310437_INSPECTIONS_20171231

�VR
NORTH CAROLINA
Department of Environmental Quai

1
Type of Visit: rQ Once Inspection U Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: Routine Q Complaint Q Follow-up Q Referral 0 Emergency Q Other ❑ Denied Access
Date of Visit: E441
7Arrival Time: Departure Time: ® County: Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: '5 C Q-0 H "" k
Certified Operator;
Back-up Operator:
Location of Farm:
Title:
Latitude:
Phone:
Phone:
Integrator:
Certification Number: 4 7�
Certification Number:
Longitude:
gaps,gn Current Design Current Design
Swine Capacity Pop. Wet Poultry Capacity Pop. Cattle Capacity
Current
Pnp.
Wea to Finish
Layer
DairyCow
Kan to Feeder
Non -La er
DairyCalf
Feeder to Finish 1760
7
DairyHeifer
Farrow to Wean
Farrow to Feeder
Design Current
D . P,oult , Ca aci Po
Layers
D Cow
Non -Dairy
Farrow to Finish
Beef Stocker
Gilts
Non-Layers
Beef Feeder
Boars
Other
Pullets
Beef Brood Cow
Turkeys
Turkey Poults
Other
Other
Discharizes 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 ❑WR)
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 P "'- ❑ NA ❑ NE
❑Yes
No
❑NA
❑NE
❑ Yes
[] No
❑ NA
❑ NE
❑ Yes [] No NA ❑ NE
[—]Yes o ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Page I of 21412015 Continued

Facility Number. - Date of Inspection: 2
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 ON E
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in). 39
5. Are there any immediate threats to the intcgrity 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 ZNo ❑ NA ❑ N E
❑ Yes Ef No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental at, 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 IVo [] 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 ONo ❑ NA [ NE
maintenance or improvement?
Waste Application
10. Are there any required but- ers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Qutside 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 ditl"er from those designated in the CAWMP? ❑ Yes 2f Now❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ 'No Yes ❑NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
No ❑ NA
E] NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No ❑ NA
❑ NE
R"uired Records & Documents
19, Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
"" NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No ❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑other;
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑Stocking ❑ Crop Yield ❑ 120 Minute Inspections []Monthly and 1" Rainfall Inspections Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes N❑ ❑ NA ❑ NE
Page 2 of 21412015 Continued

lFacility Nuinher: f3 I - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes Z N ❑ NA [3NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey [] Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
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 notii'y the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. ❑o subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes ❑ No A ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No 0
NA ❑ NE
❑ Yes No ❑ NA ❑ NE
[]Yes fo ❑NA ❑NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes
34. Does the facility require a follow-up visit by the same agency? [] Yes
No ❑ NA ❑ NE
No, ❑ NA ❑ NE
No ❑ NA ❑ NE
Reviewer/Inspector Signature: Date: zz Z `� !
Page 3 of 3 21412015

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fib 117M 10129.87 1.72 17.42
282 58
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Division of Water Resources
Facility Number - D Division of Soil and Water Conservation
Q Other Agency
Type of Visit: 7Routine
fiance Inspection Operation Review ❑ Structure Evaluation Technical Assistance
Reason for Visit: Q Complaint Q Follow-up 0 Referral 0 Emergency Q Other 0 Denied Access
Date of Visit: Arrival Time:j'J�'Z�1 Departure Time: r t' County: Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Owner Email:
Phone:
Facility Contact: Title:
Onsite Representative: S c 14- el Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Certification Number: 47 -7_�-
Certification Number:
r
Longitude:
Design Current Design Current Design Current
Swine Capacity Pop. 'Vet Poultry Capacity Pop. Cattle Capacity Pop.
Wean to Finish
Wean to Feeder
Feeder to Finish fta9
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
L*Layeron-Layer
Design Current
Dry Poultry Capacity Pop.
Layers
Non -Layers
Pullets
Turkeys
Turkey Poults
Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other: _
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
Dairy Cow
Dair Calf
Dairy Heifer
Dry Cow
.Non -Dairy
Beei' Stocker
Beef Feeder
Beef Broad Cow
[:]Yes [�<o ❑ NA ❑ NE
❑Yes
❑N❑
❑NA
❑NE
❑Yes
❑No
❑NA
❑NE
❑Yes ❑No ❑NA ❑NE
❑ Yes 21to ❑ NA ❑ NE
[:]Yes No ❑ NA ❑ NE
Page 1 of 3 21412015 Conlinned

Facili Number: 171- Date of Inspection:
1(aste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3 S
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
d No ❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental
threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
No ❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
No ❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
[7�No ❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [!,"No ❑ NA ❑ NE
maintenance or improvement?
11. is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [;-No [DNA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14, Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
E]'-&o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[a'No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
(,Ndo
[] NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
�o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Reauired Records & Documents
19. Did facility fail have Certificate Coverage & Permit
Yes
�No
NA
NE
the to the of readily available?
❑
❑
❑
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
dNo
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists [:]Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes (� No ❑ NA ❑ NE
23. If seiected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

FaciQ Number: - Date of Inspection: It Ilk
/110
24' Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
Ej N~o ❑ NA
❑ NE
25. Is the facility out of compliance with permit conditions related to sludge7 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
2 oo ❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
❑ No tiiA �❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
[] Yes
tiIo ❑ 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
EfNo ❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
34. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
No ❑ NA
❑ NF
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the 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
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
[] Yes
[7 Nc ❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
[]11o­ ❑ NA
❑ NE
Comments (refer to:question #): Explain -any YES answers and/or any additional recommendations.or any. other comments.
Use drawings or facility to better explain. situations (use additional pages as necessarv).
r cl,-3 l !v, c:;p I[ AG7
I
Reviewer/Inspector Name: PG[ tr t r/ i4�� t.e fI
Reviewer/inspector Signature: y,2 Y
Page 3 of 3
Phone: (A0
Date: it
"F-
21412015

v Division of Water Resources
'141011ty Number r` �"� . j1` 0 Division ufSoil and Water Conservation
Q Utiter Agency
vpe =.--Z
of visit: Contpllunce Inspection Operation Review Structure LValuation
0 son for Visit: D Technical Assistance
Routine
p Complaint Q FqlIoA,.up.
0 Referral n Emergency ❑ Other D Denied Access
Date of Visit: Arrive] *['[me: ?
! Dep arture Time: !! f'' County: Region:
Harm Name:
Owner Email:
Owner Name:
Phone:
Mailing Address:
Physical Address:
Facility Contact: 'ritle:
Phone:
Onsite Representative: C v u r, ���
integrator:
CertlFi d
e ❑perator: Certification Number: O -' 5'
Back-up Operator:
Location of Farm:
Certification Number:
Latitude: Longitude:
Design Current Design Current
w.
Capacity Pop. Wet Poultry Capacity Pop.
Wean to hiisll Layer
�Vcan to Fccdcr Non -La er
Feeder to Finish ( '7� 0
Farrow to Wean
Fars -ow to Feeder
Farrow to Finish I --
Other
Poults
Design Current
! ch an Stre m rm act
1. is any discharge observed from any part of the operation?
Discharge originates! at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
Design Current
Cattle Capacity Pop.
Dairy Caw
Dairy Calf
Dairy Hester
Dry Coro
Non -Dairy
Beef Stucker
11eef Feeder
Beef Brood Cow
[] Yes []'No ❑ NA ❑ NE
Yes ❑ No ❑ NA ❑ NE
A NF
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑Yes
❑ No
❑ N ❑
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 0 N1:
2. is there evidence of a past discharge from any part of the operation?
❑ Yes
0 No
NA NE
3, Were there any observable adverse impacts or potential adverse impacts to the waters
[]Yes
❑ NA ❑ Nrl
of the State other than from a discharge?
2/4/2015 Continued
page r of 3

Number:.." _ bate of Inspection:
' E
Is storage capacity (structuml plus storm storage plus heavy rainfall), less than adequate?
a, if yes, is waste level intd the structural freeboard?
Structure i Structure Z Structure 3 Structure 4
❑Yes [D u DNA ❑NE `
❑ Yes [] No [] NA ❑ N 1E
Structure S Structure 6
Identifier:
w. Spillway?,
board (in):
aboard (in).�
N- there any immediate threats to the integrity of any of the structures observed?
❑ Yes grNo ❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6
re there structures on -site which arc not properly addressed and/or managed through a
❑ Yea No ❑ NA
❑ NE
i itte management or closure plan?
Of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
of the structures need maintenance or improvement?
[] Yes No ❑ NA
❑ NE
0 this structures lack adequate markers as required by the permit?
❑ Yea � No ❑ NA
0 NE
bit .ta rooted pits, dry stacks, and/or wet stacks)
tt f.the waste management system other than the waste structures require
❑ Yes [D N ❑ NA
[] NE
any roquir ed butTere; satbacks, or compliance sitematives that need
[ ] Yea ff'No
0 NA
ONE
ee oY itit)lti�verttent?
pf'tt'cct `lt 0li �tfart? If yes, check the appropriate box below.
❑Yes E].No
[] NA
❑ NE
[] 14"ilo overload ❑ Frozen ,Around ❑ Heavy Metals (Cu, Zn, etc.)
. Wor 10 Ibl,.• : ❑ Total Phosphorus ❑ Pailure to Incorporate Manure/Sludge into Bare Soil
bp.Window ❑ Evidence of Wind drift ❑ Application Outside of Approved Area
"moo TYPOS):
i Nit these designated in the CAWMP?
[:]Yes EJ—No
❑ NA
C] NE
lsp11moon site ,sled Improvement?
[] Yes [allo
❑ NA
❑ NE
the irrigation d6f gn or Wottable
❑ Yes ❑,No
❑ NA
❑ NE
i ittl it�t--,.
[] Yes ;21 Po
❑ NA
❑ NE
_
Yet
❑ NA
❑ NE
:.;..
IVA
[ZrNo
❑
h%13
It Na
❑. NA
❑ NA ❑ NE
rs ❑ Weather Code
ions ❑ Sludge Survey
` Y. Ye [2r*No ❑ NA ❑ NE
© Yas E3 no ❑ NA ❑ NP,
r 214401S Continued

r
t KS11il_Y Number: t� Date of ins cction: —�
LAA the facility fail to calibrate waste application equipment as required lily the permit? ❑Yes [ No ❑ NA
[] N I:
Is ►. she facility out afcompliancc with permit con4itiot�s related to sludge? If yes, check ❑Yes 0 hlU ❑ NA [� NE
the appropriatAk x(es) below.
ailuth t4 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 activeiycertified operator in charge? ❑ Yes 21q; ❑ NA ❑ NE
27• Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No [3'1qA'_❑ NE
nth U —n sm a
28. Did the f'hcility fhil to properly dispose of dead animals withi24 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?
Iryes, contact a regional Air Quality representative immediately.
30. Did the racility fail to notify the Regional Office of emergency situations as required by the
Permit? (i.e., discharge, fteeboard problems, over -application)
3 l - Do subsurface the drains exist at the facility? Ifyes, check the appropriate box below.
❑ Application Field ❑ LagoonlStomge Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP7
33. Did the Reviewer/inspector fail to discum review/inspection with an on -site representative?
34. Mes the facility require a follow-up visit by the same agency?
rrrv-,/Ff •If.?
"y.
r, I , r, J r,, ., J
❑ Yes [ 3' Fo ❑ NA ❑ NE
❑ Yes 0 No ❑ NA ❑ NE
[] Yes No ❑ NA ❑ NE
❑ Yes 2foNo ❑ NA C] NE
❑ Yes ❑ NA ❑ NE
❑ Yes t3"No ❑ NA ❑ NE
❑ Yes -fro' ❑ NA ❑ NE
on$ or nay other t otaaWnts.
Phone: i n r V ( f .3
Date-. it
4
2I OI S

vision of Water Resources
Facility Number - �(� Q Division of 5oit and Water Conservation
Q Dther Agency
type of visit: om ance Inspection Operation Review Q Structure Evaluation Technical Assistance
teason for Visit: 6 Routine Q Complaint Q Follow-up ❑ Referral D Emergency Q Other Q Denied Access
Date of Visit: Arrival Time: 3 Departure Time: ® County: Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Phone:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative: jC n p HM'_' Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number: I e 97 r
Certification Number:
Longitude:
Design Current Design Current Design Current
Swine Capacity Pop. Wet Poultry Capacity Yop. Cattle Capacity Yop.
Wean to Finish Layer Dai Cow
Wean to Feeder
Wed
Non -La er
DairyCalf
to Finish
t�
DairyHeifer
Farrow to Wean
Design Current
❑ Cow
Farrow to Feeder
Farrow to Finish
D 1',oultr. Ca ad Fo
Layers
Non-Dairy
Beef Stocker
Gilts Non -Layers
Boars Pullets
Turkeys
Dthe]TurkeyPuults
Beef Feeder
Beef Brood Cow
Other
other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other: _
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d, Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
[] No
❑ NA
❑ NE
❑ Yes [] No ❑ NA ❑ NE
❑ Yes No — NA ❑ NE
[]Yes qNo ❑ NA ❑ NE
Page I of 3 21412014 Continued

