310526_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental Qual

IIIM �1S _ (I :5-1-1l nW!
- 'slop of Water Resources
Facility Number i ; �[J - ; Ja, Division of Soil and Water Conservation
Other Agency
Type of Visit: Urompliance Inspection 0 Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: Routine Q Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: / Arrival Time: o t Departure Time: 3.: County: Region:
Farm Name: 7r,-V t_ '�`G& I f,
Owner Name:U1? 1
Mailing Address:
Owner Email:
Phone: !fC Zftagn
NR/0wR
v� 2
Physical Address: I.
Facility Contact: [�uc `�--._ - Title:
e. on — ,
Onsite Representative: Integrator: - alto
Certified Operator: IlIl p ,I .6 [.. Certification Number:/
Sack -up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current
Swine Capacity Pop.
Weo Finish
o Feeder
Design Current
Wet Poultry Capacity Pop. Cattle
La er Dair Cow
Design Current
C**opacity Pop.
Non -La er
Dai Calf
to Finish
to Wean
to Feeder
to Finish
eifer
Design Current D Cow
Dry P,ouItrF Ca aci P■o , Non-Dair
La ers Beef Stocker
Non -La ers
Beef Feeder
Pullets
Beef Brood Cow
"th
Other
Turkeys
Turke Poults
10ther
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
EJ No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
[]No
D'KA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
[] No
[-NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
❑ No
❑-lA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
Ej'-Io
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes <o ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412015 Continued

FacT umber: - Date of —inspection: ,•
Wa§te Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes C3-At6__'❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes [] No C] N ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes Q 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 [r]No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes Elilo— ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes EKo ❑ 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 [C]-No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [ 1-Nb ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes Ea'N—o ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground [] Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): �J `Qf 1 r�c� cS G i
13. Soil Type(s): a-
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes G-<o ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes E]'No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes Q-1Vo ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application? ❑ Yes �o ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes [ o ❑ NA ❑ NE
e uired Records & Documents
QPN 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 �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 ❑4
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? I ❑ YestNo
o
23, If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes
o ❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facility Number: JDate of Inspection:
24.•Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes LJ"1VO
25. is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [3-No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes (ZLNo
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes o
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 [5-14
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 ED-No
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. ❑ Yes [R'No
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes [2-No
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes CBI�o
34. Does the facility require a follow-up visit by the same agency? ❑ Yes dNo
DNA ONE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
0NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
Comments (refer to"qu6ti6n[##)':jEX0tain any;+YES answers andlor�anytladilitional recommendatio`nstl ar an Iothe`r commepts
�('rr I « `� ... I
Ilse dravvin�s iiP.facility';to tietter,ex 181gysAtuatlOn9 use ii' cessa
dditional."a es as ne„
ed 3®S�-6
Reviewer/Inspector Name:��1�
Reviewer/Inspector Signature:
Page 3 of 3
Phonq, 0—
Date:
21412015

Type of Visit: Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: Q>Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: O _ O Departure Time: County: , �L �,,. Region: L-S I
Farm Name: Tt.11 N(76 Y,.... Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location'of Farm:
,.
Title:
Latitude:
Phone:
Phone:
Integrator: _ r % /4
Certification Number:
Certification Number:
Longitude:
Design C►urgent Design C►urgent
Swine C*apacity Pop. Wet Poultry Capacity Pop.
Wean to Finish Layer
Design Current
Cattle Capacity Pop.
Dairy Cow
Wean to Feeder
Non -La er
DairyCalf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Desigu Current
Dr, $oultr. C_a aci I;o
Da Cow
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turke s
Other Turke Poults
Other Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes ❑'No ❑ NA [] NE
❑ Yes] No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWR) ❑ Yes 0 No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes 4!1 No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes ;2fNo ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412014 Continued

Facil4y Number: Date of Inspection
i
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes J2-No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes EjNo ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): a'
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
Fl-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
qNo
❑ 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
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
ep+o
PNo
❑ 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
�3 No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
ff No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
FeMo
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?
❑ Yes
❑ No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
❑ NA
❑ NE
Commen' 6=(refer3tu-question #)`=Explain any YES, answers andlor any recommendat�ona or anyiother comments���" , t
Use drawings of. facility to better explain situations. (use additionalpages as necessary)
AL
Reviewer/Ins ector Name - "� sy, a'3"Fr 4., ,
Phone:
p 2
Rt �. ..
Reviewer/Inspector Signature: Date: [�
Page 2 of 3 12128104 Continued

Facili Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
�Z No
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
;;�`IVo
❑ NA ❑ NE
the appropriate box(es) below.
TT
❑ 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
b No
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
;2 No
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
0
34. Does the facility require a follow-up visit by the same agency?
❑ Yes 2[No ❑ NA ❑ NE
❑ Yes ZNo ❑ NA ❑ NE
❑ Yes E;^No [DNA ❑ NE
❑ Yes P No ❑ NA ❑ NE
❑ Yes ONO
❑ Yes ❑' No
❑ Yes �2( No
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
Co'mivegt`s (Kefer't"o q�bt
ela n"any Yinswe'riandlor;any aadihonal recommendations or a'ny other comments g
Use�drLawings af�fa�illain�sltu_ ationsm(useadditivnal pa�esaspecessarY)e:
�-
7 j ,Z1­) t i. 82
Reviewer/Inspector Name:
Reviewer/Inspector Signatui
Page 3 of 3
Phone: qQ (V 32�
Date: U 1 16
21412015

Type of Visit: Compliance Inspection 0 Operation Review O Structure Evaluation Q Technical Assistance
Reason for Visit: �Koutine 0 Complaint �.0 Follow-up 0 Referral Q Emergency 0 Other Q Denied Access_
Date of Visit: Arrival Time: O Departure Time: County: �r1'`� Ln
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: ,
Certified Operator:
Back-up Operator:
Location of Farm:
Phone:
Title:
Phone:
rh
Region: �J
Integrator: 11/�. 8
Certification Number:
Certification Number:
Latitude: Longitude:
Design Current Design C►urrent Desigurrent
Swine Capacity Fop. Wet Poultry Capacity Pop. Cattle Capacityn CPop.
Wean to Finish
La er
Dairy Cow
Wean to Feeder
Non -La er
DairyCalf
Feeder to Finish
arrow to Wean
Dairy Heifer
Design Current D Cow
Farrow to Feeder Dt, P.oultr Ca aci P.o Non -Dairy
Farrow to Finish - La ers Beef Stocker
Gilts Non -Layers Beef Feeder
Boars Pullets Beef Brood Cow
Turkeys
Other Turkey Poults
Other Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes 2[ No ❑ NA ❑ NE
0 Yes ZNo
❑ Yes EffNo
❑ Yes _'No
❑ Yes ;D'No
❑ Yes ZNo
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3 21412014 Continued

Facility Number: jDate of Inspection:
$�
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
[No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
[] Yes
[�j No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:^
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
=NoO
❑ N E
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
Z J No
❑ NA
❑ NE
waste management or closure plan'?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes /0 No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ✓� No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ,f No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes P� No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 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 No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes ,E� No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑WUP []Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑ Yes ZNo
❑ Yes No
❑ Yes dNo
❑ Yes 6 No
❑ NA ❑ NE
❑ NA' ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. OYes—EjNo ❑ 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 Q No ❑ NA ❑ NE
23. If selected, did the facility tail to install and maintain rainbreakers on irrigation equipment? ❑ Yes t No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facili Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [2�No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes Z 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 ,Z"'No ❑ NA [] NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes PNo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
(Ord s L Coo
Revieweranspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
❑ Yes Z� No ❑ NA ❑ NE
❑ Yes E�No ❑ NA ❑ NE
❑ Yes Ej No ❑ NA ❑ NE
❑ Yes ,EfNo ❑ NA ❑ NE
❑ Yes -6 No
❑ Yes [No
❑ Yes ZNo
[DNA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Phone: �?
Date: 5
1214ZO 14

(Type of Visit: ZFCompliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: (XRoutine 0 Complaint 0 Follow-up O Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: S.' RNI County: Region: W t RD
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Title:
Phone:
Integrator:
Phone:
Certified Operator:—F-.w%o&3e 13, 4ik Certification Number:
Back-up Operator:
Location of Farm;
Latitude:
Certification Number:
Longitude:
Design Current
Design C*urrent Design
Current
Swine Capacity Pop.
Wet Poultry Capacity Pop. Cattle Capacity
Pop.
Wean to Finish
Layer Dai Cow
Non -La er Dai Calf
Wean to Feeder
Feeder to Finish 120b
Dai Heifer
Farrow to Wean
Design C*urrent Dry Cow
Farrow to Feeder
Dr, Poaktr Ca aci P,o Non -Dairy
Farrow to Finish
Layers Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
TUrkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes �' o ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ;ErNo ❑ NA ❑ NE
❑ Yes E�No ❑ NA ❑ NE
Page I of 3 21412011 Continued

i
Facility Number: - DInspection: -4- �I
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
;E'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: L-
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):_
5. Are there any immediate threats to the integrity of any of the structures observed?
[:]Yes
ONo
❑ 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
Vj No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
[] Yes
VrNo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
ONo
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
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?
7"'
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
FrNo
❑ 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 No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable [:]Yes WNo ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
[:]Yes ;' No
[:]Yes VTNo
❑ NA ❑ NE
❑ NA ❑ NE
Required Records & Documents
t9. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes Vf No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes VNo ❑ 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
[7No
❑ 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
❑ SIudge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
14 No
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
gNo
❑ NA ❑ NE
Page 2 of 21412014 Continued

l
i
Facili Number: 3 - b Date of Inspection: ' Y-
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
o No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
;Z 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
�fNo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
[—]Yes
P 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.
i
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
0 Yes
V] 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
0 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
[ZI'No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
[4No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
UfNo ❑ NA ❑ NE
Reviewer/Inspector Name: _TjpA: ?1 0AV
Reviewer/Inspector Signature:
Page 3 of 3
Phone: as�-�6� o� a0
Date: 0 " q- ) Lf
21412014

