820695_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental Quai

Type of Visit: _om 'ance Inspection Operation Review 0 Structure Evaluation 0 Tecbnical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: &, Arrival Time: 4 3 De arture Time: t 4 - ty: 64WF-5d p a Coun Region: (Z
Farm Name: Gy-[Ie-ec.t.W pp d Owner Email:
Owner Name: Gf 7—,<vk , pDc [' ILA S1' f Phone:'
Mailing Address:
Physical Address:
Facility Contact: co (( (( Title: Phone:
Onsite Representative: t r
Certified Operator: G ae.^9= rc ji0✓t
Back-up Operator:
Location of Farm:
Latitude:
Integrator: ><ii( Y
Certification Number: `7 , l 7 69
Certification Number:
Longitude:
Swine
Wean to Finish
Design Current
Capacity Pop.
Wet Pottltry
Layer
Design
Capacity
Current
Pop.
Design Current
Cattle Capacity Pop.
Daig Cow
Wean to Feeder
Moe)
ft
Non -La er
Daia Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
D . P,oul
Layers
Design
Ca aci
Current
P,o
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Turk
Turkey Puults
Other
Beef Brood Cow
Other
Other
Discharges and Stream Imnacts
1. Is any discharge observed from any part of the operation? ❑ Yes ❑'1Vo— ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No [3-NA ❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWR) [-]Yes ❑ No ❑ 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 E], A ❑ NE
2. Is there evidence of a past discharge from any part of the operation? [:]Yes 0 No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters [-]Yes ENo ❑ NA [] NE
of the State other than from a discharge?
Page 1 of 3 21412015 Continued

Facility Dumber: jDate of Inspection: u
Was a Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes D-K-o ❑ NA ❑ NE
a. if yes, is waste level into the structural freeboard? ❑ Yes ❑ No [r AA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3(7 3 ( 33 V
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
[ZkNio
❑ 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
Q'�lo
❑ NA
❑ NE
8_ Do any of the structures lack adequate markers as required by the permit?
❑ Yes
H-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
[a —No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
R to
❑ NA
❑ NE
maintenance or improvement?
I I . is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes D"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): C � �1 ` f 6r V
13. Soil Type(s): tj o,
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes �o ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes FTNo D NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes ❑Ko ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
❑ Yes ®-lq-o ❑ NA ❑ NE
❑Yes E5 —No ❑NA ❑NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[2-9-o
❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check
❑ Yes
1_]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
[3-115'
❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
EJ-No
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes L; No ❑ NA ONE
Page 2 of 3 21412015 Continued

Facili,umber: Z _ I Date of Inspection: -r-
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ❑Ko ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑-11o__ ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance;
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [�No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
[(IX-oo
❑ 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
❑'16o
[] 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
Q, o
❑ 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
I D Ko
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWAV?
❑ Yes
,Ko_
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
M-TTo
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
to
❑ NA
❑ NE
Reviewer/inspector Name; c �J t} `�"1S' Phone: �i0
Reviewer/Inspector Signature: Date: 7;:IvJ '
Page 3 of 3 21412015

Type of Visit: (compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: J'Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: : 3U County: S "( Region:,'(
c
Farm Name: • e "t L'v'20 Ve�v �f r ^ r e✓I Owner Email:
Owner Name: ."'_�c-11L�1 of t - S [� �- Phone:
Mailing Address:
Physical Address: ! -
Facility Contact: cult kS �` `'L t { Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator: KI;.s
Certification Number:
Certification Number:
Longitude:
Swtne:r.
DestgnCurrent- DeSiga Current
Capactty, Popp
Design Current
Pop.
Wet Poultry Capactt} P
Cattle Capacity
can to
La
" er �-
DairyCow
Wean to Feeder
No b l v n-La er
DairyCalf
Feeder to Finish
- - �
Design Current •;
D , P.o_ult "; Ca acity Po
La ers
Dai Heifer
Farrow to Wean
Dry Cow
Non -Dairy
Beef Stocker
Farrow to Feeder
Farrow to Finish
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
S.
Turkeys
Qther _
Turkey Poults
Other
Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes EJK° ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes []No ['fNA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR) ❑ Yes []No Ej-'NA 0 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)
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
E3 A
❑ NE
❑ Yes
N
Y
❑ NA
❑ NE
❑ Yes
ILJ
❑ NA
❑ NE
Page 1 of 3 21412015 Continued

Facility Dumber: & _ Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes G'Mo— ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No �A ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): q
Observed Freeboard (in): 1K s5 q I �S 7
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes E. o [DNA ❑ NE
(i.e_, large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes eNo ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
O'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
Q4o
❑ NA
❑ NE
maintenance or improvement'?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
,--��
lo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): 9-rs kta-d,1- 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? P'les J`--' \ ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes ❑I�o ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
ETN o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑/ No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[l"No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
ffN o
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes C3 No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
❑ Sludge
Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes [7(No
❑ 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

Fi6fity Number: Cr I is jDate of Inspection:
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 2 to ❑ 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 0-'No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes D- o ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface 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?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes 2No
❑ Yes 2io
❑NA ❑NE
❑NA ❑NE
❑ Yes [3No [DNA ❑ NE
[:]Yes [3'fqo ❑ NA ❑ NE
[:]Yes [f 'No ❑ NA ❑ NE
❑ Yes CjKo ❑ NA ❑ NE
❑ Yes �No ❑ NA ❑ NE
Reviewer/Inspector Name: 13i Phone: (014 3
Reviewer/Inspector Signature: ( ' Date: k
Page 3 of 3 21412015

4u 'by
'ivision of Water Resources
MCH!,umber ®- ® Division of Soil and Water Conservation
Q Other Agency
Type of Visit: ompliance Inspection 0 Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: (DoRoutine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: L i aCl� Departure Time: County: Sf j Region:
Farm Name: �K�y( Owner Email:
�'T--
Owner Name: >.t!l�l ORQ ��yl, . Phone:
Mailing Address:
Physical Address:
Facility Contact: &' /LcgI i cTitle: Phone:
Onsite Representative: u Integrator: 'S —
rqff
Certified Operator: �a h (� �� �y1 Certification Number-17ntl 7,9 9
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design Current Design Current Design Current
Swine Capacity Pop. Wet Poultry Capacity Pop. Cattle Capacity Pop.
Wean to Finish ILayer I Dairy Cow
Wean to Feeder Non -La er
I
I
Daig Calf
Feeder to Finish Daig Heifer
Farrow to Wean DesignI ffy.urr—en t Cow
Farrow to Feeder D , P,o_ul Ca aci P,o Non. -Dairy
Farrow to Finish Layers Beef Stocker
Gilts Non -La ers Beef Feeder
Boars Pullets Beef Brood Cow
keys
Other Turkey Poults
Other Other
Discharges and Stream Impacts
I. Is any discharge observed from any part of the operation?
❑ Yes
E To
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
E�rNA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
❑ No
EMI 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
dNA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
❑1Vo
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
EI'No
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412015 Continued

