820601_INSPECTIONS_20171231

NORTH CAROLINA
Ommdmm t of Environmental Qual

f
Type of Visit: f) Compliance Inspection 0 Operation Review Q Structure Evaluation 0 Technical Assistance
Reason for Visit: a Routine O Complaint Q Follow-up o Referral Q Emergency 0 Other Q Denied Access
Date of Visit: Arrival Time; Departure Time- / County:
Farm Name: 4. Z Owner Email:
Owner Name: I {�C.�,� Phone:
Mailing Address:
Physical Address:
Region: , L�
Facility Contact: _ DIED,_35 N � -�r� Title: Phone:
Onsite Representative: - k4 Integrator:
Certified Operator: TJ-��,4 , g�i-r71, Certification Number: [ Ck JlC
— —I
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design Current
Design
Current
Design Current
Swine Capacity Pop.
Wet Poultry
Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
I ILayer
I
Dairy Cow
Wean to Feeder
I INon-Layer
I
Dairy Calf
Feeder to Finish 3(.W
Da' Heifer
Farrow to Wean
Design
C•nrrent
Dry Cow
Farrow to Feeder
D. P.oultr
Ga aci
P.o
Non -Dairy
Farrow to Finish I
La ers
Beef Stocker
Gilts I
Non -Layers
Beef Feeder
Boars I
Pullets
Beef Brood Cow
Turkeys
Other
TurkeX Poultr
Other I I
Other
Discharges and Stream Impacts
1, Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
❑ Yes " No C:] NA ❑ NE
a. Was the conveyance man-made? [] Yes ❑ No EP NA ❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWR) ❑ Yes ❑ No NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (if yes, notify DWR) ❑ Yes ❑ No NA ❑ NE
1 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 No ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412015 Continued

Facili Number: 6CI Date of Inspection:
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:
No ❑ NA ❑ NE
No [� NA ❑ NE
Structure 5
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): �r
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yeso ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
b. Are there structures on-site which are not properly addressed and/or managed through a ❑ YesNo ❑ NA ❑ NE
waste management or closure plan
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the structures Iaek 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 F�No ❑NA ❑ NE
maintenance or improvement?
Waste Annlication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes K� No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ YesNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.
❑ PAN ❑ PAN > 101/a or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift _ ❑„,Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes 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 No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes ®No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes KR No ❑ NA ❑ NE
the appropriate box. Tj
❑ WUP ❑Checklists E3Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 0 N
❑ Waste Application ❑ Weekly Freeboard EJ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall El Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? El Yes No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? 0 Yes No
No
❑ NA ❑ NE
❑ Weather Code
[]Sludge Survey
❑ NA ❑ NE
❑NA ❑NE
Page 2 of 3 2/4/2075 Continued

Facili Number: jDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit. ❑ Yes No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes 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 � No [-]NA D NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ® No ❑ NA ❑ NE
Other Issues
2$. 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
m No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
T
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
[P No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, overapplication)
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 CA% MP?
❑ Yes
No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
[:]Yes
No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
fpNo
❑ NA
❑ NE
Comments � eft:r to u R k ; � �
( g ection #} Eapinifi"" YES answers..and/or..any addrtranal recom
_. f , , r.+ i6en tionsor.any�othe'r,.cowments.:-
Use drawin s of:factlrtyttobe_tter ezplaitnahans (use addrttonsl pales as necessary}.,-
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 7f -3`
Date: cok9hle_
2/4/2015