I
Division of Wa'te Quality
Facility Number l_Sl� ® Division of Soil and Water Conservation
Other Agency
Type of Visit: 3 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
teason for Visit: (/outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: j. Arrival Time: Q; y
Departure Time:
County: )j^
Reglon: ' W )h
Farm Name: 7%%�
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: i�l),,� A Lt.�Niita-
Certified Operator: �1'v1p L� • I Y lh C]
Title:
Phone:
Integrator:
Certification Number: J :S6 _
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Swine
Wean to Finish
Design Current
Capacity Pop.
Wet Poultry
Layer
Design
Capacity
Current
Pop.
Design
Cattle Capacity
DairyCow
Current
Pop.
Wean to Feeder
Non -La er
DairyCalf
Feeder to Finish d
DairyHeifer
Farrow to Wean
Dr. P.oultr.
Design
C.a acit
Current
P,o ,
D Cow
Non -Dairy
Farrow to Feeder
Farrow to Finish
{
Lavers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turke s
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes VfNo ❑ NA ❑ NE
❑ Yes 9No ❑ NA ❑ NE
❑ Yes �No ❑ NA ❑ NE
❑ Yes
Zr No
❑ NA
❑ NE
❑ Yes
EjNo
❑ NA
❑ NE
[:]Yes
[�]rNo
❑ NA
❑ NE
Page I of 3 21412011 Continued

Facilit Number: - Date of Inspection: •-
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ENo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ZfNo ❑ NA [] NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes ENo
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes E!�No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes ZI—No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes LJONo
❑ 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 ZNo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes YNo
❑ 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 6No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes R!rNo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes [IrNo ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
[:)Yes ff No
[:]Yes O—No
❑ NA ❑ NE
❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes �TNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [ErNo ❑ 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 �o
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes 0No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [!No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ZNo [DNA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes 5!fNo ❑ 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 6No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes 6No ❑ NA ❑ NE
Otherlssues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
;a'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 duality concern?
❑ Yes
ZrNo
❑ 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
ErNo
[] 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
[�JNo
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
E!�No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
[ o
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
[EI'No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of,facility to better explain situations (use additional pages as necessary).
-5 �1 3 a 13 — -e,n,ir 1 Goq�
* L- 1 mc,
Reviewer/Inspector Name: _sW,4`�M pyy Phone: -UI -=2N
Reviewer/Inspector Signature: %...� Date: 5-1-13
Page 3 of 3 21412011

(Type of Visit: (D Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: / L Arrival Time: /00 Departure Time: County: t)OPC-r-) Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: TSv✓1 0. Bt,C I rp nL� I�:N(rt
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Owner Email:
Phone:
Phone:
Integrator:
Certification Number: t —7 2
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Design Current
Wet Poultry Capacity Pop.
Layer
Design Current
Cattle Capacity Pop.
Dairy Cow
Wean to Feeder
I
jNon-Layer
I
EE
Dairy Calf
Feeder to Finish
T.�Q
128 b
Dairy Heifer
Farrow to Wean
Design Current
1)t. P,oultr. Ca acit $p
Dry Cow
Farrow to Feeder
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -Layers
Pullets
Beef Feeder
Boars
Beef Brood Cow
Other
Other
Turkeys
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)? _
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes 2(No ❑ NA ❑ NE
❑ Yes
❑ No
NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes YNo ❑ NA ❑ NE
[:]Yes a o ❑ NA ❑ NE
Page I of 3 21417011 Continued

Facility Number: - Date of Inspection: - 7-
Waste Collection & Treatment
4. Ii storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [!(No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): r l
Observed Freeboard (in): '( c4
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes dNo ❑ 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 [i]No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
dNo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[2/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
/ No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes Cl/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 dNo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
Yes ❑ No
0 NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes E(No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes �o
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage &Permit readily available? [:]Yes0 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 YNo [DNA ❑ 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
4❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Faciifi Number: I- rjLEI Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit ❑ Yes L"J i10 [:]NA [:]NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [7f 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 E3�4o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [:]Yes Ei/No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
['_11f4o
❑ 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
[21/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
[3/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
C]/No
❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
`No
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
27
❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
E2/No
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
;yNo
❑ NA ❑ NE
Comments (refer to question #): Explain any -YES answers and/or any, additional recommendations,or any.,other comments.:
Usedrawingsof facility to better explain situations (use additional° ages,as_necessary)
rs) FZ &L.os Er) 41rjk �E c- P i s c/CET P6&4JE
AA�-0 Ex1'>E4TCd F"W FZ►4TE ak/ CALMAATVAJ -
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: l II g/ I 1 i~/ 3 '0
Date: T 311 / L
21412011

A
Type of Visit: ()'Comp iance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 0 outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: County:y�( Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative: ?A-M� - V15&, Integrator:
Certification plumber: / / ;
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Wean to Finish
NJ ILayer_
Wean to Feeder
Non -La
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
feNo
Gilts
Boars
Poults
Other I I I®I [Other
Discharges and Stream Impacts
I. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
Certification Number:
Longitude:
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow _
Non -Dairy
Beef Stocker
Beef Fecder
Beef Brood Cow
❑ Yes © No ❑ NA ❑ NE
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes o ❑ NA ❑ NE
❑ Yes o ❑ NA [3 NE
❑ Yes No ❑ NA ❑ NE
Page I of 3 21412011 Continued

rFacility Number: 31- Date of Inspection: Mal 11)
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
Structure 3 Structure 4
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
❑ Yes
Structure 5
No ❑ NA ❑ NE
[—]No ❑NA ❑NE
Structure 6
❑ Yes �No[:] ❑ NE
❑ Yes 2No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or enviranmenta 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 dNo ❑ 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 Ef/No C] NA ❑ NE
maintenance or improvement?
Waste Application
10, Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ErNo ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window [] Evidence of Wind Drift , ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑ Yes
. ffZo
❑ NA
[3 NE
❑ Yes
LJ
❑ NA
❑ NE
❑ Yes
[2/No
❑ NA
❑ NE
❑ Yes
0-'No
❑ NA
❑ NE
❑ Yes
F2,1qo
❑ NA
❑ NE
-No
❑ Yes
[5
❑ NA
❑ NE
❑ Yes
E2 o
❑ NA
❑ NE
❑ 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 i No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes �fo ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facili Number: - Date of Inspection: t
24. Did the facility fail to calibrate waste application equipment as required by the perm t? ❑ Yes fo ❑ 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:
25. Did the facility fail provide documentation of an actively certified operator in charge? Yes [:]No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes QKo ❑ 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 the drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes �o ❑ NA ❑ NE
❑ Yes [24o ❑ NA ❑ NE
❑ Yes 041'o' ❑ NA ❑ NE
❑ Yes [TNo ❑ NA ❑ NE
❑ Yes 2 No ❑ NA ❑ NE
❑ Yes [ 10 ❑ NA ❑ NE
❑ Yes ONo ❑ NA ❑ NE
Reviewer/Inspector Signature:
Page 3 of 3
Date: bl
214 or

Type of Visit aCompliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: 1I ems////C� i Arrival Time: ® Departure Time: County: 1%3L / Region:
Farm Name: -I 11—n 4096G Y`P(-M Owner Email:
Owner Name: i U 1 U OZCE Phone: d' d-1 iD "V t•4
Mailing Address: ISS XZECT4 �Z6 ?I IV K �-A1 U_ 5-4
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: A'i l2 �c�SSCL� Integrator:
Certified Operator: I 1 MaT Nosace - - OperatorJCertification Number;
Back-up Operator:
Location of Farm:
Latitude:
0 0
Back-up Certification Number:
Longitude: = o = , = "
Deslgn
Current Design Current Design Current
Swine Capacity
Population Wet Poultry Capacity Population Cattle Capacity Population
❑ Wean to Finish
❑ Layer
❑ Dairy Cow
to Feeder
❑Non -Layer
El Dairy Calf
UWean
Feeder to Finish
❑ Daia Heifer
❑ Farrow to Wean
Dry Poultry ❑ Da Cow
❑ Farrow to Feeder
ElNon-DaiEy
❑ Farrow to Finish
❑ Layers ❑ Beef Stocker
❑ Gilts
❑ Non -Layers
❑Beef Feeder
❑ Boars
❑ Pullets
❑ Beef Brood Co
❑ Turkeys
©ther
❑ Other
❑ Turkey Poults
❑ Other Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes $,,No ❑ NA ❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
❑ Yes VNo
ElNA
❑ NE
❑Yes V No
❑ NA
❑ NE
12128104 Continued