Facili Number: jDate of Inspection:
a
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [�']G�o r❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? [:]Yes [—]No � A ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):�� J� O
5. Are there any immediate threats to the integrity of any of the structures observed? [:)Yes IJ 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 B'�io ❑ 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 [TNo ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes [2To ❑ 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 �o ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes fff No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? if yes, check the appropriate box below. ❑ Yes Ek o ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[:1 PAN ❑ PAN > 10%or 10 lbs_ ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window [] Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): Z of YN1(J C. 560
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[�"o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[;tNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
EWo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[2 14o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[? Iqo
[] NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
F.;Ko
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[3/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
❑ 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 rNo
o
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes
[] NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facility Number. - Date of Ins ection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [qW ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes C], o ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey [:]Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes [IN ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus toss assessments (PLAT) certification? ❑ Yes [a'IGo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
Reviewer/Inspector Name
Reviewer/]nspector Signature:
Page 3 of 3
A)
as
❑ Yes []'<o ❑ NA ❑ NE
❑ Yes [;Iql10 ❑ NA ❑ NE
❑ Yes [2'h'Io ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes El"No ❑ NA ❑ NE
❑ Yes g,'—Nlo ❑ NA ❑ NE
ElYes No ❑ NA ❑ NE
Phone:
Date: I At
21412015

j 0" 7 VK // ;
Type of Visit: Qr(C Rance Inspection Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: =0utine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: County: Mn Region:
Farm Name V r`GLV Owner Email:
Owner Name: �q y`G'C "`L� j o (-� { LbC , Phone:
Mailing Address:
Physical Address:
Facility Contact: ao,.+j S gj&te-(,tjj Title:
Onsite Representative:
Certified Operator: r" 5 I L9 N
Back-up Operator:
Location of Farm:
Latitude:
Integrator:
Phone:`` _
AJ
Certification Number: q 6 l 70,F
Certification Number:
Longitude:
Design Current
Design Current
Design Current
Swine Capacity Pop Wet Poultry
Wean to Finish Layer
Wean to Feeder S 6G _I jNon-Layer
Capacity Pop_
Cattle;. Capacity Pop.
.
Dairy_ Cow
Dairy Calf
Feeder to Finish °" "-
Farrow to Wean
"
Current
Dairy Heifer
D Cow
_Design
Farrow to Feeder I)"",Poultr,
Ca aci P,o P.
Non -Dairy
Farrow to Finish Layers
Beef Stocker
Gilts Non -Layers
Beef Feeder
Boars Pullets
Beef Brood Cow
= Turke s
Other Turke Poults
Other Other
Discharees and Stream. Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
o A
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
[-]Yes
❑ No
B-MA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
[]�<A
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
Uf NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
ff�4o
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
F:�No
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

lFadlity Number: K Date of Ins action:
Mste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ER -MU`❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes [:]No ❑ 4ift ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?,
Designed Freeboard (in):
Observed Freeboard (in): _ ��� 2— s2—-1---�b
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes Ca"N�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
�o
❑ NA
0 NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
[i]'Ko
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[�"1 l�o
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
gNo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
3-Nb
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [] Yes ❑ No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Grouted ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 tbs. ❑ 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): C� ►Mt.tc�Q, &t J V V
13. Soil Type(s): ek v
14. Do the receiving crops differ from those Jesignated 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
L7 1"0
❑ NA
❑ NE
acres determination?
IT 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
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
I f rmo
❑ NA ❑ NE
20. Does the facility fail to have all components of the CA WMP readily available? If yes, check
[:]Yes
fNo
❑ 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
d No
❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
[A No
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
0 No
❑ NA ❑ NE
Page 2 of 3
21412011 Continued

Facill umber: Date of Inspection: h.
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [moo ❑ NA 0 NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [ [DNA ❑ 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 structures) and date of first survey indicating non-compliance:
2& Did the facility fail to provide documentation of an actively certified operator in charge? [—]Yes [No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [allo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately_
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface 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?
34. Does the facility requite a follow-up visit by the same agency?
Reviewer/Inspector Signature:
Page 3 of 3
❑ Yes [2]'No ❑ NA 0 NE
0 Yes allo ❑ NA ❑ NE
[:]Yes ❑ NA ❑ NE
[—]Yes ONo ❑ NA 0 NE
❑ Yes
B"'No
❑ Yes
❑-No
❑ Yes
[ * No
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
Date:
21412014

of Visit: (f Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
in for Visit: outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: - 3 - J Arrival Time: F-TE-71-37 Departure Time: ', OO County: Region:
Farm Name: G_ U Fv %+� Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: _ 'a'm J5 tin i.5 Title: 0 W n k- f Phone:
Onsite Representative: c[ +:y!i Cmf _. integrator: � �� + `y
Certified Operator: �.� Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Resign Current
Design
Current
��„ g Desi n Current
Swine Ca aci Po
P- h' P•
Wet I'oult, >
ry
Ca .aci
Pa
Cattle Capacity Pop.
Wean to Finish
La er
Da Cow
Wean to Feeder
Non -La er
Da Calf
Feeder to Finishp
Da' Heifer
Farrow to Wean
Design
Current
D Cow
Farrow to Feeder
D PEaul
Ca aci
P,a ,
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
Turkey Poults
Other 1§1
10ther
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
E No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
,M No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
RNo
❑ NA
❑ NE
of the State other than from a discharge?
Page I of d
21412011 Continued

aciliNumber: - 5 Date of Ins ection: 6
Waste Collection & Treatment
' 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
allo
❑ 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?:
7
Designed Freeboard (in): c3; 1 _ 31 �31
Observed Freeboard (in): r j (v �' t{ S—(.
O
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
jEgNo
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
F�4 No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
Q No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
4 No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system othcr than the waste structures require
❑ Yes
(ZL No
❑ 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 ❑ 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): ; 1 15
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
0 No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
k4No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
®, No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
allo
❑ NA
❑ NE
R uired Records & Documents
19, Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
allo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
[] Yes
[KNo
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists [:)Design 0 Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. [:]Yes �]C , No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I " Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes VZ, No
Pea
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes JZ No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continned

Facili Number: - Date of inspection: /
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes MNo ❑ NA ❑ NE
25. is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes fo No ❑ NA ❑ NE
the appropriate box(es) below.
[] Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
[] Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes allo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes R No ❑ NA ❑ NE
Other Issues
2& Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes allo ❑ 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 gj No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the ❑ Yes ® No ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
yZ No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
T
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
} 2 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
5LNo
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments -
Use drawings of facility to better explain situations (use additional oases as neeessarv). f_
jpr _ �a gym- �i r C!1 p/ 5&--►% z— I �% eld � s-r sr�b • �s�SP
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Phone: � ,p--� :53CO
Date:`'�d%y
21412011
Page 3 of 3

