310101_INSPECTIONS_20171231

NORTH CAHOLINA
Department of Environmental Quaff

s ._ P Division of�W>'teriResoprres 41
Faci_Uty Number © . ®� �X rvLionf Soii and Water�Conservationfi
Type of Visit: ® Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: 4T 1 0Arrival Time:®Departure Time: ! j County: Region:Farm Name: �jI Art Y43 • �, , Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: j Title:
OnsiteRepresentative:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator:
Certification Number:
Certification Number:
Longitude:
-.. ^�F'.
��
�'
�� �;
Design.�RCurrent'�� Design Current.._
Desrgn,,��Current
Swine -
Ca aci WetPoul p h': Pop a{ o try ,CCapac ity Popp
Cattle
Capacity
Pop: W.
�-
"aDry
Turkeys
„Other_ w w gib" TurkeyPoults
Other
Other
Wean to Finish
� *�
Layer
Dairy Cow
Wean to Feeder
on -Layer
_
Dai Calf
�
Feeder to Finish
Desig
Dairy Heifer
Farrow to Wean
Cow
Farrow to Feederacid
La ers
,Po -�
Non -Dairy
Farrow to Finish
Beef Stocker
Gilts
Non -La ers
�.•.A Pullets
J,
Beef Feeder
Boars
Beef Brood Cow
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes [M No ❑ NA ❑ NE
Discharge originated at: El 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 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
Q NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
No
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 2/4/2015 Continued

Date of Inspection: 1
Facili Number: -
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
r�j No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes 6Q No NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): lj —
Observed Freeboard (in): 30
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
o No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
® No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental
threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
5g 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
[S; No
❑ NA
❑ NE
maintenance or improvement?
Application
_Waste
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
q No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes © No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes E] No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [Z No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes ® No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. is there a lack of properly operating waste application equipment?
Reauired Records & Documents
❑ Yes No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
Z] No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
® No
[DNA
❑ 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
q No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
[] Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 " Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
[] Yes
❑ No
❑ NA
© NE
Page 2 of 3 21412015 Continued

l"acili Alumber: - Date of Inspection: l
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes R!] No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ®No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes ® No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No ❑ NA Z0 NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes ❑ No ❑ NA 4 NE
❑ Yes [5d No ❑ NA ❑ NE
❑ Yes EZ No ❑ NA ❑ NE
❑ Yes f{] No ❑ NA ❑ NE
❑ Yes ® No
❑ Yes [R No
❑ Yes []A No
❑ NA ❑ NE
❑NA ONE
DNA ❑ NE
Reviewer/Inspector Signature: . Date:
Page 3 of 3 21412015

U Division of Water Resources
Facility Number 3 - l o 0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit: 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
teason for Visit: 0 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: County: Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
lr�'1 aw.nh
Certified Operator:
Back-up Operator:
Location of Farm:
Title:
Latitude:
Phone:
Phone:
Integrator:
Certification Number: y r0
Certification Number:
Longitude:
Design Current Design Current Design Current
Swine Capacity Pop. Wet Poultry Capacity Pop. Cattle Capacity Pop.
Wean to Finish
Wean to Feeder
eeder to Finish
72--y-t-1
q 740
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Layer
Non -La er
Design Current
Pullets
Other
Poults
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?
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes `,' - _ ❑ NA ❑ NE
❑ Yes
[:]No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
[/]"No
❑ NA
0 NE
❑ Yes
EfrNo
❑ NA
0 NE
Page I of 3 21412015 Continued

IlFacilityNumber: 3 n Date of Ins ection: l /
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 ❑ 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 E3 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 �10 ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? [:]Yes 'No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes []'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 qNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ENo ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ❑'No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy -Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes eNo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes rNo❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
No ❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
0 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
E"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 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes []k?4b ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes EN6'--❑ NA ❑ NE
Page 2 of 3 21412015 Continued

acili Number: 3 - co jDate of Inspection: I -- I &i L
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 D Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey [] Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No DINA 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?
Fcx/-r,— �lC -CQ, J's (a o h j --V d
ReviewerlInspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
0
❑ Yes or ❑ NA ❑ NE
❑ Yes Prl�_o ❑ NA ❑ NE
❑ Yes F, to ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes E?No
❑ Yes 12-No
❑ Yes J�EtNo
❑NA ❑NE
❑ NA ❑ NE
❑NA ❑NE
Phone: [phone] Ap�
Date: 1 Z
761ro
21412015

(dDivision of Water Resources /
Facility Number - O Division of Soil and Water Conservation V
O Other Agency
Type of Visit: Com ce inspection 0 Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: / Arrival Time: Departure Time: 3 Q County: Region:
Farm Name:
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title: Phone:
r
Onsite Representative: �/ L `� /n n Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Certification Number: 2 Z fy
Certification Number:
Latitude:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
Layer
Non-Layer
Wean to Finish
Feeder
f-to
eder to Finish
Z20
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Nan-L,
Pullets
Other
Poults
Design Current
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)?
Longitude:
Design Current
Cattle Capacity Pop.
Dairy Cow
Dai Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes �`❑ NA ❑ NE
[-]Yes
[-]No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. f s 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 [
[:)Yes L_i No
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
Page I of 3 21412015 Continued

Faciti Number: - j Date of Inspection: f G
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: 2—
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3 3 o
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[3--No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
[: No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the pertnit?
❑ Yes
ErNNo
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes EJ No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 0"'No ❑ NA ❑ NE
maintenance or improvement?
11. is there evidence of incorrect land application? If yes, check the appropriate box below, ❑ Yes Zf No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
[]Yes
0 No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
�o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ YesEl"No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
EJ�No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[ l oc
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
[] Yes
B No
❑ NA
❑ NE
the appropriate box.
[]WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
Io
❑ 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
[E No
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
En"No
❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facility Number: 1- �Q Date of Ins ection:
-. --
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes �o ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [—]Yes ED'No ❑ NA [] NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fait to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
No
❑ NA
❑ NE
❑ Yes
❑ No
[�" I�A
❑ NE
❑ Yes
No ❑ NA
❑ NE
❑ Yes
ErNo ❑ NA
❑ NE
❑ Yes
No ❑ NA
❑ NE
[] Yes
[3<o ❑ NA
❑ NE
❑ Yes
No ❑ NA
❑ Yes
No ❑ NA
�No❑
❑ Yes
NA
❑ NE
❑ NE
❑ NE
Reviewer/Inspector Signature:
Page 3 of 3
Date:
21412015

Division of Water; -Res s
Facflity Number F� / O 1 0 Division of Soil and Water. Conservation.
Q Other Agency
Type of Visit: Compliance Inspection Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: X Routine 0 Complaint Q Follow-up O Referral O Emergency Q Other O Denied Access
Date of Visit: f / Arrival Time: Departure Time: 3b County: Region:
Farm Name: CZaOL Z (2k&)1V/V f_14(L0kA Owner Email: OwnerName: L '9 C)U JVA/ Phone:
Mailing Address: q 5 ;, STC-awn Z6 Mg6,KLjJq,MC ggL 5 3 -�4
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative: {� Integrator:
CPU n
Certified Operator: �oLazx— 1' l-1 /?Zy Certification Number: QQ L41
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Design
Swine Capacity
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Boars
Current ; Design . Current Desfg© °, ~Current
Fop:- WetPoultry Capacity Pop Catt]e Capacity Pop
La er
Non -La er
Design d Current . -
°D Poultry,-�Ca" aciPo
Layers
rin-I .qw-m
- 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 DWR)
w
lf
ff
ifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes 0 No
❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ 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 No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes allo ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412014 Continued

Fa Uity Number: ! - JQ J IDate of Inspection: 11 13
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): R.S
Observed Freeboard (in): 3- -
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.) TC
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes 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) ETC
9. Does any part of the waste management system other than the waste structures require ❑ Yes j No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 0 No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ko ❑ 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 Approved Area
12. Crop Type(s):
13. Soil Type(s):
UI
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
QWUP ❑Checklists 0 Design Q Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 1No
Q Waste Application 0 Weekly Freeboard 0 Waste Analysis 0 Soil Analysis ❑ Waste Trans ers
Q Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No
❑NA ❑NE
[] Weather Code
Q Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412014 Continued

Facility Number: I - 101 IDate of Inspection: I
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes rNo
o
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes
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?
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No [DNA ❑ NE
❑ Yes No • ❑ NA ❑ NE
Reviewer/InspectorName: Amqs o, G -_3 Phone: 110r `&'-4'6u
Reviewer/Inspector Signature: f'1 . Date: 3
Page 3 of 3 2/412014

c
)C/ uwwAun u1 rr ester tlusuty
Facility Number - 0 Division of Soil, Water Conservation r
0
Other Agency
Type of Visit: ompliance Inspection Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 46 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: L! r It t a l Arrival Time: L_L_+J� Departure Time: County: Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Phone:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Design Current -
Swine Capacity Pap..
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Latitude:
Integrator:
Certification Number:
Certification Number:
Design ..Current
Wet Poultry Capacity Pop.
La er
Non -Layer
Design Current
Other
Poults
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?
Longitude:
Design -Current',",
Cattle Capacity.. _.. Popn ,
Da'x Cow
Dairy Calf
Dairy Heifer
D Cow
.Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes ,6 No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
;�rNo
❑ NA
❑ NE
Page I of 3
21412011 Continued

