310248_INSPECTIONS_20171231

NUHTH CAROLIN 'Am
Department of Environmental Qua

Type of Visit: Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: (j Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: ArrivalTime: �p Departure Time: County:
j Farm Name: �)aTj% S TO N yIStd-M Owner Email:
Phone: �) b Z��7 L4 1
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title: Phone:
Onsite Representative: -a.�� Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Certification Number:
Longitude:
Region:
Design Current
Swine Capacity Pop.
Wa n to Finish
Wet Poultry
La er
Design
Capacity
Current
Pop.
Design Current
Cattle Capacity Pop.
Da' Cow
Wean [o Feeder
Non -La er
Da Calf
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
I)I) Layers
La ers
Non -Layers
Design
Current
Dai Heifer
Cow
Beef Stocker
Gilts
Beef Feeder
Boars
Pullets
Beef Brood Cow
Q[her
Other
—TurkeyPoults
Turkeys
Other
Discharges and Stream Impacts
Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes lm No ❑ NA ❑ NE
❑ Yes ❑ No
[:]Yes [—]No
[—]Yes
❑ No
❑ Yes
F. No
'7
❑ Yes
No
ANA ❑ NE
CffNA ❑ NE
E)6A
❑ NE
❑ NA
❑ NE
❑ NA
❑ NE
Page 1 of 3 21412015 Continued

Facility Number: 31 - Zy Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
® No
T[�]
❑ 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): �1
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[a No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
[� No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4fi were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
[ja No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[$ No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
E� No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals
(Cu, Zn, etc.
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window Evidence of Wind Drift ❑ Application
Outside of Approved Area
12. Crop Type(s): C.Drf1 I 4 P-C47y6PL5
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
a No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
❑ NA
[A NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
[—]Yes
[7] No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[ja No
❑ NA
❑ NE
the appropriate box.
❑ WUP [I Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [jpNo
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
[-]Yes [KrNo
[—]Yes ❑ No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA C NE
Page 2 of 3 21412015 Continued

Facility Number: Date of Inspection: , c
24. Did the facility fail to calibrate waste application equipment as required by the permit? IX I I Yes go'Io
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check f❑� Yes No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [—]No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
PNA ❑ NE
❑ Yes [—]No DNA E�PE
❑ Yes P No ❑ NA ❑ NE
❑ Yes `}" No ❑ NA ❑ NE
❑ Yes
E;3'No
❑ NA
❑ NE
❑ Yes
9 No
❑ NA
❑ NE
❑ Yes
4;A No
❑ NA
❑ NE
❑ Yes
[ELNo
❑ NA
❑ NE
Comments (refer to question ;#):Explain any YES answers and/or any additional recommendations or any other.comments.
Use drawinas�of facility to better explain situations (ase.additional pages as necessary)...
5D'%�.5 to ['% 1k -z-K L 1-c
C&A1'Vr6%-h0V% toIz��iS _d_e
s t,A`f 17 �a�y)
PRN _ I I b�
q)A-,j : 3,51
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: n q, 1 1 34 [
Date: iZ 1 %
21412015

Reason for Visit: (Zf Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 OI
Date of Visit: Arrival Time: Departure Time: County:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Onsite Representative: 04, t CTDk''30'l Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Denied Access
Region:
Certification Number: (,4-- % S' Z
Certification Number:
Longitude:
Swine
Wean to Finish
Design
Capacity
Current
Pop.
Wet Poultry
Layer
Design
Capacity
Current
Pop.
Design Current
Cattle Capacity Pop.
DairyCow
an [o Feeder
Non -La er
DairyCalf
eeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
ir9
Orn
D . P,oult .
Layers
Design
Ca act
Current
P,o ,
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
I
113eef Brood Cow
Qther
Other
Turkeys
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes Q'No ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes ❑ No
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
F Noo
❑ NA
❑ NE
❑ Yes
❑ leo
❑ NA
❑ NE
Page I of 21412015 Continued

Facility Number: Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes <o ❑ 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 ENo ❑ 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 21'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 environments reat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes ❑ 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 d/No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes No ❑ NA
❑ 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):
❑ NE
❑ NE
13. Soil Type(s):
14. Do the receiving crops differ from [hose designated in the CAWMP?
❑Yes
❑ NA
ffgNo
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
���pN���999 /
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑Yes
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
N0 NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
2No ❑ NA
❑ NE
Reauired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
jN ❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yeso
❑ 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
..���
do ❑ 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

Facili Number: -LM Y jDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ NA ❑ NE
25. Is the facility out of compliance with conditions related to sludge? If yes, check
permit
❑ Yes
VNo ❑ NA ❑ NE
J
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 ❑0❑ NE
y
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
❑ No NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
/
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
lLJ io ❑ 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
dNo
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
dJNNo
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
� No
[3 NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
o
❑ NA
❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
r__11 r"— (Cc (oo �r j 00 d
51413" cc e J l u
Soy 1feS,i PA.
i
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: ` Y/ ! T 7') o y
Date: ' ( /`
21412015

(Type of Visit: 0 Con)prance Inspection O Operation Review O Structure Evaluation O Technical Assistance I
Reason for Visit: S—O/Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Arrival Time: Departure Time:County:
Facility Contact: nnnn,, Title:
Onsite Representative: O K50 /1
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Owner Email:
Phone:
Phone:
Integrator:
Region:
Certification Number: O / 5 Z
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish I
Wet Poultry
I Layer
Design
Capacity
Current
Pop.
Design
Cattle C+itpacity
Dai Cow
Current
Pop.
W n to Feede
I
INon-Layer
IDairy
Calf
eeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
D , Routt .
Layers
Design
Ga aci_
Current
Ro .
Dai Heifer
D Cow
Non-Dai
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
I
Pullets
113eefliroodCow
Other
El Other
Turkeys
Turke Poults
Other
Discharges and Stream Impacts
I. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DW R)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes [L]'1Qo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes
[—]No
[—]Yes
ff No
❑ Yes
6 No
❑NA ONE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 21412015 Continued

Facili Number: - 2-4 jDate of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
�o ❑ 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
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 reat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑Yes N �❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes 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 ffNo ❑ 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):
13. Soil Type(s):
i
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes ONo.
❑ 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 ENo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes � o
❑ 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 Q No'NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes /❑ No ❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑Maps ❑ Lease Agreements ❑Other: /
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes d 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 L'J No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facifl Number: 9 1 - 7A co jDate of Inspection: 2-
_
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 &24cs ❑ NA ❑ NE
the appropriate box(es) below.
❑eFai a to complete annual sludge survey ❑ Failure to develop a PDA for sludge levels
on -compliant sludge levels in any lagoon //
List structure(s) and date of first survey indicating non-compliance: 5A Jff e PD A Ac c dC
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes D-ido ❑ 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 ❑ Yes ffNo ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
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 ❑ NA ❑ NE
❑ Yes C No ❑ NA ❑ NE
❑ Yes
❑ Yes
❑ Yes
�][�N ❑ NA ❑ NE
❑ NA ❑ NE
o N❑ NA ❑ NE
(Comments (refer,to question #): Explain any-YES answers and/or anyadditional-recommendations or
any other comments.. I
Use d2awings df facility to,betterexplain situations (use'addifional pages as•necessary).;
6eC0rC(s G—k �qDaC(.
etc,
�9
�1 td Po i, • nCden�jo>r
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
,C
/
Phone: (l1i %�� ��y
Date: /V 2)
21412415

Type of Visit: (d pliance Inspection Q Operation Review Q Structure Evaluation 0 Technical Assistance
Reason for Visit: Co7Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: d i Zp i Arrival Time: 2.S Departure Time: County: J Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Phone:
Facility Contact: Title:
ii
Onsite Representative: _ �fjVs� ' � J6A a 4 Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Certification Number: i W 1 S2
Certification Number:
Longitude:
Swine
Wean to Finish
Design Current
Capacity Pop.
Wet Poultry
Layer
Design
Capacity
Current
Pop.
Design Current
Cattle Capacity Pop.
Da Cow
Wean to Feeder
Non -Layer
Da Calf
Feeder to Finish
AKO
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
D . + P,onitr,
Layers
Ca aci +
P,o ,
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
NJ Other
Turkeys
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c.. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes No
[—]Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ N
❑ Yes
❑ Yes 6 No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 21412014 Continued

