820520_INSPECTIONS_20171231

POP-
10�
NURTH CARQLINA
Department of Environmental Qual

Type of Visit: aCom nee 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 0 Denied Access
Date of Visit: / Arrival Time: Departure Time:/ /' County: �Region: �
Farm Name: _� i /n t . Owner Email:
Owner name: L ii( % T Phone:
Mailing Address:
Ph�ciral Ar1r�r�g;
Facility Contact: ,��/`%f��/-�r,•r�� Title: Phone:
Onsite Representative: , 5 2:y
v
Certified Operator:�
Back-up Operator:
Location of Farm:
Latitude:
Integrator:
Certification Number:
Certification Number:
Longitude:
DischaEges and Stream Im acts
I . Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes No ❑ NA ❑ NE
❑ 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)?
Design Current
F-1 Yesf
11 No-
Design Current
NE
Design Current
❑ Yes
Swine
Capacity Pop.
❑ NE
Wet Poultry
Capacity's Pop
Caltle
Capacity Pap.
❑ NE
Wean to Finish
Layer
Dai Cow
R
ean to Feeder
I
jNon-Layer
I
Dai ry Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design Current
Dry Cow
Farrow to Feeder
isasa�V ural. pia fl mL1L IaU
1V V11-Ldll
arrow to Finish
Layers
Beef Stocker
on -Layers
Beef Feeder
LIIGilts
oars
Pullets
Beef Brood Cow
Turkeys
ther
Turke Poults
yf'Mk I�
Other
Other
DischaEges and Stream Im acts
I . Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes No ❑ NA ❑ NE
❑ 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 ves, nntifv DWRI
F-1 Yesf
11 No-
i NA
NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
O o
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412015 Continued

Facili 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 0 No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
identifier:
Spillway?:
Designed Freeboard (in): _19,
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes �No[:] ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are the... P,*.d''.:ea'ure5 v..-SAL� "1iii.11 arm nut properly addleJJGu alldllll 111arlagLd UIIUUg11 a ❑ YCD u ❑ 'lYA ❑ 1VE
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 Q 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 O No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes 0 -'No ❑ NA ❑ NE
❑ 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 Tvrw(0—
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 equinmenO
[:]Yes [f]'No
❑ Yes []No
❑ Yes ❑ No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
[:]Yes —D`N�o ❑ NA ❑ NE
luV,-.,, Nn r NA. rl NF
1X
Required Records & Documents
No
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
E?J
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
Q No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping needimprovement? If yes, chle–c–k1 the appropriate box below.
❑ Yes
E7 No
❑ NA
❑ NE
❑ WAStP Annhentinn I 1 U/PPk1.r Frne�.� v 1 1 \ilacte A -1—;S � Coli Anai"$iJ
rIL-J 1111asic'! r ansrers
�I 111eather 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
d
Vo
❑ NA
❑ NE
23. If cele tpr� did the facility fail tr' i.^,�t:ll '^ 7 maintain �'ro,1 0^ ^... 'ti.^, � o ?
w.�. u.aii�un+. +uinv+�-una..a v� "r:u .,y^Uipii�ent.
f t v^
L� �a
�O
�� +
i—� i`:A
L�
rI XTU
L�
Page 2 of 3 21412015 Continued

Facili plumber: - Date of inspection: — p —
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes Q No ❑ NA ❑ NE
' 25. Is the facility out of compliance with permit conditions related to sludge? If yes, check C3" es ❑ No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes �o ❑ NA NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e_, discharge, freeboard problems, over -application)
31. Do subsurface 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
BO
❑ NA
❑ NE
❑ Yes
dNo
❑ NA
❑ NE
❑ Yes
[a -&o
❑ NA
❑ NE
❑ Yes
E]No
❑ NA
❑ NE
❑ Yes ❑' Vo
❑ Yes [3 -No
❑ Yes [�fNo
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Reviewer/ Inspector Signature:Z_��/ Date: fid/
Page 3 of 3 214,12015

I �L
i ype of visit: i^guompltanee inspection V uperatlon Review U Structure Evaluation U 'l eennlcal Assistance I
Reason for Visit: outiue O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time:Q; p("� Departure Time: // County:_939min-` Region: (
Farm Name: A! ryl Fa1PK3
Owner Name: 2+7_/A1 >ra />xS , G �'
Mailing Address:
nh
I Hysicall t%ULL[Gss.
Owner Email:
Phone:
Facility Contact: Title: pwr, Phone:
Onsite Representative: s'_ Integrator: /z~r
Certified Operator: ��,Certification Number:
Back-up Operator: Certification Number:
Location of Farm: Latitude:
Longitude:
Design Current
[:]No
3= �`;'i�
Design Current
i Ifll
Design Carrent
Swine Capacity Pop.
Wet )P�ul#ry
Capacity °;i. Pop. 3
Cattle Capacity Pop.
ua
1
HUM
Wean to Finish
Layer
D airy Cow
Wean to Feeder
]Non -Layer
Dairy Calf
Feeder to Finish;;
Dairy Heifer
Farrow to Wean
Design Carrent
Dry Cow
Fa,iow to Feeder
t ,I�Yo
Non-IJai
Farrow to Finish
La ers
iN
Beef Stocker
Gilts
Non -La ers
',
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Qther
Turkey Poults
Other
Other
Discharges and Stream Im..ontc
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 flops the disrharoe hunass the ` --"e management s "ten "I "If—es,t7 A, n;voN
»•b-• I,-- •'w .....naseiiie�� u�u � .iv �a)' f
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes O.No [] NA ❑ NE
❑ Yes
[:]No
❑ NA
0 NE
❑ Yes
❑ No
❑ NA
❑ NE
Page 1 of 3
❑ Ycs u No
❑ Yes No
❑ Yes V�LNo
❑ XT A— r-1`: E
❑ NA ❑ NE
❑ NA ❑ NE
2/4/2015 Continued

Facility Number: - Date of Inspection:
l Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes r�$No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No [] NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
❑ Yes (-No
❑ NA
❑ NE
the appropriate box.
5. Are there any immediate threats to the integrity of any of the structures observed?
E] Yes
EkNo
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes �No
❑ NA
U. Are there structures on-site Which are nut pruperly uddrr,"cd aild/Ur managed through a
❑ Y es
110
r--1 1:iA
t^J NE
waste management or closure plan?
�1
L__j
❑ Rainfall ❑ Stocking ❑ Crop Yield [:1120 Minute Inspections ❑ Monthly and I " Rainfall Inspections
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
E] NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
RNo
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
allo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
QNo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ®No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): ,� G•`STr
13. c,;.1. aypel(s�-
1. L!
14. Do the receiving crops differ from those designated in the CAWMP? [:]Yes allo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes 0 No ❑ NA ❑ NE
16_ Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes L3.No ❑ NA ❑ NE
acres determination?
IT Does the facility lack adequate acreage for land application?
18. Is there a lack of nronerly oneratino waste annliration Pgliipment9
Reauired Records & Documents
❑ Yes Ej No ❑ NA ❑ NE
❑ Yes rAo NA FINE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes Jallo ❑ 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.
0 WUP ❑ Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes �No
❑ NA
El NE
❑ U7 ­+e A....1 r�r:,�., 1—I W—t-6, Freeb^ A I� lit—+_ A.iai"n;n M Qoil A..ol..
1^� 111—te _F a_�ferc
I—I WrathPr
C'nr1P
Y1ra:.,uuv.a I...J ..,� v...v 1J • aa«. y�.o `�uuaa.�.....�o;�
�1
L__j
❑ Rainfall ❑ Stocking ❑ Crop Yield [:1120 Minute Inspections ❑ Monthly and I " Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
[:]Yes JC , No
❑ NA
❑ NE
23 if selectee d;A the f6eil;h, f .I t� :•,�rwll u:�+ 4�e.Lok r:.,., or.,,;•,r,�P•,r?
. U15 ... ..aiaa,oinva�ua..,�O;:r^g«......y,,.1,.a.,,aa..
�I Ve. rIZ21 Nn
�: }y" .
I—I NA
u
n NF
1_ J
Page 2 of 3 2/4/2015 Continued