iL
r ' - Divi."sion f Water Resources
Facility Ntetnber®-sion of Sod and Wa#er Conservatiott
Q Other Agcy
ff
of Visit: ® Compliance Inspection Operation Review Q Structure Evaluation Q Technical Assistance
n for Visit: *Routine O Complaint O Follow-up O Referral Q Emergency Q Other O Denied Access
Date of Visit: Lj #01M
f Arrival Time: O Departure Time: County: Region:
Farm Name: L Owner Email.
Owner Name: �' 4�-t Phone:
Mailing Address:
Physical Address:
Facility Contact: D91A Title: Phone:
Onsite Representative: 4 Integrator: s
Certified Operator: �ti 4" Certification Number:���
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Design Current
❑ Yes
Design
Current
Design Curreat
Swine Capacity Pop.
Wet Poultry
Capacity
Pop.
Cattle Capacity Pap.
Wean to Finish
ILayer
❑ No
NA
Dairy Cow
Wean to Feeder
I JNon-Layer
I
QTNA
Dairy Calf
Feeder to Finish b3
Dairy Heifer
Farrow to Wean
[:]Yes
Design
U
Dry Cow
Farrow to FeederD
. P,oult
Ca aci
$a
Non -Dairy
Farrow to Finish
Layers
No
❑ NA
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turke s
Outer
Turke f'oults
Other
10ther
Discharges and Stream Impacts
1, Is any discharge observed from any part of the operation?
❑ Yes
No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
NA
❑ NE
b_ Did the discharge reach waters of the State? (If yes, notify DWR)
[—]Yes.
❑ No
QTNA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
[:]Yes
❑ No
NA
[] NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
No
Q NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
ElYes
No
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 2/4/2015 Continued

Pacili Number: Date of Inspection: -7/f-D111 _j
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ YesNo [_]NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes nNo CRNA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: f
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 2�
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ YesNo ❑ NA [:]NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a ❑ Yes [� No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes 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 ADlflieatiOn
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes 141 No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? if yes, check the appropriate box below. ❑ Yes [P No
❑ NA
❑ NE
p 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 WinDri
❑ Application Outside of Approved Area
12. Crop Type(s): Pa-sk,_�)
:5,,, /G- n -A,
L9'iso
13. Soil Type(s): p -La.
14. Do the receiving crops differ from those Asignated in the CAWMP?
❑ Yes �No
❑ NA
[:]NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes j No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design [:]Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ERNo
[:]Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Tra sfers
❑ Rainfall ❑ Stocking [] Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ YesNo
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No
Page 2 of 3
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
2/4/2077 Continued

Facility Number: - Date of Inspection: C°
No ❑ NA❑ N`E
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative? ❑ YesNo
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes Y No
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
[—]Yes Vg No
❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey [] Failure to develop a POA for sludge
levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
❑ Yes No
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PI.AT) 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 O No
❑ NA ONE
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)
3 1. Do subsurface tile drains exist at the facility? if yes, check the appropriate box below.
❑ Yes EjNo
❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
No ❑ NA❑ N`E
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative? ❑ YesNo
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes
No ❑ NA ❑ NE
Comments refer to:question # • E lain an YES answers and/or an additional recommendations at• an
{ q ). Explain y. y i y
other co minenti': a
Use drawines of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 41
fT7 t
Date: f V
2/4/2011

Division of Water Resources
Facility Number - O Division ai 5oi! and Water Coflservatian
� Other Agency
Type of Visit: 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 0 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: q Arrival Time: Departure Time: r er. County: 5�9 � Region:
Farm Name: 4* 2-3 Owner Email:�
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: a sk ej P (
Onsite Representative:
1
Certified Operator:
Title:
Phone:
Integrator:
Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Discharges and Stream imyacts
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 DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of 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 P No ❑ NA ❑ NE
[] Yes ❑ No q9 NA ❑ NE
❑ Yes ❑ No [!ff NA ❑ NE
❑ Yes Q No
❑ Yes [�No
[:]Yes [�)No
�NA E] NE
❑NA ❑NE
❑NA E] NE
Page 1 of 3 21412015 Continued
Design Current
Design
Current
Design Current
Swine
@apaeity Pop.
Wet t'oultry
Capacity
f'op.
Cattle Capacity Pop.
Wean to Finish
Layer
Dai Cow
Wean to Feeder
Non -Layer
Dai Calf
Feeder to Finish
Dai Heifer
Farrow to Wean
Design
Current
Cow
Farrow to Feeder
D . P,oul
Ca��aci
Po
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars Pullets
Beef Brood I---
owTurke
Turkeys
s
Other -
Turke ?oults
Other
Other
Discharges and Stream imyacts
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 DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of 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 P No ❑ NA ❑ NE
[] Yes ❑ No q9 NA ❑ NE
❑ Yes ❑ No [!ff NA ❑ NE
❑ Yes Q No
❑ Yes [�No
[:]Yes [�)No
�NA E] NE
❑NA ❑NE
❑NA E] NE
Page 1 of 3 21412015 Continued