Facility Number: - AMDate of Ins ection: t 1
Waste Collection &Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes EfNo
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No
Structure 1
Identifier: CA
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
❑NA ❑NE
❑ NA ❑ NE
Structure 2 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 [�No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environment threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑Yes o ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes TNo ❑ 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 E2/No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable 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
❑ Yes
No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ YesVNo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
Co
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. E✓ Yes ❑ No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? [:]Yes ZNo
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes I XNo
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facifi Number: - Date of Inspection: (I
1. Did the facility fail to calibrate waste application equipment as required by the permit. ❑ Yes �� ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes L 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 o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
I 12QO
"`777
❑ 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
PIKO
❑ 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
UK
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
DINO
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
gNo
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional reco`mmeudations or"any other comments .-
'
Use drawings of facili to better explain situafions (use additioual�oaees as necessarvl. ; >
w" ,
ri .. . w
;ro(.) USE THE KICVJ ZT10N6L-2- FGa
Reviewer/Inspector Name:
IZo tv1oJ '±N5FF ar_GNS
PhonA_-7 l V
"$
Reviewer/Inspector Signature:
Page 3 of 3
Date:

type or visit: ju LAmpnance Inspection \..l Vperarton Aevtew u Jtructure Evaluation U tecantcal Assistance
Reason for Visit: QJRoutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit:y Arrival Time: .I{D Departure Time: : Q7 M County: Ok l lYl Region: W i f1 a
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator: A i 1, G 74vxs -y\
Back-up Operator:
Location of Farm:
Title:
Latitude:
Owner Email:
Phone:
Phone:
Integrator:
Certification Number: 19
Certification Number:
Longitude:
Swine
Wean to Finish
Design Current
CapacPop ity .
I
Wt P eoultry
11-ayer
Design
Capacity
I
Current
Pop.
Design Current
Cattle P1.
Dairy Cow
Wean to Feeder
I
jNon-Layer
I
Dairy Calf
Feeder to sh
p (
Dairy Heifer
Farrow to Wean
Farrow [o Feeder
Farrow to Finish
Dr. P,oulti.
Layers
Design
Ca aci
C•ucrent
P,o ,
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Pullets
Beef Feeder
Boars
lBeefBroodCow
Other
Other
Turkeys
Tor ey Poults
Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑`Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
6No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
VTNo
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 21412011 Continued

t
Facility Number: - Date of Inspection a f
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 2rNo ❑ 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
01qo
❑ 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
Z 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
X1 No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
r/} 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?
j
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes mil No ❑ NA ❑ NE
maintenance or improvement? to
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Pending ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, 2 , et .)
❑ 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 14 No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes �/ No ❑ NA ❑ NE
acres determination? ,
17. Does the facility lack adequate acreage for land application?
❑ Yes VTNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes ro
TT
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes ff No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes P-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 P No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes nNo
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes No
T
❑ NA
❑ NE
Page 2 of 3
21412011 Continued

Facili Number: jDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
Vj No
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
J!J'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
Zf No
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
j!j No
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
No
❑ NA ❑ NE
and report mortality rates that were higher than normal?
,,o
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
VfNo
❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
No
❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
No
❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
�No
❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
1
V I No
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
ZNo
❑ NA ❑ NE
Reviewer/Inspector Signature: �jQyyvy Date: O�5 13
Page 3 of 3 21412011

Reason for Visit: u. outine 0 Complaint 0 Follow-up O Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: 3 / Arrival Time: 7o Departure Timer County: Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Owner Email:
Phone:
Phone:
Onsite Representative:
f J (^� i� �i
►YN/ 7%�
�o/HN 5 dN
Intte��gratorr:
Certified Operator:
ANl T/-}
SOHNSO/Y
CerhO)tion Number: S S
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
TDesign
sh
der
Current
Capacity Pop.
Wet Poultry
La er
Non -La er
Design
Capacity
Current
Pop.
Design Current
Cattle Capacity Pop.
Da' Cow
DairyCalf
ish
ean
eder
toFeeder
Farrow to Finish
$
D , P,oult .
Layers
Design
Ca act
Current
P,o P.
Da' Heifer
D Cow
Non -Dairy
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
I I
lurk e s
T7key Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes XN o ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
[—]Yes [:]No
❑ Yes V,
No
❑ Yes P
o
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 21412011 Condisued

Facility Amber: jDate of inspection: ) 3
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No
a. If yes, is waste level into the structural freeboard? ❑ Ye 61No
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
Structure 1 Structure 2
LA64a d
,5
L3
Structure 3 Structure 4
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?
❑ NA ❑ NE
❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes No ❑ NA ❑ NE
❑ Yes �kNo ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the 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 rx I No ❑ NA ❑ NE
maintenance or improvement? TT\
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. ❑ YesNo ❑ 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?
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`�IANo
❑ Yes No
❑ Yes No
❑ Yes Ixl No
[—]Yes No
i
❑ Yes No
❑ Yes No
Q WUP El Checklists .❑ Design ❑ Maps []Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 'N No
❑a Waste Application '❑ Weekly Freeboard t❑ Waste Analysis ❑r Soil Analysis ❑ Ran
&te Trsfers
❑` Rainfall [3 Stocking Q Crop Yield e❑ 120 Minute Inspections FL] Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
Q Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: jDate of Inspection: �[
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes U(I 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:
❑ NA ❑ NE
❑ NA )A NE
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes 0 No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes ❑ No 7777���� � NA
❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
���[[[
❑ Yes No ❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes No ❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes ;4_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 IXI No ❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes No ❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
[:]Yes No ❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes ONo ❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any, other comments_
Use drawings of facility to better explain situations (use additional pages as necessary).
Gt��►a�.P-�,a�I n�-E ao�
of ao�� SLLA GE SLrCIUC�`� i7 t JJ 2ECo(�pS - a lap
,c y.T oNr> iNro�aF
To CFftV66 �,.� f-
EjCtIGLDSIl�
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: I) b)% 3�
Date: � �l/ 3 ho
21412011

TAe of Visit: Compliance Inspection 0 Operation Review p Structure Evaluation O Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up O Referral O Emergency Q Other O Denied Access
Date of Visit: Arrival Time: Departure Time: County: "L., UN Region:
Farm Name: D 'got � �cwq sa/v P a R tM Owner Email:
Owner Name: AU1 1` \(Q HA) SO,V 1 ,Phone:
Mailing Address: ' +90 ruSS C--LL- 1` (�� (�WSJ N 1 LL �4G
Physical Address:
Facility Contact:
Title:
Onsite Representative: AT/I T A q E.
Ul _ OPH N SQ%A/
f Certified Operator: bAylo . \—.,014N50AJ
Back-up Operator:
Location of Farm:
Phone:
Integrator:
Certification Number:
Certification Number:
Latitude: Longitude:
Design Current
Swine Capacity Pop.
Wean to sh
Wet Poultry
I 11-ayer
Design
Capacity
IDai
Current
Pop.
Design Current
Cattle Capacity Pop.
Cow
Wean to Feeder
I INon-Layer
IDai
Calf
Feeder [o Finish
Farrow to can
Farrow to Feeder
Farrow to Finish
006
D , P,oult .
Layers
Design
Ca aci_
Current
P,o ,
Dai Heifer
Cow
Non-Dai
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
jBeefBmodCow
Other
El Other
Turkeys
Turkey Poults
Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes 11� No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
[:]Yes ❑ No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Page I of 21412011 Continued