1
1 ,
Facility Number: —
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
Identifier: I-AGanl{
❑ Yes ANo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
Spillway?:
Designed Freeboard (in): 1 L7
Observed Freeboard (in): y
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 [INA ElNE
through a waste management or closure plan? IX
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 114No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes IiNc, ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes �No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[]PAN ❑ PAN > 10% or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Wind/ow ❑ Evidence of Wind rift ElApplication Outside of
Area
12. Crop type(s) S 6) ��Ll (-_e suA e ( P +
—
13. Soil type(s) 1gt3Qk0LI[_
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA ❑ NE.
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
�ZNo
❑ NA ❑ NE
33.E - i_. .. 6 Sv.�J °3 .�R,.P�a.t T;�Y F�7�i�"
Comments`(refer to�guest�on'°#} Explain any YES answers�andior any1recommendat1on&9r�any%other; comments �x -',a ,
Use drawings of facility to bhons et (use additional pages�asSnecessary) °�'f b � � � ; � V�
'6;6-A��Bf$"�', $=A X.
'
Reviewer/Inspector Name
' ®x' = ,-.y.jF�..{. `;` `r',.` Phone: �I}i♦�'��l�— ��
Reviewer/Inspector Signature:
. Date: 6
Page 2 of 3 12128104 Continued

r
.•
Facility Number: 31 — 00 Date of Inspection
Required
Records & Documents
19.
Did the facility fail to have Certificate of Coverage & Permit readily available?
❑ Yes
XNo
❑ NA
❑ NE
20.
Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes ANo
❑ NA
❑ NE
the appropriate box. El WUP 0 Checklists ❑ Design El Maps ❑Other
21.
Does record keeping need improvement? if yes, check the appropriate box below.
❑ Yes
Itnual
❑ NA
❑ NE
El Waste Application El Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑Xaste Transfers
Certification
EIRainfall ❑ Stocking E]Crop Yield C3 t20 Minute Inspections (] Monthly and 1"
Rain Inspections 0
Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
No
❑ NA
❑ NE
23.
if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes XNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
Yes
❑No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
74
❑ Yes X No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
ANA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
'kNo
El NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
�No
❑ NA
❑ NE
Additional/ Comments, and/or Drawings:
I4�8�51oq �,5
191CM I ' A16 eccor�
to$
No sL%AZAF sua.t,E�o�C
�x '/b
�� �t c.� �� �uE ►nr juZ
GA L4
1�Q14 i F �-�E63oRt� FoC� �A ��/b
Page 3 of 3 12128104

Type of Visit 36Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: County: Al Region:
Farm Name: i �m 1�iai-E Ir-A2fn Owner Email:
r asp- 9�-3a9
Owner Name: Phone:
Mailing Address: !� J � � ►2-EC-'j�} 1�L. Y" ilV K l 1 ,,_
Physical Address:
Facility Contact: Title:
Onsite Representative: 0 N LAN/Ee_yy_')0e LAW►6--
Certified Operator: LA,
Back-up Operator:
Phone No:
Integrator:
Operator Certification Number: S 60
Back-up Certification Number:
Location of Farm: Latitude: [= o = 6 = 1{ Longitude: = ° = ` 0 it
Design
Current
Design Current
Design
Current
Swine
@ap, acity
Population
vVet Fvultry Capy Population
Cattle Capacity
Population
❑ Wean to Finish
❑ Layer
❑ Dai Cow
❑ Wean to Feeder
❑ Non -Layer
❑ Dai Calf
Feeder to Finish
❑ Dairy Heifer
El arrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
ElNon-Dairy
El Farrow to Finish
❑ Layers
❑ Beef Stocker
ElGiltsGilts
❑ ers
❑ Beef Feeder
❑Boars
❑ Pullets
ID Beef Brood Cow
-
❑ Turkeys
it e 1
Turkey Poults
❑ Other
❑ Other
Number of 5truetures:
Discharges & Stream Impacts
Is any discharge observed from any part of the operation? ❑ Yes �No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
XNo
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
12128104
Continued

Facility Number: 3 1 —j
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
Identifier: LACClf V
Spillway?:
Designed Freeboard (in): 9 .
Observed Freeboard (in):
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 property addressed and/or managed
through a waste management or closure plan?
❑ Yes VNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes
qNo
❑ NA
❑ NE
❑ Yes
XNo
❑ NA
❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes �No [--].NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes, �lo El 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 [�No [I NA [I NE
maintenance or improvement? `
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes YNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? if yes, check the appropriate box below. ❑ Yes ILI No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.) ✓�
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) S ZELL
13. Soil type(s),_..-
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes 9No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes );�(No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes 91 ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes jt�No ❑ NA ❑ NE
Comments (refer to question #): Explain any YE5 answers and/or any recommendations or any other comments.
Use drawings of facillty to better explain situations. (use additional pages as necessary):
�1�91c�q a.g
��jdtilog � .�-
�s 1 a�1og 1. g
Reviewer/inspector Name Phone: 4 — 6o 4
Reviewer/]nspector 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? ❑ Yes �No ❑ NA ❑ NE
20, Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes'P�No ❑ NA ❑ NE
the appropirate box. 0 WUP B Checklists 0 Design 0 Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ANo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard [D Waste Analysis ❑ Soil Analysis ❑ �aste Transfers ❑ Xnual Certification
0 Rainfall ❑ Stocking 0 Crop Yield 0 120 Minute Inspections ❑ Monthly and 1" Rain Inspections 0 Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
KNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
*o
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
9 No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit'?
❑ Yes
JXNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
XNo
NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
XNA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
ANo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern'?
❑ Yes]
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
%No
❑ NA
❑ NE
General Permit? (ic/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
ANo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
14 No
❑ NA
❑ NE
Additional Comments and/or-Dra vmg's:
Page 3 of 3 12128104

Diyision of Water Quality
Facility Number 3 O Division of Soil and Water Conservation
- — Q Other Agency
type of Visit Acompiiance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Fallow up 0 Referral Q Emergency 0 Other ❑ Denied Access
Date of Visit: I=1�1"a Arrival Time: ® Departure Time: County: Li Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: Qi Ni
Certified Operator: lmo`T+iL• /VO&L-
Back-up Operator:
Location of Farm:
Phone:
Phone No:
Integrator:
Operator Certification Number: - i _t 2
Back-up Certification Number:
Latitude: = o = Longitude: = ° 0 ' 0
Design. Current Design. Current
Swine Capacity`'Population. Wet,.Poultry . Capacity Population
❑ Wean to Finish
❑ Wean to Feeder
Feeder to Finish
/
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
r
❑ Layer
on -Layer
Dry Poultry
Other
❑ Other_ I
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
i
i
❑ Beef Brood Cow
i
Number of•Structures:
Discharees & Stream Impacts
I. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes KNo ❑ NA ❑ NE
❑ Yes
[]No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
3� No
❑ NA
❑ NE
❑ Yes
Po
❑ NA
❑ NE
12128104 Continued

Faci ity Number:
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier: Qo
Spillway?:
Designed Freeboard (in): �. S
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes NNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes 4 No ❑ NA ❑ NE
❑ Yes 0 No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the 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 XNo ❑ NA ❑ NE
maintenance or improvement?
Waste ADplication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [ No ❑ NA ❑ NE
maintenance/improvement? 11
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.) I
❑ PAN ❑ PAN > 10% or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
INo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
12� No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
R No
❑ NA
ElNE
18. Is there a lack of properly operating waste application equipment?
ElYes
[ ZNo
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations orany other comments. .
Use drawings of facility to better explain situations. (use additional pages as necessary):
rt4n.wt C.00 �-S � oo� .
•
Reviewer/Inspector Name I -- rvi -----_- -� —_ j ----1 Phone: Q'�(.Q �3
Reviewer/Inspector Signature: Date: d
Page 2 of 3 12128104 Continued

J
Facility Number: 3 — Date of Inspection IT7
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 19No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [;TNo . ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design [I Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ;qNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes �No ❑ NA ❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
o
El NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yeso
[I NA
[I NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yeso
JN
ElNA
ElNE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yeso
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
�NA
❑ NE
Other issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
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?
❑ Yes
No
[INA
❑ NE
If yes, contact a regional Air Quality representative immediately
N
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes E�No ❑ NA ❑ NE
Page 3 of 3 12128104

J.1 c
Factiity NUm
Y Lj
Division of Water°.Quality, f`
Q Davison of Soil and Water Consei vat►on'
0 Other Agency:. alEfl
Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: / O Arrival 'Time: '477 Departure Time: li'/ County:
Farm Name: / v4 �G�/ill, Owner Email:
Owner Name: /YI _. Phone: _
Mailing Address:
Physical Address:
Facility Contact: Title: G Phone No: %
Onsite Representative: y � Integrator: fJ�h"7,,,
Certified Operator: Operator Certification Number:
Back-up Operator:
Location of Farm:
Back-up Certification Number:
Region: to
Latitude: 0 0 = d [= Longitude: ❑ o = , =
Design 'Currents Design Current"" Design"' Current
Swine Capacity Population �, Wet Poultry �."Capacity" Population "Cattle ` " "Capacity Poplatton
❑ Layer
❑ Non -Layer
�.
Dry Poultry
Other
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turke 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?
❑ Dairy Cow
❑ Daia Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
I
Number of Structures �1
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page ! of 3
a
❑ Yes XNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
LINE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes XNo ❑ NA ❑ NE
❑ Yes )eNo ❑ NA ❑ NE
12128104 Continued I