FacHi Number: - Date of Inspection: /
,, r 24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes fEq- No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check E Yes JgNo ❑ 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 [g No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes S 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
nPrm;0 ii.rrlcarnba, f—Jie1—ar--hl-
11
_....... 1.rr.,.m., nvar_annliraf:n..�
over ..rr.......,,..�
3 I. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below_
❑ Application Field ❑ Lagoon/storage Pond ❑ Other:
❑ Yes ZLNo 0 NA ❑ NE
❑ Yes allo ❑ NA ❑ NE
❑ Yes RNo ❑ NA ❑ NE
❑ Yes [&No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes ❑E..No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative? ❑ Yes & No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? [:]Yes [j3_No ❑ NA ONE
Reviewer/Inspector Name:
Reviewer/Inspector Signatlu
Page 3 of 3
Phone: 9if1J O/,'j'1
Date: 2/ 7
21412015

Type of Visit: 9) Compliance Inspection O Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: (V Routine O Complaint Q Follow-up O Referral Q Emergency Q Other O Denied Access
Date of Visit: �oll,v Arrival Time: Departure Time: County: Region: Ro
Farm Name: " fat
Owner Name: —CLT[' 1�e', LLP -�
Mailing Address: 35 S ('LeCW RU.A S460) RA err,
Phvciral Arirlracc• S�
Owner Email:
Phone:
V
Facility Contact:Title: Phone:
Onsite Representative: C tereA [A) e -, Integrator: FLes+ago-
Certified Operator: Deyt[k-Q �,tW L uK_ Certification Number: .2.2!g 1 7
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
DesianCurrent
Swine Pop :
Wet Poul try
Design
Capacity
Current
Pop.
= Design Current,
Cattle Capacity Pap.
Discharge originated at_ ❑ Structure ❑ Application Field ❑ Other:
Wean to Finish
Layer
Dai Cow
❑ Yes
Wean to Feeder D oaO
Non -Layer
❑ NE
b. Did the discharge reach waters ofthe State? (If yes. notify DWR)
❑ Yes
❑ No
Dairy Calf
❑ NE
Feeder to Finish
*� .-,
Dai Heifer
d. Does the discharge bypass the waste management system'? (If yes, notify DWR)
Farrow to Wean
_
Design
Current
Q Cow
❑ Yes
Farrow to Feeder
D , iPoultr�
Ca "aci
PIL P.
Non -Dairy
❑ No
Farrow to Finish
La ers
of the State other than from a discharge?
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Otherk '.
Other
Turkeys""
_
Turke Poults
Other
M
Discharees and Stream Impacts
1. Is any discharge observed from any pari of the operation?
❑ Yes
No
❑ NA
❑ NE
Discharge originated at_ ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters ofthe 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
❑ No
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 2/4/2015 Continued

Facili Number: - 5:20 Date of Ins ection: 7 1 bo i 4e
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure l Structure 2 Structure 3 Structure 4 Structure 5
Identifier: 1
Spillway?: R4 _
Designed Freeboard (in): I q`
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
®No E] NA ❑NE
❑No E] NA ❑NE
Structure 6
❑ Yes MNo ❑ NA ❑ NE
6 Are there structures on -cite lvhir•h arp not nrnnert.. nAdrAccAd an&nr mannnert thr,ugh a
......_......... structures on-site ......... ..re—, t....h... ., ..w..w•,... ....... •.. ......+..b.... ..,, .,..b. ..
11 Yec
LJ •..,
171 N.
�� ..,
�1 AIA
L_t ...
171 NF
waste management or closure plan?
❑ Yes
jr.-C." No
❑ NA
❑ NE
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
[21, No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
® No
E] NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
[4 No
❑ NA
❑ NE
❑ � ❑ �❑ W - -act- -A tjg l ys,g ❑ Kni I A na4,s+r--
9. Does any part of the waste management system other than the waste structures require
❑ Yes
[0 No
❑ NA
❑ NE
maintenance or improvement?
iW"th,
Els }1tore
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
Waste Application
❑ NA
❑ NE
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 0 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 r ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): %<W11 l�P�ts-Ft,�t'e tlQvusFt��
13. Soil Type(s): At4
14. Do the receiving crops differ from those designated in the CAW MP? ❑ Yes ® No [:]NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes 14 No ❑ NA EINE
t6. Did thn C-414 t.. C •I /,, n ....dl........ to LI t. ,7..-'_ , ett t.t.. it1 van M AIA n RTA I—I Nip
.u. v... L 1 .µ4...4y' 1411 LV Jelt GILUIVI Vr1L.la Net LllC ILl1L.'.,a L1V11 Ulnl6ll Vr W'CLLQ VIC t�J I L.J V Y l�V LJ a•�a " +•++
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment'?
Required Records & Documents
❑ Yes ® No ❑ NA ❑ NE
F-1 Yes M No ❑ NA ❑ NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
M No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
jr.-C." No
❑ NA
❑ NE
the appropriate box.
❑t�b.R ❑ehel�}i� ❑ ❑ Mapes L]is
_]Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
[4 No
❑ NA
❑ NE
❑ � ❑ �❑ W - -act- -A tjg l ys,g ❑ Kni I A na4,s+r--
❑
❑1�1
£-ede-
❑ � ❑ �• ❑ �- ❑ ❑ 11
iW"th,
Els }1tore
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
[N No
❑ NA
❑ NE
23. If selected- did the facility fail to install and maintain rainhreakerc on irrigation eauinment? 1-1 Yes M No f91 NA n NE
---- ---- --- -1 - --------"--- -`---- --------- --- --- -tom--- - a . 1� a� `y �.
Page 2 of 2/412015 Continued

Facili Number: jDate of Ins ection: j ICA
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 POA for sludge levels
MNon-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 Z] 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
Vq No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
® No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. were any additional problems noted which cause non-compliance of the permit or CAMP?
❑ Yes
No
❑ NA
LJNE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
M] No
❑ NA
[:]NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
X] No
❑ NA
❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility. to better explain situations (ase additional pages as necessary).
,,s.) Ptanr ern �ktce �o�ge Sita lev�C.
Reviewer/Inspector Name: L' aJ 1,(y1yiQ+z> 7 _ Phone:
Reviewed]nspector Signature: Date:
Page 3 of 3 2/4/2015

of
sof Visit: roroutfline
nee Inspection 0 Operation Review 0 Structur4
in for Visit: 0 Complaint 0 Follow-up 0 Referral 0
-/917867 - Iv -6- 1-6--
0 Other 0 Denied Access
Date of Visit: �,3 / Arrival Time: ' 3 fl Departure Time: :317 County Region: Region:
Farm Name: -M Farm f G Owner Email:
Owner Name: A- `]~I'Y(_ Q/�'!f %. L P ^� Phone:
Mailing Address:
Physical Address:
Facility Contact: '12Zefj!�L// .�/7Xr17 /� Title: Phone:
Onsite Representative: SGYy� _ Integrator: ^Fl_e _
Certified Operator: �s'mR-�_ Certification Number: /f y
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation'!
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes C,No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
Design Curreat
Design
Current.
Design Chrrent
Swine
Capacity PopA..
Wet Poultry
Capacity
Pop.
Cattle Capacity Pop.
can to Finish
Layer
Dairy Cow
Wean to FeederNon-La
er
D ' Calf
Feeder to Finish
-
f _a, ._`.
'., ..
Dairy Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder Dr P.,oul Ca aci Po . -
Non -Dai
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
lurke s
Other;;.
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation'!
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes C,No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
[:]Yes ❑ No
[-]Yes (allo
❑ Yes 12 No
❑ NA ❑ NE
❑ NA ❑ NE
DNA ❑NE
Page I of 3 21412014 Continued