Facility Number: - Ll Date of Inspection: I I
I
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
j� No
❑ NA
❑ NE
'i 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: (pJ
Spillway?:
Designed Freeboard (in): ILq!•nS
Observed Freeboard (in): 7 oC
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
No
"""
❑ NA
❑ NE
waste management or closure plan?
///
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ////��'"''--"'tttttt�No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yesb'''l'''j"'"' No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks) �t��l[
9. Does any part of the waste management system other than the waste structures require ❑ Yes b{ I No ❑ NA ❑ NE
maintenance or improvement? '--�
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes )� No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes 2§,No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate
Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): Q M" W 11 Fil s 1C>
l
13. Soil Type(s): #(,V S
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes 1yl No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes [Yf No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes )2§.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.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
[]Other:
21.
Does record keeping need improvement? If yes, check the appropriate box below.
�,{
❑",/Yes IX I No
❑ NA ❑ NE
El
Waste Application Q Weekly Freeboard Q Waste Analysis El Soil Analysis
❑ yraste 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 min 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
V412011 Continued

Facility Number: - Date of Inspection: If J
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 fist survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
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 4 No
❑ Yes ❑ No
❑ Yes 0 No
❑ NA
❑ NE
NA
❑NE
❑ NA
❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes !� No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ YesRNo
No ❑ NA ❑ NE
❑ Yes ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments' s
Use drawings of facility to better explain situations (use additional pages as necessary).
�;�
A � I (Z(L QS F �( AA- l• io 7-0. FtiK a �`
pqr�
_t�P i;c ca9P �tGt_D FoCC c tw
n �ug�ilc�l Due
g� 7H�c � 6� dal I
NA�� 4PLAN i� RfiSE�D C3N6 �C-Sct�� Fc��� NExJ �_4'`I QE>4ouE
caws Fu2oµ'` o71-a f CSC -LAC aF- (�;t.tT 1/%/
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 'V 0 - )11 � W4
Date:
21412011

(Type of Visit Rcompliance Inspection 0 Operation Review O Structure Evaluation 0 Technical Assistance I
Reason for Visit '�(Routine O Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: 0 Arrival Time: ® Departure Time: County: N Region:
Farm Name: 'bAul O �t �HN SON `(-} 1i (Y1 Owner Email:
Owner Name:._T�)ACVIc) Phone: lgl6 a3'�/SS
Mailing Address: DU �l.�S� �I L "� c53c H icc_ , /VC
Physical Address:
Facility Contact: Title:
OnsiteRepresentative:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone No:
Inte rator:
OporlCertification Number: I O c �S Q
Back-up Certification Number:
o I —I f-7 o ^I , � 11
Latitude: � � I I Longitude: I I I
Swine
Design
Capacity
C+urren[
population
Design Current
Wet Poultry C•apa c�t�ty Population Cattle
Design Current
Capacity Populatiou
❑ Wean to Finish
❑ Wean to Feeder
10 Layer I
ILI Non -Layer I
Dry Poultry
❑ La ers
❑ Non -La ers
❑Pullets
❑ Dairy Cow
I ❑ Dairy Calf
❑ Dairy Heifer
El Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
Feeder to Finish
El Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
❑Beef Brood Co
❑ Turke s
Other
❑ Other
Number of Structures:
❑ Turkey Poults
❑Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
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 I of 3
❑ Yes X No ❑ NA ❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
0
❑ NA
❑ NE
❑ Yes ❑ No
❑ Yes No
❑ NA
❑ NE
El Yes No
El NA
El NE
12128104
Continued

Eacility,Numb7W —
Date of Inspection HMO
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier: LluC jy
Spillway?:
Designed Freeboard (in):
q
Observed Freeboard (in):
3C1
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 A No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes XNo ❑ NA ❑ NE
❑ Yes XNo ❑ 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 4No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes Wo ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes KNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
maintenance/improvement?
❑ Yes XNo ❑ NA ❑ NE
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 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. Croptype(s) Coe-M Fic,CUF `L (.yue"o- %
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ YesZAKNo
❑ 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 X No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes MNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments
Use drawings of facility to better explain situations. (use additional pages as necessary) ' * „'
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Phone:
Date:
Page 2 of 3 12128104 Com iinued

Facility Number: — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes `XNo El NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ yes 'mil No El NA El NE
the appropriate box. 0 WUP El Checklists 0 Design El Maps ❑ d Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 7 I.� No El NA [I NE
El Waste Application [3 Weekly Freeboard ❑ Waste Analysis 0 Soil Analysis ❑/aste Transfers ❑/nnual Certification
El Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections El Monthly and 1" Rain Inspections 0 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
El NA
El NE
❑ Yes No
❑ NA
El NE
❑ Yes I
El NA
❑ NE
Ely No
❑ NA
❑ NE
❑ Yes
'ANo ❑ NA ❑ NE
❑ Yes ❑ No �n NA ❑ NE
❑ Yes )qNo ❑ NA ❑ NE
❑ Yes , Mo ❑ NA ❑ NE
❑ Yes kNo
❑ NA
❑ NE
❑ Yes .IT7 No
❑ NA
❑ NE
❑ Yes ArNo
❑ NA
❑ NE
❑ Yest No
❑ NA
❑ NE
Additional Comments and/or Drawings:
N �}SK �� S�uOGE EXC t�7i IOTL
uR���dv puc_- �O11
►old9/o 1. �
Page 3 of 3 12128104

Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit fjk Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: a Arrival Time: ® Departure Time: County: .� Region:
Farm Name: )NhUlts �0I314scw FA2n'1 Owner Email: /�cY]
Owner Name: �Au11� \- • \ONA1$Oil/
1_ � t-
Phone: /I<2>-(0 c- -el5s
Mailing Address: Ov I I SL 1 d V03 E H ILJL /JreC
Physical Address:
Facility Contact:
Title:
Phone No:
OnsiteRepresentative: h,60I1> `i' AN1YA �D}i/✓Sa%✓ Integrator: Q-
Certified Operator: l.AV 1 --� F. _�omvsolv Operator Certification Number: �u
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: [7o [7.
M « Longitude: n ° n n
Design _ Current Des gn Cu rent a D sign
Swtne a „
- Capacity;=Populahon %„ Wet,P,oriltry �,.Capac, �rtulahon'""WCattle-a c ty
Curren"t
Populat'on
�i
❑ Wean to Finish
it,
❑ Layer
El Dairy Cow
❑ Wean to Feeder
❑ Non -Layer
❑ Dairy Calf
Feeder to Finish
❑Farrow to Wean
Uwsa
I lckl:�
Dry Poultry w z
-`
❑ a
Layers
" ❑ Non -Layers
�> ❑ Pullets
❑ Turkeys
❑ Dairy Heifer
El Dry Cow
ElNon-Dairy
..
El Farrow to Feeders
❑Farrow to Finish
❑ Gilts
' El Beef Stocker
❑ Beef Feeder
❑ Boars
Other
❑Beef Brood Co
_
Nof Structures:
_
"❑Turkey Pouets
., ❑
Other
ll ❑ Other
C
Discharges & Stream Impacts
I. Is any discharge observed from any part of the operation?
Discharge originated at ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
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 x No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
0
❑ Yes ❑ No
❑ Yes] No
❑ Yes No
12128104
❑ NA ❑ NE
El NA [I NE
❑ NA ❑ NE
Continued

Facility Number: Date of Inspection
Waste Collection & Treatment �..,(
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes NJ 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: I-A000d
Spillway?:
Designed Freeboard (in): 19.5
Observed Freeboard (in): yy
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
����YYY////��,,,,,
ly No ❑ NA ❑ NE
through a waste management or closure plan?
/ 1
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes
No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
,tyµl
✓Lyle 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
p�
lyJ No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
No ❑ NA ❑ NE
❑ Excessive Pending ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
/)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of 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
15. Does the receiving crop and/or land application site need improvement? ❑ Yes
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
17. Does the facility lack adequate acreage for land application? ❑ Yes
18. Is there a lack of properly operating waste application equipment? ❑ Yes
No ❑ NA ❑ NE
No ❑ NA ❑ NE
No ❑ NA ❑ NE
No ❑ NA ❑ NE
No ❑ NA ❑ NE
Comments (refer to question #): Explain,any'YES answ`,ers and/orany rice mendatrons or anyother cowmen s. , m
Use drawings of facility to better explain situations (use additional pages as riecessary) s. a�
IReviewer/Inspector Name I U-1MRA0#0 Phone: C170 - -11(0' aSbH I
Reviewer/Inspector Signature: Date: JNPS/Qq
12128104 Continued