Date of Inspection "•7"`!!201 -'
Facility Number: —
Waste Collection & Treatment
4, Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
Cl Yes
P�No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No ❑ NA ❑ NE
Structure i Structure 2 Structure 3 Structure 4
Structure
5 Structure 6
Identifier:
Spillway?: 1LJ19
Designed Freeboard (in): 7 Iq 5
Observed Freeboard (in):
5, Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
�No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
//
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
�No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
ZNo ❑ NA ❑ NE
S. Do any oft he 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
No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No ❑ NA ❑ NE
maintenance/improvement?
(((
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu,
Zn, etc.)
1
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drifl ❑ Application Outsi ee of Area
��xQA'ic! 0✓/� ���`l�i�
12. Crop type(s) . (l�`� .. J.�j-�
Cl�� 7-,�
13. Soil type(s) j V
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
#iNo
❑ NA
[INE
15. Does the receiving crop and/or land application site need improvement?
ElYes
� No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination;❑
Yes
XNo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
XNo
❑ NA
❑ NE
/S) 745 �- 7/ 5
h`�I✓ �'� �4 S��roc2 v� yr✓ �G'v�z p5.
Reviewer/Inspector Name 1: -..
Reviewer/Inspector Signature:
Phone:
Date: Jr /
12128104 y ,� Continued

Facility Number: Date of Inspection i O
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropirate box.
❑ WUP El Checklists [I Design ❑Maps ❑Other
❑ Yes J" No ❑ NA ❑ NE
❑ Yes XNo ❑ NA ❑ NE
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
VNo
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual
Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1"
Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
)2fNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
NA
El NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
//❑ NA
El NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
,�,/No
JA No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
;�dNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
ElYes
❑ No
ZO'NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes P No ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
eo
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes J[J No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
/
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes ko
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes :zNo
❑ NA
❑ NE
Additional Comments and/or Drawings:
il��JJ
/297�"
!/� I �-E�
�
12128104

1
Division of Water Quality
-Facility Numbeir rj �� O Division of Soil and Water Conservation
- - . - - Other Agency
Type of Visit OCompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 011outine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: I VZ§40 Arrival Time: 2; 3 Departure Time: unty: Wzz- / Region:&JII 09
Farm Name: �z�'J 11EiGF_ F�yi_ _ Owner Email:
Owner Name: % /1'i Phone;
Mailing Address:
e
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: �� NO t 6'191VN Integrator: I_// 0*51j�
Certified Operator; _-...,� -7,/No be Operator Certification Number:
Back-up Operator:
Location of Farm:
Back-up Certification Number:
Latitude: = o = t Longitude: = ° =, = If
i
Design Current,Design Current
Swine Capacity Population. Wet Poultry Capacity Population
❑ Wean to Finish
❑ Wean to Feeder
Feeder to Finish 112001
❑ Farrow to Wean
❑ Farrow to Feeder j
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other t
Imo!
❑ Layer
❑ Non -Layer
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets k
❑ Turkeys
❑ Turkey Poults
❑ Other _ -
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at; ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Desigq,` Current
Cattle:_,Capacity Population
❑
DairyCow
❑
Dairy Calf
❑
Dairy Heifer
❑
Dg Cow
❑
Non -Dairy
❑
Beef Stocker
❑
Beef Feeder
❑
Beef Brood Co
Number of Structures
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page 1 of 3
❑ Yes No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
A No
❑ NA
❑ NE
❑ Yes
XNo
❑ NA
❑ NE
12128104
Continued

Date of Inspection
Facility Number: - 2
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes ;6 No
❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes ❑ No
❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure
4 Structure 5
Structure 6
Identifier:
Spillway?: O
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes P No
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
ElYes
XNo
❑ NA ElNE
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
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
/�'No
❑ Yes
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
/51No
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 PlNo
❑ NA ❑ NE
maintenance/improvement?
1. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ YesXNo
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals
(Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 lbs []Total Phosphorus [:]Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence Drift ❑ Applica ion of Area
�ofnWind
12. Crop typc(s) �f�/j7 V,V • 64T�"!�"Z 5+(cf
Outside
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes pZNo
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes No
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes No ❑ NA ❑ NE
IT Does the facility lack adequate acreage for land application?
❑ Yes )ZNo
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes ><O
❑ 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): .
F7--o 31/0 5 �Ozc yr �Po� ,/v��o / �.� G zir�� a� �z Fro T�s
•
T
Reviewer/Inspector Name Phone: O-- 79,b.— Zlo
Reviewer/Inspector Signature: Date: 2!o O00
Page 2 of 3 12128104 Continued

Facility Number: 3 — Date of Inspection
Reauired 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 El NE
the appropriate box. ❑ WUP El Check] ists El Design ❑Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes VNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ t20 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/[nspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes P(No
❑ NA
❑ NE
❑ Yes ❑ No
ZNA
❑ NE
❑ Yes /No
❑ NA
❑ NE
❑ Yes YNo
(I NA
❑ NE
❑ Yes XNo ❑ NA ❑ NE
❑ Yes ❑ No XNA ❑ NE
❑ Yes tz'No
❑ NA ❑ NE
❑ Yes P No
❑ NA ❑ NE
❑ Yes )2fNo
❑ NA ❑ NE
❑ Yes )ZNo
❑ NA ❑ NE
❑ Yes ;No
❑ NA ❑ NE
❑ Yes ;TNo
❑ NA ❑ NE
Additional Comments and/or Drawings:
ho
Page 3 of 3 12128104

Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: 0 Arrival Time: - on Departure Time: � County: � Region:
Farm Name: ,[/ r++ Lf/ 0 6 � Ai6tZ Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: % Title:
Onsite Representative: ,�f �
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Other
❑ Other
Phone:
Phone No:
Integrator:
Operator Certitcation Number:
Back-up Certification Number:
Latitude: = c 0 1 0 « Longitude: = ° = ' ❑''
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non-Layet
Dry Poultry
❑
Layers
❑
Non -Layers
❑
Pullets
❑
Turkeys
❑
Turkey Poults
❑
Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Appiication Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifei
Dary Cow
E3Non-Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
Number of Structures: F;
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge? V
❑ Yes XNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
ZNo
❑ NA
❑ NE
❑ Yes
O No
❑ NA
❑ NE
12128104 Continued

Facility Number�/ Date of Inspection _f
drip
rWaste
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 1 Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier: _
Spillway?: /
Designed Freeboard (in):
Observed Freeboard (in): :3
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
ff 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
RfNo
❑ 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
Zoo
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
[2NNo
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
ZNo
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
Z J No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
)� No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ 'Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drifl ❑ Application Outside
of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
ZNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
eNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acre determinations❑ Yes
-KNo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
0No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
ZNo
❑ NA
❑ NE
C6i9QV.M.= ,:Y,_ ... �,:... ., _,,�_..-
Reviewer/Inspector Name p ; ` Phone: U r
Reviewer/Inspector Signature: Date: v�
12/28 4 Continued

Faciliq Numher:Z j Date of Inspection
_ter
r
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available'? ❑ Yes VfNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design El maps [I Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes VNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ 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
VfNo❑DNA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
El No
, J NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
❑ NA
f!rNE
25.
Did the facility fail to conduct a sludge survey as required by the permit'?
❑ Yes
❑ No
❑ NA
•ENE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
Z No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ NA ONE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the pen -nit or CAWMP?
❑ Yes
ZNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
ON
❑ 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
EfNo
❑ 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
[11No
❑ NA
❑ NE
General Pen -nit? (ic/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
;'No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
[:INo
❑ NA
❑ NE
Additional Comments and/or Drawings:
12/2"4

Type of Visit Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit outine Q Complaint Q Follow up Q Emergency Notification Q Other ❑ Denied Access
I —F
acility Number Date of Visit: (0 Time:
�/� 'PPNot (Operational 0 Below Threshold
� Permitted�Certified 0 iConditionally Certified © Registered Date Last Operated
or Above Threshold: .........................
/Farm Name: ......� 17 4.... c�.k�. ,•..... rXY'.....................................I........ County:... {... 1 �.1.YJ.............................................
OwnerName: ................................................... ........................................................................ -Phone No:
MailingAddress: ..... . .......... . . . ............................................................... ........ . ..................... ..................................................................................... ..........................
Facility Contact: j
Onsite Representative: �f�1�1....�?..L.........................................................
Title:
CertifiedOperator: ................................................... .............................................................
Location of Farm.-
.................... I., ........ . Phone No:...................................................
Integrator: ... mm..cp hl...............................................
Operator Certification Number: ..........................................
0 Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 0 ` " Longitude • 4 it
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes O NNo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Identifier:
Freeboard (inches):
12112103
Structprc 1 Structure 2 Structure 3
..........................................................................................................
,315—
Structure 4 Structure S
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ;2r<o
❑ Yes �No
❑ Yes ,�No
Structure 6
Continued

