670053_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental Qual

Type of Visit: ompliance Inspection O Operation Review O Structure Evaluation O "Technical Assistance
Reason for Visit: Q4,outine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: [7(dc7 Departure Time: County: r�rt n W Region:�� l
Farm Name: �i,4' � L F../, L. " t ! Owner Email:
Owner Name: In o Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: f
Certified Operator:
Back-up Operator:
Location of Farm:
1(
Latitude:
Phone:
Integrator: J C- ffu'oQ
Certification Number: t '� �7
Certification Number:
Longitude:
Design Current.
Design
Current
Design Current
Swine Capacity Pap.
Wet Pouitr1y
Capacity
Pop.
C**attle Capacity . Pop.
Wean to Finish
I
11-ayer
I
Dairy Cow
Wean to Feeder
I
JNon-Layer
I
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
Dr, P,oultr,
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 jal
I Other
Discharees and Stream Imoacts
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 y s notify//DyyWR)
c. What is the estimated volume that reached waters of the �falPpy"O'�
❑ Yes [c]..I'do ❑ NA ❑ NE
❑ Yes
❑ No
[]NA
❑ NE
❑ Yes
❑ No
[Er A
❑ NE
d. Does the discharge bypass the waste management sy �?,(1£y s��� notify DWR) ❑ Yes ❑ No NA ❑ NE
2. is there evidence of a past discharge from any part of the operation? VV (( ❑ Yes [3No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adv�t����'` iWtSeborwters ❑ Yes Fj"No ❑ NA ❑ NE
of the State other than from a discharge? Wrlmingtro ns egional Section
Office
Page I of 3 21412015 Continued

Facili Number: (—- S Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [ o [] NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No L3qA_ ❑ 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 [ o ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
❑'moo
❑ 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
[3`lgo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
[:]Yes
[3-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'RTo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[A -No-
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes C]"IVo ❑ 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): B&ti'%l at •�` . (:.-
13. Soil Type(s): rb V_ 65 �V _t
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [2'No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes �lo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable [:]Yes [" o ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Reauired Records & Documents
❑ Yes [�
[:]Yes L No
❑ NA ❑ NE
❑ NA ❑ NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
�o
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[2-f4o
❑ 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
[3No
❑ 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
0No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
ffNo
❑ NA
❑ NE
Page 2 of 3 21412015 Continued

FacilityNumber: _ -3 71 1 Date of Ins e0on: k•cr_?
24. Did the facility fail to calibrIe waste application equipment as required by the permit? ❑ Yes E�FM
25' Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [E 190
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 [o
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes 0-lq-o
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes l No
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 �o
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 ETNo
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 [fNo
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes ETNo
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes []'No
34. Does the facility require a follow-up visit by the same agency? ❑ Yes [a"'No
Comments (ref so question #) Eapelam anyrYES'answers and/or.aayatlditiu©al rec©mmendat ©ns or any other
Use dravmgs:oMINI
ffacility to better ea lain stiiatiuns'(use additional a es as necessa I
[ �J {� }C� ,�} �1 J''4JiL C �✓l pQf ! t )� Cv"��' E2/ !e.
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3of3
M U0
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
DNA ❑NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑NA ❑NE
-e 4."s ku /
Phone: f/&- t3.- 9 -1' 7
Date: r —Tw- we.
21412015

r
� Division of Water Resources
Fa umber (r -7 W Division of Soil and Water Conservation
s
� 0 Other Agency
Type of Visit: compliance Inspection 0 Operation Review 0 Structure Evaluation Q Technical Assistance
Reason for Visit: j�Koutine O Complaint O Follow-up Q Referral 0 Emergency O Other O Denied Access
Date of Visit: Arrival Time: //j�� Departure Time: 0 County: Region:
Farm Name: L �% Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator:
Title:
Phone:
Integrator: i'MAG
Certification Number: J O
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish I
Wet Pointry
I Layer
Design
Capacity
Current
Pop.
Design Current
Cattle Capacity Pop.
Dairy Cow
Wean to Feeder
Non -La er
EEI
Dairy Calf
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
D , P,oul
Layers
Design
C_a AN
C►urrent
P,o
Dairy Heifer
Cow
Non -Dairy
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?
[]Yes
UNo
[DNA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made:?
❑ Yes
�allo
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
&No
[] NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
[] Yes
ETNo
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3
21412014 Continued

Facility Number: Date of Inspection: 10
Waste Collection & Treatment
4. ls; torage 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 0 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 P 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 0 Yes 5XNo ❑ 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? 0 Yes E�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 PjNo ❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes P No ❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [';�No ❑ NA
ONE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes E�'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 F;I"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?
Reauired Records & Documents
❑ Yes,.ONo ❑ NA ❑ NE
❑ Yes ,EJ No ❑ NA ❑ NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes ,,0 No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes ;2 No
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes ❑'No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
0 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 'Rio
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
[:]Yes ONo
❑ NA
❑ NE
Page 2 of 3 21412015 Continued

Facility Number: E 7 - Date of Inspection:
24. Did the 4facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ej No
25. I, the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [ ZNo
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 PrNo
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes 1 0
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes NA ❑ NE
and report mortality rates that were higher than normal?
T
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes Jam-' 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 ;I No ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
3 L 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 No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
D Yes o ❑ NA ❑ NE
'No
34. Does the facility require a follow-up visit by the same agency?
❑ Yes ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations`or any other. comments. ,A •'=
Use drawings of facility to better explain situations (use additional. pages as necessary).
:
re to/ c..fi
$ n r
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
'1
N
i
Phone: 9Y
A 407 Z3
Date: /a 6
21412015

Type of Visit: ��FRoutinc
'fiance Inspection Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: County: Region:
Farm Name: ' n��� - "�,r ,,i t Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator: ;� G l
Certification Number:
Certification Number:
Longitude:
Swine
Wean to Finish
Design CurrentWif
C►apacity Pop.
Wet Poultry
Layer
Design
C*apacity
Current
Pop.
Design Current
Cattle Capacity Pop.
DairyCow
Dairy Calf
Dairy Heifer
Wean to Feeder
Non -La er
Feeder to Finish
/L
Farrow to Wean
Design
Current
D Cow
Farrow to Feeder
la } P,oultr,
Layers
Non -Layers
Ca aci
Pao
Non -Dairy
Farrow to Finish
Beef Stocker
Gilts
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
I I
Turke s
TurkeyPoults
10ther
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes M No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes 4No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes No
❑ NA
❑ NE
2. is there evidence of a past discharge from any part of the operation?
❑ Yes No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ YesgNo
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412015 Continued

Facility Number: - Q Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes jo No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes �fNo ❑ 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 �jNo ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.) TT
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes ff No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes [ 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 VNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑WLTP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑ Yes No
❑ Yes o
❑ Yes No
0 Yes C3'No
❑ Yes TZ�No
❑ Yes 6No
❑ Yes ONo
❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes Jallo
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? [—]Yes d-No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 6140
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑ NA ❑ NE
Page 2 of 3
21412014 Continued
1

Facility Number: 4,1 O Ts Date of inspection: ,3
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ]'No ❑ NA ❑ NE
25 Is the facility out of compliance with permit conditions related to sludge? If yes, check [:]Yes C:jNo ❑ 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 D,No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes M-No ❑ 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 2"No ❑ NA_ ❑ NE
If yes, contact a regional Air Quality representative immediately. T
30. Did the facility fail to notify the Regional Office of emergency situations as required by the ❑ Yes Pr
❑ 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 o
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes WNo
❑ NA
❑ NE
Comments (refer to question ff): 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):
cllallr Fy
r �
al-
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date: f/tJ
21412014

nwl VJ oa53
I?ivi'sion of Water Quality
Facility Number l__1Q _J - rj � ®Division of Soil and Water Conservation
QQ Other Agency
Type of Visit: G-Compliance Inspection 0 Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit: 2 Routine O Complaint Q Follow-up 0 Referral 0 Emergency 0 Other Q Denied Access
Date of Visit: Arrival Time: : U /YI Departure Time: D County: Region:,
Farm Name: L - ] i Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator: p1f^�6kdVyl
Back-up Operator:
Location of Farm:
Title:
Latitude:
Phone:
Phone:
Integrator: rr��
Certification Number: R`i �J b5
Certification Number:
Longitude:
Swine
Wean to Finish
Design
Capacity
Current
Pop.
Design Current
Wet Poultry Capacity Pop.
I 11-ayer I
Desiga Current
Cattle Capacity Pop.
Dairy Cow
Wean to Feeder
I iNon-Layer
I
dairy Calf
Feeder to Finish
r
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Design Curreut
l a aci
Layers
Dry Cow
Non -Dairy
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 �TNo ❑ NA ❑ NE
[:]Yes rFZPNo
—
❑ Yes 7r'No
❑ Yes [;�'No
❑ Yes �No
[:]Yes [�rNo
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 21412011 Continued

Facili Number: - 53 Date of Inspection: r
Waste Cotlection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): t-
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes 0 No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? 0 Yes P No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes [4No ❑ 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
[;n No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
VTNo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
V1 No
❑ NA
ONE
❑ 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
ff No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
V" 0
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
VNo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[;?No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
PFNo
❑ 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 71 No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes Vf No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes eNo
❑ NA 0 NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412014 Continued

Facility Number: -3 jDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes )ZTNo
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes pll�o
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 �rNo
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [] Yes �No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface file 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?
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑NA ❑NE
[:]Yes
PINo
❑ NA
❑ NE
[:]Yes
PfNo
❑ NA
❑ NE
❑ Yes
7fNo
❑ NA
❑ NE
[:]Yes
VNo
❑ NA
❑ NE
❑ Yes No
❑ Yes [� No
❑ NA ❑ NE
❑ NA ❑ NE
Reviewer/Inspector Name: T_"An D ao - Phone:
Reviewer/Inspector Signature: ka � 7&atLL __ Date:
Page 3 of 3 Z (412014

(Type of Visit: 0 Compliance Inspection U Operation Review U Structure Evaluation U Technical Assistance I
Reason for Visit: Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: 1 Arrival Time: Departure Time: County: <D&SL0Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: Cbe:M5 Kflew��
Certified Operator:
Phone:
Integrator:
Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Wean to Feeder
Wet Poultry
La er
Non -La er
Design
Capacity
C►urrent
Pop.
Design Current
Cattle Capacity Pop.
Dairy Cow
Design
Ca aci_
Current
P.op -
Dairy Calf
—Dairy Heifer
Dry Cow
Non -Dairy
Feeder to Finish
Farrow to Wean
Farrow to Feeder
D My]P,ouIt ,
Farrow to Finish
Layers.
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turke s
Turkey Poults
Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation? [:]Yes No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? []Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) ❑ Yes ❑ No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
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
❑ Yes Zo
[:]Yes �No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 21412011 Continued

