310457_INSPECTIONS_20171231

NUHTH CAHQLINA
Department of Environmental Qual

(Type of Visit: Q Cot lance Inspection U Operation Review U Structure Evaluation U Technical Assistance
Reason for Visit"
Q Complaint Q Follow-up 0 Referral ❑ Emergency Q Other Q Denied Access
Date of Visit: Arrival Time: Departure Time: Z r County: Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: r C-%4— ic►i'-t-{�
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Phone:
Integrator:
Certification Number: 3 6
Certification Number:
Longitude:
Design Cnrrent
Swine Capacity Pap.
Finish
Feeder
Finish Lr Zy Q
Wet out,
La er
Non -La er
Design
Capacity
CFrmjjtl
Pnp.
t
Cattle Capacity Pup.
DairyCow
DairyCalf
DairyHeifer
Wean
P,oult
La ers
Design
Ca acI
Current
Po
D Cow
Non -Dairy
Beef Stocker
to Feeder
pFarrowFinish
Non -La ers
Beef Feeder
Pullets
Beef Brood Cow
Other
Turkeys
Turkey Poults
Other
Other
Discharges and Stream Imfpacts
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 ❑-11o"_❑ NA ❑ NE
❑ Yes [] No
❑ Yes ❑ No
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
[frNo
❑ NA
❑ NE
❑Yes
� o
❑NA
❑NE
Page 1 of 21412015 Continued

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

1~ acili Plum r: IDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑15o ❑ 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 E
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
No ❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
[] Yes
No ❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
E5'No ❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
No ❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? [] Yes [!j'No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? Yes eo ❑ NA ❑ NE
Reviewer/Inspector Signature:
Page 3 of 3
Date: 6 41 kz
21412015

(9 Division of Water Resources
Facility Number - ® ❑ Division of Soil and Water Conservation
,) Q Other Agency 11
Type of Visit: p CC pliance Inspection D Operation Review 0 Structure Evaluation Q Technical Assistance I
Reason for Visit: Routine D Complaint Q Follow-up Q Referral ❑ Emergency Q Other Q Denied Access
Date of Visit: Arrival Time: Departure Time: � County: j�� Region:
Farm Name: Owner Email:
Owner Dame: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: mxuj__
Certified Operator:
Phone:
Integrator: a Q
Certification Number: t `,
Back-up Operator: Certification Number:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Latitude: Longitude:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
Layer I I L�l
Non -La er
Design Current
llry roultry LADACUY rOD.
La ers
Non -Layers
Pullets
Turkeys
Turkey Poults
Other
Discharges and Stream Imoactsand 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? (lt'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
ofthe State other than from a discharge?
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non-Dair
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes /No ❑ NA ❑ NE
❑ Yes [:]No
❑ Yes ❑ No
❑ NA ❑ NE
❑NA []NE
❑ Yes ❑ o ❑ NA ❑ NL
[:]Yes V ❑ NA ❑ N E
❑ Yes VNo ❑ NA ❑ NE
Page ! of 3 21412015 Continued

JFaSillt Number: jDate of Inspection:
Waste Collection & Treatment
4. Ip storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes CO/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: Wvo) I LA &,W Z'
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): J V
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes itc, ❑ 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 ZNo ❑ 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 environment l threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes YNo
o �] 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 No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [2f No ❑ NA ❑ NE
tt`)
mainenance or improvemen .
1 l . Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes E2f No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ YesZo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
Zf/No
❑ NA
❑ NE
18. is there a lack of properly operating waste application equipment?
❑ Yes
Q/�o
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
o
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? Ifyes, 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 ❑ l20 Minute Inspections ❑ Monthly and l" Rainfall Inspecti�V�o
❑ 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?
❑Yeso
❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Fa flit Number: -[ Date of Ins ection:
24. }}Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes v
25.1Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey El Failure to develop a POA for sludge levels
❑ NA ❑ NE
❑ NA ❑ NE
❑ 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 ❑ 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 tail 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 the drains exist at the facility? if yes, check the appropriate box below
❑ Application Field ❑ LagoonlStorage Pond ❑ ❑ther:
32. Were any additional problems Hated which cause non-compliance of the permit or CAWMP? ❑Yes Lin NN NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? [:)Yes ICJ N ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
Na
❑ NA
❑ NE
❑ Yes
a
❑ NA
❑ NE
❑ Yes
LfJ No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes No [] NA ❑ NE
Comments (refer to question;#): °Explain any: YES; answers and/orany, additional recnmmendatiane oridny Othery�omments:
Use. drawlggs of racility. to better eirplain:situatfons(use'additfonal pages as necessary):.
Reviewerllnspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
PhoneU/0
Date:
14f 5

* C9 Division of Water Resources
Facility Number ©- © ❑ Division of Soil and Water Conservation
❑ Other Agency
Type of Visit: mpliance Inspection 0 Operation Review ❑ Structure Evaluation ❑ Technical Assistance
Reason for Visit: Routine ❑ Complaint ❑ Follow-up ❑ Referral ❑ Emergency ❑ Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: County: �-+ti1 Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Owner Email:
Phone:
Onsite Representative: g r Mail C -1 (RI A-e integrator:
Certified Operator -
Back -up Operator:
Location of Farm:
Design Current
Swine Capacity Pop.
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Latitude:
Phone:
Certification Number: - I91 S L
Certification Number:
Design Current
Wet Poultry Capacity Pop.
Layer
Non -La er
Design Current
Dry Poultry Capacity Pop.
Layers
Non -La ers
Pullets
Turkeys
Turkey Poults
Other
Discharges and Stream Impacts
Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other: _
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
Longitude:
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes 2 No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑Yes ❑ o ❑NA ❑NE
❑ Yes [ ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Page 1 nr3 21412015 Continued

Facility Number: - L Date of Inspection:
Waste Collection & Treatment
4� Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
[2f/No
[] NA
❑ NE
a. If yes, is waste Ieve I into the structural freeboard?
[] Yes
❑ No
❑ NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: �_&b L'fi &.VWU4
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 51
5. Are there any immediate threats to the integrity of any of the structures observed?
Yes
No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmgo
l threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit:?
❑ Yes
0 NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
E�/No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
ZN
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application'? If yes, check the appropriate box below.
❑ Yes
0 No
❑ NA
❑ NE
0 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?
❑ Yes
o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
o
�F7No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
��N
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
0 Yes
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available`? if yes, check
❑ Yes
�Zo
❑ 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
YNo
❑ NA
❑ NE
❑ Waste Application ❑ Weckly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑Stacking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑Yeso
❑ NA]
NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
;�No
❑ NA
❑ NE
Page 2 of.3
21412015 Continued

FFacilft Number: - Date of inspection: & 11-1
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [ ❑ NA ❑ NE
Ais 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 ❑ 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:
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ 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
3, <,No-❑ NA ❑ NE
�No ❑ NA ❑ NE
o ❑NA ❑NE
Cumments;(reter:to yuestinn;#) _Explain any. YES4nswers;and/or any additional recommendations ur, uny other;eomments:
Use "druwings:of facility tn;better;explain situations.{use additional paizes us necessary].
0WN(�R_-?ASSC0 ; 0jq , fApEK6,a -le CAI 0( {SANG 69 fo
UFLO-P uC-�I 6WNCA .
Reviewer/Inspector Name: 'J Q } d �; M(.u_
Reviewer/inspector Signature:
Page 3 of 3
Phone: b ~ l
Date:
21412015

[� Division of Water Quality
Facility Number - 0 Division of Soil and Water Conservation
p Other Agency
Type of Visit: a rRo4tine
fiance Inspection Operation Review ❑ Structure Evaluation Technical Assistance
Reason for Visit: Q Complaint a Follow-up Q Referral Q Emergency Q Other Q Denied Access
Date of Visit: 2 Arrival Time: p Departure Time: County: Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Onsite Representative: &.(— } ,+ C� [ L Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Other
Other
Latitude-
Phone:
Certification Number:
Certifieation Number:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
Layer
Non -La er
Pullets
Other
Poults
Design Current
Discharges_and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
Longitude:
Design Current
Cattle Capacity Pop.
Dairy Cow
Dai Calf
Dai Heifer
Dry Cow
.Non-Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes �No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ NA ❑ NE
❑ Yes ONo ❑ NA ❑ NE
Page 1 of 3 21412011 Continued