U
I ype of visit: C9'Compliance Inspection V Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit: toutine 0 Complaint Q Follow-up O Referral O Emergency Q Other Q Denied Access
Date of Visit: /3 Arrival Time: D; oo Departure Time: County:Region:
jV
Farm NameCeOl I Owner Email:
Owner Name: � �p� j j Phone:
Mailing Address:
Physical Address:
Facility Contact: U, Zt ����r�/ ^, Title: /Siry Phone:
Onsite Representative: Integrator: PY,7 L, ✓�
Certified Operator: Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design Current Current Design Current
�1]esign
Swine Capacity Pap. Wet�Poultry Capacity Pop. Caftle @apaeity Pop.
Wean to Finish Layer airy Cow
Wean to Feeder
Non -Layer
airy Calf
Feeder to Finish
"' "" ^ ~,;' '
Dairy Heifer
Farrow to Wean
Design Current
Dry Cow
Farrow to Feeder
Farrow to Finish
D . �P.ou1 ;' Ca aci P,o .
Layers
Non -Dairy
Beef Stocker
Beef Feeder
Gilts
Non -Layers
Boars
Pullets
Beef Brood Cow
Turkeys
Other
Turkey Poults
Other
Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify 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 C, No ❑ NA ❑ NE
❑ Yes [:]No
[:]Yes [:]No
[:]Yes [—]No
❑ Yes ®• No
[:]Yes D§_No
❑NA ❑NE
❑NA ❑NE
❑NA ❑NE
❑NA ❑NE
❑NA ❑NE
Page I of 3 21412011 Continued

Facility Number: - JDate of Inspection: 71/
t Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ®,No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): 3.P_ 30;7—
Observed Freeboard (in). ` o
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
all� 33
3 e S-11
❑ Yes MNo ❑ NA ❑ NE
6. Are there structures on -site which are not properly addressed and/or managed through a
[—]Yes
allo
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an Immediate public health
or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
[:]Yes
Our
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
FXJ 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
01 No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
allo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes Z[No ❑ NA ❑ NE
D 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 Drill ❑ Application Outside of Approved Area
12. Crop Type(s):-
13. Soil Type(s): ,,_kp
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes R No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes KNo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes 0 No ❑ NA ❑ NE
acres determination?
17. Does the facility lade adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes 2!� No ❑ NA ❑ NE
❑ Yes C3-No ❑ 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 [g_No ❑ NA ONE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? if yes, check the appropriate box below. ❑ Yes 0 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 [Z No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes D3-No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facili Number: Date of ins ection: (q-_2,7—/3
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes CgNo ❑ NA ❑ NE
f
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ® No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
[] Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes ['No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ® No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30, Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes CZ No ❑ NA ❑ NE
❑ Yes [A No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes R No ❑ NA ❑ NE
❑ Yes Z] No
❑ Yes R No
❑ Yes 0 No
❑NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
1Comments (refer to question #): Explain any YES answers and/or any additional recommettdations or any other comments
Use'dra'wmgs.9f facility to better explain situations (use additional patres as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: �'�p-1�33--3 00
Date:
21412011

` - Division f Water Quality
l�
Facility Number ®- JL a Division of Soil and WMMAGinsenvanaq
Q Other Agency �!
type of visit:ance Inspection Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit; Routine Q Complaint Q Follow-up Q Referral p Emergency Q Other Q Denied Access
Date of visit: 16 —1-4z— 1 Arrival Time: I 9L: J Departure Time: County:Region:
Farm Name_&,,. �,�;p Al'�s,�ry (' ,s,,,,�� y` Owner Email:
Owner Name:. ��is�jlfl .S Phone:
Mailing Address:
Physical Address:
Facility Contact: �� (�' .�f� Title: Phone:
Onsite Representative:
Certified Operator:
Back-up Operator:
Integrator: '_4PLP il4_
Certification Number:
Certification Number:
Location of Farm: Latitude: Longitude:
Desiign Current
Design
Current
Design t►nrrent
Shine
Capacity Pop.
Wet.Poultry
Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
La er
Dairy Cow
/6?k3E>
I jNon-Layer
I
Dairy Calf
?(
Wean to Feeder
(a oti
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design
'Current
Dry Cow
Farrow to Feeder
Dry, P,oul
Ca achy
l;o
Non -Dairy
Farrow to Finish
Layers
Non -La ers
Beef Stocker
Beef Feeder
Gilts
Boars
Pullets
Beef Brood Cow
Turke s
Other
Pouets
Other
_F[Turkey
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 eg-No ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes [:]No
❑ Yes [&No
[:]Yes allo
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑NA ❑NE
Page I of 3 21412011 Continued

Facili Number: - Date of Ins ection: 0
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [Z No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No [DNA ❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier.
Spillway?:
Designed Freeboard (in):
q
Observed Freeboard (in): � ,� / V 33
3 to
��
---
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
ED No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
KA 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
[g 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?
I I. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
allo
❑ 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) COr., v .�.- u.[•� /�'
.`
-
13. Soil Type(s):
14. Do the receiving crops differ/from those designated in the CAWMP?
❑ Yes
M No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
[] Yes
[ No
[] NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
No
[] NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
® No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Repaired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
® No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
® No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
® No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and i" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
® No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
[:]Yes
® No
❑ NA
❑ NE
Page 2 of 3
21412011 Continued

Facili Number: - Date of Inspection: --
/
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[R No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
allo ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
❑ Yes
® No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
® No ❑ NA ❑ NE
Other issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ 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
[21 No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
MNo ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
® No ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
0 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
0 No ❑ NA ❑ NE
r y x.�� Y,
Comments. (refer to question #):. Explain any YES answers and/or any additional recommendations or an other comments.
Use drawings of facility to better explain situations (use -additional pages as necessary):
Reviewer/Inspector Name. 7
Reviewer/Inspector Signature:
Page 3 of 3
Phone: _23_ � _33ya
Date: G -- //
21412011

Type of Visit: ompli a Inspection Operation Review 0 Structure Evaluation Q Technical Assistance
Reason for Visit: Routine Q Complaint Q Follow-up Q Referral Q Emergency 0 Other p Denied Access
Date of Visit: - Arrival Time: , Ov Departure Time: p County: Region:
Farm Name: �© /—,5 Owner Email:
Owner Name: '0 7w,:I Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative: ��r� - Integrator: 1�ur
Certified Operator: �� Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude: Longitude:
In
Design Current
1] ign Current Design Current
Swine
CaPact Cattle aci Po .
tY P
Wean to Finish
La er Dairy Cow
Wean to Feeder
p
Non -Layer
Dai Calf
Feeder to Finish
"�
Dai Heifer
Farrow to Wean
Destgn
DryPaulte Can aci
Current
P,o
D Cow
Farrow to Feeder
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turke s
Other
Turkey Poults
Other
Other
Discharses and Stream Impacts
L 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 �LNo [] NA ❑ NE
❑ Yes
❑ No
[] NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
[] NA
❑ NE
❑ Yes
JKNo
❑ NA
❑ NE
❑ Yes
R,No
❑ NA
❑ NE
Page I of 3
21412011 Continued