• FaciliNumber: - Date of Ins ection:
Waste Collection & Treatment
~ 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level" into the structural freeboard?
Structure 1
Identifier:
Structure 2 Structure 3 Structure 4
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
❑ Yes 2,No ❑ NA ❑ NE
❑ Yes ❑ No [DNA ❑ NE
Structure 5 Structure 6
❑ Yes ® No ❑ NA ❑ NE
6. Are there structures on-site which are not properly addressed and/or managed through a
[—]Yes
U] No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
® No
[D 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
Q No
❑ NA
F] NE
maintenance or improvement?
11. Is there evidence of incorrect land application? if yes, check the appropriate box below. ❑ Yes JZ No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc_)
F] PAN n PAN > 10% or 10 lbs. n Total Phosphorus _n Failure to Incorporate Manure/Sludge into Bare Soil
El Outside of Acceptable Crop Window __.❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes ;&No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes EINo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes allo DNA ❑ NE
acres determination?
IT Does the facility lack adequate acreage for land application? ❑ Yes "No E]NA [:]NE
1 Q is +h— ., 1� 1. .,F....,...,..5.. ,. ..t :.....:.... .. _.n
. �_ ..� a.lr.l�. 0. la..n VL FLUP�lly operating --waste apjJ11Uauvu cgrirpILIUII :
r-1 V—
LJ L c.a
I� ?Q—
�t INU
n Af A
u 1•n
rt ATF
L i .•,..
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? If yes, check the appropriate box below. ❑ Yes El No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield [:1120 Minute inspections ❑ Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes CR 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
❑ NA ❑ NE
Page 2 of 3 11412014 Continued

r Facie Number: - Date of Ins ection:
1 24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check Yes
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
rM No ❑ NA ❑ NE
❑No E] NA E] NE
[}� Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ® No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes ® No ❑ NA ❑ NE
❑ Yes Eg No ❑ NA ❑ NE
❑ Yes 0 No [] NA ❑ NE
❑ Yes [K No ❑ NA ❑ NE
❑ Yes 54 No
❑ Yes 24 No
❑ Yes J&No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Commepts refer to
{ question.#)• Explain any;YEB answers and/or any additional recommendations or an other comments
Use drawings of
fatilitylo better explain situations.(ase addrhanal pages as necessary).
Reviewer/Inspector Name:
Phone:O— SD, --33
Reviewer/Inspector Signature: Date:
Page 3 of 3 2/412014

ly
Type of Visit: (I -Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance I
Reason for Visit: Q Routine 0 Complaint O Follow-up Q Referral O Emergency 0 Other 0 Denied Access
Date of Visit: ® Arrival Time: Departure Time: County: Region: 7
Farm Name:Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: r/' W Lzrn j4-" . Title: ©ww eC Phone:
Onsite Representative: v -s' Integrator:
Certified Operator: .j7otze—_ Certification Number: /may
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design Current - .� Desrgn�Current - Design Current
Swine Capacity,' Pop. Wet Pou tryC apacity Pop. Cattle ' Capacity Pop.
M cr - . �.
ANNE
Wean to Finish La er Dairy Cow
Wean to Feeder D Non -La er Dairy Calf
Feeder to Finish a,a Dairy Heifer
Farrow to Wean Desi n�urrenf Dry Cow
Farrow to Feeder Dr 3P,oultiCa aci P,o'. Non -Dairy
Farrow to Finish I ILayers I Beef Stocker
Gilts Non -Layers Beef Feeder
Boars Pullets Beef Brood Cow
.. - - ... Ti -L we . .. ........... .. .... .
Otherfflpljjj��j ITurkey Poults
Other Other
Discharges and 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)?
[:]Yes SLNo ❑ NA ❑ NE
[:]Yes
❑No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
[] NE
d. Does the discharge bypass the waste management system? (if yes, notify DWQ) ❑ Yes ❑ No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? [:]Yes 4 No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters [:]Yes ® No ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

Facility Number: - I) jDate of Inspection:
I Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ®.No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): Z
Observed Freeboard (in): —
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 2 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?
❑ Yes
® No
❑ NA
❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
[3 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)
❑ NE
I R Tc thara n IQ of pruner i., ''ti^^ • ate ' l.catr:..^. .o
• t.. F J opera ng . as app equipaTiCTi:
rl v
t—I l W
f<71 rr
1� L I V
9. Does any part of the waste management system other than the waste structures require
[:]Yes
® No
❑ NA
❑ NE
maintenance or improvement?
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[Z No
Waste Application
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
to No
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
CE No
❑ NA
❑ NE
maintenance or improvement?
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
E] Other:
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes PQ -No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 ibs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
1 1. L, 0:1 -r--_i_'. r#..
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
[g No
U NA
U NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
I R Tc thara n IQ of pruner i., ''ti^^ • ate ' l.catr:..^. .o
• t.. F J opera ng . as app equipaTiCTi:
rl v
t—I l W
f<71 rr
1� L I V
I''I ASA
iJ .
n `�E
Re uired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[Z No
NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
to No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
E] Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
[:]Yes
® No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections [:]Monthly and 1" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
® No
❑ NA
❑ NE
Page 2 of 3
2/4/2011 Continued

• Facility Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes RNo
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ® No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ 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
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ® No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal'?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
E] NA [j NE
[:]Yes jg[No ❑ NA ❑ NE
❑ Yes �Z_No ❑ NA ❑ NE
❑ Yes [a No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes
0 No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
RNo
❑ NA
❑ NE
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: d C11--ovo
Date: — /3
2/4/2011

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 0 Denied Access
Date of Visit: Arrival Time: D.'ad Departure Time: 't7 V County: Region: o �D
Farm Name: .W7;rPj, & Owner Email:
Owner Name: 47—m yc mt� /—L.jP Phone:
Mailing Address:
Physical Address:
Facility Contact: �7�aejL,-l�L Ili! "cysr /I -r-- Title: Phone:
Onsite Representative: ,5*� integrator: rr�•�
Certified Operator: Certification Number: /may
Back-up Operator:
:
Location of Farm:
Latitude:
Cerfifientinn Numhnr_
Longitude:
Design Current
Design
Current
Design Current
Swine Capacity P,op.
W..et Poultry
Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
Layer
Dairy Cow
Wean to Feeder
Non -Ler
���
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Dry Cow
Farrow to Feeder
D . P,oul
Ca aci
Po .
Non -Dairy
Farrow to Finish
La erg
Beef Stocker
Gilts
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turke s
Othe
urkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes � No ❑ NA ❑ NE
[—]Yes [] No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWR) [] Yes ❑ No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? []Yes C5J.No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes 54 -No ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 214/2014 Continued

