310351_INSPECTIONS_20171231

NUH I H UAHULINA
Department of Environmental Qual

Date of Visit: 1121�f Arrival Time: Co I Departure Time: %Q County: Region:
Farm Name: :LnbH Ike k�►, 'tg., Owner Email:
Owner Name: ��ti^��e A;-- t g Phone:
Mailing Address:
Physical Address:
Facility Contact: �ei7 - ';Towle 5 Title: Phone:
Onsite Representative: Integrator:
Certified Operator:
Back-up Operator:
Location of Farm: Latitude:
Certification Number:
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Wet Poultry
Layer
Design
Capacity
Current
Pop.
Design Current
Cattle Capacity Pap.
Dairy Cow
ean to Feeder
on -Layer
Dairy Calf
V'Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
D , P.oul.
Layers
Design
Ca aci
Wrent
,
Dairy Heifer
D Cow
Non
Beef Stocker
Gilts
Non -Layers
113eef Feeder
Boars
Pullets
Beef Brood Cow
Qtber
Other
Turkeys
Turkey Pouets
Other
Dischar es and Stream_ Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes �0[:] NA ❑ NE
❑ Yes [-]No
[—]Yes [—]No
[]NA ❑NE
❑ NA ❑ NE
❑ Yes ❑ N ❑ NA ❑ NE
❑ Yes V ❑ NA ❑ NE
❑ Yes V ❑ NA ❑ NE
Page I of 3 21412015 Continued

Facility Number: jDate of Inspection:
Waste Collection& Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ❑ No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure l Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): �• 32 Tr
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 Eel 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 environmental hreat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes N❑ NA ❑ NE
�ZD8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes to ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes o ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? if yes, check the appropriate box below. ❑ Yes 2rNo ❑ 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 [2rNo ❑ 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 No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
[:]Yes No
❑ Yesra'No
❑NA ❑NE
❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
[:]Yes No ❑ NA ❑ NE
❑WUP ❑Checklists El Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ZNo ❑ 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 InspectioWNc
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes do ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facility N,imber: 31- Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit?
[—]Yes
0No
❑ NA [:]NE
25. Is the facility out of compliance with permit conditions related to sludge? if yes, check
�s
@ No
❑ NA ❑ NE
box(es) below.ure
Zaropriate
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
ET -No
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
❑ No
[3115A ❑ 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
E o ❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
�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
F3<0 NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
No ❑ NA
❑ NE
Comments(referto question !#.) Explain any:YE5 answe nd/or anydiflorialrecoTnunendations orvany c►thercominents
�,
Use'drawin: of facility tobetter egpla�n�sityahons:(use addition ._pales.;. nec... `arYi�: .
��1A0ILI
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date: / !.
21412015

f
• Division oiWater Resources
Facility Number - ® fl Divisio of Sail aad Water Conservaiiflu
0+ Other Agency
Type of Visit: 0 Co pliance Inspection Operation Review p Structure Evaluation p Technical Assistance
Reason for Visit�Routtine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: 2 ( Departure Time: 2 Y County:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Owner Email:
Phone:
Facility Contact: Title:
Onsite Representative: -7--9 0 ok f �.' f /X " II Integrator:
Phone:
Region:
Certified Operator: Certification Number: Y? & P72—
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Swine
Wean to Finish
Design Current
Capacity Pop.
I
Design Current
Wet Poultry Capacity P.
I La er
Design Current
Cattle Capacity Pop.
DairyCow
can to Feeder
Non -Layer
DairyCalf
Feeder to Finish
2 p
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Design Current
, Ca aci P,o
Layers
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Gilts
ers
Boars
EDnt
Beef Brood Cow
Other
Other
oints
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
No 0 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 DWR)
❑ Yes
[:]No ❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
[:]No ❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
Eallo NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
IGTKo l__I NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412015 Continued

Facility Number: 3_i - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure 1 Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
Structure 5
❑ Yes
❑ Yes
No ❑ NA
❑ No ❑ NA
Structure 6
No ❑ NA
No ❑ NA
❑ NE
❑ NE
❑ NE
❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
�❑ NA
❑ NE
$. 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
dNo 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
N ❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ NA
gNo
❑ 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
Ef>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 N 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 El Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 6 No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections [:]Monthly and V Rainfall Inspections Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes N 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 Continuer!

Facili Number: - Z Date of ins ection:
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
No ❑ NA
❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
L3 1YO ❑ NA
❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes
No ❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
❑ No LE "'" ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes No ❑ NA ❑ NE
❑ Yes ❑W�__Ej NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes dNo ❑ NA ❑ NE
❑ Yes ff'Ro NA ❑ NE
❑iv ❑ Yes -ow ❑ NA ❑ NE
❑ Yes 0-50 EI NA ❑ NE
i�a.via.n•.arau�Ya. a. w. i. n..,... _ . / _. V . - - ■ . - `,V"( 1 , ....,,...
Reviewer/Inspector Signature:
Page 3 of 3
Date: -7/Z P/ r
214/201s

Type of Visit: Compliance Inspection 0 Operation Review p Structure Evaluation Q Technical Assistance
Reason for Visit: .tEI-Routine O Complaint Q Follow-up O Referral O Emergency 0 Other O Denied Access
Date of Visit: I Arrival Time: O Departure Time: County: `nl Region:
Farm Name: ,, o, iino_ Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: G141"'a X[ ,�d ..S s
Certified Operator:
Back-up Operator:
Location of Farm:
Title:
Latitude:
Phone:
Integrator: rLt JA
Certification Number:
Certification Number:
Longitude:
rieder
wine
an to Finish
Design
Capacity
C•urreAt Design Current
Pop. Wet Poultry Capacity Pop.
Layer
Design Current
Cattle Capacity Pop.
DairyCow
an to Feeder
Non -La er
DairyCalf
to Finish
Design Gnrrent
D . P.oult , Ca aci P,o ,
Layers
DairyHeifer
Dry Cow
Non -Dairy
Beef Stocker
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Non -Layers
Pullets
Beef Feeder
Boars
Beef Brood Cow
Other
Other
I
Turkeys
Turkey Poults
10tb,
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 ❑ NA ❑ NE
❑ Yes
Irl No
❑ NA
❑ NE
❑ Yes
❑' No
❑ NA
❑ NE
❑ Yes ZNo
❑ Yes 2 f No
❑ Yes ❑ No
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
Page 1 of 3 21412015 Continued

1�)
Facili Number: jDate of Ins ection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes J2 No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes KNo ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
E f No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed andlor managed through a
❑ Yes
[?fNo
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
❑"No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
ZNo
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
E�rNo
❑ NA
❑ NE
maintenance or improvement?
Waste Anplication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes C;kNo ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes eNo ❑ 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 ZNo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes EErNo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable [:]Yes ONo ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Reauired Records & Documents
❑ Yes ;"No ❑ NA ❑ NE
❑ Yes L'No ❑ NA ❑ NE
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 a ❑ Design [:]Maps [:]Lease Agreements
❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
;5,1Qo
❑ 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
L2'lNo
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
EINo
❑ NA
❑ NE
Page 2 of 3
21412015 Continued

Facility Number: - Date of Inspection: 2 -
24. Did the facility fail to calibrate waste application equi�ment as required by the permit? [—]Yes
P'•No
❑ NA
❑ NE
�5. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes
E:rNo
❑ NA
❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey El 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
;3 No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes
C;�No
❑ NA
❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes
[,_2-*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
L2 r4o
❑ 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
eNo
❑ 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
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
'Lg-No
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
ONo
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes
❑"No
❑ NA
❑ NE
34. Does the facility'require a follow-up visit by the same agency? ❑ Yes
F-;Ko
❑ 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).
a3
Al
Lj'�'�
Reviewer/Inspector Name: K,tPhone: �-
Reviewer/Inspector Signature: Date: lZ l
Page 3 of 3 21412 4S