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

]Facility Number: -53 jDate of Ins ection: { 3
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes /No
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey []Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? [—]Yes ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly. dispose of dead animals with 24 hours and/or document [:]Yes No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes7No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes❑
NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
/No
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
I 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 fuse additional napes as necessarv).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
ONaJ
Phone: b 0
Date:
21412011

Type of Visit: (D 7Routine
pliance Inspection Q Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: 3 v Departure Time: County: Jj4L0Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative: CL'f__'%2s &q RU; r1(' Integrator:
Certified Operator: Certification Number: 1 i (0
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design C►urrent
Swine Capacity Pop. Wet Poultry
Wean to Finish La er
Design
Capacity
Current Design
Pop. Cattle C•apaci#y
Dairy Cow
Curren t
Pop.
Wean to Feeder
Layer
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design
Current Dry Cow
Farrow to Feeder
Farrow to Finish
IRR P,nult .
Layers
C•_a aci
P,a P. Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
01
Boars
Pullets
lBecfBroodCow
Qtber
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 No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes ❑ N ❑ NA ❑ NE
❑ Yes ;70
❑ NA ❑ NE
❑ Yes ❑ NA ❑ NE
Page 1 of 3 21412011 Continued

Facili 'Number: - Date of Inspection:
Was'g Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
[:]Yes
No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environment threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
8. Do any of the structures lack adequate markers as by the
[:]Yes
❑ Yes
No
❑ NA
NA
❑ NE
NE
required permit?
IJ
❑
❑
(not applicable to roofed pits, dry stacks, and/or wet stacks)
WNc
9. Does any part of the waste management system other than the waste structures require
❑Yes
❑ NA
❑ NE
maintenance or improvement?
Waste Application
ZNo
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
❑ NA
❑ NE
maintenance or improvement?
/No
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
[:]Yes
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals
(Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate
Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes L_I
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes VNo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
[:]Yes No
❑ NA
❑ NE
the appropriate box.
❑WUP El Checklists ❑Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes o ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ 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 ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: - S Date of Inspection: ► L
24, Did the facility fail to calibrate waste application equipment as required by the permit. ❑ Yes Q/Nc ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes WNo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
[—]Yes 9 0
❑ Yes 2 No
❑ Yes
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. ❑ Yes
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
❑ NA ❑ NE
❑ NA ❑ NE
]�No
❑ NA
❑ NE
No
NA
NE
❑
❑
<o
❑ NA
❑ NE
[�'�1`0
❑ NA
❑ NE
VIVO
❑ NA
❑ NE
(Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments . � 1�_
Use drawings of facilit
y to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date: 7 ��
21412011

Divisi©n of Water Qaality" `
Q D�vasion of Soil andl.Wateir Conservation
��> b
a_
Type of Visit C mpliance 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: t I Arrival Time: ® Departure Time: 3 County:. (1QSL 6+J Region: -_-
Farm Name: Owner Email:
Owner Name: Phone:
FaetittyNumber
� �J.
Mailing Address:
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: Cuts �p L Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: � o � ' = Longitude: = e = t =
dl
Design Curreni:, .Des�gt% Current Current
Swine -Capacity
- ,, ry-,Design
Population WetPoultry Capacity Populatton;Cattle Capacity-aPopu1 tion
..
r
t ❑ Wean to Finish
- -
❑ Layer
s
❑ DairyCow
❑ Wean to Feeder
[] Non -La er
❑ DairyCalf
Feeder to Finish ic"�.j$
�., "" :; ❑ DairyHeifer
❑ Farrow to Wean
'Dry P ultry ".
❑ D Cow
❑ Farrow to Feeder
; ❑ Non -Dairy
❑ Farrow to Finish
❑ Layers
� El Beef Stocker
El Gilts
�� ❑ Non -Lavers
` ❑ Beef Feeder
❑ Boars
❑Pullets
Beef Brood Cowl
❑❑
Turkeys
�>
Other
TurkeyPouts
❑.
9d
❑ Other
❑Other
�� �iumber-of�Structures:
"-
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page 1 of 3
❑ Yes /,�o ❑ NA ❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
❑ ❑ NA
❑ NE
❑ Yes
ElYes
❑ NA
❑ NE
❑ Yes
No ❑ NA
❑ NE
12/28/04 Continued

Facility Number: 9 — Date of Inspection
Waste Collection & Treatment
i� 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structu e l Structure 2 Structure 3 Structure 4
Identifier: iA
Spillway?:
Designed Freeboard (in):
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 3No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes WN, ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental th t, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
S. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ENo ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes L! No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 2/No ❑ NA ❑ NE
maintenance/improvement? �,�
11, Is there evidence of incorrect application? If yes, check the appropriate box below. El Yes E: No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
< El NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
El Yes
ZoEl NA
El NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ YesVN-o
o El NA
[I NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
El Yes
❑ NA
❑ NE
Comments,(refer to'question #) 'Explain -any YES'.answers-andlor any recommendations or•any other�comments°"
Use drawings of facility to. better explain situations. (use adddiogal pages as necessary)
ti-
do d i C.. AL
T
Reviewer/Inspector Name n' Phone:
Reviewer/Inspector Signature: Date:
Page 2 of 3
I
Continued

Facility Number: Date of Inspection )
Reuuired Records & Documents
19. Did the facility fail to have Certificate of Coverage.& Permit readily available? ❑ Yes ONo ❑ 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 El Maps El Other �
21. Does record keeping need improvement? If yes, check the appropriate box below. ElYes O No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and t'.' Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes Yo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 2o ❑ NA ❑ NE
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 property 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? (iel discharge, freeboard problems, over application)
32. Did Reviewer/inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
Additional Comments and/or Drawings:
❑ Yes [� o El NA El NE
El Yes Ed
❑ NA ❑ NE
eyes o ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑Yes Zo
� El NA El NE
❑ Yes
❑ NA El NE
❑ Yes ❑ NA ❑ NE
❑ Yes
NA
❑ NE
❑ Yes
N ❑ NA
❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
Page 3 of 3 I2128104

Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit )b Routine 0 Complaint 0 Follow up O Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: ® Departure Time: County: QMS"�' Region:
Farm Name: C'014lacZl C 1` piRm s C_— i` _ _. Owner Email:
Owner Name: C0H QCLl G �ARm Phone: 9�D" S 9a -C3 OS
Mailing Address: aL�ER�N,i y e
Physical Address:
Facility Contact:
Title: Phone No:
/�
Onsite Representative: CJL+ -T1 S �w�C-r� Integrator:
Certified Operator: —\ �Q'' }-EtT14 �0NN50"" Operator
cation Number: 11?5&9 7
Back-up Operator:
Location of Farm:
Back-up Certification Number:
Latitude: = o = , Longitude: = ° 0 6
Design
Swine Capacity
Current Design
Population Wet Poultry Capacity
C►urrent
Population
Design
Cattle Capacity
C**urrent
Population
❑ Wean to Finish
10 Layer
❑ Dairy Cow
❑ Dairy Calf
❑ Wean to Feeder
10 Non -Layer I
❑ Feeder to Finish
Dry Poultry
El Layers
❑ Non -La ers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑Beef Feeder,
Farrow to Wean p1
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Beef Brood Co
Number of Structures
❑ Other 10 Other I
I
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 "RNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
V No
❑ NA
❑ NE
❑ Yes
'�kVo
❑ NA
❑ NE
12128104 Continued

Facility Number: & — 5
Date of Inspection 1 U
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
Identifier: to cloo t4
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 4
❑ Yes X No
❑ Yes ❑ No
Structure 4 Structure 5
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?
❑ NA ❑ NE
❑NA ❑NE
Structure 6
❑ Yes P No ❑ NA ❑ NE
❑ Yes KNo ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes *o ❑ NA ❑ NE
S. 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) 0
9. Does any part of the waste management system other than the waste structures require ❑ Yes bIJ No ❑ NA ElNE
maintenance or improvement? V
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No [INA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) W14 —
13. Soil type(s)
I(-L
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
tN
ElNA
❑ NE
1S. Is there a lack of properly operating waste application equipment?
ElYeso
❑ 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 situatEoas. (use-addrteonal pages as necessary): �, �. �,
Reviewer/Inspector Name W `-km"� E Phone: q10 16
Reviewer/Inspector Signature: Date: L/I / / d
Page 2 of 3 12128104 Continued

Facility Number: (p� —rj Date of Inspection
Reauired Records & Documents
19.
Did the facility fail to have Certificate of Coverage & Permit readily available?
❑ Yes XNo
❑ NA
ElNE
20.
Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
XNo
❑ NA
❑ NE
the appropriate box. El WUP ❑ Checklists El Design [:j Maps ❑Other
21.
Does record keeping need improvement? if yes, check the appropriate box below.
❑ Yes
X No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑/aste Transfers B /nual
Certification
[] Rainfall U Stocking 0 Crop Yield 0 120 Minute Inspections 0 Monthly and 1"
Rain Inspections 0 Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
INNo
❑ 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
�PkNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
No
❑ NA
❑ NE
27_
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
�No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
0 No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No -
El NA
El NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
No
❑ NA
❑ NE
Additional Comments and/or Drawings: �=
SLup Cx�OAI J L orl�J) o�
Page 3 of 3 12128104

Division of Water Quality
Facility Number (D = 5 3 O Division of SoC il and Water onservation
Other Agency
Type of Visit Ncompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit XRoutine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: SlypEl Arrival Time: ® Departure Time: County: (2)NS LO"­� Region:
Farm Name: �1 Owner Email:
Owner Name: ��{C�'��!-F��l 1 �An�-'m�7 ._ Phone:
Mailing Address: •7-J�a �� 5 C�-�E� `�-� C-INr�� /xl+C �a
Physical Address:
Facility Contact: Title:
Onsite Representative. C c�ct-, S Flo PeL-IIgx'
Certified Operator:
Back-up Operator:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: E__1 u E__1 Longitude: [� ° 0 ; = u
Design Current
Design Current
Design Current
Swine Capacity Population
Wet Poultry Capacity Population
Cattle Capacity Population
❑ an to Finish
10 Layer I
Dai Cow
❑ an to Feeder
10 Non -La er
❑ Dai Calf
❑ Feeder to Finish
❑ Daiiy Heifer
Farrow to Wean
Dry Poultry
E]Dry Cow
❑ Farrow to Feeder
El Non -DI
El Farrow to Finish
❑ Layers
❑ Beef Stocker
❑ Gilts
❑ Non -Layers
❑Beef Feeder
❑ Boars
❑ Pullets
❑ Be --
Turkeys
Other
❑ Turkey Poults
Number of Structures:
❑ Other ❑ Other
Discharp_es & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
0 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
No
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12128104
Continued