Facility i�umber: Date of Inspection:
❑ Yes No
❑ NA
❑ NE
Waste Collection & Treatment
13. Soil Type(s): d -e- O
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
[] Yes
[WNo ❑ NA
T❑
❑ NE
a. If yes, is waste level into the structural freeboard?
D Yes
No
NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Struct
e 6
❑ Yes
Identifier:_
❑ Yes No
❑ NA
❑ NE
Spillway?:
Designed Freeboard (in):
❑ Yes
No
❑ NA
I'
Observed Freeboard (in): 7
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
5. Are there any immediate threats to theintegrityof any of the structures observed?
❑ Yes
9 No [—]NA
1
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
T
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
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?
13. Soil Type(s): d -e- O
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes No
❑ NA
[] NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
9. Does any part of the waste management system other than the waste structures require
❑ Yes No
❑ NA
❑ NE
maintenance or improvement?
Waste Aoolication
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 No [DNA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.
❑ PAN ❑ PAN > 10% or 10 lbs. [f 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): UY45
13. Soil Type(s): d -e- O
14_ Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
E>No
❑ NA
ONE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
�j 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?
IT Does the facility lack adequate acreage for lard application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Rereuired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[A 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 h No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers 0 Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall InspectiI
❑ 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 T 2/4/2015 Continued

)Facili umber: - Date of Inspection: Zt
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 ❑ YesNo E]NA E]NE
the appropriate box(es) below.
E] 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?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
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, aver -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?
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
P No
❑ NA
❑ NE
[] Yes WNo ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No
❑ Yes 1P No
❑ NA ❑ NE
❑ NA ❑ NE
ReviewerfInspector Name: l _ _ Phone: —q 3"loo
Reviewer/Inspector Signature: Date: -1
Page 3 of 3 /4/2015

Type of visit: 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: .0 Routine (D Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit. U
C
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Arrival Time: r Departure Time: �j. County Region:)
T� "o Kf" 4I Owner.
Phone:
Facility Contact:26A),�0— 1W Title:
Onsite Representative: t4
Certified Operator:'
Back-up Operator:
Phone:
Integrator:
Certification Number: L 64 %
Certification Number:
Location of Farm: Latitude: Longitude:
Deslgn Current
❑ Yes
Design
Current
Design Current
Swine Capacity Pop.
R'et Poultry
Ghpacity
Pop.
Cattle Capacity Pap.
Wean to Finish
❑ Yes
La er
NA
❑ NE
Dairy Cow
Wean to Feeder
❑ No
Non -La er
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
Dairy Calf
XI Feeder to Finish
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
Dairy Heifer
Farrow to Wean
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
Design
Current
Dry Cow
Farrow to Feeder
3. Were there any observable adverse impacts or potential adverse impacts to the waters
Q . moult .
Gapa
Pio
Non-Daity
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
OtherA.
Turlte Poults
Other
Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
JpNo
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field [] Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
❑ No
NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
[] No
/n NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
[] YesNo
C3NA
❑ 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 I of 3 2/4/2014 Continued

Facili umber: -A Date of Inspection: {
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ YesNo
E]NA
F]NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
NNo 4NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes�No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a ❑ YesNo E]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 structuress need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes Xj No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes FQ No [—]NA [:]NE
maintenance or improvement? Lr
11, is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes 10 No [:]NA
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ TotaI Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of
12. Crop Type(s):
13. Soil Type(s):
[:]NE
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?
1$. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ Yes jo No
0 Yes No
❑ Yes No
❑ Yes E� No
❑ Yes [P No
[:]Yes ® No
[:]Yes No
❑ WUP ❑Checklists [:]Design ❑ Maps [] Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below_ ❑ Yes Y, No
C3Waste Application ❑ Weekly Freeboard ElWaste Analysis ❑ Soil Analysis E]Waste Transfers
❑ Rainfall ElStocking ❑ Crop Yield [3120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? E]Yes 91 No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 1 No
Page 2 of 3
DNA ❑ NE
❑ NA ❑ NE
❑NA []NE
❑ NA ❑ NE
❑ NA ❑ NE
E]NA C]NE
[:]NA [:]NE
❑ NA ❑ NE
❑ Weather Code
Sludge Survey
[DNA ❑ NE
❑ NA ❑ NE
21412014 Continued