1.
Facility Number: 1231 - Date of Inspection-J/,�q 110�
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 0 /No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No C] NA ❑ NE
Structure 1
Identifier: LRG<oN I
Spillway?:
Designed Freeboard (in):
Structure 2 Structure 3 Structure 4
u4Z
Observed Freeboard (in): 219 Lrz�' _
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
Structure 5 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 �N❑ ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes YNo ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes "(No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
[:)Yes
dNo
❑ NA
❑ NE
maintenance or improvement?
11. is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
t No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus [] Failure to Incorporate
Manure/Sludge
into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
&No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
rfN
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
o
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
EJ/N o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
Pio
❑ NA
❑ NE
Reauired 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 E3<o ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and J" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes L2l,N ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes o ❑ NA ❑ NE
Page 2 of3 21412011 Continued

F2611t Number: - Date of inspection:
24. Did the facility fail to calibrate waste application equipment as required by the perm' ? ❑ Yes �o ❑ 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 [] 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 ONo ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes 'TTTT' ❑ 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 �o ❑ NA ❑ NE
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: T
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes L6 N ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes U Nq ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes �yNo ❑ NA ❑ NE
FCo ments(refer.to question #}: Explain any YES answers and/or.any additional recommendations or any other.com►nents.dra* nes of facility to -better exalaIn situations [use additional naaes as necessarv).
Reviewer/Inspector Name:
Phone: 10 6 " 3 V?
Reviewer/]nspector Signature:
Date:
Page 3 of 3 1 21412011

4D Division of Water Quality
Facility Number � - I � 0 Division of Soil and Water Conservation
❑ Other Agency V 11
Type of Visit: C pliance Inspection Operation Review 0 Structure Evaluation Technical Assistance
r Reason foVisit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 10
Dlenied Access
Date of Visit: Arrival Time: I JU Q I departure Time: ® County: Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Owner Email:
Phone:
Onsite Representative: n Gjdy >�]$,'[ �VL Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Latitude:
Phone:
Certification Number: 119 1223
Certification Number:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
L
ayer I I —d
Poults
Design Current
Dischnrges_and _Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other: _
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
Longitude:
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
.Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
[—]Yes /No ❑ NA ❑ NE
❑Yes
No
❑NA
❑NE
❑Yes
No
❑NA
❑NE
❑ Yes FNo
NA ❑ NE
Yes ❑ NA ❑ NE
Yes ❑ NA ❑ NE
Page I of 3 21412011 Continued

1"acilit N mber: jDate of lns ectbn;
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
N❑ ❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
[] No ❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Identifier: " i LA
Structure 5
Structure 6
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): I
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
C6 N CC] NA
C] NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
No ❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environment 1 threat, notify DWQ
7. Do any of the structures need maintenance or improvement`? ❑ YesY
o ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit'? ❑ Yeso ❑ 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):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes [�
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes LJ o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes N
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes u No
❑ NA
❑ NE
Required Records _& Documents
Z'Xo
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 o
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? if yes, check the appropriate box below. ❑ Yes eNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis [] Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? [] Yes [] NA ❑ NE
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes gNo ❑ NA ❑ NE
Page 2 of 3 VV20II Continued

Facili NV tuber: - Date of Inspection: t
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑Yes ❑ NA ❑ NE
25. Is the facility out of compliance with 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 No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ZNo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
No
❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? Ifyes, 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
I,I
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
o
❑ NA
❑ NE
Comments:(refer to question #):Explain any YES: answers. and/or., any'additianal recommendations or.-anyother comments::.
llse'drarvings of faeility.to.bettcr.explain situations (use'additiotral �ages.affi necessary};,;-; ,'.::
s? ;t-°, ;' R
.. h _ ; i:`.
k::
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: J i�
Date:
2/4/2 II

U Division of Water Quality
Facility Number ©- © 0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit: Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: iJ/Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other Q Denied Access
Date of Visit: Arrival Time: Departure Timer County:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Phone:
Physical Address:
Facility Contact: Title: Ph one:
Onsite Representative: 3E±&d Wls� 4- LL- Integrator: d
Certification Number: j�� -D
Certified Operator:
Back-up Operator:
Location of Farm:
Design Current
Swine Capacity Pop.
Wean to Finish
Wean to Feeder
Feeder to Finish 1496
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Latitude:
Region:
Certification Number:
Design Current
Wet Poultry Capacity Pop.
Layer
Non -Layer
Design Current
Dry Poultry Capacity Pop,
Layers
Non -Layers
Pullets
Turkeys
Turkey Poults
ether
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 DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
Longitude:
Design Current
Cattle Capacity Pop.
Dairy Cow
Dai Calf
Dairy Heifer
D Cow
.Non-Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes M No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes ❑ ❑ NA ❑ NE
❑ Yes ❑ NA [] NE
❑ Yes ffNo ❑ NA ❑ NE
Page 1 of 3 21412011 Continued

Fac#q Number: - IDate of Inspection:
In —
Waste Collection & Treatment
4. Is forage 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: LA61 A) f a j U
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):�
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes [�] No ❑ NA ❑ NE
(i.e„ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a [—]Yes ['/No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmen l 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 YNo ❑ 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 buffers, setbacks, or compliance alternatives that need ❑ Yes 0 No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes EZ No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10°% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
]T
❑ NA
❑ NE
16, Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
L'J No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ NA
❑ NE
18. Is there a lack of property operating waste application equipment?
❑ Yes
YNo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
o
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ 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 [3 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 o ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes Qr�o ❑ NA ❑ NE
Page 2 of 3 2/4C1011 Continued

FaclUty Number: - Date of Inspection:
r
24. Did the facility fail to calibrate waste application equipment as required by the permit. ❑ Yes rNo
N ❑ NA ❑ NE
25. Is`the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a PDA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26, Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes gNo ❑ 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?
24. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
[3 'Vo
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes io ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes Nv ❑ NA ❑ NE
Comments (refer. to: question ): Explain any;YES answers;andloraany,additlonalireevmmendatlons'.or;any'other. eothinents: i, ''.t .I. ,a
Uffie dirawln s of facili to 6etter:exRRlainsit�iatlons; use;;additional`} aQes:as
`.�•- Y l 7� F4 •.ff �'L � .[ fiLtBY ki ShY �•��=$$if�.$5 �(. �'��ti.'b.
Reviewer/Inspector Name: T,0) t! [. Phone I /0 —71
P WO
Reviewer/Inspector Signature: Date:
Page 3 of 3 2I I

V Division of Water Quality
11 Facility Number - 0 Division of Soil and Water Conservation
❑ Other Agency 11
Type of Visit: O Cotp�liance Inspection U Operation Review U Structure Evaluation Q Technical Assistance I
Reason for Visit: Routine Q Complaint Q Follow-up Q Referral Q Emergency Q Other ._ Q Denied Access
Date of Visit: Arrival Time: bQ Departure Time: i County: Ouiob Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Onsite Representative: 3jZ,C nil' V�i-'I-[. I-�e_ Z.L, Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Latitude:
Phone:
Certification Number:
Certification Number -
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
Layer
Non -Layer I I El
Pullets
other
Poults
Design Current
Discharees and Stream impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at; ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d, Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
Longitude:
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
❑ Cow
.Non-Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes No ❑ NA ❑ NE
[:]Yes ❑ No
[:]Yes [:]No
❑NA ❑NE
❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
io
❑ NA
❑ NE
[:]Yes
[ Io
❑ NA
❑ NE
Page 1 of 3 21412011 Continued

Facili Number: - date of Inspection: .5
14,011,
Waste Collection & Treatment
4. Ii storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [D/No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
II Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: Lt LA &*o 0 7,
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):'1114
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 2 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 t reat, 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 ❑ 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 cl_NZ ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes aNXo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [7—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 EErNo ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
[:]Yes
F2"No
❑ NA
[] NE
Required Records &_Documents
19. Did the facility fail to have the Certificate of Coverage &Permit readily available?
❑ Yes
o
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
El Yes
Ej/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 itilo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes FE[N/o ❑ NA [] NE
Page 2 of 3 21412011 Continued

Faciii Number: - Lj 5 Date of Inspection: b
24, Did the facility fail to calibrate waste application equipment as required by the permi 7 ❑ Yes �No
� o ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑ 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 rNo
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ 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)
❑ Yes Jo ir0
[:]Yes No
❑ Yes EN
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below. [] Yes
❑ Application Field ❑ Lagoon/Storage 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
M
❑ NA
❑ NE
❑ NA
❑ NE
[DNA
❑ NE
❑ NA
❑ NE
EK
❑ NA
❑ NE
QXo
❑ NA
❑ NE
E3-�o
❑ NA
❑ NE
,Comments (refer to question 9): Explain any YES answers and/or any additional recommendations or.any.other comments.;;-.,, .°
Use. drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Phone: (%) 7f6 ,3000'�
Reviewer/Inspector Signature:
Date: S A a
Page 3 of 3 l 21412011