A
Facili Number: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes )Z]'No
a. If yes, is waste level into the structural freeboard? ❑ Yes rNo
Structure 1 Structure 2
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
❑ NA ❑ NE
❑ NA ❑ NE
Structure 3 Structure 4 Structure 5 Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
❑ Yes �No ❑ NA ❑ NE
❑ Yes 9No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes PfNo ❑ 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) T
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement? 71
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes P No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes Vf No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. [] Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes KNo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes V No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes rf f No ❑ NA ❑ NE
acres determination? 7
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 YJ No
❑ Yes, ,s No
f
❑ Yes No
❑ Yes No
❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ YesIsIfers
No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste
❑ 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 0 No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes (ZNo
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑NA ❑NE
Page 2 of 3 21412011 Continued

a
• Facili Number: - JBI Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes �TNo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [:]Yes PNo ❑ 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?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
24. At the time of the inspection did the facility pose an odor or air quality concem?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes
;No
❑ NA
❑ NE
❑ Yes
16 No
❑ NA
❑ NE
❑ Yes ?TNo
❑ Yes F41No
❑ Yes VrNo
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes 4 No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or GAWMP? 0 Yes �frNo ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes ] No ❑ NA ❑ NE
Reviewer/Inspector Name: ::s 1�O�n�
Reviewer/Inspector Signature: tJ
Page 3 of 3
Phone: p9�o�`�
Date: r+ H
21412011

Kivisiim'6f
ivision of Water Quality
Frciit -Number % Soil and Water Conservation
.ty © LJ
Other
. . -
Type of Visit: Compliance Inspection O Operation Review p Structure Evaluation 0 Technical Assistance
Reason for Visit: Routine O Complaint O Follow-up 0 Referral O Emergency O Other O Denied Access
: 1`
Date of Visit: Arrival Time: Departure Time: CountyapC.-1/V Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Owner Email:
Phone:
Facility Contact:
Title:
Phone:
Onsite Representative:
��57 C]L
[ ql /
Integrator:
Certified Operator: (LCZOC-
1 NN
Certification Number: co
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Latitude:
Certification Number:
Longitude:
Design Current Design Current Design ' Current
Capacity Pop. Wet Poultry Capacity.- Pop. Cattle . Capacity =Pop
La er
Non -La Cr
Design _Current',-',.
Dry. Poultry Ca aci Pop.
Farrow to Finish
Gilts
Boars
.Other ...
Other
Layers
Non -Layers
Pullets
Turkeys
Turkey Poults
Other
71
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?
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes 10 No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
[:]Yes ❑ No
❑ Yes V No
❑ Yes 10 No
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3 21412011 Continued

Facili Number: I I - T5 El jDate of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):^
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
4No
❑ 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?
�C
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 4No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes ONo ❑ 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 'ANo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need [:]Yes �No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window _ ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): J�1
13. Soil Type(s):
ICLF
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
1p No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
JANo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
JANo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
JQ 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
No
❑ NA
❑ NE
the appropriate box.
Q WUP OChecklists 0 Design 0 Maps 0 Lease Agreements
[]Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
Q Waste Application ❑ Weekly Freeboard ❑ Waste Analysis Q Soil Analysis ❑ Waste Trans rs ❑ Weather Code
[] Rainfall ❑ Stocking [] Crop Yield Q 120 Minute Inspections Q Monthly and 1" Rainfall Inspections Q Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes � No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ YesA No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: - / Date of Inspection: 1
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List 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 �4240 ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes �No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes No ❑ NA [3NE
and report mortality rates that were higher than normal? 10
24. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes]
No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
T�
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No
❑ NA
❑ NE
Reviewer/Inspector Name:
Reviewer/inspector Signature:
Page 3 of 3
Phone: Coe 1 1
Date: 191VI 0
21412011

s Division of Water Quality
Facility Number - �j 0 Division of Soil and Water Conservation /.
0 Other Agency
Type of visit: Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: )$ Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: Ot County: C!/1/ Region:
Farm Name: t2dL_ C)LA1 Al FA 2Nl Owner Email:
Owner Name: ( (Lo (_ 1 (2)CA 1 NJJ _ Phone: (3l0 —1Qa 9` _3(D (DO
Mailing Address: )95 � Q S7(ZoLk+� R _ M'gc'Nou�g . Nc
Physical Address:
Facility Contact:
Title: Phone:
Onsite Representative: -RAL_ 1 N/�/ - _ Irate ra',
Do, l
Certified Operator: ��i OC� �l NN -, Certification Number:
Back-up Operator:
Location of Farm:
Design Current
Swine Capacity Pop.
Wean to Finish
Wean to Feeder
Feeder to Finish (}
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
.. Other
ET-5ther
Latitude:
Certification Number:
Longitude:
Design Current
Wet Poultry Capacity Pop. Cattle
Layer
Nan -La er
Design Current
Dry Poultry CaDatity Poo.
Layers
Non -La ers
Pullets
Turkeys
Turkey Poults
Other
aauho
Design ; Current
Capacity -Pop:
Dai Cow
Dairy Calf
Dairy Heifer
Dry Cow
.Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
Discharp_es and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes ANo ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) [] Yes ❑ No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
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 No
❑ Yes No
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3 21412011 Continued

Facility Number: jDate of Inspection: jy
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ANo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Struc + a� Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
u►150KIN
Identifier: OOA(
Spillway?:
Designed Freeboard (in):�J . ���Is
Observed Freeboard (in): _ 3
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes No
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
No
❑ NA
❑ NE
waste management or closure plan?
�\
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
0 No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
No
54
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
[ No
❑ NA
❑ NE
maintenance or improvement?
Waste AoPlication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ' 1 ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s): ` I IAA L\J v f LA'T(ZL-W1l.tC--
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No
N
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
V
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
Yes
No
[] NA
❑ NE
the appropriate box.
OWUP Checklists ODesign ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes XNo
❑ NA ❑ NE
Waste Application 0 Weekly Freeboard Q Waste Analysis 0Soil Analysis ❑ �aste Transfers [] Weather Code
❑ Rainfall 0 Stocking ❑ Crop Yield 0120 Minute Inspections Q Monthly and 1" Rainfall Inspections Q Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: - j Date of inspection: f
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 0q No ❑ NA NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes
No
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
❑ Yes
No
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concem?
❑ Yes
(] No
If yes, contact a regional Air Quality representative immediately.
L�
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
No
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
No
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes lNo ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes MNo ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments N=
Use: drawines of facility to better explain situations (use additional pages as necessary). .
LAJ ' A • (OA a- to/ I lr
%8111 1 • I vxq 4,O
s)1%.11, 1.9
994T/ oN bu6 Sol a
A100) SOµC'
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Cox v z'
NE
Phone: Qj02zi(9 --�3a'1
,vYt� Date: jny11
2/4/20II

Faculty N"6ib x
�y
Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit XRoutine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: IK�N:] Arrival Time: ® Departure Time: County: Li N Region:
Farm Name: �-:QgoL CkxUVN PPV-fn Owner Email:
Owner Name: r—__ gkoc Z . C�t_x1 NX Phone: lX5-o?q ?-4(_ (06 -
Mailing Address: I `1 S_W, S-74Z ql+ V_d f )?AClvaufl 11 S34 71 (19
Physical Address:
Facility Contact: / Title:
Onsite Representative: _ me, -
Certified Operator: E URCIL ► l - Q tA 1AIX/
Phone No:
Integrator: 11 n�}
Operator Cefication Number: of OL/ld
Back-up Operator: Back-up Certification Number:
Location of Farm:
Latitude: =1 c E:1' = « Longitude: [� o = i 0 «
Design Current D
Swine
Capacityro`Populatian we Pouitr� .JCa
-_ a a-
❑ Wean to Finish
❑ La er
❑ Wean to Feeder
❑ Non -La er
Feeder to Finish
yolwo "rt
❑ Farrow to Wean
Dry Poultry'r
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Layers
❑ Lilts
❑ Non -Layers
❑ Boars:
ElPullets
❑ Turke s
©they
❑ Turkey Poults
❑ Other`
❑ 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?
Cy ow
Cy alf
y Heifer
Cow
Beef Stocker
Beef Feeder
Beef Brood
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 XNo ❑ NA ❑ NE
El Yes
El No
El NA
El NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
'qNo
❑ NA
❑ NE
❑ Yes
❑ NA
❑ NE
12128104 Continued

,1
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 3 Structure 4
Identifier: (.AQp3V
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes ANO
El Yes ❑ No
Structure 5
El NA El NE
❑ NA ❑ NE
Structure 6
❑ Yes 10 No ❑ NA ❑ NE
❑ Yes ANo ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes] No ❑ NA ❑ NE
S. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ yes t No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below
❑ Yes IANo
❑ Yes VNo
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑NA ❑NE
El NA El NE
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift
❑ Application Outside of Area
12.
Crop type(s) 5 r2l 915ZCN�
13.
Soil type(s)
L-_TaKU 1 LLjF
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
0No
❑ NA
❑ NE
IS.
Does the receiving crop and/or land application site need improvement?
❑ Yes
oNo
❑ NA'
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
� No
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
rVf,p(No
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
ONo
❑ NA
❑ NE
Comments refer to question # . Explain an YES aniwers and/or an reeom' '»i `M
._ ( q )' P Y y mendations or��any other comments "_.
Use drawings of facility to better explain situations. (use additional=pages as -necessary)'
w.4•
Lfrw/o A-
'l9110 1-Ca
Reviewer/Inspector Name f)�1 'S
Phone: 96 3
Reviewer/Inspector Signature: `�-� .
Date: f S�/(]
Page 2 of 3 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 No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists El Design [] Maps [I Other
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes XNo
ElNA
ElNE
❑ Waste Application ElWeekly Freeboard ❑ Waste Analysis ElSoil Analysis ❑ W ste
Transfers❑
AOlual Certification
0 Rainfall ElStocking 0 Crop Yield 0 120 Minute Inspections 0 Monthly and 1" Ram
Inspections C1 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
No
ElNA
ElNE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
No
❑ NA
El NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
No
El NA
El NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
No
❑ NA
[I NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
f No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
] No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
\
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
No
❑ NA
❑ NE
JI
"ditional CoFn' rnenisl and/or Drawings :: _ =:
�'Au�rrcvJ �E �1 i
•
sn,lrT C so F 15(-UlOct r ?G A FC5 4�_ Q-C Goes
Page 3 of 3 12128104