-.
racility Number: - Date of inspection:
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No �❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No [] NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
�No[]
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not property addressed and/or managed through a
❑ Yes
No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public stealth 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
❑
❑ 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 EfNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes M No ❑ NA ❑ NE
maintenance or improvement'?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes No [] NA [] NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside oFAcceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside oi'Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No ❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
51N��[] NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
[.] Yes
No ❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
No ❑ NA
❑ NE
18. Is there a lack ❑Fproperly operating waste application equipment?
❑ Yes
No ❑ NA
E] NE
Required Records &_Doc_uments
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
EIINo❑ NA
❑ NE
the appropriate box.
❑ W UP ❑Checklists ❑ Design ❑ Maps [] Lease Agreements ❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [E 'y NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes n No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

.•
acilit Number: jDate of Inspection: f
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes 0 000 D NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? if yes, check ❑ 'No Yes Q❑ 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 No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
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 ErNo ❑ NA ❑ NE
[:]Yes No ❑ NA ❑ NE
❑ Yes 00 ❑ NA ❑ NE
❑ Yes ❑i <0 ❑ NA ❑ NE
❑ Yes
❑ Yes
❑ Yes
Q No 0 NA ❑ NE
0 N _HA ❑ NE
2o NA NE
Reviewer/Inspector Signature:
Page 3 of 3
Date: S
21412014

Type of Visit: ompliance Inspection 0 Operation Review 0 Structure Evaluation Q Technical Assistance
Reason for Visit: �utine ❑ Complaint Q Follow-up Q Referral Q Emergency p Other 0 Denied Access
Date of Visit: y Arrival Time: a Departure Time: County:
Farm Name: A" Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Phone:
Region: LL/41
Onsite Representative: ��-��� Integrator:
Certified Operator: Certification Number: (� S'
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design Current
Deslgn
Current
Design Current
Swine Capacity Pvp.
Wet Poultry
Capacity
Pop.
Cattle Capacity Pap.
Finish
Layer
Dai Cow
Feeder
Non -La er
Dai Calf
o Finish
0
Dai Heifer
o Wean
Design
Current
D Cow
to Feeder
D . P,oultr
Ca aclt
P,v
Non -Dairy
PFad
to Finish
La ers
Beef Stocker
Non -La ers
Beef Feeder
Pullets
Beef Brood Cow
Turke s
Turke Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure Application Field [] Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
Yes ONo ❑ NA [] NE
Yes 0 No
Yes ff No
Yes LffNo
Yes [fNo
Yes �rNo
NA NE
�NA NE
NA ❑ NE
[� NA [] NE
NA NE
Page I of 3 214120I4 Continued

Facility Number: Date of Inspection: 12,11111V
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 2rNo ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: I
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 JZNo ❑ 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 r2'lqo ❑ 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 P No ❑ NA ❑ NE
maintenance or improvement? TT
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes PrRo ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, cheek the appropriate box below. ❑ Yes Pio ❑ 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 0 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?
IS. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure andlor operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ Yes Jallo ❑ NA [] NE
❑ Yes No [DNA ❑ NE
❑ Yes ff'No ❑ NA ❑ NE
❑ Yes .fNo ❑ NA ❑ NE
❑ Yes ]�No ❑ NA ❑ NE
❑ Yes
iff No
❑ NA
❑ NE
[:]Yes
ZNo
❑ NA
❑ NE
❑ W[]P ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes o
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste T7nsfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 " Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ff o
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412014 Continued

]r"aelli lumber: - Date of Inspection:
24, Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
XNo
❑ NA ❑ NE
25, Is the facility out of compliance with permit conditions related to sludge? If yes, check
[:]Yes
O-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
ZNo
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
Z_No
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
;ZNo
❑ 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
P1Vo
❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
T%
30, Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
Wo
❑ NA ❑ NE
permit? (i,c,, discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
[Z�Io
❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
0�4o
❑ 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
�o
❑ NA ❑ NE
Reviewer/Inspector Signature: L� �. ^� Date: 2- 1!
�—
Page 3 of 3 2/4/201

Type of Visit: Compliance Inspection 0 Operation Review n Structure Evaluation Technical Assistance
Reason for Visit: erioutine Q Com taint p Follow-up D Referral Q Emergency ❑ Other Q Denied Access
Date of Visit: Arrival Time:l_k.l���+•v Departure Time: JUI County: Region:
Farm Name: Owner Email:
Owner Name:
Mailing, Address:
Physical Address:
Facility Contact: Title:
Phone:
Phone:
Onsite Representative: Integrator:
Certified Operator; L � 15•14y^�Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current
Design Current
Design Current
Swine Capacity Pop.
Wet Poultry Capacity Pop.
Cattle Capacity Pop.
Wean to Finish
La er
Dai Cow
❑ai Calf
Dairy Heifer
Wean to Feeder
on -Laver
Feeder to Finish
Farrow to Wean
Deslgn Current
Dry Cow
Farrow to Feeder
Dr. P,oultr. Ea aci pop.
Non-Dal
Farrow to Finish
Layers
Non -Layers
Beef Stocker
Gilts
Beef Feeder
Boars
Pullets
01
113eef Brood Cow
Turke s
Other
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes VfNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
[:]Yes -
FfNo
❑ NA
❑ NE
❑ Yes
;2 No
❑ NA
❑ NE
Page 1 of 3 21412011 Continued

1
F'aciiit►+ Number: i - 14 1 F7 I Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus hearty rainfall) less than adequate? ❑ Yes eNo ❑ 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
ZfNo
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
�Z_No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental
threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
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
E] Yes
No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
7No
❑ 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 Typc(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
4 No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
Zr No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
Eno
❑ NA
[] NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[7No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[3/No
❑ NA
❑ NE
Reauired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes m No NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes T 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 V'No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I " Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes & ❑ NA [] NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [KNo ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

i
Facility Number: -L4 jDate of Inspection;
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes EIo ❑ NA ❑ NE
25, Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes �o ❑ NA ❑ NE
the appropriate box(es) below. �����`""''"'
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, ovcr-application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
[:]Yes
ZNo
❑ NA
❑ NE
[:]Yes
[;?No
❑ NA
❑ NE
❑ Yes
PTNo
❑ NA
❑ NE
❑ Yes
�TNo
❑ NA
❑ NE
[-]Yes
No
❑ NA
❑ NE
❑ Yes
ONo
❑ NA
❑ NE
32, Were any additional problems noted which cause non-compliance of the permit or CAWMP? [:]Yes 7] No ❑ NA ❑ NE
33, Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes �No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes ONo ❑ NA [] NE
Comments (refer to question 9): Explain any YES answers and/or any additlonal recommendations or any other comments:
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Date: D�3 I ^ B
21412011

e
Type of Visit: `Compliance Inspection Q Operation Review 0 Structure Evaluation ❑ Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other ❑ Denied Access
If
Date of Visit: Arrival Time: Departure Time: County: Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: SGT T �(]"
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Owner Email:
Phone:
Phone -
Integrator:
Certif'fcatio�n Number: 196,45
Certification Number:
Longitude:
Design Current Design Current
Swine Capacity Pop. Wet Poultry Capacity Pop.
Design Current
Cattle Capacity Pap.
Wean to Finish
I 11-ayer
I
airy Cow
Wean to Feeder
I jNon-Layer
I
airy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design Current
Dry Cow
Farrow to Feeder
Dr• P,nultr. Ca aclt P,o
Layers
Non -Dairy
Farrow to Finish
Beef Stocker
Gilts
Non -Layers
13eef Feeder
Boars
Pullets
I
113eef Brood Cow
Other
Other
Turke s
Turke Puuets
Other
Discharges and Stream Imparts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other: _
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (if yes, notify DWQ)
2. is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
[:]Yes [:]No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Page I of 3 21412011 Continued

aciii Number: 1 JDate of Inspection: EMT 9L
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?
Structure I Structure 2 Structure 3 Structure 4
Identifier: C14a-
Spillway?:
Designed Freeboard (in): ,rrj
Observed Freeboard (in): - r
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
Structure 5
XNo ❑ NA ❑ NE
❑ No ❑ NA ❑ NE
Structure 6
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes i No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes �(No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ 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): jEa=� &_Jq_9 W94E I
13. Soil Type(s):
14, Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Reouired Records & Documents Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
No
❑ NA
❑ NE
20, Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No
❑ NA
❑ NE
the appropriate box.
QWUP ❑Checklists Q Design 0 Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ YesIsfers
N
El Waste Application El Weekly Freeboard [] Waste Analysis � Soil Analysis ❑ V/6te
0 Rainfall ❑ Stocking Q❑ Crop Yield Q 120 Minute Inspections Q Monthly and i " Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes N
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes N
o ❑ NA ❑ NE
0 Weather Code
Sludge Survey
o ❑ NA ❑ NE
o ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

FacilI Number: - Uate 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
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
PNo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
[:]No ONA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
No ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface file drains exist at the facility? If yes, check the appropriate box below.
❑Yes
No ❑ NA ❑ NE
❑ Application Field ❑ LagoonlStorage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
No ❑ NA ❑ NE
No ❑ NA ❑ NE
No ❑ NA ❑ NE
IComments (refer to question #):. Explain any.YE5 answers and/or, any, additioAal;recommendations,ar: any other comments.,-
We''drawings.of facility-to.better, explainsifttatiane.(use;addifionals'puges.as
cr�����T,� a�� ao►a
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:-�
Date:
21412011

Division of Water Quality
`Facility Number f - © 0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit: Compliance Inspection Operation Review 0 Structure Evaluation Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency0 Other 0 Denied Access
Date Df Visit: Arrival Time: ® Departure Time: L County: C iN Region:
Farm Name: 11��i6L 5 Fuel. v�& Owner Email:
Owner Name: L� / Nosce S Phone: 9/0-9 IF? _� I (03
Mailing Address: ..,) 4 �'!? 0 SAL III C11yaiO4yVC coop TIC)( � ---- .
Physical Address:
Facility Contact:
Title:
Phone:
Onsite Representative:
S—=,,7-7
l Ay IU J r (L
Intrator:
Certified Operator:
[ "L 7 �`'� �J�T ��-
90
Certification Number:
1 g d-4S
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
Certification Number:
Latitude:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
La er
Nan -La er
t]ry rouury
Layers _
Non -Layers
Pullets
Turkeys
`turkey Poults
other
Design Current
Longitude:
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
.Non-Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
XNo
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
o
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ YesJ�No
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 214120II Continued

Facili Number: - Date of Ins ection: MIM111
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 i Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: A(e olQ
Spillway?:
Designed Freeboard (in):
o
T l . S
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?
EYes 4 No ❑ NA ❑ NE
❑ Yes �To ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes kNo ❑ 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 attematives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
1 l . Is there evidence of incorrect land 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 i 0 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crap Window' ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): _� L (�,(ZCW� -
13. Soil Type(s): fir, Le c,-j bN
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application? ❑ Yes No ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes jb6_No ❑ NA ❑ NE
Re uired Records & D cuments
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.
QWUP ❑Checklists [] Design [] Maps ❑ Lease Agreements
❑ Yes No ❑ NA ❑ NE
❑ Yes INo ❑ NA ❑ NE
❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes �No
0 Waste Application Q Weekly Freeboard Q Waste Analysis 0 Soil Analysis [3Waste Transfers
Q Rainfall ❑ Stocking [] Crop Yield Q 120 Minute Inspections Q Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes N23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes N
❑ NA ❑ NE
Q Weather Code
e
❑ ❑NA ❑NE
o ❑ NA ❑ NE
Page 2 of 3
21412011 Continued
41