10 Division of Water Quality
Facility Number ❑ Division of Sol] and Water Conservation
Q Other Agency
Type of Visit Cro pliance Inspection Q Operation Review ❑ Structure Evaluation Q Technical Assistance
Reason for Visit dRoutine Q Complaint Q Follow up Q Referral Q Emergency Q Other ❑ Denied Access
Date of Visit: 3 $q Arrival Time: .t b Departure Time: County: A4Pi.7d;OU Region:
Farm Name: _
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Owner Email:
Phone:
Onsite Representative: +i3c"v-rr ryMTL14"A _ Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Phone No:
Operator Certification Number:
Back-up Certification Number:
Latitude: 0 0 0 ` = " Longitude: ❑ 0 01 ❑ f1
Design Current Design Current
Capacity Population Wct Poultry Capacity Population
❑ La er
❑ Non -Layer I EEI�
❑ Wean to Finish
❑ Wean to Feeder
Feeder to Finish
28$8
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Harrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Dry Poultry
❑ Layers
❑ Non -Layers
Pullets
Turke s
❑ Turkey Poults
Other
Discharges & Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
El
Dairy Cow
Lj
Dairy Calf
El
Dairy Heifer
El
Dry Cow
El
Non-Dai
❑
Beef Stocker
❑
Beef Feeder
❑
Beef Brood Co
Number of Structures: E]
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. Dees 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 EJ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
El Yes
o
El NA
❑NE
El Yes
Zo
❑ NA
❑ NE
Page I of 3 12128104 continued

Facility Number: — S
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: W6,fft9%J t i.p4t s�J L
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3
5. Are there any immediate threats to the integrity of any of the structures observed'? ❑ Yes dNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes ZNo ❑ NA ❑ NE
through a waste management or closure plan'?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes 2 No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑Yes �No El NA El 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 0No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ENo ❑ NA ❑ NE
maintenance/imp rove in ent?
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, Z11, 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?
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ Yes
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
17. Does the facility lack adequate acreage for land application? ❑ Yes
18. is there a Zack of properly operating waste application equipment? ❑ Yes
Ej�,Io
❑ NA
❑ NE
�(Na
❑ NA
❑ NE
l No
❑ NA
❑ NE
dNo
❑ NA
❑ NE
YN❑
❑ NA
❑ NE
.... � ... .. �.. � .:..::.�x:.�:..�.:.ri'.'�:�1•:..i�x::..z�:'3��':'.�:�:..>..':i�:.
Comments {refer; toyuestitin'#): Explain any Y1S..answers,'andlc�r any recnmmendationsor,.eny„ other rvmntents:e
Use drawings of facility to better. explain. situations. ,(use additional pages as necessary
.. - a .-5 .'L._:.6 '8x8 ) .e .. F •4t3 �+ ix i,. %+a :i'S -,:'R ci+S: .r•t nJ rC'`Se.'3fs
Reviewerlins ector Name T s 3 ? ' hone:
Reviewerllnspector Signature: gdetlt L Date: 3 V9
Page 2 of 3 121251W Gontinuea

Facility Number: f — Y7 Date of Inspection
:Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes [ No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check ❑ Yes �No ❑ NA ❑ NE
the appropriate box.
❑ WUP El Checklists ❑Design ❑Maps ❑ Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
[:]Yes
lJ No
❑ NA
❑ NE
[:]Waste Application ❑ Wcekly Freeboard [:]Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
[:]Annual
Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections [:]
Weather
Cade
22.
Did the facility fail to install and maintain a rain gauge?
El Yes
0 No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
E7 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
NN
6"o
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
ElE Yes
No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
Z No
Cl NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
e No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
D<o
❑ 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?
ElYes
EI No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
[3/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
ti
El NA
[I NE
33. Does facility require afollow-up visit by same agency?
❑ Yes
No
❑ NA
ElNE
AdditionalCamments.andlor Drawings: ' { F
.. ... .- .. .. .. ....�:k':. ... .... .....Z •:'%.�- a -^. �.au 1..i°.•�. ."-a'i9.{ring:.. i'4. ai.:�itSYi.��'Y k'c=
Page 3 of 3 12128104

Type of Visit 0 TRoullne
pllance inspection Q Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit Q Complaint Q Follow up Q Referral q Emergency Q Other ❑ Denied Access
Date of visit: 7a a Arrival Time: Departure Time: County: Region:
Farm Name: Owner Email:
Owner Name: _
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: 3RFI* (y1ItCk.CLC
Certified Operator:
Back-up Operator:
Title:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: = [= I =16 Longitude: = o = I = It
Design Current
Des€gn Current
Design Current
Sw€ne Ca acit Pa ul tiou
LVet Poultr Ca aci Po ulation
Cattle Ca a Pn ulation
❑ Wean to Finish
❑ La er
❑ Dairy Cow
❑ Wean to Feeder
on -Laver
❑ Dairy Cali'
Feeder to Finish
1APPy
'L--m
❑ Dairy Heifer
El Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
Layers
El Beef Stocker
El Gilts
Non -Layers
❑ Beef Feeder
❑ Boars
Pullets
❑Beef Brood Cow
Turkeys
Other
❑Turke Poultr
❑ Other
Other
Number of Structures:
Discharges & Stream lmpaets
1. Is any discharge observed t'rom any part of the operation?
❑ Yes
o
❑ 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
ElNA
ElNE
2. Is there evidence of a past discharge from any part of the operation?
ElYes
rN�
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters ol'the State
❑ Yes
No
❑ NA
❑ NE
other than from a discharge'?
Page I of 3
12128104
Continued

Facility Number:
Date of Inspection z�
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate7
a. if yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
identifier; Cni�12 AA LA &-gol L
❑ Yes O No ❑ NA ❑ NE
[I Yes [I No El NA [I NE
Structure 5 Structure 6
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3U
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental th at, 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 Io ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks) '
4. Does any part of the waste management system other than the waste structures require ❑ Yes 91N,
ElNA El NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ❑ NA ❑ NE
maintenance/imp rove m ent? 94
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 > l0% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Mar ure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[--] Yes
17. Does the facility lack adequate acreage for land application? ❑ Yes
18. Is there a lack of properly operating waste application equipment?
ElYes
N ❑ NA
El NE
❑ NA
❑ NE
ElNA
❑ NE
/No
IJ NiElNA
El NE
No ❑ NA
❑ NE
Reviewer/inspector Name �; - - Q Phone:
w:
Reviewer/inspector Signature: Date: +*i
pwfyp 7 „f 7 12/ IR Iwnrinund

it 11.
Facility Number: — Date of Inspection 6
RBguired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes E2 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes l 2No ❑ NA ❑ NE
the appropirate box, ❑ WUp ❑ Checklists ❑ Design ElMaP s ElOther
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
0 No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual
Certification
❑ Rain Fall ❑ Stocking ❑ 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
ZNo
❑ NA
❑ NE
23.
if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
ZNo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
� o
❑ NA
El NE
25.
Did the Facility fail to conduct a sludge survey as required by the permit?
El
N❑
❑ 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
LI No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
o
El NA
❑ NE
29,
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
[I Yes
WNo
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
3U. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
�,/
LEI No
❑ NA
❑ NE
ifyes, contact a regional Air Quality representative immediately
31, Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
9-<o
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector rail to discuss review/inspection with an on -site representative?
❑ Yes
P""
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
[--]Yes
I►�-'1vo
❑ NA
❑ NE
Additional.Comments and/or Drawings:
Page 3 of 3 12128104

r M-4
Type of Visit of Co Hance Inspection a Operation Review Q Structure Evaluation Q Technical Assistance
Reason far Visit Routine Q Complaint d Fallow up Q Referral Q Emergency Q Other ❑ Denied Access
Date of Visit: v c+ff Arrival Time: ® Departure Time: County: b Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: �: +.Tr,14 ,u_
Certified Operator:
Back-up Operator:
Owner Email:
Phone:
Phone No:
Integrator•
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: 0 ❑ ❑ & = Longitude: ❑ a ❑ 4 ❑
Current
Design Current
esignurrent
iesign
pacity
Population
Wet Poultry Capacity Population
Cattle Capacity Population
❑ Wean to Finish
❑ La er
❑ Dai Cow
❑ Wean to Feeder
n-La er
❑ Dairy Calf
Feeder to Finish
?X
Z d
❑ Dai Heifer
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
ElNon-Dairy
El Farrow to Finish
La ers
❑ Beef Stocker
❑ Gilts
❑ Non -Layers
❑ Beef Feeder
❑ Boars
❑ Pullets
❑Beef Brood Cow
[-I Turkeys
Other
❑ "rurkey Poults
❑ Other
Numhar of Structures:
❑ Other
I
Discharees & Stream impacts
I . Is any discharge observed from any part of the operation?
❑ Yes
o
❑ 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)
Cl 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
o
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
No
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
12128104
Continued