Facilii Number: 0-110 jDate of Inspection:
r /
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
21 No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): /91
Observed Freeboard (in): JD
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
RNo
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
0,No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
Pq No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
a No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
CK No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes 0 No ❑ NA ❑ NE
❑ 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): �(
l4. 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?
18. Is there a lack of properly operating waste application equipment?
❑ Yes (R No ❑ NA ❑ NE
❑ Yes F 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 ZLNo ❑ NA ❑ NE
the appropriate box.
❑Vl'UP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements []Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes � No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes g No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes KNo
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 2/4/2014 Continued

Facility Number: - O Date of Inspection:
7d, Tiirl the f?cilify, fail tin, ealihrafe wacte annliratinn c•miinment ac rimnireri by t}lr hermit? n Yec � No n NA n NE
J rr•---'---••-�--r----••' —. •-�----- r---- u
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check J -Yes e"'o' ❑ NA D 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:p%/�
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes j. No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes CaNo ❑ 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 R1 No ❑ NA ❑ NE
❑ Yes M No ❑ NA ❑ NE
❑ Yes QNo ❑ NA ❑ NE
❑ Yes RNo ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes KNo ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative? ❑ Yes 0 No ❑ NA ❑ NE
34Does the Er^ili,ty requ. a f'-]]^ - p visit by f— 5° agency -Yes 01 No n NA F NE ..- -1. u.-, .]? yaZ u
Comments (refer to question ft Explain any YES.answers and/or any additional recommendations or any�other comments &6
Use drawings a4 facility to better explain situations,(use,add.tiotiiil pages as necessary).
i YGl! r1 /'7 : 9.--
Re.;ewer /Inspector Name:
Reviewer/Inspector Signature
Page 3 of 3
Phone-/-�`'��3`'av
Date:
,2/4/2014

aYPU LF1 rwLa: V %-UL 1puance inspection v vperauon xeveew V structure r vaiunuon V iecnnicai Assistance
Reason for Visit: &koutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: � Arrival Time: Departure Time: il7ri County: Six Region:
Farm Name y!'I 446 L L Owner Email:
Owner Name: 14roi yar,=lire t' l 7 Phone:
Mailing Address:
Physical Address:
Facility Contact: - 2Za rr �� `/i��Gr. p� Title: Q w,-1 ee - Phone:
[incite RPnrPCPntafiva• C... t..*a...•.,t..:• �rri��+
Certified Operator: Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Ll.I ILLI GJ AL1U Stream 11LpYcL3
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 [0 No 0 NA ❑ NE
❑ Yes
Swine
Destgn
Capacity
..
Current �esgn
F.
Pop. Wet Poultry yCapaCity
Current
Pop.
Design Current
Cattle Capacity Pap.
❑ NA
Wean to Finish
❑ Yes
© No
❑ NA
La er
Dairy Cow
Wean to Feeder
Non -Layer
¢' k "" "
Design
I} _ 1?ouIt aci
"'
Current
P,o
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Layers
Beef Stocker
Gilts
I INon-Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turke s
Other Turkey Poults
Other Other
z.�
Ll.I ILLI GJ AL1U Stream 11LpYcL3
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 [0 No 0 NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
E] NE
❑ Yes
2) No
❑ NA
❑ NE
❑ Yes
© No
❑ NA
❑ NE
Page I of 3 2/4/2011 Continued

Facili Number: I Date of Inspection: ,;Z—
❑ Yes
® No
❑ NA
❑ NE
Waste Collection & Treatment
❑ Yes
[3 No
❑ NA
❑ NE
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
Eg No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
❑ NA
Identifier:
18. Is there a lack of properly operating waste application equipment?
❑ Yes
.2 No
U NA
Spillway?:
Required Records & Documents
9—
Designed Freeboard (in): /9 -
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
,® No
❑ NA
Observed
Observed Freeboard (in): 6726
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
g No
❑ NA
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
® No
0 NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
2 e No
❑ NA
0 NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
Ryes
[:]No
❑ NA
❑ NE
S. 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
O -No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
P�] No
❑ NA
❑ NE
ataintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [:]Yes allo ❑ NA ❑ NE
0 Excessive Ponding ❑ Hydraulic Overload 0 Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
f1 nnXr I—I On AT rnot -_ 1n LL.. I—I -r-1 I-1 C_:I._- r____ _r. r _--- rcl..a E)--. c,.a
L 1 I - • r IN - IV /V vl 1V IVa. " I VLal l LI%JDFIIUIU3 " UaIJUIL; LV nji uipviam ; 1viaLWGaiuur,L IIILV ualc .w..
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): /19 4-" rr/
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
[3 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
.2 No
U NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
,® No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
g No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. [-]Yes ISa No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes allo
23_ If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes RNo
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 2/4/2011 Continued

Facili jDate of inspection: / /Z
:r
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [EqLNo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes FNo E] NA C] NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes � No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ,®. No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
,❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32V Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. id 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 ;�;_No ❑ NA ❑ NE
❑ Yes [F No ❑ NA ❑ NE
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes [, No ❑ NA ❑ NE
❑ Yes Ig No
❑ Yes 0 No
❑ Yes ® No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Reviewer/Inspector Name: nf
Reviewer/Inspector Signature:
Page 3 of 3
Phone: Z -1p- 33x0
Date: a I v�-
2/4/2011

rype of Visit:omp_liance Inspection Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: (8 RRooutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: J County: Region: -Q
Farm Name: /42= L L
Owner Name: /.I- r171 �ciiri� L L /
Mailing Address:
Physical Address:
Owner Email:
Phone:
Facility Contact: 1/'i�/`rc/f �1r Title: eel&Jw o— Phone:
Onsite Representative: Integrator:1�aaS2��
Certified Operator: Certification Number:j—��
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
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)?
.1 Yl...... i.- J'__L__ L_ �___ L_ r
u. v . tA1G UnI-11dige Vy� ass ht: WdNtU 111dilagU111C lL JyJtei l? (11 yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge'?
❑ Yes �No El NA E] NE
❑ Yes ❑ No
[:]Yes ❑No
L-iYes U No
❑ Yes Q No
❑ Yes gNo
C] NA E] NE
❑ NA ❑ NE
❑ NA L^J NB
❑NA ❑NE
❑NA ❑NE
Page I of 3 2/4/1011 Continued

Facility Number: - IDate of Inspection: ,o2r�7��J/t
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes g No ❑ NA ❑ NE
a. if yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): 19L
Observed Freeboard (in):
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 D NA ❑ NE
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
CR No
❑ NA
❑ NE
waste management or closure plan?
❑ Yes
rO No
❑ NA
❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
M Yec
I
No.
- _
n NA
u
M NF
u
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)
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
9. Does any part of the waste management system other than the waste structures require
❑ Yes
[N No
❑ NA
❑ NE
maintenance or improvement?
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
Waste Application
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
RNo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes M 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): at U rr 7r
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
P.No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
rO No
❑ NA
❑ NE
16. Did the faciiiiy fail to secure and/or operate per the irrigation design or wettable
❑Yes
�No
U NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
Q No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
Q No
❑ NA
[] NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
R No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
® No
❑ NA
❑ NE
the appropriate box.
❑WUP [:]Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes allo
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ®No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes [Z No
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page.2 of 3 214/2011 Continued

Facility Number: jDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? [:]Yes ®,No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [:�LNo
the appropriate box(es) below.
❑ Failure to complete annual sludge survey [:]Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes ® No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ® No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the ReviewerlInspector fail to discuss review/inspection with an on-site representative?
34. Does the facility require a follow-up visit by the same agency?
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
F] NA EjNE
❑Yes 10No ❑NA ❑NE
❑ Yes .R No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes ELNo ❑ NA ❑ NE
[:]Yes ® No
❑ Yes No
❑ Yes 2 No
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
Reviewer/Inspector Name: ��l�C_(j--y��•� Phone: 33 —3310
Re viewerA nspector Signature: _ ��, 1L7 `– Date:
Page 3 of 3 2/4/2011