Faciii Number: t - Date of Inspection:
24' Did it a facility fail to calibrate waste application equipment as required by the permit? ❑ Yes Z6 No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [] No ❑ NA XNE
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
XNo ❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
❑ No �NA
❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
No ❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
b�Vo ❑ 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
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 CA WMP?
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 O.Vo ❑ NA ❑ NE
❑ Yes K No
❑ Yes No
❑ Yes o
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.;:.:;
Use drawings of facility to better explain situations (use additional pages as necessar ].. n.. a...
Vj - A ` ,pigs _ L4j:o s
D195)11 � :'�
go _t )
5 )131r ��FQ r 100
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: q jt)' 77G:4?d r
Date: in /I!a //'
21412011

Type of Visit
Compliance Inspection
0 Operation Review 0 Structure Evaluation
❑ Technical Assistance
Reason for Visit
Routine 0 Complaint
0 Follow up 0 Referral 0 Emergency
0 Other ❑ Denied Access
Date of Visit: Arrival 'Time: ® Departure Time: County: _A/ Region:
Farm Name: A 12 Owner Email:
OwnerName: Q J_U:l I Phone: 9 /d -�3-39 (�
Mailing Address: �d „ NC I\\ CUMATL4►) ) C -- Q O 501
Physical Address:
Facility Contact: I Title:
Onsite Representative:CAI c-?—
Certified Operator: Y '_ m i i CNAEL S . Koy rER.
Sack -up Operator:
Phone No:
Integrator:
C,1010
Operator Certification Number:
Sack -up Certification Number:
Location of Farm: Latitude: [= e = 4 =" Longitude: 0 ° 0 6 = is
Design Current
Design Current
urrent
"Capmty
Capacity Population
►Vet Poultry Capacity Population
ateopulation
❑ Wean to Finish
❑ Layer
❑ DairyCow
❑ Wean to Feeder
❑ Non -La er
❑ DairyCalf
Feeder to Finish j (A
❑ DairyHeii'er
Farrow to Wean
Dry poultry
❑ D Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
La ers
❑ Beef Stocker
❑ Gilts
❑ Non -Layers
❑Beef Feeder
❑ Soars
Pullets
❑ Beef Brood Cowl
❑ Turkeys
ot e
❑ Other
ILJ urkey Poults
Other
Number of Structures:
Discharges & Stream Impacts
1. is any discharge observed fromany part of the operation'?
ElYes
No
x
❑NA
ElNE
Discharge originated at: ElStructure ❑Application Field ElOther
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
�6 No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
ANo
El NA
❑ NE
other than from a discharge?
12128104
Continued

Facility &umber: ] - q 3 Date of Inspection 15
Waste Collection & Treatment
4, Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes *o ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: �40
Spillway?:
Designed Freeboard (in): , S
Observed Frecboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 19No
[3NA ❑ NE
(ic/ large trees, severe erosion, seepage, etc.) v
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes No
❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes )� No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes �ANo
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10, Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No
❑ NA ❑ NE
maintenance/improvement?
11, Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) Lk-) N E- j
13. Soil type(s)=05'3�R/
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
;.:.- :..> . :,....,. �':-.',air"s' �::,z ;• .. %it i �. . 4 .s �-49.4 ... .- .as��. , z4.11"";t ':ia ;fit: ,
iCnmments; referltnsquestiv #] xplaEniany;aYE5 answers andl0r,:any�recommendatlons,of anlu
ther comments.. ?;
EJsedeY �s( s," ., s t-4 A 'G. 1i4cf�-''=+�if'�.�wv7 cilq .. .
ra.w((ings.oi��flfaciiitywwst'�.y bre�ttyyeyyr explain situations[use aaddit�nn�assl;payy.g�ges1$agsLneccssary)y..
i..4 L•iQ'i ,KX2.,,, �+• Z, :�.{,'Y\P } �'. �a:ii' MdiF.s�.W i."13 HAY Y ri f. '9Y
AL
qV
Review erllnspector Name . €` m DA l�iF° Phone:
Reviewer/Inspector Signature: Date:
Page 2 of 3 12128104 Continued

Facility Number: —Lf Date of Inspection
Reauired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes XNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes P\No ❑ NA ❑ NE
0 Design [j Maps ❑Other
the appropriate box. 3 WUP ❑ Checklists 21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes )ko
[INA ❑ NE
[] Waste Application ElWeekly Freeboard 0 Waste Analysis 0 Soil Analysis ❑ Yaste Transfers El IPinual Certification
(] Rainfall ❑ Stocking 0 Crop Yield 0 120 Minute Inspections El Monthly and I" Rain inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
I%No
❑ NA
❑ NE
23.
if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
�4 No
❑ NA
❑ NE
24.
Did the Facility rail to calibrate waste application equipment as required by the permit?
❑ Yes
$N❑
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No
❑ NA
W NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
)qNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No )kNA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
No
0
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
0 No
ElNA
ElNE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
kNo
❑ NA
ElNE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
No
❑ NA
❑ NE
Additional Comments and/or Drawings:. .
p�l�9li� ot•Oi
� � �a ` 5����� �x�r��rrcvs! C� �rGZ •� � � � f f��C aQp�
Page 3 of 3 I2a&04

Type of Visit WCompliance Inspection Q Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit ()(Routine ❑ Complaint O Follow up O Referral O Emergency Q Other ❑ Denied Access
Date of Visit: �1'•�1--� Arrival Time:
Time: Departure "Time: County: Region:
Farm Name: (1�YL]_�� 1Aj 4�m Owner Email: R
Owner Name: "C]71���-� 1Vr�-�� Phone:
Malling Address: � f�JO 'y�' _ 1 A AD /%V(� A/C- CQa '! of +
Physical Address:
Facility Contact: (� Title:
Onsite Representative: CLAM S QN4Q1 -*AQC 12!2!� C7L�IIlIIIII� Integrator:
Certified Operator:
Back-up Operator:
Phone No:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: 0 e ❑ ` = u Longitude: ❑ ° = - 0 "
Design Current
Design Current
Design Current
Swine Ca}�acmty Population
Wet Poultry Capacity 1'apul�tion
Ea�ttle Capacity Pgpulatlon
❑ Wean to Finish
❑ La er
❑Dai Caw
❑ Wean to Feeder
iry Calf
❑ Feeder to Finish
ton
LI&
Dairy Heifer
❑ Farrow to Wean
Dry poultry
El Dry Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
La ers
❑ Beef Stocker
❑ Gilts
Non -La ers
El Beef Feeder
❑ Boars
LJ
Pullets
❑Bees' brood Co
❑ Turkeys
Other
❑ TurkeyPoults
❑ Other
Other
I
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any kart of the operation?
❑ Yes
XNo
❑ 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? (1 f yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
No
Cl NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
C�No
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
12/28/04
Continued

3
Facility Number: --4 5
Date of Inspection
Waste Collection &'Treatment
4, Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a, 1 f yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier: La6gC q_
Spillway?:
Designed Freeboard (in): •S
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of ally of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures ou-site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes YNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes A No ❑ NA ❑ NE
❑ Yes N(No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes 14 No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes "'No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
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, Arc there any required butlers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance/improvement?
11, Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes gNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > l0% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Winddow� ❑ Evidence of Wind[ Drift ❑ ApplicationOutsideof Area
12. Crop tyPe(s)�^ L'1L�--L��1S�lJL�N�ti4 S_•' 7
13. Soil type(s) 1' 0lLys lei/ ------ --
14, Do the receiving crops differ from those designated in the CAWMP? [--]Yes KNo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes M�No ❑ NA ❑ NE
16, Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
I8. is there a lack of properly operating waste application equipment?
1oa c.aGt-i� hrar au
�"i
- cxc�
QA m S a tic AC-7) v U—:
❑ Yes
Wo
❑ NA
❑ NE
❑ Yes
JNo
❑ NA
❑ NE
Reviewer/Inspector Name I Y m P al'ya- S 1 Phone: 916 —i467-3a4
Reviewer/Inspector Signature: Date: 3' ❑,
Page 2 of 3 12128104 Continued

a
Facility Number: —Lf3 Date of Inspection
Reuuired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes �(No ❑ NA ❑ NE
20, Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [(No ❑ NA ❑ NE
the appropirate box, 0 WUP 0 Checklists
0 Design [] Maps ❑Other
21. Does record keeping need improvement? I l'yes, check the appropriate box below. ❑ Yes ) ] No ❑ NA ❑ NE
i❑ Waste Application 0 Weekly Freeboard [!]Waste Analysis 0 Soil Analysis ❑ Xaste Transfers ❑ /nnual Certification
❑ Rainfall 0 Stocking 0 Crop Yield 0 120 Minute Inspections ❑ Monthly and V Rain Inspections [3 Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
No
❑ 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
No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
XNA
❑ NE
Other Issues
28,
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
0 No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
9No
❑ 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
k 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
C� 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
Z No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
0+4o
❑ NA
❑ NE
Additianxl Comments;undl�r l .KaA,.ngs i,
Page 3 of 3 12128104

9W Division of Water Quality
Facility Number Q Division of Soil and Water Conservation
Q Other Ageney
Type of Visit M Compliance Inspection D Operation Review 0 Structure Evaluation Q Technical Assistance
Reason for Visit 0§ Routine Q Complaint Q Follow up Q Referral Q Emergency a Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: County: h&4pgAl Region:
Farm Name:
Owner Name: _
Mailing Address:
Physical Address:
Owner Email:
Phone:
Facility Contact: Title: `, Phone No:
Onsite Representative: R-+ i-W1C-1t �AICHgGt- M�W70' Integrator:
Certified Operator: + GHII L ANTE � _ „ Operator Certification Number: 1 a'_4
Back-up Operator:
Location of Farm:
Back-up Certification Number:
Latitude: ='
=' = " Longitude: = ° =' 0 "
Design Current Resign Current
Swine Capacity Population Wet Poultry Capacity Population Cattle
❑ Wean to Finish
❑ Wean to Feeder
® Feeder to Finish &0
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
❑ La er
Non -La er
Dry Poultry
lets
Poults
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
Capacity Population
❑
Dairy Cow
❑
Dairy Calf
❑
Dairy licifej
❑
Dry Cow
❑
Non-Dairy
❑
Beef Stocker
❑
Beef Feeder
❑
Beef Brood Cowl
Number of Structures: .�
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge'?
❑ Yes �No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
El Yes ❑No El NA ❑NE
❑ Yes
❑ No
❑ NA
Cl NE
❑ Yes
A No
❑ NA
❑ NE
❑ Yes
kNo
❑ NA
❑ NE
12128104 Continued

FIlcility N*mber: Date of Inspection
Waste Collection & 'Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
[]Yes O 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: 1_4cloovy
Spillway?:
Designed Freeboard (in): . S
Observed Freeboard (in):
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 VNo ❑ 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 0 No Cl 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 Ix No ❑ NA ❑ NE
maintenance or improvement?
Waste Aonlicatian
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 4 No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes W'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 Driti ❑ 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 XNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ZNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes _E�No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for Iand application? ❑ Yes ,§�`No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment'? ❑ Yes gNo
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
CET GaQU OF SLttf]C� SuQ.UE� Qc�T� QECfl4���A.
Reviewer/inspector Name 41 A. Phone:
Reviewer/inspector Signature: Date:
12128104 Continued

A . 't ■
Facility Number: —q�4 Date of Inspection
Re wired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available'? ❑ Yes ;�No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes XNo ❑ NA ❑ NE
the appropirate box.
❑ WllP ❑Checklists El Design [I Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 34 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
9No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
EfNo
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
5�No
❑ NA
❑ NE
25. Did the facility faii to conduct a sludge survey as required by the permit?
❑ Yes
ff No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
§ZNo
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
L�NA
❑ NE
❑ther lssues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes]
No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
R No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
,Q No
❑ NA
❑ NE
General Permit? (iel discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
jo No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
§f�jo
❑ NA
❑ NE
Additional Comments and/or Drawings:
12128104

Type of Visit 0 Compliance Inspection Q Operation Review 0 Structure Evaluation Q Technical Assistance
Reason for Visit '10 Routine Q Complaint Q Follow up Q Referral O Emergency Q Other ❑ denied Access
Date of Visit: Arrival Time: %Ci' Departure Time: Co nty:
Farm Name: Owner Email:
Owner Name: 5 Phone:
Mailing Address:
Physical Address:
Region:
Facility Contact: Title: hone No:
Onsite Representative:`—"" 7 ��� � � rIntegrator:
�Cr�fi9-F �Ga t
Certified Operator: �, _ � Operator Certification Number:
Back-up Operator:
Sack -up Certification Number:
Location of Farm: Latitude: = D = ` = " Longitude: = ° = 1 = f[
Design Current
Swine Capacity Papul`ation
❑ Wean to Finish
❑ Wean to Feeder
JK Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Design Current
Wet Poultry Capacity Pnpul� atiun
❑ Layer
Non -Layer
Dry Poultry
La ers
❑ Non -Layers
pullets
❑ Turke s
❑ Turkey Poults
❑ Other
Design Current
Cattle Capacity Popul5�
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Da Cow
❑ Non-Dai
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures:
Discharges & 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 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
El NA
❑ NE
3. Were there any adverse impacts or potential adverse irnpacts to the Waters of the State
❑ Yes
XNo
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12/2"4
Continued