Facili Number: - L` 5— Ds ection: 7 /
Waste CoUection & 'Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes allo ❑ 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): 31
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
Gg-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
S1 No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental
threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
® No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[2 No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
[-]Yes
El 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?
1 I. Is there evidence of incorrect land application? If yes, check the appropriate box below.
[:]Yes
® No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ 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 T,ype(s): C_ QW L vrs�
13. Soil Type(s): 07 /
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
� No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
[] Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[Z No
❑ 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
® No
❑ NA ❑ NE
the appropriate box_
❑WUP ❑Checklists ❑Desigm ❑ 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 V Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
[-]Yes
RNo
❑ NA ❑ NE
23_ If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
Q�J.No
DNA ❑ NE
Page 2 of 3
21412011 Continued

Imo]
Facility Number: jDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [ No
25. Is the facility out of compliance with permii conditions related to sludge? If yes, check ❑ Yes ER No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [—]Yes ® 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 tile drains exist at the facility? If yes, check the appropriate box below_
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
❑ NA [] NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ Yes 'EQ No ❑ NA ❑ NE
❑ Yes K No ❑ NA ❑ NE
❑ Yes [N No ❑ NA ❑ NE
❑ Yes IQ No ❑ NA 0 NE
❑ Yes
O No
[DNA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
[ANo
❑ NA
❑ NE
Phone:
Date:
21412011

a
Type of Visit compliance Inspection Q Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit wioutine O Complaint O Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: %J Arrival Time: ; a� Departure Time: /1l 17 County: r`�' Region: v
Farm Name: 2 - 4 /` t� �`� Owner Email:
Owner Name: s6r1 _ n 4 + , Phone:
Mailing Address:
Physical Address:
Facility Contact: . I exn 3 Title: Phone No:
Onsite Representative: Integrator: 0__i9w
Certified Operator: ( r Operator Certification Number: 18 -3U,S _—
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: 0 n ❑ ' [::] Longitude: = 0 = ' 0 K
n C
wGemallrPopulation
Design @nrrent
Wet Poultry Capacity Population
n
Design
Maitle Mapacity
rrurrent
MnentSwineacity
Populafion
❑ Wean to Finish
❑ La er
❑Dai Cow
Wean to Feeder O 3
❑Non -La er
❑Dai Calf
❑ Feeder to Finish
❑ Dairy Heifer
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
Gilts
PCIBoars
-
Dry Poultry
❑ La ers
❑Non -La Ts ❑ Pullets
❑ Turkeys
❑ Dry Cow
❑ Non-Dai
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow l I
Other
❑ Other
❑ Turkey Pouets
❑ Other
Number of 5truc#ures:
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)
z. 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 5LNo ❑ NA ❑ NE
El Yes
❑No
El NA
❑NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
SNo
❑ NA
❑ NE
❑ Yes
allo
❑ NA
❑ NE
Pagel of 3 12128104 Continued

F4
Facility Number: — Date of Inspection--/
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes EgNo ❑ 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 R.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 allo ❑ 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 29 No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes [allo ❑ 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 allo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes IS No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ®'Yes ❑ No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[:]PAN ❑ PAN > 10% or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
[30utside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) C.&/`1? �4 `i,�rr�S � !me...�d �LU� r-.9rlr✓'srr �s ,FL�u•
13. Soil type(s) j K
14. Do the receiving crops differ from those designated in the CAWMP?
El Yes
ONo
El NA
❑NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
9No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
�9 No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
RNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
�&No
❑ NA
❑ NE
pot".-
rnr�irat5.
Reviewerlinspector Name ` _`
Phone: —'55. c>0
Reviewerllnspector Signature: Date: 7--
Page 2 of 3 111-16iv4 uonunuea

Facility Number: — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes IN No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 19 No ❑ NA ❑ NE
the appropriate box. ❑ WUp ❑ Checklists ❑ Design ❑ Maps ❑ 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?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (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?
❑ Yes
V1 No
❑ NA
❑ NE
❑ Yes
JO No
❑ NA
❑ NE
❑ Yes
$4 No
❑ NA
❑ NE
❑ Yes
R No
❑ NA
❑ NE
❑ Yes
0 No
❑ NA
❑ NE
❑ Yes
BNo
❑ NA
❑ NE
❑ Yes D? No ❑ NA ❑ NE
❑ Yes B No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes �4 No ❑ NA ❑ NE
❑ Yes
�9 No
❑ NA
❑ NE
[--]Yes
JN No
❑ NA
❑ NE
Page 3 of 3 12128104

Type of Visit 0 Compliance Inspection 0 Operation Review (2rStructure Evaluation �0 Technical Assistance/
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency C7 Other ❑ Denied Access
Date of Visit: 't�� / Arrival Time: 4 s `DDeparture Time: .r.3v County: P— Region:
All
Farm Name: / _ lrt/ Owner Email:
Owner Name: Slz% 'i /ll7i��3 Phone:
Mailing Address:
Physical Address:
Facility Contact: S'd �/jr! �� Title: LpWA7 Y✓ Phonee No���f
Onsite Representative: Integrator: 17711.Y✓!{y
Certified Operator:/% Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: Q n 0 6 = If Longitude: = u = i = 4i
Design Current
Design Current
Design
Current
Swine C++opacity Population
Wet Poultry Capacity Population
Cattle Capacity
Population
❑ Wean to Finish
❑ Layer
❑ DairyCow
❑ Wean to Feeder
❑ Non -La t
❑ DairyCalf
❑ Feeder to Finish
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry
El Dry Cow
El Farrow to Feeder
ElNon-Dai
❑ Farrow to Finish
❑ Layers
❑ Beef Stocker
❑ Giits
❑ Non -La ers
El Beef Feeder
❑ Boars
❑ Pullets
❑ Beef Brood Cowl
❑ Turkeys
Other
❑ Other
❑ Turkey Poults
❑ Other I
res:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation'?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes ❑ No ❑ NA ONE
❑ Yes
❑ No
❑ NA
IS NE
❑ Yes
❑ No
❑ NA
[.NE
❑ NA
KNE
❑ Yes
❑ No
❑ Yes
❑ No
❑ NA
qNE
❑ Yes
❑ No
❑ NA
&NE
Page l of 3 12128104 Continued