1
5
Date of Inspection
[facility ]Number:
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
0No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No ❑ NA ❑ NE
Structure Structure 2 Structure 3 Structure 4
Structure
5 Structure 6
Identifier: LA Q)CW
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5: Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No ElNA ElNE
N
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
1A No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental
threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
NNo ❑ 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 Area
12. Crop type(s) S & 6 tj (, W
13. Soil type(s) F[ S TO A/ A
G_
Lt T R-LA Q 1 L-LF.
u
14. Do the receiving craps differ from those designated in the CAWMP?
El Yes
KNo
❑ 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
DjNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Commentsa(refer to gieestion #) Ezolain-any YEg" swer"s and/orjany recommendations or anypotlier`commettts
Use drawtngs.of facility to b'etter explain situations: (use additional pages as necessary) F�
�:,.:„» w
lap cfq Ql> NOT arr C6E-T S O I G 4GT I ut
LRe`'viewer/Inspector Name _ I Phone: 10 - f`7(o `%5bL't
Reviewerllnspector Signature:e n- adn f} 6LiSaES — _ — — Date: d 6 9
Page 2 of 3 12128104 Continued

Facility Number: Date of Inspection
Re uired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the approprrate box. 0 WUP 0 Checklists El Design 0 Maps ❑ Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
El Yes � No
❑ NA
❑ NE
/
El Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ }Waste Transfers 0 Annual Certification
0 Rainfall 0 Stocking 0 Crop Yield 0 120 Minute Inspections El Monthly and V
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 V No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes N No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes 14 No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes ❑ No
[XNA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
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? (ief discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes 1� No
❑ Yes CkNo
El NA El NE
El NA ❑NE
❑ Yes 4No ❑ NA ❑ NE
❑ Yes KNo ❑ NA ❑ NE
❑ Yes ANo ❑ NA ❑ NE
Page 3 of 3 12128104

Division of Water Quality
Facility Number 5 `3 O Division of Soil and Water Conservation
O Other Agency
Type of Visit )o Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit ,Routine 0 Complaint 0 Fallow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: ® Departure Time: County:Q/ys e-d L'-� Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Owner Email:
Phone:
Facility Contact: /� {� Title: Phone No:
Onsite Representative: ``` Lkq_ i I -S 1�Yfl2-W�G��
Certified Operator: _ J OS p 1-! I� isl T H _�Cw/v5 cvy
Back-up Operator:
Location of Farm:
Swine
Latitude: ED o
Integrator• Operator Certification Number: 9- CA-9
Back-up Certification Number:
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
❑ Mon —Layer
❑ Wean to Finish
❑ Wean to Feeder
❑ Feeder to Finish
® Farrow to Wean
3
�l3C�
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Dry Poultry.
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
Turkey Poults
F[--
❑ Other
Discharges & Stream Im acts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Longitude: [—] o [�] ' 0
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifei
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of .Structures:
77
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 [ Q No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
Ib No
❑ NA
❑ NE
❑ Yes
XNo
❑ NA
❑ NE
12128104 Continued

Facility Number:
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ;�f\No
a. if yes, is waste level into the structural freeboard? ❑ Yes ❑ No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier: LA600AI _
Spillway?:
Designed Freeboard (in): a9 4
Observed Freeboard (in): a±
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?
❑NA ❑NE
❑ NA ❑ NE
Structure 6
❑ Yes MNo ❑ 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 XNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes 9No ❑ 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 5INo ❑ NA ❑ NE
maintenance or improvement?
Waste Apnlication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 2 No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes [:RNo ❑ 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
0 No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[34 No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
R1 No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
W No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
0 No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/InspectorName nMANDA to 41N S Phone: lijo-�+q%- 3
Reviewer/Inspector Signature: Date: d
12128104 Continued

Facility Number: (p-- — Date of Inspection 1 d�
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 0 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes to No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes P( No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
[Z No
❑ NA
❑ NE
23, if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
tONo
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
0 No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
D] No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
Do No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
K No
CONA
❑ 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
10 No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
Q No
❑ NA
❑ NE
Additional Comments and/or Drawings:
12128104

ODivision of Water Quality
Facility Number 0 Division of Soil and Water Conservation
_� ---
0 Qther Agency
Type of Visit Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit /Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: ,5 Q Arrival Time: ` S Departure Time: Q r. County: /✓
Farm Name: er < Owner Email:
&4--Owner Name:J 4AM _ Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
_ _Ursrgu - �urrr�n:;
iris Capaerty. Population=
Wean to Finish ❑ L
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
i
Region:
Latitude: 0 e =' = " . Longitude: = ° =' =
Design Current.,,.."",-Design:,-Curr_ci
n
ultry "Capacity Population � Cattle 'Capacity Populati
Wean to Feeder; ❑Non -Layer I 1
Feeder to Finish
Farrow to Wean Dry Poultry:
Farrow to Feeder
Farrow to Finish s ` El Layers
Gilts ❑ Non -Layers
Boars ❑ Pullets
---- - - -- -- --- — ❑ Turks s
1er. ❑ Turkev Pouets
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
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes ;2rNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
[:]No
[]NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
[--]Yes
ZNo
❑ NA
❑ NE
❑ Yes
I No
❑ NA
❑ NE
12128104 Continued

.j
Date of Inspection �-
Facility Number:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
9No
❑ 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): 2�p
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
ZNo
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
ONo
❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
ZNo
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
0No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
ONo
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
oNo
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
9No
❑ 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 CAWMP7
IJ Yes / No
U NA
LJ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes PrNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes '0 No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes VrNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes gNo
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or; -any other comments
Use drawings of facility to better explain situations. (use additional pages as necessary):
iJC65. l/ff �Z/L57 /��'► 1 liy�/
Reviewer/Inspector Name Phone:
Reviewer/Inspector Signature: Date: Zz!aLo
Page 2 of 12128104 Continued

Facility Number: &IDate of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes X--'KNo ❑ 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 ❑ Desig
n El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 0 No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard [:]Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ 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
No
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
P(No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
�No
El NA
[I NE
26. Did the facility fail to have an actively certified operator in charge?
ElYesNo
)zf
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
El Yes
No
❑ NA
❑ NE
Other Issues
1
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
/(///�
El NA
El NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
No
❑ NA
El 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
P
ElNA
❑ 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
P No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No
❑ NA
❑ NE
Page 3 of 3 12128104

Division of Water Quality
=Fi&1ityumber S3 0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit
Hance Inspection
0 Operation Review 0 Structure Evaluation
0 Technical Assistance
Reason for Visit
zoutine0 Complaint
0 Follow up tiReferral 0 Emergency
0 Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: County: b"SLDki Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: tg=gm Toiwsor!
Phone:
Integrator:
Phone No:
Certified Operator: Operator Certification Number:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Back-up Certification Number:
Latitude: = 0 0 g 0« Longitude: 0°= f = q
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
1 ❑ er La
I❑ Non -La et
Dry Poultry
1 `�Vel'L
Pullets
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?
Cattle
Design Current,
Capacity Population.::
❑ DjjnLQow.
❑ Dairy Calf
❑ Dairy Heifei
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
I
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
12128104 Continued

Facility Number: Date of Inspection [FA7*
�.-
Waste Collection & Treatment
4~ Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
❑ No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5 Structure 6
Identifier: LA 6,66^)
Spillway?:
Designed Freeboard (in):
b
Observed Freeboard (in): qa —
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
❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
❑ No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
❑ No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
❑ No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
❑ No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drifi ❑ 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
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):
���✓ tjW WA6 - DON6 i tt_(o-1 wM.Tlr NE tw. LAA)D TP,ACr 'J99 g 4 C/Q159 Rc-CwTC.P.A
T{�c ti' N ww 2 N '0 19 E ✓P DA'Tt o Flo r✓� 5 LJ
►JCc.� SsG rbT�N� .�flS. u(AT_T_6a W`��3 .SEA �, oRr~ CUJ�WL$_:� LA0 rtA'�
LIOCA Z—d. wtj art..C.T�J 0CCOs "Arj E.
ws� rJ 6C. D ALL_ 7>t "e=A'G- � `o A-0 S fog— ;J L-0 k5lr C� 2yv
Reviewer/Inspector Name tj p p Phone: qj 71 G - 7 3 If
Reviewer/Inspector Signature: Date: II0
r 212RInQ Continued

Faciiit+y Number: (o"� -- Date of Inspection
RHquired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ❑ No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ❑ No ❑ NA ❑ NE
the appropirate box.
❑ WUP El Checklists El Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 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
❑ No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
❑ No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
❑ No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
❑ No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
❑ No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
❑ No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
❑ No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
❑ No
❑ NA
❑ NE
Additional Comments and/or Drawings:
fHQ t4j a ►3 _fccxo 5 y d W UP, Q f-rrA aLE h C.PL- S 6rJ ►��w `
cja l�'^
12128104

S �41
Facility Number
Of Division of Water Quality
0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit
Compliance Inspection
0 Operation Review 0 Structure Evaluation
0 Technical Assistance
Reason for Visit
( Routine 0 Complaint
0 Follow up 0 Referral 0 Emergency
0 Other ❑ Denied Access
Date of Visit: Arrival Time: ® Departure Time: County: d/VsL j Region:
Farm Name:
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: CA)MS 66R\,Q _
Integrator:
Phone No:
Certified Operator: Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm:
Latitude: [=] o [=] ' 0 Longitude: [� ° =' = «
Design Current' DesignCurrent Design
Current";
s� ; rz
Swine. CapacityPopulation Wet;Poultry Capacity Population. Cattle Capacity .,Populahon
❑ Wean to Finish
❑ Wean to Feeder
❑ Feeder to Finish
® Farrow to Wean
is0
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Layer
❑ Non -La er
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turke s
❑ Turkey Poults
❑ Other
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes [;I/No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes IZ/No ❑ NA ❑ NE
12128104 Continued

v
Facility Number:
Date of Inspection
Waste Collection & Treatment ,_..,/
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? El 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: tA 6
Spillway?:
Designed Freeboard (in). '2-0
Observed Freeboard (in): Ig
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(ic/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes eNo ❑ 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 environ ental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ryes WNo
o El NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? El Yes ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks) ,�
4. Does any part of the waste management system other than the waste structures require El Yes LEI No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes L/J No ❑ NA ❑ NE
maintenance/improvement?
IL Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes OJ 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 ❑] Evjidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) g �� lI/ _ S &6
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ Yes
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
17. Does the facility lack adequate acreage for land application? ❑ Yes
18. Is there a lack of properly operating waste application equipment? ❑ Yes
❑No
El NA
[I NE
PNo
❑ NA
❑ NE
do❑
NA
El NE
:Ob
El NA
El NE
��Xo
❑ 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):
23{'-I•) . E4AIO 1..C-gt_jl. L4 1Jfaj I'de- ?140VC Or J±C LAV194bWX,
Reviewer/Inspector Name ` d*1 /tIM6" Phone:
Reviewer/Inspector Signature: Date:'IAt hore
A....., I .,r 2 r`nniinnod