Type of Visit: ,()-Compliance Inspection 0 Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: JErRoutine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: 1.2 / Arrival Time:�� Departure Time: County: 14A�
Farm Name: Y=lnan e ' `krP_ Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title: Phone:
Onsite Representative: (6fin'
a
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Integrator:
Certification Number:
Certification Number:
Longitude:
Region:
Design Current
Swine Capacity Pop.
Wean to Finish I
Design Current
Wet Poultry C►apacity Pop.
Layer
Design Current
Cat#le Capacity Pop.
Dairy Cow
Wean to Feeder ]Non
-Layer
El
Dairy Calf
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Design Current
D F P,oultr, Ca aci P,o -
ILayers I
Dairy Heifer
2-9-Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turke s
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 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 ja-Ro ❑ NA ❑ NE
❑ Yes M No
❑ Yes _ 3 l�o
❑ Yes 23"No
[:]Yes E Flo
❑ Yes [3-No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3 21412014 Continued

Facility Number: - Date of Inspection: 2
Waste Co'llection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [;,No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? [:]Yes ❑'No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ( -2—
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): Z
5. Are there any immediate threats" to the integrity of any of the structures observed? ❑ Yes �i o ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not'properly addressed and/or managed through a ❑ Yes KNo ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes E No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes El —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
[TNo
❑ NA
❑ NE
maintenance or improvement?
11. Is there eviderice 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 7"ype(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[i]''No
❑ NA
❑ NE
't
15. Does the receiving crop and/or land application site need improvement?
0 Yes
[ErNo
❑ 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
[�JNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
[:]Yes
[2-No
❑ NA
❑ NE
Reouired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes [3,No ❑ NA ❑ NE
20. Doc%Ohe facility fail to have all components of the CAWMP readily available? If yes, check ❑Yes �3Qo ❑ 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 �jNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? [:]Yes [ No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No ❑ NA ❑ NE
Page 2 of 3 214120I4 Continued

Facility Number: Date of Inspection: f e AVZZ7
24. Qid the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes _0 No ❑ NA ❑ NE
A Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes �'No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes La No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ErNo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes )Z`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 PAo ❑ 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 C"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
0No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
210'No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
21-No
❑ NA
❑ NE
Comments (refer -to question ) Explain any YES answers and/or any additional recommendations or any other comments.
lice draw�ngc°of'facility tobetter. egolaEn sitiiahonsi(use`additional rues as necessarv).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
AIV
Phone:
Date:
21412015

Type of Visit: kMompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: 0
Arrival Time: C Departure Time: County: a94
Region:6, Z/
Farm Name: .p,� f n� Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator:
Certification Number:
Certification Number:
Longitude:
Design
Swine Capacity
Wean to Finish
Current
Pap.
Design Current
Wet Poultry C*apacity Pop.
La er
Cattle
Dairy Cow
Design Current
Capacity Pop.
Wean to Feeder
Non -Layer
Dairy Calf
Feeder to Finish
d o
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Design Current
D . P,oul Ca aH t o
ILayers I
Non -Layers
jPullets
Dry Cow
Non -Da'
Beef Stocker
Gilts
Beef Feeder
Boars
Beef Brood Cow
Other__JTurkey
Other
Turke s
Poults
I Other
Dischar es and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)? _
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes ZrNo ❑ NA ❑ NE
❑ Yes ❑' No
❑ Yes ZNo
❑ Yes JoNo
❑ Yes 6 No
❑ Yes ONO
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 21412014 Continued

Facility Number: - Date of Ins ection:
Waste Collection & Treatment
4.1s storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes r,] No
a. If yes, is waste level into the structural freeboard? ❑ Yes No
❑ NA ❑ NE
❑ NA ❑ NE
Structure 1 Struc 7
2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 7 (/
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes [2fNo ❑ 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 Pj No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
P 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?
T
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
I I . Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
0 PAN ❑ PAN > 10% or 101bs. ❑ 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):
l4. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
En No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
V] No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
No
❑ NA
❑ NE
acres determination?
iI
17. Does the facility lack adequate acreage for land application?
❑ Yes
P No
❑ NA
❑ NE
l8. Is there a lack of properly operating waste application equipment?
❑ Yes
ff No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
l] No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
VJ 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 ZNo ❑ 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 9No ❑ NA ❑ NE
Page 2 of 3 21412014 Continued

Facility Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
534No
❑ NA ❑ NE
♦' • I.-
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
�No
❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
❑ Yes
EfNo
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
0 No
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
ONo
❑ 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 4� No ❑ NA ❑ NE
❑ Yes VfNo ❑ NA ❑ NE
❑ Yes .0 No ❑ NA ❑ NE
[]Yes No
❑ Yes No
❑ Yes No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Reviewer/Inspector Signature: L� Date: U/z77l
Page 3 of 3 /4/20 4

Type of Visit:.,Z Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: .LD"kioutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: ! Z Arrival Time: Z7t Departure Time: County: jo��e2ljk
Farm Name: Owner Email: �"'�`�"
2 in
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: `g LhY1 k. k%A Lev
Certified Operator:
Back-up Operator:
Location of Farm:
Title:
Latitude:
Phone:
Phone:
Region: 1.
Integrator:
Certification Number:
Gl�
Certification Number:
Longitude:
Design
Swine Capacity
Wean to Finish
Current Design Current
Pop. Wet Poultry Capacity Pop.
Layer
Cattle
Dairy Cow
Design
Capacity
Current
Pop.
Wean to Feeder
[Non -Layer
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Feeder to Finish
Design Current
Il . l;oult , Ca aci P,o
Farrow to Wean
Farrow to Feeder
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turke s
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 DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes �no ❑ NA ❑ NE
❑ Yes 2TNo ❑ NA ❑ NE
❑ Yes PNo ❑ NA ❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes �jNo
❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

Facility Number: - Date of Inspection: `L't
Waste Collection & Treatment
4, is storage bapacity (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 [2rNo ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: { Zr
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ZNo ❑ 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
eNo
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental
threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
E].No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
[:]Yes
f2'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
7No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
P'No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
FM
❑ NA
❑ NE
r ❑ 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
EfNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
VfNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
�' o
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
UfNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
JET No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
0 Yes
gpo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
[:]Yes
[I -No
❑ NA
❑ NE
the appropriate box.
TT
❑WUP ❑Checklists ❑Design [:]Maps [:]Lease Agreements ❑Other:
.11
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 V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes �TNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes ZNo ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: - Date of Inspection: f
r
24. Did the,facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
dNo
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
dNo
❑ 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
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
';allo
JC2'No
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes Z No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes ja'No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes P No ❑ NA ❑ NE
Comments (refer to question ff): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawinizs of faciliav to better explain situations (use additional na2es as necessarv).
� A �
j j -7
[:]Yes [�J'No ❑ NA ❑ NE
❑ Yes �To ❑ NA ❑ NE
❑ Yes [2"No ❑ NA ❑ NE
❑ Yes �/No ❑ NA ❑ NE
Reviewer/Inspector Name: V l ✓\ Phone: 67 7��7V3 4,
Reviewer/Inspector Signature: �� Date: [
Page 3 of 3 21412011

(Type of Visit: Q Compliance Inspection O Operation Review O Structure Evaluation Q Technical Assistance
Reason for Visit: O Routine O Complaint Q Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: eparture Time: County: UY4-
� RegionlC.�.J�j
Farm Namebe_ Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Phone:
Facility Contact: Title: Phone:
Onsite Representative: _ 1� Integrator:
Certified Operator: Certification Number: 466;r'0�a/
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design Current
By Swine Capacity Pop.
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
WetPoultry
Layer
]Non -Layer
Dr, P`oulte,
Design
Capacity
Design
Ca aci
C*urgent
Pop.
Current
P,o
Cattle
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Design it
Capacity Pop.
Farrow to Finish
Layers
Beef Stocker
Gilts
Boars
Non -La ers
Beef Feeder
Pullets
Beef Brood Cow
Other
Other
Turkeys
Turkey Poults
10ther
Discharges 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
E f No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
eNo
[DNA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
[:]Yes
P/No
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