IType of Visit M�liance Inspection O Operation Review O Structure Evaluation O Technical Assistance I
1 Roa��..., D.,..+t.,e (l r.,..,.,i��s (l C.,rl.,.... ! 1 os....�ln c....,...r..... (1 nor,. rl n.._;e_1 w __„--
eason .v. Vaal• v .........w v .......r.._.... v ......... up v ..e.eno. v Emerge.. v vu.e. u vc..lcu �a.ueaa '
Date of Visit: Arrival Time: Departure Time: 1p.J County�&Region: FZD
10,
Farm Name: Z Owner Email:
Owner Name: _ �i%�a�� ZPhone:
Mailing Address:
Physical Address:
Facility Contact:Dzifr= Title: 4241w Phone No:
Onsite Representative: Integrator:
IV
Certified Operator: _ _So-+• 51
Operator Certification Number: �"S
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: 0 0= 0 ll Longitude: ED EJ l El u
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
Design C►urrent
DesignCurrent
Design G&Fent
Swine Capacity, Population
Wet Poultry CapaKi—W,opulation
Cattle Capacity Popuiation
❑ Wean to Finish
❑ Layer I I
ElDairy Cow
Wean to Feeder iE9*V iTOD
Non -La er_
❑ Dai Calf
❑ Feeder to Finish
_
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
nF"t , r -A-
.� . ua. v • vv . ..ice....
❑ Farrow to Finish
❑ Layers
`� l V Vll—L4.1
El Beef Stocker
El Gilts
❑ Non -Layers
El Beef Feeder
❑ Boars
[] Pullets
❑ Beef Brood Co
Turkeys
Other
❑ Other
❑ Turkey Poults
10Other
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
❑ NA
LINE
❑ Yes
❑ No
❑ Yes
[INA
EINE
El Yes
,,KNo
9No
❑ NA
EINE
Page ! of 3 12/28/04 Continued

Facility Number:,V Date of Inspection
i
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
❑ Yes [R No ❑ NA ❑ NE
El Yes (D No [I NA ❑NE
Structure 5 Structure 6
Identifier:
❑ Yes
Spillway?:
❑ NA
Designed Freeboard (in):
15. Does the receiving crop and/or land application site need improvement?
Observed Freeboard (in): ZZ
10 No
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
1171 No El NA [:1 NE
(ie/ large trees, severe erosion, seepage, etc.)
❑ Yes
6. Are there structures on-site which are not properly addressed and/or managed El Yes
j,{
Ei No ❑ NA 0 NE
through a waste management or closure plan?
17. Does the facility lack adequate acreage for land application?
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 strictures 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)
RNo
q. Does any pa; of file waste management system other than the waste structures requireElNA
❑ Yes
allo ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need FIV-
ISL XT— M ri e rI un
maintenance/improvement?
11. Is there evidence of incorrect application'? If yes, check the appropriate box below. ❑ Yes
MNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs []Total Phosphorus ❑ Failure to incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
RI No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
10 No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
UZ No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
KNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
RNo
❑ NA
❑ NE
Comments (refer toquestior #): Explain any YES answeis and/or anysrecommii-endations or any other�comments =
Use drawings of fac�fitV to.betEer explain situations (use addihoral pages as necessary}:
A,
7
Reviewer/inspector Name
�.
Phone: O -Lf t7a
Reviewer/Inspector Signature:
Date:
12/18/04 Continued

Facility Number: e2=Date of Inspection
• Reuuired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes P&No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 9,No ❑ NA ❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑Design El Maps ❑Other
21. Does record keeping need improvement? if yes, check the appropriate box below. ❑ Yes [R No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
IN No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
Z No
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
[:1 Yes
]&No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
V[No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
ff No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
WNo
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
RNo
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
CR No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30, At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
UNo
❑ 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
IgNo
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
®,No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
IZI-No
❑ NA
❑ NE
12/28/04

E
Type of Visit j)-Co-mpliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visitutme 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: I 46e1 -L,-7 Arrival Time: Departure Time: j r;[ U �I County: Region:
Farm Name: A -a1 Fa /YYL ILL- P _ Owner Email:
Owner Name: wa Y_ r -r_ �' W %tea p, _ Phone:
Mailing Address:
Physical Address: {�
Facility Contact: +� �`� 1jrte M .;; ! itle: 6 W n - Phone No:
"T'
Onsite Representative: Ste'-{— Integrator:
Certified Operator: j'cr-�_ Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: [=]' [=]' E:] " Longitude: [� ° [� ' = ++
Design Current
Design C*urrent
Design Current
Swine Capacity Population
Wet Poultry Capacih Papulation
Cattle Capacity Papulation
❑ .to Fi.. sh
❑
Dairy
❑ Wean to Feeder a2
IQ Non -Layer I
❑ Dairy Calf
❑ Feeder to Finish
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
n Farrow to Feedern
❑ NE
'NonD.
Dairy
❑ Farrow to Finish
❑ Lavers
u
❑ Beef Stocker
❑ Gilts
❑ Non -La ars
❑ Beef Feeder
El Boars
El
F1Beef Brood Co
-
❑Turkeys
❑ No
iriuer
❑ Other
[J Turkey Poults
❑ Other
Number of Structures:
❑ Yes
I& No
❑ NA
Dischanzes & Stream Imnoe -
1. Is any discharge observed from any part of the operation?
❑ Yes
P.No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any pan of the operation?
❑ Yes
I& No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
ANo
❑ NA
❑ NE
other than from a discharge?
12/28/04
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 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 43
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
RjNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed
❑ Yes
[3,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
JZ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
9No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
CE�No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
allo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
®•No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) 2_441� ZLO"V�_
13. Soil type(s) A L.-
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
allo ❑ NA ❑ NE
IC T___aL_""___ _- _.-._"__.•_ . .n
t5. Loci LUG 1Ct;e1VIlIg CIUp MIUME ladu appucduon site need improvement!
rl�.
V Yes
rJ— rte...
tc�51,No u NA u INn
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
®, No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
�&No ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
&No ❑ NA ❑ NE
Comments (refer to question ,#) �hpfam any YE5 answers andlo any eeommendanons or4aany ather comments.
Use drawings of facility to better.explain situations. (use aaditional pagesaas necessary)
�.
Reviewer/inspectorName�� ^� G. F Phone: '�1��'� 33b0
Reviewer/inspector Signature: Date: ZZ t!o ,� 9
12/28/04 Continued

r
Facility Number: — Date of Inspection" �}
❑ Yes
[9No
❑ NA
Required Records & Documents
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
JRNo
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
❑ Yes
UQ No
❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
fZ No
❑ NA ❑ NE
the appropriate box. ❑ VXp ❑ Checklists ❑ Design ❑ Maps ❑ Other
OfNo
❑ NA
❑ NE
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
M(No
❑ NA ❑ NE
❑ ::Iasi% nppiiiauvr! ❑ iVv eekly Freeboard Li waste Analysis ❑ S.11 Analysis (� Waste ! ransrers
Conifluatlon
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I"
Rain Inspections ❑
Weather Code
22. Did the facility fail to install and maintain a rain gauge? [:]Yes ®.No ❑ NA [:INE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes R No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[9No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
JRNo
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
[:]Yes
[KNo
[-INA
❑NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
E,No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
® No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
OfNo
❑ 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
0 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
MNo
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewertinspector fail to discuss review/inspection with an on-site representative?
❑ Yes
BNo
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
V,No
❑ NA
❑ NE
12/28/04