I
Facility Number: l —s,3 Date of Inspection ti
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 appropriate box. ❑p ❑ Checklists ❑ Design ❑ Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes L` I No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ es No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? LI Yes ❑ No ❑ ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ❑ No Ld A ❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit? ❑ Yes 7No
IQ NA El NE
26. Did the facility fail to have an actively certified operator in charge? El Yes ❑ N ElNE
❑ Yes ZN ElNA ElNE
ElYes ❑ 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
L'! No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
E(No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
E No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
CJ No
❑ NA
❑ NE
General Permit? (iel discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
Fj�N
❑ NA
[INE
33. Does facility require a follow-up visit by same agency?
❑ Yes
No
❑ NA
❑ NE
al Comments and/or Drawings:
Page 3 of 3 12128104

Type of Visit 10Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Fallow up 0 Referral Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: ; epa�rture Time: `/Q County:
Farm Name: /rR� Owner Email:
Owner Name: / ./Jl�/,/�%Z� Off— Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: Thlz_n s� �2
Certified Operator:
�io�35f0 /09%
Back-up Operator:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Region: Flo
eo
Location of Farm: Latitude: ❑' ❑ ' ❑ « Longitude: ❑ o ❑ � ❑ ,S
Design C•ttr�renE
ME' Current
Design
Current
Swine
Capacity Population
Wet Poultiy' Capty' Popnl hon
Cattle
Capacity
Population
❑ Wean to Finish
❑ Layer
❑ Dairy Cow
❑ Wean to Feeder
1
10 Non -Layer I
I
❑ Dairy Calf
❑ Feeder to Finish
❑ Dairy Heifei
Farrow to Wean
Dry Poultry
❑ DEZ Cow
❑ Farrow to Feeder
ElNon-Dairy
El
❑ Farrow to Finish
❑ ers
El Stocket
❑ Gilts
N
❑ on-ts ers
El Beef Feeder
❑ Boars
Pullets
❑ Beef Brood Co
❑ Turkeys
Other
❑Turke Poults
Number of Structures:
❑ Other
❑Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
XYes
❑ No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ,Other
a. Was the conveyance man-made?
❑ Yes
ONo
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
XNo
❑ 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
ONo
❑ NA
❑ NE
3. Were there any adverse impacts or poteniial adverse impacts to the Waters of the State
❑ Yes
❑ No
❑ NA
XNE
other than from a discharge?
12128104
Continued

Facility Number: —
Date of inspection /d
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes /No
❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes ❑ No
❑ NA ❑ NE
Strut ure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?: To%D
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ yes XNo
❑ 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
El NA El 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 XNo
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes �No
El NA El NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
yes El No
El NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes ❑ No
❑ NA XNE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes ❑ No
❑ NA PINE
❑ 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
ElNo
❑ NA
INE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination,
El Yes
❑ No
❑ NA
NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA
XNL E
18. Is there a lack of properly operating waste application equipment?
ElYes
❑ No
❑ NA
ZN E
Reviewer/Inspector Name ,� 77
Phone: q/O
Reviewer/Inspector Signature: Date: /O G
12128104 Continued

..
Facility Number: j Date of Inspection
Required Records & Documents I ,
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 El Yes El No El NA (� NE
the appropirate box. /
El El El El Maps [I Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA )] NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ No ❑ NA V NE
23. If selected, did the facility faii to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No ❑ NA E
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ❑ No ❑ NA NE
25. Did the facility fail to conduct a sludge survey as required by the permit? ❑ Yes ❑ No ❑ NA Xj
NE
26. Did the facility fail to have an actively certified operator in charge? ElYes ElNo ❑ NA NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ❑ Yes ❑ No ❑ NA ;dNE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes ❑ No ❑ NA /P1NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document ❑ Yes ❑ No ❑ NA [XNE
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? El Yes El No El NA 1�1 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 JWVo ❑ NA ❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes ❑ No ❑ NA VNE
33. Does facility require a follow-up visit by same agency? ❑ Yes ❑ No ❑ NA ZNE
Additional Comments and/or ;Drawings:`
-
Av
�iF}5�E
L r�cJ AV�E!/nPFAl� f Gt/�S�f &}r K
*'e��e� s / vo�/J�
F�C ���c� r �� G�,✓v���ou�✓ro D.e���� ST�Gc ��,�� ����
GAG-ooN. ���P Lr/�I�y 6 �R.�'/�_ . irp C'o.✓��✓� �' 12,6104
-rif

w
0
A

61) H .S 3
Type of Visit 8 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: Arrival Time: C?0 Departure Time: County: 4ffSLOr� Region:
Farm Name: T
Owner Name: _
Mailing Address:
Physical Address:
Facility Contact:
OnsiteRepresentative: _ C-UPCU5 QAtil.WfUc
Certified Operator: "reful ? ENS CA-ro Gffi,
Back-up Operator:
Location of Farm:
Title:
Owner Email:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: 0 n 0 . Longitude: = ° 0 ,
Design Current Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population Cattle Capacity Population
❑ Wean to Finish
❑ Wean to Feeder
❑ Feeder to Finish
M;F;T7ow to Wean 39a5 3CDA
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
❑ Layer
❑ on -Layer
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turke s
❑ urkey 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
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocket
❑ Beef Feeder
❑ Beef Brood Cowi
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes [tNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
El NA
[I NE
❑Yes
No
❑ Yes
o
❑ NA
ElNE
❑ Yes
LI No
❑ NA
❑ NE
12128104 Continued

Facility Number: �7 — 3 Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
�No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No ❑•NA ❑ NE
Struclure 1 Structure 2 Structure 3 Structure 4
Structure
5 Structure 6
Identifier: LAC
Spillway?:
Designed Freeboard (in): Z°
Observed Freeboard (in): 33
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
o ❑ 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?
eat, notify DWQ
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmentaFNo
7. Do any of the structures need maintenance or improvement?
El Yes
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
u 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
dNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
C(No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
dNo ❑ 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) 3 EA.'AV(4) 5 0 ) Fscvc l �)
13. Soil type(s) f oQ E ri
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
o El NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination, El Yes
fN o ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
0 No ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
V No ❑ NA ❑ NE
ts.) g6t n To can►i7a1Db WCED coN TA-Ot, zW f-cj fr�laaS,
a f.) aj ►.lAs 7C APP LASE AIUr►rr bn., s � .SPfL? h t 1G(,EfU M ^7' A" Er ^, r n. Cfi4p zo�6. cgt,cviA
sPR` kt.G oL ft 6 hl j� fa ar►n fLoW Nth-r� a�Ar6
13 "A ILL rI. f "r,,a Y, RVOJ C" .SEED u a u s zio & f�MAQ,
Ga aEn- 06&ZU ba LJ& U"C •{Ztrt.a ALfb En— 'W GS cr1r1L�.�j �t rtl,
ev
viewer/Inspector Name i H 1 /�LV *, i �, Phone ' d Y-•3 00 rc at/
Riewer/Inspector Signature: .T C� Date: s�17 �65
12128104 Continued

Facility Number: 6) — s3 Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes UNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 21 No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. 21Yes ❑ No ❑ NA ❑ NE
9 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
aN
22.
Did the facility fail to install and maintain a rain gauge?
Yes
o
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
[ Yes
011
❑ NA
❑ NP
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ NA
WN E
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
LJ No
❑ NA
❑
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
[ No
El
[ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ NA
dN E
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[ (,No
El NA
El NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
El Yes
[2 No
Cl 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?
El Yes
�f
Ef 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
O 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?
El Yes
E'No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
40
❑ NA
❑ NE
Addit,onal Cos<nments and/or Draweigs_`
12128104

Type of Visit A Compliance Inspection O Operation Review O goon Evaluation
for Visit 9 Routine Q Complaint O Follow up Q Emergency Notification Q Other ❑ Denied Access
Facility Number Date of Visit:
Permitted ❑ Certifiied/ 13 Conditionally Certified 13 Registered
Farm Name:
Owner Name:
Mailing Address:
Facility Contact:
Onsite Representative:
Title:
Time:
Date Last Operated or Above Threshold: -
County: L ISG Cd
Phone No:
a '-;-,ME.'%.'-Phone No:
Integrator:
Certified Operator: T V. .. , Operator CertiScation Number: _.
Location of Farm:
A Swine ❑ Poultry ❑ Cattle ❑ Norse Latitude • 4 " Longitude • ' 9r.
t £` Design 4niiiimt
fl ,-. ' S 7
SwinePo
"tian
tionPY'Cattle
=Po
Dairy
Non -Dairy
._
i
otal'SSLW
7Namlber�o�3.agooas^
`
Wean to Feeder
��
Layer
Feeder to Finish
Non-Layer
Farrow to wean
�'
. '- -•- '- ' -
� ��
Farrow to Feeder
Farrow to Finish
Gilts,4
Boars
Discbm eS &Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes Z No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? [:]Yes O'No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes Z No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes PTNo
Structure 1 - Structure 2 Structure 3 Structure 4 Structure 5 Structure 5
Identifier:
Freeboard (inches):
12112103 Continued