Facility Number: - Date of —Inspection:
WasteCollection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes Zf No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier.
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):�
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes �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 .f!!fNo ❑ 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 217No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes ONo
[DNA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures
require ❑ Yes E'No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes eNo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes to
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground
❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure
to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift
❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes Z No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes '01No ❑ 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
2<0
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
P�No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
O No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
o
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, the the appropriate box w. Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly FreeboardfinutWeInspections
aste Analysis Soil Analysis Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Monthly and V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes 1Z ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: jDate of Inspection:
24. Di4 the facility fail to calibrate waste application equipment as required by the perm [:]Yes ONO
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [:]Yes T'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 ZNo
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes eNo ❑ 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 ENo ❑ 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 ZNo ❑ 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
PNo
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
VNo
❑ 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
To
❑ 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).
� FLI>6//1- 7
11117110y 317
es re/n d6l-e- OrK&-z � av
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date:
21412011

r.
[Facility Number
Q Division of Water Quality
0 Division of Soil and Water Conservation
O Other Agency
Type of Visit j2r6^ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Tec ical Assistance
Reason for Visit �outine O Complaint O Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: / % Arrival Time: Departure Time: County: Regionsli✓/%'
Farm Name: ✓: i.++ Z! V_1/'t4_ Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Phone:
Facility Contact: Title: Phone No:
Onsite Representative: �C�f�yl S" Integrator:,�L�
Certified Operator: Operator Certification Number:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Back-up Certification Number:
Latitude: [= c [= A [ Longitude: = ° 0 ` =
cg
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
II ❑ Non -La et
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharees & Stream impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current I
Cattle Capacity Population
❑ DaiEy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Coyj
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes EQ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
�o
❑ Yes
�io
❑ NA
❑ NE
❑ Yes
2<o
❑ NA
❑ NE
12128104 Continued

Facility'Number: 31 -7- Date of Inspection 2 Aeln
-waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ,fNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Strueture 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: y 3/
SpillwayT
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ❑-5o
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes oNo
❑ 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 .2 No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ZNo
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes .0'No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ YesE201io
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ,8 No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes �21go
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes ErNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes -ETONo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes ZrNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes _20&�o
❑ NA
❑ NE
Comments refer to uestion #)c Explain any YES. answers°and/or anyZr`ecommendations or_any other comments , *" ;
_ _
Use draK�ngs oI facility to better explain sitnations (use. add�honal pages as necessary)
�-
Reviewer/Inspector Name
`r Phone:
Reviewer/Inspector Signature:
Date: 2 j
Page 2 of 3 121A104 Continued

r_ Facility Number: — Date of Inspection
'Required Records & Documents
19. Did the facility fail to have 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 ZNo ❑ NA ❑ NE
the appropriate box. ❑ W`IJp ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ,2Io ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes ,'No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes ATNo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes ONo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes LROfqo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes -r— No
❑ NA
❑ NE
2T
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes ,FeMo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes ETNo
❑ 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 E 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 AI�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 j2No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes JVNo
❑ NA
❑ NE
Additional Comments and/or -Drawings:
i,✓ � �,� et--Urz��
O /
C ���CJst_ lti S�fl
lee
Page 3 of 3 12128104

Type of Visit ,,-O Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Routine O Complaint O Foliow up 0 Referral O Emergency 0 Other ❑Denied Access
Date of Visit: Arrival Time: Departure Time: County:
Farm Name:rG� /` Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: r
Certified Operator:
Back-up Operator:
Phone:
Region:
Phone No:
Integrator• /c 1 „_
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: = 0 = = Longitude: = ° = 4 = "
gnEurrent
Design Crent
esignCciulation
11
F
Wet Poultry
Capacity Population
Cattle Capacity Population
❑ Wean to Finish
❑ Wean to Feeder
❑ Feeder to Finish
❑ DairyHeifer
❑ Farrow to Wean
Farrow to Feeder
Farrow to Finish
❑ Gilts
❑ Boars
7Non-Layers
J
Turkeys
❑rMOther
❑ D Cow
❑ Non -Dairy❑
❑ Beef Stocker
❑Beef Feeder
❑ Beef Brood Co
Other
urke Poultser
Number of Structures:
❑ Layer
Dairy Cow
❑ Non -Layer
Dairy Calf
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes ,ENo
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
❑ Yes
L
1 No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
fNo
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
'jI No
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12128104
Continued

Faeility Number: — Date of Inspection
Wasie 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 PNo ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: Z 2, �%
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): �2
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes pMo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes % ❑ 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 P'No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ,CNo ❑ 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 -f�No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes O'No ❑ NA ❑ NE
maintenance/improvement?
It. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes P�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)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes ZNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
V No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
jEf No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
EfNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
VNo
❑ NA
❑ NE
Commeuts (refer to question #) eEiWain any YES;ansyrers and/or any recommendations=or any other eotnuients.
Use drawings of facility to, better explain situations (use additional pages as necessary)
e
Reviewer/Inspector Name - --� Phone:
Reviewer/Inspector Signature: Date: L4
12128104 Continued

r -
Facility Number: Date of Inspection
R4wired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 2No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes �No ❑ NA ❑ NE
the appropriate box.
❑ WUF ❑ Checklists El Design [I Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ,ETNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes Z No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
Pw&o
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
,ETNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
6''No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
El Yes
f NNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? i
❑ Yes
E No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
El,Y� Yes
r,�
No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
FefNo
❑ 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?
ElZ 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
XNo
❑ NA
❑ NE
General Permit? (iel discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
;�No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
jNo
❑ NA
❑ NE
Additional Comments andlorrtDrawings'�
ry ..
17
�s lag <<�
Pi
1212VO4

ANIMAL WASTE UTILIZATION PLAN
Producer:
Location:
Telephone:
Type Operation:
Number of Animals:
(Design Capacity)
STORAGE STRUCTURE:
APPLICATION METHOD:
CHARLES KNOWLES
189 POWELL PAGE RD
WALLACE NC 28466
910-532-2320
RECEIVED / DENR / DWQ
Aquifer Protection Section
MAR 2.0 2009
Existing Feeder to Finish Swine
3648.00 hogs
Anaerobic Waste Treatment Lagoon
Irrigation
The waste from your animal facility must be land applied at a
specified rate to prevent pollution of surface water and/or
groundwater. The plant.nutrients in the animal waste should be used
to reduce the amount of commercial fertilizer required for the crops
in the fields where the waste is to be applied.
This waste utilization plan uses nitrogen as the limiting nutrient.
Waste should be analyzed before each application cycle. Annual soil
tests are strongly encouraged so that all plant nutrients can be
balanced for realistic yields of the crop to be grown.
Several factors are important in implementing your waste utilization
plan in order to maximize the fertilizer value of the waste and to
ensure that it is applied in an environmentally safe manner:
I. Always apply waste based on the needs of the crop to be
grown and the nutrient content of the waste. Do not apply
more nitrogen than the crop can utilize.
2. Soil types are important as they have different infiltration
rates, leaching potentials, cation exchange capacities, and
available water holding capacities.
3. Normally waste shall be applied to land eroding at less than
5 tons per acre per year. Waste may be applied to land
eroding at 5 or more tons per acre annually, but less than
10 tons per acre per year providing that adequate filter
strips are established.
4. Do not apply waste on saturated soils, when it is raining,
or when the surface is frozen. Either of these conditions
may result in runoff to surface waters which is not allowed
under DWQ regulations.
Page: 1

r
(Type of Visit Jf Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance I
Reason for Visit Q� Routine O Complaint 0 Follow up 0 Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: !:fc' Arrival Time: Departure Time: County: f Region:
Farm Name: _ �i , 0-1a 711/i,e- ,1�✓ 12-7 Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Phone:
Facility Contact: Title: Phone No:
Onsite Representative:—L7�r'si�, /f ti -I/f' S Integrator: WI&ahnn
Certified Operator: Operator Certification umber:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: ❑ c = ❑ « Longitude: [= ° ❑ ` = "
Design Current
.Swine Capacity Population
❑ Wean to Finish
❑ Wean to Feeder
0 Feeder to Finish
iz, 6
-j-
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other'
❑ Other
Design Current
Wet Poultry Capacity Population
❑ Layer
❑ Non -La ec
'Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifej
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures:,
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes Z No ❑ NA ❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
❑ No ❑ NA -
❑ NE
❑ Yes
❑ Yes
,0'Nfo ❑ NA
❑ NE
❑ Yes
No ❑ NA
❑ NE
12128104 Continued