Facility Number: g- (,2 Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ❑ No ❑ NA PINE
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 FLNE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes ❑ No ❑ NA EINE
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 23NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
❑ No ❑ NA ONE
(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 OJNE
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 ERNE
❑ 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 [3NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
IT Does the facility lack adequate acreage for land application? ❑ Yes
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No ❑ NA R NE
❑ No El NA [El NE
❑ No ❑ NA E INE
❑ No ❑ NA ENE
/t/c3I Psi i3 rp La�pD���i0'4r -f' 11 i ji f
/hd`'.��lr.�;,3��Fg/�.t�/! �e Gf kS�ovr�r� j rt /�'lcrrc�I`C� %7►� QY.0 dl�� �/iS ��i/Ins Lv�d`� ;�/w
/�/Ka^�.�.�
l vs7`�v rdr- � %tad( �-r`c GZ hL ® O AGfC ulytr_ �g
[Reviewer/Inspector
eviewer/Inspector Name 1 , Phone: /O�-y/ 3 D
Signature: Date:
Page 2 of I-Wal" uonrrnuea

• Facility Number: `r Date of Inspection
Required Records & Documents
' 19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ❑ No ❑ NA [HNE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ❑ No ❑ NA [3NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA UNE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ No
❑ NA
® NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
❑ NA
0 NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
❑ NA
ONE
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
ONE
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
aNE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
❑ No
❑ NA
ONE
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
e NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
El Yes
❑ 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
RNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
,Yes
❑ No
❑ NA
❑ NE
Add�ti©nal#Commentswand/oi Dr win s it = f 6„ x ti
54
AL
/�'f+'= �i'ihi5 4�`� I��U/�`j�� �aq�D�tj �.u�i�G �uJ` �:�CB�a�L•�Cc �''`— 3 /1'—sue/4�
`�lrm r!?aKa >
/�07 ��r..�--b?-sue.
Page 3 of 3 12/28/04

Type of Visit �rtipliance Inspection O Operation Review O Structure Evaluation Q Technical Assistance
Reason for Visit outine O Complaint O Follow up 0 Referral O Emergency 0 Other 0 Denied Access
Date of Visit: `i1L!__L-L�`�J� Arrival Time: 1 .'fjQ Departure Time: ,`�f7 County: $'— Region:
Farm Name: n. rlh UJ iF_ j✓:!L'Cfy 922z%Z r-k Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: (�d:'G�y dr/ I7 Title:
Onsite Representative:. _<4M_1<_
Certified Operator:~�`--
Back-up Operator:
Phone No: �/l9 "J /"��i�a
Integrator: duf'Et �f3/
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: = a = 1 = " Longitude: = ° Q , =
��MavaclMfizftovMatioq
Swine
❑_Wean to Finish
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Otl<er
❑ Other
Discharges & Stream Impacts
Design Current
Wet Poultry Capacity Popul�hour
❑ Layer
[IN n-Layer
FPoultry
❑ Layers
❑ Non -La ers
❑ Pullets
❑ Turkeys
❑ Turkev Poults
❑ Other
Design Gtr . ent
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
(] Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
Number . f Structures:
1. Is any discharge observed from any part of the operation?
❑ Yes
Q 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? (I f yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
allo
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
[K No
❑ NA
❑ NE
other than from a discharge?
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? ❑ Yes 9 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): j c3
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes L, 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 P9 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 [3No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ yes 5? 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 El Yes ®Na El NA [I 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)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CA W M P?
❑ Yes
[&No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
allo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
R No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
[ANo
❑ NA
❑ NE
18. is there a lack of properly operating waste application equipment?
❑ Yes
E3-No
❑ NA
❑ NE
^� �41
Comments (refer to question_#) Explatmany YES answers and/or any recommendations r any other comments.
`Use drawings of facility to hetter explainsituations; (use additeonaf pages as necessary):� *�
Reviewer/Inspector Name �~u
Reviewer/Inspector Signature:
Phone:
Date: 11-9-19MC11
12128104 Continued

c1 Facility Number: EZ —65t5T Date of Inspection
Required Records & Documents
14. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes (3No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 0 No ❑ NA ❑ NE
the appropriate box. ❑ WUp ❑ Checklists ❑ Desig
n ❑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 I" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes C5No ❑ NA ❑ NE
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes RNO ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
allo
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
MNo
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
ERNo
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
EK No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
RNo
❑ NA
❑ NE
24. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
allo
❑ 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
[RNo
❑ 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
BNo
❑ 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
12128104

1
Type of Visit QoCompliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit outine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: / Arrival Time: Departure Time:
Farm Name: UJh i D co
County%-77 Region:
eAwoer Email:
Owner Name: _�Sr�-s-�- G�? Phone:
Mailing Address:
Physical Address:
Facility Contact: Slz-" Title:
Onsite Representative: �r'J
Certified Operator:
Back-up Operator:
Location of Farm:
Phone No:
Integrator: /iJkiD
Operator Certification Number:
Back-up Certification Number:
Latitude: = v =.
" Longitude: = o = ` = "
Destgn Curre�;,
Desig ,Current
- -Design Current
Swine ;Capacity _Population
Wet Poultry
C�apacty�Population
Cattle Capacity Population
❑ Wean to Finish
❑ La er
❑ DairyCow
® Wean to Feeder
t9
❑ Nvn-La er
❑Dai Calf
❑ Feeder to Finish
El Dairy Heifer
❑ Farrow to Wean`
Dry Poultry,
❑ D Cow
❑ Non -Dairy
❑ Farrow to Feeder T -` -" -
❑ Farrow to Finish
❑ Layers
❑ Beef Stocker
❑ Gilts
❑ Non -Layers
❑ Beef Feeder
❑ Boars
-
.-' ❑Pullets
❑Turke
❑ Beef Brood Co
Numberof Structures:
s
Other ' ❑Turke Pouets
❑ Other ❑Other
Discharges & Stream Imaacts
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 LqNo ❑ 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 — w
tt Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 0-No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): 3 _ 1 3 j :3
Observed Freeboard (in): 133 SL f 3 3
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 0 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 [9 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 14 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 ZNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 2LNo ❑ NA ❑ NE
maintenance/improvement?
11. is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes fRNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area/
12. Croptype(s) ,�, r�.-t-/�. /.Slcn FIDW e� G`
D/`-,t /6fMUj'
13. Soil type(s)
14. Do the receiving crops direr from those designated in the CAWMP?
❑ Yes
[9No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
M-No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
[RNo
❑ NA
❑ NE
IT Does the facility lack adequate acreage for land application?
❑ Yes
P No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
O-No
❑ NA
❑ NE
Reviewer/Inspector Name -=j Phone:
Reviewer/inspector Signature: Date:
mage l of 5 121za/U4 uonunuea