4 '
Fpcility Number: Yn Date of Inspection
V4iste 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. IA 6T I_ LA&-vJ L
Spillway?:
Designed Freeboard (in): /
Observed Freeboard (in): 3 -o
5. Are there any, immediate threats to the integrity of any of the structures observed?
(iel 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 EJ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes dNo ❑ NA ❑ NE
El Yes JZ`No El NA El 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 L�J No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ENo ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks) ,,.�,,//
9. Does any part of the waste management system other than the waste structures require ❑Yes I�No ❑ NA ❑ NE
maintenance or improvement?
Waste Anolication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes Cl/No ❑ NA ❑ NE
maintenancelimprovement?
11. is there evidence of incorrect application? If yes, check the appropriate box below. [--]yes O No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 1bs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outsidc 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 ,0 No [I NA El NE
l�
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 b"'No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes [;, No El NA El NE
El Yes !Q No ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
;4 1jo_o rfNo Caro or smr afc Ta i9pliv�
Reviewer/inspector Name Phone:
Reviewer/Inspector Signature: Date:
12128104 Continued

i
s
acility Number: — Date of Inspection 0 rf
F
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes Ell o ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes D'No ❑ NA ❑ NE
the appropiiate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps [I Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
P,<o
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V
Rain Inspections❑
Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
CMJ 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
[IL7
,ICJ,,
"No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Ye
L�J No
El 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
ld<o
❑ NA
❑ NE
Other Issues
29. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
Io
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
EYNo
❑ 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
ONo
❑ 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 rail to discuss review/inspection with an on -site representative?
Yes
ElE
��
11ro
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
L? o
❑ NA
❑ NE
Page 3 of 3 12128104

Type of Visit (D �C(ompliance Inspection Q Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit CJ Routine Q Complaint Q Follow up Q Referral Q Emergency Q Other ❑ Denied Access
Date of Visit: 6.1
I Arrival Time: Departure Time: County: bvPL� Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Owner Email:
Phone:
Onsite Representative: jet a-&` Integrator:
Certified Operator:
Back-up Operator:
Phone No:
Operator Certification Number:
Sack -up Certification Number:
Location of Farm: Latitude: = 0 0 f = Longitude: 0 c = 1 =
Design . Current Design Current ,� ..; ' :� Design Current
Swine �' x Wet Pauli�'r' ' Cattle.'
Capueity Population x ryF Capacity P,aP. ion;' Capacity `P.opulatiun
❑ Wean to Finish K❑ Layer FY R ❑ DairyCow
❑ Wean to Feeder ❑ Non -Layer 1 ❑ Daia Calf
Feeder to Finish gd� '` ❑Dai Heifer
.;:..
❑ Farrow to Wean ❑ ❑ Cow
•y°Poultry _ i. 6r :':
El Farrow to Feeder s! ❑ Non -Dairy
❑ Farrow to Finish ❑ Layers ❑ Beef Stocker
❑ Non -Layers i
El Gilts ❑ Beef Feeder
❑ Boars ❑ Pullets ❑ Heef Brood Cowl
❑ Turkeys
Other ❑ Turkey Poults
❑ Other er,; 5tructures::
Discharges & Stream Impacts
/
1. Is any discharge observed from any part of the operation?
El Yes
7 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
Cl 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
❑
El NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation`?
El Yes7No
❑
❑ NA
El NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
El Yes
❑ NA
❑ NE
other than from a discharge?
12128104
Continued

Facility Number: 3 Date of Inspection o
Waste Collection & Treatment �%
4. Is storage capacity (structural plus stonn storage plus heavy rainfall) less than adequate? ❑ Yes Ek o ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier. (A Crna w", f
Spillway?:
Designed Freeboard (in): [ ,
Observed Freeboard (in): 3$
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes o [DNA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmentalat, 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 ❑ ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks) f
9. Does any part of the waste management system other than the waste structures require ❑ Yes E No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes E No ❑ NA ❑ NE
maintenance/improvement? �,�
11. is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes L�1No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Froaen 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
o El NA
El NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
WNo ❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
�No ElNA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
EZ o ❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
El yes
VNo ❑ NA
❑ NE
Comments (refer.to question #): Explain any YES, answers and/or any recommendation .or any; other: comments.
Used rawings of: facility to better explain situations: (use additional pages. aspecessary)::
AL
Reviewer/Inspector Name `j a i� [I l Phone: 3
Reviewer/Inspector Signature: Date:
Page 2 of 3 12128104 Continued

Facility Number: Date of Inspection
Required _Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check
the approprrate box.
❑ WllP El Checklists ❑Design ❑Maps ❑ other
21. Does record keeping need improvement? if yes, check the appropriate box below. ❑ Yes ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes Er No ❑ NA ❑ NE
23. If 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 ❑ NA ❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit? ❑ Yes VNq ❑ NA ❑ NE
26. Did the facility fail to have an actively certified operator in charge? ❑ Yes VNo
N ElNA ElNE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification`? ElYes ❑ NA ❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes Z No ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document ❑ Yes ZNo ❑ NA ❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes [a No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately
31, Did the facility fail to notify the regional office of emergency situations as required by ❑ Yes ONo ❑ NA ❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes u No ❑ NA ❑ NE
33. Does facility require a follow-up visit by same agency? ❑ Yes Lam[ No ❑ NA ❑ NE
Comments and/or Drawings:
❑ Yes u No ❑ NA ❑ NE
❑ Yes Z No ❑ NA ❑ NE
12128104

Type of Visit C[Compliance Inspection Q Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit Q/kowine Q Complaint a Follow up Q Referral Q Emergency Q Other ❑ Denied Access
Date of Visit: 3 'LO 6L Arrival Time: JO S' I Departure Time: County: DV Region:
Farm Name: _
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Owner Email:
Phone:
Onsite Representative: J 6-P—OL aGhA—tT Integrator:
Certified Operator:
Back-up Operator:
Phone No:
Operator Certification Number:
Bach -up Certification Number:
Location of Farm: Latitude: 0 U 0 4 =44 Longitude: = o = ' =
Ai
Design Current
Design Gurrent
Design Grr uent
Swine
Capaty Population
Wet Poultry Gapa�fty Population
Cattle •opacity Population
❑ Wean to Finish
Layer
I
❑ Dairy Cow
❑ Wean to Feeder I 110 Non -Layer I I
❑ Dairy Calf
Feeder to Finish rLrft
❑ Dai Heifer
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
La ers
El Beef Stocker
❑ Gilts
Non -Layers
❑ Beef Feeder
El Boars
❑ Pullets
❑Beef Brood Cowl
Turke s
Othe
❑ ❑ther
rkey Puults
❑ Other
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
❑ o
[:3NA
ElNE
2. Is there evidence of a past discharge from any part of the operation'?
El Yes
o
ElNA
ElNE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
ElYes
No
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
1212M4
Continued

f u
Facility Number: 3) - u'S7 Date of InspectionI
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ZNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure l Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier. G A4 a7NZ LA U62V
Spillway?:
Designed Freeboard (in): S.] �'� • J
Observed Freeboard (in): 3.5 3 �
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes U 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 lJ 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 MhrNo ❑ 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 2 No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes LJ 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 > l0% 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) B (G ) 9 G a
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
P<O ❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
(2/No ❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
[:fT El NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
El Yes
No ❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or.anyvecommendatiuns:or,any other. ramments.
Use drawings of facility to better explain situations. (use additional page's as necessary):'..
Reviewer/Inspector Name �, Phone: Q �-] 24oS 02
Reviewer/Inspector Signature: Date: 1312A&>(.
n...... 7 .,r 2 17/79/44 r....t.H...,a