Facility NumDate 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 ❑ Checklists0 Design ❑ Maps El Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
LY,No
❑ NA
❑ NE
0 Waste Application El Weekly Freeboard El Waste Analysis 0 Soil Analysis [I Yaste Transfers El Anal Certification
0 Rainfall ❑ Stocking El Crop Yield 0 120 Minute Inspections El Monthly and 1"
Rain Inspections [3
Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
P No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
A No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
XNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
No
❑ NA
❑ NE
W.N.
ID/QI /67 1.�+
�Isslo 3. a
12128104

0 Division of Water Quality
Facility Number 3 I � 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 ❑ Denied Access
Date of Visit: I j Q� O$' Arrival Time: �t—Departure Time: County: L'1 A( Region:
D Farm Name: DAUN.1QHA/Sc_W FA2M Owner Email: !1
Owner Name: "bAu I � F..�c,N vsc)N n - Phone: 9)0 - 9 9 L/ 55� CFI)
Mailing Address: 3 (o Fuss F_F_L - V6 FUSE Hi t-L
Physical Address:
Facility Contact: Title:
`
OnsiteRepresentative: l!Aults AIITA 3C�HNSCA/
Certified Operator: 'bA V I n �• CWAI SqR/
Back-up Operator:
Location of Farm:
Phone No:
Integrator:
Operator Certification Number: 1 8--175 o
Back-up Certification Number:
Latitude: = = = Longitude: mom, M
.. .
' Design Current Design Current
Desr^.Current
gu
Swine
_
Capacity Population Wet Poultry Capacity' Population
eat le „ Capacity,, Populahoti
❑ Wean to Finish
�- ❑ La er
❑Dai Cow
❑Wean to Feeder
❑ Non -Layer
I
❑ Dairy Calf
Feeder to Finish
$$U �d oU -
`. ❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
'. ❑ Farrow to Feeder
❑ Layers
i ❑ Non -Dairy "
El Farrow to Finish
El Beef Stocker
El Gifts
❑ Non -Layers
' El Beef Feeder
❑ Boars
' Pullets
❑
❑Beef Brood Cow
— — — - - -
- ❑ Turkeys
Other
.K Other
El Turkey Poults
-
..
El
- ❑ Other
Number of Structures
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes XNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
0
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
0 No
❑ NA
❑ NE
❑ Yes
;iTNo
❑ NA
❑ NE
12128104 Continued

�acility Number: 31 — y
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: (-*Qcu.)71
Spillway?: Designed Freeboard (in): 17.5
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 Xo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes I:fNo ❑ NA ❑ NE
❑ Yes E�No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ,(No ❑ NA ❑ NE
8. Do any of the stucmres 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 _I�No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ICt,No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes tqNo ❑ NA ❑ NE
❑ Excessive Pending ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window [:]Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
rrr
ytl No
El 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
��
It No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations ,or any,other comments
Use drawings of facility to better explain situations. (use additional pages as necessary):::
(Z —oQ.pS If6A-T-4-a4,0Cz9-1s-\. r-AJZWI- C.00r-s poop.
Reviewer/Inspector Name I H r/v A L D (& & 5 Phone: 4/0 — t7(c — a );*T
Reviewer/Inspector Signature: a" Date: ///grj/'59
Paee 2 of3

Facility Number: 3) ati 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 ❑ Design El Maps [I Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a min gauge?
❑ Yes
IL9 No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
ONo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
OfNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
9No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
KNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
y11 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
A 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)
' 11,/
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
El Yes
pl No
❑ NA
❑ NE
Page 3 of 12128104

r d Division of Water Quality
Facility Number S I - } 0 Division of Soil and Water Conservation
'I 0 Other Agency
Type of Visit 6 �C(ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit .eJ Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: 11 U (r Arrival Time: `' ' Departure Time: County: Q�F Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Owner Email:
Phone:
Facility Contact: { Title:
Onsite Representative: ''At�S» `F f1W'TM �J e N aJ :'cr.� Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone No:
Operator Certification Number:
Back-up Certification Number:
Latitude: = U = ' =„ Longitude: = o = , = „
Utz.' f ;'
Design ,Current ., . - " -
Design Current, " Design Current ,
Swine .'
Capacity Populahop Wet Poultry
Capacity Population Cattle
Capacity' Populatfli
❑ Wean to Finish
I
IE]Layer
I:., ❑ Dairy Cow
;.
❑ Wean to Feeder
I;-, ❑ Non -Layer
11 ❑ Dairy Calf
Feeder to Finish
Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
.•.
❑ Farrow to Feeder
[-]Non -Dai
❑ Farrow to Finish
❑ La ers
- El Beef Stocker
❑ Gilts
❑Non -Layers
❑ Beef Feeder
❑ Boars
I I ❑ Pullets
❑ Beef Brood Co
--
-- ❑ Turkeys
- -- —
--
Other
❑ Turke Points
a
❑ Other
` El
�'"
Numberof Structures
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes IJ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes 0
0NNo ❑ NA ❑ NE
❑ Yes P1 No ❑ NA ❑ NE
❑ Yes L7 No ❑ NA ❑ NE
Page 1 of 3 12128104 Continued

facility Number: ^ — Date of Inspection h c Jb
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes 0 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: 6A GvjJ )
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3 `i
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes [2/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 ❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ENo ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks) . //
9. Does any part of the waste management system other than the waste structures require El Yes C3 No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
maintenance/improvement?
❑ Yes VNo ❑ NA ❑ NE
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes /No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 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)
13. Soil type(s)
cwS httWc CC
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ Yes
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
17. Does the facility lack adequate acreage for land application? ❑ Yes
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
a No
❑ NA
❑ NE
El No
❑ NA
❑ NE
ETNo
❑ NA
❑ NE
0"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): ,
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Phone: L71y /70
Date: 000d to
Pn. 7 nr?

Facility Number: — �, 4Q Date of Inspection
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
No
❑ NA
❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
ZZNo
❑ 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 Inspectionss
Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
�/El
�
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
,�, I/`Jo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
,L�._.�J/N�o
❑ NA
❑ NE
[:
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
NNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
,
L/No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
ff/Nc
[INA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
Yes
Elf
[2 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
D19/0
❑ 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
ONo
❑ 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
EDNo
[INA
❑ NE
33.
Does facility require a follow-up visit by same agency?
Yes
El�
0 No
❑ NA
❑ NE
Comments and/or Drawings:
Page 3 of 3 12128104

Type of Visit ('Kcoo I'ance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit C'J Routine O Complaint O Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: /0 dj Arrival Time: Departure Time: County:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: ��f� ✓u USo d
Certified Operator:
Back-up Operator:
Location of Farm:
Owner Email:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Region:
Latitude: [o [=, [� Longitude: =o=,
p Design Current rZft@Destgn Current`
Syvtne4 .a.r, Capacity :P po tion _ Wet PoultrA Ewa .., Pop�ula&[ on
aq
❑ Wean to Finish ❑ Layer I
Cattle d
R
Dairy Cow
Design
Capacity.,
Gvucrent
Population
❑Wean
[o Feeder
10 Non -Layer
I
❑
Dairy Calf
®
Feeder to Finish
k2yoa
_
n
❑
❑
❑
❑❑Beef
x - �' , ❑Turke
'r -
�P,oultry ', : ,
Layers
Non -Layers
Pullets
Turke s
❑
❑
Dairy Heifer
❑
Farrow to Wean
Dry Cow
❑
El
Farrow to Feeder
Farrow to Finish
El
❑Beef
Non -Dairy
Stocket
❑
❑
Gilts
Boars
❑
Beef Feeder
Brood Coa
Other
�' „ „
� �
.Number; of Structures �:
❑
Other
�❑Other
'
Discharses & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes P/No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
[--]No
❑ NA
❑ NE
0
❑ NA
❑ NE
❑ Yes
❑ NNo
❑ Yes
N�fi
❑ NA
❑ NE
❑ Yes
Ld No
❑ NA
❑ NE
12128104 Continued

