860028_INSPECTIONS_20171231

Type of Visit: p3Compliance Inspection U Operation Review U Structure Evaluation lJ Technical Assistance
Reason for Visit: S� Routine O Complaint O Follow-up O Referral O Emereencv O Other O Denied Access
Date of Visit: Arrival Time: � Departure Time: County: .S� Region: d'US C
Farm Name: T r�(/Y4S II Phone:
Ownevmail:
Owner Name: L. VW
VII�171Ik
Mailing Address: 7/ / W� 'K /t ,kill PJG 2 f6 2—
Physical Address:
Facility Contact: �pgM �� t'I-e Title:
Onsite Representative:
Certified Operator: e - P AG
Back-up Operator:
Location of Farm:
Phone: "336--A6-076
Integrator: 1-4"N
Certification Number:
Certification Number: �r7
Latitude: -76 O-zr% 1 L7 11 Longitude: tC O � L16
z-'71 N, KP�y� �d, +2 rNa, S, K L<,�.4M 5rr
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 DW R)
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 A No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes ❑ No
❑ Yes No
❑ Yes No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 21412015 Continued

Facility Number: - • Date of Inspection: 2
(Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes XNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3
5. Are there any immediate threats to the integrity of any of the structures observed? ❑Yes No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.) �(
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes No ❑ NA ❑ NE
waste management or closure plan? J�
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NF
(not applicable to roofed pits, dry stacks, and/or wet stacks) j
9. Does any part of the waste management system other than the waste structures require ❑ Yes IJ(I No ❑ NA ❑ NE
maintenance or improvement? 7�
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes I►/I 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): 5"11 grA44 horn JrATN
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available'?
❑ Yes I����Y////I No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? (ryes, check
❑ Yes lyl No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design [3 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 lyl NA ❑ NE
Page 2 of 3 21412015 Continued

[Facility Number: • Date of Inspection: 2
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
No ❑ NA ❑ NE
25. is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a PDA for sludge
levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail 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
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.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes ;XI No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes No ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawines of facility to better explain situations (use additional paves as necessarv).
—1?.A0 tic hale 1peaf de.�t� e 0��d ,
2l, Setl j^f pkj 4.r D-Icttw 1_= 2D1(o nrIi .t �C� PC> vJ nt�C� ��s +t. CDNc ZolBuvn.�lr�
2�; /�� 1 rU l�i�. e� 14 O. ttl lr6rA i A AtX � J444 c Gi Wl
z51 S�+nc% Pj%le/
l0%6=1•d7, Ib N
R fvdL Y 1. 10 ILA
ex"Sf h" next- CLte "(04-t 2°l9,
Reviewer/Inspector Name: PAL-i/ , "'r /tii1G II
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date:
21412015

Dale of Visit: 1 t Arrival Timer Departure Time: County: lru iV• Region: Ws�
Farm Name: fin) 4 FarrA _s Owner Email:
Owner Name: C t L, M1 4 e.
Mailing Address:
Phone: W (3 36) 366 ` ligy,3
Physical Address:
Cell
Facility Contact: S Title: Ph ne�33b) 3 b b- 0-7 6
k� OnsiteRepresentative: Integrator: Lt 14
Certified Operator: L^,�ylAli" V-s q'� (_Iben 1 l LP
Back-up Operator:
Location of Farm:
Certification Number:
Certification Number:
Latitude:, , 0 1 ;L % 11 Longitude: Qd 6 / � t
Z-1-7 N., (9) Zephyr "- (P,) TwIn DaKS�a 5a),g*W
on c
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system'? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
o �� K- Kul • �
❑ Yes lYl No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Page I of 3 21412015 Continued

Facili Number: Tin - isDate of Inspection:
Waste Collection & Treatment �[
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate'? ❑ Yes /I\ i No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes[ ❑ No ❑ NA ❑ NE
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
Structure 1 Structure 2
k,4
Structure 3 Structure 4 Structure 5 Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
❑ Yes] No El NA ❑ NE
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes M No [DNA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require Yes ❑ No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes k-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 (kutside of Approved Area
12. Crop Type(s)
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes I (( No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes iXi No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes IRNo ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
06 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
0�<o
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
XNo
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. oes record keeping need i rovement? If pprepria ❑ Yes No ❑ ❑ NE
Waste Applica ' nekly Free card Waste Analysis Soil Analysis �Y+`. ae eivim ors Weather Code
dRainfall 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 KNo XNA ❑ NE
Page 2 of 3 21412015 Continued

jDate of Inspection:
Facility Number: z7f
24. Did the facility fail to calibrate waste application equipment as required by the permit?
[:]Yes
IgNo
[:]NA [:]NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
No
❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a PDA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail 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
0 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 3�rNo ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the ❑ Yes No ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes No ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
Fle�ec 'Roll.
aoiS Ce � ln�xt,o,J fey d ?Irk' C .� ' sue ()t of
Soil fe5f5 due,2617. l�c
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:' -176 — q( qq
Date: -7/11 a2 O
21412015

r
Operation Review C) Structure Evaluation
for Visit: • Routine O Complaint 0 Follow-up O Referral O Emergency O Other Q Denied Access
Date of Visit: j �,�Z/—Zoi9(, Arrival Time: %Q; oo Departure Time: /; a0a County: 51 ray Region:4/ 0
Farm Name: IJ�I+/ /I Far^//o.S Owner Email:
/ �T
Owner Name: t� . Lam• r qtJ rL /J / r�/ Phone:
Mailing Address: /� / r�/%Ii f B /` ��jKirl /�L 2 d D Z /
Physical Address:
Facility Contact: J� e y V N`> t Title:
Onsite Representative: Up L Pa ryL- f
Certified Operator: CkAeIc S (QpCy 31, t`L
Back-up Operator:
Location of Farm:
Latitude:
Integrator:
Phone: eel 33�-V-D767
Certification Number: 2CL- 5 -7
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
Wet Poultry
Design
Capacity
Current
Pop.
Design Current
Cattle Capacity Pop.
Wean to Finish
La er
DairyCow
Wean to Feeder
Non -La er
DairyCalf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
P P.oultr.
Layers
Design
Ca racit +
Current
Fop.
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
I lBeefBroodCow
Other
MI Other
Turke s
Turke Poults
Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes UNo [:]NA [_]NE
❑ Yes [:]No [:]NA [:]NE
❑ Yes ❑ No [:]NA [:]NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
CRNo
❑ NA
❑ NE
Page 1 of 21412014Continued

G
Facility Number: 2 $ • Date of Ins ection: AS 11
1$
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 I Structure 2 Structure 3 Structure 4
L Identifier: A2610/L
Structure 5
Structure 6
Spillway?: r5
Designed Freeboard (in):
Observed Freeboard (in): 0"
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
S�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
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 DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
EL 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
'ZNo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
E�No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
Ig-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) L Orn r.. I �!y/a�/ 4 /� ►r
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
fC No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
5L.No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
JRLNo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
jj� No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
Q No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
EL No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
4 No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design (]Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? 416yeorei w A, th a ap p i hzimw
Yes
JK No
❑ NA
❑ NE
Q Waste Application EKeekly Freeboard Waste Analysis [] Soil Analysis
�
Qther Code
[21' ainfall E28[ cking []'Crop Yield �120 Minute Inspections []Monthly and l" Rainfall Inspections
udge 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
MNA
❑ NE
Page 2 of 3
21412014 Continued

Facilit Number: I• Date of Inspection: 0 - S
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes 0 No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes R 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 21 No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes Q No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes ,R No ❑ NA ❑ NE
❑ Yes -ERI No ❑ NA ❑ NE
❑ Yes ®,No ❑ NA ❑ NE
❑ Yes '®No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes " No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes JZ No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes INo ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any'additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
��-Soi I-s me. 2017 -Nee .-S er[, /Z//3//za/5 4Ij of a( r ,'C
2`l CqA/er^AV' UN/L ire �/f
/51, 4oLZ�L 0)"Me'4r-Gk[,f�6a1(
!LS, Slµd,,4 sCAftlej c,mt /I/3//201L/-- DayG- //-07- 2-01L/
saw �� c
� 3-16-te,s
7-2-7- ZVI g,t6 N - 3,It
^/_ I,57
P1o5 - 97 trios - 1,80
ks s 23 k,vy-7,0/ k�o�6 so
Reviewer/Inspector Name:
Phone: 3_V-77 '/b f
Reviewer/Inspector Signature:
Page 3 of 3
Date: .S-/L - Zofs
21412014

for Visit: O Routine O Complaint 0 Follow-up O Referral 0 Emergency O Other 0 Denied Access
Date of Visit: 7 e2 Arrival Time: Departure Time: ® County: U Y P
Farm Name: W q Parm5 Owner Email:
Region: SAG
Owner Name: C • L • VJV I
t e-
Phone:
t
36 4 —
q q q
Mailing Address: q 19 h 1
/�
t-e 2d
E I Kin 1
r'3 '
�p
.14
Physical Address:
Facility Contact: :LDey 1„ t+-c,'at Title:
OnsiteRepresentative: �Tnp�/ �}- Pl��
Certified Operator: e'yo_rke's ('TQeA4 ) yjh 1 �e_
Back-up Operator:
Location of Farm:
Latitude:
Phone: e- 36 b - n :
Integrator: Lot- 14
Certification Number:
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Wet Poultry
La er
Design
Capacity
Current
Pop.
Design Current
Cattle Capacity Pop.
DairyCow
Wean to Feeder
Non -La er
DairyCalf
Feeder to Finish
DairyHeifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Dr. P,oult ,
Design
Ca aci M
Current
P,o .
D Cow
Non -Dairy
Beef Stocker
Gilts
Beef Feeder
Boars
MLayers
BeefBroodCowOther
Other
Other
Discharges and Stream Impacts
1. is any discharge observed from any part of the operation?
❑ Yes
t6 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 DWR)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
[A No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
17p No
❑ NA
❑ NE
of the State other than from a discharge?
T
Page I of 21412014 Continued

[Facility Number: Date of Inspection:
go I
Waste Collection & Treatment qW
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
Pd 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: 0✓1
Spillway?:
Designed Freeboard (in):
V
Observed Freeboard (in): 1
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
a 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
�6o
❑ 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
X No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[)KNo
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
[:]Yes
RNo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
y�
10. Are there any required buffers, setbacks, or compliance alternatives that need
El Yes
IXl No
Y
[3 NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes gNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drriiiftt ❑ Application Outside of Approved Area
12. Crop Type(s): 0 "— Q' A V jI ) >"�Li�d
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
CR"No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
EJ�No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
X No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
CRINO
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
jDeNo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
KNo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[rNo
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists [3 Design [:]Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? ILje ❑ Yes 0 No NQ ❑ NE
Waste Applies ion [%Weekly Freeboard Waste Analysis �il Analysis �— Weather Code
dRainfall Stocking [3Crop Yield 0 120 Minute Inspections CffMonthly and 1" Rainfall Inspections ECRI-ludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No [3NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 9 No �NA ❑ NE
Page 2 of 3 21412014 Continued

Facili Number: • Date of Inspection: 020
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
NIo
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
No
❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge
levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
❑ Yes
04 No
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
N No
XNA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
XNo
❑ 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
tp No
'ram
❑ 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
No
❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
IZNo
❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
['5k1No
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
O(No
❑ NA ❑ NE
(Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments. I
Use drawings of facility to better, explain situations (use additional pages as necessary).
, i l -tes-t- Aue'i n aoll
Cal'Ibra ion due'tn dtol5, �Aoz21e G�`t0.Yy12�e✓ �lneclLeci ?
SludJ�e_ 31��Oli�
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: / 1— S;Z O f
Date: I I o2a p26 13
2/4/2014

for Visit: IQ Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time:(peparture Time: County: Sur r Region: W 5 ��
Farm Name: ' W�t'i F a_Y- AA 5 Owner Email:
Owner Name: C L • W -�-e
1F� e
Mailing Address: Zf� 0. (am-,
O r V 'P_
Physical Address:
Facility Contact: -To ey \K I h't 1� e, Title:
Onsite Representative: ) &j L
Certified Operator: CV\Q1r �e S �f0 �1.t T tii
Back-up Operator:
Location of Farm:
Phone: Wo((C-11)aA 36?& —103
Phone e, 3 tP % — o ? % 7
Integrator: L4-
Certification Number:
Certification Number:
too t l J O
Latitude: 3 02 � t a.i Longitude: QOo �� 1 6'4
_--1? NI 2 Ze.p64r •1 C Turin Oafe-,5 ./ 12 60-2rA,_ ForK
po x-rvm on �'-
Design Current
Design Current
Design Current
Swine Capacity Pop.
Wet Poultry Capacity Pop.
Cattle Capacity Pop.
Wean to Finish
La er
DairyCow
Wean to Feeder
Non -La er
DairyCalf
Feeder to Finish
DairyHeifer
Farrow to Wean
2
Design' Current
D Cow
Farrow to Feeder
D . P,oult . Ca aci P,o
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
I
I
Pullets
I Beef Brood Cow
Turkeys
III OprWthWerM
Turkey Ponits
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes XNo ❑ NA ❑ NE
[—]Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes J? No
❑ Yes 0 No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
Page I of 21412011 Continued

Facili Number: Date of Inspection: i 3
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 14 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: L ooh
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): r
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or 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 XNo ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 1� No ❑ 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
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
[:]Yes XNo ❑ NA ❑ NE
❑ Yes K No ❑ NA ❑ NE
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
2_{y, Does record keeping need ' provement? appropriate trm ❑ Yes No
[RLJ rite Applic ion Weekly Freeboard Waste Analysis Soil Analysis Waste Transfers
ainfall Stocking ffCropi Yield ❑ 120 Minute Inspections �vtonthly and I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? [:]Yes �,No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No
❑ NA ❑ NE
❑ Weather Code
Sludge Survey
❑NA ❑NE
15?13A ❑ NE
Page 2 of 3 21412011 Continued

Facili Number: Date of Inspection: ' aO
24. Did the facility fail to calibrate waste app :cation equipment as required by the permit? W ❑ Yes �(No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes OrNo ❑ 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 XNo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
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 06No ❑ NA ❑ NE
❑ Yes �iNo ❑ NA ❑ NE
[:]Yes
YNo
❑ NA
❑ NE
❑ Yes
�No
❑ NA
❑ NE
❑ Yes
0 No
❑ NA
❑ NE
❑ Yes
RNo
❑ NA
❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments.
Use drawines of facility to better exalain situations (use additional oases as necessary). t
�oi3 Soil test 4.0�o.�lw 1b11,
2. W1 bru:torl o'Pboti_k ! n ezo 1 3
Sludge SurvV_y due- 1aI31/a614•U
_1/aL/13 - a'72 a/6)13= a.17 9/►S
Reviewer/Inspector Name: Meli5so- R65Aroe.1t_
Reviewer/Inspector Signature: qM Q O.i t A& 114&M J h 01 k J
Page 3 of 3
a = 1.Vq
Phone: -7 S I — P-g%
Date: 1 ++ ;La ,-2_613
21412011

for Visit: (0 Routine
0 Other 0 Denied Access
Date of Visit: i 7 /l3 /17.i Arrival Time: Departure Time: a., County: , Ltrf Region: I-B k0
Farm Name: W- Trim__ 1 Owner Email:
Owner Name: C. L , W I- I -k Phone: ( } D'kh)
Mailing Address: 725- S`i to M r k d Fl ,`,1 , rJ 6 7—F6 Z 1
Physical Address: I'
Facility Contact: _o e, W I-J 1 C Title:
Onsite Representative: ,/ O e. 1� 'Fe1
Certified Operator: dlyLcs
Back-up Operator:
Location of Farm:
Integrator:
Phone! () ?i'' /I 6 - 676 /
I- �K
Certification Number:
Certification Number:
Latitude: a Z 2- z% Longitude: 0 0 1
17-71 N� fZ ik�oPt,7r �d,� �T, e;, Oclks 9JI/ �. Sale 1:,/k kJ 0^C�)
Swine
Wean to Finish
Design Current
Capacity Pop.
Design Current
Wet Poultry Capacity Pop.
[Layer
Design Current
Cattle Capacity Pop.
Dai Cow
Wean to Feeder
Non -La er
Dai Calf
Feeder to Finish
Dai Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
A 7_2
Design Current
Dr. P,oultr. Ca acl P,o
Layers
D Cow
Non -Doi
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turkeys
Turke Pouets
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 XNo
❑ Yes [-]No
[:]Yes ❑ No
❑ Yes ❑ No
❑ Yes No
❑ Yes No
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
/ Page I of 21412011 Continued

•]Facility Number: Z • Date of inspection: 3
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes JJ�No
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑��'''No
Structure 1 Structure 2
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
❑ NA ❑ NE
❑NA ❑NE
Structure 3 Structure 4 Structure 5 Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
❑ Yes X No
❑ Yes XNo
❑ NA ❑ NE
❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes 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 [3NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes �No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes XNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN> 10%or 10lbs. ❑ 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): SMg I C 'l f- t'X / l0 y 6// dI. CO r^ f)00"
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
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 [:]Design ❑ Maps [:]Lease Agreements ❑Other:
21. Does record keeping need improvement? ❑ Yes No ❑ NA ❑ NE
2e4�h?4t2
O�W_a ste Application [2<eekly Freeboard EWaste Analysis oil Analysis a . eather Code
[✓� Rainfall Stocking Crop Yield [2 20 Minute Inspections Monthly and V 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 k 4 NA ❑ NE
Page 2 of 3 21412011 Continued

