oil Ccrser-raC_oa
Se --rice, or the N.C. Cocperative ?=ersion Se_ --,rice. The fo= should be sent to:
❑epar-.-enc oc' =:.v==argent, Head t_h aac
Ui vision. or = :-r== or;.-ental Management
Water Quality Section, Planntrg Branch
P.O. Box 29535
Raleigh, N.C. 276ZS-CS35
Phone: [phone]
Form 17: :iGVri0i94
:TaC.r�al rZesaurces
Steve W. Tedder, Chief
Water Quality Section
Dace: avt-� isf3
P.C. 3= 29.[r35. Rde gh. -.Ncr - C,-xc.Sr.z 2752b-^rSZ5 74ecncr,s 919-723-7/0 1:: FAX 414-73.3 =a46
An eoL C Ccccrcrjty A _.=ve Ac�an cs:Glcyer s _ recyCac! i M. rCC,er

RcGic._R.:LT_ON FORM ;OR ANIMAL F'Z:)LC_' Op=?_A'= ONS
Department of Environment, Health and Natural Resources
Division of E,zvi=cnmental Management
Water Quality Sect;on
If z-he animal waste management system for your feedlot ome=ation
is
desicned to sure more than c-
ecual to z 00 head
of cat_? e,
73
horses, 230 swine, 1,000 sheep, or 30,000 b__ds chat
are served
by
a liauic waste system, t :en toys
form ;rust be L'_lled
cut and :nailed
by December 31, 1-593 pursuant _c
_3A NCAC 2 H.0217 (c)
:_^. order to
be
deemed pe=_tted by DE.`"_. please
p-J.4n t clearly -
Saran Name:_ t
uai?'__^_c Address:
C.^.unty :
Owner (s) lame:
Manager(s) Name:
Lessee Name:
Sarm Location (me as speci=ic as possible: --cad names, direction,
IA1lemost, etc ) �c� 1Q S� °Vd7 ` {�-�
I UR T,3
--CF' 6
\ ZT L
Lam _tudelLang i=ude if known: ��1 5� ��'-�7�1-���
Design camacit_v of animal waste manageme system (Number and type
c' con ined ani_-naI (s)) L4tQ
Average animal nomulation on the farm (Number and type of animal (s)
raised) C�5 �~
Year Production Began iY� ASCS Tract No.:_ .
Type of Waste Management System Used: t_pc'x-r'1
Acres Available for Land Application of Wa;te:
DATE: Owners) Signature .
s) r -�`�� 3
1�i�.7 �,► �Z�.rcr/,�— d17nr��L-. �a�r � I I — �9' �1