Facility Number: 3 (— a Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
StructuI Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: [A(oon%
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): go
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ElNE
(ie/ large trees, severe erosion, seepage, etc.) ��
6. Are there structures on -site which are not properly addressed and/or managed ElE 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 environmentalthat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑Yes Nc ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes P�lo ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks) ,_.,�
9. Does any part of the waste management system other than the waste structures require El Yes L� No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes to NA ElNE
maintenance/improvement?11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑Yeso ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN [:IPAN > 10% or ] 0 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window El Evidence of Wind Drifl ElApplication Outside of Area
12. Crop type(s) C WS FEsC'V E C `1 /
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
LCf�j Np ❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[ T ❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination` ❑ Yes
LI No [INA
❑ NE
17. Does the facility lack adequate acreage for land application?
ElYes❑
NA
r�N
ElNE
18. Is there a lack of properly operating waste application equipment?
❑Yes
❑ NA
❑ NE
Fi��, AP D
01146cJa.pS ZAI G�,� 5PA42E
Reviewer/Inspector Name I oj4y,,/��z�}/�p l5L � `� PhoneE 4 — % (3 I
Reviewer/Inspector Signature: Date: /0 1 V5_
Continued

&acility Number: —a Date of Inspection Iri OS -
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes o ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections El Weather Code
22. Did the facility fail to install and maintain a rain gauge? El Yes L9 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? El7 Yes L--No El NA El NE
25. Did the facility fail to conduct a sludge survey as required by the permit? ❑ Yes C1//o ❑ NA ❑ NE
26. Did the facility fail to have an actively certified operator in charge? ❑ Yes Ly No ❑ NA ❑ NE
❑ Yes L/JZo ❑ NA ❑ NE
❑ Yes E No ❑ NA ❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
Lj no
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
El Yes
,,�
t� No
❑ NA
ElNE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
ElYes
[XNo
❑ 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
[2 Nc
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
;No
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
��—�jj����������/�NN�/
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
u No
❑ NA
❑ NE
Additional Comments and/or Drawings:
12128104

rIf
(Type of Visit 6 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 24
Date of Visit: l o (. o y Time: �
0 Not Operational O Below Threshold
Permitted dcerfified [3 Conditionally Certified 0 Registered Date Last Operated or Above Threshold: _.
Farm Name: .OA\zD Ja1Jos-tP EA(Lw^v County: — OvPLIIj
Owner Name:
?`failing Address:
Facility Contact:
Title:
Phone No:
Phone No:
OnsiteRepresentative:LSD A011 A 50Otl50d . Integrator. CAA-MwS
Certified Operator:------.. _ _ Operator Certification Number:
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude =• = =� Longitude =• =1 =11
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes dN0
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 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 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Freeboard (inches):
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes dNo
❑ Yes 7No
r
[I Yes
Structure 6
12112103 Continued

Facility Number: 3 ( — nt, Date of Inspection i0 0
r
5.
Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑ Yes
2(140
seepage, etc.)
6.
Are there structures on -site which are not properly addressed and/or managed through a waste management or
❑ yes
/
io
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/umprovement?
❑ Yes
8.
Does any part of the waste management system other than waste structures require maintenanceftmprovement?
❑ Yes
QNNo
9.
Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
❑ Yes
[/No
elevation markings?
Waste Application
10.
Are there any buffers that need maintenance/improvement?
❑ Yes
p N
11.
Is there evidence of over application? If yes, check the appropriate box below.
❑ Yes
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12.
Crop type Es W e W Csw
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
--
Md I
b) Does the facility need a wettable acre determination?
❑ Yes
QN
c) Ibis facility is pended for a wettable acre determination?
❑ Yes
15.
Does the receiving crop need improvement?
❑ Yes
p o
16.
Is there a lack of adequate waste application equipment?
❑ Yes
L7 No
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ yes 01�0
liquid level of lagoon or storage pond with no agitation?
18, Are there any dead animals not disposed of properly within 24 hours? ❑ Yes
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes To
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 M'No
Air Quality representative immediately.
'_comments ccefer togncshon ttr�Esplam ate!>I')�-aaswe>cs a�/orany rea4oas ur any other co�eots3,
Use daawings oElse�rty to better egplam s�hrahoas. (use addtho�t'pages as necessary) � ❑Field Copy ❑Final Noes �
WASTE ANA`-'1S.ii GaoD %R, Cep QA`t'S Qut�l� ANib Aa'rF1tL Svart.QLL D.QT�.
3.F 42APLA- .%S LATE Pc:=tiSE SuG tn1tt ArS17;t`p - 9AMeLE td 3-1-Y V (,1S 61i/.
Vpa-
Reviewer/Inspector Name 5 ryT 'c
..'
o
Reviewer/InspectorSignature: 61V� Date: to (o oLj
12112103 Continued

Facility Number: 31 _ 201Date of Inspection
Required Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes No
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.) ❑ Yes
23. Does record keeping need improvement?. If yes, check the appropriate box below. ❑ Yes No
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ SoilSampling
24.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
25.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
No
26.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
No
27.
Did Reviewer/Inspector fail to discuss reviewlinspection with on -site representative?
[IYes
28.
Does facility require a follow-up visit by same agency?
[I Yes
—3l!No
21No
29.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
[3/No
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
E Yes
❑ Noo
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ yes
0190
32. Did the facility fail to install and maintain a rain gauge?
ElYes
o
33. Did the facility fail to conduct an annual sludge survey?
El Yes
--GH//
cr/ o
34. Did the facility fail to calibrate waste application equipment?
0 Yes
QNo
35. Does record keeping_fo�NPDES required forms need improvement? If yes, check the appropriate box below.
td Yes
❑ No
❑ Stocking Form p Crop Yield Form []Rainfall []Inspection After 1" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
0 No violations or deficiencies were noted dnnng this visit You will receive no farther correspondence about this visit
" ' ona6CW&ikats.a$d/orD—mw-Mgs
12112103

9DiV9i6n of Water Quality
0 Division of Soil and Water Conservation
- �..
O Other Agency.
Type of Visit to Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit fi6 Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
IFacility Number Z Dale of Visit:
#Permitted ❑ Certified ❑ Conditionally Certified ❑ Registered
Farm Name:...'M...F�,i............
......L..13.(c.>...........................
Owner Name:.....{0 �t
...'J.J/c:................... ..:f%.t �flt................................
Facility Contact:
Title:
/ Printed on: 7/21/2000
Date Last Operate r Above Threshold: ..
County:..... ___uz°GZi✓
-.........................................
Phone No:
Phone No:
MailingAddress: ..................................................................
Onsite Representative: g � 0, L__.S
P ................1✓........!%............td .. Inte ra... .............. ............................................
Certified Operator: ...................
................................ ......................................................... ... Operator Certification Number:..........................................
Location of Farm:
❑ Poultry ❑ Cattle ❑ Horse Latitude =a =1 =11
Design Current -
c Catmeity Pnnnlitinn
Wean to Feeder
i
Feeder to Finish
a
_
Farrow to Wean
--
Farrow to Feeder
-
Farrow to Finish
Gifts
J
Boars
Longitude �• �• ���
Design Current
Poultry Capacity Population Cattle
❑ Layer ❑Dairy
❑ Non -Layer ❑Non -Dairy
❑ Other
Total Design Capacity
Total SSW
JLJ Suhsurface Drains Present 1p Lagoon Area f❑ Spray Field Area
iIoldingPoals�/Sold aa
Traps; ❑ No Liquid Waste Management System
�t..,..,...�. ._. 9 - _g Y --� . .... .....
Discharges & Stream Impacts
1. Is any discharge observed from any pan 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 now in gat/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any pan of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
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):
5/00
❑ Yes /C(No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes /INO
❑Yes f7�f0
❑ YesNo
Structure
Continued on back