Facility Number:,y Date of Inspection
5'. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes ;j:rNo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑ Yes 00
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 maintenancetimprovement? ❑ Yes eNo
S. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes 25"N4 0
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes XNo
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes ;ZrNo
11. Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes P1<0
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type Vo e cUP. %G ) . 'R.2_TYntoA n. ( dt ) 44P �Csti10,rCP.
13.
Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes eNo
14.
a) Does the facility lack adequate acreage for land application?
❑ Yes 0No
b) Does the facility need a wettable acre determination?
❑ Yes eNo
c) This facility is pended for a wettable acre determination?
❑ Yes 0 No
15.
Does the receiving crop need improvement?
❑ Yes eNo
16.
Is there a lack of adequate waste application equipment?
❑ Yes 12No
Odor Issues
17.
Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
[j yes 0No
liquid level of lagoon or storage pond with no agitation?
18.
Are there any dead animals not disposed of properly within 24 hours?
❑ Yes ,Iio
19.
Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes WNo
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 [-To
Air Quality representative immediately.
v
Field Conv ❑ Final Notes
;S /9/03 �SUr'� �e
Pol f thaw /?e-epl
Reviewer/Inspector Name A
Reviewer/Inspector Signature:
Date:
uizZiv3 aonanuea

Facility Number: 3 — Date of Inspection
Required 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?
(ie/ 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?
(ie/ 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 1" fain
❑ 120 Minute Inspections ❑ Annual Certification Form
❑ Yes ❑ No
❑ Yes gNo
❑ Yes P�No
❑ Yes grNo
❑ Yes JNo
❑ Yes Q"No
❑ Yes &No
❑ Yes r;�'No
❑ Yes JPfiTo
❑ Yes ONO
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes [:]No
❑ Yes ❑ No
❑ Yes ❑ No
12112103

Type of Visit oCompliance Inspection 0 Operation Review O Lagoon Evaluation I
Reason for Visit 16 Routine O Complaint 0 Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Z Date of Visit:
Permitted OCertified 0 Conditionally Certified © Registered
-7-, -` 1UO61t?_�ar
Farm Name: --_ --
Owner Name: �'M Ai O � /C
Mailing Address:
3 S OZ Time: 13: 3S
=Not Below Threshold
Date Last Operated or Above Threshold: at
County: ✓ ue /r - —
Phone No:
Facility Contact: Title: Phone No:
-77 �^-+ Aj O �ijC Integrator:
Onsite Representative: rator: g
Certified Operator: Operator Certification Number:
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' ��°° Longitude • 6
Design Current Design,. Current Design Current
Swine Capacity Po ulatiori Poultry Ca aci Po%ulation Cattle Capacity Population
❑ Wean to Feeder pl-
La er❑ElFeeder to Finish Non -La er ❑ Non-Dai ❑ Farrow to Wean
-
❑ Farrow to Feeder ❑ Other
El Farrow to Finish Total Design Capacity .
❑ Gilts
❑ Boars i. ,. : Total SSLW
Drains
No
Discharges — Stream Impacts
1, Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated now in gal/min?
d. Does discharge bypass a lagoon system'? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
Area I_I Spray Field Are":-:
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection && Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure 1 Structure 2 Structure 3 Structure 4 Structure S
Identifier: I
Freeboard (inches): 38
05103101
❑ Yes No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes J9No
❑ Yes 10
❑ Yes 9No
Structure 6
Continued

11) Facility Number: 31 —S2_G1 Date of Inspection 3 C 42
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste ADDlication
❑ Yes ONO
❑ Yes ZNo
❑ Yes ONO
❑ Yes El No
❑ Yes ZNo
10. Are there any buffers that need maintenance/improvement? ❑ Yes 0 No
11. Is there evidence of over application? ❑ Excessive Ponding 1 ❑ PAN ❑ Hydraulic Overload ❑ Yes ONO
f
12. Crop type Feycu e A Otpt e r-Be r+^'1, t/Ae_% Vei STy +' e sry q, L r 6 oq jv.+ Qye e Seca
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes ZNo
14. a) Does the facility lack adequate acreage for land application? ❑ Yes PfNo
b) Does the facility need a wettable acre determination? ElYes 0No
c) This facility is pended for a wettable acre determination? ❑ Yes ONO
15. Does the receiving crop need improvement? ❑ Yes XNo
16,
Is there a lack of adequate waste application equipment?
❑ Yes
JZJ No
Required
Records & Documents
17.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
❑ No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
ONO
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
10Yes
❑ Yes
;ZNo
21. Did the facility fail to have a actively certified operator in charge? ❑ Yes J21rNo
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes ONO
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes jzfNo
24. Does facility require a follow-up visit by same agency? ❑ Yes ONO
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? Yes ❑ No
10 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
uest#j Explain any Y)1S an_swersvandlor any recommendations or, any'other cottamentsk z
Comments (refer t!ty
Uto bettxpl
^
li. Nee/45 L'e!'4 c t4C a-/' k;s iC able .
9 • /V c e A 16 be s-,)re 40 ELSE' q Si s 0 days
Or Ct 1►4r-A41PL-)mV0t4tf Oil 4kQ �122"2`s�� calcvCa-fe -tie n+-�t�ay��
�'an
o- clegcdQP1e
�rPPJ�,ed• -"l.,.e wAs4e a^al s; I is av4 let Me bvt u
t,�ras vs.e�; no ov��ajof�l�cc��rar� ,^es✓1-�ed aPp�r�'pn�l
y
Reviewer/Inspector Name i4*VT -» "I-41 l�q _ ' .,
Reviewer/Inspector Signature: Date: 4'
05103101 Continued

Facility Number: 31 —S"Z� Date of Inspection S 4Z Printed on: 7/21/2000
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes VrNo
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes gNo
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 PNo
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes ONO
32, Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ❑ No
bona omments an or Drawings:,
25. 'T4 aAct )ovi1S mn 6e <kor4e-wd 44 4;S JvdS,�c�
-fie 7reen �-�kQ �5I"Ve- /� Places -b I►'!/ .Noble s�i`ai -T�ct� Gle'"tJA1
5kC--4e-n A -,e pvllf if p.-I Of �of 4hen'1 are nod svi-Fable g44ke
41-►-,Q 11`, 00-(o110w 6t, ee-0abie
tLGI S (%4CS ► h - p�IfT D� P1llr 1 S Yl0 t� Sv 4.gL>le, an acc0o +G"L 4ke-t
C a t+.�e t7cil: k � a-�-Lt,� P � 1 � G� -l� et, -�: �►,.e w h2 h -� �e 1n11.�D j� -� h , •.c� i s
Sv - gble
411e itaG1'li4) trefsl avid ne""A`r're Lvell kelig
5/00
J

I
�`Drvrsion, Of Water Quality,—,,t �, :..
.tt
rx' , QDwision�ofS
oil andWaterConservation
s
Q Other, xgency"r,,', t += ti t, [:
of Visit J0'Compliance Inspection Q Operation Review O Lagoon Evaluation
Reason for Visit .0 Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number f JrZ Date of Visit:
Permitted © Certified [3 Conditionally Certified . 0 Registered
Farm Name: / ' N o b Ie....Fa �
............... ............ .
Owner Name: ............................. ... .....o..................................
l........ ......................
Time: 0 = S Printed on: 7/21/2000
Not Operational O Below Threshold
Date Last Operated or Above Threshold: .........................
County:.........V�1!..'.....................................................
Phone No :....................
FacilityContact: ...............................................................................Fitle:.:.............................................................. Phone No:.................................
MailingAddress: .......................................................................................................................................................................................................... ...........
Onsite Representative: ,..,,�.., t, ,,,,, JN °.. Integrator: .........................
.....-........................................................... ...P.. �. ...... r:...
Certified Operator: ............. Operator Certification umber ........
Location'of Farm:
swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • 4 it Longitude • 6 44
r,,_:VapaCity,POPUlatiOn
E3 Wean to Feeder
eeder to Finish
/ 2 0 O
;f Farrow to Wean
=Ij Farrow to Feeder
E, ❑ Farrow to Finish
s Gilts
Boars
Design Current Desttgn`'- Cnrredt
Poultry Capacity Population Cattle Ca aci Population
❑ Layer ❑Dairy
❑ Non -Layer I 1 ❑ Non -Dairy
❑ Other
Total Design Capacity'.'
Total SSLW ;'
�Naaiber,ol LagoE►ns ❑ Subsurface Drains Present ❑ Lagoon Area ❑ Spray Feld Area
i ; 3 <botllingiPoeds fl Solid'Traps �' ❑ No Liquid Waste Management System
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: []Lagoon ❑ Spray Field [:]Other
a, If discharge is observed, was the conveyance man-made?
b. If discharge is observed. did it reach Water of the State'? (If yes, notify DWQ)
c. Ii'discharge is observed. what is the estimated flow in galhnin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier: ................ I .................. .................................... ........... ........................ .................. .................. ......... I...................
Freeboard (inches): i Z
5100
❑ Yes ONO
❑ Yes E'No
❑ Yes JQ N10
/? A
❑ Yes ,PfNo
❑ Yes 0
❑ Yes/No
❑ Yes�o
Structure
Continued on back