i
D1VlSlOIiOfWater Q ty Hall 111
.O
yx.� CtDivision of Soiland Wateronsevtir>cOthr"Agencon,
77
Type of Visit Compliance Inspection 0 Operation Review 0 Structure Evaluation Q Technical Assistance
Reason for Visit KRoutine O Complaint 0 Follow up O Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: 55 Departure Time: County: W d Region:
Farm Name: G l9 AU_ OWAIW CAM Owner Email:
Owner Name: — - QUtnrAJ Phone:
Mailing Address: I 't) S7czcgA p Wa
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: ' SV-(L0L C )W AIA/
Certified Operator: Qu_ LNN
Back-up Operator:
Location of Farm:
Integrator: f�
Operator Certification Number: g 14
Back-up Certification Number:
Latitude: = o = t Longitude: = ° =' =
-Design Current
Swine Capacity Population Wet Poultry -Cap
❑ Wean to Finish Via. ❑ Layer
❑ Wean to Feeder 4—
❑ Non -Layer_
LQ Feeder to Finish:
M.
Dry Poultry
Farrow to Wean
❑ Farrow to Feeder
❑ Layers
Farrow to Finish
❑ Non -Layers
❑ Gilts
❑ Pullets
❑ Boars
❑ Turkeys
Other; -
Murkey Poults
❑ Other
I
=>
❑ Other
('nrrent
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?
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
No
❑ NA
❑ NE
❑ Yes qNo ❑ NA ❑ NE
12128104 Continued

Facility Number: — /Q1
Date of Inspection 3 0
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
XNo[INA [INE
a. If yes, is waste level into the structural freeboard?
ElYes
❑No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5 Structure 6
Identifier: t 445ZC XW
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
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
X No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
ONo ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
A[No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
kNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[:]PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) S� f
13. Soil type(s) 1 l Mt AV- U Lk Al
(47 R-CAU i C_(_,E L&C (mil
14. Do the receiving crops differ from those designated in the CAWMP?
El Yes
KNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
4 No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
LANo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
iNo
ElNA
ElNE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ NA
❑ NE
100 t
;I2of69 I,N
LReviewer/Inspector Name C) f�A . ��/� M Phone: 91Q-�(o-'tZ14
Reviewer/Inspector Signature: Date: ��3�Oq
Page 2 of 3 12128104 Continued

Facijty Number: -lO1f Date of Inspection
R_eauired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes )ZI`No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes i No ❑ NA ❑ NE
the appropirate box. Q WUp 0 Checklists
0 Design 0 Maps [I Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
[] Waste Application 0 Weekly Freeboard ❑ Waste Analysis 0 Soil Analysis ❑ W/te Transfers ❑ tyinual Certification
0 Rainfall 0 Stocking 3 Crop Yield [] 120 Minute Inspections 0 Monthly and V Rain Inspections /ED Weather Code
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32, Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes
�No
❑ NA
El NE
❑ Yes
Wo
❑ NA
❑ NE
❑ Yes
0 No
❑ NA
❑ NE
❑ Yes
OkNo
❑ NA
❑ NE
❑ Yes
XNo
❑ NA
❑ NE
❑ Yes
'XNo
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
XNo
❑ NA
❑ NE
❑ Yes
ONo
❑ NA
❑ NE
❑ Yes *o ❑ NA ❑ NE
❑ Yes JN No ❑ NA ❑ NE
Page 3 of 3 12128104

Division of Water Quality
Facility Number Division of Soil and Water Conservation
O Other Agency v
Type of Visit J& Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit col Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: I qj I Qf Arrival Time: Departure Time: County: �kQU N Region:
Farm Name:
Owner Email:
Owner Name: G�G L— _�� N Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:Q�La L u 1 N
Certified Operator: eQfL0L Qu 1N�
Phone No:
Integrator:
Operator Certification Number: Q cgLi l
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: = e = = Longitude: 0 ° ❑
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er j
I
�+ ❑ Non -La er
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
Qiurkey 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 Cowl
Number of Structures: =1
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page 1 of 3
❑ Yes] No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
No
❑ NA
❑ NE
❑ Yes
0,No
❑ NA
❑ NE
12128104 Continued

Facility Number: — f O 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 3
Identifier: (-A&00l1
Structure 4
❑ Yes ANO
❑ Yes ❑ No
Structure 5
El NA El NE
El NA El NE
Structure 6
Spillway?: `` q
Designed Freeboard (in):
Observed Freeboard (in): _ 3Q
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 KNo ❑ 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
kfNo
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
No
❑ NA
❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
�No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No
Ir
ElNA
❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
JgNo
❑ NA
❑ NE '
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
INo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
fi�Mo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
�YNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
,kNo
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
GOLNC,' -a'o rno� ► �SI�E o F c_F�cod^1 Dt Ke Ity 9F `r D,4� OcLyco
AL
Reviewer/Inspector Name a I A1.6 Phone: ! /Q - I6 4 3
Reviewer/Inspector Signature: _ Date: wIlLJlt3
Page 2 of 3 12128104 Continued

Facility Number: 1 — Date of Inspection [
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 0 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ONo El NA [I 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 �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
)�No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
o
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
E\\No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
ElYes
EJ�No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
D�No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
1�No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
I�No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
]� No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
[I NA
[I NE
If yes, contact a regional Air Quality representative immediately
ro
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
E No
❑ NA
❑ NE
Page 3 of 3 12128104

0 Division of Water Quality
Facility Number 3 i p l 0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit 0 7Routine
pliance Inspection Operation Review O Structure Evaluation 0 Technical Assistance
Reason for Visit O Complaint O Follow up Q Referral O Emergency O Other ❑ Denied Access
Date of Visit: tp o7 Arrival Time: Departure Time: County: OUPLE-A) Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Onsite Representative: CRAX Lk- Q i d_-blk.I Integrator:
Certified Operator:
Back-up Operator:
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
Phone No:
Operator Certification Number:
Back-up Certification Number:
Latitude: 0 0= 1 Longitude: 0°= I=
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
❑ Non -Layer
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures:
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
❑ No ❑ NA
❑ NE
❑ Yes
❑ Yes
❑ NA
<yo
[I NE
El Yes
❑ NA
❑ NE
12128104 Continued

Facility Number: t — 161Date of Inspection Id 1
f Waste Collection & Treatment
,.,/
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
El Yes LJi No
❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes ❑ No
❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: l A(SapO
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 36
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
,_/
El Yes E2,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
environment7thrat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
El NA [I NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑yes
[INA ElNE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes j!fNo
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes M No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drifl ❑ 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
[INo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
Ealyles
❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
E(No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
El Yes
No
❑ NA
❑ NE
Comments (refer to question ft 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):
iSt) �:>kc.n 3 to "A C,,yT0A U
Reviewer/Inspector Name ' 1a Phone: '%qK -7�'W)r
Reviewer/Inspector Signature: Date: I d

acility Number: 3 t — b t Date of Inspection a aye o
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 E'No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design El Maps []Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 14No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
[]rNo
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[��,/
❑ NA
El NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
,
1No
L-
❑ NA
El NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
ElYes
2(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
po
[--]'NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
dN.
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
IJ 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
El�,
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
[�:J o
El NA
❑ NE
33. Does facility require a follow-up visit by same agency?
El Yes
[3 No
❑ NA
❑ NE
Comments and/or Drawings:
12128104

i 4:) Division of Water Quality
Facility Number ` O Division of Soil and Water Conservation /
0 Other Agency V
Type of Visit C1,ommpiiance 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: d Arrival Time: =� Departure Time: County: Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Phone:
Facility Contact: //�� Title:
Onsite Representative: 12A <2 Integrator:
Phone No:
Certified Operator: Operator Certification Number:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Boars
Back-up Certification Number:
Latitude: 0 c = ' 0 Longitude: 0 ° = ' 0
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
--, j ❑ Non -Layer - -- - - --
Other
❑ Other
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
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?
Page 1 of 3
❑ Yes WNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
El Yes � Vo ❑NA ❑NE
❑ Yes No ❑ NA ❑ NE
12128104 Continued

Facility Number:
Date of Inspection a
_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 l Structure 2 Structure 3 Structure 4
Identifier: LA
❑ Yes No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
Spillway?:
Designed Freeboard (in): , S
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 ffNo ❑ NA ❑ NE
through a waste management or closure plan?
NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ElYes �'N
o ❑ NA El
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes [:3NA [INE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ yes No ❑ NA ElN
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes WN [__1 NA Elmaintenance/improvement?
It. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes No ❑ NA E] I-,❑ Excessive Ponding ElHydraulic Overload ElFrozen Ground ElHeavy Metals (Cu, Zn, etc.)
ElPAN ❑ PAN > 10% or l0 lbs ❑ Total Phosphorus [:]Failure to Incorporate Manure/Sludge into Bare Soil
ElOutside of Acceptable Crop Window ElEvidence of Wind Drift ElApplication Outside of Area
12. Crop type(s) . (H -/- G ) ,S�o
%j
13. Soil type(s) AX)l VAJ �ay 1V_rL'.�C
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes LTNo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? 0Yes ElNo ElNA ElNE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes EoNo ElNA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes ao [3NA ❑ NE
UNo ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
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):
1t.} tAO CWY •t` &64464-t- A,✓tle44C- C tf1 t tvl Peens -ter.
rs;} �;/ pvr Dr WE6P "A17 ,4,• L AITIA1416.
����� �C�o�n'[C�� I1�6►c.6 ERR. � �,(�r Mom' )CC
Reviewer/Inspector Name F_ pRAI Jkj��A Phone: 7AV /71'o �-
Reviewer/Inspector Signature:
Page 2 of 3
Date:
8����bG
12128104 Continued