Facility Number: —� Date of Inspection / O
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 evide�ncey of over applic tion? ❑ Excessive Ponding ❑ PANS�❑ Hydraul' Overload
12. Crop type 0,61J, IE
13. Do the receiving crops differ with thole designated in the Certified Animal Waste Management Plan (CA
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?
0 iVq 001ittigijs:or. ft riciencies were ngted ditripg this -Visit; - You iviti•t'eegiyte titi fut th¢t
....................................
-:-corresnmidence:abotiEth�s�istt:•.•.•.•.•.•.•.•.�.�.�:•.•.•.•.•.•.•.•.•.•.�.�.•.•.•.•.�.•.•.•.•.•.-.�.•.
U ,6cr, U/r ;rm 1XV9�a�l/%rcQ H��sso A) htBov 7-%c
p�✓eER/ r�i /a : ��v�IEA�%,�/✓f�m oun/TS,
I/
❑ Yes ¢1 No
❑Yes #No
❑ Yes VfNo
❑ Yes U(No
❑ Yes �No
❑ Yes P(No
❑ Yes XNo
❑ Yes '0 No
❑ Yes VNO
❑ Yes IJo
❑ Yes P No
❑ Yes ((No
❑ Yes #No
❑ Yes VNo
[]Yes PrNo
❑ Yes o
❑ Yes No
❑ Yest No
❑ Yes No
❑ Yes /❑ No
❑ Yes /"No
❑ Yes. QNo
Reviewer/InspectorName �..,`n."je,t, „y '-.'a'--r._'
Reviewer/Inspector Signature: / P, /W Date: / / 5/00

• Facility Number: —Z Datc of Inspection / / 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?
El Yes
J
1/I/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
ONO
((((((J
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.)
El Yes
n,/NNo
31. Do the animals feed storage bins fail to have appropriate cover?
❑ Yes
L�'N0
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes
❑ No
_Additional -Comments anorDrawings:-
15) UR�/+K UP J�ozL omP�-CT<on/ �N F,�CuE �45T�,�
W42�,I, X&V&q oww�U#
LfrC.9DfJ
J
5100

E3 Division of Soil and Water Conservation -Operation Review
E3 Division of Soil'and Water Conservation •Compliance Inspection
♦ M[vision of Water Quality - Compliance Inspection
3 Other Agency =Operation Review, - - -
Routine O Complaint O Follow-up of DWQ inspection 017ollow-up of DSWC review O Other
Facility Number H=Rt I
Date of Inspection Time of Inspection Ej=24 hr. (hh:mm)
#Permitted 0 Certified E3 Condom i� ally Certified 13 Registered 0 Not O erational Date Last Operated: _
Farm Name: (// htSl(!�-\ rn-' ................. County:.................. / ��.a_.._.c�....._ 1Gti........................_..�.�............L.}......... .... ...........
Owner Name:
Facility Contact:
Title:
Phone No:
Phone No:
MailingAddress: .............................................. .................... .................................................. ..................................... ................... ..........................
Onsite Representative: .....-.. integrator: .......... .Ke......... S................................
Certified Operator:
Location of Farm:
Operator Certification Number:
Latitude =•=' =.1 Longitude =• =' =11
Design Current - - - Design - Current - Design Current
Capacity Population Cattle Capacity Po ulation
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
" ❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts,
❑ Boars
❑ Layer ❑ Dairy
❑ Non -Layer ❑ Non -Dairy -
❑ Other _
Total Design Capacity
Total SSLW
jNumber of Lagoons JE1 Subsurface Drains Present ❑ Lagoon Area ❑ Spray Field Area I
Holding,Poads / Solid Traps JE1 No Liquid Waste Management System
Discharges & Jtream Impacts -
l. Is any discharge observed from any part of the operation? ❑ Yes [XIo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
h. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑yt No
c. If discharge is observed, what is the estimated flow in gal/min'? '//
,///
d. Does discharge bypass a lagoon system? (If yes, notify DW ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes KNo
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 [�N0
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard(inches): ......... .f-'............. .......................................................................................................... ......................................................................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes o
seepage, etc.)
3/23/99 Continued on back

Facility Number: — Date of Inspection
6.
Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
❑Yes
o
(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?'
Oyes
❑ No
8.
Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
)<No
9.
Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
gNo
Waste Application
10.
Are there any buffers that need maintenance/improvement?
❑ Yes
9No
11.
Is there evidence of over application? []Excessive Ponding ❑ PAN
❑ Yes
VN0
12.
Crop type
13.
Do the receiving cro s diffel with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
WNo
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?
M Yes
❑ No
16.
Is there a lack of adequate waste application equipment?
❑ Yes
9No
Renuired Records & Documents
17.
Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
XNc,
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
WNO
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
�(No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
KNO
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
kNO
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
WNo
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
KNo
24.
Does facility require a follow-up visit by same agency?
❑ Yes
KTNo
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
'KNo
Qibl'atigris;orclefcieuices- ereitgte�•iljttiitgthis:visit; Yoitwi�l-i.ec$ipetio:further-:-:
.•:•corresbotidence:abouCthisvtslt:-::-:::•:-:•:•::•:•:
:..................... .
Use drawings of -facility. to better, explain sitpahons 1(use addiftonalp
r�
tpr�N�W���. ('Dt.WVc�/s`ry,\�G•,w'Jv�r �{tw.
ffipw�l y(�v eww+1tM/ (,v,
4-ay 0
CLG
A, w r f I_ k--k p tk_
y� N uu.6d� vw o(4Al.�rt��
G�«-y �' �� _J•y,,,,,�-__II re—s-�+-melt, I
�� ;,�.,,f��� Ft1� A'LVI cr{—sr�st�� .
s; s..ff- vim. MCI.
Reviewer/Inspector Name
Reviewer/InspectorSignaturVlC7) r -y1/L Zlr„,OV,� Date:

Facility Number: 2,— Date of Iuspection
Odor Issu t -
26. Does the discharge pipe from the confinement building to rstora/gepond 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?
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 J�`No
❑ Yes $No
❑ Yes &0
❑ Yes Wlo
❑ Yes k(N'o
❑ Yes �Io
wuP y�fr�74 3 7 Sb MAI � Co, ,K , h vw� v �✓ yy, i.
�vhJ-tss�
y217'�{
oY� L � �' � �vY.r s ���p�l.� ���'oCs� •/�r. k�s�" was -!�l°�
3015 s Aw
Cam' pact, alp t
A - At*,) k)LO Wl _c - CSkv-;JP --
i��4N I b -7
►q,vtsw - V\,X-S
4d
Jnti
Imo - wr. VJu P r� Kc�1— C'o,,� 10 �wN.
T of\ s o rc � lea v S.V U-a, 15 albttiei ,014 4o Wct-.P