Facility Number: j y — tnj Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes El"No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes lJ No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design [I Maps ❑ Other
2 1. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections El Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes LJ No ❑ NA ❑ NE
23. If 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 ❑ NA ElNE
25. Did the facility fail to conduct a sludge survey as required by the permit? ❑ Yes L'1 N El NA El NE
26. Did the facility fail to have an actively certified operator in charge'? El Yes ElNA [INE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ElYes /NoEl NA ❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
,._,
�'nio
L❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
2No ❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
[ 'No ❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
�Ia ❑ 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
91K10 ❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
No ❑ NA
❑ NE
Additional Comments -and/or Drawings:
Page 3 of 3 12128104

0� W ArE��G
r
March 9, 2006
Jerry W. Pickett
Pickett's Pigs
537 Washboard Avenue
Mount Olive, North Carolina 28365
Michael F. Easley, Governor
William G. Ross Jr., Secretary
North Carolina Department of Environment and Natural Resources
Alan W. Klimek, P.E. Director
Division of Water Quality
Subject: Sludge Survey Testing Dates
Certificate of Coverage No. NCA231457
" Pickett's Pigs
Animal Waste Management System
Duplin County
Dear Mr. Pickett:
The Division of Water Quality (Division) received your sludge survey information on March 1, 2046.
With your results, you requested that a sludge survey for the lagoons at the Pickett's Pigs facility not be
required until 2008. Due to the amounts of treatment volume available, the Division agrees that a sludge
survey is not needed unti 12007. The results of the 2007 sludge survey are to be submitted with the
Annual Certification Form that will be due on March 1, 2408. Thank you for your attention to this
matter. If you have any questions, please call me at [phone].
Sincerely,
Todd A. Bennett
Environmental Engineer
Cc: Aquifer Protection Section, Wilmington Regional Office
Central Files
RECEP1ED
MAN
AtUnCaro na
Ulu
Aquifer Protection Section 1636 Mail Service Center Raleigh, NC 27699-1636 Phone [phone] Customer Service
Internet: www.ncwatcrqug1itv.org Location; 2728 Capital Blvd. Raleigh, NC 27604 Fax [phone]
An Equal t7pportunkylAfrmative Acton Employer— 50%Recyded/1D% Post Consumer Paper

�!l i;iMIMMY`rMW
Type of Visit I" Compliance Inspection Q Operation Review O Lagoon Evaluation
Reason for Visit VRoutine O Complaint O Follow up Q Emergency Notification O Other © Denied Access
r __j Facility Number hate of Visit: Time:
Q Not Operational Q Below Threshold
Permitted 0 Ce ' ed 13 Conditionally Certified © Registered Date Last Operated or Above Threshold: .........................
Farm Name :�I L' �r� r��.......Z County: .... tlG
............. » ......... ..... ...... _..........
.... .....................»... ......
OwnerName: ...................... ............. ?e-" •TT..................... Phone No:.......................................................................................
MailingAddress: . ... ................................... . .................. . .......... .............. . ........ . ...... . . . ...... _............... .......... .................. ............... ................ ...... ..........................
FacilityContact: .............................................................................. Title:...,............ �_'XV A................... Phone No:................
Onsite Representative:...: �C `! .. ...... .. Integrator:..._,
Certified Operator: ................................................... ........ . .. . ...... . .... ............. . .... . ....... . ... Operator Certification Number:..........................................
Location of Farm:
AL
Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude Longitude
�. .�f
s, Desxg!nf Cil�nrellt,'
:
. .
:Y �'i.' ' ;;1 Y. •+.. .§, Fyxi. ,, ".If .:+I. •1.fi ' !; •';. "Current
fi 3' Desegtt = �`' CtIrrent ;; 3s Desi r..s,F' i.
" SF3$,.-'
3 r r':.i': r
Swine ,-Ca aci yPo "ulation
r hit u
Poultry .. ? i" :: C 1::;; _'; ` gSCi Po ulatiap
Cat € Po u atiaJ.;.o.CaittliC❑
Wean to Feeder❑Layer
❑Dairy
Feeder to Finish
r.JJ
❑ Non -Layer ❑ Non -Dairy
Farrow to Wean
�
F '� .r - k -
f.�r.r•sYY �rf p!•1 3,. S... ll �I •i`;� if 1 _;�.ii: =�'i�u•F •a�:
❑ Other
Farrow to Feeder
�f•
❑w t Fini h
arro o s
.:i•.i�.... 1„j. 1: :b�[.' - tii , i� .3 ri •i ll i
':gig; V:.ri: r r
;ru, iJoW
y..
: ,.'f Design`CijOkity l
re';�?!
Gilts
a ^%;E '"r�'' •''` :•,� , �r.' Y � :i. r�,l� I?f ��,fi ,� ��.s, ¢ ,:3
-
Boarsr''�?.Tatal'S5LW
_ '>^'lNuxfiber of La
::.i i'I
NI „�,.".-.-rfj p. ;1 =11:. 11:;]+�I�Hn. ��,q3 •�
' ji.' � .s" i?•y'.,.:i:... V
..
y �.Nnlrlinn Annric f RMW Tiinnc.,
Discharses & 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) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/rain?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes XNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes R'No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes o
Structure I St=ture 2 Structure 3 Structure 4 Structure 5 Structure
Identifier: .........r� �............
Freeboard (inches):
>.......................................................................................................................................................
„
12112103 Continued

Facility Number: � Date of Inspection 5 ►9 0
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑ Yes No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
❑ yes XNo
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
❑ Yes Z No
8, Does any part of the waste management system other than waste structures require maintenancelimprovement?
Oyes ❑ No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
❑ Yes No
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes XNo
11. Is there evidence of over application? If yes, check the appropriate box below.
❑ Yes No
❑ Excessive Ponding ❑ PAN ❑ ydraulic Over oad ❑ F xen Ground ❑ Copper d/or Zinc
12. Crop type �Irjeln,110�4
13. Do the receiving crops differ with those designated hfthe Certified Animal Waste Management Plan (CAW')?
❑ Yes No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes No
b) Does the facility need a wettable acre determination?
❑ Yes ❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes ❑ No
J 15. Does the receiving crop need improvement?
❑ Yes No
16. Is there a lack of adequate waste application equipment?
❑ Yes ZNo
Odor Imues
17. 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?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes ,dNo
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes ZNo
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 �ZNo
Air Quality representative immediately.
azt other: comeiits"= ;{
Comments (refer. to gnestlon.#}r "'Explain any :YF.S rsrvei s °aaii/or arny,Arecommeiidatians or hhj yy o 'IV r +
Use dra►vin ��,Wk�#er. eic law sitiyatians:use additional; cs`ais riecessa P r1��( P� r3')sw?" ❑ Field Copy ❑ Final Notes y '.�W:,. ii"::. •u"..... ie..FS.i.. ''�ii+.•rt 1'�1^y.fi:�- ,�,.. .7 "/Ifni �Yf"'i�:l hn'.l li. '1��..YI,4+yt�iY.i:11. .F f
23}l�g�v� ,.j�z� Ili Po2T s�o Nwv F.� [,<,„e dq
40W 7 t
ReviewerMs ector Name
GtS 0
Reviewer/Inspector Signature:
Date:
I2112103 Continued

Facility Number: hate of Inspection
Rcnulred Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(iel WUP, checklists, design, maps, etc.)
23. Does record keeping need improvement? If yes, check the appropriate box below.
❑ 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?
25. Did the facility fail to have a actively certified operator in charge?
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
Oel discharge, freeboard problems, over application)
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
28, Does facility require a follow-up visit by same agency?
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
32, Did the facility fail to install and maintain a rain gauge?
33. Did the facility fail to conduct an annual sludge survey?
34. Did the facility fail to calibrate waste application equipment?
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After V Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
❑ Yes Er&o
❑ Yes o
❑ Yes 'fO'FTo
❑ Yes eNo
❑ Yes ONO
❑ Yes ZNo
❑ Yes LR'No
❑ Yes ,B'No
❑ Yes;3<0
Yes ❑ No
❑ Yes ONo
❑ Yes Offsio
❑ Yes Aff<o
❑ Yes frN"o
o
El Yes
12112103