FAcility Amber: jDateof Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permi . ❑ Yes R No ❑ NA ❑ NE
25. is the facility out of compliance with permit conditions related to sludge? if yes, check ❑ YesNo ❑ NA [:]NE
the appropriate box(es) below. la
❑ 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.
34. 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
[ No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes Q No D NA ❑ NE
❑ Yes No
❑ Yes] No
❑ Yes No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
.recommendations or any,other cohiiili&ifs
NeAraiiingsansv of fecihty to better explain (sev additional pages as neves
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 1 to /j - 3�D
Date: « ��
2/4/2014

J
Type of visit: t® Compliance Inspection t., Operation Review U Structure Evaluation O'Technical Assistance
Reason for Visit: O Routine O Complaint O Follow-up 0 Referral O Emergency O Other 0 Denied Access
Date of Visit: 1 ; Arrival Time: l a: �Departure Timer County: �^`� s aj Region: 1-7 _.1kj
Farm Name: ,`:i. f ( N Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Title:
Latitude:
Phone:
Integrator: -71) ^1
Certification Number:' b ��
Certification Number:
Longitude:
Design Current
❑No
Design
Current
Design Current
Swine Gapaeity Pop.
Wet Poultry
Capacity
Pop.
Cattle Capacity Pap.
Finish
La er
Da Cow
Feeder
Non -La er
Da' Calf
o Finish QD
U
Da' Heifer
,24
o Wean
Design
Current
D Cow
o Feeder
D . P,oul
Ca aci
Po
Non -Dairy
o Finish
La ers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
IMI IFMWWOt
Turkey Poults
Other
Other
Discharges and Stream I enacts
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)
❑ Yes P No ❑ NA ❑ NE
[:]Yes
❑No
NA
❑ NE
❑ Yes
❑ No
NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes [:]No PcJ 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 No ❑ NA ❑ NE
of the State other than from a discharge? T
Page 1 of 3 2/4/2011 Continued

IFacWty plumber: - Date of Inspection: 7
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? [] Yes [P No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No o NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: �^
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes P No ❑ NA 0 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 N3 No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes U No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes j hNo ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks) T
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 ❑ YesNo [-]NA ❑ NE
maintenance or improvement? P9
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [:]Yes j�PNo ❑ 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 op indow Evidence of ' d Drift ❑ App�Cation Outside of Approved Area
12. Crop Type(s): f
a Q LLQ Q S q
13. Soil Type(s): Ai 1&,,-,4vi - k 1Oz�^_Y4)
14_ Do the receiving crops differ from those designated in the CAWMP?
I5. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
'1 �' rc)- t! .'C — •l%l
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
` p No
❑ NA
❑ NE
❑ Yes
[❑p No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes riNo
❑ Waste Application F1 Weekly Freeboard E] Waste Analysis ❑ Soil Analysis ❑ Waste T sfers
❑ 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 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 21412011 Continued

Facili Number: - A Date of ins ection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes and No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes T� No [—]NA ❑ NE
the appropriate box(es) below_
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ri{ No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond [] Other:
❑ Yes 1� No ❑ NA ❑ NE
❑ Yes ] No ❑ NA 0 NE
❑ Yes { (1 No ❑ NA [D NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ YesNo E]NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative? ❑ Yes 2 No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
[:]Yes U No ❑ NA ❑ NE
Comments (refer;,,to question ft Explain any YES answers and/or any additional recommendations or anyuther comments.i - .
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 1/"_33'-37m
7m
Date: -711 5 1 1
214/2011