Facili Number: - 2 • Date of Inspection: 77 3
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes �No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes �No ❑ NA ❑ NE
the appropriate box(es) below. ii����
❑ 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 property dispose of dead animals with 24 hours and/or document ❑ Yes No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the ❑ Yes XNo ❑ 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. ❑ YesXNo ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:_
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes /II�yQ�ti.No ❑ NA ❑ NE
1J9 34. Does the facility require a follow-up visit by the same agency? ❑ Yes No ❑ NA ❑ NE
Comments (refer to question ii): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
i
23 Slu e SttrJey 'is dtte I Z/3/l2ollf
cell/�� �r (,,�e a,�e �e LrMe a��! �.;srwj�, 2-cu 42biz rLvk&--,A
2013,
411 s/l 2-' 2,716 N
3�a1/12 = 3, 2- A 4
lV2-11I = 2r110
9/1 /11 z.5-0 t) J_
Reviewer/inspector Name: P4'�1 F&L AA t I zAd I Phone: 634
Reviewer/Inspector Signature: ��"� Date: 27i 1 Z
Page 3 of 3 21412011

Type of Visit
Compliance Inspection
O Operation Review Q Structure Evaluation
O Technical Assistance
Reason for Visit
X Routine 0 Complaint
Q Follow up 0 Referral 0 Emergency
0 Other ❑ Denied Access
Date of Visit: I Jam, I I I Arrival Time: ailm Departure Time: 'I /O .f I County: JUG Region: }may
Farm Name: (Pj vFarts Owner Email: 'J
Owner Name: ' Lo L ��e+ Phone: 3 — -t 4 4 3 � W a
Mailing Address: �f05 5ajem �orl� P-c�•, �llCin,NL a86af Do
Physical Address:
Facility Contact: SOS LO T If Title:
Onsite Representative: Jo'
Certified Operator:�e—
Phone No:
Integrator: 4 i�
Operator Certification Number: `-•� ?
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: e � ® Longitude: ®o I J Y
1/-�7 N-0�'bsov►.eKt� `�3) PJ-
'WKI Ai i' x aA -rf.U-! .U,e Qao Aoj . °E io i ej /L-r �m <7 e Oe � its . N , _ r/i h AMti
Wean to Finish
Wean to Feede
Feeder to Finis
Pullets
Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
Feeder
Brood
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
0
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes No
❑ Yes Iy No
12128104
❑ NA ❑ NE
❑ NA ❑ NE
Continued

Facility Number: q (p — ,2 • Date of Inspection L L •
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 [:1 No
❑ NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: 4l C
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes L� No
El NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
f`
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes No
❑ NA
❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes I�No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes �] No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10.
Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
IxNo ❑ NA
❑ NE
maintenance/improvement?
11.
Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
XNo ❑ NA
❑ NE
❑ Excessive Pending ❑ 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
/] S
12.
Crop type(s) /1( /u(� (D' 1jo
13.
Soil type(s) 7�
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
��,,((
EKNo ❑ 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 acre determination ?
❑ Yes
�r No ❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
ArNo ❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
X No ❑ NA
❑ NE
Comments (refer,to question #):
Explain any YES answers and/or any, recommendations or any other comments.
Used"rawiiigs of facility to better explain situationsa(use additional pages as-'necessary)`r
Reviewer/Inspector Name
a , ;r ." _y ?`; Phone:
— -sq
Reviewer/Inspector Signature:
Date:
3
Page 2 of 3 " v 12128104 Continued

Facility Number: — *Of Inspection I �/T! 1 1 I •
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes i�jo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP eadily availa ? If yes, check El Yes LrJ1/No ❑ NA ElNE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design Maps ❑ Other ,,�i
21. Do—oessr/record keeping need, improvement? — / is a ox a ow. ❑ Yes L`7 No ❑ NA ❑ NE
[,,3_1Waste Application// Ly"Weekly Freeboard 11�Naste Analysis ❑ Soil nalysis D*4AO �ronsfer9 ❑��ea
I�'Rainfall ❑ Str,�king ❑ CroA)Xeld 120 Minute Inspections Monthly and I" Rain Inspections Bather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
[XNo
[:1 NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
0 NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
]p No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
[,No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
0 No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
XNo
❑ 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
❑ 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
VNo
❑ 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
O No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
X No
❑ NA
❑ NE
ASd�di[ional Comments and/or Drawings:
aO101 a011 dot I �eS+S ? �bj� 5nmple5k-
. SiuSurveh now. ap
4y ) . cecSit
a /aal 11 Lk She.. cavt-�515 = a• 7 1 h 5 , N/(o60
W
Page 3 of 3 12128104

Facility Number
Division of Water Quality _
Division of Soil and Water Conservation
Other Agency
Type of Visit VCompliance
Inspection
0 Operation Review 0 Structure Evaluation
0 Technical Assistance
Reason for Visit
7 Routine 0 Complaint
0 Follow up 0 Referral 0 Emergency
0 Other ❑ Denied Access
Date of Visit: Arrival Time: FT.,30_ Departure Time: n •'.S County: SU I Region: W 5
Farm Name: 5a 1-104 Owner Email:
Owner Name: e , L' Phone: 3 b (7 " Y q q 3 I F4� +can J
Mailing Address: 7 U S- _901 nm n r le- 200. I .- 1 �. i 11 �, Iy C_, ia ge, 2- 4
Physical Address:
Facility Contact: O e_t..t-•P Title:
Onsite Representative: So PJA 1 Fe
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Other"'
❑ Other
Latitude: I 9 o
Phone No: :K(L) .7te
Integrator:
Operator Certification Number:
Back-up Certification Number:
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -Layer
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & 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)
o
Longitude:
Design Current
Cattle Capacity Population
E]Dairy Cow
❑ Dairy Calf
❑ Dairy Heifei
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures: �j
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes No ❑ NA ❑ NE
❑ Yes TTT❑l No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes o ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
12128104 Continued

Facility Num0 of Inspection � 6 •
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes gNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes XNo ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps ❑Other
21. Doe record keeping need improve relxiafe b--ex//;btFew�— ❑ Yes No ❑ NA ❑ NE
.rite Appliicc lion i�'We kly Freeboard Waste Analysis C4o.,i_l, AAnalysis e16eHi€cataen
1�7 Rainfall IwJ Stocking WCrop Yield 120 Minute Inspections M4onthly and I" Rain Inspections eather Code
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
1A'dditional Comments and/or Drawings: _
Lik .z5Ol
❑ Yes �I No ,❑( NA ❑ NE
El Yes 111❑l No LC A ❑ NE
❑ Yes
XNo
❑ NA
❑ NE
❑ Yes
�No
❑ NA
❑ NE
❑ Yes
*o
❑ NA
❑ NE
❑ Yes
XNo
❑ NA
❑ NE
❑ Yes [(No ❑ NA ❑ NE
❑ Yes � No ❑ NA ❑ NE
❑ Yes *No ❑ NA ❑ NE
❑ Yes )(No ❑ NA ❑ NE
❑ Yes 4 No ❑ NA ❑ NE
❑ Yes UNo ❑ NA ❑ NE
�. 20 to 5�-
s Se ? C`c l,4,� aa�q --tom
Page 3 of 3 12128104

Facility Number: 4 — ag • Date of Inspection 3 O •
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes VNo
❑ 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. Q. OOrI
Spillway?:
Designed Freeboard (in): -t—1 Y
Observed Freeboard (in): �_
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes KNo
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes t�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 )S�No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes Na 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 LY No ❑ NA El NE
maintenance or improvement? ,`
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes �(No ❑ NA ❑ NE
maintenance/improvement?,.,
11. Is there evidence of incorrect application? If yes, check the appropriate box below. El Yes qNo ❑ NA ❑ NE
ElExcessive Ponding ElHydraulic 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.
Crop type(s) (' 1✓
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
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[:] Yes
��[[No
tF ,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
No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/Inspector Name p _ br o cj(_ Phone: 11 I — SoZ$ `J
Reviewer/Inspector Signature: s 0 ��L�n )", A a Date: 2
12128104 Continued

Type of Visit Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Imo/ Arrival Time: Departure Time: unty: U r r U Region: 23lla&
Farm Name: I L) q F0.11r m-s Owner Email: ' I'/ 2 % r
Owner Name: C—t"L o (,J—)V%1 }P 11 IPhane: .�i0t, q Y YJ/f_Far al-i 6L(4
Mailing Address: ! .1(1 �P ►/�_FO i ROQLI� F 1 10
Physical Address:
Facility Contact: — [ 0 e-u l l (iP_ Title:
Onsite Representative:
Certified Operator: �• 1 ��
Back-up Operator:
Location of Farm:
l.
Phone No: 36 -01 b
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: ISV ®1 ®, Longitude: ®o RM, ®'u
Design Current
Design Current
Design Current
Swine Capacity Population
Wet Poultry Capacity Population
Cattle Capacity Population
❑ Wean to Finish
10 Layer I
❑ Dairy Cow
❑ Wean to Feeder
I JLJ Non -Layer I
❑ Dairy Calf
❑ Feeder to Finish
❑ Dairy Heifer
Farrow to Wean I A 't001
Dry Poultry
❑ Dry Cow
Farrow to Feeder
Laers
❑Non-Dai
Farrow to Finish
El❑
El Beef Stocker
❑ Gilts
❑ Non -La ers
❑Beef Feeder
El Boars
❑ Pullets
❑ Beef Brood Cow
❑ Turkeys
Other
1110
❑ Turkey Pouets
Other
❑ Other
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes
�No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
0
❑ No
❑ NA
❑ NE
❑ Yes , N'o ❑ NA ❑ NE
❑ Yes I(vo ❑ NA ❑ NE
12128104 Continued

•
Facility Number: — Date of Inspection
11
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes No ❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑Yes No ❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Identifier. _
Structure 5 Structure 6
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): _3 a-
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes IJSI No ❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
�i�/
❑ Yes Ua No ❑ NA
❑ NE
through a waste management or closure plan?
�C
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 A< ❑ 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 V No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes )6o ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes o El NA ❑ NE
❑ Excessive Pending El Hydraulic Overload El 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. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or.land application site need improvement?
❑ Yes
❑ Yes
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
17. Does the facility lack adequate acreage for land application? ❑ Yes
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No ❑ NA ❑ NE
No ❑ NA ❑ NE
Yl No ❑ NA ❑ NE
ONo ❑ NA ❑ NE
)S(No ❑ NA ❑ NE
nsiY,:tsr,i 1n ny,r$'§f n�A+le.wt�f4,M1u ?r {¢ t Wt
I Comments (refer to question #): Ezplaln any YES answers and/or any, recommeQjh'IA s or any otlil comments* s i ti # > t,
Use drawings of facility tabetter ex Imn situations use, additional a es as necesstir t `' x tb 3 Z {
g tY P ( p r F :ink Y) ��1t$bMMai'�t�t &
Reviewer/Inspector Name (eI t ?'aA" 3 r"ac1;z�Phone: — a g
Reviewer/Inspector Signature - Al d t1 A_ 1 J Ard Date: Q

Facility Number: —e of Inspection •
Required Records & Documents /
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes MElNA ElNE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes :eo ❑ NA ❑ NE
the appropriate box. ❑ WUp ❑ Checklists ❑ Design El Maps El Other
21. Do record keeping need im ovement? I e epprepria ❑ Yes No ❑ NA ❑ NE
—�aste Application Wely Freeboard Waste Analysis Soilalysis (� Waste Transfers tiort
�yRainfall Stocking ISd Crop Yield 120 to
Inspections LVJ Monthly and 1" Rain Inspections Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes V No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 1KNo ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes �TNo ❑ NA ❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit? ❑ Yes ,XNo ❑ NA ❑ NE
26. Did the facility fail to have an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ❑ Yes No ❑ NA ❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes , fNo [I NA [I NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document El Yes p(1 No El NA El NE
and report the mortality rates that were higher than normal? /�
30. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes 1]Q No [I NA El NE
If yes, contact a regional Air Quality representative immediately �C
31. Did the facility fail to notify the regional office of emergency situations as required by ❑ Yes No ❑ NA ❑ NE
General Permit? (ic/ discharge, freeboard problems, over application) r
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes N ❑ NA ❑ NE
33. Does facility require a follow-up visit by same agency? ❑Yes No ❑ NA ❑ NE
a cx� q ?
al 0?009 sot I sow>Jp lens ? - 1
�5. �I e�e� ►Joy �C�-t-�- ��
V� 0.sfc a�alv�ses o
le�a4�o2y �.Ni 1//oq= z.q Ibc Nl/cba
/lower°

, ., r� Dtv�s�on of Water Qualil Q
Fax HUY Number' Division of Soil and Water Conservation ! 3Q
�n Other Agency
y
Type of Visit Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: , F� Departure Time: 0 3 0 County: �U rr a Region: ILL R= v
Farm Name: t t ") / :4 5 Owner Email:
�,l rr
Owner Name: ' ' W (-FP Phone: �VUy3 iQGt
Mailing Address: —) I0S" i.LIP,IM rn r [L Il-,0CLJ g C I l<in
Physical Address:
Facility Contact: .1Qe t_t I.LAIP Title:
Onsite Repreese�ntt�attive:
Certified Op r1E aFor: 1
Back-up Operator:
Location of Farm:
Phone No: C 3 — 076
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: ®o [D, ®.. Longitude: 1001U, ®"
Depsgn Current
Design :Current
r.,
Design ti;,
CPacirY Po ation
till_ l
Wet PaltrY Capacity Po ulation
Cattle Ca acttY ,Po'Pulation-
(='
❑
Wean to Finish
❑ Layer
❑ Dairy Cow
"{
El
Wean to Feeder
10Non-Layer
I
Dairy Calf
�fi ❑ Feeder to Finish
- ❑ Dairy Heifer
Farrow to Wean a
Dry Poultry
❑ Dry Cow
14
Farrow to Feeder
❑ Layers
❑ Non -Dairy
4 ❑ Farrow to Finish
El Beef Stocker
El Gilts
i. Non -Layers
❑ Beef Feeder
El Boars
El pallets
El Beef Brood Cow
ElTurkeys
Other '
❑ Turkey Poults
_
❑ Other
❑ Other
Number of Structures
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes x
No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
0
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes �(No
❑ Yes *No
12128104
❑ NA ❑ NE
❑NA ❑NE
Continued

Facility Number: — • Date of Inspectionr�
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes ;KNo
❑ 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: J.aa
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 1 1
5. Are there any immediate to thr"'eatts to the integrity of any of the structures observed?
❑ Yes �kNo
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes �(No
❑ NA
❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes �(No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes XNo ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes [ No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes KNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes k'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 Acce table Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
a
12. Crop type(s)
13. Soil type(s)
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
4 No
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
Dk o
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre detennination ?
❑ Yes
WNo
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
0 No
ElNA
ElNE
18.
Is there a lack of properly operating waste application equipment?
ElYes
WNo
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):.
er/Inspector Name (QL� Phone:er/Inspector Signature Date: 5 t7
t
Page 2 of 3 1 - v - 12128104 Continued

Facility Number: •Date of Inspection •
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ACJ No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists I� ❑ Design El Maps El Other
21. Do record keeping need imp vemen[? 1 ❑ Yes No ❑ NA ❑ NE
Waste Applica ' n Wee y Freeboard ❑Waste Analysis `U' Soil An lysis � t�
ainfaII Stocking ` Crop Yield 120 Minute Inspections Monthly and I" Rain Inspections Bather 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
0 NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
A,No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
lNo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
QkNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
ANo
❑ 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
XNo
❑ 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
I*o
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
No
❑ NA
❑ NE
Additional Comments and/or Drawings:
4
Sj>�,, 5 u r Ve tj VnoA- vtr-cA un+11 LQ009 .
D u E, 8QJ. 0-007+

Number
Division of Water Quality
Division of Soil and Water onservntion n �
0 Other Agency 7
IType of Visit Compliance Inspection O Operation Review O Structure Evaluation Q Technical Assistance I
Reason for Visit Routine O Complaint O Follow up O Referral 0 Emergency O Other ❑ Denied Access
Date of Visit: ,�t Arrival Time: Departure Time: County: L
r r Region: -.JPQ
4i' Farm Name: —_bo Far- mS Owner Email:
Owner Name: C ' L Lo h t 2 Phone: 1(o (,q " U U
Mailing Address: T `] Q.l eA �( VZ F-U • ��J h N . o� ip o�—j
Physical Address:
+/
Facility Contact: �•'ey w VA, Ve- Title: Phone C o(:� 3tP'P� C)1
.1 �1
Onsite Representative: O-Cy�� i }� Integrator: S M ti tf d
Certified Operator: C�ld r I T- �1 1 �Q Operator Certification Number:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Other
❑ Other
Back-up Certification Number:
Latitude: ®e I«' [ D "Longitude: MOM I
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
i
❑ Non -Layer
Dry Poultry
Pullets
Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current,
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocket
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures: EE
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 f KNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
0
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
tk5io
❑ NA
❑ NE
❑ Yes
Io
❑ NA
❑ NE
12128104 Continued

Facility Number. — �.g • Date of Inspection ( 0
Waste Collection & Treatment ��rr//__""
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: Q wn
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
NNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes
[XNo ❑ NA El NE
through a waste management or closure plan?
TT''
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes
N'o ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
$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
qNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
jNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
- No ❑ NA ❑ NE
ElExcessive Pending ❑ 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 ❑ Evidenc of Wind Drifl ❑ Application Outside of Area
12. Crop type(s) �V�IIt1tA-.0 a,L)
'.
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
4No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
IgNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
6 No
❑ NA
FINE
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):
Reviewer/Inspector Name VVI A2 I L5501 OS6. Irb Phone: I — sa 19 I
Reviewer/Inspector Signature.1.6_fiDate: 9 J ) ) to 'Z
UA, At*.� . s /2/28/04 Continued

Facility Number: $ — a? 4?ate of Inspection iWT U /J •
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes IyNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes $No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Doe record keeping need im rovement? If yes, check he appropriate box b ow. ❑ Yes *5rNo ❑ NA ❑ NE
R(waste Applica ' n 9Wee ly Freeboard L� aste Analysis ,oiil, lysis `�-..aswrr- T mm"er3 ❑
Ib Rainfall Stocking IrJ Crop Yield 120 Minute Inspections ; onthly and I" Rain Inspections eather Code
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge'?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes No
❑ Yes / No
❑ Yes ,�No
❑ Yes [(No
❑ Yes wIo
❑ Yes VNO
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ Yes dNo ❑ NA ❑ NE
❑ Yes $No ❑ NA ❑ NE
[:]Yes N;�4o ❑ NA ❑ NE
❑ Yes
�610
❑ NA
❑ NE
❑ Yes
X No
❑ NA
❑ NE
❑ Yes
VNo
❑ NA
❑ NE
Additional Comments and/or Drawings:
a5 No- replrecl uRJ6I 2009 w due- V1 io
`
12128104