Type of Visit ompliance Inspection O Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit 011outine O Complaint Q Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: ` , Arrival Time: 42 f fDeparture Time: ,r � County: Region:
Farm Name: 1�m /d`;*fs ilf Owner Email:
Owner Name: ael-e It W rQ-6-, j.- e- Phone: .'-.3/Z'— !go bq
Mailing Address:
Physical Address:
Facility Contact: Gt'!rC 1�1� I`drrt Pe Title:
Onsite Representative: �•L _
Certified Operator:
Back-up Operator:
Phone No:
Integrator:
Operator Certification Number: O�V5,7
Back-up Certification Number:
Location of Farm: Latitude: E=1 e 0 ' EA u Longitude: = o =, 0 "
Discharges & Stream impacts
1. Is any discharge observed from any part of the operation?
Design ... Cnrrent --
Design Current Design Current
Swine
Capacity Populate n Wet Poultry
Capacity Population C►attle Capacity Population
f1 Wean to Finl�h
❑ Lu.,er
❑
.__. Wean to Feeder
O ❑ Non -Layer
VaMr
ODairy Calf
❑ Feeder to Finish
❑ NA
❑ Raii Heifer
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
n Farrow to Feeder
❑ NE
_ 1,=-1 Nrnn_nairy
ElFarrow to Finish
❑ La ers
❑Beef Stocker
❑ Gilts
❑ Non -Layers
❑Pullets
110 Beef Feeder
❑ Boars
0 NA
❑Beef Brood Co
2. Is there evidence of a past discharge from any part of the operation?
-.' ❑ Turkeys
RNo
Other
❑ Other
❑ Turkey Poults
❑Other
-
Number of Structures:
❑ Yes
(;No
❑ NA
Discharges & Stream impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
RNo
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQj
❑ Yes
0 No
0 NA
U NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
RNo
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
(;No
❑ NA
❑ NE
_ r_
uui�cr iu3u llVril a QISCnarge!
Page I of 3
12/28/04
Continued

Facility Number: —3,2a Date of Inspection - D
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
C.No
❑ NA
❑ NE
a. if yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Desiened Freeboard (in): 1g
Observed Freeboard (in): (o
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed
❑ Yes
No
❑ NA
❑ NE
through a waste management or closure plan?
If any of questions 46 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
R No
❑ NA
❑ NE
S. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes [jd 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 RfNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes WNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 14No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
I—I o w i,t E—I n n ws III _ t n tt I—I -r­t nt _t ii r. _:t.._ r_ __ _ . L ! /01...4 a n _ c a
u 1 emir !__! rnsl 4V/0 U1 IV Jun L_! 1 ural rlluwt/llultlu u rauulc LV 11lLVIt1Vl1lG 1v11UU1Gl J1l1U8D 111LV UWG wig
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [RNo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre detertnination?❑ Yes ff[No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes B No ❑ NA EINE
18. Is there a lack of properly operating waste application equipment? ❑ Yes JRNo ❑ NA ❑ NE
xplain:situ
ReviewerlInspector NamePhone:
iia-- 33-3�c�
Irz JF Reviewer/InspectorSignature: Date: T"%(p�J�
P. 7 .jr ? 722RInd Cn�tinuvd

r
Faeility Number: — Date of Inspection la"
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 9No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 14No (INA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 5INo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes RNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes EgNo ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes(�No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
® No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
Wo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
V1 No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
®.No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
[9 No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
[[No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
RINo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
M No
❑ NA
❑ NE
Page 3 of 3 12/28/04

ivision of Water Quality ! -30
Facility Number. Q2 0 Division of Soil and Water Conservation r�
- 0 Other Agency
Type of Visit
ompliarice
Inspection
0 Operation Review 0 Structure Evaluation
0 Technical Assistance
Reason for "Visit
ry13r •wutine
Complaint
Volul ur i'!J-1 rtCLIR_--_II -ErasergCn[y
Lit Other iV YCIIICU Kla:Gjj
Date of Visit: 14,2AM Arrival Time: Q.�J� DepartureTime: � County: �' `' Region:
Farm Name: I l_ v „ T a*, -In 5 / G !F Owner Email:
Owner Name: e w ra".K Z�Is- Phone:
Mailing Address:
Physical Address: '1
Facility Contact: O ,:w2 Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
�7 Phone No:
intevratar• /V/�.0✓f+�K�
Operator Certification Number -
Back -up Certification Number:
Location of Farm: Latitude: [=O
=6
=is Longitude: = 0 0 + =1"
Swine
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ w'ean to Finish ❑J La er
ER Wean to FeederQ Jr ❑ Non -Laver
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Dry Poultry
❑ La ers
❑ Non -La ers
❑ Pullets
❑Turke s
❑ Turkey Poults
❑ Other
il'....
viaa.ua, rc� � al.ream impacts
1. Is any discharge obsen ed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made`?
Cattle
Design Curren
Capacity. aPopulat
J Dairy Cow
❑ NE
] Dairy Calf
❑ No
] Daia Heifer
❑ NE
] Dry Cow
] Non -Dai
] Beef Stocker
EINE
] Beef Feeder
❑ No
] Beef Brood Cowl
Z[No
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes allo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
EINE
❑ Yes
❑ No
❑ Yes
Z[No
❑ NA
EINE
❑ Yes
NNo
❑ NA
❑ NE
12/28/04 Continued
7

Facility Number: — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a, if yes, is waste level into the structural freeboard?
I J[1LLeLLLIG f �L1 Lief LLIL L Stractu1G 31 o[I UG LLUG "t
❑ Yes MNo ❑ NA ❑ NE
❑Yes []No [--INA EINE
p._UGtU_e rJ PJIteI LLLtuIe 6
Identifier:
Spillway?:
Reviewer/Inspector Name Phone: 9'jO-- —V33
Revieweriinspector Signature: - Date: %V 2ar�
Designed Freeboard (in): /
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
® No
❑ NA ❑ NE
(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 bWQ
7. Do any of the structures need maintenance or improvement'!
LJ Yes
JQ No
LJ NA LJ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
9No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
C No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
®.No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
®No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals
(Cu, Zn, etc_)
❑ PAN 0 PAN 1 10 or 10 lbs. 0 To*.al Phosp.h, nus r1 Failure.,, t
J U VJrJ11V1 uJ Lf Failure LV Inl V11 k1Vl ate
,,.1......_ «t..UA..,. o.._.. CO:t
lYlali LLl [:/.]1LiUb'G 11 -1 -LO UQIG JVII
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)��� .
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
(R -No
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
XNo
❑ NA ❑ NE
t6. 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 ' la^L S „rz„erl., t: .:
lack o. properly operating waste application eguipruent:
�
tJ Y es
LSI
pq No
r'� r1
Li INA 1i i'vE
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 Phone: 9'jO-- —V33
Revieweriinspector Signature: - Date: %V 2ar�
12128104 Continued

tt Facility l�iumber: — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 29 No ❑ NA ❑ NE
20. Toes the fariiity fail to have all comnonentc of the CAW. -NfP readily available? If ves, check 1 1 veU Mm. FINA l,_,l NF
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 0 N ❑ NA ❑ NE
li r1 Weekly Freeboard _ M nr_-•- "--t__-__ 1—I
u rr'as%c Application u weexiy rteco�aru u waste Hnaiysis u ��it Aiiniyai� �„J wastC I Iattarc+a u r .Ul,ar ��r.t.t..aLlvu
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes MNo ❑ NA ❑ NE
23- if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes C9No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[9No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
Z,No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
[9No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
KNo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
(A No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
8 No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
9No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
® No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
Eq No
❑ NA
❑ NE
33-
Does facility require a follow-up visit by same agency?
❑ Yes
ANo
❑ NA
❑ NE
Additional Comments and/or Drawings:
12128104