Fadiity Number: 3 Date of Inspection EU6101i
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes o ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes L li o ❑ NA ❑ NE
the appropriate box. ❑ WUp ❑ Checklists / ❑ Design [I Maps El Other ✓
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers J(J Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain InspectionVNNNo,
Weather Code
22. Did the facility fail to install and maintain a rain gauge? El Yes
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑Yes
[I NA
El NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
El Yes
�ZN'ou'
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility Y P g fail to have an active! certified operator in charge?
❑ Yes
ElYes
L7N ❑ NA
CJ No ❑ NA
❑ NE
❑ 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
21'NNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
U 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
EI 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
��/
O No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
❑ No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
No
❑ NA
❑ NE
Additional Comments and/or Drawings:
i
H,,
Page 3 of 3 12128104

FadI tyNuinber
a.. I
1 Division of Water Quality
O Division of Soil and Water Conservation
0 Other Agency
N
Type of Visit 0 Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance I
Reason for Visit 0 Routine 0 Complaint Q Follow up Q Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: �I�I Arrival Time: I f 0 Departure Time: County:
Farm Name: _�.�,���''C!/_ _, „ �� ,,, f�,_ , , Owner Email:
Owner Name: /&4L _&ed .7"f A Phone:
Mailing Address:
J
Physical Address:
Facility Contact: Title:
Onsite Representative: 1�.Q/�7L ax1'J') Integrator:
Certified Operator:
Back-up Operator:
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 - -
Phone No:
Operator Certification Number:
Back-up Certification Number:
Region:
Latitude: = c = c Longitude: = ° [� i
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
1 ❑ Non -Layer
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turke s
❑ Turkey Poults
❑ Other
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifei
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures: EJ
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 Y(No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
[:]Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
[:]Yes
[--]No
❑ Yes
X No
❑ NA
❑ NE
❑ Yes
XNo
❑ 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?
El NA El NE
El NA ❑NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?: 1✓d
Designed Freeboard (in): IQ. Jf
Observed Freeboard (in): Zq
❑ Yes 9No
❑ Yes ❑ No
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 0 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 VrNo ❑ 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 9No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes VfNo ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ;dNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
maintenance/improvement?
❑ Yes 0No ❑ NA ❑ NE
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 0 No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 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)
113. Soil type(s)
l4. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes Po
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
ElYes ONo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination: ❑ Yes No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes XNo
❑ NA
❑ NE
SozG ls: �,r Pa�> �r+o4lf,o vim.
'O2 GR�!gr�ee� o Qu1N�,t� Sq'yo Lvn,H /7,�pf� 2,►
ZfR--r 'Z20c�1nF_1VT W&'frt1f2 4,vo /Zd /r1 �, 7�- sp4c7-2o"I,
Reviewer/Inspector Name
F
Phone:
Reviewer/Inspector Signature: Date: I D 11 b5
12128104 Continued

. ..
Facility Number: Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes VfNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes PfNo ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes /No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking Cl Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain'Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes KNo
❑ NA ❑ NE
❑ Yes )ZfNo
❑ NA ❑ NE
❑ Yes ;�No
❑ NA ❑ NE
❑ Yes �dNo
❑ NA ❑ NE
❑ Yes No
1 0
❑ NA ElNE
❑ Yes WlNo ❑ NA A" E
❑ Yes
A No
❑ NA
❑ NE
❑ Yes
A No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑Yes
No
❑NA
El NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
4ee_
�i�Znl7fj-Z/�
12128104

Type of Visit ® Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number a Date of visit: Ej�= Time-
rO—N'otOperational 0 Below Threshold
Permitted dCertified [:] Con/dittifon�a'll�y ertified 0 Registered Date Last Operated or Above Threshold: _.
Farm Name: L uC �[iJ __ _ . . _ County: ... Qyeuxl\)
Owner Name:
Mailing Address:
Facility Contact:
Onsite Representative: Z _(� Lrn*`
Certified Operator:
Location of Farm:
Title:
Phone No:
- - ----- Phone Phone No: __..._ . .. _.
Integrator:
Operator Certification Number.
L
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • 4 " Longitude ' ' "
Discharses & Stream Iniyacts
1. Is any discharge observed from any part of the operation? ❑ Yes Q 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 gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2_ Is there evidence of past discharge from any part of the operation? ❑ Yes W7No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes
Waste Collection & Treatment
4_ Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard (inches): 2"r
12112103 Continued

FacilityNumber: 31
Date of Inspection
5: Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenancefimprovement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenanmrunprovement?
11. Is there evidence of over application? If yes, check the appropriate box below.
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground
I2. Crop type
❑ Copper and/or Zinc
5616
❑ Yes &No
❑ Yes dNo
Yes ❑ No
❑ Yes 2rNElYes
❑ Yes
❑ Yes �No
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes EjrNNo
14. a) Does the facility lack adequate acreage for land application? ❑ Yes B<O
b) Does the facility need a wettable acre determination? ❑ Yes 01' qo
c) This facility is pended for a wettable acre determination? ❑ Y s dNa
15. Does the receiving crop need improvement? Yes ❑ No
16. Is there a lack of adequate waste application equipment? ❑ Yes Q'No
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge attor below [:]Yes [.io
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? [:]Yes [340
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes 12�K0
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.
�Cnmmm�ts refer to gnestrora-tl) �F,xpiam at;y YLS aaswns aad/or any or,anp�other oo_ ts. x � -�'
=Else draw;n�s of EacTi=y' !o lbetttr edam srt�tAc�. �a�e ad�hcriaiegages as r]'3'� � � Feld Copy ❑ Finai Notes t • -��- 3
7.) Ds0 WAUS 6F "W'qj
Cw lto u E w�-69 C"JTrt6L-
L P G, Ev✓ t �.r, �S _fg6to �ldT EXGEE� k�orr�e�SC �.�ECD CbAD,
t-A &d&fJ AX)At,✓S2 S Ca-0— G O DAYI�5 �r ,R, ANco AF-r&,c...Sq r.p�
Reviewer/inspector Namem
Reviewer/Inspector Signature: Date: o
12112103 Continued

Facility Number: Date of Inspection 1 b
_R_ eguired Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes L-fwo
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 CP4
23. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [�4o
❑ 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 Noo
25_ Did the facility fail to have a actively certified operator in charge? ❑ Yes ❑1,10
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes o
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes
28. Does facility require a follow-up visit by same agency? ❑ Yes
29. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes 7No
NI MES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35) es 0 No
31. If selected, did the facility fail to install and maintain rainbmakers on irrigation equipment? [I Yes
32_ Did the facility fail to install and maintain a rain gauge? El Yes�ro'
33. Did the facility fail to conduct an annual sludge survey? ❑ Yes ;,��
34. Did the facility fail to calibrate waste application equipment? ❑ Yes ��N
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below. ❑ Yes L No
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ inspection After 1" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
12112103

Type of Visit 10 Compliance Inspection 0 Operation Review 0 Lagoon Evaluation
Reason for Visit Routine 0 Complaint 0 Follow up 0 Emergency Notification 0 Other ❑ Denied Access
Facility Number Date of Visit: Time: 1 /dam
/3 1 10 Not Operational Q Below Threshold
0 Permitted [3 Certified 0 Conditionally Certified 0 Registered Date Last Operated or Above Threshold•.
Farm Name:—je;za OL al�6w &Ina County:
�Q�L F ,�} 1 J��GL/il
Owner Name: lynNf'y Phone No:
Mailing Address:
Facility Contact: Title: Phone No:
Onsite Representative: 6&Q L- aZA-26) Integrator: JOAJ _5 �
Certified Operator: Operator Certification Number:
Location of Farm:
Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' 4 " Longitude 0 '
Design Current
Design Current Design Current
Swine Capacitv Population
Poultry
Capacity Population Cattle Capacitv Population
❑ Wean to Feeder
1
10 Layer
❑ Dai
Feeder to Finish
❑ Non -Layer
❑ Non-Dai
Farrow to Wean
— - -
❑ Farrow to Feeder
❑ Other
❑ Farrow to Finish
Total Design Capacity
❑ Gilts
❑ goy
Total SSLW
Number of Lagoons © ❑ subsurface Drains Present 110 Lagoon Area 10 Spray
Field Area
— --- — -- -- -- -- -- ---- - -- ... _ _._I
Holding PondsJ Solid Traps
Q ❑ No Liquid Waste Management System
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. if discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (if yes, notify DWQ)
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 Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier: 1 G r% r�e/wt,%Q
Freeboard (inches):
05103101
❑ Yes 9No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes No
❑ Yes No
❑ Yes �dNo
Structure 6
Continued