Division of Water Quality
❑ Division of Soil and Water Conservation
❑ Other Agency
Facility Number: 860028 Facility Status: Active Permit: AWS860028 ❑ Denied Access
Inspection Type: Compliance Inspection Inactive or Closed Date:
Reason for Visit: Routine County: Surry Region: Winston-Salem
Date of Visit: 11/03/2006 Entry TIme:09:10 AM Exit Time: 10:40 AM Incident #:
Farm Name: W4 Farms Owner Email:
Owner: C L White
Mailing Address: 705 Salem Fork Rd Elkin NC 28621
Physical Address:
Facility Status: ❑ Compliant ❑ Not Compliant Integrator:
Location of Farm:
not given map, attached to plan
Question Areas:
Discharges & Stream Impacts
Records and Documents
Certified Operator: Charles J White
Secondary OIC(s):
alY-I41rli-1:L•le8�
Latitude:36°22'27" Longitude:80°46'55"
Waste Collection & Treatment Waste Application
Other Issues
Operator Certification Number: 20054
On -Site Representative(s): Name Title Phone
On -site representative Joey White Phone: [phone]
24 hour contact name Joey White 1 Phone: [phone]
Primary Inspector: i sa Rosebrock Phone:
Inspector Signatu Date:
Secondary Inspector(s):
Inspection Summary:
4. Forgot to record freeboard. Was between 36-48 inches.
21. Records are excellent!
24. Suggest keeping copy of performance sheet with calibration records.
10/3/06 waste analysis=2.1 lbs. N/1000 gal.
Page: 1

Permit: AWS860028 Owner- Facility: C L White Facility Number: 860028
Inspection Date: 11/03/2006 Inspection Type: Compliance Inspection Reason for Visit: Routine
Regulated Operations Design Capacity Current Population
Swine
O Swine - Farrow to Wean 2,400 2,312
Total Design Capacity: 2,400 I
Total SSLW: 1,039,200
Waste Structures
Type Identifier Closed Date Start Data Designed Freeboard Observed Freeboard
agoon LAGOON 24.00 i
a
a
Page: 2

Permit: AWS860028 Owner -Facility: C L White Facility Number: 860028
Inspection Date: 11/03/2006 Inspection Type: Compliance Inspection Reason for Visit: Routine
Discharges S Stream Impacts
Yes
No
NA
NE
1. Is any discharge observed from any part of the operation?
❑
■
❑
Cl
Discharge originated at:
Structure
❑
Application Field
. ❑
Other
❑
a. Was conveyance man-made?
❑
■
❑
❑
b. Did discharge reach Waters of the State? (if yes, notify DWQ)
❑
■
❑
❑
c. Estimated volume reaching surface waters?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
Cl
■
Cl
❑
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 Waters of the State other than from a
❑
■
Cl
❑
discharge?
Waste Collection, Storage & Treatment
Yes
No
NA
NE
4. Is storage capacity less than adequate?
❑
■
❑
❑
If yes, is waste level into structural freeboard?
❑
5. Are there any immediate threats to the integrity of any of the structures observed (Led large trees, severe
❑
■
Cl
❑
erosion, seepage, etc.)?
6. Are there structures on -site that are not properly addressed and/or managed through a waste management ❑
■
❑
❑
or closure plan?
7. Do any of the structures need maintenance or improvement?
❑
■
❑
❑
8. Do any of the structures lack adequate markers as required by the permit? (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 maintenance or
❑
■
❑
❑
improvement?
Waste Application
Yes
No
NA
NE
10. Are there any required buffers, setbacks, or compliance alternatives that need maintenance or
❑
■
❑
❑
improvement?
11. Is there evidence of incorrect application?
❑
■
❑
❑
If yes, check the appropriate box below.
Excessive Ponding?
❑
Hydraulic Overload?
❑
Frozen Ground?
❑
Heavy metals (Cu, Zn, etc)?
❑
Page: 3

Permit: AWS860028 Owner -Facility: C L White
Facility Number:
860028
Inspection Date: 11/03/2006 Inspection Type: Compliance Inspection
Reason for Malt: Routine
Waste Application
Yea No
NA NE
PAN?
Cl
Is PAN > 10%/10 lbs.?
❑
Total P205?
Cl
Failure to incorporate manure/sludge into bare soil?
❑
Outside of acceptable crop window?
❑
Evidence of v✓ind drift?
❑
Application outside of application area?
❑
Crop Type 1
Corn (Silage)
Crop Type 2
Small Grain (Wheat,
Barley,
Oats)
Crop Type 3
Crop Type 4
Crop Type 5
Crop Type 6
Soil Type 1
Soil Type 2
Soil Type 3
Soil Type 4
Soil Type 5
Soil Type 6
14. Do the receiving crops differ from those designated in the Certified Animal Waste Management
❑ ■
❑ ❑
Plan(CAWMP)?
15. Does the receiving crop and/or land application site need improvement?
❑ ■
❑ ❑
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination? ❑ ■
❑ ❑
17. Does the facility lack adequate acreage for land application?
❑ 0
❑ ❑
18. Is there a lack of properly operating waste application equipment?
❑ 0
❑ Cl
Records and Documents
Yea No
NA NE
19. Did the facility fail to have Certificate of Coverage and Permit readily available?
❑ ■
❑ ❑
20. Does the facility fail to have all components of the CAWMP readily available?
❑ E
❑ ❑
If yes, check the appropriate box below.
WUP?
❑
Page:4

Permit: AWS860028 Owner- Facility: C L White Facility
Number:
860028
Inspection Data: 11/03/2006 Inspection Type: Compliance Inspection Reason for Visit: Routine
Records and Documents
Yea
No
NA
NE
Checklists?
❑
Design?
❑
Maps?
❑
Other?
❑
21. Does record keeping need improvement?
❑
■
❑
❑
If yes, check the appropriate box below.
Waste Application?
❑
120 Minute inspections?
❑
Weather code?
❑
Weekly Freeboard?
❑
Transfers?
❑
Rainfall?
❑
Inspections after> 1 inch rainfall & monthly?
❑
Waste Analysis?
❑
Annual soil analysis?
❑
Crop yields?
❑
Stocking?
❑
Annual Certification Form (NPDES only)?
❑
22. Did the facility fail to install and maintain a rain gauge?
❑
■
❑
❑
23. If selected, did the facility fail to install and maintain a rainbreaker on irrigation equipment (NPDES only)?
❑
■
❑
❑
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?
❑
■
❑
Cl
26. Did the facility fail to have an actively certified operator in charge?
❑
■
❑
❑
27. Did the facility fail to secure a phosphorous loss assessment (PLAT) certification?
❑
❑
■
❑
Otherlssues
Yes
No
NA
NE
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 those
❑
■
❑
❑
mortality rates that exceed normal rates?
30. At the time of the inspection did the facility pose an air quality concern? If yes, contact a regional Air
Cl
■
❑
❑
Quality representative immediately.
Page: 5

e
Permit: AWS860028 Owner- Facility: C L White Facility Number: 860028
Inspection Date: 11/03/2006 Inspection Type: Compliance Inspection Reason for Visit: Routine
Otherlssues Yes No NA NE
31. Did the facility fail to notify regional DWQ of emergency situations as required by Permit?
32. Did Reviewer/inspector fail to discuss review/inspection with on -site representative?
33. Does facility require a follow-up visit by same agency?
❑ ■ ❑ ❑
Page: 6

Division of Water Quality
Facility Number _ $� ivision of Soil and Water Conservation
.Other Agency
Type of Visit
Compliance Inspection
O Operation Review O Structure Evaluation
O Technical Assistance
Reason for Visit
9 Routine 0 Complaint
0 Follow up 0 Referral 0 Emergency
0 Other ❑ Denied Access
Date of Visit: '' Arrival Time: Departure Time: County: Ut'r- x,
l Region:' /��0A
'
Farm Name: W Farm,5 Owner Email: 11 w 14 L% L
Owner Name: LL WK1�t' Phone: JiO6 13MMSUI'r� ilel
Mailing Address: OS S d (tyK t6*- V_ t El le-i " , t'� ;z 8 67 21
Physical Address: "�
Facility Contact: -�! 8t LA Title:
Onsite Representative: tj 11
Certified Operator: Oj�
Back-up Operator:
Location of Farm:
Phone No: C _ 0 76
Integrator:
miuKbi
Operator Certification Number: t
a0ps e
Back-up Certification Number:
11
Latitude: ®c ® ® Longitude:
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population
❑ Wean to Finish 1 ❑ Layer
❑ Wean to Feeder i1 ❑ Non -Layer _J
r1 - _
LJ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other, .
❑ Other
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullers
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
Cattle
Design Current
Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures: 1 ICJ
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes �No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
0
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
*0
[]NA
❑ NE
❑ Yes pQ No ❑ NA ❑ NE
Page 1 of 12128104 Continued

Facility Numb • Date of Inspection I L 1 I :1 1 de
WasteCollection & Treatment ��{��
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier: (moor
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes )No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes �No ❑ NA ❑ NE
❑ Yes 9No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes '4No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes $No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes IQNo ❑ NA [I NE
El Excessive Ponding El Hydraulic Overload ❑ Frozen Ground [3 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. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ Yes
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
17. Does the facility lack adequate acreage for land application? ❑ Yes
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ NA ❑ NE
XNo ❑ NA ❑ NE
JNo ❑ NA El NE
ElNA ❑ NE
❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/Inspector Name Q ( Phone: —
Reviewer/Inspector Signature. Date: 1
Page 2 of 3 " 12178104 - Continued

Facility Number: — Ote 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 CA WMP readily available? If yes, check ❑ Yes / ❑ NA ❑ NE
❑ Design ❑Maps Other
the appropriate box. ❑ WUP ❑ Checklists ` 21.D_(QL,es record keeping need�.i/_'},t�/rovement? pprepreele-bex-lielvw. ❑ Yes V No ❑ NA ❑ NE
L+ Dante Application 1=1 Wely Freeboard Waste Analysis Eoil alysis "�..er' '"n�nan`-re-- euEien
I� Rainfall �tocking u 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 XNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes �o ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit? El Yes No ❑ NA ❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit? ❑ Yes No ❑ NA ❑ NE
26. Did the facility fail to have an actively certified operator in charge? ❑ Yes I No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ❑ Yes ❑ No *A ❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes N7o ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document ❑yes o ❑ NA ❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes XNo ❑ 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? El Yes No ❑ NA ❑ NE
33. Does facility require a follow-up visit by same agency? ❑ Yes Vo ❑ NA ❑ NE
Additional Comments and/or Drawings:
1a13do(o - a.\ ice- N/ 1ooa
®
Page 3 of 3 12128104

Division of Water Quality
❑ Division of Soil and Water Conservation
❑ Other Agency
Facility Number: 860028 Facility Status: Active Permit: AWS860028 ❑ Denied Access
Inspection Type: Compliance Inspection
Inactive or Closed Date:
Reason for Visit: Routine
County: Surry
Region: Winston-Salem
Date of Visit: 03/08/2005 Entry Time:09,40 AM
Exit Time: 11,05 AM Incident #:
Farm Name: W4 Farms
Owner Email:
Owner: C L White
Phone: [phone]
Mailing Address: 705 Salem Fork Rd
Elkin NC 28621
Physical Address:
Facility Status: ❑ Compliant ❑ Not Compliant
Integrator:
L & H Farms
Location of Farm:
Latitude:
36°22'27" Longitude: 80°46'55"
not given map, attached to plan
Question Areas:
Discharges & Stream Impacts 0 Waste Collection & Treatment
Waste Application
Records and Documents Other Issues
Certified Operator: Charles J White
Operator Certification Number: 20054
Secondary OIC(s):
On -Site Representative(s): Name
Title Phone
On -site representative Joey White
Phone: [phone]
24 hour contact name Joey White
Phone: [phone]
Primary Inspector: Melissa M Rosebrock
Phone: [phone]
Ext.383
Inspector Signature:
Date:
Secondary Inspector(s):
Phone:
Phone:
Inspection Summary:
18. Operator had already installed pressure gauge on irrigation gun.
21. Went over new permit requirements with operator.
21. February 2005 applications utilized a waste analysis of 1.7 lbs. N/1000 gal for PAN calculations. Since this is a little low for this
farm, may want to check when new sample comes back.
Page: 1

f
Permit: AWS860028 Owner- Facility: C L White
Inspection Dale: 03/08/2005 Inspection Type: Compliance Inspection
Regulated Operations
Facility Number: 860028
Reason for Visit: Routine
Design Capacity Current Population
Swine
® Swine - Farrow to Wean 2,400 2,335
Total Design Capacity: 2,400
Total SSLW: 1,039,200
Waste Structures
Tvoe Identifier Closed Data Start Date Dealoned Freeboard Observed Freeboard
Lagoon LAGOON 38.00
Page: 2

Permit: AWS860028 Owner -Facility: CLWhite Facility Number: 860028
Inspection Date: 03/08/2005 Inspection Type: Compliance Inspection Reason for Visit: Routine
MgrharQee_ A Stream Imnacts
1. Is any discharge observed from any part of the operation?
Vas
❑
No NA
moo
NF
Discharge originated at:
Structure
❑
Application Field
❑
Other
❑
a. Was conveyance man-made?
❑
■ ❑
❑
b. Did discharge reach Waters of the State? (if yes, notify DWO)
❑
0 ❑
❑
c. Estimated volume reaching surface waters?
d. Does discharge bypass the waste management system? (if yes, notify DW0)
❑
0 ❑
❑
2. Is there evidence of a past discharge from any part of the operation?
❑
0 ❑
❑
3. Were there any adverse impacts or potential adverse Impacts to Waters of the State other than from a discharge?
❑
vas
0 ❑
No NA
❑
NF
Waste Collection. Storage A Treatment
4. Is storage capacity less than adequate?
❑
M ❑
❑
If yes, Is waste level into structural freeboard?
❑
5. Are there any Immediate threats to the integrity of any of the structures observed (ke./ large trees, severe erosion,
❑
M ❑
❑
seepage, etc.)?
6. Are there structures on -site that are not properly addressed and/or managed through a waste management or
❑
0 ❑
❑
closure plan?
7. Do any of the structures need maintenance or Improvement?
❑
0 ❑
❑
8. Do any of the structures lack adequate markers as required by the pennit? (Not applicable to roofed pits, dry stacks
❑
M ❑
❑
and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require maintenance or
❑
■ ❑
❑
improvement?
Vas
No NA
NF
West Iirp .ation
10. Are there any required buffers, setbacks, or compliance alternatives that need maintenance or Improvement?
❑
0 ❑
❑
11. Is there evidence of incorrect application?
❑
❑
❑
If yes, check the appropriate box below.
Excessive Ponding?
❑
Hydraulic Overload?
❑
Frozen Ground?
❑
Heavy metals (Cu, Zn, etc)?
❑
PAN?
❑
Is PAN> 10%/10 lbs.?
❑
Total P2O57
❑
Failure to Incorporate manure/sludge Into bare soil?
❑
Outside of acceptable crop window?
❑
Evidence of wind drift?
❑
Application outside of application area?
❑
Crop Type 1
Soybeans
Crop Type 2
Corn (Sllage)
Crop Type 3
Corn (Grain)
Crop Type 4
Alfalfa
Crop Type 5 Fescue (Hay, Pasture)
Page: 3