Im
Facility Number: — Date of Inspection
ReQuired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes [XNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes V-No ❑ NA ❑ NE
the appropriate box.
❑ WUP El Checklists El Design ❑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 V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
54No
❑ NA
❑ NE
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
EqNo
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
MNo
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
allo
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
EffNo
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
ZINo
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
KNo
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
allo
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
O-No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
gNo
❑ 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
Jallo
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
[;�No
❑ NA
❑ NE
Page 3 of 3
12128104

G-155y-ision of Water Quality 7 M6
Facility Number �J 0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit ompliance Inspection D Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 011outine 0 Complaint 0 Follow up 0 Referral O Emergency O Other ❑ Denied Access
Date of Visit: f Arrival Time: .' Departure Time: ��Q County: '�-- Region: f--�=—
Farm Name: 1 er Owner Email:
Owner Name: iS Phone:
Mailing Address:
Physical Address:
Facility Contact: /1�ift/ C-d5-' t- Title- Phone No:
Onsite Representative: t t�'/'~ Integrator:
Certified Operator: p
O eratar Certification Number:
fir¢
Back-up Operator:
Location of Farrar:
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: [� o E-1 . ED t, Longitude: = o = L ❑ H
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
��� /a�`C%OD ❑ Non -La er
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Design Current
Cattle Capacity Population
❑
Dairy Cow
❑
Dairy Calf
❑
Dairy Heifer
❑
Dry Cow
❑
Non -Dairy
❑
Beef Stocker
❑
Beef Feeder
❑
Beef Brood Co
Number of Structures:
©;
❑Yes ®No ❑NA ONE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NB
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 CgNo ❑ NA ❑ NE
other than from a discharge?._._,.a,_.,:.
12128104 Continued

Facility Number:Date of Inspection
y Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
PINo
❑ 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): c 3f 31 31 31
3 c3
Observed Freeboard (in): —/Q 3 Y�dl_7,9
3 67
0
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.)
b. 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?
Cl Yes
® No
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
G� 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
9Yes
o
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[3 No
❑ NA
❑ NE
maintenance/improvement?
I I . Is there evidence of incorrect application? If yes, check the appropriate box below. ® Yes ❑ No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ l=rozen Ground ❑ Heavy Metals (Cu. Zn, etc.)
tAPAN ❑ PAN > 10% or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
R Outside of Acceptable Crop Window ❑ Evidence
� o%f Wind Drift ❑ Application Outside of Area Q ,�
12. Crop type(s) rJ/
fn ! � CO�,lrl�Dtct�r►N WA
13. Soil types)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes C9 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
9 No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes
ONO
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes
54No
❑ NA
❑ NE
IComments (refer to question #): Explain any YES answers and/or any recommendations or any other comments. I
Use drawings of facility to better explain situations. (use additional pages as necessary):
fg'
fi e 7Jo :C yo aJ-115,u r p !J DaQ b-e w4P01-Y'91'L__d n nab
t4i'Ae4�7` you .3u�t w r-•s 1
Reviewer/Inspector Name 2' �'�'�- Phone:
Reviewer/Inspector Signature: Date:
17/719/!1lf f narir�s�vd

Facility Number: —6 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 BNo ❑ NA ❑ NE
the appropiate box. ❑ W'Up ❑ Checklists ❑ Design ❑ Maps ❑ 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?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28_ Were any additional problems noted which cause non-compliance of the permit or CAW -MP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes CgNo ❑ NA ❑ NE
❑Yes ®No El NA El NE
❑ Yes 9 No ❑ NA ❑ NE
❑ Yes ® No
❑ Yes 9 No
❑ Yes $4 No
El NA ❑NE
El NA El NE
❑NA ❑NE
❑ Yes ® No ❑ NA ❑ NE
Additional Comments and/or Drawings:
Jk
% Mad 'Pa
k/ mod! 6�&-6
W,`/1 /9vfk 1zcA ad -A r6 AA�_-.s
&— h )s IT-7 �Z ..,1- h -es� 4 C a1 ou-0
pump
fur /vCccJ /rh. iT i .� YOOr—
12128104

December 1, 2006
CERTIFIED MAIL
RETURN RECEIPT REQUESTED
Sam Ennis
Coach Whip Nursery Complex
636 Bayshore Dr
Wilmington, NC 28411
Michael F. Easley, Governor
William G. Ross Jr., Secretary
North Carolina Department of Environment and Natural Resources
Subject: Application for Renewal of Coverage for Expiring NPDES General Permit
Dear Permittee:
Alan W. Klimek, P.E. Director
Division of Water Quality
RECEIVED
DEC 0 6 2006
DW-KYUiiElAliPMOMLOWE
Your facility is currently approved for operation under one of the Animal Waste Operation NPDES General Permits, which expire on
July 1, 2007. Due to changes in federal rules, facilities that do not discharge nor propose to discharge may choose whether or not to
retain coverage under an NPDES General Permit. Copies of the draft animal waste operation NPDES general permits and the State
Non -Discharge General Permits are available at hgp://h2o.enr.state.nc.usiaps/afou/downloads.htm or by writing or calling:
NCDENR — DWQ Animal Feeding Operations Unit
1636 Mail Service Center
Raleigh, North Carolina 27699-1636
Telephone number: [phone]
1n order to assure your continued coverage under one of these two t es of general permits, you must submit an ApOication for Rermit
coverage to the Division. Enclosed you will find a `Request for Certificate of Coverage Facility Currently Covered_ by an Expirin
NPDES General Permit.' The application form must be corn leted and returned by January 2 2007. Please note yQu must include
two 2 coRies of your most recent Waste Utilization Plan with the ffiXplication form.
Failure to request renewal of your coverage under a general permit within the time period specified may result in a civil penalty.
Operation of your facility without coverage under a valid general permit would constitute a violation of NCGS 143-215.1 and could
result in assessments of civil penalties of up to $25,000 per day.
If you have any questions about the draft general permits, the enclosed application, or any related matter please feel free to contact the
Animal Feeding Operations Unit staff at 919-733-3221.
Sincerely,
Ted L Bush, Jr., Chief
Aquifer Protection Section
Enclosures
cc (w/o enclosures): Sampson County Soil and Water Conservation District
Fayetteville Regional Office, Aquifer Protection Section
AFO Unit Central Files - 820695
Murphy Family Farms
Aquifer Protection Section 1636 Mail Service Center
Internet: www.ncwaierattalitv.ora Location: 2728 Capital Boulevard
An Equal OpportunitylAffinative Aclion Employer 5D% RecyclLd 10% Post Consumer Paper
Raleigh, NC 27699-1636 Telephone:
Raleigh, NC 27604 Fax 1:
Fax 2:
Customer Service:
ow
N 1 Carolina
(919)
[phone]
[phone]
[phone]