4
Facility Number: /— Date of inspection?
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
XlEfNo
❑ Yes ❑ No
❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Structure 6
Identifier: 101-11
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
(ic/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes P(No
El NA ❑ NE
through a waste management or closure plan?
II
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 ElNE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ YesNo
)Zf
[INA ❑ 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
❑ YesNo
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes ff Na
❑ NA ❑ NE
maintenance/improvement?
1 l . is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes ;ZNo
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals
(Cu, Zn, etc.)
❑ PAN ❑ PAN > l0% or ld lbs []Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window El Evidence of Wind Drift ❑ Application
Outside of Area
]
12. Crop type(s) -C] W,77LWA- l ,9V 1. 15 f!� ! f lJf25E�1]� . aa,,�
_ �ffr►�
�■ -
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes FrNo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? 12rYes ❑ No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ Yes
No ❑ NA ❑ NE
�No ❑ NA ❑ NE
[V(No ❑ NA ❑ NE
Comments (refer to question 0): 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): .
Reviewerllnspeetar Name
Phone:
Reviewer/inspector Signature:
ZfZd.J ZEE Date:
Page 2 of 3 12128104 ' Continued

Facility Number: , j' — Date of Inspection 2 O
Reauired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes gNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes XNo ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design El Maps ❑ ether
21. Does record keeping need improvement'? If yes, check the appropriate box below. ErYes ❑ No ❑ NA ❑ NE
Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
Rainfall ❑ Stacking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
;EfN❑
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
VNA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
zNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
;� NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
X No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
L,LE No
El NA
El NE
and report the mortality rates that were higher than normal'?
I
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
�No.
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
No
❑ NA
❑ NE
Additional Comments and/or Drawings:
�r����G'f}��d�I �r� ��'� I/'`f.4 � V�r •�� �,t�-CO��3�Q,
2-�) A)K�
Page 3 of 3 12128104

r
of Visit ,Co pliance Inspection Q Operation Review Q Structure Evaluation Q Technical Assis#ante
son for Visit L7 Routine Q Complaint Q Follow up Q Referral Q Emergency Q Other ❑ Denied Access
Date of Visit: y 111 ' Arrival Time: 1 TS Departure Time: County: DUPE Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: _C1LWbALLL_ f0'QLMP'=A_
Certified Operator:
Back-up Operator:
Owner Email:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: = =1 =is Longitude: = v = 4 = 1i
Design Gurrent
Swine Capacity Population
Design Current
Wct PvuEtry Cap city population
Design Current
Cattle Eapacity l'opulativn
❑ Wean to Finish
❑ Layer
11E]
Dai Cow
❑ Wean to Feeder I
Non -La er I I
airy Cali'
© Feeder to Finish I
--Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
Non -Dairy
❑ Farrow to Finish
La ers
❑ Beef Stocker
❑ Gilts
Non-I.a ers
❑ Beef Feeder
❑ Boars
Pullets
Beef Brood
Turke s
.Cowl
Other
❑Turke Poults
❑ Other
❑ other
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
El No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ NN
[I NA
El NE
2. Is there evidence of a past discharge from any part of the operation?
El Yes
I N
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
El Yes
Id No
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
12/28/04
Continued

I+aeilit� Number: — Date of Inspection I I.
le
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure i Structure 2 Structure 3 Structure 4
Identifier: CA4adl�%1
Spillway?:
Designed Freeboard (in): i •c�
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes ONo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes 2(No ❑ NA ❑ NE
❑ Yes VNo ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? El2 Yes No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes VNo ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes S N❑ ❑ NA ❑ NE
maintenance or improvement?
Waste Application ,�
10. Are there any required buffers, setbacks, or compliance alternatives that need ElE Yes No ❑ NA ❑ NE
ma inte n a n celi mprove m e nt?
1 l . is there evidence of incorrect 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 Area
12. Crop type(s) w) SG () G W $
13.
Soil type(s) Tome$1sri
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
2(No
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
2 No
❑ NA
❑ NE
16.
Did the facility fait to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
ZNo
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
[2� o
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
�N❑
❑ NA
❑ NE
Comments (refer to question 4): 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):
Qb,) wuP at t)3 vewm od PAO Foo. t.ost-aJ F� LA. owx'J (,
fZC-1✓0 :?L.A A7 lb rr.I ?EAaV M owN Cfk_ ,tom N E,0 5
915 1? rl(AA ,�, �►WT VO P-
ro ��.c P� o�.� Gap-, r4 s Pis,
Reviewer/inspector Name o/�rJ �A�L-,L � Phone: +�� 7°i G " z
ReviewerAnspector Signature: Date: 'fl►� a
24 G L Vf J ■WLW VY LJ VrirrriNGir

v
'Facility Number: 3 — 3 Date of Inspection t o
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have l components of the CAWMP readily available? If yes, check 2/yes ❑ No ElNA ElNE
the appropriate box. Elf ❑ ❑ ❑
WllP Checklists Design Maps ❑ Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
L7 Yes
[:]No
❑ NA
❑ NE
❑ Waste Application ❑ kly Freeboard ❑ Waste Analysis ❑ Soil Analysis [:]Waste Transfers
❑ Annual Certification
❑ Rainfall [:]Stocking ❑ 120 Minute Inspections ❑ Monthly and 1"
XropYield
Rain Inspections ❑
Weather
Code
22.
Did the facility fail to install and maintain a rain gauge?
If
❑ Yes
�No
�No
❑ NA
❑ NE
23.
selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ NA
❑ NE
24,
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No7NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No
❑ NE
26,
Did the facility fail to have an actively certified operator in charge?
❑ Yes
Ld No
ElNA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
El No
A
❑ NE
Other issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
CTNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
eoo
❑ 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
O No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility rail to natify the regional office of emergency situations as required by
❑ Yes
LI 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
CJ No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
to
❑ NA
❑ NE
Comments and/or Drawings:
Page 3 of 3 12128104

C
Type of Visit x
Compliance Inspection ❑ Operation Review ❑ Structure Evaluation ❑ Technical Assistance
Reason for Visiit ❑ Routine ❑ Complaint ❑ Follow up ❑ Referral X Emergency ❑ Other ❑ Denied Access
Date of Visit: p Arrivul'1'ime: Departure Time: County:' �L�� Region: • i
Farm Name: Owner Email:
Owner Name: _- �- --10,, &C4 147U&S. 7__;A CPhone:
Mailing Address: _.._
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator: —
Back-up Operator: —
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Fccdcr
Farrow to Finish
Gilts
Boars
Other
❑ Other
"Title:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: 0 e = & = Longitude: = 0 0 6
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
S
La er
Non -Layer
Dry Poultry
Layers
Non -Layers
❑ Pullets.
❑ Turkeys
❑ Turkey Poults
Other
Discharges & Stream Impacts
1, Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Ilesign Current
Cattle Capacity Population
❑ Dai Cow
❑ Dairy Calf
❑ Daia Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures:
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)`'
d, Does discharge bypass the waste management system? (If yes, notify DWQ)
2. is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
M
❑ Yes ZNo ❑ NA ❑ NE
❑Yes El No ❑NA El NE
❑Yes ❑No ❑NA ONE
es ❑ Na ❑ NA ❑ NE
XYes ❑ No ❑ NA ❑ NE
❑ Yes ZZ No ❑ NA ❑ NE
12128104 Continued

• y
Facility Number: — Date of Inspection((
Waste Collection & Treatment
4. Is storage capacity (structural plus stortn storage plus heavy rainfall) less than adequate? ❑ Yes XNo ❑ NA ❑ NE
a. 1f 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 �Ao ❑ NA ❑ NE
(iel large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes VNo ❑ 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 RNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit'? El 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 L?rNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10, Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ❑ No ❑ NA ;2TONE
maintenance/improvement?
It. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes XNo [INA ❑ NE
ElExcessive Ponding [IHydraulic Overload ElFrozen 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 ❑ No ❑ NAleNE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ❑ No ❑ NA ONE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination,[:] Yes ❑ No ❑ NA P NE
17. Does the facility lack adequate acreage for land application? ❑ Yes ❑ No ❑ NA XNE
18. Is there a lack of properly operating waste application equipment? ❑ Yes ❑ No ❑ NA 1/J NE
d`questlon,#}.Vixplainyany .1 S iiriswi
�k 8; .: I ff ZZ.7 ,�Z.II VAdJV lY G, ::_..-4,-: ..,,;X1,X jV;;1*4W.
G � �
a :�;.:;; r
Reviewer/Inspector Name � �: :. .s hone: M—�6
Reviewer/Inspector Signature:
Date: ,!r
■ n mnrrrrr.rw
12128104 Condmued
-�GUF f'irJ .•f� U��rY 012, e—

f ;
Facility Number: / — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ❑ No ❑ NA ONE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ❑ No ❑ NA NE
the appropirate box.
❑ WUP El Checklists El Design El Maps ❑ ether
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA 9 NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minutc 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 tail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No ❑ NA NE
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ❑ No ❑ NA NE
25. Did the facility fail to conduct a sludge survey as required by the permit? ❑ Yes ❑ No ❑ NA NE
25. Did the facility fail to have an actively certified operator in charge? ❑ Yes ❑ No ❑ NA NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ❑ Yes ❑ No ❑ NA NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit'? (ie/ discharge, freeboard problems, over application)
32. Did Revi ewer/] nspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes
❑ No
❑ NA
NE
❑ Yes
❑ No
Cl NA
to
VNE
❑ Yes
Cl No
Cl NA
XNE
❑ Yes
)ZNo
///;dNo
El NA
❑ NE
El Yes
❑ NA
❑ NE
❑ Yes
/No
❑ NA
❑ NE
Adiiitiunal Comments andlor Drawlng sc .:�.
Aa �al e
WQ
i fi �I1I ►� � l ' -_-�4nl ea55 � 4L-;;,�,�
rf � f.E 0�� lv r
Goy
�Aw
7,0
�Ajy�
Tz/28104

4
L
Visit (j,C,a,liance Inspection Q aperatlon Review Q Structure Bvaluation Q Technical Assistance
for Visit 04Routlne 0 Complaint 0 Fallow up 0 Referral Q Emergency Q Other ❑ denied Access
Date of visit: I Arrival Time: y j Departure Time: County: 69uPw� Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: n��,, Title:
Onsite Representative:._CaAni&= E"__t[1 M(
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
U Farrow to Finish
❑ Gilts
Other
❑ Other
Owner Email:
Phone:
Phone No:
integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: = = = Longitude: = o = 6 s�
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -La er ;
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Imparts
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
❑ Daia Heifei
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
I
i.
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 No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
El Yes
El NA
El NE
El No
❑ Yes
El NA
El NE
El Yes
7No
❑ NA
❑ NF
12128104 Continued