• • r
Permit: AWS860028 Owner -Facility: C L White
Facility Number: 860028
Inspection Date: 03/08/2005 Inspection Type: Compliance Inspection
Reason for Visit: Routine
Waste Applinnfirin
Crop Type 6
Vag No NA NE
Small Grain (Wheat,
Barley,
Oats)
Soil Type 1
Sol] Type 2
Soil Type 3
Soil Type 4
Soil Type 5
Soil Type 6
14. Do the receiving crops differ from those designated in the Certified Animal Waste Management Plan(CAWMP)? 00
❑
❑
15. Does the receiving crop and/or land application site need Improvement?
❑
0 ❑
❑
16. Did the facility fall to secure and/or operate per the Irrigation design or wettable acre determination?
❑
0 ❑
❑
17. Does the facility lack adequate acreage for land application?
❑
0 ❑
❑
18. Is there a lack of properly operating waste application equipment?
❑
yns
N ❑
No NA
❑
NF
Records and Documents
19. Did the facility fail to have Certificate of Coverage and Permit readily available?
❑
N ❑
❑
20. Does the facility fail to have all components of the CAWMP readily available?
❑
0 ❑
❑
If yes, check the appropriate box below,
WUP?
❑
Checklists?
❑
Design?
❑
Maps?
❑
Other?
❑
21. Does record keeping need improvement?
E
❑ ❑
❑
If yes, check the appropriate box below.
Waste Application?
❑
120 Minute inspections?
❑
Weather code?
❑
Weekly Freeboard?
❑
Transfers?
❑
Rainfall?
❑
Inspections after> 1 inch rainfall & monthly?
0
Waste Analysis?
❑
Annual soil analysis?
❑
Crop yields?
❑
Stocking?
❑
Annual Certification Form (NPDES only)?
❑
22. Did the facility fail to Install and maintain a rain gauge?
❑
goo
23. If selected, did the facility fail to Install and maintain a minbreaker on irrigation equipment (NPDES only)?
❑
moo
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑
moo
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑
m ❑
❑
26. Did the facility fail to have an actively certified operator in charge?
❑
E ❑
❑
Page: 4

r-I
u
L
Peril: AWS860028
Owner- Facility: C L White
Facility Number: 860028
Inspection Date: 03/08/2005 Inspection Type: Compliance Inspection Reason for Visit: Routine
27. Did the facility fail to secure a phosphorous 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 those mortality
rates that exceed normal rates?
30. At the time of the Inspection did the facility pose an air quality concern? If yes, contact a regional Air Quality
representative immediately.
31. Did the facility fail to notify regional DWQ of emergency situations as required by Permit?
32. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
33. Does facility require a follow-up visit by same agency?
0
Page: 5

j Type of Visit X Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit (UrRoutine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: 1 Arrival Time:� ] Departure Time: County: -r�� r Region: �
Farm Name: jw) t ra r m s Owner Email: J O (� TC
J 7
Owner Name:-�/ 1,�.�h I�e— Phone: _3b1��6�,7
Mailing Address: / DSO .Sn -eAm Fo r lc 1� E� K I In I N C_
Physical Address: ��1
Facility Contact: 2 I AD 1 Title: Phone No v V-76-,
L
Onsite Representative: S�'�� Lo tj I -,0—L Integrator: 114, P
Certified Operator. Cho.l 1I �• L�. 'h�Operator Certification Number: abb5
Back-up Operator:
Location of Farm:
Back-up Certification Number:
Latitude: ®° ® ® Longitude:
S
�( Destgn Current'
Swipe Ca aci iPo ulation
tYp,
WffitP.uItjtCapi,ifP0t
esigurrent
a '�.. w
;; 8De5tgn Current
Maon Cattle Ca acr Po ulafionp
.,a �k.�P . �? p�
{
..
❑ Wean to Finish
❑ La er
❑ Dairy Cow
❑ Wean to Feeder
❑Non -La er
ODairy Calf
Feeder to Finish
Dry Roultry
Dairy Heifer
Farrow to Wean
❑ Dry Cow
Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Non -Dairy
❑ La ers
❑ N Nets ers
El Pullets
Li Turkc s
❑Beef Stocker
El Beef Feeder
❑ Beef Brood Cow
Number of Structures:_ n
❑ TurkeyPouets
❑ Other
❑ Other
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? (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 J�No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
0
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes X, NNo ❑ NA ❑ NE
El Yes 0 ❑ NA ❑ NE
12128104 Continued

Facility Number: — • Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes *No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Stricture 2 Structure 3 Structure 4 Stricture 5 Structure 6
Identifier: !!``
Spillway?: �l
Designed Freeboard (in): r' )
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes t
ElNA ElNE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ElYes ❑ 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
Z40
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
[No
ElNA
❑ 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
YNo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No
❑ NA
❑ NE
maintenance/improvement?
/
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
XNo
ElNA
[INE
❑ Excessive Ponding ElHydraulic 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
12. Croptype(s)
13. Soil type(s)
14. Do the receiving crops differ from those
❑ Evidence of Wind Drill ❑ Application Outside of Area
❑ Yes
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination`❑ Yes No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes No ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes bj�o ❑ NA ❑ NE
Pressure ����e.5 on — 04 /
IReviewer/Inspector Name �I Y I �'� ja-''C�Q ` �Ql' d .��'_k f ; ". Phone: 39
Reviewer/inspector Signatur . M l i l j Al? _it Date: $ OS
12128104 Continued

Facility Number: — oZ$ Dot Inspection Imo/ •
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 Vo ❑ NA ❑ NE
ElEl❑ Design El ❑Other
the appropirate box. WUP Checklists ��/��/ VVVVVV
21. Do s record keeping need impr'vement? If yes, the k the appropriate box//below. �// l Yes [:]No [:]NA ❑ NE
aste Application ❑ �ekly Freeboard 'aste Analysis LYSoiI nalysis L�J Waste Transfers7=""�
ainfall❑ Sticking ❑ Croo�ield 20MingteInspections Monthly and V Rain Inspectionsather Code
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes KNo ❑ NA ❑ NE
❑ Yes ❑ NA ❑ NE
❑ YestNZ'
❑ NA FINE
❑ Yes jK, NNo ❑ NA ❑ NE
❑ Yes ky�No []NA ❑ NE
❑ Yes �KNo ❑ NA ❑ NE
❑ Yes XNo
❑ NA ❑ NE
❑ Yes XNo
❑ NA ❑ NE
❑ Yes XNo
❑ NA ❑ NE
❑ Yes )_J<No
❑ NA ❑ NE
❑ Yes o
❑ NA ❑ NE
❑ Yes,No
❑ NA ❑ NE
Additional Comments and/fir Drawings.
12/2"4
12/2"4

a Technical Assistance Site Visit
Natural Resources Conservation Sei
Soil and Water Conservation District
Other...
Facility Number 86 - 28 Date: 10/12/04 Time: 11:30 Time On Farm: 75 WSRO
Farm Name W4 Farms
County Surry Phone: [phone]
Mailing Address 705 Salem Fork Road Elkin NC 28621
Onsite
Representative Joey White Integrator lPremium Standard Farms
Compliance Inspection (pilot only)
Technical Assistance
Confirmation for Removal
❑ Operating below threshold
IN Swine ❑ Poultry ❑ Cattle ❑ Horse
Design Current
Capacity Population
❑ Wean to Feeder
❑ Feeder to Finish
® Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
2400
W2350
Purpose Of Visit
Response to DWQ/DENR referral
Response to DSWC/SWCD referral
Response to complaint/local referral
Requested by producertintegrator
Follow-up
Emergency
Other...
Design Current
Capacity Population
❑ Layer
❑ Non Layer
❑ Dairy
❑ Non -Dairy
❑ Other
GENERAL QUESTIONS:
1. Is waste discharging from any part of the operation and reaching surface waters or wetlands? ❑ yes ® no
2.
❑ Dairy
❑ Non -Dairy
❑ Other
GENERAL QUESTIONS:
1. Is waste discharging from any part of the operation and reaching surface waters or wetlands? ❑ yes ® no
2.
❑ Other
GENERAL QUESTIONS:
1. Is waste discharging from any part of the operation and reaching surface waters or wetlands? ❑ yes ® no
2.
Is there evidence of a past waste discharge from any part of the operation that waste reached
❑ yes
® no
surface waters or wetlands?
3.
Does any problem pose an immediate threat to the integrity of the waste structure (large trees,
❑ yes
® no
seepage, severe erosion, etc.)?
4.
Is there evidence of nitrogen over application, hydraulic overloading or excessive ponding
[]yes
® no
requiring DWQ notification?
5.
Is there evidence of improper dead animal disposal that poses a threat to the environment
[]yes
® no
and/or public health?
6.
Is the waste level within the structural freeboard elevation range for any waste structure?
❑ yes
® no
Structural Structure 2 Structure 3 Structure 4 Structure 5
Identifier Lagoon
Level (inches) 30
CROP TYPES ICom Soybeans Wheat Fescue raze j jFescue-hay
SPRAYFIELD
SOIL TYPES Fairview
7. What type of technical assistance does the onsite representative feel is needed? (list in comment section)
1 03/10/03

0 •
Facility Number 86 - 28 Date:
10/12/04
PARAMETER
Q No assistance provided/requested
❑ 8.
Waste spill leaving site
TECHNICAL ASSISTANCE Needed
Provided
❑ 9.
Waste spill contained on site
25. Waste Plan Revision or Amendment
El
El
10.
Level in structural freeboard
26. Waste Plan Conditional Amendment
❑
❑
❑ 11.
Level in storm storage
27. Review or Evaluate Waste Plan w/producer
❑
❑
❑ 12.
Waste structure integrity compromised
28. Forms Need (list In comment section)
❑
❑
❑ 13.
Waste structure needs maintenance
29. Missing Components (list In comments)
❑
❑
[114.
Over application >= 10% & 10 lbs.
❑
❑
[115.
Over application < 10% or < 10 lbs.
30. 21-1.0200 recertification
[116.
Hydraulic overloading
31. Five & Thirty day Plans of Action (PoA)
❑
❑
32. Irrigation record keeping assistance
❑
❑
❑ 17. Deficient irrigation records
❑ 18.
Late/missing waste analysis
33. Organize/computerization of records
❑
❑
❑ 19.
Late/missing lagoon level records
34. Sludge Evaluation
❑
❑
❑ 20. Late/missing soils analysis
[121.
Crop needs improvement
35. Sludge or Closure Plan
❑
❑
❑ 22.
Crop inconsistent with waste plan
36. Sludge removal/closure procedures
❑
❑
37. Waste Structure Evaluation
❑
❑
❑ 23. Irrigation maintenance deficiency
❑ 24.
Deficient sprayfield conditions
38. Structure Needs Improvement
❑
❑
39. Operation & Maintenance Improvements
❑
❑
40. Marker check/calibration
❑
❑
Reaulatory Referrals
41. Site evaluation
❑
❑
❑ Referred to DWQ Date:
42. Irrigation Calibration
❑
❑
❑ Referred to NCDA Date:
Irrigation designfinstallation
El
El
El Other...
43. system
Date:
44. Secure Irrigation Information (maps, etc.)
❑
❑
LIST IMPROVEMENTS
45.Operating Improvements (pull signs, etc.)
❑
Cl
MADE BY OPERATION
46. Wettable Acre Determination
❑
❑
1
47. Evaluate WAD certification/rechecks
❑
❑
48. Crop evaluation/recommendations
❑
❑
2.
49. Drainage worklevaluation
❑
❑
50. Land shaping, subsoiling, aeration, etc.
51. Runoff control, stormwater diversion, etc.
❑
❑
❑
❑
3
52. Buffer Improvements
❑
❑
53. Field measurements(GPS, surveying, etc.)
❑
❑
4.
54. Mortality BMPs
❑
❑
55. Waste operator education (NPDES)
❑
❑
5.
56. Operation & maintenance education
❑
❑
57. Record keeping education
❑
19
6
58. Crop/forage management education
❑
❑
03/10/03

a 1 59. Soil and/or waste sampling education ❑ ❑
Facility Number 86 - 28 Date: 10/12/04
COMMENTS:
Waste Analysis: 10/08/04 ALS 1.7 Ibs.N/1000 gals. I, 7/23/04 ALS 2.8 Ibs.N/1000 gals. I
Soil samples dated 3/02/04 looked good.
Facility and records look good. Good farm.
Mr. White has received his new C.O.C. and general permit.
• Mr. White will start using the new application forms on the next waste applications.
TECHNICAL SPECIALIST IRocky Durham I rony Davis
03/10/03

Facility Number 86 28 Dale of Visit: 4/IS/2004 Time: 0940
Not Operational O Below Threshold
M Permitted ® Certified [3 Conditionally Certified E3 Registered Date Last Operated or Above Threshold_ _ __
FarmName: WI aKms.............................................................................. County: 511rxy ...................................... WIJ&Q......
Owner Name: C.i ,._.-.-.-•---._._._._ Rbite--.-•-.-.-.-•-•-------.-.-.-. Phone No: 33d 365=4443--•-•-•-•-------•---•---._._..
Mailing Address: ..7.0S..Salem.lAKlf.iiclmd........................................................................ ENJI..J.![C................................................................. 2>I U..............
FacilityContact: JneY..White.........................................Title:............................................... Phone No:......................................
Onsite Representative: JDcy--''1111te.-.-•-------------------------------•---_ Integrator:h&.HkHIJ[IS.-•-•-.-.-•--------_._._._._..
Certified Operator:Cliarls.d.............................. kY. UR................................................. Operator Certification Number:2QQS.9.............................
Location of Farm:
tot given map, attached to plan
Swine [IPoultry ❑ Cattle
®"Swore
❑ Horse Latitude 36 • 22
-111
27 Longitude 80 • 46 S5
Design
Current
Design Current
a acit
Population Poultry Capacity
Population Cattle
Capacity Population
❑ Wean to Feeder
10 Layer
Ic Dairy
❑ Feeder to Finish
❑ Non -Layer
JE1 Non -Dairy
® Farrow to Wean 2400
2335
❑ Farrow to Feeder
❑ Other
❑ Farrow to Finish
Total Design Capacity
2,400
❑ Gilts
I-1 Boars
TotalSSLW
1,039,200
Number of Lagoons I
_ _ ._ .._1 0
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes M No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (if yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes M No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes M No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? M Spillway ❑ Yes M No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ........ .agnnn........ ..................................................... ........................... ....
Freeboard (inches): 35
/1/11/03 0
Continued

Facility Number: 86-28 Date of Inspection 4/15/2004
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes ® No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑ Yes ® No
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes ® No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes ® No
9.
Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
❑ Yes
OR No
elevation markings?
Waste Application
10.
Are there any buffers that need maintenance/improvement?
❑ Yes
®No
11.
Is there evidence of over application? If yes, check the appropriate box below.
❑ Yes
®No
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12.
Crop type Alfalfa Corn (Silage & Grain) Soybeans
13.
Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
® No
14.
a) Does the facility lack adequate acreage for land application?
❑ Yes
®No
b) Does the facility need a wettable acre determination?
❑ Yes
®No
c) This facility is pended for a wettable acre determination?
❑ Yes
®No
15.
Does the receiving crop need improvement?
❑ Yes
®No
16.
Is there a lack of adequate waste application equipment?
❑ Yes
®No
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours?
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
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
Air Quality representative immediately.
New incinerator is installed and functioning.
Records look great!
10/04 waste analysis = 3.2 lbs. N/1000 gal.
Reviewer/Inspector Name M
❑ Yes ❑ No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
Field Copy ® Final Notes
Reviewer/Inspector Signature:
Date:
12112103 Continued

Facility [Number: 86-28 jeof Inspection 4/15/2004
Required
Records & Documents
21.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
®No
22.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ic/ WUP, checklists, design, maps, etc.)
❑ Yes
®No
23.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
% No
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
24.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
®No
25.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
®No
26.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
®No
27.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
®No
28.
Does facility require a follow-up visit by same agency?
❑ Yes
®No
29.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
® No
NPDES Permitted Facilities
30.
Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
❑ Yes
®No
31.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
32.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ No
33.
Did the facility fail to conduct an annual sludge survey?
❑ Yes
❑ No
34.
Did the facility fail to calibrate waste application equipment?
❑ Yes
❑ No
35.
Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below.
❑ Yes
❑ No
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall [-]Inspection After V Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
12112103

(Type of Visit O Compliance Inspection O Operation Review O Lagoon Evaluation( fJ(/ g{ fo_ ?lf . cK
on for Visit O Routine O Complaint O Follow up O Emergency Notification O Other �J ❑ Denied
Facility Number oZ Date of Visit: 0 Time:
Q Not Operational Q Below Threshold
® Permitted Q Certified [3 Conditionally Certified [3 Registered Date Last Operated or Above Threshold: .........................
FarmName: ... n......... A....a.�.......�..._I.................................................................... County: ......... CJf r/../.......`......t.../...,.../.......................
Owner Name: ....._L.t.. L.......... �. C........................................................... Phone No: ... 3.?J. i?........3_4 4 ....7.....L...T-. /...... ...
t� I p� r ..... ..
Mailing Address: ...aas.........�Q;I,Q !1 ............ �r_�� .....Ml.:.....L ►..<<..n.......i._NC'.................`.'.. 5;v..............
Facility Contact: .. Q...... �26'I..fe..................... Title: ................................................................ Phone No:
r..................................
Onsite Representative: ... Q w je................................�........... Integrator:..... � t...14.........r..�rn.�......................
Certified Operator:....... ..,..., .. .,, ,� 1 ,,,, erOtor Certification Number:...,., ,� 5.
Location of Farm: CLbYwon a etr Ups �lac� Y)� J o W k i f�- w� Sv r f T
FIQ Fj- �I
Latitude • 11 Longitude • ��7777-7-�
Swine []Poultry[]Cattle[]Horse® ©�
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
J'il li 6�9 102c)(
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
❑ Yes
❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
❑ Yes
❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
❑ Yes
❑ No
2. Is there evidence of past discharge from any part of the operation?
❑ Yes
*0
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
❑ Yes
No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? Spillway
"`
❑ Yes
No
Structure I Structure 2 Structure 3 ��/
Structure 4 Structure 5
Identifier: ........... 0�0.......................................... .................................... ................................... ................................... ..................
Structure 6
Freeboard (inches):
12112103
Continued

Facility Number: — Date of Inspection
5.
Are there any immediate threats to the inn egrity of any of the structures observed? (ie// trees, severe erosion,
❑ Yes
No
seepage, etc.)
6.
Are there structures on -site which are not properly addressed and/or managed through a waste management or
❑ Yes
No
closure plan?
(If any of questions 4.6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7.
Do any of the structures need maintenance/improvement?
❑ Yes
No
8.
Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
No
9.
Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
❑ Yes
No
elevation markings?
Waste Application
10.
Are there any buffers that need maintenance/improvement?
❑ Yes
No
11.
Is there evidence of over application? If yes, check the appropriate box below.
❑ Yes
No
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload Frozen Ground ❑ Copper and/or Zinc
12.
Crop type
13.
Do the receiving crops differ with th a designated in the Ce 'fied A imal Waste Management Plan (CAWMP)?
❑ Yes
o
14.
a) Does the facility lack adequate acreage for land application?
❑ YesZNo
b) Does the facility need a wettable acre determination?
❑ Yes
No
c) This facility is pended for a wettable acre determination?
❑ Yes
No
15.
Does the receiving crop need improvement?
❑ Yes
)(No
16.
Is there a lack of adequate waste application equipment?
❑Yes
KNo
Odor Issues
17.
Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
-E3-yeo-_E3.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
6No
19.
Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
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
XNo
Air Quality representative immediately.
boogc°�P
�olalo3 N = 3.a 1OC6 P.
Reviewer/Inspector Name
ReviewerAnspector Signa
Field Copy ❑ Final Notes
Date:

Facility Number: — of Inspection
•
Required Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes ANo
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.) ❑ Yes KNO
23. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes X<o
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
24.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
No
25.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
No
26.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
No
27.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ YesfNo
0
28.
Does facility require a follow-up visit by same agency?
❑ Yeso
29.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
ElYes
NPDES
Permitted Facilities
30.
Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
-BA es-9
No
31.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
32.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ No
33.
Did the facility fail to conduct an annual sludge survey?
❑ Yes
❑ No
34.
Did the facility fail to calibrate waste application equipment?
❑ Yes
❑ No
35.
Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below.
❑ Yes
❑ No
❑ Stocking Form ❑ Crop Yield Form []Rainfall []Inspection After 1" Rain
Ill No violations or deficiencies were noted during this'visit. You will receive no further correspondence about this visit.
12112103

ical Assistance Site Visit
Natural Resources Conservation Service
Soil and Water Conservation District
Other...
Facility Number
$6 -
28
Date: 9/g/03
Time: 14:30
Time On Farm: 75 WSRO
Farm Name
W4 Farms
County Surry
Phone: [phone]
Mailing Address 705 Salem Fork Road
Elkin NC
Onsite
Representative Joey White Integrator IL & H Farms
Compliance Inspection (pilot only)
Technical Assistance
Confirmation for Removal
fl No Animals -Date Last Ooerat
Operating below
® Swine ❑ Poultry ❑ Cattle ❑ Horse
Design Current
Capacity Population
❑ Wean to Feeder
❑ Feeder to Finish
® Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
2400
2325
OO Routine
O Response to DWQ/DENR referral
O Response to DSWC/SWCD referral
O Response to complaint/local referral
O Requested by producer/integrator
O Follow-up
O Emergency
O Other...
Design Current
Capacity Population
❑ Layer
❑ Non -Layer
❑ Dairy
❑ Non -Dairy
❑ Other
28621
GENERAL QUESTIONS:
1. Is waste discharging from any part of the operation and reaching surface waters or wetlands? ❑ yes ®no
2. Is there evidence of a past waste discharge from any part of the operation that waste reached ❑ yes ® no
surface waters or wetlands?
3. Does any problem pose an immediate threat to the integrity of the waste structure (large trees, ❑ yes ®no
seepage, severe erosion, etc.)?
4. Is there evidence of nitrogen over application, hydraulic overloading or excessive ponding ❑ yes ®no
requiring DWQ notification?
5. Is there evidence of improper dead animal disposal that poses a threat to the environment ❑ yes ®no
and/or public health?
6. Is the waste level within the structural freeboard elevation range for any waste structure? ❑ yes ®no
Structural Structure 2 Structure 3 Structure 4 Structure 5
Identifier Lagoon
Level (Inches) 1 32 I j
CROP TYPES lCom Soybeans Wheat[Alfalfa Fescue -graze Fescue -ha
SPRAYFIELD
SOIL TYPES Fairview
7. What type of technical assistance does the onsite representative feel is needed? (list in comment section)
03/10/03
❑ Dairy
❑ Non -Dairy
❑ Other
28621
GENERAL QUESTIONS:
1. Is waste discharging from any part of the operation and reaching surface waters or wetlands? ❑ yes ®no
2. Is there evidence of a past waste discharge from any part of the operation that waste reached ❑ yes ® no
surface waters or wetlands?
3. Does any problem pose an immediate threat to the integrity of the waste structure (large trees, ❑ yes ®no
seepage, severe erosion, etc.)?
4. Is there evidence of nitrogen over application, hydraulic overloading or excessive ponding ❑ yes ®no
requiring DWQ notification?
5. Is there evidence of improper dead animal disposal that poses a threat to the environment ❑ yes ®no
and/or public health?
6. Is the waste level within the structural freeboard elevation range for any waste structure? ❑ yes ®no
Structural Structure 2 Structure 3 Structure 4 Structure 5
Identifier Lagoon
Level (Inches) 1 32 I j
CROP TYPES lCom Soybeans Wheat[Alfalfa Fescue -graze Fescue -ha
SPRAYFIELD
SOIL TYPES Fairview
7. What type of technical assistance does the onsite representative feel is needed? (list in comment section)
03/10/03
❑ Other
28621
GENERAL QUESTIONS:
1. Is waste discharging from any part of the operation and reaching surface waters or wetlands? ❑ yes ®no
2. Is there evidence of a past waste discharge from any part of the operation that waste reached ❑ yes ® no
surface waters or wetlands?
3. Does any problem pose an immediate threat to the integrity of the waste structure (large trees, ❑ yes ®no
seepage, severe erosion, etc.)?
4. Is there evidence of nitrogen over application, hydraulic overloading or excessive ponding ❑ yes ®no
requiring DWQ notification?
5. Is there evidence of improper dead animal disposal that poses a threat to the environment ❑ yes ®no
and/or public health?
6. Is the waste level within the structural freeboard elevation range for any waste structure? ❑ yes ®no
Structural Structure 2 Structure 3 Structure 4 Structure 5
Identifier Lagoon
Level (Inches) 1 32 I j
CROP TYPES lCom Soybeans Wheat[Alfalfa Fescue -graze Fescue -ha
SPRAYFIELD
SOIL TYPES Fairview
7. What type of technical assistance does the onsite representative feel is needed? (list in comment section)
03/10/03

L
Facility Number 86 28 Date:
9/9/03
PARAMETER
pp No assistance provided/requested
❑ 8. Waste spill leaving site
TECHNICAL ASSISTANCE Needed
Provided
❑ 9. Waste spill contained on site
25. Waste Plan Revision or Amendment
❑
❑
❑ 10. Level in structural freeboard
Conditional Amendment
❑
❑
❑ 11. Level in storm storage
26. Waste Plan
27. Review or Evaluate Waste Plan w/producer
❑
❑
❑ 12. Waste structure integrity compromised
28. Forms Need (list in comment section)
❑
❑
❑ 13. Waste structure needs maintenance
29. Missing Components (list in comments)
❑
❑
❑ 14. Over application >= 10% & 10 lbs.
El
❑
[115. Over application < 10% or < 10 lbs.
30. 2H.0200 re -certification
[116. Hydraulic overloading
31. Five & Thirty day Plans of Action (PoA)
❑
❑
❑ 17. Deficient irrigation records
32. Irrigation record keeping assistance
❑
❑
[118. Late/missing waste analysis
33. Organizelcomputerization of records
❑
❑
❑ 19. Late/missing lagoon level records
34. Sludge Evaluation
❑
❑
❑ 20. Late/missing soils analysis
[121. Crop needs improvement
35. Sludge or Closure Plan
❑
❑
❑ 22. Crop inconsistent with waste plan
36. Sludge removal/closure procedures
❑
❑
37. Waste Structure Evaluation
❑
❑
❑ 23. Irrigation maintenance deficiency
❑ 24. Deficient sprayfield conditions
38. Structure Needs Improvement
❑
❑
39.Operation & Maintenance Improvements
❑
❑
40. Marker check/calibration
❑
❑
Regulatory Referrals
41. Site evaluation
❑
❑
❑ Referred to DWQ Date:
42. Irrigation Calibration
❑
❑
❑ Referred to NCDA Date:
design/installation
El
❑
Other...
43. Irrigation system
Date:
44. Secure irrigation information (maps, etc.)
❑
❑
LIST IMPROVEMENTS
45. Operating improvements (pull signs, etc.)
❑
❑
MADE BY OPERATION
46. Wettable Acre Determination
❑
❑
1
47. Evaluate WAD certification/rechecks
❑
❑
48. Crop evaluation/recommendations
❑
❑
2.
49. Drainage worklevaluation
❑
❑
50. Land shaping, subsoiling, aeration, etc.
51. Runoff control, stormwater diversion, etc.
❑
❑
❑
❑
3
52. Buffer improvements
❑
❑
53. Field measurements(GPS, surveying, etc.)
❑
❑
4.
54. Mortality BMPs
❑
❑
55. Waste operator education (NPDES)
❑
❑
5.
56. Operation & maintenance education
❑
❑
57. Record keeping education
❑
❑
6
58. Crop/forage management education
❑
❑
59. Soil and/or waste sampling education
❑
❑
03/10/03

0 •
Facility Number 86 28 Date: 9/9/03
NTS:
Waste analysis: 6-25-03 ALS 3.2
4-22-03 ALS 3.0 "
1-09-03 ALS 2.3 "
Soil analysis dated 2-05-03 looked good.
Facility and records look good. Good farm.
TECHNICAL SPECIALIST lRocky Durham rony Davis Icameron Pardue
SIGNATURE
Date Entered: 9/15/03 Entered By: lRocky Durham
03/10/03

atlbn
II D Other Agency
II
Type of Visit *Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit 0• Routine O Complaint O Fallow up O Emergency Notification O Other ❑ Denied Access
Facility Number 86 28 Date of Visit: Ol/30/2003 Time: 0935
10 Not Operational O Below Threshold
® Permitted M Certified [3 Conditionally Certified 13 Registered Date Last Operated or Above Threshold: .........................
FarmName: .A..F.aICIItLS........................................................................................................ County: S.urry .................................................. W.S.RQ........
OwnerName: C.L........................................... MAP .......................................................... Phone No: 33.6.3.6644.43 ...........................................................
Mailing Address: 7.QS.Saletn.Fuxk Rvad....................................................................... EIAwt... NG................................................................ 2b621...............
Facility Contact: d.Q.(:Y.W..111te...................................................... Title:................................................................ Phone No:...................................................
Onsite Representative: Joey .�1.b te................................................................................... Integrator: LA.H.Farxim .........................................................
Certified Opera tor:.Gltaxlss.d. ............................... W. Me...................I............................ Operator Certification Number: 2,Q0.S.4.............................
Location of Farm:
rot given map, attached to plan
Tv V
M Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 36 22 27 Longitude 80 46 55
Design Current
Swine Canaefty Ponulation
❑ Wean to Feeder
❑ Feeder to Finish
® Farrow to Wean
2400
2260
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Number of Lagoons
Holding Ponds / Solid Traps
Design Current Design Current
Poultry _ Capacity Population Cattle Capacity Population
❑ Layer ❑ Dairy
❑ Non -Layer I 1 10 Non -Dairy
❑ Other
Total Design Capacity 2,400
Total SSLW 1,039,200
Subsurface Drains Present JJ❑ Lagoon Area J❑ Spray Field Area
No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes M No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the Slate'? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes M No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge'? ❑ Yes M No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? M Spillway ❑ Yes M No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ..........Lagoon....................................................................................................................................................... ...................................
Freeboard (inches): 26
05103101 #-7 J,( �— ��/ Continued

Facility Number: 86-28 Date of Inspection O1/30/2003 •
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Aoglication
❑ Yes ®No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes ®No
10. Are there any buffers that need maintenance/improvement? ❑ Yes ®No
11. Is there evidence of over application? ❑ Excessive Pending ❑ PAN ❑ Hydraulic Overload ❑ Yes ®No
12. Crop type Fescue (Graze) Fescue (Hay) Small Grain (Wheat, Barley, Corn (Silage & Grain)
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes ®No
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes ®No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
■ �
1■yaw �vMg.
f■zym='m
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
0 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use'additional pages as necessary): ❑ Field Copy ® Final Notes
19. Soil samples for 2003 have been sent. Results have not yet been received.
27. Facility has been approved through EQIP program for an incinerator which is to be installed by this Summer.
Facility and records look great as usual!
Waste analyses:
10/3/02 ALS = 2.4 lbs. N/1000 gal.
1/10/03 ALS = 2.3 lbs. N/1000 gal.
Fri
Reviewer/Inspector Name Mel'ssa Rosebrock
Reviewer/Inspector Signatu Date:
O5103101 r Continued

Facility Number: 86-28 of Inspection 01/30/2003
Odor Issues
26.
Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
❑ Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
27.
Are there any dead animals not disposed of properly within 24 hours?
❑ Yes ®No
28.
Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes ® No
roads, building structure, and/or public property)
29.
Is the land application spray system intake not located near the liquid surface of the lagoon?
❑ Yes ®No
30.
Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
❑ Yes ®No
31.
Do the animals feed storage bins fail to have appropriate cover?
❑ Yes ® No
32.
Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes ®No
Not applicable.
expressed thought that many certified operators in the area only needed 1-2 more renewal hours this year to meet the
mt ofsix hours in three years. I left message on 2112103 with Brenda Rose, Extension Director far Surry Co. to contact
if they were planning any training this year,
O5103101

F
Type of Visit 9R Compliance Inspection
Operation Review 0 Lagoon Evaluation
Reason for Visit )NRoutine O Complaint 0 Follow up O Emergency Notification O Other El Denied Access
Facility Number
Date of Visit: 01 Time:
rO Not Operational Below Threshold
Permitted ) ] Certified [3 Conditionally Certified [3 Registered Date Last Operated or Above Threshold:
Farm Name: Ll 4 ft—Qrw:S County: 5urr\) '/'/'/
Owner Name: L L• 11�Y11��p— n i� Phone
�No:
� 33/D •• 3642. qT�
Mailing Address: IOS � Ipm 1For IL 'C-!Y. 1 4)1 Ili � � O bog 1
Facility Contact: .56211 )1)k t 71 Title:
Onsite Representative: � 11
Certified Operator:
Location of Farm:
Phone No:
Integrator: f! `t H BQcm:5
Operator Certification Number: 2 L7 y
Swine ❑Poultry []Cattle ❑Horse Latitude ®• ®• ®- Longitude ®• 52TV•
Design Current ',' Design Current, - u Design Current
'r'
SwIne,`�'� �'.-`iCa'acitY"
Po uistiou'Poulfn,;'����Ca"aciri"iPoulationn<<Cattle .'°. Ca'acity �Po ulation
❑ Wean to Feeder
���
❑ La er '❑ Dairy r
Feeder to Finish
F. ❑ Non -La er i it, ❑ Non-Dai
,f
'
Farrow to Wean
66
,3 ,ilh i �';i
F ❑Other �`.?? i,l ` �' I ` �I'��
Farrow to Feeder
t' ,n t �+ i�.y'y
❑ Farrow to Finish
Total DeSfgn Capacttyt'I I
J
ToSSBoars ?
,
!.
❑ Gilts
❑
0
,iI ❑ Subsurface Drains Present ❑ La oon Area ❑ spray Field Area t+`?
,Holding Ponds 1 Solid Traps
�
1` lt.' ❑ No Liquid Waste Management System
Discharges & tream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes PkNo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. if discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes El No
No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes i,>(I No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes {jJ No
Waste Collection R Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? Illl Spillway ❑ Yes Xo
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard (inches):
05103101 Continued

•
Facility Number: Date of Inspection Q 01*
5.
Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑ Yes
] No
seepage, etc.)
TC
6.
Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
([f any of questions 4-6 was answered yes, and the situation poses an
El Yes
�No
immediate public health or environmental threat, notify DWQ)
7.
Do any of the structures need maintenance/improvement?
❑ Yes
No
8.
Does any part of the waste management system other than waste structures require maintenance/improvement?
Elv-
Yes
,f
pV No
9.
Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
XNo
Waste Application
10.
Are there any buffers that need maintenance/improvement?
❑ Yes
XNo
11.
Is there evidence of over application? ❑ Excessive Pending ❑ PAN Hydraulic Overload
❑ Yes
.9<No
12.
Crop type 1
13.
Do the receiving crops differ with th se designated in the C ified Animal Wast Mana ment Plan ( MP)?
❑ Yes
Too
14.
a) Does the facility lack adequate acreage for land application?
El Yes7.�
b) Does the facility need a wettable acre determination?
El Yes
�y No
c) This facility is pended for a wettable acre determination?
❑ Yes
No
15.
Does the receiving crop need improvement?
❑ Yes
yy No
16.
is there a lack of adequate waste application equipment?
❑ Yes
N0
Reguired Records & Documents
17.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
XNo
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.) / /
❑Yes
I
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
No
20.
is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?'
��//
(ie/ discharge, freeboard problems, over application)
El Yes
No
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
No
24.
Does facility require a follow-up visit by same agency?
❑ Yes
*0
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
4 No
No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
f 1 I' , , ( Ifl4 1 JY 1P { 4 RC. h FFF 1 N
Comments (refer to question #) 4�Ezplain anytYES answers and/or anyirecommendations oq,anyother corotmenta
Use drawmgs;of facilify'to better explain situations. (use additional pages as necessary) °q q(�.II Field Canv
$
Final Notes
Vio(o 3 AL5 a. 3 165. N I obo aloQ,
Io/3/o;t /%311,o00 U .
_.. W.
Reviewer/Inspector Name
Reviewer/Inspector Signature: ad LAM &df 14 otl Date:
3o d
05103101 r
Continued

Facility No Date of Inspection
Odor Issues
26.
Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
S--N�
liquid level of lagoon or storage pond with no agitation?
27.
Are there any dead animals not disposed of properly within 24 hours?
❑ Yes
xNo
28.
Is there anv evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
ElYes
No
roads, building structure, and/or public property)
29.
Is the land application spray system intake not located near the liquid surface of the lagoon?
❑ Yes
X No
30.
Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
❑ Yes
o
31.
Do the animals feed storage bins fail to have appropriate cover?
ElYes
No
32.
Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes
x'No
Additional Comments :and/or .Drawings: " '.,,, t
a� n)O+ -
n o-?!�4 ? �ooa �,`.r�..°zJ ° %u- art n�
4"V st
a4
°
lIi
05103101
9103