P-
Division of ,Soil and Water Conservation =Operation Review j
0 Division of Soil and Water Conservation - Compliance Inspection
O Division of Water Quality - Compliance Inspection k r
© Other Agency Operation Revic►v
JaRoutine Q Complaint Q Follo►►•-rip of t)WQ inspection Q F0llo►r-ujnf 1)SIVC review Q Other
Facility Number I):Itc of Inspection
Time+ of Inspection Q 124 hr. (hh:mm)
0 Permitted Certified Conditionally Certified © Registered Not (} erational Date last Operated:
T sme: ......,. County: ................... ..................... ........ ............Farin N.
Owner Name: Phone No:
Facility Contact:
...................... ............. .l'itle:
MailingAddress: ...................................................... .................
Onsite Representative:...*- P—!...............
Certified Operator:
Location of Farm:
Phone No-
.. ................... ................... ......L......1....... ....
...................
..,
., Integrator:.......( .�,.�C�..—:15.............................................
Operator Certiricatiotn Number:
Latitude ' 1 66 Longitude L J • 4 C�64
Design Current Design Current Design Current
Swine Capacity Population Poultry Capacity Population Cattle Capacity Population
❑ Wean to Feeder ❑ Layer I ❑ Dairy
�Q ❑ I'eedcr to Finish Non -Layer I I ❑ Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder ❑ Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ Boars 'Total SSLW
Number of Lagoons 5— ❑ Subsurface Drains Present jjol.agoonArea ❑ spray Field Area
Holding Ponds 1 Solid Traps ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation (Ii' yes, notify DWQ)?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. [f discharge is observed, was the conveyance man-made'?
1). 1I'discharge is obscrvcd, did it rcnch� ❑ Surface Waters ❑ Waters of the State
c. li' discharge is observed. what is the estimated flow in gal/min?
d. Does discharge hypass a lagoon system?
2. is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts to the waters of the State other than From a discharge'?
Waste Collection & Treatment
4. is storage capacity (freeboard plus storm storage) less than adequaic'?
Structure l Structure 2 StmCturr 3 Structure 4
Idcniificr:
Structure 5
❑ Yes
XNo
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
J�dNo
❑ Yes
ft�No
❑ Yes
No
Structure f
Freeboard {inches): ......... ...........................3. ............
1lbly9
Continued on hack

FijAUty Number: 31 51 Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ic/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -Site which are not Properly addressed and/or managed through a waste managcrnent or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/im provetew?
S. Does any pait of the waste management system other than waste structures require maintenance/itprovement?
9. Do any stuctures lack adequate, gauged markers with required top of•dike, maximum and minimum
liquid level elevation markings?
Waste AvOication
10. Are there any buffers that need mainlenancc/imPrnvcmenl?
11. Is there evidence of over application? ❑ Ponding ❑ Nitrogen
12. Crap type r��-.....�....�...... ��''.�"t..
13. Do the receiving crops differ with those designated iit the Certilied Animal Waste Management Plan (CAWMP)?
14. Does the facility lack wettable acreage for land application? (footprint)
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equiprrtent?
Required Records & Documents
17. Fail to have Certificate of Coverage & Gen cral Permit readily available•?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, snaps, etc.)
19, Does record keeping need improvement? ('set irrigation. frcehoard, waste analysis & soil sample reports)
20• Is facility not in compliance with any applicable setback criteria in effect al the lime of design?
21. Did the facility fail to have a certified operator in responsible charge?
I
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(iel discharge, freeboard problems, over application)
23. Did Reviewer/inspector fail to discuss rcvicwhrispection with on -site representative?
24. Does facility require a follow-up visit by same agency'?
Nn.viaiations.at deficie-riries .were rioted. dtirin' :ttiii-visit:. 7'ri ' r' flfreieive' *further : .
.. egrrt sAp�lideiice. al}. ..this visit: . . .............. .. ...... ..... • .
❑ Yes tR(No
❑ Yes Z No
wYes ❑ No
❑ Yes %No
❑ Yes KNo
❑ Yes lu No
❑ Yes 0 No
❑ Yes �k*o
❑ Yes KNo
❑ Yes XNo
❑ Yes [9Ncr
❑ Yes t�No
❑ Yes JdNo
OYes ❑ No
❑ Yes 14 No
❑ Yes � No
❑ Yes PqNo
❑ Yes &No
❑ Yes M 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): :
kco
�t''�-+�-22s� � fit►. v Ql��►��- lt� �-`CG �v��L,, l�'��+-�
.A
Reviewer/Inspector Name
Reviewer/Inspector Signature: � C 4 L-- � "�Date: '731`1.19 `1 1 l/6/99

M
x ['] Division of Soil and Water Conservation 17 Other Agency
JWDivision of Water Quality
Routine 0 Cntn faint Q Follow-up of I)W ins cation Q Follow-up of DSWC review a Other
Date of Inspection G
Facility Number
Time of Inspection Con 24 hr. (hh:mmj
13 Registered -Certified E3 Applied for Permit Q Permitted 0 Not Operational Date Last Operated:
FarmName:.... ���� .... ( �k �`........................................................... County:.....�..`.�.........................,...... .......................
OwnerName:... ........................................................... Phone No:.............,.,..............................................
Facility Contact: .................................. .....1........... LL .... . Title:
pp................................................................ Phone No:..................................................
Mailing Address; ...... �J.... L.1!-.....& Q........1�`ti.]....�� �....0 ................. ,C
Onsite Representative. " 4.... ............................................................................. Integrator:....................................................
Certified Operator:............................................................................................................... Operator Certification Number:
Locatio of arm:
j......... .. ........ .......,.
..............................................
Latitude ' ' " Longitude 0 ' 'r
..........
lk%ign. Current
Swine Canficity Population
❑ Wean to Feeder
Feeder to Finish
e)0$6
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
..
. ...........
Number of.Lagors (:Holding Ponds; ❑ Subsurface Drains Present 11 Magoon Area ❑ spray field Area
❑ No Liquid Waste Management System
General
I. 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 ff No
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ) ❑ Yes No
c. If discharge is observed, what is the estimated flow in gal/min? 1
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
MNo
4. Were there any adverse impacts to the waters of the State other than from a discharge?
❑ Yes
D"No
5. Does any part of the waste management system (other than lagoonslholding ponds) require
❑ Yes
% No
m ai n to n an celi m pro ve me nt?
G. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
MNo
7. Did the facility fail to have a certified operator in responsible charge?
❑ Yes
�R:No
7/25/97

R
Facility Number: 3 —
8. Are there lagoons or storage ponds on site which need to he properly closed? ❑ Yes No
Structures _(Lagcinns,l 91ding,Ponds, Flush Pits, etc.)
9. Is storage capacity (Freeboard plus storm storage) less than adequate? ❑ Yes No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ............. ............... ............................. .................................... .... I ......................... .... ......................................................................
Freeboard(ft): .......... rdZ.r.�r.....................2r........,.....................................................,.,.........,............................................................,....,.................
10. Is seepage observed from any of the structures? ❑ Yes M No
11. is erosion, or any other threats to the integrity of any of the structures observed? ❑ Yes CkNo
12.
Do any of the structures need maintenancelimprovement?
Yes
❑ No
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or enviromnental threat, notify DWQ)
13.
Do any of the structures lack adequate minimum or maximum liquid level markers?
❑ Yes
[ANo
Waste Application
14.
Is there physical evidence of over application?
❑ Yes
C3 No
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15.
Crop type t
16.
Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
Uf Yes
KN_6 �
17.
Does the facility have a lack of adequate acreage for land application?
❑ Yes
UNo
18.
Does the receiving crop need improvement?
CxYes
❑ No
19.
Is there a lack of available waste application equipment?
E[Yes
❑ No
20.
Does facility require a follow-up visit by same agency?
❑ Yes
CKNo
21.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
Wo
22.
Does record keeping need improvement?
ayes
❑ No
For
Certified or Permitted Facilities Only
23.
Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑ Yes
� No
24.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
0 No
25.
Were any additional problems noted which cause noncompliance of the Permit?
❑ Yes
PLNo
[� Na.Violation:sor dertciencies.rvere nated,during this'visit.� Yon vi l] i• cei ve-no•ftirtheri
co&000000 dhout this'visit:
Comments. rt fer to o4titin #)...Xxpl tin any:NFS answers. aria/ot• any .recotmen atlo"I.r or any..ottiier corn nepts `�4.
vae drawtrt s of fatnlltt to letter ex Iain':sttuahons., use additional ` a es as necc" , �;_;;
..,i' n u S Fi
. - .... .. .� �: - - •s::.:i.::::.... ��... .:. .. ',F.i.. AtiSiSi::.iti N. :,N:. i.iF':.si',
lai Cam,, ti' ,�.,,,� ►-e►�+� vti-. �► o ><,. 5. ►,,
t r
l�, �G 1 ` 0►1 4T ill - • '.f ��+ +-"� �1.._�n� �r'�1 �� IG�cscti 'it �►.G�
_"R►r4� ""- X7��'iJ1 S«L' {,� • , ' �'4.. 5 L { XQ t'�l.'tiT 1 i7�c
r7va [} ; -IJ" pkp 7��s1�7
Reviewerfinspector Name _, ii='ss;• .
Reviewer/Inspector Signature: ��� . Date: �G �g