Facility Number: 3I _� Date of Inspection / Printed on.• 7/21/2000
5. Abe there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑ Yes No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
❑ Yes No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement'?
❑ Yes ,ffNo
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes )2'No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes XNo
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
10
❑ Yes f�No
1
12, Crop type �� r c�p�6i !'r�S7 re 1 t—C�SGt/e fcis4Jrezr,„� Jf 6re,;
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
14, a) Does the facility lack adequate acreage for land application?
JF,�(No
❑ Yes ENO
b) Does the facility need a wettable acre determination?
❑ Yes ZNo
c) This facility is pended for a wettable acre determination?
❑ Yes )3 No
15. Does the receiving crop need improvement?
❑ Yes gNo
16. Is there a lack of adequate waste application equipment?
❑ Yes -No
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available? ❑ Yes ONO
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.) ❑
Yes ONO
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports) ❑ Yes ONO
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes ,"No
21. Did the facility fail to have a actively certified operator in charge? ❑ Yes zNo
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes _ No
23. Did Reviewer/inspector fail to discuss review/inspection with on -site representative? ❑ Yes ONO
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? ❑ YesXNo
.NO. iOlatigris:o�- ilc#iciencies -vvg're ppted. diWiiiii {:his:visp :01 -reeeiye 06futthgr - ' - '
correspondence. abotiti this visit.
question #): Explain any YES answers and/or any rE
I�G,c►11,4y and reedrd5 are Vey'y weir/ k,0- �kC���e172SGue Gap.
r 1
Reviewer/Inspector Name 'CO✓ z�.i �l �( s t ��e�,.1. , ' "�'Er aC �'�
! ' 1,
Reviewer/Inspector Signature: Date: / nr S./ho

Facility Number: Date of Inspection Printed on: 10/26/2000
Odor -Issues
- V
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes eNo
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes�No
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes ,❑ No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes'10!No
31. Do the animals feed storage bins fail to have appropriate cover? El Yes (�No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? El Yes /❑ No
5100

__ - N1i1 j 1 _ �:"7 �R' G
4z I s J r Drnslon of Water Quality sgs �4 �Y�1
Wt
iAslon 4'96il and Water %ouservation
�
l" ' Q Other'Agency at 'A[ ,
��` _z�d.3+�
J
Type of Visit Compliance Inspection O Operation Review Q Lagoon Evaluation
Reason for Visit Routine O Complaint O Follow up Q Emergency Notification O Other ❑ Denied Access
Facility Number Date of Visit: t) Time: � / ed on: 7/21/2000
Not O erational 0 Below Threshold
Permitted [3 Conditionally Certifie 13 Registered Date Last Operated or Above Threshold:
© Gert' d p
Farm Name: f ... ....e..V4;�.
/ ............. ........................................�v r, County:..... j0Je.rl................................. .._.........Owner Name:....`1'1.............r Phone No:
,n^ /
Facility Contact:........................-:.....................Title:....�1!>!w Phone No:...................................................
:'Nailing Address: .....................................................................................................................
......... ............................ I.............. .................... ..........................
............
Onsite Representative ............. ./ l% /'�. Integrator:.... %....................................................
Certified Operator:..........!. .. r-��-............. Operator Certification Number:...........................................
Location of Farm:
L.T €
j Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude Longitude ��• ��«
Design Current Design Current Design Current
Swizie Capacity Population Poultry Capacity Population Cattle Capacity Population
❑ Wean to Feeder ❑ Layer I I ❑ Dairy
Feeder to Finish 7 eP 10 JE1 Non -Layer I Non -Dairy
❑ Farrow fa Wean
❑ Farrow to,Feeder, ❑Other
❑ Farrow to i' inish Total Design Capacity
❑ Gilts
❑ Boars Total SSLW
Number of. Lagoons JEI Subsurface Drains Present ❑ Lagoon .Area 10 Spray Field Area
Holding Ponds / Solid Traps 10 No Liquid Waste Management System
Discharges & Stream I.muacts
1. Is any discharge observed from any pat of the operation? ❑ Yes O(No
Discharge originated at: CJ•Lagoon ❑ Spray Field ❑ Other
a, If discharge is observed, was the Qonveyancc 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 11112 estilnated lio%v in gal/min?
d. Does discharge bypass a lagoon system? (If yes, nolify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes &,No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes'�V0
Waste Collection & 'Treatment \
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes Ir0
Structure I Structure 2 Structure ; Structure 4 Structure 5 Structure 6
Idcnli tier: ...............
Freeboard finches): I�
5/00 111
Continued on back

J,Waciliky. Number: — Date of inspection )) p Printed on: 7/21/2000
Odor Issues —
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below Cl Yes �j No
liquid level of lagoon or storage pond with no agitation? , `
27. Are there any dead animals not disposed of properly within 24 hours? _ [:]Yes �('No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes 4No
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes [% No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes No
Additional omments an orDrawings:
A,
w
5100

Facility Number: 3 / —�� Date of Inspection /J Printed on; 7/21/2000
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure'plan? ❑ Yes #N0
(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 No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes o
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes 0
Waste Application \
10. Are there any buffers that need maintenance/improvement? ❑ Yes ONO
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes No
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20, Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative'?
24. Does facility require a follow-up visit by same agency? '
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
io. 0, atWnS..Or• tlefeiencies were itgt;ed dit-ritig 1. js;visit; • Y;oit #ill -receive lid further. ;
CHEF! ondence. about . is.vistit..... .
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):
C
❑ Yes _9�No
❑ Yes o
❑ Yes No
❑ Yes No
❑ Yes No .
❑ Yes No
❑ Yes �No
❑ Yes 4No
❑ Yes o
ElYes No
❑ Yes ANo
❑ Yes RNo
El Yes 'kNo
❑ Yes No
❑ Yes No
AL
Reviewer/Inspector Name
Reviewer/Inspector Signature: [—A ,_, — rU A F A I ; Al I . Date: j I / if 5 1 1W 5100

` D Division of Soil aii l Water, Conservat,on 'Qperation,Review ,
j.} ! Q.D1Vi5i0A D�SOiI anil'Water,COnserva40II '�Conipha�nce Inspeetion �
F
DiAslonf Water Qui ity Compllanee 1CnSpectloll ii, `fir H > " ��
:@' �..,....„.. .• OtherAgency,, OperationRevre
19 Routine O Complaint 0 Follow-up of DWQ inspection O Follow-np of DSWC review 0 Other
Facility Number Z Date of Inspection // /7
Time of Inspection 1 11610 124 hr. (hh:mm)
Permitted X Certified [] Conditionally Certified 13 Registered Not O crational Date Last Operated:
...........
Farm Name: .........r1}'.t....�`c.0.1�� ..../` iQL!!1... Count f` ��✓.......................... .U)Ik.....
-� -AlY' ........p a
OwnerName :.......... ./..,1.,1�.',� ...... .............. ....... l............................................ Phone No:.... � ..`.. ./.............................................
Facility Contact: ........,C.l..!J ......... A^ Sle....................... Title:... 1/✓,± i� Phone No:...................................................
MailingAddress: ....... %'-.....S,4.X., ......a...........................................:NIGL..........NC... ... .. ............ . ...........
Onsite Representative: ............./��f? �u Integrator......./`�,���11L...................................................
......................................................... ..
Certified Operator:.........1//%?1�{G/t....................L............................... Operator Certification Number: ..... l.r�...............
*..... ..........r�.... SVlF4�-....jT A..1�,�:......... ,t.... �11 ....... 03.......a...... Sri...t..7c ., ........... o.S'r . ........1..7
71-W. ..S4&4.6C r`A. .. .. F .. s..... :. ...M..i.... FRoIYJ.....,�r ..../..7oi os�/.., ...... iO.t�... .4 ../..7..eq...... -t R.
Latitude ' 9 " Longitude • 4 "
„ Design Current," Design. Current Design Current
Swine ° ''Capacity Po Population , - Poult „,
rY Ca 'aeity , Pa ' elation ;Cattle Capacity Population,"'
❑ Wean to Feeder ❑Layer JE1 Dairy
Feeder to Finish p Q ❑Non -Layer ❑ Non -Dairy
❑ Farrow to Wean
Y s
iV
❑ Farrow to Feeder ❑Other
Farrow to Finish
Total D .
` ❑ ,' .°esign Capacity Zbc�
❑ Gilts
❑ Boars' �','�� Total''SSLW /�i2 0V
Dumber of'Lagoons ' ❑Subsurface Drains Present ❑ Lagoon Area ❑ Spray Field Area
4 0
' Holding Pon& /Solid Traps ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of (lie State? (If' yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in galltnin?
d. Dues discharge bypass a lagoon system'? (If ycs, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4, Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier: ,[%
Freeboard(inches): .........T...I................. .............................................................................................................................................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
3/23/99
[]Yes XNo
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes �No
❑ Yes No
❑ Yes kNo
Structure 6
...................
❑ Yes XNo
Continued on back

Facility Number: Date of Inspection
!�
i 6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
❑ Yes No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
❑ Yes ko
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes JKNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
❑ Yes XNo
elevation markings'?
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes XNo
11, Is there evidence of over application? ❑ Excessive Ponding [-IPAN
ElYes XNo
12. Crop type 4 AC &A17 #t 2 �#6 , rr fC.vt�
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes No
9No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
b) Does the facility need a wettable acre determination?
❑ Yes .X No
c) This facility is pended for a wettable acre determination'?
❑ Yes KNo
15. Does the receiving crop need improvement?
❑ Yes X No
16. Is there a lack of adequate waste application equipment?
❑ Yes KNo
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes KNo
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes 0,No
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes No
-No
21. Did the facility fail to have a actively certified operator in charge?
❑ Yes
22. Fail to notify regional DWQ of emergency situations as required by General Permit'?
(ie/ discharge, Freeboard problems, over application) ❑ Yes EMNo
21 Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes ;kNo
24. Does facility require a follow-up visit by same agency? ❑ Yes No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes No
. . vit... Qi1s or• ileficiericles W4= re bO(ed dtri'iOg Ois:visit: You will eegiye tio, f`ui•thor
corresnotideitce: abaut. this visit.: • . • . .. .. .
99