Facility Number: Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ire/ trees, severe erosion, ❑ Yes VNo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑ Yes No
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes ONO
S. Does any part of the waste management system other than waste structures require maintenancelimprovement? ❑ Yes XNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes ONo
elevation markings?
Waste Application
10. Are there any buffers that need maintenancerimprovement? ❑ Yes 090
11. Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes VNO
❑ Excessive Ponndiing E3 PAN �Hlyfraulic oad ❑ Frozen Gro ❑Copper d/orZinc
12. Crop type A �'9 W"��GL D
13. Do the receiving crops differ with those designated in the Certified Animal-Wasm Managemen&lan (CAWMP)? ❑ Yes�,ffNo
14. a) Does the facility lack adequate acreage for land application? ❑ Yes XNo
b) Does the facility need a wettable acre determination? ❑ Yes ❑ No
c) This facility is pended for a wettable acre determination? ❑ Yes ❑ No
15. Does the receiving crop need improvement? ❑ Yes )ZfNo
16. Is there a lack of adequate waste application equipment? ❑ Yes No
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes INo
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes �No
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes �Ao
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 PNo
Air Quality representative immediately.
g [I Field Copy ❑Final Notes
��74 Eos e A&ngtlx�p ii4q,� Lac- ,•�+A Aa
tz
Reviewer/inspector Name j
Reviewer/Inspector Signature-:
Date:
12112103 Continued

FaciliLl�ty Number: Date of Inspections 7�G
Required Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes 39No
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.) ❑ Yes EINo
23. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes �IIITO
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes fi� No
25. Did the facility fail to have a actively certified operator in charge?
❑ Yes
A No
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
No
27. Did Reviewer/Inspector fail to discuss review/mspection with on -site representative?
❑ Yes
[ No
28. Does facility require a follow-up visit by same agency?
❑ Yes
VNo
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
&No
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
❑ Yes
U(No
/❑
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
No
32. Did the facility fail to install and maintain a rain gauge?
❑ Yes
AlNo
33. Did the facility fail to conduct an annual sludge survey?
❑ Yes
)9'N'o
34. Did the facility fail to calibrate waste application equipment?
❑ Yes
❑ No
35. Does record keeping for NPDES required forms need improvement? nt? If yes, check the appropriate box below.
❑ Yes
❑ No
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After 1" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
11/I2f03

Type of Visit ffl Compliance Inspection 0 Operation Review 0 Lagoon Evaluation
Reason for Visit o Routine 0 Complaint 0 Follow up 0 Emergency Notification 0 Other ❑ Denied Access
Facility Number Date of visit: O Time:
Not O erational Below Threshold
Permitted 0 C rtified O Conditionally Certified [3Registered Date Last Operated or Above
-1Threshold-
Farm Name: � County:/i/II�L�W
Owner Name: /7L Phone No:
Mailing Address:
Facility Contact: Tittll: hone No:
Onsite Representative: C' MIK � Integrator:
Certified Operator:
Location of Farm:
Operator Certification Number:
0 Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 0 6 u Longitude 0 ' 0 k
Design Current
Design torrent
Design Current
ne Ca aci P,o ulation
ry Ca aci P,o ulation Cattle to aci P,o ulation
Feeder
❑ Dairy
tONonH-La
Finish
J�rfffarrow
Nnn_Dniry
Wean
❑ Other
Feeder
Finish
Total IDesign Capacity
❑ Gilts
❑ goy
Total SSLW
❑ Subsurface Drains PresentLa oon Area
❑ S ra Field Are_._Holding
Number of lspsl��Mln
Ponds 1 Solid T
No Li uid Waste Mana ement S stem
Discharges & Stream Impact
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier: I (-
Freeboard (inches): .12
05103101
❑ Yes jt No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes 0 No
❑ Yes 2TNo
❑ Yes W1No
Structure 6
Continued

Facility Number: q 75 Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes O No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? El Yes 'ONo
(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 VfNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ,_,{
elevation markings? ❑ Yes IC1 No
_Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes V(No
I I - Is there evidence of over application? 1 ❑ Excessive Ponding _ ❑ PAN ❑ Hydraulic Ovkrload ❑ Yes A No
12. Crop type yl z? Ma b k (11A41 C5mw,,- t 00f1�rb � - �-Fsc a
i r �
No 13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan AWMP)? ❑ Yes
14.
a) Does the facility lack adequate acreage for land application?
❑ Yes
VNo
b) Does the facility need a wettable acre determination?
❑ Yes
❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes
❑ No
15.
Does the receiving crop need improvement?
❑ Yes
No
16.
is there a lack of adequate waste application equipment?
❑ Yes
No
Reguired Records & Documents
iNo
17.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
No
19.
Does record keeping need improvement? (iel 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
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
VNo
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes
ONo
(ie/ discharge, freeboard problems, over application)
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
IX No
24.
Does facility require a follow-up visit by same agency?
❑ Yes
No
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
PNo
113 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Comr ients,(refersto4questioii#) ,IExpIiinfaoy YES answers and/or_any comment! Lions or any other iu plf5-
Use dg's„of facility to better eiokjn situahons °(use addidonal'pag rawines-e necess ❑Field Copv ❑ Final Notes
,.. ,
�P"-i- Qovrtjo_ A uvgo bof F irfr �J4Z-=�✓p�P S ro
"o-o o p , A:tPfF "O�eD S 61CIE O W A }gyp PAC KeD
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date: 22SLP
05103101 Continued

Facility lumber: — Date of Inspection I L/'Lg9/ v3
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours?
28. is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon?
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
31. Do the animals feed storage bins fail to have appropriate cover?
32. Do the flush tanks lack a submerged fill pipe or a permanenthemporary cover?
❑ Yes T No
❑ Yes [71 No
❑ Yes ;� No
❑ Yes ( No
❑ Yes [XNo
❑ Yes No
❑ Yes ❑ No
Additional Comments and/or Drawings:,
OO1JrZNU fa- U)oRk 'V7 UOA- 5r4ficj q(qp y
�UFRS ENDSEN;
FPaRm T4(-z- -�v c ss of
H F 9�0 ONrc-cl -Puu-F10 t.O��r S►4mP�C- s
c:P EIS
Fp R
J 3
2�
tic, oC-R , [A PPr- Ac
10 U Pf�
A-r �(Y\ �
RFCOADA-0
s� 0,0 LkGana �
vEL btuFp OP �AG�orJ
05103101

0 Division of Water Quality
0 Division of Soil and Water Conservation
Q Other Agency
Type of Visit 0 Compliance Inspection O Operation Review 0 Lagoon Evaluation
Reason for Visit 91Routine O Complaint 0 Follow up Q Emergency Notification 0 Other ❑ Denied Access
Facilitv Number Date of Visit: �B Time;
Nat O erational OBelowThreshold
Permitted 13Certified Q Conditionally Certified D Registered Date Last Operate
r]�Above
_Threshold:
/Farm Name: �1 _ County: bU51-0C
Owner Name:
Mailing Address:
Phone No:
Facility Contact: Title: hone No:
�
Onsite Representative: '� I ntegra`tor:
Certified Operator:
Location of Farm:
Operator Certification Number:
swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 0 C « Longitude 4 u
Design Current Design Current Design Current
Swine Capacity Population Poultry Capacity Population Cattle Ca acity Population
❑ Wean to Feeder ❑ La cr ❑ Dairy
eeder to Finish ❑ Non -Layer I I JEJ Non -Dairy
Farrow to Wean 00
Farrow to Feeder ❑ Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ Boars Total SSLW
Number of Lagoons ®. ❑ Subsurface Drains Present 11EILagoon Area 10 Spray Field Area
Holding Ponds / Solid Traps JE3 No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes �NO
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system'? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ElYes zNo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes XN o
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard (inches):
05103101 Continued

r
Facility Number: & — Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ic/ trees, severe erosion,
El Yes
_
l /J No
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
El Yes
VNo
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?
Cl Yes
No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
/
elevation markings?
❑ Yes
No
Waste Aunlication
10. Are there any buffers that need maintenance/improvement?
❑ Yes
,�f
L,� No
11. is there evidence of over application? Excessive Ponding ❑ PAN Hydrau 'c Overlo
❑ Y s
VNG
12. Crop type L/F
13. Do the receiving crops differ with those designat d in the Certified Animal W to Manageme n (CAWMP)?
es
o
14. a) Does the facility lack adequate acreage for land application?
ElYes2'No
b) Does the facility need a wettable acre determination?
❑ YesNo
c) This facility is pended for a wettable acre determination?
❑ Yes
❑ No
15. Does the receiving crop need improvement?
Yes
❑ No
16. Is there a lack of adequate waste application equipment?
//❑ Yes
�No
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
PNo
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
19. Does record keoninn naPr9 irnnrnvPment? tie/ irrigation frprboard, waste analysis & soil sample reports)
r...a »��......r_... - I a
❑ Yes
,U�No
l� No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ YesNo
9No
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?
❑ Yes
No
X
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
V'No
24. Does facility require a follow-up visit by same agency?
[I Yes
o
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
7No
0 No violations ar deficiencies were noted during this£ visit. You will receive no further correspondence about this visit.
• - ..r+.�a:+' :+ice.. 3 --?w4v 'w'."' )- .�y'
Co1Illllen#S refer;�to.queshun #) kitp[amu®�y YE nswe�rs,,andlor awn recommmendahons or, any of er cflmments Y r ., Y
W
Use draw�n`gs of fac�hty'to better�eaplan s�tuateons: (use addtpnnal;pages:a�s necessary .: Field Copy ❑Final Notes W
:.
/� OnlT7il/u �- a t?r e✓ h' ?-�/�rVG- ��P��S.
10 S /lwk 4W5 �- �I��YFa
D [�oi►�%�€'o� (�(��5. /'��C�O�IffC �DNOM257 ��S �7�ic�
�
T
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date:
O5103101 Continued

F . I-,
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
❑ 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
o
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
o
X
30.
Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
31.
or broken fan blade(s), inoperable shutters, etc.)
Do the animals feed storage bins fail to have appropriate cover?
❑ Yes
❑ Yes
yo
ONo
32.
Do the flush tanks tack a submerged fill pipe or a permanent/temporary cover?
❑ Yes
❑ No
Addi 'onal Comments and/or Drawings:jji-
..
AROMWO 6?141
el 15 d-kll-5 --S
05103101