Facility Number: 3 / 33 Date of Inspection ll Y�
Wa4'Collection & Treatment
r,
r4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes U 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: 2'
/
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): � j _2
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes P'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 -B 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 -ffNo
❑ NA
❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes -ErNo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes B'No
❑ NA
❑ NE
maintenance/improvement?
11. is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes /0 No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 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) _ _ t'%/�G�_ �/��
a
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes-,E3No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes — -No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination%❑ Yes.,E 1vo ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? [:]Yes _E3?;`o­ ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes _EJNtL ❑ NA ❑ NE
Reviewerllnspector Name �-- a< / r,� hone: 7 el6 - 7�
ReviewerlInspector Signature: Date:
12128104 Continued

Facility ,Number: 3 Date of Inspection �/d G
Rimed Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes E]"No ❑ NA Cl NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes �' o ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps El Other
21. Does record keeping need improvement? if yes, check the appropriate box below. ❑ Yes Ef'No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 " Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ZNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑'No
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
0 No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
D-NO
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes 0,No
❑ NA ❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes BNo
❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes 0-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 12No
❑ 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 ETNo
❑ 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 47-1—No
❑ NA ❑ NE
12128104

6 Permitted)dCerdfied 0 Conditionally Certified 13 Registered Date Last
Farm Name: ,�� - ✓�-___ Coca
Threshold:
Owner Name: _ ---------... _ Phone No:
Mailing Address:
Facility Contact: J _- Title:._ . _ _--------------__ _-._ ._ Phone No:
Onsite Representative: 9 i v�b �. M. _. Integrator: A
Certified Operator:. _ _ __.. ... _ . _ ..__..... ... _ Operator Certifiratian
Location of Farm:
F\
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude Longitade �• �' �"
Discharges -StreamImpa
1. Is any discharge observed from any part of the operation? ❑ Yes �No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gallmin?
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):
12112103
❑ Yes ❑ No
❑ Yes j"No
❑ Yes `�No
❑ Yes QdNo
Structure 6
Continued

Facility Number: — Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (id trees, severe erosion, es ❑ No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑ Yes
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? [(Yes AWNo
8. Does any part of the waste management system other than waste structures require maintenancerimprovement? !❑ Yes TNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes 121Qo
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes 'ONO
11. Is there evidence of over application? If yes, check the appropriate boa below. ❑ Yes .moo
❑ Excessive Ponding ❑ PAN ❑ Hy c Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type S (�
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes
14. a) Does the facility lack adequate acreage for land application? ❑ Yes RNo
b) Does the facility need a wettable acre determination? ❑ Yes ,Ergo
c) This facility is pended for a wettable acre determination? ❑ Yes ,ff No
15. Does the receiving crop need improvement? ❑ Yes P No
I6. Is there a lack of adequate waste application equipment? ❑ Yes ' 1q0
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge agar below ❑ Yes PORo
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes P No
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes ;W<o
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 J2�W
Air Quality representative immediately-
Else-
f 12 Cr
�ao�s 540�,
y 1 e cord s ovt rie-�-- 4- d- o r o ,r lV
Reviewer/hmpector Name
ReviewerAnspeewr Signature:
Date:
MUM Conw"W

Facility Number: ��� L�cJ Date of inspection
. . i •— c r
Requireditecords & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes ON 0
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes No
23. Does record keeping need improvement? If yes, check the appropriate box below.
�es ❑ No
❑ Waste Application ❑ FreeboardeWaste Analysis ❑ Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes 00
25. Did the facility fail to have a actively certified operator in charge?
❑ Yes ,B'No
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
Yes ONo
(ie/ discharge, freeboard problems, over application)
❑
27_ Did ReviewerAnspector fail to discuss reviewlinspectian with on -site representative?
[:]Yes E040
28. Does facility require a follow-up visit by same agency?
❑ Yes eNo
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes PAia
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (if no, skip questions 31-35)
�es ❑ No
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes , faWo
32. Did the facility fail to install and maintain a rain gauge?
❑ Yes eNo
33. Did the facility fail to conduct an annual sludge survey?
❑ Yes ,OYTo
34. Did the facility fail to calibrate waste application equipment?
❑ Yes '2No
35. Does record steeping for NPDES required forms need improvement? If yes, check the appropriate box below.
❑ Yes 1KNo
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall . ❑ Inspection After 1" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
113 No violations or deficiencies were noted duriina this visit. You will receive no further correspondence about this visit.
FA
o.�- t,3i rt 6 o ,-3 +o r r f/�/6 j y a S/- Oy
Pcrar�:�ry evfs: Clsea/ . 7/y�u/ WQ3�
a,Z alyS Vs, ��/C�2.S e 7�%e mo�c r�ul r
GI/O�C GZ/�C!!y /loT
OliE/- cr�e4lo �--z-' - � �� s •ems
12112103

(Type of Visit QrCompliance Inspection O Operation Review O Lagoon Evaluation I
IReason for Visit 6 Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Date of Visit: I
Facility Number
Permitted Certified 0 Conditionally Certified 0 Registered
Farm Name: �-
Owner Name:
Tame:
Not Operational O Below Threshold
Date -Last Ope r Above old:
County: ,�' f_
Phone No:
Mailing Address:
Facility Contact: _ . _ _ .. _ ... Title: .. __ one
Onsite Representative: gL Integrator:
Certified Operator. Operator Certification Number:
Location of Farm:
Vswine ❑ Poultry ❑ Cattle ❑ Norse Latitude • 4 u Longitude • �u
Discharges & Stream Impa
1. Is any discharge observed from any part of the operation? ❑ Yes R<o
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure i Struc 2 Structure 3 Structure 4 Structure 5
Identifier: ��_
Freeboard (inches):
l2/I2M
❑ Yes ❑ No
❑ Yes 12R166
❑ Yes Rtro
❑ Yes OrKo
Structure 5
Continued

Facility Number: -f Date of inspection C�
5. Arerthi re zay immediate threats to the integrity of any of the structures o served? (ie/ trees, severe erosion, ❑ Yes ;ZNo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑ Yes
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? ❑ Yes 'ONO
S. Does any part of the waste management system other than waste structures require maintenancerimprovement? ❑ Yes �No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes,,Z"No
elevation markings?
Waste ARplication
10. Are there any buffers that need maintenanc:ehmprovement? ❑ Yes XNo
1 I . Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes PrIlo
❑ Excessive Ponding [I PAN [I Hydraulic Overload ❑ Frozen Ground El Copper and/or Zinc
12. Crop type �a �� //-ir JT
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes 01No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes Z14o
b) Does the facility need a wettable acre determination? ❑ Yes 2No
c) This facility is pended for a wettable acre determination? ❑ Yes LI-No
15. Does the receiving crop need improvement? ❑ Yes E!rNo
16. Is there a lack of adequate waste application equipment? ❑ Yes Eli o
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes ErNo
liquid level of lagoon or storage pond with no agitation?
IS. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes J" No
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes .Q No
roads, building structure, and/or public property) 1
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional ❑ Yes o
Air Quality representative immediately.
❑ Feld Copy ❑ Final Notes
Alec' r ['Gn��/�.�c�.��/
y.
ReviewerAWapector Name':-
ReviewerAWspector Signature: Date:

Facility Number: s Date of Inspection E2=F
Reuuired Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes P610
22. Does the facility fail to have all components of the Certified Animal Waste Management Platt readily available?
(ie/ WUP, checklists, design, maps, etc.) ❑ Yes �(No
23. Does record keeping need improvement? if yes, check the appropriate box below. ❑ Yes RNo
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes P140
25. Did the facility fail to have a actively certified operator in charge?
❑ Yes ;KNo
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
[:]Yes
(ie/ discharge, freeboard problems, over application)
VNo
27. Did Reviewer/inspector fail to discuss reviewfmspection with on -site representative?
❑ Yes gNo
28. Does facility require a follow-up visit by same agency?
❑ Yes ;�,No
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes 42No
I PDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
F1'e$ ❑ No
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes eNo
32. Did the facility fail to install and maintain a rain gauge?
❑ Yes XNo
33. Did the facility fail to conduct an annual sludge survey?
❑ Yes ❑ No
34. Did the facility fail to calibrate waste application equipment?
❑ Yes No
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below.
❑ Yes o
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After 1" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
l2112/03

r,
Type of Visit 6-Compliance Inspection 0 Operation Review 0 Lagoon Evaluation I
Reason far Visit ISRoutine 0 Complaint O Follow up Q Emergency Notification Q Other ❑ Denied Access
Facility Number
Date of Visit: � Time:
rO 3�
Not Operational 0 Below Threshold
UPermitted S Certified M Conditionally Certified D Registered Date Last Operated or Above Threshold:
mil
Farm Name: +�!/DA� /'r%!r e- Aa- l'P County: [ p//117
Owner Name:
Mailing Address:
Phone No:
Facility Contact: Title: Phone No:
Onsite Representative: Z51u>AE'.,- Integrator:
Certified Operator: Operator Certification Number:
Location of Farm:
[]Swine ❑ Poultry ❑ Cattle ❑Horse Latitude 0 ° 66 Longitude a °
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes FrNo
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 I Structure 2 Structure 3 Structure 4 Structure 5
Identifier: 2
Freeboard (inches): 35 3 (/
05103101
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes KNo
❑ Yes FrNo
❑ Yes tZ No
Structure 6
Continued

h.
f'Facility Number: 3f — 3 j Date of inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
_ 8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid_ level
elevation markings?
❑ Yes - 93 No
❑ Yes RLNo
❑ Yes R o
IR Yes ❑ No
❑ Yes RNo
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes EgNo
11. is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes MNo
12. Crop typedl!
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes Eallo
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?
0 Yes
❑ No
16.
is there a lack of adequate waste application equipment?
❑ Yes
RNo
Required
Records & Documents
17.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
K[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
1KNo
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
Q No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
§QNo
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
91 No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes
0 No
(ie/ discharge, freeboard problems, over application)
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
UNo
24.
Does facility require a follow-up visit by same agency?
❑ Yes
&d No
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
5a No
0 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Coents (refer, to question #r7 E0.lain any YES answeWnud[lor any ec rommendatious or any=other com mmments.;
Use �ratviugs of facility to better eaplaui situations. °(use'adc'�itional pag s as necessary)
❑ Field Copy ❑ Final Notes
U. _ .
#� —(��n �vu e✓'i het ktO�✓i�t,� .
Old Ilky oteeWo 7�v k. us.1.! "A �cdr�� c�
-A> IwJ^ i°
AI _i_ J&14 an '7Rel/ W� y
/yob: Jl/aa�� 5 n� an G>� ott•- 'J46f '9.
A, eelp
Reviewer/Inspector Name r '> Y .
Reviewer/Inspector Signature:
Date: Q�
O5103101 �� Continued

' Facility 'umber: Date of Inspection
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes P5No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes IgNo
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes RNo
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 t5No
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.) ElYes ^LNo
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes KNo
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes k No
Additional Comments and/or Drawings:
05103101

Type of Visit _,4erCompliance Inspection O Operation Review O Lagoon Evaluation I
Reason for Visit erRoutine O Complaint. O Follow up' O Emergency Notification O Other . ❑ Denied Access
Facility Number 3 3 ] Date of Visit: I
0 Permitted [3 Certified 0 Conditionally Certified 13 Registered
Farm Name: m . �Q...
�e: �G1................................... ltt....... .......................................
Owner Name: Q 5
Time: /) : 20
Not Operational O Below Threshold
Date Last Operated or Above Threshold: ........_...............
County:... ](.....................................................,....
PhoneNo: ........................................................... . ..... . . ........
FacilityContact: ............................................................................... Title:................................................................ Phone No:...................................................
MailingAddress: . .............................................................................
Onsite Re resentative•( kA/'IcJ �(�lIntegrator:
....................................I..........►r..a .41..................................
.................
Certified Operator: ................................................... ............................................................. Operator Certification Number: ................................... .....
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • 4 66 Longitude • 6 «
Design : _ Current y Design Current :, Design Current
Swine Ca act Po nladon Poultry. „ Ca ci .,:Po ulatioa:. Cattle = Ca ci Pa floe
ti Wean to Feeder ❑ Layer ❑ Dairy
" ❑ Feeder to Finish . ❑ Non -Layer ❑ Non -Dairy
❑ Farrow to Wean
Farrow to Feeder ❑Other
❑ Farrow to Finish
Gilts Tota�'Dest C aCl
_ - P
❑Boars _ Tota1:SSLW _
Number of Lagoons _ ❑ Subsurface Drains Present ❑ Lagoon Area . ❑ Spray Field Area y
_.
:-- Holding Ponds /Sand Traps ° ❑ No Liquid Waste Management System
Discharges & Stream Im acts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made`'
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gaUmin?
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 ?� Structure 3 Structure 4 Structure 5
Identifier:
_.................................................................................... I ....................
L4 Freeboard (inches): `t 2-
5/00
❑ Yes )2rNo
❑ Yes ,O'No
❑ Yes 14,140
IQ
❑ Yes P No
❑ Yes 2fNo
❑ Yes JgNo
❑ Yes allo
Structure 6
Continued on buck

Facilily}Vumber: 3 —3 Date of Inspection Printed on: 7/21/2000
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/.trees, severe erosion, ❑ Yes 3dNo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? �QYesDONo
(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 2f No
8. Does any part of the waste management system other than waste structures require maintenancelimproventent? ❑ Yes oNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes O'No
Waste application
10. Are there any buffers that need maintenance/improvement'? ❑ Yes ,&No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes RfNo
12. Crop type /'1r''tu DioL n" ` &-- l 1 G.-A jyi
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss reviewlinspection 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?
Io yiQlatiQris:o deticie�c.ias vtAere noted- ditrfng iiis:visit: • Y'oi� Wi l •i•eeeiye iio further
coriespo de>Etct_ about: this :visit ...:... _
❑ Yes ZNo
❑ Yes Jam-' No
❑ Yes �To
❑ Yes pNo
❑ Yes JXNo
❑ Yes XNo
❑ Yes JFZNo
❑ Yes EfNo
❑ Yes No
Cl Yes 01
❑ Yes ,fNo
ElYes'No
❑ Yes ZNo
❑ Yes )2�No
❑ Yes/No
�1 �4yemr� '5 GUrrch f j� �e� CJoSep� dut�. $Q Svre 40 Ge.� a Co��l
✓ J
n�coro#s Rom'�� ke�� ov1 a 1De�'ietd aGrea9
c
V�eeot �o be Sore 4z> 15 f el.,[ Is ri
y
Reviewer/Inspector Name 1.'01_WL'-ja I I
Reviewer/Inspector Signature: �/�� ` _ Date, 5/Qp

Facility Number: T — I Date of Inspection
'6dar issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes,&NO
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes -Q No
roads, building structure, and/or public property) 77
29. Is the land application spray system intake not located near the liquid surface of the lagoon? El Yes E-VO
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 No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes -C�No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ❑ No
itiona Comments an Or; raFYings. x.• . F'. ,- }r ct 7 ,:. r .is a'"

1- yw
f♦ 1Drvtston of Water Quality
O=Div�stoti of Soil and Water ConservafJon
O'Ather Agency"
(Type of Visit O+ Compliance Inspection Q Operation Review 0 Lagoon Evaluation
Reason for Visit 0• Routine Q Complaint Q Follow up 0 Emergency Notification Q Other ❑ Denied Access
Facility Number 31 351 Date of Visit: 11-7-2001 Time: 11:20
Q Not Operational O Below Threshold
® Permitted ® Certified 13 Conditionally Certified [3 Registered Date Last Operated or Above Threshold: . __ __ __ ._ _...
Farm Name: iKoip.MjAc.Farju.................................................................... County: I?uptliu.................................... )?4'jR0 ......
Owner Name: �11�irle�_ - --- --------Q------=----- - ----- ---- Phone No: 43.QS2:?,29------ - --------- -----------
Mailing Address: J,89.1'o.we]1.l.agc.1 QAd ............................... ....'W..allage..NC........................................................... 18.466 ..............
Facility Contact: ...........................................................Title: Phone No:
................. ..........................................
Onsite Representative: Charles_�c�iJg]tA1o�Yl Integrator:
Certified Operator:Chariks-F ............................ moxlel ........................................... Operator Certification Number: 1$7..Ct1.............................
Location of Farm:
West of Wallace. South side of Hwy 41 approx. 1.7 miles West of SR 1100. Farm is to the left after entering farm path. &
qr
® Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 34 • 44 20 Longitude 78 • 07 17
Design Current
Swine Capacity Pdnulation
❑ Wean to Feeder
® Feeder to Finish
3648
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Design Current Design Current
Poultry Capacity Population Cattle Capacity Population
❑ Layer I I ❑ Dairy
❑ Non -Layer ❑ Non -Dairy
❑ Other
-Total Design Capacity 3,648
Total SSLW 492,480
Number of Lagoons 2 [®-Subsurface Drains Present JIM Lagoon Area ❑ Spray Field Area
Holding Ponds / Solid Traps ❑ No Liquid Waste Management System
Discharses & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes ® No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ® No
b. if discharge is observed, did it reach Water of the State? (if yes, notify DWQ) El Yes No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ® No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes ® No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ®No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ® No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:--•--.lrotl Mine--.__. ------ harles_K...... ..........................
Freeboard (inches): 48 42
AC/A 71At l __. i___-._J