Facility Number: Date of Inspection
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes JKNo
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 Po
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 JZ No
30. Were any major maintenance problems with the vdntilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes jKNQ
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes ;ENO
32, Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes XNo
lAdditional,,C6inmeiits.,Aiid/or,Dt'4W1I1gS
v �O&S AJOT- A-pPC�
ful�4
vs& 'r-AP-5 8 w1hrE•p- G=AIL-
Ai
3123/99

Division of Soil and Water Conservation ❑ Other Agency
® Division of Water Quality
JO Routine O Complaint O Follow-up_of_DVVQ inspection O Follow-up of DSWC review O Other j
inner -
Date of Inspection g
Facility Number 3 Time of Inspection ! o0 24 hr. (hh:mm)
Registered ® Certified`` 1I Applied for Permit [3 Permitted 13 Not Opera Date Last Operated:...
FarmName:......... 1tr.....1`!k.4........... �rxr.Yt............................................................... County: .... D.NPkh....................................... .......................
Owner Name:....TI,r.....................................5 ' fi4h......... Phone No:.�.g14)29$- 3L .........................
................................................ ..................... ......................
Facility Contact: ....................................... ...... Title:................. . Phone No:
MailingAddress:....�15 ..... �.1 � �.......Q............................................................. ...kir............................................. .. 2L......
Onsite Representative: ......�"►m ....... N.Ab.................... ........ Integrator: ....... '.yty. } .....
Certified Operator; ................. .. Operator Certification Number • 17ot?, �.......,
Location of Farm:
rm..t`5..... 0a ..... i ............... R..Iaa..t... Qt ... rA. CK...ioA.... r.t.................� .... t.............................................................I....... ;
........ ....... ... ' ...
Latitude 0' 6 " Longitude ' «
.� Design. ,Current Design Current `
Swore ::s Gapacrty Population ; .Poultry Capacity Population C
❑ Wean to Feeder
Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
❑ Layer 10 Dairy
❑ Non -Layer I0 Non -Dairy
❑ Other
- k� Tdtal Design Capaclfy Zpo
n
Total: SSLW r (, 7,a�
f
Subsurface Drains Present ❑ Lagoon Area ILI Spray Field Area
No Liquid Waste Management System < 2 -WN
General
1. Are there any buffers that need maintenance/improvement? ❑ Yes ® No
2. Is any discharge observed from any part of the operation? ❑ Yes No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes No
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ) ❑ Yes 'j No
c. If discharge is observed, what is the estimated flow in gal/ nin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes No
3. Is there evidence of past discharge from any part of the operation? ❑ Yes No
4. Were there any adverse impacts to the waters of the State other than from a discharge? ❑ Yes §4 No
5. Does -any part of the waste management system (other than lagoons/holding ponds) require ❑ Yes 1A No
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes ® No
7. Did the facility fail to have a certified operator in responsible charge? ❑ Yes M No
7/25/97
Continued on back

Facility Numlx•r:
8. Are there lagoons or storage ponds on site which need to be properly closed'? ❑ Yes K3 No
Structures (La2oons.I1oldine Ponds, Flush Pits,
9. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
[denti f ier:
.................................................................................................................................................................................................. I ........ I.......
Freeboard (ft): ............ -. ............... I ............ I......
10. Is seepage observed from any of the structures'? 0 Ycs X] No
11. Is erosion, or any other threats to the integrity of any of the structures observed? ❑ Yes Q No
12. Do any of the structures need trriintenance/improvement'? ❑ Yes No
(If any of questions 9-12 was answered yeas, and the situation poses
an immediate public health or environmental threat, notify DWQ)
{
13. Do any of the structures lack adequate minimum or maximum liquid level markers? ❑ Yes No
Waste Application
14. Is there physical evidence of over application? ❑ Yes No a
(If in excess of WMP, or runoff entering waters of the State. notify DWQ)
15. Crop type ............... �Y.!f.+.A ... ..................................:..Gil ..4..........................................................................................................................y..............................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)? ❑ Yes [9 No
17. Does the facility have a lack of adequate acreage for land application? ❑ Yes No
18. Does the receiving crop need improvement? ❑ Yes No
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewerhnspector fail to discuss review/inspection with on -site representative?
r
22. Does record keeping need improvement?
For Certified or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
24. Were any additional problems noted which cause noncompliance of the Certified AW,VIP?
25. Were any additional problems noted which cause noncompliance of the Permit'?
No.violations or deficiencit s were noted during this:visit. Xou.will receive no further
correspondence about this:visit..
Comments.(referjo question*): Explain any NES answers and/or any recomanendations.,or,
Use drawings of�fucilityto better explain situations, (use additional pages as ncce5sary} r'
u: „
COn�triut w�rKin� or, \ove 6,W br. d;VA_ WOM-
11
❑ Yes S No
❑ Yes No
❑ Yet No
❑ Yes No
❑ Yes No
❑ Yes No
❑ Yes M No.
7/25/97
Reviewer/Inspector Name
Reviewer/Inspector Signature:
—_1 Date: 9.

" a t❑ DSWC Animal Feedlot Operation Review
F �12 DWQ Animal Feedlot Operation Site Inspection ;
x.
0 Routine AConiplaint O Follow-u of I)W ins cclion O)H ollow-ll of DSWC review O Other
Date oFlnspectiart D a !
Facility Number `
Time of Inspection % 24 hr. (hh:mm)
© Registered M Certified Q Applied for Permit © Permitted Q Not Operational I Date Last Operated:
Farm Name:. .. .... ..!Q.k�.,l � ... -.0 ..Y..-1 -� County . .. ................. .......................
LOwner Name; .... L.,h�1..........11.4..IQ..,.....I�r ............................. Phone No: f I...........:.........�...
�� p� .......................... ) Q... G%
Facility Contact: .�L..'..1'.!...... ..Q..�......"�! ..... Title: Q w...ki-e ! Phone No: . ...
MailingAddress: 1r G ......................................... ............................................................... ..........................
. .
Onsite Representative:.1n..
Certified Operator.......................................................
Location of Farm:
.. Integrator . .......y .............. I.
I z t�
.............................................. Operator Certification Number :...... ,�,.......
............................................... .............. ..........
Latitude • LJ, " Longitude • ' '<
Design Current
Swine Capacity Population
❑ Wean to Feeder
El-t'eeder to Finish
I Z
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Design Current Design Current
Poultry Capacity Population. Cattle .Capacity. Population
❑ Layer JE3 Dairy
❑ Non -Layer JE1 Non -Dairy
❑ Other
Total Design Capacity
Total SSLW
Number of Lagoons 1 Holding Ponds, ❑ Suhsurface Drains Present ❑ Lagoon Area JUSprayField Area
❑ No Liquid Waste Management System
General
1. Are there any buffers that need mainletiance/improvement?
❑ Yes
❑ No
2, Is any discharge observed from any part of the operation?
❑ Yes
B-Nwo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
❑ Yes
❑ No
b. II' discharge is observed, did it reach Surface Water'? (lf yes, notify DWQ)
❑ Yes
❑ No
c. If discharge is observed, what is the estimated flow in gal/thin?
d. Dues discharge bypass a lagoon syste.m'? (li' yes, notifv DWQ)
❑Yes
❑ Now
3. Is there evidence of past discharge from any part of the operation?
❑ Yes
8'No
4. Were there any adverse impacts to the waters of the State other than from a discharge'?
❑ Yes
044-5
5. Does any part of the waste management system (other than lagoons/holding ponds) require
❑ Yes
�
allo
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
alo
7. Did the facility fail to have a certified operator in responsible charge?
❑ Yes
❑ No
7/25/07
Continued on back

rFacility Number:
8. Are there lagoons or storage ponds on site which need to be properly closed'! 0 Yes 9-150—
Structures (Lagoohs ,11oldinp. Ponds, Flush I'it.9, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes a], o
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
-C ............. ....... ­ ...... * ...... ................................. ................................... .................... .... ........ ­­­* ........
Freeboard(ft): ....... TV% . / ........... . ...... I ........................... .......... I ....... ... ......... I ....... ......... .................................... ....... I ............................
10. Is seepage observed from any of the structures? El Yes U-Ko�
11. Is erosion, or any other threats to the integrity of any of the structures observed'? El Yes 211;ro�
12. Do any of the structures need maintenance/improvement? F-1 Yes
(if any of questions 9-12 was answered yes, and the situation poses
an immediate public. health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate ininirnurn or maximum liquid level markers? El Yes
Waste Applicatioi
14. Is there physical evidence of over application? El Yes apl�o­�
(If in excess of WMP, or r noff e tering waters o the State, notify DWQ)
15. Crop type .... .. a . . ... Xu",/X ....................... Af e ........................................................................................................
/ ...........
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)? El Yes 0 No
17. Does the facility have a lack of adequate acreage for land application'?0 Yes atlo�
18. Does the receiving crop need improvement? El Yes
19. Is there a lack of available waste application equipment? El Yes
20. Does facility require a follow-up visit by same agency? El Yes �o
21. Did'Revi ewer/] nspector fail to discuss review/inspection with on -site repr sentative? ZlfPelo No
22. Does record keeping need improvement'? l7o74 C n1 6 ❑ Yes El No
For Certified or Pennitted 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 AWMP9 ❑ Yes ❑ No
25. >w(e"any additional problems noted which cause noncompliance of the Permit? El Yes QM�O
ETNo.vio'lkio'ns Ordeficien'cies were- noted- during this visit. -youmill receive no ftirther
coeresp6ndehce Eitiout this'visit'.,',
CWPM(s (refer6`4uestion lxpla . in any YES answers andlor any recommendations or'any other `conments.
Use drawings of faiilitv to betterexplain situations.'
(use additional pages a,s necessary) :
ty e, e to ejelnt, ql-IA-1
19
?r?
5) Ae A/,f /* 97946
zl�
0 *L 0 on
OV r-P tAJ P(�
— 1, 97AfL0et22feJAT)/97
.................
Reviewer/Inspector Name j
A
A
Reviewer/Inspector Signature: P;A Date: I P