Facility Number: — Date of Inspection 1 1
Waste Collection & Treatment 1
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes l'1 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
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes E 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 eNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes 2<o ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑Yes ZNo El NA [I NE
maintenance or improvement'?
Waste Application _,/
10, Are there any required buffers, setbacks, or compliance alternatives that need El Yes E No. ❑ NA ❑ NE
maintenance/improvement? �
1 l . Is there evidence of incorrect application`? If yes, check the appropriate box below. ElYes O 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) &6a'r--Z1� w) S 60 c Wj
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[Z NNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
N
[I NA
El NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination:
❑ Yes
�No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
CTN.
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
zv, r.J vP sN a ws �cao �F�v soav P q.� on! Ch-O P F-0 z to �T.W 6, .S'o ���A�IL
1. c2b sa Yu, To Xs-AVt cT Ae40 %t&TIA 1. AF fC IL. t " lQ-AX�J FA L t
o.
Reviewer/Ins
n _�-
e{ �t1at1 3 3�i o ector Name
p
Reviewer/Inspector Signature: Date: 5 o.S-
12/28/04 Continued

f
Facility Number: (late of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage 8i Permit readily available? ❑ Yes 2r No ❑ NA ❑ NE
20. Does the facility fail to haeWUP
❑mponents of the CAWMP readily available? If yes, check Yes ❑ No [I NA El NE
the appropirate box. ❑ Checklists ❑ Design El Maps ❑Other
21,
Does record keeping need improvement? If yes, check the appropriate box below.
Lf Yes
❑ No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual
Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections VMnthly and V
Rain inspections ❑
Weather
Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
El'No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
I'No
❑l NA
ElNE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
ElNo
2 NNAA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
El Yes
❑ No
[2 A
❑ NE
25.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
9<A
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes LI No ❑ NA ❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
94o ❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time ofthe inspection did the facility pose an odor or air quality concern?
El Yes
, _�
LJ No ❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
El Yes
,,�
LJ 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?
ElYes
"No NA
[INE
33.
Does facility require a follow-up visit by same agency?
ElYes
:NoONA
❑ NE
Aid tional: umnierits:andltir'Drwln s: . dl C
12128104

i1
IType of Visit .0 Compliance Inspection D Operation Review O Lagoon Evaluation I
Reason for Visit .0 Routine 0 Complaint Q Follow up Q Emergency Notification 4 Other •--7c.r..- ❑ Denied Access
Facility Number 4 Date of Visit: 7 27 'D Tune: II S • go
❑ Not Operational Q Below Threshold
Gifermitted Certified {{3 Conditionally Certified © Registered Date Last Operated or Above Threshold: ----------
Farm Name: _ .. t r.»...._._._.......»..........
........ » .....» » County: !�� .....__..._.._.__ ..!d
Owner Name:+ -a C-'Phone No:
Mailing Address:.._
Facility Contact: _M» _.».__. _.... ._ ......__.»......»» ....»_._ Title: ___...._.__ . ...._... » ..»»..»».. Phone No:
Onsite Representative: ��+'v a PA Cam ', r1j , C-0 Ir- S .',,t �tegrator• Cn�ac�
Certified Operator: C'� i4"1�A {. Operator Certification. Number:
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • 4 is Longitude • 4 «
si "S 1,r w: `Desii Curtrat
Current M ... Current.,: >:' .
1�
K...:
Swine :Ca ,rPo alatioa; PaulPotilatioa':.Fx Cattle
aci '•Po uistitean°
El Wean to Feeder
Feeder to Finish
(O17
1 �J
Farrow to Wean
13 Farrow to Feeder
Farrow to Finish
Gilts
❑ Boars
_:N
D
FE]Non-Layer
-Dairy
t
1
M•Other
.fir . ,I.n •y�, .'4 .
1
'
as
;;' ot��Defig�iCaPacitY;;i
T0tai'5Svw."
Discharges & Stroam lMpacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
❑ Yes XNo
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes ;TNo
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? ❑ Spillway ❑ Yes XNo
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Fnmcboard (inches):
12112103
Continued

Facility Number:,5 I— 3
Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (iel 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 pion?
(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?
B. Does any part of the waste management system other than waste structures require maintenancefimprovement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Auto Leation
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? If yes, check the appropriate box below.
❑ Excess
12. Crop type
13. Do the rece
❑ Yes A No
❑ Yes Z No
❑ Yes 0 No
❑ Yes J' No
❑ Yes 9No
❑ Yes No
❑ Yes No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes XNo
b) Does the facility need a wettable acre determination? ❑ Yes ❑ No
c) This facility is pended for a wettable acre determination? ❑ Yes ❑ No
15. Does the receiving crop need improvement? ❑ Yes 9No
16. Is there a lack of adequate waste application equipment? ❑ Yes 0No
Dior Lssues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge attor below ❑ yes XNo
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes ANo
19, Is there any evidence of wind drift during land application? (Le. residue on neighboring vegetation, asphalt, ❑ Yes �f No
roads, building structure, and/or public property) !
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional ❑ Yes "NO
Air Quality representative immediately.
. _....».�:.� cs%�-.,.,..e;:..-,sa:--�x;..�.3>r.'��e�: .... •..�....;,, ....u�:-..r-•�:i� ilr �x� €no 1
a �.rN.i�
Cammeats {refer to gnestiva #): Ex a Yk a�a�s► im a�adlor say, re crimes datiOns oi�, y� commtnta: = i'
1,,.c � � ��n/°�?:;':�/�S�ki�NrvyA��wF: €t•i.;
uryg. Vi. "F&34� MM��VY/�t 1 �iK �::' 1.... i.i!:
Llae dtawueg s o! �tcility to /better expl� sitnalioats {t se pages. as.nee�$rY):
❑ Field Copy ❑ Final Notes'
s�. � t'�'.�....•:,1 ::�_ :, H.!��. , , �::, •: se;�•. BS5 17c.= �i�'4.:-� x�t. w�w.w�r�ww
Reviewerampector Name 1-11
Reviewerfluspeetor Signature:
Date:
W121W Lonanuea

ki
Vaillity Number: Date of Inspection
Reauired Records & Documents
21. Fail to have Certificate of Coverage fit General Permit or other Permit readily available? ❑ Yes JO No
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.) ❑ Yes No
23. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes P(No
25. Did the facility fail to have a actively certified operator in charge?
❑ Yes )6 No
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(iel discharge, freeboard problems, over application)
❑ Yes
�No
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
�No
28. Does facility require a follow-up visit by same agency?
❑ Yes
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
/CZNo
No
NFQES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
❑ Yes
No
31. If selected, did the facility fail to install and maintain minbreakers on irrigation equipment?
❑ Yes
❑ No
32. Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ No
33. Did the facility fail to conduct an annual sludge survey?
❑ Yes
❑ No
34. Did the facility fail to calibrate waste application equipment?
❑ Yes
❑ No
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below.
❑ Yes
❑ No
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After 1" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
113 No violations or deficiencies were noted dating this visit. You will receive no further correspondence about this visit.
12//12103

Type of Visit Compliance Inspection 0 Operation Review Q Lagoon Evaluation
Reason for Visit koutine Q Complaint Q Fallow up O Emergency Notification Q Other ❑ Denied Access
Date of Visit: Time:
Facility Number
Not U crational 0 13el w' hrc h ld
© Permitted [3 CertilleGinditionaliy Certified C] Registered Hate Last Operated nr Aboye'I'hrestiold:
Farm Name: -AlCounty: G W
Owner Name:e Nu:
Mailing Address:
Facility Contact: Title:- Phone No:
Unsite Representative: ,(� ■ --------------- - Integrator -
Certified Operator: Operator Certification Number:
Location of Farm:
6wine ❑ Poultry ❑ Cattle ❑ Horse Latitude a « Longitude 0 ' "
Design Current Design Current Design Current
Swine Ca act Population Poultry Cal)acitv Population Cattle Capacity Population
❑ Wean to Feeder ❑ Layer I : ❑ Dairy
Feeder to Finish 1jWZT11 10 Non -Layer I I Non-Dai
Farrow to Wean
❑ Farrow to Feeder ❑ Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ Boars 'Total SSLW
Number of Lagoons 10 Subsurface Drains Present J10 La non Area 10 Spray Field Area
Holding Ponds 1 Solid Traps Q ❑ 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 conveyance man-made'? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (if yes, notify DWQ)
c. 1 f discharge is observed, what is the estimated I'low 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 0211cction & 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): Z
65103101
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes XNo
❑ Yes XNo
❑ Yes INO
Structure G
Continued

Facility Number: — Date of Inspection f '
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑ Yes
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
El Yes
No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
❑ Yes
o
8. Does any part of the waste management system other than waste structures require maintenance/improvemen(?
❑ YesgN
No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
No
Waste -Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes
A, No
11. Is there evident of over application9 xc sive Ponding PAN Hydraulic Ove Ioad
2",
❑yes
No
12. Crop type G A
13. Do the receiving crops differ with those designated to e Certified Animal Waste Management Plan (am
AWMP),
❑ es
o
A
14. a) Does the facility lack adequate acreage for land application?
El Yes
b) Does the facility need a wettable acre determination?
❑ Yes
ANo
c) This facility is pended for a wettable acre determination?
❑ Yes
No
X
l5. Does the receiving crop need improvement?
❑ Yes
LVNo
16. Is there a lack of adequate waste application equipment?
❑ Yes
ONo
ReguiredRecords & Documgnts
ZNO
17. Fail to have CcrtiCcate of Coverage & General Permit or ather Permit readily available?
Cl Yes
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ic/ W€]P, checklists, design, maps, etc.)
❑ Yes
V6No
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
)ZINo
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?
❑ Yes
No
22. Nail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes
(ic/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
,.d]
No
24. Does facility require a follow-up visit by same agency?
❑ Yes
XN o
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ YesXNo
No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Comments'(refer� tiff:question#}:::Expla€n'any:YES'answersJaadlpr a><y recgmmendatians or any other :ciimments; : ; :' ,;' :' ...";". - ` ':..
.. ..
',
'b-i• •',ii •, .•:R i A 7 S4E i s �°'v+s k
17se,drawings of facility to better expliiin situattIons use additional pages as necessary}:
• pj` , Field Copy ❑ Fin ai Notes
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date: 7
05103101 Continued

Facility Number: Date of Inspection
QAU 1n=
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours?
28. Is there any evidence of wind drift: during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon?
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
31. Do the animals feed storage bins fail to have appropriate cover?
32. Do the flush tanks lack a submerged rill pipe or a permanent/temporary cover?
❑ Yes ❑ No
❑ Yes No
❑ Yes a
❑ Yes ;
Z"NO
❑ Yes I[J No
❑ Yes /�N— o
❑ Yes ❑ No
Additional Comments and/or:Drawings:
A
03/03101

to
Type of Visit 40 Compliance Inspection Q Operation Review 0 Lagoon Evaluation
Resson for Visit eRoutine ❑ Complaint. D Follow up Q Emergency Notification D Other ❑ Denied Access
Facility Number 3 i Date of Visit: l S Time:
Not Operational Below Threshold
0 Permitted 0 Certified 13 Conditionally Certified 0 Registered Date Last Operated or Above Threshold: ................. ...
FarmName: ...........N...�................................................ County: ..t7 V P.r.`.:1.................................» .......................
r� � GtJ �v f G..
OwnerName:.......... ..... ................................................................................. Phone No:.......................................................................................
Facility Contact:
Title:
MailingAddress: ................................................................................
Onsite Representative: ..........................................................
Certified Operator:
Location of Farm:
PhoneNo:.... ...............................................
p..................................................... ..........................
Integrator: r r -,q ; u.r..'57".1 ( r. ...............
Operator Certification Number:.... ................., ...................
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude e ' " Longitude • 4 64
Design Current
Swine Consent Population
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Design Current Design Current "., .
Poultry Cilai .: Population Cattle Capacity Po ulatiob`!
❑ Layer I JEJ Dairy I I
f
❑ Non -Layer I I I[] Non -Dairy
❑ Other -
Total Design Capacity
Total SSL W
Number of Legoorin ] 1 = ❑ Subsurface Drains Present Lagoon Area 10 Spray Field Area
Holding Ponds 1 Solid Traps. JEJNo Liquid Waste Management System
Dischar es & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes ONO
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes M10
b. If discharge is observed, did it reach Water of the State? (if yes, notify DWQ) ❑ Yes ,!fNo
c. II' discharge is observed, what is the estimated flow in gallrnin? ri /
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ONO
2. Is there evidence of past discharge from any part of the operation? ❑ Yes ONo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ;31No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes e[�Nu
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
ldcnti1 per . .................................................................................................................................................................................................................
Freeboard (inches):
5I00 Continued on back

Faci •y Number: 3 j — c[- 317 Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes NO
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes E 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 maintenancelimprovement? 1❑
Yes )2fNo
8. Does any part of the waste management system other than waste structures require maintenancelimprovement?
❑ Yes Q'No
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 0 No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
❑ Yes 0No
12. Crop type Ce0A.'" p
ve)C, ��y Srwq[ G�cLt� C{` 'I, �11PA ' I teA &
f
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes ONO
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?
❑ YesY"10
lb. Is there a lack of adequate waste application equipment?
❑ Yes )IfNo
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes ,ENo
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
WUP, design,
❑ Yes ZNo
(ie/ checklists, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes)J No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
21. Did the facility fail to have a actively certified operator in charge?
"PINo
❑ Yes j71No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes EJINo
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/inspector fail to discuss review/inspection with on -site representative?
❑ Yes No
24. Does facility require a follow-up visit by same agency?
❑ Yes/J^0
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ YesIRNO
flAt rls of G>1eimvibs rp �►prig s'vsitit
correspondence: about: this visit.
Comments (re€ectu question #):. Eicpiain any YES answers and/or y rec[tmmendat3oigai air gtty,other toiaianenta: `'
44;.; ::.....
bse drawing of facility to better explain'situatiotis; [use, ad' udonai pagcsras neces y)': ;kj. e t' i , ., i1.s ` ". '_.: ",I)
r1
Reviewer/Inspector Name ,
Reviewer/Inspector Signature:
V1
Date:
5)00