i -
41J/UJ/Vl 4 unsiI ueu
Facility Number: 31-351 Date of Inspection 11-7-2001
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes N No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑Yes ❑ No
(if any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes N No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes N No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes N No
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes N No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes N No
12. Crop type Coastal Bermuda (Hay) Small Grain Overseed
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes N No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes N No
b) Does the facility need a wettable acre determination? ❑ Yes N No
c) This facility is pended for a wettable acre determination? ❑ Yes N No
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 or other Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(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?
❑ Yes N No
❑ Yes N No
❑ Yes N No
❑ Yes N No
❑ Yes N No
❑ Yes N No
❑ Yes N No
❑ Yes N No
❑ Yes N No
❑ Yes ® No
❑ Yes N No
0 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Corniiients (i efer to `question # Ezplain-any YES answers apolor any -recommendations of aoy other comments .- -27
se drawings of facELty to;better-expla�nsituations {u UseFaddrtipnal pages as:necessary)
a
= ; El Copy ❑ Final Notes
6. A lagoon is currently being closed out. Be sure to get a copy of closure plan in records.
19. Spray records are being kept on a per field acerage basis. Need to be sure to spray evenly over field as it appears is currently being
done.
Reviewer/Inspector Name Stonewall.Mathis entered by Bette Rose
Reviewer/Inspector Signature: Date:

05103101 Continued
Facility Number: 31--351 Date of Inspection 11-7-2t?01
Odor issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes OR No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes ® No
roads, building structure, and/or public property)
29_ Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes ® No
30_ Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes ®No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes ® No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ❑ No

Facility Number 31 351 Bate of Visit: 11-7-20111 Time: i I:ZO
Q Not O erational Q Below Threshold
® Permitted ® Certified 13 Conditionally Certified [] Registered Date Last Operated or Above Threshold: . ...... .. .. ..
Farm Name: Iron Mine.Farm.................................................................... County: D-Uplia.................................... WjRQ......
Owner Name: Charltj_------------- - Kn4-------------------------- Phone No:'?JAM2:MD-----------------------------
Mailing Address: l8Q.FQwe1L.PAgc.RQad....................................................................... N'aRai ie... N.C........................................................... Z8.46 6..............
Facility Contact: ................................................... ....Title: ... Phone No:
OnsiteRepresentative- char]e5_&Cxlcluu03YL�5 Integrator:�pj�yxa��__________________.
Certified Operator: Charles..14 Qarlcaf ............................ Kxta !le i........................................... Operator Certification Number: 187..CaI.............................
Location of Farm:
West of Wallace. South side of Hwy 41 approl. 1.7 miles West of SR 1100. Farm is to the left after entering farm path. #
® Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 34 • 44 20 u Longitude
Design. Current
Design
Current
Design Current
Swine Capacity Population
Poultry Capacity
Population Cattle
Capacity Population
❑ Wean to Feeder
❑ Layer .
I
I
ILI
Dairy
® Feeder to Finish
364$
❑ Non -Layer
❑ Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Other
❑ Farrow to Finish
Total Design Capacity
3,648
❑ Gilts
Total SSLW
492,480
❑ Boars
Number of Lagoons 2 ® Subsurface Drains Present JIN Lagoon Area 10 Spray Field Area
Holding Ponds / Solid Traps ❑ No Liquid Waste Management System
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes ® No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. if discharge is observed, was the conveyance man-made? ❑ Yes ® No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑Yes ®No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ® No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes ® No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ® No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ® No
Structure 1 Structure 2 Structure 3 Structure 4 Structure S Structure 6
Identifier: ...... InomMine--- - ...... --------------•--------------•----------------•-----------•------------•-----------•-------
Freeboard (inches): 48 42

t.
VJ/VJti%VI
Facility Number: 31-351
Date of Inspection I 11-7-2001
L UMMuea
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
12. Crop type Coastal Berrnuda (Hay) Small Grain Overseed
❑ Yes N No
❑ Yes ❑ No
❑ Yes N No
❑ Yes N No
❑ Yes N No
❑ Yes ® No
❑ Yes ® No
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes N No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes N No
b) Does the facility need a wettable acre determination? ❑ Yes N No
c) This facility is pended for a wettable acre determination? ❑ Yes N No
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Wguired Records &_Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP,. checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(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?
❑ Yes ® No
❑ Yes ® No
❑ Yes N No
❑ Yes N No
❑ Yes N No
❑ Yes N No
❑ Yes N No
❑ Yes N No
❑ Yes N No
❑ Yes N No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes N No
© No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
❑ Field Copy ❑ Final Notes
6. A lagoon is currently being closed out. Be sure to get a copy of closure plan in records.
19. Spray records are being kept on a per field acerage basis. Need to be sure to spray evenly over field as it appears is currently being
z
Reviewer/Inspector Name Stonewall Mathis entered, by Bette Rose.'.
Reviewer/Inspector Signature: Date:

i
1
'O5103101 Continued
Facility Number: 31-351 Date of Inspection 11-7-2001
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes ®No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes ®No
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes ®No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes ®No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes ® No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ❑ No
Addioonal;, omments'an or-_rawings -_ _

Facility Number 31 351 Bate of Visit: 11-7-2001 Time: 11:20
rO Not Operational Q Below Threshold
® Permitted ® Certified © Conditionally Certified 13 Registered Date Last Operated or Above Threshold: - ..
Farm Name: lrort Mira.Farr....................... ....................... County: VzWia .................................... WI.S?------
Owner Name: Charles----------------- KJIQtLIeS.------------------------- Phone No: 4�Q3Z:?2D___---------------------------
Mailing Address: 1%Q.r9.W.q]I Rage.KQAdl............ .......................................................... .W.At>j#eg...NC........................................................... 18.46.6 ..............
Facility Contact: ...........................................................Title:............................................... Phone No:
..................................... .
OusiteRepresentative: CllSrJe5_&�1€AAA4]K1eSIntegrator:
Certified Operator: QaLrjcs.F............................. KAO.Naes...................... ..................... Operator Certification Number: JA7.41.............................
Location of Farm:
West of Wallace. South side of Hwy 41 approx. 1.7 miles West of SR 1100. Farm is to the left after entering farm path.
® Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 34 OF 44 � 20 u Longitude F 78 OF 07 6 17 u
Design Current
Swine rnmarity Pnni lation
❑ Wean to Feeder
® Feeder to Finish
3648
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Design Current Design Current
Poultry Capacity Population Cattle Cavacitv Po elation
❑ Layer I ❑ Dairy
❑ Non -Layer JEI Non -Dairy
❑ Other
Total Design Capacity 3,648
Total SSLW 492,480
Number of Lagoons 2 IN Subsurface Drains Present ® Lagoon Area ❑ Spray Field Area
Holding Ponds / Solid Traps JEI No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes ® No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ®No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) [] yes ®No
c. If discharge is observed, what is the estimated flow in gaUrnin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ®No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes ®No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ® No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ® No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ...... Irian-h i=--.--...__._Charlr&K_.__._-------------------------- -.-
Freeboard (inches): 48 42
ne/n7 in■ �_ _�

• v�iv.i: �i'i
Facility Number: 31-351
Date of Inspection 11-7-2001
r-onimaeu
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
12. Crop type Coastal Bermuda (Hay) Small Grain Overseed
❑ Yes ® No
❑ Yes ❑ No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes ® No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes ® No
b) Does the facility need a wettable acre determination? ❑ Yes ® No
c) This facility is pended for a wettable acre determination? ❑ Yes ® No
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(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?
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
[] No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Cominents (refer to.questign #) Explain any YES answers and/or any;recotnmendations or any other comments -
Use drawings -of facility to.better explam,situations (use :additional pages as necessary} ❑ Field Gopy ❑Final Notes
e.: -
6. A lagoon is currently being closed out. Be sure to get a copy of closure plan in records.
+
19. Spray records are being kept on a per field acerage basis. Need to be sure to spray evenly over field as it appears is currently being
one.
Reviewer/Inspector Name Stonewall Mathis entered by Bette Rose
Reviewer/Inspector Signature: Date:

. 95103101
Facility Number: 31-351
Date of Inspection 11-7-21)Ol
Continued
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge atlor below ❑ Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes ® No
28, Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes ®No
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes ®No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes ® No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes ® No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes ❑ No
A itiona -omments'an or.Drawings

Division of Water Quality
_ ONiCo"
visionof Soil and Water..nservaf,on
�. Dther. Agency x r
} -
Type of Visit (R Compliance inspection O Operation Review Q Lagoon Evaluation
Reason for Visit 0 Routine O Complaint O Follow up O Emergency Notification O Other p Denied Access
Facility Number Data of Visit-, nONot
Time: �Printed on: 7/21/2000 Operational 0 Below Threshold
,Permitted [] Certified [3 Conditionally Certified [3 Registered Date Last Operated o bone Threshold- ------------
I J'� J j
Farm Name :...................................../.....!...�..... ...................................................
. County:.....-....-....! ...... .....................
OwnerName: ............... .... ... . ...... .......?.............................. Phone No:..............-....-......-..--........-..............................................
Facility Contact: 5 ..W'. Title: Phone No: „,,,,,,,,,,,,,,•--,-_- ..--_--_----
Mailing Address: ............ .......... ........... ......
Onsite Representative:.. �... ,�-. S--•,-• Integrator:
CertifiedOperator:......................................._..-......-.............................................................. Operator Certification Num r:.......-....-.....-....-_.................
Location of Farm:
I— 1 w
6 Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude �' �� F- ;: Longitude ' 4
Design Current Design Current Design Current
Swine Capacity Population Poultry Capacity Population Cattle Capacity Population
❑ Wean to Feeder ❑ Layer I I ❑ Dairy
eeder to•Finish L ❑Non -Layer ❑ Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder ❑ Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ Boars Total SSLW
Number of Lagoons Subsurface Drains Pres❑ Lag -inn Area ❑ Spray Field Area
ent
Holding Ponds / Solid Traps ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes XNo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the convoyanco man-made? ❑Yes []No
b- If discharge is observed, did it reach Water of the State'? (If yes, notify DWQ) ❑Yes ❑ No
c. If -discharge is observed. what is the estimated lion° in gal/rain`'
d. Dees discharge bypass a lagoon system? (if yes, notify DWQ) ❑ Yes []No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ONo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure; � i � StructyFcStructure ti
Identifier: ............ .......-.-......
............... .....................
.........
...............
....
Freeboard (inches):'rv'�/
5/00
❑ Spillway ❑ Yes �6No
Structure 4 Structure 5 Structure 6
Continued on back

Ifaciiily,-Nuinber: Date of Inspection III / d40 Printed on: 7/21/2000
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes /KNo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes ANo
(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?
�es
❑ No
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
/�IC1a
✓�
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
A Vo
Waste application
10. Are there any buffers that need maintenance/improvement?
❑ Yes
4No
1. Is there evidence of over�pplicat� ? ❑ Excessive Ponding ❑ PAN [I Hydraulic Overload
El Yes
pbo
12. Crop type 06f/-t/
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
No
I4. a) Does the facility lack adequate acreage for land application?
[] Yes
No
b) Does the facility need a wettable acre determination?
❑ Yes
o
c) This facility is pended for a wettable acre determination?
❑ Yes
o
15. Does the receiving crop need improvement?
❑ Yes
o
16. Is there a lack of adequate waste application equipment?
❑ Yes
CNo
- ��
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
kNo
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
❑ Yes
�i�
(ie/ WUP, checklists, design, maps, etc.)
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
o
21. Did the facility fail to have a actively certified operator in charge?
ElYes
o
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
'No
(ie/ discharge, freeboard problems, over application)
❑ Yes
E
23. Did Reviewer/Inspector fail to discuss reviewlinspection with on -site representative?
❑ Yes
dLINo
24. Does facility require a follow-up visit by same agency?
❑ Yes
o
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
No
i4•yi6lhfi6tis'or o iEl ndiC S V►' t IE' h6ted-diWirig 4his_V1sit. Y:OIt'Will •CeC0iVe fib rufrlth&
'."COil`CSflOilffellCC.�OUt.tills.Vlslt�'.'.'.'.'.'.'.'.'.'.".' _'.'.•.'. .'. .'.'.'"'.'.'.'.'.'.'.'.'. .'.'.'.
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):
wj 0 04ick 1011A 40 lb5. d" SWAGS tr55i,
7 �-
-A�.�-
I Reviewer/Inspector Name f , i 7 Yl'd/ /VAVIA�` I
Reviewer/Inspector Signature -,_---,Date:

Facttity Il ufiber: — Date of Inspection Printed on: 7/21/2000
_Odor Issaes `
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below AYes ❑ 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 4yNo
29. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes ZrNlo
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 CRJ-WO
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 !J2 AMo
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes AfNo
32. Do the flush tanks lack a submerged fill pipe or a peimanent/temporary cover? ❑ Yes P-1blo
5/00

II C1 Division of Soil and Water Conservation Qperation Review ".
i!',
',­3DivDivision of oaftd.W9t6r_ Conservation oPaqce bis 66
0 n of Water�Quali�_jnpliaiki Inspection7. ,bivi�w t ;Compliance
'y
enc Review
OpFx�iti_ -`
J!j Routine 0 Complaint 0 Follow-up of DWQ inspection -0 Follow-ug of DSWC review 0 Other
Facility Number
Date of Inspection
Time of Inspection Go 24 hr. (hh:mm)
VPermitted [3 Certified [:] Conditionally Certified [3 Registered
1[3 Not Operat=ional Date Last Operated: ..........................
Farm Name: qrl y '-5 .
County: If...................
. ....... .............
I—- .......................
Owner Name: .................................................. ................................
Phone No:
FacilityContact: .............................................................................. Title: ..............................................
................. Phone No: ...................................................
MailingAddress: .................. . .................................................................................................
... ................................................................................. ..........................
Onsite Representative. OW.L-.�e .. .............................................................
* . . ....... .. ....... .. .......... . ......
Integrator: ....... N V. i!�r .. j4 .......... .............................
CertifiedOperator: ................................................... ........................ ....................................
Operator Certification Number:..........................................
Location of Farm:
A
............................................................................................................................................................................................................................................... I ................. .......
.................................................................................................................................................................................................................................................. . ...... . .......
Latitude =1 i Longitude
D esign Current D "IV Cirreit
Design Current
Swine 'Capacity Population...Poultry Ca acity EationX Capacity Population
1:1 Wean to Feeder aye Dairy
ceder to Finish g 0 Non -Layer ELI Non -Dairy
0 Farrow to Wean
❑ Farrow to Feeder ❑Other
D Farrow to Finish -- ----- _16tAl-D&igii:'Ck adt y
0 Gilts
Boars T6taj SSM
NumberTof,Lagoons Subsurface Drains Present 110 Lagoon Area
I[] Spray Field Area
Holding ,,Poi�& / SoIid Traps =No Liquid Waste Management System
r.Discharges
& Stream Impacts
1. Is any discharge observed from any part of the operation?
El Yes
0
Discharge originated at: El Lagoon D Spray Field El Other
a. If discharge is observed, was the conveyance man-made'?
D Yes
E] No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
D Yes
[] No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system'? (If yes, notify DWQ)
D Yes
El No
2. Is there evidence of past discharge from any part of the operation?
El Yes
JXNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? El Yes
XNo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage). less than adequate? El Spillway
El Yes
P(No
Struct I SF(clure 2
0 t T Structure 3 Structure 4 Structure 5
Structure 6
Identifier:
Freeboard(inches): ........30...... I .......... ....... ­.�� .............. ............ 9.5� ............ ................................... ...................................
... ...... .....
................... I ...............
S. Are there any immediate threats to the integrity of any of the structures observed? (ic/ trees, severe erosion,
El Yes
;9 No
seepage, etc.)
3/23/99
Continued on back