Type of Visit: Z Compliance Inspection Q Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: QW*outine 0 Complaint O Follow-up 0 Referral Q Emergency O Other O Denied Access
Date of Visit: � Arrival Time: Departure Time: �County:
Farm Name: * l l V T10Y 055 -1c y Owner Email:
Owner Name: I t ` t r Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator: I-
Back-up Operator:
Title:
Phone:
Integrator:
Certification Number:
Certification Number:
Location of Farm: Latitude: Longitude:
i
Discharees and Stream Impacts Rbutwtu
1. Is any discharge observed from any part of the operation? DEQJD
Discharge originated at: [:]Structure ❑ Application Field 1 Other:
a. Was the conveyance man-made? NOV 0 8 2018
❑ Yes
,,23'**No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
b- Did the discharge reach waters of the State? {If yes, not, ify DW E] Yes ❑ No ❑ NA ❑ NE
c- What is the estimated volume that reach�a�Tfiu'o,":-
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? ❑ Yeso [:]NA 0 NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes �o ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 2/4/2011 Continued

FDciliNumber: Date of Inspection: —7 lip 113
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 'O'No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
Structure 2 Structure 3 Structure 4
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a
waste management or closure plan?
Structure 5 Structure 6
❑ Yes rE No ❑ NA [] NE
❑
YesNo DNA ❑ 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 po ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes �2<0
❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes�o ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ YesNo
❑ NA
E]NE
maintenance or improvement?
.10
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
EYes,."No
-E]NA
❑ NE
Excessive Ponding ❑ Hydraulic Overload [jFrozen Ground E]Heavy Metals (n, ec.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate
Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?❑Yes
No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes XNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
[] Yes EJ'No-
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes No
C] NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes XNo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
If
❑ Yes 9 No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes )XNo
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ YesNo C] NA [:]NE
❑ Waste Application ❑ Weekly Freeboard E]Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes X, No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes WNo ❑ NA ❑ NE
Page 2 of 3 2/4/2011 Continued

Facilityumber: - Date of inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [3`90 ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [] Yes )zr
o ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non -compliance -
26. Did the facility fail provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface file drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes ANO
❑ Yes.IWo
Yes/�No
❑ Yes FrNo
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes ON. ❑ NA ❑ NE
❑ Yes No
❑ Yes No
❑ Yes�No
❑Yes 1�To
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer -to question #): Explain any YES answers and/or any additional recommendations ioranylother comments
Use drawings of facility`to better explain situations (use additional pages as necessary).* x� _
M Cn U4 aLL- 1 a -3 1- 14
std R- y -13 t
R �
Reviewer/Ins ector Na e:
Reviewer/Inspector Signature:
Page 3 of 3
FREIP-Wo
Phone: Tyl 1-101-36
Date:
214120f]

jType of Visit: iW Compliance Inspection U Operatiou Review Q Structure Evaluation () Tecbnical Assistance
Reason for Visit: 4D Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time:Qaa5i�County: &!2 -er Regionl f
Farm Name: 13 s L /A)044)J"wner Email:
Owner Name: $t Phone:
Mailing Address:
Physical Address:
Facility Contact:
LA:$ IV l ey,, o rxdTitle:
I~
Onsite Representative:
Certified Operator: I �7r ? RU.,— —
Back-up Operator:
Location or Farm:
Latitude:
Phone:
Integrator: QQ//
Certification Number: �Ofp
Certification Number:
Longitude:
Design Gurrent'w
{� 'Y -
Design
Current
Design Current
Swine Capacity Pop.
Wet"Poultry
Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
I a er
Da Cow
Wean to Feeder A L-_ANon-La er
Da Calf
Feeder to Finishatry
w.
heifer
Farrow to Wean
Dry Cow
Farrow to Feeder
D . P,oW
Ca aci
Po
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
❑ Yes N No ❑ NA ❑ NE
a. Was the conveyance man-made? ❑ Yes ❑ No NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) ❑ Yes [:]No NA ❑ NE
e. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (if yes, notify DWQ) ❑ Yes ❑ No NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ YesNo ❑ NA [:]NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters E]Yes 9No ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