Facility Ivi�mber: , t„�...,,—............ Date at Inspection:ICUL6 EA
Additional vmments and/or rawtings:
LpwA 1) , Av- -,A-5 0.►-� 111. I + tC�� .'� I����r. ��=c•,� , �,t
bERR--pwr
�( 35-3G?00 V�.aorl
9 La -- 3 So — g-.-CO q
4/july 1

k
C Animal Feedlot Operation Review =4= i;ii,F=RF
1 p w €, :, w :: E .: z i i;;:� ❑ D5VV
�S:.F`. �
DWQ Animal Feedlot Operation Site Inspection
Routine ❑ Complaint ❑ Follow-up of DWQ inspection ❑ Follow-up (if DSWC: review ❑�� Other
Date of Inspection
Facility Number �
Time of InspLT(ion ;e � 24 hr. (hh:mm)
© Registered P Certified 13 Applied for Permit 13 Permitted 113 Not Operational I [late bast Operated:
Farm Name:......Pll4 A.S...
.f...'P.1�5]................. I... .. County:........ ..tf�.........................
Owner Name:....,..�dCrr.v........�Il.....,T.M4.t................................................................ Phone No:.,lu'��.�1..ox� -Tazz.,.................., ................
Facility Contract: ....�C!C . ....... 1".!.0................................ Title: ...... Q.W.!.-. j .......................................... Phone No: „��i 1.11a.���i..- ]r� SA-.......
,.3- failing Address:....57j.ff........� "bw-j......AV................................................ .........A!T.:...dfa:+!e ... J. Mir..................................$-%5......
Onsite Representative:.... .........1".tlGt'sATZ.......... .............. I.................................... Integrator ...... .Ghbof:o.......... 16 ........
Operator Certification Number'....... y...... Certified [3perator;..,...,..,�f.� �}.,.......��...e�.�-4. �.................................................... D �.. „�Z.. ........
Locution of Farm.
.......:T44 ......... > ....`t ...+w........ x�oir.,,....... . �nsV.ia� ....Tug ,,.. t:...., a�a............ S� .i.57 f..,...,...#.... xLb5.... Cr x. .
' !�..... ............fir....... ?..,..,.., .... Q .�..........Q,5S tv.; t.S.......Cin....Y ......st .� ....% .t � ...............................
Latitude Da �'f , ��91 Longitude • ®4 ®1(
Swine
Ihsign Current .Design Current
Capacity Population Poultry Capacity Population
❑ Layer
[) ❑ Non-l-ayer
❑ Wean to Feeder
Feeder Finish
El Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
El Gilts
El Boars
--------------- ------------------ - --- -------------------------
Design Current
Cattle Capaci.ty,.Populatiori .
❑ Dairy
❑ Non -Dairy
❑ Other
Total Design Capacity
Total SSLW - �s- - +
Number of Lagoons 1 Holding Ponds ,� ❑ Subsurface Drains present Lagoon Area ❑ Spray Field Area
❑ No Liquid Waste Management System
General
1. Are there any buffers that need tnaintenancelimprove2ttent?
❑ Yes
[$�No
2. Is any discharge observed from any part of the operatitm?
❑ Yes
No
Dischargeoriginated at; El LEl❑ agoon Spray Field Other
a, If discharge. is observed, was the conveyance man-made".
❑ Yes
� No
b. If discharges is observed, did it rcach Surface Water" (If yes. notify DWQ)
❑ Yes
, � No
c. If discharge is observed, what is the estimated flow in gallmin?
d. Does discharge bypass a lagoon system? (If ycs, notify DWQ)
❑ Yes
'L�1j No
3. is there evidence of past discharge from any part of the operation?
El 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
giNo
• maintenancelimprovenient?
5. Is facility not in compliance with any applicable setback criteria in effect at the time of design'?
❑ Yes
P No
7. Did the facility fail to have a certified operator in responsible charge?
El Yes
fRN❑
7/25/97
Continued on hack

• Facility Number: 31 — 1
8. Are there lagoons or storage ponds on site which need to be properly closed'? ❑ Yes ® Na
Structures f Laeoons,lloldine fonds. Flush Pits, etc.?
9. Is storage capacity (freeboard plus storm storage) less than adequate:? ❑ Yes 19 No
Stricture l Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:.[....�.................................................................................... ...................... ............................................
Freeboard (ft): .......... 2-
�.................. ............ ....................................
........... I ........... ........... I........................
10. Is seepage observed from any of the structures? ❑ Yes No
1 I. 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?
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify ❑WQ)
13. Do any of the structures lack adequate mininium or maximum liquid level markers?
Waste_Application
14. Is there physical evidence of over application'?
(If in excess of W,MP, or runoff entering waters of the State. notify DWQ)
15. Crop type .............4:t7r< W..... ..�'j",n.U.
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWIMP)?
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 Reviewerllnspector fail to discuss review/inspection with on -Site representative?
22. Does record keeping need improvement? t
For Certified or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Managernent 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. violations or deficiencies ►were noted during thkvisit..You'.W1II receive no ftirther
0&606ndence about this;visit:-
M Yes ❑ No
❑ Yes ® No
❑ Yes IRI No
❑ Yeti Q,No
❑ Yes R1 No
❑ Yes t,No
❑ Yes IN No
❑ Yes ® No
❑ Yes K No
Yes ❑ No
❑ Yes IN No
❑ Yes 0 No
❑ Yes q No
Comments (refer to'question #): Explain any YES answers and/or any:; recommendations.ok;any outer.commen#s;
Use drawings of facility to.better explain sttuntiorts, (use additioutd:pai as: necessary):` `§ !YF
{ ,!4 ,i='` i.i.i ill. ! ........... > ....., eeei 1
or, �, ate r uAt kvo, m6ula 6 14 w 4 L e 1* �, a ro in -a. a&r
�pa� s�o�id sae cLes��d��� ff r f t} j +
LZ. UVdOkc3 50i1 4A ldo'k 50'M tt anArVsi� s6vM &e tl', ter' i AI ed j4Rr%. Al( rvA)jj (,Ljz voj
011d� ��oult1 1� e cer�� Pam` G+a fz, ucJ 5Mgll rain avr�s•eej SkO r� W f _ sf kj in
��txn.. Q e�cy act•14rt �� ate
Label 4Lc (ajooty wd�)�L KAS �L�M�'A k4vwk, i n .5 rtcark.
7/25/97
ii Reviewer/Inspector Name -: ...4iF, ....
i'Ii h • :. A AR rn Yf .
Reviewer/luspc,etor Signature: All,, , Z_ - A L. Date:

•
•
i Site Requires Immediate Attentio
_WfFacility No.
%
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE. , 1995
d . , Time: //Z: S�
Farm Name/Owner:
Mailing Address:
County:
Integrator._
3
On Site Representative:
Physical Address/Location:
Phone:
Type of Operation: IS ' Poultry Cattle
Design Capacity: Number of Animals on Site:
DEM Certification Number: ACE
Latitude: E
DEM Certificatio Number: ACNEW
Longitude:.Elevation: Feet
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of i Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches) 0 or No Actual Freeboard: Ft. Inches
Was any seepage observed from the lagoon(s)? Yes ot&o Was any erosion observed? (9 or No
Is adequate land available for spray? Yes or Ng Is the cover cr9P adequate? Yes or No
Crop(s) being utilized:
Does the facility meet SCS minimumtsetback criteria? 200 Feet from Dwellings?QLel:�or Na
100 Feet from Wells? 0 or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or o
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes ore
Is animal waste discharged into waters of a state by man-made ditch, flushing system, or other
similar man-made devices? Yes or o If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated an specific acreage
Additional
r
coverjcrop)? Yes or No
�
TY015
If
cc: Facility Assessment Unit Use Attachments if Needed.