Facility Number: j — Jj2L Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑ Yes
;Z No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
❑ Yes
Q� No
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
❑ Yes
P No
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
VNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
No
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes
0 No
11, is there evidence of over application9 ❑ Excessive Ponding ❑ PAN ❑ Hydraulic OverlNM:515P
El Yes
ffNo
12. Crop type (VkpA
13. Do the receiving crops differ with those designated in the Certi ed Animal Waste Management Plan (CAWMP)?
❑ Yes
No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
[� No
b) Does the facility need a wettable acre determination?
❑ Yes
VNo
c) This facility is pended for a wettable acre determination?
❑ Yes
[INo
15. Does the receiving crop need improvement?
❑ Yes
7No
16. Is there a lack of adequate waste application equipment?
❑ Yes
[Z No
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
VfNo
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
P No
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
VfNo
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
VNo
21. Did the facility fail to have a actively certified operator in charge?
❑ Yes
No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes
No
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
24. Does facility require a follow-up visit by same agency?
❑ Yes
JVNo
No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
No
0 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Cotttaiei�ts.(refer to question #) Explain.any M answers and/or ---any recommepdatiaris ar anrr%other colds tenis:
_
onapaeas necUse drawtngs offcltrey ry) ❑Field Conv ❑Final Note',
Ot�E(ZAS oN �CrvoA� Aao �5 Ur01J��r�Li�(y r L{J9R OW
�7
REMVO�iQCL `r► O1 V OVOy EGF_< 7��J R M F L oIJ LJXLc.,,
-rsX- Oar o O
Q� r-k e 6r" c--- mPtrzfN-OC
��sflCC��n� Q,rJ tE-�1�Io�e
Reviewer/Inspector Name µ
Reviewer/laspector Signature: Date:
05103101 Continued

Facility lumber:51 — KI Date of Inspection
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours?
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure. and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon?
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters. etc.)
31. Do the animals feed storage bins fail to have appropriate cover?
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes 0 No
❑Yes [/No
❑ Yes [V No
❑ Yes 7 No
❑ Yes XNo
❑ Yes VNo
❑ Yes ❑ No
Additional Comments and/or. Drawings::°
AL
N Do,�� �tlJo tv�w
Rs�� PLRr1 R�7��r) 1 c9C.(�E� . SF ��PczR
()l.'LVM �Rz-c-A'rEsn
+/I r+ (Oz
Do
�44"C - Q V-', `6E- ':�-O R r d DOC9 N Sow
5AmPtc- 64EE-r5 a � vkt , r F Cr-N L y
15 WOu L_o bz KK F
0�E�.
OAF". E-O r (Zq -r�� c- l',,i!5� ` ©(zvq
F.'e�G©,j %gym > Ia©o - 4w
05103101

sion,of Water Quality tl
- O Drv�saon,�of So&aind Water Conservation
x -
O Other_Agency _ {
Type of Visit O Compliance Inspection Q Operation Review O Lagoon Evaluation
Reason for Visit O Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number 31 101 Bate of Visit: 4/17/2002 Time: 9:55
Q Not Operational Q Below Threshold
® Permitted ® Certified © Conditionally Certified 0 Registered Date Last Operated or Above Threshold:. __ .... -- -- _
Farm Name: Er.r.9jQm1Ttn.JFAr #.......................................................... . ._.... County: I?u4hol....................................
1?1JliQ-------
Owner Name: lrrr------------------- l2sww__.------- - --- - - - - --- Phone No: 1�495�943.- ----- - --- ------------..
Mailing Address: 1951,Stroud. wAd.................................................•-.....-----......._..... MagmaliaL.......................................................... .'.8.453..............
Facility Contact: ........................... ......................... Title: Phone No:
Onsite Representative: PJXQ) Q1tariA---------------------------------------- Integrator: PeSI��ACULS--------------------------•
Certified Operator: Err-nlB.................................. Qluiipm................................................ Operator Certification Number:ZZ410.--...............
Location of Farm:
south of Kenansville. On North side of SR 1922 approx. 0.1 mile West of Hwy IL +
® Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 34 •
55 4
00 u Longitude
77 • 59 37 w
- .. .
Design "Current = -
Design
Current. ;
_: Design Current
Swine- Ca aci po elation - Poultry
Capacity
Population.-. Cattle
- p Capacity:..Po ulation
❑ Wean to Feeder
® Feeder to Finish
4220
4005
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Number of Lagoons I 2 I EI Subsurface Drains Present IlEl Lagoon Area I❑ Spray Field Area
Holding Ponds / Solid Traps „ ❑ No Liquid Waste Management System
Discharges & Stream impacts
1. Is any 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 gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes ®No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ❑ No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes IN No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:__1&2_uan=Md-.......... ------------------ --•--•--•--•--•--•--•--•----------------------------- ---•--•--•--•--•--•--•--•--...........................
Freeboard (inches): 26 _
neiniinr

v3iu�iul
Facility Number: 3t—lOt Date of Inspection 4/I712002
5. Are'there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. is there evidence of over application? ❑ Excessive Ponding ❑ PAN ® Hydraulic Overload
12. Crop type Coastal Bermuda (Hay) Coastal Bermuda (Graze) Small Grain Overseed
U uerrnuea
® Yes ❑ No
❑ Yes ® No
® Yes ❑ No
❑ Yes ®No
❑ Yes ® No
❑ Yes ® No
® Yes ❑ No
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ® Yes ❑ 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?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(iel discharge, freeboard problems, over application)
23. Did Reviewer/inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes ® No
❑ Yes ® No
® Yes ❑ No
® Yes ❑ No
❑ Yes ® No
❑ Yes ® No
❑ Yes ❑ No
❑ Yes ® No
❑ Yes ❑ No
® Yes ❑ No
0 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
- F _.
Comments:( refer to question #) Ezplain.any YES answers and/or any recommendations or any other comments
Use dr•.awings of facility to better explain �ituations (nse additiona! pages as necessary) ❑Field Copy ❑Final Notes e
�=
5. All trees on the lagoon wall need to be removed in accordance with good engineering practices. This includes removing all trees from
e top of the dike to the outside toe of the dike wall.
7. Need to extend recently replaced pipe which drains the hog house into the lagoon further into lagoon to prevent erosion of the inner
dike wall which is occurring.
11. There has been hydraulic overloading. 32,000 gallons/acre has been applied during some events. Need to not apply more than I
inch/acre during any event per waste utilization plan requirements.
Reviewer/Inspector Name Stonewall` Mathis ..
Reviewer/Inspector Signature: Date: Z 17LO2 _

Continued
05103101
.Facility Number: 31--101
Date of inspection 4/17/2002
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes ® No
28. 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)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes ❑ No
30. Were any major maintenance problems with the ventilation fan(s) noted? (Le, broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes ® No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes []No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ❑ No
13 and 15. The field across the creek which is supposedly leased for purposes of waste application is designated for bermuda in the
waste utilization plan; the bermuda stand in this field needs to be significantly improved and the field needs to be maintained for
rite application. Also, the field with the solid set sprinklers in it needs to have the remaining rye crop removed by cutting and
sling it. Also, the cows need to be fed bales of hay somewhere other than in the sprayfield area as the remaining spoil from these
feeding activities appears to inhibit the growth of the receiving crop.
14 and 25. A map that appears to have wetted acres on it shows the acreage for the field across the creek (leased field) as having
three pulls each with around 2.5 to 3 acres in them; the waste plan is written based on an irrigation design table for this field which
shows the 3 pulls as around 5.5 to 6 acres each. It appears that the 2.5 to 3 acre pulls are correct. Need to determine the proper
wetted acreage in this field and have the -waste utilization plan written accordingly.
Also, there is an irrigation design r�fiich shows 25 solid set sprinklers in the solid set field for a total of 11+ acres. There is
anothei-design-which shows 18 sprinklers -in the solid set field for a total of 7.35 acres. Mr. Quinn and I counted the risers and there
are 18. Therefore, it appears that the irrigation design for-] 8 sprinklers is what has been installed. This is what the plan is currently
written for and as such this part should not change when the plan is rewritten.
Also, the irrigation design map as well as one of the irrigation design tables shows a pull 6 going in the direction of Mr. Quinn',,
tobacco plant greenhouse and horse bam. This pull is not currently included in the waste plan and it should not be as it appears
unfeasible that this pull can be properly made.
Also, the Waste Utilization Plan is written based on 4180 finishing animals but the farm is permitted for 4220 and is actually
running around 4220 finishing animals per Mr. Quinn's statements. Waste plan needs to be written based on 4220 finishers.
Also, in the solid set field, it appears that Mr. Quinn currently runs three risers at a time. This means that he should have 6
ones of 3 risers each. Mr. Quinn did say that he usually does not use the sprinklers that are.closest to the woods.
Also, there is no documentation available for the lease agreement for the field across the creek and it needs to be available.
Mr. Harold Jones of the Duplin District Office came out and met with Mr. Quinn and me primarily to discuss these
discrepancies which were found with regards to the waste utilization plan and the irrigation designs. The proper wetted acres for thi:
farm need to be determined in all cases and the waste utilization plan needs to be written accordingly and Mr. Quinn needs to keep
is records accordingly. Also, the documentation for the correct wetted acres and waste plan needs to be kept well organized and be
resented as the proper design for the system so that future inspectors and reviewers do not have to attempt to sort this out again. Thi
rite utilization plan currently shows around a 1900 pound deficit. The plan will still have to have a nitrogen deficit and be
followed once the necessary changes are made to the plan; this may require changing some of the cropping practices.
I8. Need to have lagoon design information for both lagoons available. The design information for the one lagoon which is
LL
available shows a 24 inch freeboard requirement for the lagoon.
19. Need to take soil samples for each field for soil test purposes. Need to record application events after each event; has not yet
recorded event for solid set section 5 on Monday April 15, 2002.