Fa4lity Number: 31 - c� Date of Inspection g51 Oil
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 property within 24 hours? ❑ Yes/21No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes JZNo
roads, building structure, and/or public property)
24. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes j2r�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 ,21No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? 0-Yes /❑ No
Additional Comments and/or Drawings:
5100

`n of,Water uaEi.t �: , .;
)<1ir�fsiq Q yE.:;:t:
"r.:'`'
�.�...';" ;:,,;:.. �: r
x �'.,
` k'
,
Division
"
€, hi
�; !'
"I;.:�i r i.
�. .
r
of.SoiE and`Water.ConservatioII
. tip. '.FBI . N • •
❑thee, A enc u'
_�►i',Y
�
y'. �r ;
_� �. �� .'N' ,s ,.Y'".,t,R..�
a, r
i '.
'a
-`'L � I �`
{{
'd: si"" ... . . . ' }T.., `y i'•i
• �
l
(Type of Visit V Compliance Inspection 0 Operation Review Q Lagoon Evaluation I
Reason for Visit WRoutine D Complaint 0 Follow up Q Emergency Notification Q Other ❑ Denied Access
Facility Number Date. ur Visit: �1^ � �% 'r'ime: © Printed on: 7/21/2000
Q Not Operational Q Below Threshold
Permitted © CertifiedC) Conditionally Certified 0 Registered ' Date Last Operated or Above Threshold:
Farm Name: K±.r �- . ` County:......L--rA► 1.................................................
Owner Name:
Facility Contact:
Title:
['hone No:
Phone No:
Mailing Address: ...............................................
Onsite Representative:Integrator:...............................................................................l 1..�rick
Certified Operator:- ............................. .................................................................................. Operator Certification Number:
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude a 6 4' Longitude 0 6 «
Design Current Design Current Design Current
Swine Capacity Po ulation Poultry Capacity Population Cattle Capacity Population
❑ Wean to Feeder JE1 Layer ❑ Dairy
Feeder to Finish C] ❑ Non -Layer ❑ Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder ❑ Otltcr
❑ Farrow to Finish Total Design Capacity
❑ Gilts
El Boars Total SSLW
Number of Lagoons ❑ Subsurface Drains Present ❑ L.ig--on Area ❑ Spray Field Area
Holding Ponds 1 Solid Traps I JE1 No Liquid Waste Management System
Discharg_es & Stream lmpactti
1. is any discharge observed from any part of the operation'? ❑ Yes D�No
Dischnrae originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. II' discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
h. If discharge is ohserved, did it reach Water ol'the Stale'? {lf y'os, notify DWQ) El Yes [IN -0
c. II' discharge is observed. what is the estiIT1,11 i [low in gal/min?
d. Dews 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 gNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes gNo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate'? ❑ Spillway ❑ Yes JS�No
Structure i Structure 2 Struu[tire 3 Structure 4 Structurc 5 Structure b
Identi ficr:.........................................................
..... .......... ................................... .................................... .................................... ...... ..............................
Freeboard (inches): 3�
5100 Continued on hack

Facility Number:`3) — q'39 Date of Inspectaort
k'ritttcd on: 712112000
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 XNo
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenancelimprovement'! ❑ Yes No
8. Does any part of the waste management system other than waste structures require maintenancelimprovement? ❑ Yes No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes O No
Wmte Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes �o
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes allo
12. Crap type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes 9No
14. a) Does the facility lack adequate acreage for Ian1 application? ❑ Yes �No
b) Does the facility need a wettable acre determination? ❑ Yes ❑ No
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 (lie Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement'? (iel 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 certil'ied operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Pcrmit?
(ie/ discharge, freeboard probleins, 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?
. : i'Ho •yia�atitiris �!i' d�F�cie;rtcie5 rvtrr� �r�tedii>;�ring #h#s;vis�ti • Y:o� will •reetrivte �ti ft�irt�t�r
icorres nrideitce, about, this .visit.
❑ Yes ❑ No
❑ Yes D�No
❑ Yes g$ No
❑ Yes IZNo
Cl Yes *o
❑ Yes XNo
❑ Yes VNo
❑ Yes WNo
❑ Yes 4No
❑ Yes N No
❑ Yes t9 No
❑ Yes Pq No
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):
5l ►'��,.p•� ►..-awe �-�v��r U j51'�`j' ��r'� c� �1 Y-�i 4�+-��,1- Ak
Au�►� i�-L Gam+----�2� ' #G Sw,.e� �,,,t- e�3 �r�%r �.�`
"��� 1 � �.� � � a-• �� aches eye c�+-� � ►��� � ��d ,
9V
Reviewerllnspector Name 1
Reviewer/Inspector Signature.
,--ftQ 31S ---�q6�
Date: - G' G 51Uo

t r+
Facility Number: — Date of Iu,spection 2 G Printed on: 7/21/2000
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge War holow ❑ Yes KNo
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes KNo
29. 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 9No
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 N�No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes 4 No
32. Do the flush tanks lack a submerged rill pipe or a peimanent/temparary cover? ❑ Yes Vd No
[Additional Comments and/orDrawings:
J
5/00

6:
L
Division Soil and Water Conservation Other A etic '
eF •iri':: i its
Division of Water Quality
`^"•Fill... F's..f w ,7if 3
, Rn._i,
i
Routine OComplaint O Follow-up of DWO inspection O Fallow• -up of USWC reviev< 0 Other
Date of Inspection 7 ,
Facility Number 3 Time of Inspection f 24 hr. (hh:mm)
D RegisteredJ�Certified Cj Applied For Permit ©Permitted 0 Not Operational Date Last Operated:
Farm Name: J ,
Owner Name: ..... g7.)aK ................................. •�►-4„/ Phone No:
................ .... : ..................��.. ...... .............................
Facility Contact:.. 1 Y.1r.E............................................... Title :....�L``I..?...f./L............................ Phone No:....�x.�..........`t�.�:. 7.....
Mailing Addt'ess:...... frDr....`............. yl?r:....�......................... .....(.�....!x,(r...........f.............
Onsite Representative: ...... . .s.c��L'`''r......:........ Integrator: ........ CfI]................................... .......
Certified Operator-,.......F.'.....'".............................. ............. ..r...........�.................%f... Operator Certification lumber:...'zz..'.L& .........
Locution of Farm:L�-•-
. . . .. .... ... .........
C
G
Latitude • 4 " Longitude ` 6
t stgn f : g g
urrt n _ Design Current!,
Design urren
[7s�iiue capacity: Population,;,: Poultry;. Capacity ':Population Cattle Citpacity Population
❑ Wean to Feeder
® Feeder to Finish
L p
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
I[:Number tif.La [irnil Holditt .. Ponds . ❑ Subsurface Urams Present ❑Lagoon Area C
g u
;."........... ❑ No Liquid Waste Management System
General J
1. Are there any buffers that need maintenance/improvement?
1 Is any discharge observed from any part of the operation?
Discharge originates! at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d, Does discharge bypass a lagoon system? (If yes, notify DWQ)
3. Is there evidence of past discharge from any part of the operation?
4. Were there any adverse impacts to the waters of the State other than from a discharge?
5. Does any part of the waste management system (other than lagoons/holding ponds) require
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
7. Did the facility fail to have a certified operator in responsible charge?
7/25l97
Spray Field
❑ Yes B No
0 Yes J9 No
❑ Yes a] No
❑ Yes JZ No
❑ Yes
R No
❑ Yes
CR No
❑ Yes
2 No
❑ Yes
H$ No
❑ Yes
93 No
[]Yes
�@ No
Continued an hack

Facility Number:
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (Lagoons.lioldine Ponds, Flush Pits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier:
Freeboard(ft): ......... l9, d....................................i......................................................................
10. is seepage observed from any of the structures?
11. Is erosion, or any other threats to the integrity of any of the structures observed?
12. Do any of the structures need maintenance/improvement?
(If any of questions 9.12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
Waste ApRligation
14. Is there physical evidence of over application?
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
❑ Yes 0 No
❑ Yes 0 No
Structure 5 Structure 6
.
15. Crop type...............�w.�....................................................L....... .............. .. .........................................................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)'?
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/Inspector fail to discuss reviewlinspection with on -site representative?
22. Does record keeping need improvement?
For Certified or Permitted Fac&ies Only
23. Does the facility fait to have a copy of the Animal Waste Management Plan readily available?
244. Were any additional problems noted which cause noncompliance of the Certified AWMP?
25. Were any additional problems noted which cause noncompliance of the Permit?
0-No.violations or def"tciencies.were iioted-during this'visit.• You:will receive'nv furth_ er
correspondence about this: visit:• : - : ' . ' .....
❑ Yes 9 No
❑ Yes (9 No
❑ Yes R] No
❑ Yes ZNo
❑ Yes 91 No
❑ Yes X No
❑ Yes A No
RYes ❑ No
Cl Yes EkNo
❑ Yes No
❑ Yes No
❑ Yes ig No
❑ Yes Z No
❑ Yes ja No
❑ Yes [allo
si:•.... ... :i:::ss :s: ...:�:..i•.:�«::, i�i::':r: �:'.F.4"a.:' '.. asss.sss.:.�s�s•r e • �A �k3
Comments (rcPer to question # •; plain a? 3' i3Y 5 answers, m Vo;, eny recommendations: orany ntheir{{'c±pxtmtents.
3 & & E Ej �?i�! lii. r! §'!j IF EFL 1
[ 'drawings of facility tti bcttet'explair>il ttuativtts� u$e dditiodai pages as;ncce�sary}: ° li,F!`;li'Ellli== ;; :,,` ... ;; _
use.
s. ;3S�, a file ,!. $•: F .�.««� F F is EEi Feee' n ; _
L`d' �{J'7-J-�vi-....►- � CJ�ti'� [J)-L• ���vt' i'T�CLt��dc .�v�- ���I�-t�L �nt��.'
IV-GGG� 'ice � ,� G'.x !'ems.. J� -�i • �s
S
7/25197
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date:

Facility Number 31 437 Date of Inspection Brd
Time of Inspection24 hr. (hh:mm)
❑ Registered N Certified 0 Applied for Permit © Permitted 113 Not Onerational Date Last Operated:. .........................
Farm Name: dnbxt.,SAu.Wirlan d.FjLrm........................................................................... County: D'tpllul................................................ MR0.........
OwnerName: Ja bjL............................•........... 59aut eriand............................................. Phone No: U.".7.97.....................................................................
FacilityContact: .............................................................................. Title:............................,................................... Phone No:...................................................
Mailing Address: 188A.S.NCA11..................................................................................... chlu ammin...NC..........,.....,................................. 28521..............
Onsite Representative: UyvAet:............................................................................................ Integrator: CArrWV.s.FnLad&.1mLc ............................................
Certified Operator:johpx........................................ SoliftrlAW.................................. Operator Certification Number:22.41.4 .............................
Location of Farm:
Latitude =10
51 , 15 " Longitude =0 42 1 43 _
' '
Swlne
{ Desl n
Ga'� cgi �
" Current
Pa `�ulgtionl
Desi ti Current
Poult!' Ca City Pa uls iti�n 1(
;� ❑ La er
;;'i:' Desi n I' ''Current
Ca {le jlli �t� ;j'! { Caf agi ;� i Pa"ul tlari �
❑ Wean to Feeder
❑ Dai
® Feeder to Finish
Cl Farrow to Wean
1760
f �u Non -Layer
` J7fHfil7Sf1li?!f'[AiHfBfVP d777�fliHtiiIDi:H:!.WifB.'11!HlGI7?'.1111N#fli7uf:fR!%7i81f!
,i
❑ Non-Dai
r¢' !Iii'I�'I�`iiiijnirl:iil�ili.' t illiY{i'? I�!�jl rj, 3 i���r�
f( ;l +i all ,°jj r:',, II1.
�( !:i� jjl k fill, � Jf i
f f ii ; c! ,f u �I ;'''rI� j ;..; !'
!!�i.�{f'�'�j?'r �,'rf!�.r��4'lfnl�i�7k�Jt3{�i �'f�l(�
1,'1fiU
2,.
?;
1�,;;ll
ji
3h
�
'
1
!
Farrow to Feeder
❑ Other
Farrow to Finish
A:'?r
r�il�ss�w�f��;�=7,600
S.
!
j
iftr!
1atalDesigaaacity;!(j
i �f[' f{ I#:il��i4;�{I.i•?jslfi'i;v:
i
Gilts
Boars
Number of Lagoons 1 Haiding Ponds 1 ®Subsurface Drains Present ❑ Lagoon Area ® Spray Field Area 1
❑ No Li uid Waste Management System r,
General
1. Are there any buffers that need maintenance/improvement?
2. Is any discharge observed from any part of the operation?
Discharge originated at: []Lagoon ❑ Spray Field []Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Surface Water? (if yes, notify DWQ)
c. if discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
3. Is there evidence of past discharge from any part of the operation?
4. Were there any adverse impacts to the waters of the State other than from a discharge?
5. Does any part of the waste management system (other than lagoons/holding ponds) require
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
7. Did the facility fail to have a certified operator in responsible charge?
7/25/97
❑ Yes ® No
Continued an hack