U
9
Division of Water Quality.
Facility Number j O Division of Soil and Water Conservation'Of
s
1 0 Other Agenev
Type of Visit I?Wompliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit O Routine O Complaint 01=ollow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: f � Coun 1 _ .Sri Region: �R �
� Departure Time: , i7 t3'= • '-- g
Farm Name: , S. � aek aJ : Q W L&1'5l 1, Owner Email:
Owner Name: _ j _W__ C Y_ - f?ex, ,Ln0"' Phone:
Mailing Address:
Physical Address:
Facility Contact: tv LU � �0+ �l�' Title:
Onsite Representative:
Certified Operator: J,4-uj ey
Back-up Operator:
Location of Farm:
Swine
Wean t0 Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Phone No:
Integrator:(_y%'W''`- _
Operator Certification dumber:
Back-up Certification Number:
Latitude: = o = ❑ � Longitude: ❑ o =, ="
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
FEJ
a er
I-3bDOI on -La et
Other
❑ Other
Dry Poultry
Non-L
Pullets
Poults
Discharges & Stream Impacts
I . Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a- Was the conveyance man-made?
b. Did the discharge reach waters of the State? Of yes, notify DWQ)
Design Current
Cattle Capacity Population
❑
Dairy Cow
❑
Dairy Calf
❑
Dairy Heifer
❑
Da Cow
❑
Nan -Dairy
❑
Beef Stocker
❑
Beef Feeder
❑
Beef Brood Co
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures: ®'
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 qNo ❑ NA ❑ NE
❑ Yes
K No
❑ NA
❑ NE
❑ Yes
,0 No
❑ NA
❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes CKNo ❑ NA ❑ NE
12128104 Continued

e
�..' Facility Manber: — Date of Inspection —D
1 Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 :Structure 2: Structure 3 _ --Structure 4
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes KNo ❑ NA ❑ NE
Structure' 5 Structure 6
Identifier:
Spillway?:
} Designed Freeboard (in): /3 j F - 1�3 j 3 !
- 31
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
&No ❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
R 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
IRNo ❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
RNo ❑ 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
[9 No ❑ NA
❑ NE
maintenance or improvement?
Waste Apnlication
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
(0 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 Ibs ❑ 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) C!f_),eyL / 7fl &drvs / duly ,,-r /Sme l Cara 16uhflau e, r
13. Soil type(s) �, h p
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
W No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination, ❑ Yes
®.,No
❑ NA
❑ NE
IT Does the facility lack adequate acreage for land application?
❑ Yes
[Q No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[gNo
❑ NA
❑ NE
Reviewer/Inspector Name [ ` Phone: r/
Reviewer/Inspector Signature: Date:
12128104 Continued

I:aeility Dumber: Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available'? ❑ Yes &No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes XNo ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ n Desi g ❑Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below_ ❑ Yes 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 I" 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
E9 No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
(9No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
ER 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
f9 No
❑ NA
❑ NE
Other Issues
28_
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
(X No
❑ NA
❑ NE
29.
Did the facility fail to property 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
0 No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
iWNo
❑ NA
❑ NE
;Additional C-6mmentiand/or Drawings: s "m , n °> a ;e^k. ,e :
12128104

Type of Visit Q Compliance Inspection O Operation Review O lagoon Evaluation
Reason for Visit ® Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number 82
Date or Visit: k - a - 6 Time:
10 Not Operational Q Below Threshold
Wermitted O'Certified D Conditionally Certified © Registered Date Last Operated or Above Threshold: ... ._.. _._ ..
Farm Name: .....� Qg.4 .. �5... ' fC.6K+ jrr_ �p.+. %Jif- Cottnty: .-....... s .t!^ �.FN.......... ...F
--
Owner Name: S 42 — .._ : s Phone No:...........................................................
Mailing Address: ..__..............................
Facility Contact: %�"7� C'.R -�e �c r - /I?g Phone No: ....-.._ 'ty ..�.�..---•------•..---------................mow......._.........Titla:._..,.....----•--�.._......... �..........
Onsite Representative:..-....... Integrator.
l/ fit........... �—...,._�_......_..-_.-...-.... r J s4
Certified Operator:........ �Operator Certification Number:
Location of Farm:
EE Swine © Poultry ❑ Cattle ❑ Horse Latitude ' 6 &° Longitude • 6 tt
Design ~ Ce>!i=
SWtAe ;Cans;nty i�nnild
Design Current
risr11v _Vnh afinn. ,..Cy
Wean to Feeder
/SGDO
Layer
Feeder to Finish
'PO
Non -Layer
Farrow to Wean
f
Farrow to Feeder
-
Other
Farrow to Finish
J - TotAi Dent
El Gilts
El Boars
Design - Cur iml
ty-
C
To6d-,SSLW 'C
F
�Nnmber of Lagoons
E
Dischax es & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made'?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated 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
❑ Yes (A No
❑ Yes ❑ No
❑ Yes ❑ No
t4 / A
❑ Yes ❑ No
❑ Yes OLNo
❑ Yes ® No
❑ Yes [� No
Structure 1
Structure 2 Structure 3
Structure 4 Structure 5
Structure 6
Identifier: ........ f.................
_.... ........._...._ �._,_ ...............
... ....... _ .... s_ ......-...•.-....
...........�d.................
Freeboard (inches): 7
/
y `7 7 �r
��j
C /
12112103
Continued

acilityWumber:,S -- (orj`S Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes R No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑ Yes P 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 maintenancelimprovement? ❑ Yes CO No
8. Does any part of the waste management system other than waste structures require maintenancelimprovement? ❑ Yes [N No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes Q No
elevation markings?
Waste Aanlication
10. Are there any buffers that need maintenance/improvement? ❑ Yes 9A No
11. Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes M No
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type / 6t4 t4 'y' /Ca�.v ! s Y 4 C." t-o-' ' / f e, f- —
13. Do the receiving crops differ with those designated in the Certifier) Animal Waste Management Plan (CAWW)? ❑ 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 EB No
c) This facility is pended for a wettable acre determination? ❑ Yes 10 No
15. Does the receiving crop need improvement? ❑ Yes [M No
16. Is there a lack of adequate waste application equipment? ❑ Yes 0 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 ® No
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes No
19, 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)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional ❑ Yes No
Air Quality representative immediately.
M Feld Copy ❑ Final Notes
O to n c f'40
�I\Ot[4 h-t-kc_vc 4Y G �/ p 11~,e J cJw�AGrf- rf SS/I1-��si, f ,ryp
Mr. I C.Ci �t AO.S GPf�f i r kl a�TG dtw-Fc r- . a c- Q/ I 1 GQ ion$$
T1i
"4R � C A!uW; nhot P. ea ,c w V C__
S
PcGla1tj� TC eytoQJtA joW3 r0 PCTV4CT
_
GcS,
t,& ►- r t vL '�' -Cn v. r._ : `\ 7 Cp r e-� ,1
I I*.aG #.S k&_i A. 5po-f of etbs\nn rv1.rV I, f 1c� - Cidid��'�
l..actoO/v l h4j SLo"e- "t`h4S+', riCa'jG Vcv,.Q'je—
�GJGtu` �bv�Sts ^aV t- C-04�0` S+Cv��IKq V�py
FOGk� a� nir�zvl r+c���� 'f'a r�tCrCa��t i...aa.'E'cwr
VcLC ck\4r�-J.
Reviewer/Inspector Name A4a s
Reviewer/Inspector Signature: Date: 'f1G1
awisiv✓