011tonofWater1Quahty;;
on of Soil and Water,Conservation
O bther.'Agenay
Type of Visit O Compliance Inspection Operation Review O Lagoon Evaluation
Reason for Visit 0• Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number 86 28 Date of Visit: 6/25/2002 Time:
0 Not Operational 0 Below Threshold
® Permitted ® Certified 0 Conditionally Certified [3 Registered Date Last Operated or Above Threshold:
FarmName: W. A.F.air..tm........................................................................................................ Countv: S.uxxy................................................... \\.SfZQ........
Owner Name: C.L........................................... .white........................................................... Phone No:33.67,3,66,4.44.3 ...................
Mailing Address: ZQS..Saletn. nxk>Zvad....................................................................... E1.64i... N..C................................................................ IUD ..............
Facility Contact: ..............................................................................Title:
Onsite Representative: ,Jeey.Wllite.......
Phone No:
ntegra tor: L.&B-F.ax1A5..........................................................
Certified Operator:Glxarjes.d ............................... W—ldle ................................................ Operator Certification Number: 2QUS4.............................
Location of Farm:
not given map, attached to plan _
® Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude F 36 •F 22 27 Longitude F 80 •F 46 55
7.1
Design Current
Design Current
Design Current
Swine Capacity Population
Poultry
Capacity Population Cattle
Capacity Population
❑ Wean to Feeder
❑ Layer
❑ Dairy
❑ Feeder to Finish
❑ Non -Layer
❑ Non -Dairy
® Farrow to Wean
2400
2250
❑ Farrow to Feeder
❑ Other
❑ Farrow to Finish
Total Design Capacity
2,400
❑ Gilts
Total SSLW
1,039,200
❑Boars
Number of Lagoons
Holding Ponds / Solid Traps
Drains Present JI❑ Lagoon Area J❑ Spray Field Area
Waste Management System
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes ® No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. if discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) - ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes ® No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ®No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ® Spillway ❑ Yes ®No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ...................................................................................................................................................................................................................
Freeboard (inches): 38.
05103101 Continued

Facility Number: 86-28 Date of Inspection 6/25/2002
5. Are there any immediate threats to theitfbgrity of any of the structures observed? (ie/ tesevere erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any strictures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes ®No
❑ Yes ®No
❑ Yes ®No
11.
12.
Is there evidence of over application? ❑ Excessive Pending ❑ PAN ❑ Hydraulic Overload
Crop type Small Grain (Wheat, Barley, Fescue (Hay) Com (Silage & Grain)
❑ Yes
®No
13.
Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
®No
14.
a) Does the facility lack adequate acreage for land application?
❑ Yes
® No
b) Does the facility need a wettable acre determination?
❑ Yes
❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes
❑ No
15.
Does the receiving crop need improvement?
❑ Yes
®No
16.
4
Is there a lack of adequate waste application equipment?
❑ Yes
®No
Required
Records &. Documents
17.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
®No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
®No
19.
Does record keeping need improvement'? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
® No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
®No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
®No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
®No
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
®No
24.
Does facility require a follow-up visit by same agency?
❑ Yes
®No
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
®No
No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary): I ❑ -.
Field Copy ❑Final Notes
Facility and records are in compliance.
Reviewer/Inspector Name Rocky Durham
Reviewer/Inspector Signature: Date:
O5103101 Continued

Facility Number: 86-28 Date of Inspection 6/25/2002
0
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge actor below ❑ Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes ® No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes ® No
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes ® No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes ® No
31. Do the animals feed storage bins fail to have appropriate cover'? ❑ Yes ® No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ❑ No
Additional Comments and/orDrawings:
Waste analysis: 1-11-02 ALS 3.1 lbs.N./1000 gals. I
+
O5103101

(Type of Visit O Compliance Inspection O Operation Review O Lagoon Evaluation I
Reason for Visit O Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number, 86 28 bate of Visit: Ip4/2002 ']'line: 0920
Not Operational Q Below Threshold
e Permitted ■ Certified E3 Conditionally Certified E3 Registered Date Last Operated or Above Threshold: .........................
FarmName: 31'4.Y.Urxns........................................................................................................ County:$.ur)ry .................................................. WSRO........
OwnerName: C1........................................... White .......................................................... Phone No: 336.3.0-44.43 ...........................................................
Mailing Address: 7Q..S.5AIcjtx.F.oxk..liA.afd....................................................................... Elkjxk..N.0 ................................................................ MAN ..............
Facility Contact: Joey..W.Itite......................................................Title:................................................................ Phone No:(AAl.J3b.3.b6.,49bS...............
Onsite Representative: Joey..aad..C.L,..W..hlte............................................................... Integrator: L..&.JJ.Farxu$ .........................................................
Certified Operator:..Chaxde&L............................. wwilc ................................................ Operator Certification Number: ZQAS4.............................
Location of Farm:
rot given map, attached to plan ►
® Swine []Poultry []Cattle []Horse Latitude 36 • 22 27 Longitude F8070 F46 55 «
Discharges 8� Stream Impacts
I. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made'?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system'? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ® Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier: ier: ..........Lagoan.......................................................................................................................................................
Freeboard (inches): 28
❑ Yes ® No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
Structure 6
05103101 _ ndnued '

Facility Number: 86-28 . Date of Inspection 1/14/2002
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes ®No
❑ Yes ® No
❑ Yes ® No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes ® No
12. Crop type Corn (Silage & Grain) Fescue (Graze) Fescue (Hay) Small Grain (Wheat, Barley,
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes ® No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes IN No
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes ®No
® Yes ❑ No
❑ Yes ®No
❑ Yes ® No
❑ Yes ®No
❑ Yes ® No
❑ Yes ® No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes ® No
10 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
wiwigi .,y...... .....

Facility.Number: 86-28 Datonspection 1/14/2002 •
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours?
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon?
30. Were any major maintenance problems with the ventilation fans) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
31. Do the animals feed storage bins fail to have appropriate cover?
32. Do the Flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes ❑ No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes IN No
❑ Yes ® No
l.' ittotta 1 !otnmentsian .6r] rawtngs:
05103101
05103101

Type of Visit Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit 0Routine O Complaint O Follow up 0 Emergency Notification 0 Other ❑ Denied Access
Dale of Visit: �� Time: 1_�
Facility Number
10 Not Operational OBelowThreshold
j Permitted O(Certified D Conditionally Certified E3 Registered Date Last Operated or Above Threshold:
Farm Name: Jt) T Fiarm5 County: SUrr N '/
Owner Name: -1 ni h11i-P Phone No: 33ea. .3166.0t{3
Mailing Address: —:7t% Salem r6rIL P=a • I E 1 Ka D 1 N C_ of 96 -2I
1
Facility Contact: �I _�.t� Vl it0 _ 1 _ �Title: Phone 'NIIoLH) 3�e. 3 (b- qq
Onsite Repr(sentative: 6g.+-f 1 t) l TY. ; (, L L1J11 XtL Integrator: I1 rLi.Y'IYI�S
ll
Certified Operator: _C�%11AQS i J.) h -%P, Operator Certification Number: o%
Location of Farm:
N Swine []Poultry ❑ Cattle ❑ Horse Latitude ®* ®, ®.. Longitude E=0 Imo` ®"
Swine
Design
Capacity
Current
Population
Design Current - Design Current
Poultr Ca cityPo ulation' Cattle Capacity Population
❑ La er ❑ Dairy
ILINon-Layer I Non -Dairy I-
❑ Other I
Total Design Capacity O
Total SSLW 11,nJA.zM
❑ Wean to Feeder
El Feeder to Finish
KI Farrow to Wean
Lj Farrow to Feeder
❑ Farrow to Finish
❑ Gilts,
❑ Boars
a��,A: a 'tT I ❑ No Liquid Waste Manapement System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
*o
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
❑ Yes
❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
❑ Yes
❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
❑ Yes
❑ No
2. Is there evidence of past discharge from any part of the operation?
❑ Yes
No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
❑ Yes
I7D No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? Spillway
❑ Yes
�'j No
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Structure 6
Identifier:
Freeboard (inches):
05103101
Continued

• •
Facility Number: — Date of Inspection I 1 / / W / 0.4
5.
Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑ Yes
�[,
Y1I No
seepage, etc.)
6.
Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
❑ Yes
No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7.
Do any of the structures need maintenance/improvement?
❑ Yes
A No
8.
Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
KNo
9.
Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
4 No
Waste
10.
Application
Are there any buffers that need maintenance/improvement?
❑ Yes
KNo
11.
Is there evidence of over application? ❑ Excessive Pointing ❑ PAN ❑ Hydraulic Overload
❑ Yes
N No
12.
Crop type (IAW
13.
e / ,
Do the receiving crops diffe with those designated n the Certified Animal Waste Management PI n (CAWMP)
❑ Yes
VNo
14.
a) Does the facility lack adequate acreage for land application?
❑ Yes
o
b) Does the facility need a wettable acre determination?
❑ Yeso
Fo
c) This facility is periled for a wettable acre determination?
ElYes
15.
Does the receiving crop need improvement?
❑ Yes
�No
16.
Is there a lack of adequate waste application equipment?
❑ Yes
t%No
Reauired
Records & Documents
17.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
El Yes
��..//
1i(,I No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
/ `
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
4 No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
Yes
❑ No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
Tt No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
RNo
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes
KNo
(ie/ discharge, freeboard problems, over application)
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
No
24.
Does facility require a follow-up visit by same agency?
❑ Yes
QCJ No
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
Al No
0 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
'Coommmments'(�efer to question #) ' Explaimany vES answers and/or anyfr�ecommendatlons or auyother comments
A, ,:kri*a. av
Use'tdrawings of facility, to better�explmn,situations (use additionnl.phges as necessary) +'❑Field ".
Copy Final Notes
1q. I� w up,
�����,�, ..���-c-�I,�,� ALA �.�,c�:ti�,..►' /)�,x,�,v—��-,.Q,,(,�� ..
Reviewer/Inspector Name I .v
Reviewer/Inspector Signature: Date:
05103101 1
Continued

•
Facility Number: — Date Inspection 11 / IY/OLI
Odor Issues
26.
Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
P—`Isw—No
liquid level of lagoon or storage pond with no agitation?
27.
Are there any dead animals not disposed of properly within 24 hours?
❑ Yes
No
28.
Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
No
roads, building structure, and/or public property)
29.
Is the land application spray system intake not located near the liquid surface of the lagoon?
❑ Yes
No
30.
Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
.,.�(
or broken fan blade(s), inoperable shutters, etc.)
El Yes
p(J No
31.
Do the animals feed storage bins fail to have appropriate cover?
❑ Yes
No
32.
Do the flush tanks lack a submerged fill pipe or a permanent/temporary, cover?
❑ Yes
kNo
05103101

Facility Number 86 28 Date of Visit: 9/12/2001 'Time: 15:00
0 Not Operational 0 Below Threshold
e Permitted E Certified 0 Conditionally Certified 0 Registered Date Last Operated or Above Threshold: .........................
Farm Name: W. A.F,arms........................................................................................................ County: S.ujrjry .................................................. liSJiQ.........
OwnerName: C.L. .......................................... Whitc .......................................................... Phone No: 33.6..3.66.44.43 ...........................................................
MailingAddress: 7..O.5.S,all:M.FAl'.k R9..all....................................................................... Eikk..N.0 ................................................................ 2$621..............
FacilityContact: ..............................................................................Title:................................................................ Phone No:...................................................
Onsite Representative: .toty...Wbltc.................................................................................. Integrator: L.A..1F.F.OX.m.........................................................
Certified Operator:.Cheri a .................................. Vamic ................................................ Operator Certification Number: 2QU54.............................
Location of Farm:
rot given map, attached to plan
® Swine [I Poultry [I Cattle ❑ Horse Latitude 36 • 22 27 Longitude 80 • 46 55
Design Current Design Cup n't w. k DesigndCu�rent
Swine . Ca acit P,o ulation Poultry Ca acit P.o ulation Cattle Ca acit ulation ,
❑ Wean to Feeder ❑Layer ❑Dairy
❑ Feeder to Finish ❑Non -Layer 4' ❑Non Datry
4y'
® Farrow to Wean 2400 2400
❑ Farrow to Feeder ❑Other
❑ Farrow to Finish Total Design @apactty. 2,400
❑ Gilts
❑ Boars y teT
�' ., tat S�SLW; ._ 1,039,200-
Number of Lagoons �1 ❑ Subsurface Drains Present]❑ Lagoon Area ❑ Spray Field Area
Holding Ponds /Solid Treps ❑ No Liquid Waste Management System 10
Discharges.& Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes ® No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system'? (if yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes ®No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes 0 No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ® No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ............................................................................................................................................. ......................................................................
Freeboard (inches): 32
05103101 Continued

Facility Number: 86-28 • Date of Inspection 9/12/2001 •
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any sluctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes
® No
❑ Yes
® No
❑ Yes
® No
❑ Yes
® No
❑ Yes
IN No
❑ Yes
® No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes ® No
12. Crop type _Corn (Silage & Grain)
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes ® No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes ® No
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/. discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes ® No
0 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.'
05103101 Continued

' Facility Number: 86-28te of Inspection 9/12/2001
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours?
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon?
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
31. Do the animals feed storage bins fail to have appropriate cover?
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes ❑ No
it on'a •ommen an or �a ngf—
UJUJIIMM
UJUJIIMM

Facility Number 86 28 Dale of Visit: 1 3/l/2001 Time; 0900
Q Not Operational Q Below Threshold
® Permitted 0 Certified 0 Conditionally Certified E3 Registered Date Last Operated or Above Threshold: .........................
FarmName: W.4.k:axma........................................................................................................ County: SlArry................................................... .WSW........
OwnerNamc:G.1........................................... WMAe......... '................................................. Phone No: 3.3.6-26.64.40 ..........................................................
Mailing Address: ..7.4S..SAIen EQrk,.RQAd........................................................................ Elkin..t`.IG................................................................. Z86.21 ..............
Facility Contact: Joy ..Whits.......................................................Title:............................................................... Phone No: Hmm.3.3.60. b..49.65..........
Onsite Representative: JAeX.Willlte.................................................................................. Integrator: L.d1.H.F,arms..........................................................
Certified Operator:ClteClEs.................................. whitp ................................................ Operator Certification Number: 20.054.............................
Location of Farm:
tot given map, attached to plan
® Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 36 • 22 27 Longitude 80 • F46 11 =11
Design
Current
Design GuFrenf x lDestgn Current ''.
Swine Ca Tacit
P,o ulation
Poultry Ca acit P,o ulahon ''Cattle Ca acitA io ulation �'<
❑ Wean to Feeder
10 Dairy
I
I
a;.
❑ Feeder to Finish
❑Non -Layer
10 Non -Dairy
® Farrow to Wean 2400
2400+
❑ Farrow to Feeder
❑ O[her}
ill otal Design Capacity 2,400
❑ Farrow to Finish
❑ Gilts
❑ Boars
Total SSLW 1,039,200
Number of Lagoons ❑ Subsurface Drains Present ❑ Lagoon Area ❑ Spray Field Afea
Holding Ponds /Solid Traps 0 ❑ No Liquid Waste Management System
Discharges & Stream Impacts
I. Is any discharge observed from any part of the operation? ❑ Yes ® No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (II'yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes ® No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ® No
01/01/01 -A,— "7 //3,r/ Continued
sty✓

Facility Number: 86-28 Dane of Inspection 3/1/2001 • '
Waste Collection R Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ® Spillway ❑ Yes ® No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ier: ..........L4PQ0.0..........................................................................................................................................................................................
Freeboard(inches): ............... M ............... .................................... ................................... .................................... .................................... ....................................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes ®No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan'? ❑ Yes ® No
(]f any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes ® No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes ® No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes ❑ No
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes ® No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes ®No
12. Crop type Small Grain (Wheat, Barley, Corn (Silage & Grain) Soybeans
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes ®No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes ® No
b) Does the facility need a wettable acre determination? ❑ Yes ®No
c) This facility is pended for a wettable acre determination? ❑ Yes ®No
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
17. Are rock outcrops present?
® Yes ❑ No
❑ Yes ® No
.❑ Yes ❑ No
18. Is there a water supply well within 250 feet of the sprayfield boundary? ❑ Unknown ❑ Yes ❑ No
❑ On -site ❑ Off -site
Required Records & Documents
19. Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes ® No
20. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.) ® Yes ❑ No
21. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
22. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
23. Did the facility fail to have a actively certified operator in charge?
24. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
25. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
26. Does facility require a follow-up visit by same agency?
27. Were any additional problems noted which cause noncompliance of the Certified AWMP?
Odor Issues
28. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
❑ Yes ®No
❑ Yes ®No
❑ Yes ® No
❑ Yes ®No
❑ Yes ®No
❑ Yes ® No
® Yes ❑ No
❑ Yes ® No
29. Are there any dead animals not disposed of properly within 24 hours?
01/01/01
❑ Yes ® No
Continued

Facility Number: 86-28 do of inspection 3/1/2001 •
30. Is there any evidence of wind drift�ng land application'? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
31. Is the land application spray system intake not located near the liquid surface of the lagoon'?
32. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
33. Do the animals feed storage bins fail to have appropriate cover?
34. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
Printed on: 3/2/2001
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes ®No
❑ Yes ® No
0 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Comments refer to questio : xplainanTanswerstandor any recommendatither cmts .
t
Ud awif facilit to berx situationsueadditidCopy ® Final Notes
15. Just a few bare spots dUvo drought this Fall. Should not affect PAN/uptake/balance.
18. Checklists could not be located. To be added today by Sorry SWCD.
25. Tract 1099 Field 4 needs to be added to include pasture/grass. This field is in the plan, just needs to have this crop added. Is to be
revised today by Sorry SWCD.
Reviewer/Inspector Name Melissa Rosebrock
Reviewer/Inspector Signature: Date:
01/01/01