Type of Visit (YCompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
1 Reason Tor vlsli V Kouilne V CornplalnT V ronow up V KeTerral l-! Emergency U Ulner I__! Uenlcu F►1UGB55 !
Date of Visit: Arrival Time:: ;Q(� Departure Time: I County: Region:
Farm Name: /%- t` OE Owner Email:
Owner Name: LJ_a i -e—cn l I Phone:
Mailing Address:
Physical Address:
Facility Contact: CI t I` f. / W f0 tner Title:
Onsite Representative: _viatr��
Certified Operator:
Back-up Operator:
Phone No:
Integrator: rr
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: = 0 =I ="
Longitude: = e =I = u
Design C*urreut
Design Current
Design Current
Swine Capacity Population
A. Capacity Population
C►attle Capacity Population
❑ Wean to Finish
❑ Layer
❑ Da Cow
IN Wean to Feeder
Non -Layer
airy Calf
❑ Feeder to Finish1
❑ NA
❑ Dai Heifer
❑ Farrow to Wean
,
Dry Poultry;,-
JE1 Dr Cow
n . _
L__I yarrow to reeaer
❑ La ers
r--+ —
UNon-Vairy
El Farrow to Finish
❑ Beef Stocker
❑ Gilts
❑ Non -Layers
El Beef Feeder
El Boars
El Pullets
❑ Beef Brood Cow
;�...: -
❑ Turkeys
-
Other
❑ Other
❑ Turkey Poults
Number of 5truetures:
❑ Yes
ther
❑ NA
Discharges & Stream Impacts
1 _ Is any discharge observed from any part of the operation?
[:]Yes
3 No
[-INA
❑NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
[M No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
91 No
❑ NA
❑ NE
e. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
[K No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
EtNo
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
&INo
❑ NA
❑ NE
other than from a discharge?
`
Page I of 3
12128/04
Continued

Facility Number: $' — Date of Inspection tY tl- 6
Waste Collection & Treatment
I 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
.0 No ❑ NA ❑ NE
S.— tuye t St^.acture 2 S :acture ? 8­ucare ^
auu�iuic i
8t^:c Structure
c Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): J 9
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
® No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed
❑ Yes
JC 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
i. Do any of the structures need maintenance or improvement?
Li Yes
Y`J No ❑ NA ❑ Nt
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
14 No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
n vac
MM. n NA MNP
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
V No ❑ NA ❑ NE
.. . .�
. riari+;cr,: � mpry i%emii�c:
Tiaiii u,
H. Is there evidence of incorrect application? If yes, check the appropriate box below.
J0 Yes
❑ No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
I—I PAM 1- I AAAI 1A0/ nr In the rl -r-t.1 AL ,�„hn...� rl P. ihL t.. T,,. -..r —t. K4�
._/Q1.A-.• in4n P� Cnil
— .. ,. , ... �.......,� ..�. ,.� . u........ �... . r....., ,..........
U...,.b ....
... ..
tA Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside
of Area
12. Crop h'Pe(s) Z�_"'r
13. Soil type(s) Tf to
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes No ❑ NA ❑ NE
15_ Does the receiving crop and/or land application site need improvement? ❑ Yes No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes JZ No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
1$. Is there a lack of properly operating waste application equipment?
❑ Yes [9 No ❑ NA EINE
❑ Yes X[No ❑ NA ❑ NE
IComments (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):
T
Reviewer/inspector Name { � �.
e-✓ 7 Phone:
ReviewerAnspector Signature: Date: d~0 b
Page 3 of 3 12/28/04 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 ® No ❑ NA ❑ NE
the appropriate box. ❑ WUp ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes Jallo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
JR No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[RNo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
JR No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
PKNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
JZNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
[9 No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CA WMP?
❑ Yes
KNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
JXNo
❑ 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
0 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
19 No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
allo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
KNo
❑ NA
❑ NE
Additional 'Comments and/or Drawings:?
T
Page 3 of 3 12/28/04

i
Type of Visit CM Compliance Inspection O Operation Review 0 Lagoon Evaluation
Reason for Visit ®Routine Q Complaint 0 Follow up Q Emergency Notification O Other ❑ Denied Access
Date of Visit: Time:
Facility Number S.�O �
10 Not Operational 0 Below Threshold j
E3"fermitted Certified ❑ Conditionally Certified 0 ReAsitered Date Last Operated or Above Threshold:
Farm Name: Parr,[County:
Owner Name:._ 11r r ell Phone No:
Mailing Address: :?S-,5-- C—I&ct koce-1 �r<+rrP/l s,` NC _-:2S� !tYY
Facilih• Contact: QCr/'P h1i4.n.op ,,_Title: ,p PhoneNo:
Onsite Representative: _p�r��IL" �ra4noa le Integrator_
Certified Operator: �rGQ Operator Certification Number:
Location of Farm:
laZwine ❑ Poultry ❑ Cattle ❑ Horse Latitude �• �° �= Longitude �• �K
Design Current
Swine vn_"Ierift"
jean to Feeder Zoo
7c�
❑ Feeder to Finish
❑ Farrow to «'ean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Design Current Design Current
Poultry Ca acih• Population Cattle Ca1DRCitV Po ulation
❑ Laver ❑ Dairy
❑ Non -Laver ❑ Non -Dairy :J
❑ Other
Total Design Capacity
Total SSLW
Number of Lagoons I LL1 Subsurface Drains Present
Bolding Ponds I Solid Traps _ ,. ❑ No Liquid Waste Managed
Discharges 8- Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Sprav Field ❑ Other
a" If discharge is observted, was the conveyance man-made?
b, If discharge is observed, did it reach Rater of the State? (If yes, notify DWQ)
c" If dischame is observed, what is the estimated flow in sial/min?
d. Does discharge bypass a lagoon system? (If yes. notify DWQ)
Z. Is there evidence of past discharge from aav 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 8- Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure ? Structure 3 Structure 4 Structure 5
Identifier: %
Freeboard (inches):
05/03101
Continued
❑ Yes
ErK-,-o
❑ Yes
Blo
❑ Yes
EINo
❑ Yes
LINO
❑ Yes
RNO
❑ Yes
aio
❑ Yes
END
Structure 6
Continued