3 `L)ivision of-V.'ater Q�ahty
.Obivtsion of;Soi1 a td'.Water CouservaUon
m
' D Other Agency
r
Type of Visit 4 Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit Routine O Complaint O Follow up O Emergency Hotification O Other ❑ denied Access
Facility :dumber 3 i t?
© Permitted 13 Certified © Conditionally Certified (] Registered
Farm Name: ✓�O� V �'b ti G► ...
............ ................................................................................... .......
Owner Name: ...................................................l,43'
tr �
........................................................................
El Time: r� Printed on. 7/21/2000
Not Operational O Below Threshold
Date Last Operated or Above Threshold : .........................
Countv:1DV1a/ "
Phone No:
Facility Contact:.............................................................................. Title:........................ Phone No:
MailingAddress: .................................. ...................................................................................................................................................................... ..........................
Onsite Representative:.. .' a Q V '� Integrator: ........................
.Ple „ a C
.................................................................................... �..9.........---......................................
Certified Operator:,,,•,,,,,,,.,,,,•, Operator Certification Number:
Location of Farm:
A SvAne ❑ Poultry ❑ Cattle ❑ Norse Latitude �• �& 44 Longitude ' 6 «
IlEcis+
Swine Via. aicity Pa elation
Wean to Feeder
Feeder to Finish
2Z
Farrow to Wean
t
= Farrow to Feeder
Farrow to Finish
Gilts
=1 Boars
Design Current Design Current
Poultry Capacity Population Cattle Ca aci -' Po ulation
❑ Layer ❑ Dairy
❑ Non -Layer I I I[] Non -Dairy
❑ Other j
Total Design Capacity
Total SSLW
itlt'�of j,pp� _ `� 1❑ Subsurface Drains Present j © Lagoon Area I0 Spray Field Area I
10004ag Ponds / Solyd Traps No Liquid Waste Management System
Discharges & Stream Impacks
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State'? (If yes, notify DWQ)
c. If discharge is observed. what is the estimated flow in gal/min'?
d. Does discharge bypass a lagoon system'? (If yes, notify DWQ)
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 Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure ; Structure 4 Structure 5
Identifier: .....I-b Z...........................
...................... ................................... ........ ........................... ....................................
Freeboard (inches): 151b
5100
❑ Yes 12fN0
❑ Yes Pr' No
❑ Yes eNo
n
❑ Yes 10 No
❑ Yes No
❑ Yes XNo
❑ Yes No
Structure
Continued on back

1 acuity"Number: ] —] rj [)ate of inspection Printed on: 7/21/2000
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
closure plan? Yes �'No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes )ETNo
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes )Z/No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes,�ffNo
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes ,ONO
11. Is there evidence of over application? ❑ Excessive Ponding XrPAN ❑ Hydraulic Overload Y'Yes ❑ No
12. Crop type .6cr ^% U d-A rj G �,^ rti t1 �cti 5-� ✓ E' s+ +�l r f (7 �Gi i +'1
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes 'Pilo
14. a) Does the facility lack adequate acreage for land application? ❑ Yes J2['No
b) Does the facility need a wettable acre determination? ❑ Yes ,0'No
c) This facility is pended for a wettable acre determination? ❑ Yes 10"No
I5. Does the receiving crop need improvement? ❑ Yes filrNo
16. Is there a lack of adequate waste application equipment? ❑ Yes ,fNo
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available? ❑ Yes PNo
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(iel WUP, checklists, design, maps, etc.) ❑ Yes eNo
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports) OYes ❑ No
20. is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes -ZErNo
21. Did the facility fail to have a actively certified operator in charge? ❑ Yes.0'No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes No
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative`? ❑ Yes /)2]rNo
24. Does facility require a follow-up visit by same agency? ❑ Yes PNo
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes10
ISo yiQl "risAr dgCciencie5 were potea dut tng Nis. visit: - Ybu will fo&*4y iio ui-ther •
rorrespoildenC' e' about. this visit.
CC e 0GGu �rra eA `
� i1 d
-ih� 7�!JBG - Zal Sr►t�lC^q �'+•- G�^p� 6n old 1r�•2tss fan d `7 -
1G1. ��G O✓era r�Gli i]a� above Zva� ail alt.e �o nod %SnOcv,h wa��
h;rscJe►t ��/�j �� sdr �o sera n� . �ecp�►-tr►,ey�� �o -fak4C (,t>as-tie►�e5
c very �D daa kK aw w�� �s be; �5 sP�r e�L P� i �r 4a S a ge
5vre 1 e ttsc waae .�al s►'r da to w��ti� (a o(a 0►7 tie422-1
ZrS,
�y
Reviewer/Inspector Name r `" Date:510
Reviewer/Inspector Signature: Is

Facility Number: Date of luspection Printed on: 7/21/2000
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ yes ❑ No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes -No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes J?fNo
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes /Q No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes �TNo
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes J'No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ❑ No
Additiona-omments and/orDrawings:
rj A-900 ,,.,r,rIs- sho&[d be rem✓nd�_
I\j64 = Tt,e was* I a-1 r)-,eds /D �e re ^: fie, -Fay LzZD h°yS
64 rrc Ill and iq .rree-Os
fin -fkc 1r r, jAk deS; n ILlel4able Gcres)eVecl't ly 44e
4-�e br��,✓, .
C pops 4fe well
J
5/00

,✓ Dtvt§ton of Soil and Water Conservagon Operation
_'D Division of Soil and Water Conservagon - CompUance Inspection r r
2.1
�Ihvtston of Water Qtalrty ;Compliance inspecgote
. ..
� Ot11er:Agency: Operation Review'
liftRoutine 0 Com taint Q Follow-up of DWQ inspection O Follow-up of DSWC review Q Other
Facility Number 3 ] p I Date of Inspection
Time of Inspection 24 hr. (hh:mm)
Permitted J&CCertified © Conditionally Certified 13 Registered JE3 Not O erational %Date Last Operated::
Farm Name: �YJIYIL.. I u.►�ytCl—. Caunty:........... 1ilti...........................................
........................ .-
Owner Name:...:..k.!`.................................f.!...................................... Phone No:............. ........................ ..._.
Facility Contact:
........... Title:
MailingAddress:..................................................................
..........................................
Onsite Representative: ... �.,rAl ............................... ..V1 !��..
Certified Operator:
Location of Farm:
Phone No:
.......................................... ....�............. ..........................
Integrator. ................. �...... .
Operator Certification Number: ..........................................
Latitude E= Longitude
Design "Current,nt
Design Current Design: ;Cuft6
_ : ' : Po` nlatioeCapcoultiPoultry Po illation Cattle .Caact:$wine y
❑ Wean to Feeder JEI Layer ❑ Dairy
Feeder to Finish t / ❑ Non -Layer ❑Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder ❑ Other
❑ Farrow to Finish Total Design, Capacity L.
❑ Gilts
El Boars Total 5SLW.
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes k 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)
c. If discharge is observed, what is the estimated flow in gaUrnin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
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 Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Freeboard (inches): ,,,.,.r b 2—&
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes 2fNo
❑ Yes 04 No
❑ Yes [ANo
Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed? (iel trees, severe erosion, ❑ Yes KNo
seepage, etc.)
3/23/99 Continued on Lack

Facility Number: Date of Inspection • Printed on7/21/2000
t- '
5. Are there any immediate threats to the integrity of any of the structures observed'? Oe/ trees, severe erosion, ❑ Yes FANo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? El Yes �No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes Imo'
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes 4No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes UNo
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes ® No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes ❑-No
12. Crop type - -�-�- - - - �'�---- - --
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
IT Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge'?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
violaiioris:or deficiencies -were noted- ding this'Asit: You will-tr&,6W rid further ;
comes oridence: about: this visit. :::::::: ' :::::::::::::::::::::::::::
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):
l
❑ Yes ONo
❑ Yes q No
❑ Yes K No -
El Yes Wo
❑ Yes j No
❑ Yes No
❑ Yes M No
❑ Yes 15(No
❑ Yes 0 No
❑ Yes RNo
❑ Yes I�INo
❑ Yes R No
❑ Yes 14No
❑ Yes [sq No
❑ Yes (0 No
Reviewer/Inspector Name t- . r< e ✓ Mr Vul-A-,
Reviewer/InspectorSignature: e__--- to n t � , n 9 „ Date: 140 ,2 2;7_1 Zdot]S/pp

:Facility Number: 7 t fd r
Date of Inspection
Odor ISSnes
26.
Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge atlor below
❑ Yes
allo
liquid level of lagoon or storage pond with no agitation?
27.
Are there any dead animals not disposed of properly within 24 hours?
❑ Yes
E'No
28.
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)
29.
Is the land application spray system intake not located near the liquid surface of the lagoon?
❑ Yes
15�No
30.
Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
❑ Yes
04 No
31.
Do the animals feed storage bins fail to have appropriate cover?
❑ Yes
F2No
32.
Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
Ei Yes
[io
3/23/99

Division of Soil and Water. Conseiwation-•�Operatron.'Re view ,=
V � -El Division of Soil and Water Conse6'ation ':Compliance inspection
e '4 •
Division of Water Quality :ConnpliattceInspection mm
ff;Other Agency �Operahon� eviev,
0 Routine Complaint" Q Follow-up of DWQ inspection Q Follow -tip of DSWC review Q Other
Facility Number p Date of Inspection I (p III
Time of Inspection I I 1' Ga J 24 hr. (hh:mm)
Permitted Q Certified 13 Conditionally Certified [] Registered 10 Not O erational Date Last Operated
Farm Name: ` r County: il............................................................
ayl ,
.� r . ��lU) 29 �.oso3
Owner Name: ...................... .o.......-................ 1.i.±!!�.............................. Phone No: .................... .
FacilityContact:.............................................................................. Title:................................................................ Phone No:
MailingAddress: ......... ....... 3......7.r.�C14}Li.......,.............................................. ........ c ....i............................... .�.......
Onsite Representative: y1� 'IYSl ........ .�F.k+1........................................................ Integrator:... tCfi ...Ar..!5
Certified Operator:................................................................................................................ Operator Certificationn Number:U1 .Q.......................
Location of Farm:
r..sr........s' ...... .�7 Q LS....t i. ...........1�?�5.... I�......................................................................
s . s >..AL
................................................................................................................................................................................................................................................................
Latitude •©f Oo • Longitude "17 • ®' f6
g :Design- Curreirt.-.-.. Design. . Current-
`- Desi n Current
Capacity Population _3' Capacity.;: Population ;
Swine _ Poult m 'n .,;Cattle Capacity Population
❑ Wean to Feeder
Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts ,
❑ Boars
I1lukiibei of Lagoons : ® ❑Subsurface Drains Present ❑ Lagoon Area
❑ spray Field Area J
- Holding Ponds / Solid Traps
0 ❑ No Liquid Waste Management System
Discharges & Stream Imvacts
1. Is any 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 gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
❑ Yes
❑ No
2. Is there evidence of past discharge from any part of the operation?
}Yes
(❑_Yes
❑ No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
❑ No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
❑ Yes
$No
Structure 1 Structure 2 Structure 3 Structure 4 Structure a
Structure b
Identifier:
t Freeboard (inches): .......... .. .
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑ Yes
❑ No
seepage, etc.)
3/23/99
Continued on
back