Facility Number: 31--437 Date of Inspection 1 11-24-98
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (Lagoon1jigiding Ponds, Flush Pits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure i Structure 2 Structure 3
Identifier:
Freeboard(ft): ..............2 Q..................................................,....................................
10. Is seepage observed from any of the structures?
Structure 4 Structure 5
11. Is erosion, or any other threats to the integrity of any of the structures observed?
12. Do any of the structures need maintenance/improvement?
(If any of questions 9-12 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
Waste AR1211calion
14. Is there physical evidence of over application?
(If in excess of WMP, or runoff' entering waters of the State, notify DWQ)
❑ Yes ® No
❑ Yes ® No
Structure 5
............................................................................
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
15. Crop type ......��, .5tal. satnauda asa....... mall . ixaati W..i at. >3aal, t.......................................................................................................................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)? ❑ Yes ® No
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
22. Does record keeping need improvement?
For Certified or Permitted Egellitiel Unly
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
25. Were any additional problems noted which cause noncompliance of the Permit?
-'No:�ialatioin.vr. deffciencies:were noted during:this visit.. VYou will reie 'e.nn.furth 'r::.
O rtsO ideh O'60t this �yisit o - ....: :....... . . :: . . ' :.::. - :. - . - : - ::::::::::.:.::::. .
18. Continue to work on weed management in coastal fields. Need to get current soil analysis,
❑ Yes ® No
® Yes ❑ No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes IN No
❑ Yes ® No
❑Yes No
Ak
qF
Reviewerllnspector Name Pavid Holsinger ,,

Routine 12Complaint Follow-u of DW ins ection Follow-ug of DSWC review Of her
Facility Number 31 437 Date of Inspection 418198
., ., Time of Inspection 15:40 d 24 hr. (hh:mm)
U Registered 0 Certified [3 Applied for Permit © Permitted 113 Not O erational Date Last Operated:
Farm Name: JAbn5:auMer1iwd.FAr u........................................................................... County: Dulaft ............................................... W. 1110.........
OwnerName: djtbn......................................... Smdherlan d........,.................................... Phone No: 29.11AM ....................................................................
FacilityContact: ............................................................................. Title:...............,,............................................... Phone No:...................................................
MailingAddress:1M.S.KC..111 .............................. -...................................................... Cklilnuu aak..NC....,.....,,..,,,................................. 28521..............
Onsite Representative: jQktia,SoujIwdAlxd..................................................................... Integrator: CArrWr.a.FAQdll.111C.............................................
Certified Operator:j.uha.Sftlul wlalnd.......................................................................... Operator Certification Number:22.41.4 .............................
Location of Farm:
Latitude 34 • 51 i 15 longitude 77 " 42 ll3 ii
General
1. Are there any buffers that need maintenance/improvement? ❑ Yes ® No
2. Is any discharge observed from any part of the operation?
Discharge originated at; ❑ Lagoon ❑ Spray Field ❑ Other
a. if discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
c, If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
3. is there evidence of past discharge from any part of the operation?
4. Were there any adverse impacts to the waters of the State other than from a discharge?
5. Does any part of the waste management system (other than lagoons/holding ponds) require
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
7. Did the facility fail to have a certified operator in responsible charge?
7/25197
❑ Yes ® No
Continued on hack

Facility Number: 31-437 Date of Inspection 41til98
8. Are there lagoons or storage ponds on site which need to be properly closed?
"Structures_(Lagoons.Holding Ponds. Flush Pits. etc.) .
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier:
Freeboard(ft):...............1A..............
10. Is seepage observed from any of the structures?
11. is erosion, or any other threats to the integrity of any of the structures observed?
12. Do any of the structures need maintenance/improvement?
(If any of questions 9-12 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
Waste Annlicatlon
14. Is there physical evidence of over application?
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
❑ Yes
® No
❑ Yes
® No
Structure 5 Structure 6
................................................................
[I Yes
®No
❑Yes
®No
IN Yes
❑ No
15. Crop type ......�Qa�tak.> rrnauda.Crxas�......•........................Ryc...................................................................................,
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
22. Does record keeping need improvement?
For Certified or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
25. Were any additional problems noted which cause noncompliance of the Permit?
No.vio'lition's•or. dehiiencies.were' noted during:this visit,. ,1Fofi,will- receir'e.f ..N 'ther:: .
: cyrresAoridek6 about this visit: ::::::: : .
❑ Yes ® No
❑ Yes ® No
® Yes ❑ No
❑ Yes ® No
® Yes ❑ No
❑ Yes ® No
❑ Yes ®No
❑ Yes ® No
® Yes ❑ No
❑ Yes ® No
® Yes ❑ No
❑ Yes ❑ No
12) Need to mow lower edge of outer wall to allow for thorough observation, especially along ditch. Some minor bare areas may #
need better vegetative cover especially if erosion develops.
16) W.U.Plan lists all 3 fields to be overseeded with sm.grain. Only field 2;tract 71161 currently planted in sm.grain.
4)Toolate for rye to be overseeded for this season. Very close PAN produced to available land thus mandatary for this farm.
18) Hydrant no.3;field no.3; especially not suited for waste application particularly for wet periods. May need to fill and level to
make suited for proper drainage and adequate crop production. Rye stand not uniform and needs improved cover.
2) Keep current Nitrogen balance on IRR2 form;
Bermuda indicated in WUP for 3501bNlac. which is greater than average for'FOA' soils, thus recommended that producer
aintain yield records for hay cut to verify this high yield and justify high N rate.
Reviewerllnspector Name John N. Hunt

.... A,.: ... .. .. :. ..eea. ,u i >tr.Hwxr 1F��,_' wP� :i •.l,ii
S
❑ Division of Soil and Water Conservation [3 Other Agency
Division of Water Quality.
.. F [. :'s i{e �F. , s:�m....r.,a...--•,E,•. !?' 3 ... .. .. ti.5'
.. .. .....^....".'"'^.ie."."'.`.."..r'.7."".M.!.,..`mn+v-,..;...,,�.ee.-..�.kFn--•r.,,,. .: F"fFr,-..e was'.....rnn`ir""'^'...,..-...Y.^.e,."„�i3^1:??.. '. :{'.. �Ss�_.'$.'i. .. .y.
F41toutiue OCumplaint Q Follow-u of DW ins ection
d Follow-u of l?SWC review Q Other
Facility Number � 3"i
Date of Inspection 4 $
Time of Inspection 1 d 24 hr. (hh:mm}
© Registered $Certified 0 Applied for Permit 0 Permitted
Not O erational Date last Operated:
Farm Name:...... S ............�i�wu:�....................................................
County:.....bmu !-r�........................ .........,..........,,,,,.............
11.���.........�:
OMrner Dame:... ], �f],! ........ S� 0..... ........... ................. ,......................
,,.,.... ...... Phone No:.A[0.1Z t:-..4312...................... ,,..,...............
Facility Contact:...... '-6� .......�a�.le�................ Title .........
Q.trmil........................................ Phone Na:.��}�G���- 47,� �.........
Mailing Address. ..V .A,Y......�— A ..N..(......171., ............................................
�'!!'! �!��a.l ��.........,,....,,................... Y4.......
Onsite Representative:.....A..... ...... Integrator•..... 7 C!r8 u 5.................
. ��tr
Certified Operator;._ ..... -�.06.......... W........ -?n A" U'.41i..............
I ............... .. Operator Certification Number:....: Vn-
Location of Farm:
...Tay ... , .. m....... CL\ ...... � :s .......LlAx .... A
IV�4...... �........... Yx!.w......J.a.r.. 1n......... ..., ..........................................
Latitude 0 1 " Longitude ' 6 44
.... .::.. ..;......... ...tt4. .:...
.. , . i
".:. ; .. �
Design, - Current. i' Design; ;:,:Current' ... .. ::Deli ni ::::;Current P g
"....:.y
Swine ,:,, ;t'Capa�ity
,..- ... �..�e•� ;.? �3 i:; : s
.Fs.
I?opulation : Poultry;; .; CapacityEPgpulation = Cattle;;: !..';.s.=:°s€ CapucitY `Population
1 Wean to Feeder
❑ Layer Dairy
Feeder to Finish
s={
JEI Non -Layer ❑ Nan-Dairy
Farrow to WeanOther
❑ Farrow to Feeder
.. ❑
Farrow to Finish
I�
,'Totafl:=Des n Capa�it
tg
Gilts
j £
t..�
❑ Boars
..
x : ' .. Total SSLW 7.
�E (
Nuimtiier if:I Agtioi s
1 HnldiYigfPangs Subsurface Drains Present ❑Lagoon Area Spray Field Area
..Ee
€'
: y3j-r
i "; ❑ No Liquid Waste Management System
ener
1. Are there any buffers that need maintenance/improvement?
❑ Yes
allo
2. Is any discharge observed from any part of the operation?
❑ Yes
No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
❑ Yes
[ No
b. If discharge is observed, did it reach Surface. Water'? (If yes. notify DWQ)
❑ Yes
® No
c. If discharge is observed, what is the estimated flow in gal/min?
�
A. Does discharge bypass a lagoon system'? (if yes, notify DWQ)
❑ Yes
J1 No
3. Is there evidence of past discharge from any part of the operation'?
❑ Yes
10 No
4. Were there any adverse impacts to the waters of the State other than from a discharge?
❑ Yes
51 No
5. Does any part of the waste management system (other than lagoons/holding ponds) require
14 Yes
❑ No
maintenance/improvement?
5. Is facility not in compliance withany applicable setback criteria in effect at the time of design?
❑ Yes
C9 No
7. Did the facility fail to have a certified operator in responsible charge?
❑ Yes
C9 No
7125/97
Continued an back