Type of Visit K Compliance Inspection O Operation Review O Lagoon Evaluation I
Reason for Visit Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Date of Visit; Time:
Facility Number
Q Not Operational Q Below Threshold
Permitted Cer'tiified [3 Conditionally Certified E3 Registered Date Last Operated or Above Threshold:
FarmName:.�j...`t.......Ecucry.�s......................................................................... County: ....sv.`'.R.......................................................
Owner Name:......!r...:.. `........Llw..1 ._1...¢.'....................................................................... Phone No:
Facility Contact: ........ "��� h'i e j7 .. /
._`.�.......�...................t�............'litle:............................................�../................. Phone o�.....%�_�..:._`3�_�.:.••f.••L (oJ
Mailing Address: ...��s........_SQ,..ZW..........rOf �....�..�........................... % ...k�1.ri.�..N. ............a.g.. 2 �...................:.....
Onsite Representative:.... ...... w.h... '.t............................................... Integrator:..... �'`� . ..... FQ.G.1�(�w�..............
.......... ........_........
Certified Operator....._ Q,,,h,4„2 ,,,,,,,,,,,,,,,,_...__ ,.,_, Operator Certification Number.,.,a{f
Location 'ofFarm: it_�12r-�0��i .T. �����i�-v 1
Swine []Poultry ❑ Cattle ❑ Horse Latitude ®• ©1 E=., Longitude
Swine
Design Current Design Current Design .Current
Ca tacit Po ulation Poultry Ca aci Po Population Cattle Ca' Po ulation`141
;:,'
❑ Layer ❑ Dairy
ILI Non -Layer I I Non -Dairy
2
❑ Other
Total DeSlgn-CaElacty,' b b
i
Total SSLW I. b 30 . 200
❑ Wean to Feeder
❑ Feeder to Finish
Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Number of Lagoons �. .
Holding Ponds / Solid Traps .
J J Subsurface Drains Present JJ❑ Lagoon Area I❑ Spray Field Area (
Discharges & Stream Imoactti
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? 0 Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure S
I..A.. an.......
3
❑ Yes 9 No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes
❑ No
❑ Yes
36 No
❑ Yes
9No
❑ Yes x No
Structure 6
Identifier:
Freeboard (inches):
5100
Continued on back

Facility Number: — Date of Inspection - Printed on: 1 /9/2001
5. Are there any immediate threats to toltegrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes [Yl N0
seepage, etc.) ✓{
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes )(No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public. health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes XNo
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes �(No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes XNo
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes ANo
11. Is there evidencrof ovfr application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic !Overload ❑ Yes Q� No
12.Crop type nn 4�CT, �Qf.. fYl �Of1`—���t\ 4S6l/1OeA S ,`
13. Do the receiving crops differ with those des gnated in the Certified Animal NVaste Management Plan (CAWMP)? ❑ Yes bro
14. a) Does the facility lack adequate acreage for land application? ❑ Yes ® No
b) Does the facility need a wettable acre determination? ❑ Yes L YNo
c) This facility is pended for a wettable acre determination? ❑ Yes Wo
15. Does the receiving crop need improvement? XYes ❑ No
16. Is there a lack of adequate waste application equipment? ❑ Yes
No
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available? ❑ Yes No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.) _ / 9Yes ❑ No
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports) ❑ Yes XNo
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes No
21. Did the facility fail to have a actively certified operator in charge? ❑ Yes No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes No
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes No
24. Does facility require a follow-up visit by same agency? ❑ Yes No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? 19 Yes 0
jP-N­Q-*i6-1 a{ipnjs;o dgfciejocies were i�94ed il(tt i�9 tjljs:v'sit; • Ybu XJ11 •Sec¢iye ijq fuj•ti*0 • ; • ; • .
ctiries' mdeike.ab66fthisvisit:.::::: ::::::: ::::: ::::::•:•:•:•:•:•:•:•:•:•:
Cromments (refer to question{#): Explain any YES answers apd/orany recommendations c, anylother comments �gaSt'
Use drawings„of facilit* to' Better explain situations. (use addttional pages as nece
ssary):.
1S,Tu5� ,C,j bcLre 5�6+5dua `lie �rou,/4 ', vs Fclt 560U%
�Vt4 kr Ato -t Ise o sW cflw
.. . • . ••a x. , •., r v Y —7 r 1^ I: 1 Y t Ywyy !`tCQ r
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date: 6 + 5/00

FacilityNumber: $'p 2 ate of Inspection —' • Printed on: 1/9/2001
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes 0
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes 600
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes .kNo
roads, building structure, and/or public property)
29, Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes NNo
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes kNo
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes kNo
32.. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes rNo
%%s.`. ��IdS�P�a~ps ►vlal W up 7
VV-
5100

Facility Number
Date of Visit: 9/13/2000 'fine: [4:00 Printed nn: 2/22/2001
86 28
0 Not Operational 0 Below Threshold
S Permitted 0 Certified E3 Conditionally Certified 13 Registered Date Last Operated or Above Threshold: .........................
Farm Name:\1.4..F.ufrum....................................................................................................... County: S.ujrjry .................................................. WSRQ........
OwnerName: C�,I............................................. WIRR .......................................................... Phone No:33.6r.3.66.44.43 ...........................................................
FacilityContact: .............................................................................. Title:................................................................ Phone No:...................................................
Mailing Address: J.7.9.5A1an.FQrk..Rd............................................................................ EIkUL..N.0 ................................................................ 2&GA1..............
OnsiteRepresentative: 1Q.cy...l bite................................................................................... Integrator:......................................................................................
Certified Operator:Gharics.J ............................... WII. c................................................ Operator Certification Number: 2QQ$.4.............................
Location of Farm:
not given map, attached to plan
® Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 36 • 22 27 .. Longitude 80 • 46 55 ..
Discharges I Strearn Impacts
I. Is any discharge observed from any part of the operation? ❑ Yes ® No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made'? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State'? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes ® No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ® No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ® No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: .......................................................................................................................................................................................................................
Freeboard (inches): 29
5100 Continued on back

Facilit Number: 86-28 Date of Ins ection 9/13/2000 Printed oil: 2/22/2001
5. Are there any immediate threats to the nn egrity of any of the structures observed? (ie/ tr6evere erosion, ❑ Yes ® No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes ® No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes ® No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes ® No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes ® No
Waste ADDlicalion
10. Are there any buffers that need maintenance/improvement? ❑ Yes ® No
11. Is there evidence of over application? ❑ Excessive Pending ❑ PAN ❑ Hydraulic Overload ❑ Yes ® No
12. Crop type Corn, Soybeans, Wheat Fescue (Hay)
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes ® No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes ® No
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
u' Nb violations:or de&Wnetes were:nbted :during this: visit. N6u:will ir&dve no further
.. correspondence. about this Asft. .
and Lagoon look good, very well maintained.
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
[]Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
[]Yes ® No
❑ Yes ® No
❑ Yes ® No
Reviewer/Inspector Name [Tony R. Davis
Reviewer/Inspector Signature: Date: 5100

Oky Number: 86-28 D: ' Inspection 9/13/200(1 Printed on: 2/22/2001
r Issues 0
Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours'?
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon?
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
31. Do the animals feed storage bins fail to have appropriate cover?
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
5100

Facility Number
Date of Visit. 4/10/2000 Printed no: 4/14/2000
Not Operational O Below Threshold
® Permitted ® Certified 13 Conditionally Certified [:1 Registered Date Last Operated or Above Threshold: ........................
FarmName: lY.4.FArxim....................................................................................................... County: Smxy................................................... WSRQ........
OwnerName: C..1..............................................White........................................................... Phone No: 336r.3.60 4443...........................................................
Facility Contact: Joex. ..h.Ile......................................................Title: OpmAtor ........................................... Phone No: 3J.6j6&.49j6S .......................
MailingAddress: 7.QS.SA1eItt.CRrk.Rd............................................................................EIURAC ................................................................ 28.621..............
Onsite Representative: .locy...WjIte................................................................................... Integrator: L..A.H.Far'dnS...................................................
......
Certified Operator:Ch0r1R5.l.............................. W. Me................................................ Operator Certification Number: 2,QQS4.............................
Location of Farm:
®Swine ❑ Poultry ❑ Cattle ❑ HorLatitude 36 • 22 27 {, Longitude F 80 OF 46 55 ,,
Design
Current
Design Current I) sign? . Cuurr`en[Ft'
Ca tacit
P,o ulation
Poultry Ca tacit Population Cattle Ca tacit IP.o tulation
o Feeder
❑Layer
❑Dairy
to Finish
❑Non -Layer
❑Non -Dairy
to Wean
rp[]FeedertoF�inish
2400
2320to
Feeder
to Finish
Total Design Capa i
Total SSLW 1,039,200
JNumber of Lagoons
]�
❑Subsurface Drains Present ❑ I,agoon Area ❑ Spray Field Area
Holding Ponds / Solid Traps
❑ No Liquid Waste Management System
Discharges &: Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes ® No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made'? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State'? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system'? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes ® No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ® No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: .......................................................................................................................................................................................................................
Freeboard (inches): 32
CAtinued on back

Facility Number: 86-28 Date of Inspection 4/10/2000 Printcd on; 4/14/2000
5. Are there any immediate threats to the ineity of any of the structures observed? (ie/ treelovere erosion, ❑ Yes ® No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes ® No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement'?
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN
12. Crop type Fescue (Hay) Small Grain (Wheat, Barley,
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
[]Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes ® No

Facitity Number: 86-28 Ilyf Inspection 4/10/2000 • printed on: 4/14/2000
Odor Issues
26.
Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
❑ Yes
❑No
liquid level of lagoon or storage pond with no agitation?
27.
Are there any dead animals not disposed of properly within 24 hours?
❑ Yes
® No
28.
Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
® No
roads, building structure, and/or public property)
29.
Is the land application spray system intake not located near the liquid surface of the lagoon?
❑ Yes
® No
30.
Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
❑ Yes
® No
31.
Do the animals feed storage bins fail to have appropriate cover?
❑ Yes
® No
32.
Do the Flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes
❑ No
' rhona>omments ari or rawmgs:

[WRoutine Q Complaint O Follow-up of DWQ inspection Q Follow-up of DSWC review 0 Other
Facility Number Date of Inspection IO 0
Time of Inspection 24 hr. (hh:mm)
0 Permitted *Certified 0 Conditionally Certified 13 Registered Not O erational Date Last Operated:
FarmName: ..........SA J..'L....... 1 .�..Y--m J..................................................................
OwnerName:...... C...�� ........1,\.I.................................................................
Facility Contact: ....._ ....1�. Y................... Title: .0............!
Mailing Address:
Onsite Representative:... �j��y�^��� .�..... W.b.1. ��...............................................
Certified Operator:......TQ, ,�.yJ Y�.l,.
...........................................................
Location of Farm:
County:............/ V.rZr....................................................
Phone No:...3 .W..:....31.6...'..T. .. L... /�..................
�r.................... Phone No:.l..IYJ..........
.................El..!/—Ifa...1..�1..N4....._.........C.a..��/
Integrator: .......biA...... E f�.x..rr��,.].........................
Operator Certification Number: .... CKpp.: y,,,.._....
Latitude Longitude ®• L—Lraj I Q
❑Wean[lDestgn If4CurrenN�F"' Destgn Current i,� ,Ca aci Po"iula�nt
SworePupaDestgn. G yCurre
Ca aci "'Po ulition Poultry Ca'acrt lahon' Cattle r Gon
o Feeder ❑Layer ❑ Datry
❑ Feeder to Finish ❑ Non -Layer I❑Non-Dairy
Farrow [o Wean . , ,d• . , .:
1t ,
❑ Farrow to Feeder ❑ Other
❑Farrow to Finish Tofah Destgn.,Capacity�� a 00
❑Gilts x,- _�'�•;
❑ Boars Tolal SSLW (� ��
V; I Number of Lagoons ID Subsurface Drains Present ❑ Lagoon Area I0 Spray Field Area sz
Holding Ponds / Solid Trapsa No Liquid Waste Management System
e°i TnF �I � i •
Discharges & Stream Impacts
I. Is any discharge observed from any part of the operation?
❑ Yes j�No
Discharge originated at: El Lagoon [I Spray Field [I Other // ``
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated Flow in gal/min?
d. Does discharge bypass a lagoon system? (If ycs, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes )(No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure G
Identifier: ^
Freeboard(inches): .........._. ./�...�.'..........................................................................................................................................................................................
5. Are there any immediate Threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes 'XNo
seepage, etc.)
3/23/99 Continued on back

• Facility Number: — ;Tof Inspection
6. Are there structures on -site w ich are no roperly addressed and/or managed through a w e management or ^7—T yyy...���
closure plan? Yes }� No
(If any of questions 4-6 was answered yes, and the situation poses an '
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes )TNo
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes -VNO
9.
Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes <No
Waste
Application
10.
Are there any buffers that need maintenance/improvement?
❑ Yes
No
11.
Is there evidence of over application? ❑ Excessive Ponding ❑ PAN
❑ Yes
No
12.
Crop type 664\kA, Al
13.
Do the receiving crops diTfer with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
14.
a) Does the facility lack adequate acreage for land application?
❑ YesiNo
No
b) Does the facility need a wettable acre determination?
❑ YesNo
c) This facility is pended for a wettable acre determination?
❑ Yes
No
15.
Does the receiving crop need improvement?
❑ Yes
No
I
16.
Is there a lack of adequate waste application equipment?
❑ Yes
)ko
Required
Records & Documents
17.
Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
�/
f7d No
T`
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
o
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ YesfNo
o
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
No
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
�(` o
24.
Does facility require a follow-up visit by same agency?
❑ Yes
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
ElYes
PO
1.
�Vd Yigla�igttjs;oxil$t"jcit:ncie� •w�$re jn9te�1�lurepg t�tjs:v�s�t; Y:oit ;wii��•ecgiyt tio: furth$r; • ;
c6rresn6ridence: abbot: this :visit
Reviewer/Inspector Name
r'!
Date:

FacIlity Number: — as I I�of Inspection
Odor Issues
26.
Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation? ON I T aJDC0
27.
Arc there any dead animals not disposed of properly within 24 hours?
❑ Yes
ANo
28.
Is there any evidence of wind drift during land application'? (i.e. residue on neighboring vegetation, asphalt,
[]Yes
>No
roads, building structure, and/or public property)
29.
Is the land application spray system intake not located near the liquid surface of the lagoon?
❑ Yes
)No
30.
Were any major maintenance problems with the ventilation fan(s) noted'? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
❑ Yes
IN o
31.
Do the animals feed storage bins fail to have appropriate cover?
❑ Yes
No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? Qm i T d6c
�ssUe�af' Coe unoler r�V Se �ee�u�l
5 i� n e (Yl c l g, 19 a Y'.

Facility Number 86 28 Date of Inspection 6-22-99
Time of Inspection 9:311 24 hr. (hh:mm)
® Permitted ® Certified 0 Conditionally Certified E3 Registered 0 Not O erational Date Last Operated: ..........................
FarmName:\!'.4..F.arms........................................................................................................ County: S.tjr)ry................................................... WSRO........
OwnerName: C..L........................................... MAC ........................................................... Phone No: 9103b6 44.43...........................................................
FacilityContact: .............................................................................. Title:................................................................ Phone No:...................................................
Mailing Address: 1.7.9.Salsm.karklid............................................................................ Elkia..N.0 ................................................................ 2$.621..............
OnsiteRepresentative: Jmy...Wbite................................................................................... Integrator:......................................................................................
Certified Operator:Clxairlea.J..............................Wwle ................................................ Operator Certification Number: 2QUS4.............................
Location of Farm:
Latitude 36 • 22 ' 27 Longitude 80 • 46 ' 55
<tai F"'' Designs Cu'crent ' - Destgn ' Current& x Destgn'. y Currentb
t m a rCa acif +Po tulati n
4;r Swtne Ca tacit Po tulation Poultry-= Ca acit P,o ulatton' Cattle ` t
❑ Wean to Feeder ❑Layer ;,. ❑ Dairy
❑ Feeder to Finish ❑Non -Layer ❑ Non Dairy
Farrow to Wean 2400 2400
❑ Farrow to Feeder ❑Other
❑ Farrow to Finish ;; kTo al D s gfl C paClty 2,400
❑ Gilts
❑ Boars Total SSLW 1,039,200
J
Number of Lagoons ❑ Subsurface Drains Present ❑ Lagoon Area ❑Spray Ficld Arca
Holding Ponds /Solid Traps=M10 No Liquid Waste Management System
Discharges &Stream Impacts
I. Is any discharge observed from any part of the operation? ❑ Yes ® No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State'? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min'?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes ® No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ® No
Waste Collection -& Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ® No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: lagoon
Freeboard(inches):........3Q.1.tl&11tas........................................................................................................................................................................................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes ® No
seepage, etc.)
3/23/99 Continued on back
Ulf-
/

Facility Number: 86-28 1 Date of Inspection
6. Are the' structures on -site which are *perly addressed and/or managed through a* management or
closure plan?
(if any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
6-22-99
❑ Yes
® No
❑ Yes
® No
❑ Yes
® No
❑ Yes
® No
❑ Yes
® No
11. Is there evidence of over application? ❑ Excessive Pending ❑ PAN ❑ Yes ® No
12. Crop type Wheat Rye
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes ® No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes ® No
b) Does the facility need a wettable acre determination'? ❑ Yes ❑ No
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency'?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes ❑ No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
[]Yes ® No
❑ Yes ® No
[]Yes ® No
❑ Yes ® No
3/23/99

Facility Number 86 28 Date of Inspection 5/27/99
Time of Inspection 10:00 24 hr. (hh:mm)
® Permitted ® Certified [3 Conditionally Certified 0 Registered 0 NM O erational Date Last Operated: ..........................
Farm Name: W..4..F.arw....................................................................................................... County: S.uciry.................................................. WSRQ........
Owner Name: C L...........................................
Facility Contact:
Title:
Mailing Address: 1.7.9.SRl1em EQrk.lid............................................................................
Phone No: 9.10-3.66444...........................................................
Onsite Representative: .C.L,,.&Charlo.Y hift............................................................ Integrator:
Phone No:
MG21 ..............
Certified Operator:Charles.l.............................. W..bjtv ................................................ Operator Certification Number: 20054.............................
Location of Farm:
Latitude 36 • 22 27 Longitude 80 • 46 55
Design
I:e
Swme
Current.
, •Design ' tCtirrent , '( .y jY. '3`,� IDesign,i; Ci rk, qdt, 1
diA'M `� W -PY �: ib tne�' Fv: 'Y
Poultry ague„��
Ca acit
Wean Feeder
P,o ulation
Cup acitP,o wlatmn�::Cm Ca tacit Po wlation ;
❑ Layer ❑ Dairy
❑ to
- ❑ Feeder to Finish
a ® Farrow Wean
10 Non -Layer I Non -Dairy ti
to 2400
❑ Farrow to Feeder
2400
❑ Other
a t
Total Des gn Capacity 2,400
❑ Farrow to Finish
❑ Gilts
❑ Boars
T, o�ta1SSLfiW: 1t039t200
Number of Lagoons O ❑ Subsurface Drains Present ❑ Lagoon Area I0 Spray Field Area
Holding Ponds /Solid Traps I ❑ No Liyuid Waste Management System
Discharges _& Stream Imi pacts
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
Identifier:
❑ Yes ® No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Freeboard (inches): ...............3..0...............
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
❑ Yes ® No
3/23/99 Continued on back