State of North Carolina
Department of Environment
and Natural Resources - t
Division of Water Quality 13Y:-
JAN 0 6 2000
James B. Hunt, Jr., Governor
Bill Holman, Secretary
Kerr T. Stevens, Director
David Johnson
David Johnson Farm
787 Fussel Road
Rose Hill NC 28458
Dear David Johnson:
91 QAj
01
,
NCDENR
NORTH CAROLINA DEPARTMENT OF
ENVIRONMENT AND NATURAL RESOURCES
December 30, 1999
Subject: Fertilizer Application Recordkeeping
Animal Waste Management System
Facility Number.31-248
Duplin County
This letter is being sent to clarify the recordkeeping requirement for Plant Available Nitrogen (PAN)
application on fields that are part of your Certified Animal Waste Management Plan.
In order to show that the agronomic loading rates for the crops being grown are not being exceeded, you
must keep records of all sources of nitrogen that are being added to these sites. This would include nitrogen
from all types of animal waste as well as municipal and industrial sludges/residuals, and commercial fertilizers.
Beginning January 1, 2000, all nitrogen sources applied to land receiving animal waste are required to
be kept on the appropriate recordkeeping forms (i.e. IRRI, IRR2, DRYI, DRY2, DRY3, SLURI, SLUR2,
SLD1, and SLD2) and maintained in the facility records for review. The Division of Water Quality (DWQ)
compliance inspectors and Division of Soil and Water operation reviewers will review all recordkeeping during
routine inspections. Facilities not documenting all sources of nitrogen application will be subject to an
appropriate enforcement action.
Please be advised that nothing in this letter should be taken as removing from you the responsibility or
liability for failure to comply with any State Rule, State Statute, Local County Ordinance, or permitting
requirement.
If you have any questions regarding this letter, please do not hesitate to contact Ms. Sonya Avant of the
DWQ staff at [phone] ext. 571.
Sincerel
CJE�
Kerr T. Stevens, Director
Division of Water Quality
cc: Wilmington Regional Office
Duplin County Soil and Water Conservation District
Facility File
1617 Mail Service Center, Raleigh, North Carolina 27699-1617 Telephone [phone] Fax [phone]
An Equal Opportunity Affirmative Action Employer 50% recycled/10% post -consumer paper

Q Division of Soil and Water Conservation Operation Review -
E3Division of Soil and WaterConservation .Compliance�Inspeedon . ;>- ...
JNDiyision of Water Quality e�Coin li ce Inspection - -
-- Other Agency.- OperationReview - - r - -
19PRoutine Q Complaint O Follow-up of DWQ inspection Q Follow -tip of DSWC review Q Other
Date of Inspection q
Facility Number 3 p � 24 hr. Time of Inspection
[)Permitted 0 Certified'` 3 Conditionally Certified 0 Registered � Not O erational Date Last Operated:
riAY1\ ,I"160 V{....�.-- County:.... vf- t"V............................................................
Farm Name: ............ .. Cl... ......... �.......... � ��
Owner Name:
-bo-W.........................JO1t:tWv............................................. Phone No: ...... 0K)....M-7-L4-5asa......
.................................
FacilityContact: ..............................................................................Title: ................................................................ Phone No:...................................................
MailingAddress: ......... Tr ....... rv11 5e.i......I... LlJ.................................................... ............ 1Z4Se..... . 1../'.. 1�1(............................... .... �. nr. .......
Onsite Representative: .......... bAY�Q..... .�iII U-09.r.-..................................................... Integrator:.......... ct?.>Y.Y. llL......................................................
Certified Operator: ................................................... ............................................................. Operator Certification Number:..........................................
Location of Farm:
Latitude =• 0' =•' Longitude =• =' ="
- Design Current.
Swine Capacity Population
❑ Wean to Feeder
® Feeder to Finish
ZSZ
zwo
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts,
❑ Boars
1Number of Lagoons ❑Subsurface Drair
_Holding Ponds / Solid Traps ❑ No Liquid Waste
Discharges & Stream Impacts
Is any discharge observed from any pan 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
❑ Yes No
❑ Yes No
❑ Yes nNo
❑ Yes ® No
❑ Yes ® No
❑ Yes No
❑ Yes No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ,r
Freeboard (inches): ............ .�................ ..........
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes R No
seepage, etc.)
3/23/99 Continued on back

V
` Facility Number: — Date of Inspection )Z
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes P 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 (RNo
8. Does any part of the waste management system other than waste structures require maintenance/improvement? 59 Yes ❑ No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
(ONo
Waste Application
10.
Are there any buffers that need maintenance/improvement?
❑ Yes
No
1 I .
Is there evidence of over application? ❑ Excessive Pronding El PAN
El Yes
No
12.
Crop type Corn �t 14 T/ Sav�nr. • acue. Ok'z fi
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?
❑ Yes
O No
Required
Records & Documents
17.
Fail to have Certificate of Coverage & General Permit readily available?
Yes
❑ 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)
OYes
❑ No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
No
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?
(ie/ discharge, freeboard problems, over application)
❑ Yes
No
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
P)No
24.
Does facility require a follow-up visit by same agency?
❑ Yes
P No
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
PNo
Nviolatidris;ot- &iticiencies were h * 'd-during this:visit: You will-rebeive lid further ; •;
comes ondence:about:thisvisit:..................
'Comments (defer to• -question #): Explain any YES answers and/orany recommendations or any -other --co, mrte_nfs
'_Use drawings of facility to better explain`situations: (use additional pages as necessary)
!)• �-t:h .Z -_ _ 1vj to 6 tKadle ot, IhSIJPS O
M1UC- i'i'D U>ar� Ori I fil:.S ! n � �L52 S . 0.�C'S r'ti
ktuseS OL*-. t J`
Ilk.c. TO'cilir{� is VxA iwr �%%Jttcv ln6l�pn �oascJ o � 1 ja rv(e-
I-i- 1-CTCtt'+ tiC�JS •.hour) 'k"roved , /+
11- A, cop, o�� CDC-w— G P si-to,,IJ he_ L"� w� lure reI-L�OOS.
19. F?V-ve ruards Si L)J� be_ 4' �- �� A �11 ( `(-c spr;ty fo(k1-CA
(, V'XO-''lt­ Lae,
Reviewer/Inspector Name
Reviewer/Inspector Signature. - ._ Date: ISO nl
3/23/99

' F cility Number: —qA Date of Inspection
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge allor 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 RNo
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring Vegetation, asphalt, ❑ Yes 1�No
roads, building structure, and/or public properly)
29. Is the land application spray system intake not located near the liquid surface of the lagoon?
❑ Yes
[PNo
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
fPo
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 pennanent/temporary cover?
❑ Yes
;No
3/23/99

Division of Soil and Water Conservation ❑ Other Agency
Division of Water Quality
[ I Date of Inspection/ 5 ZT 9g
[ Facility Number I� .
i Time of Inspection ��'24 hr. (hh:mm)
0 Registered M Certified [3 Applied for Permit U Permitted 10 Not Operational Date Last Operated:._...._.,,,.
FarmName: .......... ,Y..8..4v.,e....... �,o6vws........7C-.-..r
:....................................................
County: ...1.11�kx..
....................................... ......... :.............
OwnerName: ................. I,1.aXs.l]. .................. ......
.............................................
Phone No:...C`I.1.�,..�
g5-_`{. 5 1.......................................
FacilityContact: .............................................................................. Tit1e:................................p............................... Phone No:...................................................
MailingAddress:...:..121...... Fass4:G.....:�.:.................:........................I..................... .... &,e......ku..l... M........................................ .Z..t�........
Onsite Representative:......_bo.V .ft....:...s]A6c'.*x......................................................... Integrator: .... _& .Y0 b .........
Certified Operator;... e�.�al�ttis. ............................. Operator Certification Number;......e5�
..... gv1................... ( .........................
Location of Farm: '
Ch....ui......st .......lri...SY .!Li3..,..1...'la..r:les....sa......a�..._SR...1.161.:...............................................................................................:............
...
Latitude ®• 0. Longitude =? a$ ';«
t�Eje--,+ Desigrr:(-Current a ., Design Current Design_ CurrentX
Swme Capacity Population Poultry ' Capacity Population Cattle Capacity Population`
'. ❑ Wean to Feeder - -.,: ❑Layer I ❑Dairy
Feeder to Finish 2-IMO JLJ Non -Layer I1 10 Non-Dairy
'h ❑ Farrow to Wean - -
❑ Farrow to Feeder ❑ Other F
❑ Farrow to Finish :. Total Design Capacity ' Z go
❑ Gilts
❑Boats ; Total SSLW . 313 8 73oo
.v. r
Number, of Lagoons/ Holding Ponds ❑ Subsurface Drains Present ❑ Lagoon Area 10 Spray Field Area
z = �` ❑ No Liquid Waste Management System
General
I-. Are there any buffers that need maintenance/improvement?
2. 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 Surface Water? (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)
3. Is there evidence of past discharge from any pan 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
maintenance/improvement?
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?
7/25/97
❑ Yes ® No
❑ Yes EP No
[]Yes [H No
❑ Yes [P No
t 1- qk
❑ Yes (rr��5 No
❑ Yes lt3 No
❑ Yes ® No
CA Yes ❑ No
❑ Yes j `� No
❑ Yes 6 No
Continued on back