Facility Number: —spC
Date of Inspection - o
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
{.-VJW cL t]laLl:
(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
❑ Yes [ o
❑ Yes Owo
El -yes ❑ No
❑ Yrc �TTn
❑ Yes O1lo
10. Are there any buffers that need maintenance/improvement? ❑ Yes S'?S
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes 04-0
12. Crop hype B,o C 0 ue&<a
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes E34?6-
14. a) Does the facility lack adequate acreage for land application? ❑ Yes D.Aio
b) Does the facility need a wettable acre determination? ❑ Yes O'Igo
c) This facility is pended for a wettable acre determination? ❑ Yes. Quo
15. Does the receiving crop need improvement? [IYes E1V0i
16.
Is there a lack of adequate waste application equipment?
❑ Yes
EIKo
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, desiE, maps; etc.)
❑ Yes
044'0-
44o19_
19
Does record keeping need improvement? (ie/ irrigation, freebomr , waste analysis & soil sample reports)
t`' p lames
to
20.
is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
U -No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
�io
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes
©'No
(ie/ discharge, freeboard problems, over application)
23.
Did Reviewer/Inspector fail to discuss review/inspection with on-site representative?
❑ Yes
ENo
24.
Does facility require a follow-up visit by same agency?
❑ Yes
[cfTo
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
0-No-
113
No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
laiUse dren is sof fto..gdest better explain s nv YES answers and/or any recomtitendattotis'or any'other eofnments:
,{ q p
g ty Ubsitiuns (rise addtdoaal pages as necessary). ®d eld Copy El Final Notes
nt= I
1 7 /+if. Wru/M�JP A., Ao,.,,S Oy-ev- f/,e 1/u9d6
/17 (0/a.,S 4 P,t_,Ovc w.k� , a/weele), rAe 4,,,.4
44%ve t-/CaleC/ 441-C S,0, S 8n6/ a 1('ew
+°.44 6 44 9 00 gOV e, .
�.•�� rt i 4l[v>'a�� MGrc� r5 irr•1.9uY:ari e�l[rlTj .S3'� 4yojOra�{ r.�ur' 1t�crr t.va5 u .;;�.�t
WJtA 'lhy v r
Reviewertlnspector Name ! %r)Ork 6'�hY
Reviewer/Inspector Signature: Date: y [s y
05/03/01
Continued

Farm Name/Owner:
Mailing Address::
Site Requires Immediate Attention: ^11A
Far_ility No. ga _=�r6
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: j,/ 1995
„---
Time: ;?,42/30
a
county: e -m4 s a,
Integrator. 7 P,-acYa+ n ,
On Site Representative: _,,!-- ,o.,e
Physical Address/Location:
-c
/U -) -,;yZ - -..T-7 7
Phone: .a A -5"`
Type of Operation: Swine Poultry Cattle
Design Capacity: Number of Animals on Site: , va 64a, 4W
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: Longitude: to
Circle Yes or No
Does the Animal Waste Lagoon ha sufficient freeboard of I Foot + 25 year 24 hour storm event
(approximately ]Foot + 7 inches) Yew or No Actual Freeboard: _ Ft. _Inches
Was any seepage observed from the lag n(s)? Yes or 9 Was any erosion observed? Yes or No
Is adequate land available for spray? Ygyor No Is the cover crop adequate? Yes or No
Crop(s) being utilized:
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellin ?? vP, cr Nu
100 Feet from Wells? QY_eif or No
Is the animal waste stockpiled within 100 Feet of USGS Blue -Line Stream? Yes or(9 �
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line: Yes or i+o�
Is animal waste discharged into water of the state by man-made ditch 'Anjus ing sy '
'...,...,,, „u.)lull� D��tGl11, VI other
similar man-made devices? Yes ori If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? Yes or No AII)a
Additional Comments:
1
Inspector N y
Signature
cc: Facility Assessment Unit Use Attachments if Needed.

Site Requires Immediate Attention:N O
Facility No. SZ- szo
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: jUL
4 t? 1995
Time:
Farm Name/Owner:
Mailing Address:--Kt—
28 44
County: S4tVSar✓
Integrawr: FaYwis _7v� Phone: /910) .5,2 - 57 7 1
On Site Representative: W ,,,,t 2., Phone:. t 91 0) 53 L - 4O 32EK
Physical Address/Location:
Type of Operation: Swine ✓ Poultry
Design Capacity: 624 -6 . 6wo-3 Number of
DEM Certification Number: ACE
Latitude: Longitude: ° _
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches) Yes or No Actual Freeboard: 3 Ft. O Inches
Was any seepage observed from the la (s)? Yes o& Was any erosion observed? Yes o6D
Is adequate land available for spray? Ye r No Is the cover crop adequate? Yes or No
Crop(s) being utilized: 13erw�v.do�
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellin Ye oz
100 Feet from Wells? �' No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or l�o
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line:
Is animal waste discharged into water of the state by man-made ditch, flushing system,
similar man-made devices? Yes or( 19 If Yes, Please Explain.
Cattle
Animals on Site:
DEM Certification Number: ACNEW
No
Yes ord o�
or other y
Does the facility maintain adequate waste management records (volumes of manure, land applied,
cn 4v urri rr�f ri nn �rwrif r nrrpo rro tuif3ti rnvar rrnn)) ! Yac hr Nn
Y I b r"^' uwaub� naua w.w vJry.
Additional Comments: Re<1 sfcs e_c/ %/ - Zz- 'I.3 , beve.,✓ /aj rid:. c �o�✓ ! S
R,ck Reve.1s
Inspector Name
Signature
cc: Facility Assessment Unit Use Attachments if Needed.

114.' i z --
KIM" CAROLIM DIKPARTXMT OF EWIROMUMT, HSALTE' L N MZAL RZSOM E5
DIVISION OF EUMONMENTAL MANAGE20M
Fayetteville Regional office
Animal Operation Compliance inspection Form
'/Jy�ysF��E�
].y��:1�¢. Lwbww4'�ry
7Pz i�,40Z rte:^.T'�.YARK i��I.liaOLV
I)sokne. ca.rrcii 1 Dicmel Wr
:ya�RTfl�.ff - �wT:i2 ::�{'� `h �w.Y'�i—or Sf4..aI.�.Tf •'f*...�.. r.� r.
y,.a�..
—e,ox77A NdrrelIS Nc 213444
CG 10) 532 A 085
All questions answered negatively will be discussed in sufficient detail in
the -Comments Section to enable the deemed Permittee to perform the appropriate
corrections:
SECTION r
Animal 07mration Type-r-WrOWW)1
Horses, cattle, wine, poultry, or sheep
$EGTIDN Ii
T I N I COMMENTS
1. Does the number and type of animal meet or exceed
4-'ke ! h71R1 —4ier410L'7 Tr+ali7fi fgAA 16 Al
U.. % V - I!, `L iLG1: L�- LLIC %IVV S1CGLi,,
horses (75), swine (250), sheep (1,000),.and
poultry(30,000 birds with liquid waste
systanj
2. Does this facility meet criteria for
Animal Operation AECIST'RATIO ?
3. Are animals confined fed or maintained
in this facility for a 12 -month period?
4. sloes this facility have a CERT'IFISD ARIM
jASTZ NANAGF.KMT P.W.
5. Does this facility maintain Waste management
records (Volumes of manure, land applied,
spray irrigated on specific acreage with
Spec i f ti r• nr,..e� ,. 1 9
..rc..
G. Does this facility meet the SCS minimum
setback criteria for neighboring houses,
wells, etc?

M _0R I
kISId Site Manaqem_e_ra
1. Yo animal rasLa aLoCkpilA& 8f lagoon
construction within 100 ft. of a USCS
Map Blue Line Stream?
2. Is animal waste land applied or spray
irrigator] wi*hin iS It. of s UVG0 Slap
Blue Line Stream?
3. Does this facility have adequate acreage
on which to apply the Waste?
4. Does the land application-site have a
cover crop in accordance with the
Mt=FICATION
5_ Is animal waste discharged into waters of
the state by man-made ditch, flushing system,
or other similar man-made devices?
6. Does the animal waste management at this
farm adhere to Rest Management Practices
(BMP) of the approved CERTUICATIOH?
7. Does animal waste lagoon have sufficient•
freeboard? Haw much? (Approximately ,3 )
B. Is the general condition of this cAro facility,
including management and operation,
satisfactory?
l DNqrY
CaMents

lw
c
0
r
rw