Date of Visir. 9-5-2U01 Time: 10I10 Printed on: 91 i 02009
Facility Number f7 53
® Not Operational Q Below Threshold
Permitted E Certified E3 Conditionally Certified 0 Registered Date Last Operated or Above Threshold:
Farm Name: County:
OtivnerName: _ �.---------__._�_ Qs77CiE�aIIi1�.I.Xsi��Phone No:
Failing Address:
Faciliri•Contact: ............................................ Title: ...__».__..----•-....__... Phone No:
Onsite Representative: Curti�Ra�i�hJ�husu�B�uce______.__ Intebrator. ____-___�_ __.__.__ ____-- ---•
Certified Operator. Jos.qph Operator Certification Number -
Location of Farm:
® Swine © Poultry 1:] Cattle '❑ Horse Latitude 57`` Longitude ' 39 14 54
Dischar e`s & Stream Imnacts
1. Is any discharge observed from any part of the operation'
. E] Yes ®No ..
Discharge originated at: .ElLagoon [ Sprav Field .L Other
a- If discharge is observed, was the convevance man-made? Yes © No
b. If discharge is observed, did it re=h Water of the State? (If yes, notify DWQ) 0 Yes 0 No
c. If discharge is observed, Vhat is tae estimated flow in gallmin?
d. Does discharge bypass a laCcon s.•suem? (if yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes 0 No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? 0 Yes ® No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less th= ad=uate? E. Spillway ❑ Yes ® No
Structure I' Structure 2 Snucture 3 Structure 4 Structure 5 Structure 6
Identifier: .._..... .».._...._. _. .». _;....--_......_...._.._.»._.... .... ...... ___....._....... ..._... __.....__....
Freeboard (inches):

�FaciiityNumber: _6--r;
Date of Inspection 1 9-5-200I
Printed on: 9/1012001
5. Are there am' immediate threats to the integrity of any o: the structures observed? (le/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closUue 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 maintenanceftmprovement?
S. Does any part of the waste management system other than waste structures require maintenancefimprovement?
9. Do any stuctures lack: adequate, gauged markers with required ma.�mum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenancefmzprovement? .
11. Is there evidence of over application? ❑ Excessive Ponding ® PAN ❑ Hydraulic Overload
❑ Yes No
❑ Yes No
9 Yes ❑ No
❑ Yes ❑ No
0 Yes ❑ No
® Yes ❑ No
® Yes ❑ No
12. Crop type Coastal Bermuda (Hay) Rye
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes ❑ No
14. a) Does the facility lack adequate acreage for land application?
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 or other Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
9. Does re; ., d 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 Reviewedlnspector fail to discuss reviewfmspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
® Yes © No
❑ Yes ❑ No
❑ Yes ❑ No
0 Yes ❑ No
❑ Yes ❑ No
❑ Yes ®No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
® Yes ❑ No
25. Were any additional problems noted which cause noncompliance ofthe.Certified AWNT? ❑ Yes ❑ No
3Q No violations or deficiencies were noted during this visit You will receive no further correspondence about this visit
Field Copy ❑ Final Notes
done for permit review of expiring permit and re -issuance to new owner -- Cohade Farms. Visit done with GWS_
is currently de -populated until new permit and change of ownership is complete.
4. Unsure of how to read the gauge, but this is an estimate.
7. Lagoon is in need of mowing and inner wall needs weed removal especially along front wall with inlet pipes. i
9. New marker should be installed with better level marldngs and indicating top of dike elevation at lowest point. Required
freeboard level and design may be based on original design and elevations, thus marker may need to be custom made
showing non-use zone between top of dike and design maximum level. Cont. on Page 3
Reviewer/Inspector Name 3leaii uii eke .:::,.- ..
Reviewer/Inspector Signature: Date:

Facility Numlier: G;_a; Date of Inspection . I 9- '_t►f�l
Printed on: 9/10:2001
Odor Issues
26_ Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge atlor below
liquid level of lagoon or storage pond with no agitation"
27. Are there ant dead animals not disposed of properly rAithiz 24 hours?
28, is there any evidence of wind drift during land application" {i.e, residue on neighboring vegetation asphalt,
roads, building structure, and/or public property)
29. Is the land application spray system intake not located new the liquid surfa: a of the lagoon?
30_ Were any major maintenance problems with the ventilation fan(s) noted? (i.e_ broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc_)
31. Do the animals feed storage bins fail to have appropriate cover?
32. Do the flush tanks lack a submerged fill pipe or a permanenthempo=3- cover?
91 Yes No
1� Yes No
U Yes No
❑ Yes E No
D Yes S No
D Yes 9 No
D Yes IK No
0. Site needs a storage area for cut hay until it can be removed from site. Bales are stacked in woodline, along field
Aches, surrounding Monitoring Well #4, and evidence of storage on grassed waterway.
1. Some indication of PAN over -application for rye grass overseed based on submitted interim and final reports with
aditional overseed window of October -March. However, current permit doesn't have stipulated windows and no
aditional agronomic waste utilization plan (WUP).
5. Fields are severely overgrown with heights well over 3 feet in many areas. Summer hay had only been harvested
nce this year since 2 cuttings of rye earlier this year_ Fields should not be overseeded with rye grass unless grazed — u�
ereal rye. Bermuda fields have excessive competition with native grasses and some broadleaf weeds. Field #3 (across
ath from office) is the best bermuda field, but it could still use improvement in areas_ Most of remaining Bermuda is
npossible to determine quality or quantity due to overgrown nature, but Coharie Farms indicates that they will re -sprig
lost of site next spring. Fescue is non-existant in Field #4 near front gate and in good condition in other field with a little
nprovement needed.
dmrnended cutting fields ASAP. Pull soil samples and get lime apoiied by end of October to all fields. Fields could
aeration, if not replacing them in spring.
5. Facility may need additional solid set sprinkler heads to help with irrigation.
No Report left on -site or with Coharie Farms, we just discussed many of the issues mentioned in this report.
Site should be re -visited shortly once re -stocking is started and definitely next spring after re -sprigging.
Note: Coharie Farms purchased 50-60 acres of woods adjacent to farm and plan to utilize it for waste application in the
uture — 2003 at earliest. They also propose to look at changing irrgation equipment at least in some areas to linear or
center pivot system in the future.

rj
Division of Water Quality
p Division of Soil and Water Coriservation
-Y
T: 0 Other. Agency
Type of Visit p Compliance Inspection p Operation Review p Lagoon Evaluation
Reason for Visit p Routine p Complaint p Follow up p Emergency Notification p Other ❑ Denied Access
Facility Number Date of visit: 10/24/2000 Time: 9:30 Printed on: 11/16/2000
p Not Operational p Below Threshold
Permitted ■ Certified 13 Conditionally Certified p Registered Date Last Operated or Above Threshold:
Farm Name:OceamxAety.Ea.t:mts.Lxtt......................................................................---...... County: Ous.lmw............................................ ... Wi.RO.........
Owner Name: ......................... ......................... 0.cca.n.v tw..Eartats..Lld........................ Phone No:(252).3Q.9AZOS........ ........................ .......................
Facility Contact: ......................................... ..........Title: .. Phone No:................
Mailing Address: P.O..Rox.395.9...........................................................................................W.xlson--.N.'C............................................:................ Z78.95 ..............
Onsite Representative: LI.mer..Suttsan .............................................................................Integrator:.......................................................................................
Certified Operator:. aseph.................................... 10101son...................................... ...... Operator Certification Number: 1RG,89.............................
Location of Farm:
I�
® Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude Longitude • 54
Design Current
Swine Capacity Population
p Wean to Feeder
❑ Feeder to Imish
❑ Farrow to Wean
❑ Farrow to Feeder
® Farrow to Finish
❑ Gilts
p Boars
Design Current Design Current
Poultry Capacity Population Cattle Capacity Population
❑ Layer
❑ Non -Layer
Other
ELI
Total Design Capacity 1,200
Total SSLW 1,700,400
Number of Lagoons I ❑ u sur ace Drains Present ❑ ,agoon rea ❑ Spray is rea
Holding Ponds / Solid Traps ❑ No Liquid Waste Management System
Esc arges _ tream mpacts
1. Is any discharge observed from any part of the operation? ❑ Yes Ig No
Discharge originated at: p Lagoon ❑ Spray Field p Other
a. if discharge is observed, was the conveyance man-made? ❑ Yes ® No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ® No
c. If discharge is observed, what is the estimated flow in gal/min? nla
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ®No
2. Is there evidence of past discharge from any part of the operation? ❑Yes ®No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ®No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? p Spillway p Yes ®No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard{inches}- ----------- ----4.Ct... ............ - ----....................................................................... ......................................................................

5/00 Continued on hack
Facility Number: 67_53 Date of Inspection ® Printed on: 11/16/2000
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 maintcnance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11, Is there evidence of over application? p Excessive Ponding p PAN p Hydraulic Overload
12. Crop type Coastal Bermuda (Hay) Fescue (Hay) Small Grain Overseed
p Yes ® No
Yes tg No
p Yes ® No
N Yes p No
p Yes ®No
p Yes ®No
p Yes ®No
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? p Yes ® No
14. a) Does the facility lack adequate acreage for land application? []Yes ® No
b) Does the facility need a wettable acre determination? []Yes []No
c) This facility is pended for a wettable acre determination? []Yes p No
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
t 8. 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. I ail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
0 o violations or deficiencies were noted during this visit. You will receive no further
correspondence about this visit.
Yes p No
❑ Yes ® No
p Yes N No
p Yes p No
Yes p No
p Yes p No
❑ Yes p No
❑ Yes []No
® Yes []No
[]Yes ® No
❑ Yes p No
Comments (refer to question #): 'Explain any YES answers, -and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
8. The inspection revealed poor waste application distribution (no spray pattern overlap) within Field 6 by observing the condition of
the vegetation. It is requested that Oceanview operations personnel and Dr. Asady verify proper equipment usage and operation
technique for irrigation activities within this field. The grass waterway between Fields I and 7 displayed a substantial stand of wetland
grasses and should function properly to drain stormwater while minimizing sediment mobility.
15. I- ield 13 and some areas within other fields displayed a very poor stand of coastal bermuda. Signs of ponding were evident. In
addition, signs of vagrant grass shading the coastal bermuda and preventing spreading were noticed. It is recommended that Dr.
Asady and the Oceanview staff discuss spray rate reduction changes with Field 13 (reel pull zone). In addition, it is recommended the
fields be limed as needed, and an aggressive coastal bermuda sprigging be planned for the spring along with weed eradication
Reviewer/Inspector Name Brian L. Wrenn Jim Bushardt

I
Itetriewer/lnspector Signature: — Date 51O0 I
aci ity Number: 67_53 Date of Inspection ® Printed on: 11/16/2000
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below 10 Yes p No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? p Yes ® No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes ® No
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? p Yes Ig 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.) 0 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?
p Yes ® No

Lagoon Dike Inspection Report
Name of Farm / Facility
Location of Farm / Facility
Owner's Name, Address
and Telephone Number
Date of Inspection
Structural Height, Feet
Lagoon Surface Area, Sq. Ft.
Upstream Slope, xH:1V
Embankment Sliding?
( Check One, Describe if Yes }
Seepage?
( Check One, Describe if Yes )
Erosion?
( Check One, Describe if Yes )
Condition of
Vegetative Cover
( Grass, Trees )
Did Dike Overtop?
Follow -Up Inspection Needed?
Ocean Vim Farms (Oceanview Farms Ltd,L 67 - 53
Off SR 1236
Qcgan view Farms. P. 0.Box 3959, Wilson
NC 27895 910-399-1205
9 / 29/ 99 Names of Inspectors Zahid Khan
Vincmt L wi
9 - 11 Freeboard, Feet 9 -11 inches
423,200 _ Top Width, Feet 7-9
2 tQ 1 Downstream Slope, xH:1v 3 to 1
X Yes No Upstream slopes have
Cracks and bulges at various paces.
X Yes No Seepage was notes
On downstream slopes and toe of slopes.
_ X Yes No Very Mnor erosion was
alsp noted at some 121aces.
Yes X No
X Yes No
Engineering Study Needed? Yes X No
Is Dam Jurisdictional to the Dam Safety Law of 1967?
If Yes, Depth of
Overtopping, Feet
Yes X No
Other Comments Needs to u}�mlLut u_p to theequired level.
T Needs tube a dose watch on thin Lasoon.