Facility Number: 3 —3 Date of Inspection
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN
t2. Crop type
[:]No
XYes
Yes
❑ No
❑ Yes
XNo
❑ Yes
t_N(No
❑ Yes
[�g No
❑ Yes
XNo
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
0igris 0. deficiencies were pates ditrbig phis. visit' • Y:oit :Will •teeeiye Rio; further
corresp6fidence. about this visit. ... ....• • . • .... • .... • • .
❑ Yes XNo
❑ Yes f NO
❑ Yes [�rNo
❑ Yes OfNo
❑ Yes ❑ No
❑ Yes ONo
[:]Yes XNo
❑ Yes ZNo
NfYes ❑ No
❑ Yes allo
❑ Yes tv[No
❑ Yes CSf No
❑ Yes 4No
❑ Yes jj'No
❑ Yes XNo
Comments {refer=fo .quesiion . Explain any YES ariswers aridlor any -recommendations or piny 'other comments
Use`drawings of facility to better explarn situations (use additional' pages as necessary)
_ _ .
situations. _ w
l t r
.11
C U ayG a,., ..►,� .. C c rS pre �7 �� ed I L, t� ccl_ ems- •
hQ9? 5
Reviewer/Inspector Name `` '_ �� `3;:: j 3`�= •�1 =�1
Reviewer/Inspector Signature. Date: S
3/23/99

Facility Number: 3 — 3 Date of Inspection G
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes b<No
28. is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes [ kNo
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 1� No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? KYes ❑ No
3/23/99

-<: Site Requires Immediate .1 gtion:
' Faciiir; No.
DIVISION OF ENVIRON-IMENTAL MANAGE'NENIT
A.NUMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE. 1 - Z 7-- , 1995
• Time.
NlailinQ Address:
County: c> A
Inze2Tator: L'V'fW,- _ _ Phone:
On Site Representative: _c�.,�5 [�,,�� Phone: _ T
Physical Address/Location: A)(- 'e 11 z %
Type oI Operation: Swine Poultry Cattle
Desi---tt Capacity: Number of Animals on Site: Zb�Sv
DES l Certification Number: ACE DEM Certincarion Numoe:: AG' E
Latitude: Lonoirade: _CNcE.e:adon: Feet
Circle Yes or No
Does tine Animal Wasie Lagoon have st?fricient freeboard of 1 Foot - 25 ye-n 2.,-. hour storm event
(approximately 1 Foot = 7 inches)/ or No - Actual Freeboara: Ft. Itches
Was ariv seepage observed from the lagaon(s)? Yes or No Was a,-.v erosior_ ors . ,e i? Yes orC)
Is ad.-ouate land available for Spra'v? Is the cover c:o_D adeauu:e? Y is or
i
C.on(s) being utiii7ed: �� "U
Does Lhe facility meet SCS minimum setback criteria? 200 Fee: uor� Dwe'.lin�s?or No
100 Feet from We11s? or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes o
Is animal waste land applied or spray irrigated within 25 Fee; of a liSGS lvian Blue Line? Yes orb
Is animal waste discharged into waters of the state by man-made ditch, flushing syste:-n. or other
similar man-made devices? Yes or o If Yes, Please Explain.
Does tLe facility maintain adequate waste rnanaaemenr records (volumes of Ma_attre. land applied.
spray irrigated on specinc acreage with cover crop)? Yet
Additional Comments: lv1!�, -evji ,r�- aQw%' •1r
C, Q. rcaLGS� a f` tie 'CDer��� r I.c1Lf l[u. 4 w �TCGcir d
7ZSma�
cc: Facility Assessment Unit Usc Au--',:;:m:.ms if Needed.
r

Site Requires Immediate Attention: — \
Facility No. 3 1 ._ 3 S` a
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE. TY/ 172-7 ; 1995
Time: 11 TO
Farm Naive/Owner:
Mailing Address: CqO 75 S. C L_ 4..Q� /a c ' a- byu L.P
County:._ `
Integrator. Cc"_ I Phonek_t-)1f/0 ---?­8a
On Site Representative: _�h� — �-„ ,M-_ Phonenon -,9Cra - 3 V3�
Physical Address/I
Type of Operation: Swine I-' Poultry Cattle
Design Capacity: a 4y6 Number of Animals on Site: a
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude:3q ° (4�0 ' V001" Longitude: JK) ' QH' V-7 -53' Elevation: Feet ----
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot f 25 year 24 hour storm event
(approximately 1 Foot + 7 inches) es r No Actual Freeboard:. q ---Ft: Inches
Was any seepage observed from th goon(s)? Yes or(R Was any erosion observed? 64or No
• Is adequate land available for spray? Yes or No Is the cover crop adequate? Yes or No
Crop(s) being utilized:
Does the facility meet SCS minimum setback criteria?_ 200 Feet from Dwellings? 6esor No "
100 Feet from Wells? Y es or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or
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 or If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acTeage with cover crop)? Yes or No
Additional Comments:
Inspector Name Signature
cc: Facility Assessment Unit Use Attachments if Needed.

mERATIOIS TAN - WO Fax :91
Site Requires Immediate Anention -2<_
Facility Number; .3 / 3JS j
S SITE VISITATION RECORD
DATE: , 1995
Owner: Ckctk� n i e.r Farm Narne:
County:
Agent Visiting Site: '�c�,� n e_ ,�5 , .._ f - _ Phone: `1l - 6 -?d
Operator. Phone:
On Site Representative; Phone:
Physical Address: W a- m t: dS el 3Z)
Mailing Address:
Type of Operation: Swine_ Poultry Cattle
Design Capacity: 2-44 Number of Animals on Site: -- _
Latitude: _° -' _ " Longitude: Q
Type of Inspection: Ground- Aerial
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of I Foot + 25 year 24 hour storm event
(approximately I Foot + 7 inches) Yes or (ED Actual Freeboard: Peet Inches
For facilities with more that, one lagoon, please address the other lagoons' freeboard uuder the
comments section_
Was any seepage observed from the lagoon(s)? Yes or No Was there erasion of the darn?: Yes or No
Is adequate land available for Iand application? Yes or No Is the cover crop adequate? Yes or No
Additional Comments: tt+ 1 cow?„=. J % s$'
0 Fax to (9 ] 9) 7 i5-3559
Sio atu.►e of Agent

is
Site Requires Immediate Attention: k-� L,,
Facility No. 3 I - 3_SR!
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: r , 1995
Time:
Farm Name/Owner:
Mailing Address: !
County:
Integrator: uj+ a4p 1' Phone. F Qj 1-7 a - -D-- Q C)
On Site Representative: Phone:
Physical Address/Location: nCL\-f 1
Type of Operation
Swine _L� Poultry ' Cattle
Design Capacity: 2-f �j T)
Number of Animals on S ite: `� `{
DEM Certification Number: ACE DEM Certification Number: ACNEW �.
LatitAc:3 `I y�, �4" 7,7 Longitude: ±15 _' C,_-T ` I!--Yr Elevation: Feet'
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 :inches) Oe or No Actual Freeboara -3 Ft. Inches
Was any seepage observed from the lagoon(s)? Yes or No Was anv erasion observed? Yes or
Is adequate land available for spray?fs or No Is the cover crop adequate? (yf�_s or No
Crop(s) being utilized:
Does the facility meet SC um setback criteria? 200 Feet from Dwellings? es or No
100 Feet from Wells? Yes or 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 or 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: CcL,.,� c_,o_
Inspector Name Signature
cc: Facility Assessment Unit Use Attachments if Needed.