envirochem
CONSULTING
CHEMISTS
Date Sampled:
Sampled By:
Report To:
Environmental Chemists, Inc.
MAILING ADDRESS:
TELEPHONE:
SHIPPING ADDRESS:
P.O. Box 1037
[phone] (Office)
6602 Windmill Way
Wrightsville Beach,
[phone] (Lab)
Wilmington,
North Carolina 28480
(910) 3924424 (Fax)
North Carolina 28405
NCDEHNR: DWQ CERTIFICATE #94, DLS CERTIFICATE #37729
REPORT OF ANALYSIS
t
Customer: NCDEHNR-DWQ
i
127 N. Cardinal Drive Ext.
Wilmington, NC 28405
10/21/97
Jim Bushardt
Rick Shiver
Copy To: Jim Bushardt
Date of Report:
Purchase Order #:
Report Number:
October 28, 1997
7-3073
PARAMETER
UT to Limestone Creek
# 8221
Fecal Coliform, colonies/100mi
61
Reviewed by and approved for release to the client.
0
OCT 2 9 1997

enviroehem
ENVIRONMENTAL CHEMISTS, INC
Sample Col ion and Qgin of Custody
Samnlp Tenn- I•n hupnt_ FfHnent_ WAL Rtrpam_ gnil_ flthpr-
6602 Windmill Way
Wilmington, NC 28405
Phone: [phone]
FAX: [phone]
SAMPLE
COLLECTION
BOTTLE
ID
LAB
ID
PRESERVATION
I
ANALYSIS REQUESTED
I
DATE
TIME
NONE
HNO
NsOH
TRIO
OTMR
l /IDENTIFICATION
i�l Z �S eC
'0
/z _f
Zi
l o r i'/Yt
Maximum Holding Time Between Collection and Analysis: BOD 48 Hours, Coliform in Wastewater fiffours,
Coliform in Drinking Water 30 Hours,
Transfer
Relinquished By:
Date/Time
Received By:
Date/Time
1
�
2
Received with Ice Water Chi ed to Yes " No
Delivered By: .J r�'1 _T7aY' Received I
Comments:
Rejected
iZ-0Z Date: /U z/9- Time:
-�-

10 Routine O Complaint O Follow-up of DWO inspection O Follow-up of DSWC review Q Other
Date of Inspection
Facility Number
Time of inspection 24 hr. (hh:mm)
Total Time (in fraction of hours
Farm Status: ❑ Registered ❑ Applied for Permit (ex:1.25 for 1 hr 15 min)) Spent on Review
® Certified ❑ Permitted or Inspection includes travel andprocessing)
❑ ........ Not Operational rim
Last Operated :.... .... ..... .. ......... .. ..... .._.........................................................................................................
FarmName: ........... cimn.1k....... gift.?m........................... ........................................... County: ....... NOIA..... ».......................... .... .......................
Land Owner Name:........ rip .......... NQ6........................................................................ Phone No: ..... 1 10)....x r�..�.:.j.���.....................................
Facility Conctact:.... Tim ....... 0.0614................................................ Title: ........Q.k?.k........ .................. Phone No: Z1'.?Qlatzaz-.9.1...............
MailingAddress: .............. »...... .............. ............. ...... ....P-ttlkAi.11..i,-Aiu�. h.......................................
OnsiteRepresentative: .... arm.... . 66L...................................................................... Integrator: ..... MiJI..�Mi<..............................................................
.
CertifiedOperator:........... .......................................
Location of Farm:
Operator Certification Number:
Latitude ®• ©' 4 _V­ " Longitude �• ®� 0.
Type of Operation and Design Capacity
General
I. Are there any buffers that need maintenance/improvement?
2. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
3. Is there evidence of past discharge from any part of the operation?
4. Were there any adverse impacts to the waters of the State other than from a discharge?
5. Does any part of the waste management system (other than lagoons/holding ponds) require
4/30/97 maintenance/improvement?
❑ Yes W No
❑ Yes P No
❑ Yes 1ja No
❑ Yes 91 No
❑ Yes
fp No
❑ Yes
JIRNo
❑ Yes
ERNo
❑ Yes
® No
Continued
on back

Facility Number: ..--M ....... —.......7 .
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
I"No
7. Did the facility fail to have a certified operator in responsible charge?
❑ Yes
U No
8.,Are there lagoons or storage ponds on site which need to be properly closed?
❑ Yes
6.No
Structures (Lagoons and/or Holding Ponds/
9. Is storage capacity (freeboard plus storm storage) less than adequate?
❑ Yes
ONo
Freeboard (ft): Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Structure 6
: .... .. ........................... .... I....................... .... ....... I ............. . ...........................
............................
10. Is seepage observed from any of the structures?
❑ Yes
W No
11. Is erosion, or any other threats to the integrity of any of the structures observed?
❑ Yes
12 No
12. Do any of the structures need maintenance/improvement?
VTYes
❑ No
(If any of questions 9-12 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
❑ Yes
R No
31'astc Avolleation
14. Is there physical evidence of over application?
❑ Yes
EfNo
(If in excess of WMP, or runoff entering waters of the State, notify DnWQ)
15. Crop type COM.W....... 6f.MJ4....................................................t Srn►.1.............. ..............................................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
❑ Yes
cirNo
17. Does the facility have a lack of adequate acreage for land application?
❑ Yes
KNo
18. Does the receiving crop need improvement?
❑ Yes
CRNo
19. Is there a lack of available waste application equipment?
❑ Yes
IN No
20. Does facility require a follow-up visit by same agency?
❑ Yes
18 No
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
19No
For Certilij, Fagilitie,S Only
22. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
Cl Yes
IN No
23. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
UNo
24. Does record keeping need improvement?
OrYes
❑ No
Reviewer/Inspector Name rtMI
�i;k _i' ;
Reviewer/Inspector Signature: Date: R 7
cc: Division of Water Quality, Water Quality Section, Facility Assessment Unit 4/30/97

Site Requires Immediate Attenri n: NV
Facility No. SZ
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SM VISITATION RECORD
DATE: _ 7_ o _, 1995
Time: I 3c7
Farm Name/Owner: L_ ►I^ _ _ -- \ J
Mailing Address: 1A
County: _ DuP-
Integrator: u Y. tA i� Phone:
On Site Representative: Phone:
Physical Address/Location: C� R 4 hn -r'
2-18 - 3231�
Type of Operation: Swine G--:" Poultry Cattle
Design Capacity: _ l I Number of Animals on Site:
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude:° _' S-6 " . , Longitude: 10�" Elevation: Feet
Circle Yes or No
Does the Animal Waste Lagoon haZeror'No
cient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches) Actual Freeboard: 4.Ft. Inches
• Was any seepage observed from the lagoon(ss))? Yes oo Was any erosion observed? Yes r No
Is adequate land available for spray? Yes or No is th cover czop adequate? es r No
Crop(s) being utilized: CO►�StA L C,� 1f� o
Does the facility meet SCS minimum setback criteria? 200 Feet from DwellinVoNo
No
100 Feet from Wells
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? es
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes or No
Is animal waste discharged into waters of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes or To If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreaf�with.cover crop). Yes r o (( ++ t
Addition omments: Q e d S e w Cl i 1C� L� 1 1 5
`J
Inspector Name Signature
cc: Facility Assessment Unit Use Attachments if Needed.

OPERATIONS BRANCH - WO Fax:[phone] Rug 1 '90 10:07 P.04/08
Sitc Requires Liirtiediate ,Artention
Facility Number;
SITE VISITATION RECORD
• DATE, -' , 1995 `sy
e
Owner: Ali kl-P Farm Name:
County:-
' �.,.,
Agent Visiting Site. phone:
Operator: _ Pho.=
- ...
On Site Representative: Phone:
phySieal Address: CL±
Mairmg Address:
Type of Operation: Swine Poultry Cattie
Design Capacity; 7 Number of Animals on Site; T W
Latitude: n Longitude: b "
• Type of Inspection: Ground Aerial
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hoar storm event
(approximately I Foot + 7 inches) Yes orQD , Actual Freeboard: Feet -Inches
For facilities with more than one lagoon, please address the other lagoons' freeboard under the
comments section.
Was any seopage observed from the lagoon(s)? Yes o No as there erosion of the darn?: Yes or No
Is adequate Iand available for land application? Yes or No Is the cover crop adequate? Yes or No
Additional Comments; r i(,a,
Fax to (919) 7 t5-3559 SiSnacare of Agent