State of North Carolina
Department of Environment
and Natural Resources --
Wilmington Regional Office
James B. Hunt, Jr., Governor
Wayne McDevitt, Secretary
Division of Water Quality
December 2, 1997
Mr. Dennis Hughes
Oceanview Farms
Post Office Box 3959
Wilson, North Carolina 27895
Dear Dennis:
A*A
NC--DENR.-
NORTH CAROLINA DEPARTMENT OF
ENVIRONMENT AND NATURIL RESOURCE$
Subject: Compliance Inspection Report
Oceanview Farms
Permit No. WQ0011653
Onslow County
Please find attached a copy of the completed form entitled "Compliance Inspection
Report". The report summarizes the findings of a recent inspection which was conducted on
November 19, 1997 to determine compliance with permit requirements.
A summary of findings and comments noted during the inspection are listed in Section
"D" of the subject report.
If you have any questions concerning this report, please contact me at the Wilmington
Regional Office, telephone number [phone].
Sincerely,
?Jimushardt, P.E.
Environmental Engineer
Enclosure
cc: Steve-WeSf:)
Lou Polletta (Central Office)
Wilmington Office Files
Central Files
127 North Cardinal Dr., Wilmington, North Carolina 28405 Telephone [phone]
An Equal Opportunity Affirmative Action Employer FAX [phone]
50% recycled/10% post -consumer paper
t

r
CON'IPLIANCE INSPECTION REPORT
Section A: National Data S stem Codin
- Transaction Code:- N^- - YPerm it No WQ0011653
Date: 12-2-97 Inspection Type: C Inspector: S
Facility Type: 2
BI: N
Section B: Facility Data
Facility Evaluating Rating: 3
QA: N
Name and Location of Facility Inspected:
Oceanview Farms LTD. Partnership
NCSR 1236, Onslow County
t
Entry Time: 12:30 Exit Time/Date: 15:00/11-19-97
Permit Effective Date: 12-2-96 Permit Expiration Date: 11-3-01
Names, Titles of On -Site Representatives:
Dennis Hughes, Manager
Jerry Ensminger, Spray Irrigation Operator
Phone Number: [phone]
Name, Title and Address of Responsible Official:
Dennis Hughes
Post Office Box 3959
Wilson, North Carolina 27895
Phone Number: [phone] Contacted: Yes
Section C: Areas Evaluated During Inspection
(S=Satisfactory, M=Marginal, U=Unsatisfactory, N=Not Evaluated)
Permit: S
Facility Site Review: S
Laboratory: N
Pretreatment: NIA
Self -Monitoring Program: N
Sludge Disposal: N
Compliance Status: Compliance
127 North Cardinal Dr., Wilmingtim, North Carotins 28405
An Equal Opportunity Affirmative Action Employer
Records/Reports: N
Flow Measurement: N
Effluent: S
Compliance Schedules: S
Operations & Maintenance: S .
Other: N
Telephone 910-M-3900
FAX [phone]
50% recycled/10% post -consumer paper
c

Section D: Summa of Findin sJComments
i) The solid set spray irrigation system has been installed._ Fields 2,. 7- and. 13 _were used- for a
= - _ "demonstration "Tfie" solid- set -spray--system displayed a uniform spray pattern: _A few pipe
risers"- did display_ some oscillation during spray activities. It is recommended that any riser .
that displays such motion be provided with a restraining mechanism such as a rock bed collar,
located around the riser pipe for prevention of pipe ruptures.
2) The coastal bermuda crop has been overseeded with rye grass and the winter crop was
beginning to grow.
3) The lagoon freeboard was approximately three feet which is acceptable. The operations
personnel are reminded to not allow the lagoon level to exceed the 50.3 feet reference mark
(lower point of lagoon influent pipes or stick gauge reference point).
4) The facility was granted the nondischarge permit based upon a design water usage of
80,000 gpd and an animal operation consisting of a 1200 sow farrow to finish farm (approx.
12,000 total animals). The current animal inventory is between 9,000 and 10,000 animals
with a daily water consumption of approx. 50,000 gallons with water conservation methods
in place.
5) Based upon this site inspection, Oceanview Farms has developed the spray irrigation
facility as per the approved design. The farm may increase animal numbers to full design
capacity. However, the operations personnel should pay attention to permit condition I.19
requiring the use of a mobile spray vehicle (honey wagon) for applying wastewater on field
14 (8.9 acres). The farm should have the ability to spray on this land upon reaching full
animal design capacity.
Name(s) and Signature(s) of Inspector(s):
Jim Bushardt
Agency/Of celTelephone:
Date: 12-2-97
E&NR/Wilmingtonl395-3900
127 North Cardinal Dr., Wilmington, North Carolina 28405 Telephone [phone]
An Equal Opportunity Affirmative Action Employer FAX [phone]
50% recycled/10% post -consumer paper

9-
� StA7E a
,O.J�..�
State of North Carolina
Department of Environment, Health, and Natural Resources
Wilmington Regional Office
James B. Hunt, Jr.
Governor
DIVISION OF WATER QUALITY
DECEMBER 20, 1996
Mr. Michael Lewis
Coastal Ag-Development, Inc.
Post Office Box 3959
Wilson, North Carolina 27895
Subject: Compliance Inspection Report
Oceanview Farms LTD. Partnership
Permit No. WQ0011653
Onslow County
Dear Mr. Lewis:
Jonathan B. Howes
Secretary
Please find attached a copy of the completed form entitled
"Compliance Inspection Report". The report summarizes the findings of a
recent inspection which was conducted on December 17, 1996 to determine
compliance with permit requirements.
A summary of findings and comments noted during the inspection are
listed in Section "D" of the subject report.
If you have any questions concerning this report, please contact me
at the Wilmington Regional Office, telephone number [phone].
Sincerely,
Jim Bushardt, P.E.
Environmental Engineer
cc: Steve West
Wilmington Office Files
Central Files
127 Cardinal Drive -Extension, Wilmington, N.C. 28405-3845 • Telephone [phone] • Fax [phone]
An Equal Opportunity Affirmative Action Employer

COMPLIANCE INSPECTION REPORT
Section A: National Data System Coding
Transaction Code: N Permit No. WQ0011653
Date: 12-20-96 Inspection Type: C Inspector: S
Facility Type: 2 Facility Evaluating Rating: 3
BI: N QA: N
Section B: Facility Data
Name and Location of Facility Inspected:
Oceanview Farms LTD. Partnership
NCSR 1236, Onslow County
Entry Time: 10:00 Exit Time/Date: 13:00/12-17-96
Permit Effective Date: 12-2-96 Permit Expiration Date: 11-30-01
Names, Titles of On -Site Representatives:
Michael Lewis, Vice President
Coastal Ag-Development, [phone] & [phone]
Paul Luther, P.E., Manager, Environmental & Safety Services
Coastal Ag-Development, [phone]
Name, Title and Address of Responsible Official:
Michael Lewis, Vice President
Coastal Ag-Development
Post Office 3959 -
Wilson, North Carolina 27895
Contacted: Yes
Section C: Areas Evaluated During Inspection
(S=Satisfactory, M=Marginal, U=Unsatisfactory, N=Not Evaluated)
Permit: S Records/Reports: N
Facility Site Review: S Flow Measurement: N
Laboratory: N Effluent/Receiving Waters: N
Pretreatment: N Compliance Schedules: S
Self -Monitoring Program: S Operations & Maintenance: S
Sludge Disposal: N Other:
Compliance Status: Compliance

Section D: Summary of Findings/Comments
A facility site inspection was performed as a part of a permit
kick-off meeting at the Oceanview Farm on December 17, 1996. Several
items were discussed relative to the farm's transition from operating
under the Case No. 95-CVS-1993 Consent Judgement to the individual
Nondischarge Permit No. WQ0011653. Some follow-up to the meeting's
subject matter is provided as follows: The initial permit application
depicted a 100 feet buffer (from the edge of spray influence) to the
ditch that drains the eastern portion of the farm. Oceanview personnel
have questioned if a 25 feet buffer could be applied for the ditch. I
have reviewed NCAC 2H.0219 (j) (5) (M) (iii) (III) , enclosed for your review,
and found that the 100 feet buffer is proper for the spray irrigation
buffer distance to the surface drainage ditch. There have been some
modifications performed to the lagoon containment berm on the low
terrain side. A buttrice and dewatering system has been provided as
recommended by the consultant to increase the factor of safety for
lagoon berm's slope stability. No interior or exterior berm erosion was
noticed. A bentonite slurry wall around the lagoon perimeter is planned
for installation in compliance with the Division's mandated schedule.
The low point of the lagoon berm crest has been raised by approximately
1 foot. Considering this extra storage volume, Oceanview personnel have
questioned if this extra storage volume could be used and how the permit
could be modified. There would be a need to have a surveyor document the
lowest point of the berm crest and request appropriate changes within
the permit for each point listing the 50.3 feet (old berm crest minimum
elevation). The Regional Office would consider it appropriate to request
a minor permit modification to change all permit references from 50.3
feet to the resultant value.
The initial permit application was based upon a. design flow of
80,000 gpd. The farm is currently running at 2/3 design capacity or
approximately 8000 total animals. The average water consumption records
are showing average daily water usage at 35,000 gallons. A linear ratio
would show that approximately 52,000 gpd would be necessary for a full
herd of hogs (12,000 total animals). Based upon using NCSU's formula for
nitrogen loading as -was done during the initial application with no
forecasted changes to the cover crop and_no increases in the lagoon
nitrogen content, the writer would consider the permitted 100.6 acres of
net spray acreage to be conservative. Analytical efforts presented for
nitrogen loading could result in the reduced acreage necessary for
agronomic loading. The site is not hydraulic load limited. However,
please keep in mind that MRCS initially determined that 102 spray
irrigation acres were required to support the 1200 sow farrow -to -finish
swine facility. The MRCS uses a different method for spray area
requirements as compared to the Division. The water conservation efforts
by Oceanview personnel are very noteworthy and desirable, but less water
flushing the same amount of swine waste may increase the lagoon nitrogen
concentrations over time. Should the Permittee desire the Division to
consider the use of less acreage, the Regional Office would recommend
the submittal of a full permit modification.
The facility was inspected and the results are as follows:
1) An approximate 4 feet freeboard existed from the lagoon liquid level
to the berm crest.