Facility Number: �a —(.,� Date of Inspection
Required Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
Oe/ WUP, checklists, design, maps, etc.)
23. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
25. Did the facility fail to have a actively certified operator in charge?
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
Oe/ discharge, freeboard problems, over application)
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
28. Does facility require a follow-up visit by some agency?
29. Were any additional problems noted which cause noncompliance of the Certified AV;W.
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
32. Did the facility fail to install and maintain a rain gauge?
33. Did the facility fail to conduct an annual sludge survey?
34. Did the facility fail to calibrate waste application equipment?
35. Does record keeping for NPDFS required forms need improvement? If yes, check the appropriate box below.
❑ Stocking Farm ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After 1" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
❑ Yes [V No
❑ Yes 60 No
❑ Yes [p No
❑ Yes [3 No
❑ Yes M No
❑ Yes ® No
❑ Yes No
❑ Yes No
❑ Yes No
❑ Yes No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
12112103

x
�1
Division of Soil and Water Conservation ❑ Other Agency
Division of Water Quality
1W Routine O Complaint O Fo[[ow-up of DVVQ inspection O Follow-up of DSWC review O Other 1
Date of Inspection 7
Facility Number � 6
Time of Inspection c � 24 hr. (hh:mru)
© Registered M Certified 0 Applied for Permit M Permitted � Not Operational Date Last Operated:
Farm Narnc- ............. ice¢✓ � .......................
�....... - -- .. {.�............. County:......... � ...................
OwnerName: ......'r...eSf................................................. Phone No: ... 6q_) ..............��..`............ �........................ _.
Facility Contact: � ���'........................ Title: one o...................................................
Mailing Address :.....�.�5f? ..... A/C ..........°.`.'2.���.....-----•-�•----• .. ..........................
Onsitc Representative: ......... �/............................ ............... Intei;rator:_..,..�/�l- 17
Certified Operator; ...... [� _.....•. Operator Certification Number ................................
Location of Farm:
Boars
Latitude =•=, �44 Longitude �"�• =' r.�"
�Z"°��"..Current
Design -, '{urretttDes�gn�" � °Current
Capacity Populat�an x Pauitry p` Fv
Ca acrt Popt; tianCattle
.��
W a . y r� � v � ..Capacrty'rPapulahan, .�
t
�' ❑Layer❑Dairy
[� Non -Layer ❑Nan-Dairy
OtherF,
TatarDesign Capacity �`
TotaI�SSLW
N ether of Lago�o�nsl Holding°Pon�d�"s,�©�
❑Subsurface Drains Present
❑Lagoon Area
❑Spray Feld Area
❑ No Liquid Waste Management
43.:
n AF. 't"' � z �it^"1,• � 'ss` 5.�vex � �,k'. � i ..� ���
?3.5 �..
-� ziL' k;..n. .� y 9t FV
Wean to Feeder
% 6
D
❑Feeder to Finish
❑Farrow to Wean
'� ❑Farrow to Feeder
El Farrow to Finish
❑Gilts
❑
.
1. Are there any buffers that need maintenancelimprovement? ❑Yes '�No
2. Is any discharge observed from any part of the operation? ❑Yes 9 No
Discharge originated at: ❑lagoon ❑Spray Field El Other
a. If discharge is observed, was the conveyance man-made? ❑Yes j�No
b. If discharge is observed, did it reach Surface Water? (if yes, notify D1�'Q) ❑Yes �No
c. If discharge is observed, what is the estimated flow in gaUmin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) El Yes �`No
3. Is there evidence of past discharge from any part of the operation? El Yes �'No
4. Were there any adverse impacts to the waters of the State other than from a discharge? El Yes �"No
5. Does any part of the waste management system (other than lagoons/holding ponds) require El Yes '�` No
maintenance/i mprovement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design? El Yes XNo
7. Did the facility fail to have a certified operator in responsible charge? El Yes �o
7/25/47

Facility Number: ?Z
8.
Are there lagoons or storage ponds on site which need to be properly closed?
0 Yes IVNO
Structures (LagoonsHoldiag Ponds, Flush Pits, etc.)
.
9.
Is storage capacity (freeboard plus storm storage) less than adequate?
0 Yes *440
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Structure 6
Identifier: . B . ... .. . .. ............ ....... ......................... �i ... I .... ............ ...................... ... .............. . ..........
...... .......... & 'M�� 36-"
Freeboard (ft). ..... ......... 7 V . ... . .......
... 7 _2F . ..... . ..... . ..... . .... ... . .... . . ........
10.
Is seepage observed from any of the structures?
0 Yes A No
11.
Is erosion, or any other threats to the integrity of any of the structures observed?
0 Yes ;K.No
12.
Do any of the structures need maintenance/improvement?
Q Yes >tNo
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13.
Do any of the structures lack adequate minimum or maximum liquid level markers?
0 Yes O
Waste Application
14. Is there physical evidence of over application?
❑ Yes N0
(If in excess of WM[P, or runoff entering waters of the State, notify DWQ)
15.
Crop type 'b4eA,<44 11?
................ . ............ 1­6a----------- - ------ * ....................... --------------- - - ----------- ----------
............ ........ . ..........
16.
Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
0 Yes �io
17.
Does the facility have a lack of adequate acreage for land application?
❑ Yes VkNo
18.
Does the receiving crop need improvement?
Yes [I No
19.
Is there a lack of available waste application equipment?
0 Yes ANo
20.
Does facility require a follow-up visit by same agency?
0 Yes *0
21.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
[3 Yes XNo
22.
Does record keeping need improvement?
0 Yes it No
For
Certified or Permilted Facilities Only
23.
Does the facility fad to have a copy of the Animal Waste Management Plan readily available?
0 Yes PQ No
24.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
0 Yes KNo
25.
Were any additional problems noted which cause noncompliance of the Permit?
El Yes RNO
No'viola'tio'n's-6ideftciencies.'w'e're, fiotid-&nfig this',visit.-.Yo'U "Will iiceii've`irti ftirther',
............ .........
c0rresO60eke a4oijt this'vWL,'-','-,
16g,
7/25/97
I Reviewer/Inspector Name
IReviewer/Inspector Signature:.
Date: - 77- 2 ;P-