Facility Number: 34 — l(1( Date of Inspection
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenatice/improvement?
9- Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
viola(ioiis'or• deficiencies were'otp , i1tWift 4his:visiC - Y:oi* :wiil•reeeiye iti6 further
corresporideitce. about_ this visit_ . . :
❑ Yes [-]No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
Cl Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
10 Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
Conitnents`(refer to question #) Explain auy YES answers andlor;any-recommendattons or.any other comments.
Use drawings of facility_to better explainsttuations (use additional pages as necessary) =T= -
�N15�eC
t�.:QGv� t),
-'Jt t1 FL g4scLkTeS.
x. f�-
1�Cn ``VtS[[ ���`Se`Valk
utu`.nr `itfi4icG f1 E G�
Y �
{ 1l
bJoWh
n1'i�
OCR F_t p��C
[
waste
GQ�`1C(�011.
1`V�1 t�k�`e
1n0,C} ����+rC�?d
�e Gl�
Vv►NUlv��tl 'Fi +
Crer_k.
1�r, Qt/�Arl
i
\aC S"*O
`fY'r orr' +
I`4�AIV'r
Dse,
Zz. Kr.
QxJ1rtr. a ,�
A4 Vji �/ boa OP S�0 1.
1
{,.)a4r- QUOAC
Sa �{S "Jcv-1} �ff..�I- -•- dow7n-
4rt.[IA'_ 4 4rr� ir'_ d f;- Cyre�,
rj1
G- co(, t�.
VqW� o e trvGl[7eAj J�Otjl_ M.+r.
©t,irtn.
IV
Reviewer/Inspector Name
Reviewer/Inspector Signature. ��� Date: LA f 1 t I g g
3/23199

5
1
1
1

FFacility Number 3 Q Date of Inspection l4 2$
Time of inspection (J 24 hr. (hh:mm)
Iff Permitted 0 Certified E3 Conditionally Certified [3 Registered Not Operational I Date Last Operated:
Farm Name: ✓'rd v,vvn ' ei rk-% County:... /i►'1
..........-�................�................................................................................-..�r...............................-............-....-................
Owner Name: ............... .�...... QM tiA Phone No:
........................
Facility Contact: .... ...................................
MailingAddress: ................................... - ...........................
Onsite Representative: rO l �+ U 1 rt R
Certified Operator: .....................................
Location of Farm:
Title: ............................................................ I --- Phone No:...................................................
.............................................................................................................................. ..........................
......................................... Integrator:..�� ..... ...... S u� c......................................... Operator Certification Number...............................
Latitude �• �� �•' Longitude �• �° �
ej
Design Current = Design Current Design Current
Swine Capacity Population -Poaltry, =' Ca acity - Po station Cattle Capacity Populat
ion.,
❑ Wean to Feeder ❑ Layer ❑ Dairy
Feeder to Finish ZZ 0 �gQQ ,.-. ❑ Non -Layer ❑Non -Dairy
❑ Farrow to Wean
"❑ Farrow to Feeder ❑Other
❑ Farrow to Finish Total-Design-Capa6ty
❑ Gilts
❑ Boars
Total SSLW
Number of Lagoons.. ❑ Subsurface Drains Present ❑Lagoon Area 10Spray Feld Area
HoldEng;Ponds / Solid'Traps _; ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes Eff No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. if discharge is observed, was the conveyance man-made.? ❑ Yes 54No
b. If discharge is observed, did it reach Water of the State'? (If yes, notify DWQ) ❑ Yes ® No
c. If discharge is observed, what is the estimated flow in gal/min? h
d. Dices discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes No
2. Is.there evidence of past discharge from any part of the operation? ❑ Yes No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ,] No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: 2-
Freeboard(inches): -2-1........................................................................I--..................I.........I..................... I ....... .............. I. ...................................
S. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes ® No
seepage, etc.)
3/23/99 Continued on back

Facility Number: I Q j Dale of Inspection !d
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes C9No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? 19 Yes ❑ No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes Z No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes ® No
Waste Avolication
10.
Are there any buffers that need maintenance/improvement?
❑ Yes
jg No
11.
Is there evidence of over application? ❑ Excessive Ponding ® PAN
Yes
❑ No
12.
Crop type 6errKudA Pad4vfe 5�^- 1111 60-a41
13.
Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
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?
JW Yes
❑ No
16. Is there a lack of adequate waste application equipment?
❑ Yes
N No
Required Records & Documents
17_ Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
70 No
18. 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
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
J4 Yes
❑ No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
Dd No
21. Did the facility fail to have a actively certified operator in charge?
❑ Yes
JO No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
19 No
(ie/ discharge, freeboard problems, over application)
❑ Yes
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
0 No
24. Does facility require a follow-up visit by same agency?
jffYes
V No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
No
0: �io•yiolaitoris:or &flcieuctes -were ngted dirrtng 4his:visit: • Y04 wlfl•reeeiye iio ui-ther
...
oric�eitce: about" this visit . .:::::::::::::::::::::::::::::::::::
Comments°(refer`,toFquestion #):.:Explain any YESe%a#swers and/or any recommendations of any=other.eommenis:
Use;drawtngs of facilrty to better explain situations (use additional.pages as necessary)
_ u .. _ - -
e a //++
7 Ice.,ovez woody Ve�1e4a4i h firoM �t�goo►. w4 ls, K r her jwve��9gf fort 5horljd
be dane 4o �eFf Crrtit►�tG V h"'Oje 4rcll GtrC o be, fc�^,OVeO( Frame" fn�oan riJG{i1.
work 4o esoab[;sl, gf45s cove r��fJon btire q•C'i5 o,' fajaah.
1l. Ti74ccur_14e 4;,-•,�Je�►i��la�;ons resvl- eat r+t ot.EYa�pl;c.t�ia>1 arl rye ov,
7r6C4 2&4-g 4'id' �d_ �5aGres� OFvel «-<l.1ec'e.45 well o7 -jrCtCA
�%48 F,-eiA J+ (S4trcs) vvercterltcor1ion 2lbsIa6fe—
i #
Reviewer/Inspector Name
Reviewer/Inspector Signature. „ 1� Date: l cm
3/23/99

Facility ),Number: Date of Inspection Q Z$
Odor Issues
26.
Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge actor below
❑ Yes
'ANo
liquid level of lagoon or storage pond with no agitation?
27.
Are there any dead animals not disposed of properly within 24 hours?
❑ Yes
KNo
28.
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)
29.
Is the land application spray system intake not located near the liquid surface of the lagoon?
❑ Yes
No
30.
Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
❑ Yes
IgNo
31.
Do the animals feed storage bins fail to have appropriate cover?
❑ Yes
KNo
32.
Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
Yes
❑ No
'Additional Co&Enents an or Drami gs:
JS. WQrk
)�
-la 6PACr av, eY4;/0�7 Of Field
AL
o►cro
Greek I-P,,115 I.,P/2/ &13)
!$. ob4^ln
n-< -�or &oA
and kcap WjU re1,ordS.
1�i. Wqs
sn,ple analysis awe 9ao4 64 d-lyj
be.Fere
d a4e
on Gna/ I�s�s. rein- vle,r 5-l"OtAlof reyu Me keerikil weekly -`.- .boo"d
Pec�rds
2 Mn-( necCt 40 ,rev's i-} ��rwt i�l -F► urG o
in ve5f ►yq�'c la.oe Free re~vdd
3123/99

Division of Soil and Water Conservation ❑ Other Agency
Division of Water Quality
Routine 0 Complaint O Follow-up of DWQ inspection 0 Follow-up of DSWC review 0 Other
Date of Inspection
Facility Number G
Time of Inspection a C1 24 hr. (hh:mm)
0 Registered Certified [3 Applied for Permit tjPermitted 10 Not O erational Date Last Operated:
Farm Name:...... �``1t^ .1. County: D 4. ...............................
� a
OwnerName: .......................1.......`�L'?................................................................ Phone No:......\1..�G.3......................
Facility Contact:
Mailing Address:
Onsite Representative:..., .I.L`.'..``� .
Title:...........
........... I ........... I....... Phone No: .... . ...................
........ . .................. `-fs-..................................
Integrator: .... .J.. .....Azr .........................
!..
Certified Operator:................................................................................................... ...... Operator Certification Number,
Locatiop of F
1 ...t........... ........... _........... ... '.......
....... .......... t. .......�.... .... .........,1 .......... ......... ............ _ ......` ........„............. ' `�....:.... �'''>....
....1--r..._.4 ��'1 �5.... ..r. a..! ``1 ._.rii \.. s................................................................................................................. .
Latitude • 0' " Longitude ' "
General
1. Are there any buffers that need maintenance/improvement? ❑ Yes 0 No
2. Is any discharge observed from any part of the operation? ayes §jNo aN,.,
Discharge originated at: ❑ Lagoon ❑ Spray Field 00ther
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ) ❑ Yes No
c. If discharge is observed, what is the estimated flow in gal/min? 1 �i5il
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) 0 Yes ❑ No
3. Is there evidence of past discharge from any part of the operation? ❑ Yes 1.No
4. Were there any adverse impacts to the waters of the State other than from a discharge? ❑ Yes ($(No
5. Does any part of the waste management system (other than lagoons/holding ponds) require ❑ Yes 0 No
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes MNo
7. Did the facility fail to have a certified operator in responsible charge? ❑ Yes 0 No
7/25/97