facility Number: - Date of Ins ection: Pjj Z
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 I Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
0 N F] NA ❑NE
❑No /K1 NA ❑NE
Structure 6
Spillway?:
U] No
[:]NA
❑ NE
❑ Yes
Designed Freeboard (in):
❑ NA
❑ NE
❑ Yes
Q@ No
Observed Freeboard (in):
❑ NE
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ YesNo
❑ 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
,0 No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental
threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
No
❑ NA
❑ NE
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
No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes P No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable C op Window Evidenc of Wind Drift ❑ Application Outside of
Approved Area
12. Crop Type(s): G . �iI'j r� L7
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ Yes
U] No
[:]NA
❑ NE
❑ Yes
[>j6 No
❑ NA
❑ NE
❑ Yes
Q@ No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes '4:7n
No ❑ NA ❑ NE
❑ Yes FNo ❑ NA ❑ NE
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes P
No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Trfinsfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ YesNo
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 2/4/2011 Continued

Facility Number: Ds ection:
Z
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
10 No
❑ NA ❑ NE
the appropriate box(es) below.
TT��
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Failure to complete annual sludge survey [] Failure to develop a POA for sludge levels
❑ NA
❑ Non-compliant sludge levels in any lagoon
If yes, contact a regional Air Quality representative immediately.
to
List structure(s) and date of first survey indicating non-compliance:
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes
�d No
0 NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
[D Yes
F;91No
[] NA [:]NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ YesNo
❑ 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?
❑ YesNo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
to
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
0 NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE.
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
No
❑ NA
❑ NE
Comments (refer to Question #) Explain any >YYES an`swers.and/or, any additional:recommendations ar an other comments.
tike drawings'of facillty'=to bet[er explaltuations (us 'Additional pages:as necessary). �°
5(k 1
,5.a- &A...,, -e- y
Reviewer/Inspector Name: u ( Phone:
Reviewer/Inspector Signature: hate: I
Page 3 of 3 2/4/2011

� r
hype of Visit: 0 Compliance Inspection U operation Kevtew U Ntructure Evaluation U 1eennical Assistance
Reason for Visit: QF Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: jjAjbjJj::] Arrival Time: .fid Departure Time: County: �p Region:
Farm Name: ;
v41
r y�
Owner Name: jJ y /
;Hailing Address:
Physical Address: On li/f1~P &aii Ad Vpuiilo1 Gl-ve
Owner Email:
Phone:
Facility Contact: 00"0 P1PMAd Title: Phone:
WC-71exId
Onsite Representative: Q _ Integrator: H—B
Ili
Certified Operator: I fty k, VO&IIII, Certification Number: /Wto
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge'?
❑ Yes tQ-No ❑ NA ❑ NE
❑ Yes [] No ❑ NA [] NE
❑ Yes [] No ❑ NA ❑ NE
❑Yes
❑No
❑NA
❑NE
llesin
111Design
Current
Design Current
Swine Capacity Pap.
Wet Poultry Capacity
Pop.
Cattle C►apacity Pop.
Wean to Finish
jDairy Cow
Wean to Feeder
Non -La er
Dairy Calf
Feeder to Finish
`k''*'" '
Dairy Heifer
g Farrow to Wean
Design
rrent
Dry Cow
Farrow to Feeder
D Pzoult : , ; 'Ca acity
P,o ,
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
-
Ot3ter
Turkey Poults
Other
Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge'?
❑ Yes tQ-No ❑ NA ❑ NE
❑ Yes [] No ❑ NA [] NE
❑ Yes [] No ❑ NA ❑ NE
❑Yes
❑No
❑NA
❑NE
[:]Yes
tF No
❑ NA
❑ NE
❑ Yes
PE� No
❑ NA
❑ NE
Page 1 of 3 2/4/2011 Continued