* 2) All 100.6 acres have been cleared and root raked. Approximately half
of this acreage contained a maturing cover crop of rye grass. Irrigation
risers are available for water reel irrigation activities on these
grassed areas. The farm has rented a track vehicle and is discing and
aerating the soil. Also, the low area within the southern field has been
filled and somewhat leveled.
3) Soil wetness was obvious. Inclement weather and related soil
conditions have caused an impact on the irrigation system installation
schedule. Contracts have been signed concerning the installation, and
the Permittee has indicated that they will make every effort to install
the irrigation system and complete cover crop additions as quickly as
soil conditions allow.
4) Additional stormwater controls (surface water diversions) have been
implemented to enhance the spray field capability in several locations
on the farm.
5) The farm has two operators licensed for spray irrigation activities.
Both of these on -site positions are new. One of the new employees is a
site manager and the other is a spray irrigation system operator. These
personnel modifications should allow increased quality in the. uniform
application of swine waste, cropping activities, -operational records
maintenance, and lagoon level maintenance.
6) There were no odoriferous conditions detected on the downwind
(northern) property boundary. Spray activities were not being performed
at the time of the inspection.
7) The facility had a neat appearance.
Name and Signature of Ins ector:
Jim Bushardt 9;7 ✓�
Agency/Office/ �
Agency/Office/Telephone: EH&NR/Wilmington/395-3900
Date: December 20, 1996

EHNR - ENMONMENTAL MANAGEMENT TI5A: 02H .0200
(iv) wastewater treatment facilities
50 feet
(F)
Any Class I or Class II impounded reservoir used as a source of drinking water.
(i) all systems except for high rate infiltration systems
100 feet
from normal
high water
(ii) high rate infiltration systems
200 feet
from normal
high water
(G)
Any other lake or impoundment:
'
(i) for subsurface disposal
50 feat
(u) for surface disposal except for high zate infiltration systems
100 feet
(it) high rate infiltration systems
200 feet
(ID
Any building foundation except treatment facilities:
() for subsurface disposal
10 feet
(ii) for surface disposal
15 feet
(1)
Any basement:
(i) for subsurface disposal
15 feet
(ii) for surface disposal
15 feet
(J)
Any property line:
(1) for spray irrigation
150 feet
(ii) for other surface disposal systems
50 feet
(rii) for subsurface residuals injection
50 feet
(iv) for other surface treatment systems
50 feet
(v) for other subsurface systems
50 feet
(vi) for soil remediation sites
50 feet
(1)
Top of slope of embankments or cuts of two feet or more in vertical height:
(i) for systems other than rapid infiltration systems
15 feet
(ii) for rapid infiltration systems
100 feet
i
(L)
Any water line from a disposal system
10 feet
(M)
Drainage systems (Ditches, drains, surface water diversions, etc):
(i) Interceptor drains and surface water diversions (upslope):
(I) for subsurface disposal
10 feet
E '
(ln for surface disposal other than spray irrigation systems and rapid
infiltration systems
10 feet
(III) for spray irrigation systems
100 feet
(IV) for rapid infiltration systems
200 feet
(ii) Interceptor drains and surface water diversions (downslope):
(1) for subsurface disposal
25 feet
.i
(II) for surface disposal other than spray irrigation systems and rapid
infiltration systems
25 feet
i
(III) for spray irrigation systems
100 feet
(IV) for rapid infiltration systems
200 feet
_ .
(iii) Groundwater lowering and surface drainage ditchts:
(1) for subsurface disposal
25 feet
(II) for surface disposal other than spray irrigation and rapid infiltration
systems
25 feet
(III) for spray irrigation systems
100 feet
(IV) for rapid infiltration system
200 feet
(N)
Any swimming pool:
(i) for subsurface disposal 15 feet
(ii) for surface disposal 100 feet
(0) Any other nitrification field (except repair area) 20 feet
(P) Any well with the exception of an approved groundwatr, monitoring well 100 feet
(Q) Public right -of --way surface disposal 50 feat
(6) flow equalization of at least 25 percent of the facilities permitted hydraulic capacity 7rug be provided for
all seasonal or resort facilities and all other facilities with flucmasions in influrst flow which may
adversely affect the performance of the system;
NORTH CAROLM ADMINISTRATIVE CODE 06103196 Page 24

Facility, Number:--L7- S3
Division of Environmental Management
Animal Feedlot Operations Site Visitation Record
Date: VqlIg
Time: 1 "4 6"
General Information -
Farm Name: n r County:
Owner Name: G Phone No: ' 9 `I 7 Zc�S
On Site Representative: Integrator:
Mailing Address: PO 1�v7 3`1�S i
Physical 'AddIess/Location:
Latitude: I 1 Longitude: 1 I
Operation! Description: (based on design characteristics)
Type of Swine No. of Animals Type of Poultry No. of AnimaLs Type of Cattle No. of Animals
❑ Sow 0 Layer ❑ Dairy
Q Nursery ❑ Non -Layer ❑ Beef
❑ Fender _ 19OCT)
OtherType of Livesto& Number of Animals:
Number of Lagoons: I (include in the Drawings and Observations the fie board of each lagoon)
Facilitv Insner-tion:
Lagoon J
Ls la-
goon(s) freeboard less than I foot + 25 year 24 hour storm storage?: Yes ❑ No 97
Is seepage observed from the lagoon?: Yes ❑ No E!
Is erosion observed?: Yes ❑ No
Is any discharge observed? Yes ❑ No
❑ Man-made ❑ Not Man -trade
Cover Crop J
Does the facility need more acreage for spraying?: Yes ❑ No �d
Does the cover crop need improvement?: Yes ❑ Nov
( list the crops which need improvement)
Crop type:-CoIt __ r /hurls Acreage:
Setback Criteria
Is a dwelling located within 200 feet of waste application? Yes ❑ No ❑
Is a well Iocated within 100 feet of waste application? Yes ❑ No ❑
Is animal waste stockpiled within 100 feet of USGS BIue Line Stream? Yes ❑ No ❑
Is animal waste land applied or spray irrigated within 25 feet of Blue Line Stream? Yes ❑ No ❑
AO[ -- January 17,1996

w
Maintenance
Does the facility maintenance need improvement? Yes 0 No G
Is there evidence of past discharge from any part of the operation? '"``No ❑
Does record keeping need improvement? Yes Q No
Did the facility fail to have a copy of the Animal Waste Management Plan on site? Yes Q Na
Explain any Yes answers: G`T' f r I,-- L
Signature: IZn�Afl Lzfz n Date:
cc: Facility Assessment Unit _ Use Attachments if Needed
Drawings or Observations:
AOI -- January 17,1996

•
{ et
((N0 n),
n
u
Site Requires Immediate Attention: V
` Facility No. _42 - S
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: , 1995
Time:
Farm Na
Mailing.
County:
Integrator: ~`
On Site Representative: Z
Physical, Address/Location:
G
Phonr)&
Phone:
Type of Operation: Swine ✓ Poultry Cattle
Design Capacity: Number of Animals on Site:
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: Longitude: Elevation: Feet
Circle Yes or No
Does the Animal Waste Lagoon ha sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches) or No Actual Freeboard: Ft. Inches
Was any seepage observed from the lagoon(s)? Yes oeN Was any erosion observed? e or No
kX
Is adequate land available for spr y? Y o� s the cover crop adequat ? Yes or
Crop(s) being utilized: / �. �I 1
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings e or No
100 Feet from Wells? CX or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or�
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes orKs'a
animal waste discharged into waters of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes or No If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage 'th cover cro )? es or No
Additional Comments: �S Gc D f e
Sp r //, M ^ rh) l ;-A IV 14 _T �+j I mot•
`a r rr�c� /�iY11z h (/Pzrrf',
If
cc: Facility Assessment Unit Use Attachments if Needed.

Site Requires Immediate Attentipn:
Facility No. C 7 r
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIO SITE VISITATION RECORD
DATE: z , 1995
Time:
Farm Name/Owner:
Mailing
County:
C,it°
Integrator. �- Phone:
On Site Representative: X Phone:
Physical Address/Location: Gj' / o
v✓a ;�, Al- C S� I Z 3SJ� �' frSP� low �m may, 1
Type of Operation: ` Swine _& Poultry Cattle
Design Capacity: ._ -2.2 500 Number of Animals on Site:
DEM Certification Number: ACE 'DEM Certification Number: ACNEW
Latitude: Longitude: Elevation: Feet
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches) e or No A aI Freeboard: Ft. Inches
• Was any seepage observed from th agoon(s)? Yes o Was any erosion observed? Yes of
Is adequate land available for spray? Yes or o Is the cover crop adequate? Yes or(9
Crop(s) being utilized: rna
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings Y or No
100 Feet from Wells?ua or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes orPo)
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes otom""
Is animal waste discharged into waters of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes or 6) If Yes, Please Explain.
Does the facility maintain adequate waste management rec , (volumes of manure, land applied,
spray irrigated on specific acre ge with. cover crop)? D,or N
Additional Comments: f n4 ►^ t iA,
-i�
} 'W f u, J f A1 hbr r -0 i l C _—
lin. I n flik M it w i 6 'n 0 On
Inspector Name ignature
cc: Facility Assessment Unit
t
Use Attachments if Needed_