r
r
Pacility Number: 31 — z �
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures rLapoonsMolding Ponds. Flush Pits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Freeboard (ft).......... Z'.�...................
10. Is seepage observed from any of the structures?
11. Is erosion, or any other threats to the integrity of any of the structures observed?
12. Do any of the structures need maintenance/improvement?
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DIVQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
Waste Application
14. Is there physical evidence of over application?
(If in excess of WMP, or runoff entering waters of the State. notify DWQ)
15. Crop type...........YcSC.V..t......................Lorn....................W.K0. ................`. ............................................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (A WMP)?
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
r
22. Does record keeping need improvement?
For Certified or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
25. Were any additional problems noted which cause noncompliance of the Permit?
0 No.vioNtions or deficiencies were noted during this visit. You will receive no further
correspondence about this.visit:
❑ Yes t No
❑ Yes
El No
Structure
...............................
6
❑ Yes
V] No
❑ Yes
V9 No
Yes
❑ No
❑ Yes
No
❑ Yes
No
.......................................
❑ Yes
N No
❑ Yes
[XNo
❑ Yes 1j No
❑ Yes ® No
❑ Yes ®9 No
❑ Yes yyro No
4 Yes ❑ No
❑ Yes 1P No
❑ Yes JP No
❑ Yes 0 No
Comments;(refer to,question #): Explain any YES answers and/or any recommendations or any'other comments
UWdrawings of facility to better explain situatiitins. (use additional pages as necessary): r
s.G»rs� w0. tb i 1 6e t„&,t,.� eAxsw � uruna4 p-nScrj- t3.
Lre l �F low
Ltt�as-� i!� SaVWI �C�J U7 0.v0:f] p° 1 I
Iz. Inr�t' �rV-x wnll '5 -toy b.e W,00ed, tank-nux e-t-f" to reS¢cJ bare, e..*u�S. Eroc,b� wz,>-
22. (t^ri 4AYt Or- "L�'r]S s`'WU�rr � �+�- j1^+��� bytU/�vowc.,,` se..sm 1-cseu` Vvji't% se¢ se,.. %sf-s
t'v Snc l t 4uno f% 6e_ I<iFta.. J
7/25/97
Reviewer/Inspector Name _�(vi� a,,���� 'e.°
Reviewer/Inspector Signature: &;_ _ Date: �,Z7

(* RRoouuttine O Com taint O Follow-up of DWQ inspection O Follow-up of DSWC review O Other
Facility Number 3 w— 2 I
Farm Status: Registered ❑ Applied for Permit
Certified ❑ Permitted
❑ Not Operational Date Last Operated:
Farm Name: Yh .... .....
�...._...._.._
Land Owner Name: _ I� � . ytA�YI ZyA--._._ .... �....__...._....__....� ...... Phone No: _4clal..? / S �...__.... ...._......__.
Facility ConMact:....._1 AhSO.VX.... .`........ — ..... �... Title: . d�...
{.� ..... —.,...L' Phone No: ..Lol�V��S �557 .... ......
14failing Address:.._.._T._fNS�S.L�__..!<51,......Y.._.............._..........!�7.SL..!ZLl�{.._,1! ....._...._._.__..�_..]. ......
Onsite Representative: ..... .DAIVA..... a?hser..._._.....__..___......_....... ....... ....... Integrator: _�L� �.S—_....__....--.....__...---.....__....—_.
Certified Operator: _..�( _...._?.er,...r.... Operator Certification Number: ....W....�._._..._,
Location of Farm:
Latitude =*=`=- Longitude =•=`=G
Genera
1. Are there any buffers that need maintenance/improvement?
2. 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 Surface Water? (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)
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
4/30/97 maintenance/improvement?
❑ Yes QNo
❑ Yes 'in No
❑ Yes Oa No
❑ Yes M No
❑ Yes P,No
❑ Yes %No
® Yes ❑ No
Continued on back

I `
r
Facility Number: .... ._
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?
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (Lagoons and/or Holding Ponds)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Freeboard (ft): Structure 1 Structure 2 Structure 3 Structure 4
10. Is seepage observed from any of the structures?
11. Is erosion, or any other threats to the integrity of any of the structures observed?
12. Do any of the structures need maintenance/improvement?
(If any of questions 9-12 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
Structure 5
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
Waste Application
14. Is there physical evidence of over application?
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type tS.�i�e.. ._._.SDfLv.... SO+�S.._.... .....
_...._.
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
For Certified Facilities Only
22. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
23. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes KNo
❑ Yes No
❑ Yes ® No
❑ Yes 9N0
Structure 6
❑ Yes KNo
❑ Yes %No
P9 Yes ❑ No
❑ Yes KNo
❑ Yes ® No
❑ Yes allo
❑ Yes RNo
❑ Yes 1,'No
❑ Yes 19 No
❑ Yes VNo
❑ Yes PNo
❑ Yes [A No
❑ Yes ® No
24. Does record keeping need improvement? ® Yes ❑ No
CommenW(refer to question t/) ° Explain any YES answers'and/or,aay recommendations or any other comments
Use drawnngs ,of facility to better ezplam situations (use ad�honal pages as necessary)
S. Crw., 5 ou1J 6e nynnded 4Q "Sfe e .
12. Emsron arias or. Inrtar/WGr_ ,)ills Skoula G'IU( w+i4- cfuy asj Mcedea. 60,H- artar,
S�oula 6. rtSce d. t
44. S�rM rtwl skovW toe �0`( rw hvm6er "J Leh)ovmloev: UPJofe soil ins{ Carwe.'-
m�xr�
'Felt)twaw.r� a1,1�2o-geS 400lt) be iN alto,, be�t)re terti�,cul'lovv Co+iA'cdiondeca"
;s het. 31,Ig91.
Reviewer/Inspector Name ✓� rr'-�`��rs✓t� 2 :_«.'° � � "'
Reviewer/Inspector Signature: A/j /� Date:
cc: Division of Water Quality, Water Quality Section, Facility Assessment Unit 4/30/97

Site Requires Immediate Attention:
FacilityNo. 3 I - z 4 if
DIVISION OF ENVIRONMENTAL MANAGEMENT
. ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: -) r 1995
Time:
/Y° u
Farm Name/Owner: l) &zz A
Mailing Address: R 1 6b)C 3o"Z.
County:
Integrator. CAfCDlll Phone:
S10G3L)o
On Site Representative: 1�)o •— 6,+Ier• Phone: L>4_ 5 Y.TJ'7
Physical Address/Location: AIC S k it3 21 hfeADX . /• S m; (Q t So !9
/�
Type of Operation: Swine Poultry Cattle
Design Capacity: � VW n c6 ✓� Number of Animals on Site:
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: -3q _�' 2 Longitude: I �_ ° _0- ' 5-1" Elevation:- Feet
Circle Yes or No
Does the Animal Waste Lagoon hav sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches) Y� or No Actual Freeboard: '� Ft. Q Inches
Was any seepage observed from the
Is adequate land available for spray.
Crop(s) being utilized: 01'a-'ka (
;)? Yes or No Was any erosion observed? Yes or No
No Is the cover crop adequate?r No
Does the facility meet SCS minimum setback criteria? 206 Feet from Dwellings?G�or No
100 Feet from Wells? )9or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or No
Is animal waste land applied or spray irrigated 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 or0o If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? Yes or No
Additional Comments:
0. Gf­r_�
Inspector Name
jit
Signature
cc: Facility Assessment Unit
Use Attachments if Needed.