Facility Nt'nber: 86-28 D• to of Inspection
6. Are there structures on -site which are Soperly addressed and/or managed through a management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any sluctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN
12. Crop type Wheat Rye
5/27/99
❑ Yes
® No
❑ Yes
® No
❑ Yes
® No
❑ Yes
® No
❑ Yes
® No
❑ Yes
® No
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
® No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
® No
b) Does the facility need a wettable acre determination'?
❑ Yes
❑ No
c) This facility is pended for a wettable acre determination?
® Yes
❑ No
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
u' N6 violatiots:ordfeences were;noteddurini! this visit.Y6u4ill receveno ft.rther :::
correspondene about this.vtslt.::....... .
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
® Yes ❑ No
14c Operation should be able to reduce total field acres by 25% with amount of N deficit..
25 District or technical specialist needs to update WUP and have each field with tract #, soil t pe, total Acres, and crop options.
iA7Q5 C6, V K+e , oY� 6 r t t ilQ� LOU V — �iQX Qj ft?q P O n
oV0-7h0Vf'. �J J S
Reviewer/Inspector Name lRocky Durham Tony Davis
Reviewer/Inspector Signature: Date:
3/23/99

19 Kounne p eompiamt p rmtow-up of ovvv inspection p rouow-up of u�,wt: review p other
Facility Number Date of Inspection
Time of Inspection 24 hr. (hh:mm)
p Registered E Certified p Applied for Permit N Permitted JU Not OperationalDate Last Operated:
Farm Name: 4Y.4.Ear:ms........................................................................................................ County: Surry WSRO
OwnerName: C.L.......................................... W..Wte .......................................................... Phone No: 9.11[1-16.64.443 ..........................................................
FacilityContact: ...............................................................................Title:............................................................... Phone No:....................................................
Mailing Address:. 1.7.9.Sa1em.Eark.lid............................................................................ Elkin..NC................................................................. 2,862.1...............
Onsite Representative: daey-W..hike.................................................................................. Integrator:L&R.Ear.ma ............................................................
Certified Operator:Charles..d.............................. White ................................................ Operator Certification Number:20.054 .............................
Location of Farm:
Latitude Longitude ®• ®, ©,,
ri','iyn((j;'jAr
,,s�n
lC,l
1
sign ruar}rFen ,( ,ji esignrv.:,urrenI„lla;l ,i.afI PSwme
�ouaouaty( Ppanl Capacity +�PopulationF�
i,,, , -aepsaimgny,l»; purren
,,en
r n
t
❑ aye
0 can oIm's
y;
,! ❑ on- ayer
p ee er to
j
t er 41
® arrow [
arrow t
t+'
i13. ,+'..Ip
Farrow t
fire Total �DesigiiGiCapacity�!
i
v
0 Gilts
Total SSL1,023,490,200
❑Boars
!;
..°
di Present O Lagoon y
Number"of,La"oohs No�ltlin°,
Pl
finds P " gSlu ,tl❑
i II'IP fig�[.i ��I ingP+, t, ��i ::
osquide ases....anagemen System gyp'
e�l�nyreai�I,.i(
E3
General
I. Are there any buffers that need maintenance/improvement?
Yes
® No
2. Is any discharge observed from any part of the operation?
p Yes
®No
Discharge originated at: p Lagoon p Spray Field p Other
a. If discharge is observed, was the conveyance man-made?
13 Yes
p No
b. ][discharge is observed, did it reach SUrlaee Water? (Il'yes, notify DWQ)
p Yes
p No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (Ifycs, notify DWQ)
p Yes
p No
3. Is there evidence of past discharge from any part of the operation?
❑ Yes
®No
4. Were there any adverse impacts to the waters of the State other than from a discharge?
p Yes
®No
5. Does any part of the waste management system (other than lagoons/holding ponds) require
p Yes
®No
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
p Yes
®No
7. Did the facility fail to have a certified operator in responsible charge?
p Yes
®No
7/25/97

FlaciliO Number: 86_28
S. Are there lagoons or storage ponds on s1 which need to be properly closed?
Structures (Lasoons,Holdina Ponds, Flush Pits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure I Structure 2
Identifier: 1
Freeboard (11): ............ 3..feet............
10. Is seepage observed from any of the structures?
•
Structure 3 Structure 4
11. Is erosion, or any other threats to the integrity of any of the structures observed?
12. Do any of the structures need maintenance/improvement?
(If any of questions 9-12 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
Waste Application
14. Is there physical evidence of over application?
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
p Yes ® No
p Yes N No
Suvcture 5 St[Wture 6
[]Yes
® No
[]Yes
® No
p Yes
N No
p Yes
® No
p Yes
® No
15. Crop type.......Com.(Silaga.&.f'xrain.)....... Sma11..Qrain.(Nheat,.Bade..y,.....T.itnothy.... Qtchard,.&..R.ya...
Milo, Qats) Q ss
16. Do the receiving crops differ with those designated inthhe nmmal Waste Management an (A WMP)?
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
22. Does record keeping need improvement?
For Certified or Permitted Faeilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
24. Were any additional problems noted which cause noncompliance of the Certified A WMP?
25. Were any additional problems noted which cause noncompliance of the Permit?
K . Pfo'vlaLations.orucrencres were.ne.aung.tnis is:. ii ou. wl.receive na rurtner.' .
............................ ...v..a..............i.
.........................................................
p Yes ®No
p Yes ®No
p Yes ®No
p Yes is No
p Yes ®No
p Yes ®No
p Yes ®No
p Yes ® No
[]Yes N No
p Yes ® No
Reviewer/Inspector Name
Reviewer/Inspector Signature: 6 QMn/t f,1- VCR �Q (/^ Date: 316 N

p Division of
N Division of
u
I* Koutme p t-omptamt p ronov-up of uwy inspection p rt
Facility Number
p Registered 0 Certified p Applied for Permit 0 Permitted
Farm Name:
up of uawt, review C vtner
Dale of Inspection
Time of Inspection � 24 hr. (hh:mm)
p Not Operational 1 Date Last Operated:
........ County: Sorry WSRO
Owner Name: C.1........................................... WhIte .......................................................... Phone No: 9.111736.6-4.443 ..........................................................
FacilityContact: ...............................................................................Title:............................................................... Phone No:
Mailing Address:.1.79.&alem.Furls.Rd............................................................................ Elliiii..NC ................................................................ Z862J..............
Onsite Representative: Joey ..Wkite.................................................................................. lntegrator:L&n.EarmA ............................................................
Certified Operator:Cha.rles..J.............................. W.11ile ................................................. Operator Certification Nwnber:211454.............................
Location of Farm:
Latitude ®' ©° ©" Longitude
L)esignl Currenv r
estgn= urren , Design; urren • t =
Swore ."Capacity Population I; Poultry .,.
Capacity Populatmn ,Cattle, .Capacity. Population ,
"..oi !". ❑ Layer
[3 airy
+I p On -Layer
p Non -Dairy
p ter
2,400
Total Sn
,
�, �n..l
I ,:a „rr•,,`•`.V.
i! r'itt�na 1, ,. i;, .,:
Number ofiLagoons'/Molding Ponds,ii10 Subsurface
rams resen p Lagoon Area p pray Field tea
i a u ';, ��l--o
L❑
Liquid Waste management stem �a ,
9 g Y
.`, ,t
p can [o ee er
-
p ee er to ams t
® arrow to can
p arrow to ee er
p arrow to tnts
pGtts
p Boars
General
1. Are there any buffers that need maintenance/improvement?
0 Yes
H No
2. Is any discharge observed from any part of the operation?
13 Yes
®No
Discharge originated at: p Lagoon (3 Spray Field p Other
a. If discharge is observed, was the conveyance man-made`?
p Yes
p No
b. If discharge is observed, did it reach Surface Water? (If yes, notify D WQ)
13 Yes
p No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
p Yes
p No
3. Is there evidence of past discharge from any part of the operation?
p Yes
®No
4. Were there any adverse impacts to the waters of the State other than from a discharge?
p Yes
®No
5. Does any part of the waste management system (other than lagoons/holding ponds) require
p Yes
®No
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
p Yes
H No
7. Did the facility fail to have a certified operator in responsible charge?
p Yes
®No
7/25/97

act t y um er: 86_28
8. Are there lagoons or storage ponds on si0which need to be properly closed?
Structures (La ¢oons,Hold ine Ponds, Flush Pits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure I Structure 2 Structure 3
I deco i f ier:
Freeboard (ft): ............ 4..faet............
10. Is seepage observed from any of the structures?
Structure 4
11. Is erosion, or any other threats to the integrity of any of the structures observed?
12. Do any of the structures need maintenance/improvement?
(If any of questions 9-12 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
Waste Application
14. Is there physical evidence of over application?
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
• p Yes a No
p Yes a No
Snvcture 5 Strn ClUre 6
p Yes
a No
p Yes
a No
❑ Yes
a No
p Yes
a No
p Yes
a No
15. Crop type.......C.am.(Silage.&.Ctrain)....... Small..Gcaia.(WJacal,.Barley,..... Umotby.,..Qrchard,.&.!?ye...
16. Do the receiving crops differ with those designated m the Animal Waste Management Plan (A WMP)?
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
22. Does record keeping need improvement?
For Certified or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
24. Were any additional problems noted which cause noncompliance of the Certified A WMP?
25. Were any additional problems noted which cause noncompliance of the Permit?
p Yes a No
p Yes a No
p Yes a No
p Yes a No
p Yes a No
p Yes a No
p Yes a No
p Yes a No
p Yes a No
p Yes a No

JtL-s.-tam IS174 FROM W wq, R tliiLtiY iECitQI 1v
six Requirss ft=
Fac ry No.
DMSION OF EA'VMOXWNMAL MANAGEMENT -
AND AL nMLOT OPERATIONS SITE VISUAMON REOORD
DATE: SL, Imo—• 1995
7b=:
FarmNwwA)wD C.L. Wh 4e
' Sens
MA014g Adds= 19 ti Salem Ft, �< V.C, E I K W L 2
COO
Y; Sor r
ltotep ator Sm, , ncs pbma
On Six ReFeeaeataSM
pbone 36 yy�l3
My" Addre;&M eadan:
TM of Operatiow swine = poalvy ..._. came
Zy o U
Design Gpeviti': Number edAmmala CO Site: 230 0
uaoa Number. ACNEW___-_—
DEM C+,QtiiScation Ntuabar. ACE.__ DEI�i Cettifi
y�• $Ievation: ��eet
ckck Yes or No
ram. n,. Aammal R'sute Lagotra have FaMcieut i:sebowd of 1 Foot + 25 year 24 pour snorra event
Uppro:dmttely I Foot + 7 ioebet) LY*_ or No Actual Fmcbowd: _LYL U Iacbet
Was any seepage obswed from the lagoon(s)? Yes ort�lo Wat any erosion observed? Yet oz�
is adequax laud available tau apeay?� No 1< the Dom sop adegasts? did or No
OrWs) be lag vn'limd: vt No
Doer the fwMty meet SCS mmaimum setback aixria? 200 Feet from Dwelliztl
300 Fat from Wells? TQoe No
y ar,lm&l waste st c#Dcd within 100 Fat of USGS Blue Lis Strum? Yes cc *
•' is animal wane land applied or spicy irsiiated within 25 Fort of a USGS Map Blue Line? Yet orQ
L animal wuu discharged into watea of the state by man-made ditch, flushing system, or other
lWau am -made &AM? Ye; or& 1f Yes. Fleue Xglain.
Dtxt � mentaia adequtts waft management retards (volumes of manors, hind applied.
way �md os �u at7�7coos )? Yes or No
fop
t)�w sue �G...nr AL1..._.I Mim /Zn'
�Ila.� Srn�� p� �e •�nae
Ot;: Fadlity Assessment Veit Use Atncbments itNeeded.

M1tlOM 'JI1
7N
13A31 V3S NV3W SI NII1v0
133A OZ 1VA831NI !lf101NOO
SidSZH
e313N071V I 0 S 1
1II014:10$ t33f Wor OW9 0009 OOOW OOK WOZ 0001 0 0001
PIN t 0
0004Z 131VOS
39 Al W"
Alf .IOE.LV illfI
` (N1LON NIN73) '/M 90 NANd3Z •OSI
j�.l�
ag
r
Jo
(C, \
Ay
a / �._ �\\ "/ � ��J '�� ,'^`\`� )���`� i1 \\tom,. ��. �1'\ - �� �•-
it Q ro
� �; � 1. —� � �\ ��� �� ���� ��. ,/II ',S✓; ,�
LZ-98
ajxuradg xu2ag
fff

■
0 Division of WalffQualit)'
16 Koutme C t.omptamt C ruuuw-up 01 vvry uispecuuu p ruuuw-up vi varva. review C vurcr l
Date of Inspection
Facility Number Time of Inspection ® 24 hr.
p Registered 0 Certified p Applied for Permit p Permitted JU Not Operational Date Last Operated:
Farm Name: W..4.Farms........................................................................................................ County: Sorry WSRO
Owner Nannc: CJL.........................................
Facility Contact:
Title:
Mailing Address: 129..Sa1em.Fork.Rti............................................................................
Phone No: 9111-36.6444a..........................................................
Onsite Representative: Joey..White.................................................................................. Integrator:
Phone No:
2862.1..............
Certified Operator:Char.Ic&A.............................. White ................................................. Operator Certification Number:20054.............................
Location of Farm:
Latitude Longitude ®• ®' ©`°
■
Poultry i
' LVLiIr`11G31�
L '
as
General
I. Are there any buffers that need maintenance/improvement?
❑ Yes
® No
2. Is any discharge observed from any part of the operation?
p Yes
®No
Discharge originated at: p Lagoon p Spray Field p Other
a. If discharge is observed, was the conveyance man-made?
p Yes
p No
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
❑ Yes
p No
c. If discharge is observed, what is the estimated Flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
p Yes
p No
3. Is there evidence of past discharge from any part of the operation?
p Yes
®No
4. Were there any adverse impacts to the waters of the State other than from a discharge?
❑ Yes
®No
5. Does any part of the waste management system (other than lagoons/holding ponds) require
13 Yes
®No
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
p Yes
®No
7. Did the facility fail to have a certified operator in responsible charge?
p Yes
®No
7/25/97

Iereat y um : 8 _28
8. Are there lagoons or storage ponds on 9,which need to be properly closed?
p Yes H No
Structures (Laeoons,Holdine Ponds, Flush Pits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure I Structure 2 Structure 3 Structure 4
Identifier:
Freeboard (R): ..............10...............
10. Is seepage observed from any of the structures?
11. Is erosion, or any other threats to the integrity of any of the structures observed?
12. Do any of the structures need maintenance/improvement?
(If any of questions 9-12 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
Waste Application
14. Is there physical evidence of over application?
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
p Yes N No
Structure 5 St'UCmre 6
............................ ...............................
p Yes H No
p Yes N No
p Yes ® No
15. Crop type.................................................................................................................................................................................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
22. Does record keeping need improvement?
For Certified or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
24. Were any additional problems noted which cause noncompliance of the Certified A WMP?
25. Were any additional problems noted which cause noncompliance of the Permit?
'1�i0'V101atl0RS.0I'llellCl'CRC1eS;WC1'C.ROtP.U.Al117Rg thlS visit:. You. will -receive nO' IRrtRCr.'.'
• OrrespooOiie'e a4titit t#ii§:visii::::::.:.:.:.:::::::.::::::::::::::::: : ::::::::::::::::::::::: : ::::: : : :
p Yes a No
p Yes ® No
p Yes ®No
p Yes ®No
p Yes ®No
p Yes ®No
p Yes ®No
p Yes ®No
p Yes ®No
p Yes N No
p Yes ® No
p Yes ® No
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Date:

OPERATIONS BRANCH - WO Fax:[phone]
:I
,QW
lul 19 15:39 P.06/16
5iic Kcclvites fmusediate Atrtnuon
IracbX7 Number'
SIT' VISITATION RECORD
DAM: /1 I' 1495
Owner. paint {dam. W 4• �g�
County: �urru
Agent V23ltin8 Sim: Phone: 3R6-g a�q
Jn Sitt R mccn
�i% L4it1V0: Phone:
'Ilysicai Address:_ _~
— Flk;� nc
its Addrr a: / 9rf_ sSafc lc 1 _
oF(?}±eralion Swinc !J Poultry �` Catllc
;a C_;tOcity, ?v mLti: of Anim0a ari Sh8: S-w?D 23L)
2 3 1 >�o o v t _R psB�-3 9'1-►9 -6
of ?n-3P=lcn: Crllurd Amial
Circle YcA or tic
'ccs "Ic ,-1::i::ttU'N,+S[e L3.aC.^:f ^Y.YC iL :t FCGCI:CGId O� (F'CCl T �.J �Y�=? �ouZ Siol�D Cvc'll
a Or FOOL -'t
No AcivalI'.�-rard:,LQ_ � «� o Inches
rcr fac:'iliex wiW more ' 7%;:l�rolf, p!tC 3ECfGSs :ha �1:: IAy'o04� in call ancet the
culwncllis SLOcuom.
:u any sec Pagc ouscrved NO
i8nf! sv sbL for ia;;d acFiica:irn? cs -; o 's :hc alvcr :rop sdecan�? a r No
_ c
1.
i;: i!lUflai Con:I*est.4; -.1 nyc
I