Facility Number: -- �-�
8. Are there lagoons or storage ponds on site which need to be properly closed?
SIructures (La goous, HoldinE! Ponds, FIu21 Pits, etc.I
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Stricture I Structure '2
Iden ti Fier:
Freeboard (ft):............4....................
10. Is seepage observed from any of the structures'?
Structure 3 Structure 4
11. Is erosion, or any other threats to the integrity of any of the structures observed?
12, Do any of the structures need maintenance/improvement?
(IF any or questions 9-12 was answered yes, and the situation poses
an immediate puhlic health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
Waste ADDlicatirrn
❑ Yes 20 No
❑ Yes
R1 No
Structure 5 Structure 0
❑ Yes
® No
❑ Yes
IQ No
W Yes
❑ No
❑ Yes J9 No
14. Is there physical evidence of over application? ❑ Yes ® No
(if in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type ............. .
1 Y,>(!!l#....................................... .......................�4imia.......................................................................----...................................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)? ❑ Yes 15,No
17.
Does the facility have a lack of adequate acreage for land application?
❑ Yes
56No
18.
Does the receiving crop need improvement?
❑ Yes
M No
19.
Is there a lack of available waste application equipment?
❑ Yes
® No
20,
Does Facility require a follow-up visit by same agency'?
❑ Yes
9No
21.
Did Reviewerllnspec tor fail to discuss rev iewhnspection with on -site representative?
❑ Yes
® No
22.
Does record keeping need improvement?
Yes
❑ No
Eor Certified or Permitted Facilities On[}
23.
Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑ Yes
;9 No
24,
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
® No
25,
Were any additional problems noted which cause noncompliance of the Permit?
❑ Yes
® No
®• No.vialitioits'or' deficiencies were nate&d'Hng this:visit:, You will i keive•tna-further
: Ofresp0dence 6 out this:visit. " :: .
...: e...i .s.ns.....,. Ss„ ....... :: .......• , ... 1, ...:" ee: .:... .,.. .-e t'::. .». �51F°:. ":lit,':: i." •.;.I ,,, ix.....; », i3i3...giE .
Cortnrrtents.(rerer toques tion.#)v ExpIain any =YES'artswers'andlor any't�cntnntendutipns°or'iany_;oth r c rrt3t4erit�;:; a
.......,. .. ..e. « ...,3 Fi3:•u: 3 ryV f
' i i
Use rowing, to �ettcr ei fain situations: use additivnul a es is:nccessa 3
}
.:.!�... ::. E;., .:.s� ::3:i, E- iiS��9 ...33f." :: �'::e..
„f' 5.
r aw av-t., 11 �1 S P vp►� .S u �C `i i � . r: � 5 �i�y �.:: r ` r
IZ, L& 8vn Oil[.1! w dls skodd � e M1U�Pr1• i f�1�A-i 5�toulU he re, SaeJcd.
7-2- CrOt Y` e f d rc 041 ikOdjd be �A 1)an, COrM+ otcreagc 4r. (Jek�& &ON, shod d
k6t tlse3 1A C0,61c,�'n 4rl,�Cin 100'j►" I-Y\ 5" Acfd%.
7/25/97
"Tin.
Reviewer/Inspector Name Reviewerllnspectur Signature: Date: � Q�zc}�Ct'�

0 Division of Soil and Water Conservation 13 Omer Agency
® Division of Water Quality
10 Routine 0 Complaint Follow-up of DWO inspection 0 Follow-up of DSWC review 0 Other
Date of Inspection 10129lg7
Facility Number 3l 43T
'Time of inspection tG:40 24 hr. (hh:mm)
13Registered 0 Certified [3Applied for Permit O Permitted Not O erational Date Last Operated:
Farm Name: daabnSAiitb crland.Farm........................................................................... County: Qiuulltl................................................ WjRtl.........
OwnerName: daabn......................................... Switherlaud ............................................. Phone No: x9$.. 4.7&7..........,.....,....................................................
Facility Contact: ,labs.Souberla3,nd........................................ Title: cavil er.................................................. Phone No: am ........................................
MailingAddress: 1 .5...11.><...................................................................................... chinas lmia.-N.C.................................................. 21511.1............
Onsite Representative: jkQ1tTx.59xttiArka11d.................................................................... Integrator: CArrtt[P.at.1?audx.liat;.............................................
Certified Operator: J.oltlx.W.�................................&QIAthrrjAUj .................................. Operator Certification Numher: 5.............................
Location of Farm:
Latitude =0
51 ,=11 Longitude =0
42 , 03
Design Current
Design FCurrent
Design Current
llaci
Swine
Ca act P,o ulation
P,opltry Ca acl oulation Cattle
Ca Po lu a�t[an
❑ Wean to Feeder
❑ La er
❑ Dairy
® Feeder to Finish
1760
❑Non -La er
❑ Nan -Dal
❑ Farrow to Wean
Farrow to Feeder
❑ Other
Farrow to Finish
TotalhDesign Capacity
1,760
Gilts
IM Boars
Total SS.
237,600
Number of Lagoons 1 Holding Ponds �_J
® Subsurface Drains Present
❑ Lagoon Area
® Spray Field Area
❑ No Liquid Waste Mana ement S stem
General
1. Are there any buffers that need maintenance/improvement? ❑ Yes ® No
2. Is any discharge observed from any part of the operation? ❑ Yes ® No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a, If discharge is observed, was the conveyance man-made? ❑ Yes ® No
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ) ❑ Yes ® No
c. If discharge is observed, what is the estimated flow in gal/min? nla
d. Does discharge bypass a lagoon system? (if yes, notify DWQ) ❑ Yes ® No
3. is there evidence of past discharge from any part of the operation? ❑ Yes ® No
4. Were there any adverse impacts to the waters of the State other than from a discharge? ❑ Yes ® No
5. Does any part of the waste management system (other than lagoons/holding ponds) require ® Yes ❑ No
maintenance/improvement?
b. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes ®No
7. Did the facility fail to have a certified operator in responsible: charge? ❑ Yes ®No
7/25/97 Continued on hack

Facility Number: 31-437
8. Are there lagoons or storage ponds on site which need to be properly closed? ❑ Yes ❑ No
Structures [Lagoons.HoldingPoUds. Flush Pits. etc.l
9. is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes ❑ No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure d
Identifier:
Freeboard(ft):................ 2................. .................................... ................................... .................. .................. .................................... ....................................
10. is seepage observed from any of the structures? ❑ Yes ® No
11. Is erosion, or any other threats to the integrity of any of the structures observed?
12. Do any of the structures need maintenance/improvement?
(1f any of questions 9-12 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
Waste Application
14, Is there physical evidence of over application?
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type ...... aA&tal Up=ixda.jGm&S....... t all.�ixa W..h ate a��c�c..............................................................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. is there a lack of available waste application equipment?
20, Does facility require a follow-up visit by same agency?
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
22. Does record keeping need improvement?
For- Certifled or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
25. Were any additional problems noted which cause noncompliance of the Permit?
No:vitilitioims or• deflclencies *ei 6 noted duridg:this visit.: -Y i •rri11 receirie4o:further:
correspondence abbot this Aslt: " : ;
❑ Yes
® No
® Yes
❑ No
❑ Yes
® No
❑ Yes
® No
❑ Yes
®No
[I Yes
®No
❑ Yes
® No
❑ Yes
® No
❑ Yes
® No
❑ Yes
® No
® Yes
❑ No
❑ Yes
® No
❑ Yes
®No
❑ Yes
®No
. Low area in spray field should be filled, graded and reseeded.
12. Lagoon dike walls should be mowed. Bare areas should be reseeded.
2. Crop yield records should be in plan. Correct acreages for wettable area should be used in calculating N loading in spray ficids.1 Al
IVs
Reviewerllnspector Name •Brian L: Wrenn
Reviewerllnspector Signature: Date:

® Division of Soil and Water Conservation [3 Other Agency
Division of Water Quality
16 Routine Q Complaint— a -Follow-up of DWQ Inspection D Follow-up of DSWC review Q Other l
Date of Inspection 9112197
Facility Number 31 437
Time of Inspection 17:011 24 hr. (hh:mm)
Registered 0 Certified 0 Applied for Permit 13 Permitted 113 Not Operational I Date Last Operated:
Farm Name: duha.5putk19rJ Ud.E8xm........................................................................... County: MPH& ............................................... !' IRO.........
OwnerName: Mw......................................... Sautherhad ............................................. Phone No: 29.& 7.97.....................................................................
FacilityContact:.............................................................................. Title:................................................................ Phone No:...................................................
Mailing Address: 1A$:4.S.NC..la.l.................................................................................... chilllgr pixt...NC.................................................. 211521 ..............
On site Representative: John.Sntuftr.Ixtud.................................................................... Integrator: CArrplrxFauds.ipc.............................................
Certified Operator:Jqhn.W,................................. Sul&tbCrjutied................................... Operator Certification Number:1.5155 .............................
Location of Farm:
Latitude 34 • 51 6 i5 u Longitude 77 • 42 4 b3
❑ Wean to Feeder
® Feeder to Finish
1760 1760
❑ Farrow to Wean
❑ Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
1,760
237,600
Numbe' ofMaggoons 1 Holding�Ponds 1 J ® Subsurface Drains Present I❑ Lagoon Area 1® Spray Field Area
s
❑ No Liquid Waste Mana ement S stem
General
1. Are there any buffers that need maintenance/improvement? ❑ Yes ® No
2. Is any discharge observed from any part of the operation? ❑ Yes ® No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
3. Is there evidence of past discharge from any part of the operation? ❑ Yes ® No
4. Were there any adverse impacts to the waters of the State other than from a discharge? ❑ Yes ® No
5. Does any part of the waste management system (other than lagoons/holding ponds) require ❑ Yes ® No
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes ® No
7. Did the facility fail to have a certified operator in responsible charge? ❑ Yes ® No
7?25?97 Continued on hark

-- - - - -
Facility Number: 31--437
8. Are there lagoons or storage ponds on site which need to be properly closed? ❑ Yes ® No
Structures (Lagoons.Hoiding Ponds. Flush„ Pits. etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes ® No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard(ft):............ ...41................ .................................... ................................... .................................... .................................... ............................
.....,,.
10. Is seepage observed from any of the structures? ❑ Yes ® No
11. Is erosion, or any other threats to the integrity of any of the structures observed? ❑ Yes ® No
12. Do any of the structures need maintenance/improvement? ❑ Yes ® No
(if any of questions 9-12 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers? ❑ Yes ® No
Waste A1212I4cation
14. is there physical evidence of over application? ❑ Yes ® No
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type .....CpAj d.8rxmuda..�raSa.......Snaa1j.QxaitL4..WbJMl..BaXjCy.......................................................................................................................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)? ❑ Yes ® No
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/inspector fail to discuss review/inspection with on -site representative?
22. Does record keeping need improvement?
For Certified or Pgrmitted FaCilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
25. Were any additional problems noted which cause noncompliance of the Permit?
Et No:violatioins•or, deficie>licies;Were noted dtiririg_ :this irisit.: NOW -will fkeWe:ao1Uther: -
correspandence about this visit: - ; , .
24 Need to keep crop yield records to justifyldocumentation to support high nitrogen rates.
Need to update IRR2 forms for ease of detennining current Nitrogen balance.
bare spots around lagoons, need to keep mowed too to help establish desired cover.
❑ Yes ® No
❑ Yes ®N o
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes IN No
❑ Yes ❑ No
�r
Reviewer/Inspector Name John N. Hunt
Reviewer/Inspector Signature: Date:

•
•
a
Site Requires immediate Attention -,�/
Facility Number: 3 T
SITE VISITATION RECORD
DATE: 1 , 1995
Owner: =, Farm Name:
County:
Agent Visiting Site: )V a,.,1 Phone: q o la4 —1 aej -�
Operator: Phone:
On Site Representative: Phone:
Physical Address: f: .x �t ic
Mailing Address:
-:
Type of Operation: Swine X Poultry Cattle
Design Capacity: 19 6 u _ Number of Animals on Site: 7 D
Latitude: —° Longitude: a "
Type of Inspection: Ground )C Aerial
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) Yes or No Actual Freeboard: __L_ Feet � Inches
For facilities with more than one lagoon, please address the other lagoons' freeboard under the
comments section.
Was any seepage observed from the lagoon(s)? Yes or No Was there erasion of the dam?: Yes or No
Is adequate land available for land application? Yes or No Is the cover crop adequate? Yes or No
Additional Comments:
Fax to (919) 7 15 -35 59
Signature of Agent

C
•
Site Requires Immediate Attention: 0 J
Facility No.
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: — o , 1995
Time: 14 37
Farm Name/Owner: �a L"- k S. 9 u j
Mailing Address:
Countyp—
Integrator. _ L 40 'r ro �S - Phone:
On Site Representative: Phone:
Physical Address/Location: F-L!� `� I 1 ti p. t_ rL o s$ V --,y.o �,.� 2. 12 21
Type of Operation: Swine '__+ Poultry Cattle _
Design Capacity: ` I S-00 Number of Animals on Site: �' Too
o
DEM Certification Number: ACE DEM. Certification Number: ACNEW
Latitude: �° S I - ' � Longitude: )—' �' 0" 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) zl°r No Actual Freeboard: -Ft. Inches
Was any seepage observed from the lagoon(s)?
Is adequate land available for spray? EeDr No
Crop(s) being utilized: C—'a''` 5r?='r`
Yes or No Was any erosion observed? Yes or No
Is the cover crop adequate? (e or No
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings? Sor No
100 Feet from Wells? _Q or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes @�l�
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 o6Q If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acrea a with cover crop)? Yes or(N
Additional Comments: C� r. Ee L it--P
Inspector Name Signature
cc: Facility Assessment Unit Use Attachments if Needed.