Type of Visit (Compliance Inspection ❑ Operation Review ❑ Lagoon Evaluation
Reason for Visit Routine ❑ Complaint 0 Fallow up ❑ Emergency Notification Q Other ❑ Denied Access
Facility Number j S Date or Visit: 'Filrte: db
Not Operational Q Below Threshold
'PIrernutted Lj Certified Lj Conditionally Certified 0 Registered Date Last Operated or Above Threshold: .........................
Farm Name: C: �+ County:.... .........._._.................. --'- --
........._..... 1. .�?.................................... ........•.....
Owner Name: } Phone No:
.1................................................... C:..c.. �...............................
Facility Contact: ... :? ..�l.... :......+.1s .T.. G,1 Phone No:. ................................................... �.... Title...........�—..................................
Mailing Address: ...........................................................
Onsite Representative:..: .. .Y1.7 :......1.+ ..................................... Integrator: ........... I
d...-.R.J..1.�.►....
CertifiedOperator: .................................................. .............................................................. Operator Certification Number:.........................................
Location of Farm:
FSwine ❑ Poultry ❑ Cattle ❑ Horse Latitude 0 �• �" Longitude �a
f -'
Design Current Design Current Design Current
Swine Capacity Population Poultry Capacitv Population Cattle Capacity Population
❑ Wean to Feeder ❑ Layer ❑ Dairy
FLEpeder to Finish ❑ Non -Layer I JE1 Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder ❑ Other
❑ Farrow to Finish Total -Design Capacity
❑ Gilts '
❑Boars Total ss
r.::,,,
Subsurface Drains Present ❑ La oon Area ❑ Spray Field Area
'Nttmlbeir;ofLagoons ❑ g
YHoldir :Ponds'1 Solid Triips: ❑ No Liquid Waste Management System
Discharges A Stream Impacts11
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was (lie conveyance man-made?
b. If' discharge is observcd, did it reach Water of the State'? (ll-ycs, notify DWQ)
c. If discharge is observed, what is the estimated flow in gallmiu?
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?
01/011D1
❑ Yes &Io
❑ Yes ❑ No
❑ Yes ❑ No
❑Yes ❑No
❑ YesNo
❑ Yes
Continued

Facility Number: ' —l�S� Date of .Inspection Printed on: 1/9/2001
w (10
Odoelssues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes 10
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes 4Wo
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes 90-46
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 YNo
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or VV
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes ,•
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yeso
j�'r
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes No
Uditional Comments and/orDrawings: 43' :...;;,: v , .
tJL � 1 TA PI-( Et4 ±Dom. ICI nY
Asa- 04 C01 ���
5/00

Facility Number: —�
iF
Waste Collection & Treatment
Date of .Inspection ? i
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier: ........ .t.,� 1 .. . 4".4
Freeboard (inches): .............. 5.U....... ....,.................
............. .............................. ..... .... ,,...... ,.............. ....... ................ .................... ......
5. Are there any immediate threats to the integrity of any of the structures observed'? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenanceJimprovement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/itnprovement?
11. is there evidence of over application? ❑ Excessive Ponding AN ❑ Hydraulic Overload
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
h) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
19. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
20. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc,)
21. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
22. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
23. Did the Facility fail to have a actively certified operator in charge?
24. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
25. Did Reviewer/Inspector fail to discuss reviewlinspection with on -site representative`?
26. Does facility require a follow-up visit by same agency?
27. Were any additional problems noted which cause noncompliance of the Certified AWMP?
Odor Issues
28. 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?
❑ Yes �No
Structure 6
❑ Yes ANO
❑ Yes KNo
❑ Yes 12�AIo
❑ Yes 'J�'No
❑ Yes e6o
❑ Yes o
Yes o(E?�'
❑ Yes *140
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes JNo
❑ Yes Q:No
❑ Yes No
❑ Yes XNo
❑ Yes I�LNo
❑ Yes C%No
❑ Yes �No
❑ Yes P�No
❑ Yes ;(No
❑ Yes YNo
❑ Yes ; No
❑ Yes KNo
29. Are there any dead animals not disposed of properly within 24 hours?
01/01/01
❑ Yes ['No
Continued

itlivision of Water Quality
❑ Division of Soil and Water Conservation
Q Other Agency
of Visit a Compliance Inspection O Operation Review O Lagoon Evaluation
IReasonforVisit Routine O Complaint O Follow up O Emergency Notification O Other
❑ Denied Adeess
Date of Visit: rime: Printed on: 7/21/2000
Facility Number
D Not O erational D Below Threshold
Permitted Certified © Conditionally Certified 0 Registered Date Last Operated r Above ' 'hrrshold: .......................
Farm Narnc:,9r� County: ....... ..........
Owner Name: ..... �....................
.......... ........
:1� '�.. ......... Phone No:.......................................................................................
Facility Contact:
Titie:......lf^'t !f ............................. Phone No:
MailingAddress: ................... .................................................................................. ..........................
Onsite Rc resentatrve Integrator:
P �J.1�iC. �/--
...........................%.� i~
Certified Operator: � Ir .. ?. „�. � .......... Operator Certification Number:, % , ,,
Location of Farm:
A!
hdSwine ❑ Poultry ❑ Cattle ❑ Horse Latitude �' �•• Longitude •
Design Current Design Current Design Current
Swine capacity Population Poultry Capacity Population Cattle Capacity Population
❑ Wean to Feeder ❑ Layer I ❑ Dairy
Feeder to Finish ❑ Non -Layer ❑ Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder ❑ Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ Boars Total SSL W
Number of Lagoons ❑ Subsurface Drains Present ❑ Lagelon Area ❑ Spray Field Area
Holding Ponds 1 Solid Traps I j ❑ No Liquid Waste lblfanagcment System
Discharges & Stream lmEactti
1. Is any discharge observed from any part of the operation.'
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
it. II'discharge is observed, was the conveyance man-made'.'
K if discharge is observed, aid it reach Water of the State:? (il'yes, notify DWQ)
c. II -discharge is c,hservc(i, what is the estimaled flow in gal/min?
d. [ages discharge bypass a lagoon system? [if yes, notil-y 1)WQ)
❑ Yes kNo
❑ Yes ❑ No
❑ Yes ❑ No
A#-
❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes 5LTIo
3. Were there any adverse impacts or potential adverse impacts to the Witter% of* the Slate other than from a discharge`? ❑ Yes 12(No
Waste Collection & Treatmt!nt
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes 24 No
St�Koc".'
I Struc to Struc:turc, Structure 4 Structure 5 Strucluiv 6
[dentificr: ... off ........................................................................................
Freeboard (inches):
SAM
Continued on hack

1+acili13 Vumber:_7 ) — L{� lute of Inspection �%� Printed on; V21/2000
5. Are there any immediate threats to the integrity of any of the structures observed'? (ie/ trees, severe erosion, ❑ Yes XNo
seepage, etc.)
b. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑Yes No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need main tenancelimprovement? ❑ Yes WNo
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes XNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes XO
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes `gNo
11. Is there evidence of over application? LJ txeessive ronuing U rAN U rtyurautic uvertoaa U Yes ANo
12. Crop type
13. Do the receiving crops tffer with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes No
14. a) Does the facility lack adequate acreage for land application? ElYes No
h) Does the facility need a wettable acre determination'! ❑ Yes No
c) This Facility is pended for a wettable acre determination? El o
15. Does the receiving crap need improvement'? ❑ Yes XNo
16. Is there a lack of adequate waste application equipment? ❑ Yes ;<No
Retiuirrd Records & Documents
17, bail to have Certificate of Coverage & General Permit readily available? , ❑ Yes ANo
18. Dues the Facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.) ❑ Yes kN 0
19. Does record keeping need improvement'? (ie/ irrigation, freeboard, waste. -analysis & soil sample reports) Ayes ❑ No
20. Is facility not in c:ompliaucc with any applicable setback criteria in effect at the time of design•? ❑ Yes 300
21. Did the facility fail to have a actively certified operator in charge? ❑ Yes 7io
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑Ye No
23, Did Reviewer/Inspector fail to discuss reviewlinspection with on -site representative'? ❑ Yes No
24. Does facility require a follow-up visit by same agency? ❑ Yes No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes No
i'Vr vipl ttignjs:v d�fc.... .mere natea during �h s;vis�t; Yvtjx will tree iyQ �iti Turt �tt�
corres�vridertce'.about: this Visit.
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments:
Use drawings of facility to better explain situations. (use additional ges as necessary):
� r
C4�
[�
Reviewer/Inspector Name
/reviewer/Inspector Signature: Date: — r 5100

Facility Number: Date of Inspection Printed on: 7�29�20�0
Odor Issues
26, Does the discharge pipe from the confinement building to the storage pond or lagoon Fail to discharge 5L/or below ❑ Yes N0
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes '`No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes ELNo
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 RN
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan bladc(s), inoperable shutters, etc.) ❑ Yes KN0
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes N�U
32. Do the flush tanks lack a submerged fill pipe or a pertnanentltemporary cover? ❑ Yes 11(N0
Additional Comments and/orDrawings:
r
SAM