Facility Number: 3 O
i
8. Are there lagoons or storage ponds on site which need to be properly closed? ❑ Yes Q(No
Structures (LatwonsHolding Ponds Flush Pits etc.
9. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes A No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard(ft): ....................................................................................................................................................................
10. Is seepage observed from any of the structures? ❑ Yes IgNo
11. Is erosion, or any other threats to the integrity of any of the structures observed? XYes ❑ No
12. Do any of the structures need maintenance/improvement? Yes ❑ No
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers? ❑ Yes CKNo
Waste Application
14.
Is there physical evidence of over application?
❑ Yes
J( No
ff entering waters of the State, notify DWQ)
(If in excess of WNW or ru7f2.�
L 1,
15.
Crop type .: \.(....J. ?.)..J-!............................. ............................... .................... I......................................
16.
Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
❑ Yes
10 No
17.
Does the facility have a lack of adequate acreage for land application?
❑ Yes
5d No
18.
Does the receiving crop need improvement?
Yes
❑ No
19.
Is there a lack of available waste application equipment?
❑ Yes
5dNo
20.
Does facility require a follow-up visit by same agency?
❑ Yes
allo
21.
Did Reviewer/inspector fail to discuss review/inspection with on -site representative?
❑ Yes
ZI No
22.
Does record keeping need 'improvement?
(XYes .
❑ No
For Certified or Permitted Facilities 4n11
23.
Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑ Yes
ONo
24.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
RNo
c� 25.
Were any additional problems noted which cause noncompliance of the Permit?
❑ Yes
W No
No.vialationsor. deficiencies:were_nated,auring this:visit.- :You :will recei:ve:i 6:f�th:er::
correspWtdepce Ahout tbis:visit.• : : . .
I W
�p � l � ►-ear t� .f� i 1 '��-�� SL 1
7/25/97
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Date:

i Facility Number: �j — Efate or inspection
e
. ►.G, icy, -fit �1c�s G ��\ �,t�s LPL
Ir
7/25/97

.............. ____--___-- _....
❑ DSWC Animal Feedlot Operation Review
® DWQ Animal Feedlot Operation Site Inspection
Routine 0 Complaint 0 Follow-up of DWQ inspection 0 Follow-up of DS1i'C review 0 Other
Date of Inspection t7 2
Facility Number pl
Time of Inspection 0 24 hr. (hh:mm)
E3 Registered 0 Certified0 Applied for Permit 0 Permitted 10 Not Operational Date Last Operated:
Farm Name; ...... l�r-hraI...... au-iit-r..-.-.--Fuxh.................................................. County:...... tf?�in..............-.................................................
OwnerName: ....... 6cr&(...- ui n............................................. ... ... ... Phone No: 01A)..Z.41v:.OQ4.....-..............-........ ............. ...... ........ ....................
Facility Contact: ..... &KY91 ....... Ql.iar'L..................................... Title: ...... CWist r.......................................... Phone No:. (� ilA.�• Q6.: A 1............
Nfailing Address:.%�lg...��-....S, u.3.... U................................... Z
Onsite Representative: ... &rrd----- Qv, an ....................................................................Integrator: -....sJ+L...................................................................
Certified Operator,..................................................... ....................................................... Operator Certification Number, .........................................
Location of Farm:
............... irn......1:-.44...1QCs- ....Ttax...... e..... c ^... 1,..tg ..-.-. A cre.....is.....a.3...�n� .�..
..-- ..............................I................... ----- ....... .......... ........................... .......... .................. ................ ...........................
..-.
Latitude 1 « Longitude ' 4 C
Design Current . Design Current Design Current
Swine Capacity Population Poultry Capacity Population Cattle Capacity. Population,
....
❑ Wean to Feeder ❑Layer Elairy
EA Feeder to Finish 1AIX0 JE1 Non -Layer I 1 ❑ Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder ❑ Other
❑ Farrow to FinishI Total Design Capacity
❑ Gilts
❑ Boars Total SSLW
Number of Lagoons / Holding Ponds �!_� ❑ Subsurface Drains Present ❑ Lagoon Area JE1 Spray Field Area
❑ No Liquid Waste Management System
General
1. Are there any buffers that need maintenance/improvement? ❑ Yes Q No
2. Is any discharge observed from any part of the operation? ❑ Yes ® No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed. wa.; the conveyance man-made?
b. If discharge is observed, did it reach Surface Water" of yes, notify, DWQ)
c. If discharge is observed, what is the estimated flow in OaUrnin?
d, Does discharge bypass a lagoon system? (If yes, notify DWQ)
3, is there evidence of past discharge from any part of the operation?
4. Were there any adverse impacts to the waters of the State other than from a discharge?
5. Does any part of the waste management system (other than lagoons/holding ponds) require
maintenancelimprovement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
7. Did the facility fail to have a certified operator in responsible charge?
7I25197
❑ Yes ® No
❑ Yes tO No
❑ Yes ® No
❑ Yes No
❑ Yes] No
RJ Yes ❑ No
❑ Yes (XNo
❑ Yes JM No
Continued on back

FadtityNumber- 31 —)p1
8. Are there lagoons or storage ponds on site which need to be properly closed? Yes ® No
Structures.(Lagoons,Iloldin Poiids, Flush Pits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes JA No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard(ft)'..........................................................................................................................................
10. Is seepage observed from any of the structures? Cl Yes 15DNo,,'
11. Is erosion, or any other threats to the integrity of any of the structures observed'? ❑ Yes 50 No
12. Do any of the structures need maintenance/improvement? Yes ❑ No
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers? ❑ Yes No
Waste Application
14. Is there physical evidence of over application? ❑ Yes No
(If in excess of WNW, or runoff entering waters of the State, notify DWQ)
15. Crop type ........... bf,'fftAl........................................................... small ...CAif\..............................................................................................................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)? ❑ Yes iallo
17. Does the facility have a lack of adequate acreage for land application? ❑ Yes ® No
18.
Does the receiving crop need improvement?
ERYes
❑ No
19.
Is there a lack of available waste application equipment?
❑ Yes
R No
20.
Does facility require a follow-up visit by same agency?
❑ Yes
RNo
21,
Did Reviewer/Inspector fail to discuss reviewlinspection with on -site representative?
❑ Yes
Jallo
22.
Does record keeping need improvement'?
Yes
❑ No
For Certified or Permitted Facilities_ Only
23.
Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑ Yes
® No
24,
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
0 No
25_
Were any additional problems noted which cause noncompliance of the Permit?
❑ Yes
[Z No
No.violations or deticiencies.were note'ddtir.ing this.visit.:You.4ill recei've-no further,
correspondence Al out this:visit:.:
Cotcctments(refer to question #): Explain any YES answers and/or any recoiinmendatyons or any other comments.
U.5 drawn s.of facilit ,t-o better ex lam situatons u.se additional Pa Ws as iecessary}
t's` a„� lurn,nuP��e • �a na1 date piy� o ���e �e roSs a)�5� cFuks t eft•
1Z 1,-a�cnn �nyur a ookr Wc.11s s�tov(d jaa nw [rocs car. (a oan bv�tr wad s�ot.�d one rein
Cc�.�-0.ck t Ii5�i[.� O�e �� assls�ce . g
2Z• Feld ntxn6rs jn wuS4 (Xita+;., �lan 51puld ne CntrejA o-iJ (fskJ in 5�,xcy Yt'LOYD%.
Uoa�t W%S�e a.ro.YS+S .
7125197
Reviewer/Inspector Name h
s
Reviewer/Inspector Signature: Date:

Site Requires Immediate Attenti n: IJO
' Facility No.�L
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATION SITE.VISITATION RECORD
DATE: l:P2-3 , 1995
Time: 03 K__
Farm Name/Owner: 7 P
Mailing Address: 1i>
County: / / LEA,)
Integrator: �r �_ - Phone:
On Site Representative: _/Z0Z_ ZLIIAIW Phone:
Physical Address/Location: �f T iJ �� RAJ, _S- 7,2e_ �7 �
Type of Operation: Sw. e Poultry Cattle
Design Capacity: Number of Animals on Site.
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: 95/ r6 " Longitude: 7/_2° SF' Elevation: Feet
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
n //
(approximately 1 Foot + 7 inches)!/ r No Actual Freeboard'' Ft. 41 Inches
Was any seepage obser<.,ed from the laaoon(s)? Yes r N Was any erosion observed? Yes or No
Is adequate land available fo spray? ye or No Is the cover crop adequate? Yes or No
Crop(s) being utilized: Wsr'i""_
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings Yes r No
100 Feet from Wells Yes r No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or No
Is animal waste land applied or spray irrigate t within 25 Feet of a USGS Map Blue Line? Yes or No
Is animal waste discharged into waters of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes r _N If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes -of manure, land applied,
spray irrigated on specificeage with cover crop)? Yes o No
Additional Comment %AI �� 111�oz`—g' _tom
L�C��� a ►� — %'� /q9,17 ^ S e9PCJ i r re
Inspecior Name Si tune
v_
cc: Facility Assessment Unit
Use Attachments if Needed.