Facilit Number: 15ate of inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
& No
❑ NA
❑ NE
a, if yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
identifier:
Spillway?:
Designed Freeboard (in): �3
Observed Freeboard (in): 33
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
N No
❑ NA
❑ NE
(i-e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not property addressed and/or managed through a
❑ Yes
�jNo
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
Yes
❑ No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
No
❑ NA
❑ NE
(not applicable to rooted pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10_ Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN 0 PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift [3Application
Outside of Approved Area
12. Crop Type(s): "e' S
13. Soil Type(s): ' 1 .S
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
tRNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
CR No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
ERNo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
KI No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
tR No
❑ NA
[] NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps p Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. t�_%FYcs ❑ 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? � � -IJ-5 , SfeA 7?, ❑ Yes [ No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes ❑ No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
'K NA ❑ NE
Page 2 of 3 2/4/2011 Continued

Facili Number: `6
Date of Inspection: 101
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes 0 No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ® 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 a 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.
34. 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 t@ No ❑ NA ❑ NE
❑ Yes JR No ❑ NA ❑ NE
❑ Yes tR No ❑ NA ❑ NE
❑ Yes 5a -No ❑ NA ❑ NE
❑ Yes CR No
❑ Yes ® No
❑ Yes ® No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments .(refer to question #) Explatn anyYES answer"s :and/or any additronalrecommendations ar. anv other comments.
�ffi ; 54" i
r
Use drawings of faciltt-vto.better explain,situahons:('nse9additional pages as necessary).
Pleo e. work a, bare y0s c) fb- r;de �1a� i t Nei. aft, s W4, 4fide�
ream dao a� /a 1 � f� y 4 1/, of'
sh�eF-aE 'of malh ¢ I RRas 01 owt KF seoso-l. 9
Q5-, Stud,�
Wef land�61)4`0rM andgod rejadj excef� as 17AWAOt"O'
Uig^ n� 4► Mbfead- �fre-e.-bW fh�` l «/ �[t rl� jfird 1o,Jw$Fc!>�r.
0-VjnAAraVd, �lc�[al mr mss e � �ad�c� al h 1� c �� "' saw h►h, b-�dtol�
d o ago r J�s pp,*
�n CIOV) 'r rl"e ,�►d�.�
r
Reviewedlnspector Name:
Reviewedlnspector Signature:
Page 3 of 3
Phone: of r -q m114-
Ot�7(1P)
Date: " 1 ip o1
2/412011

W
Facility No.—Faros Name Bit lb Date
Permit `" COC OIC NPDES(Rainbreaker PLAT Annual Cert
Pop. Design Current FB
Type Drops
Lagoon 1 2 3 4 5 6 7
Spillway
Design freeboard
Observed freeboard in
Sludge Survey Date
Sludge Depth ft
Liquid Trt. Zone ft
Ratio Sludge to Treatment Volume
Design Actual Width
Qli�------�
Wettable Acres
WUP
Weekly Freeboard
1 in Inspections �f
120 min Insp.
Weather Codes
Trans#er Sheets
RAIN GAUGE [�
Dead box or incinerator
Mortality Records
�i Oar 04'40� 34)-I
�9P)Lf
W gl0gla1 o7N1A
c
Verify PHONE NUMBERS and affiliations
Date last WUP FRO Q 01 Date last WUP at farm App. Hardware
FRO or Farm Records Saki
Lagoon #
Top Dike
Stop Pump
Start Pump
Conversion- Cu -I 30001= 108 Iblac; Zn -I 3000= 213 Iblac
g1" "44g
Soil Test Date
pH Fields
Lime Needed
ff)j(=
Lime Applied
Cu -I Z/Zn-1 ✓✓
Needs P
Cann Yield
Wettable Acres
WUP
Weekly Freeboard
1 in Inspections �f
120 min Insp.
Weather Codes
Trans#er Sheets
RAIN GAUGE [�
Dead box or incinerator
Mortality Records
�i Oar 04'40� 34)-I
�9P)Lf
W gl0gla1 o7N1A
c
Verify PHONE NUMBERS and affiliations
Date last WUP FRO Q 01 Date last WUP at farm App. Hardware
FRO or Farm Records Saki
Lagoon #
Top Dike
Stop Pump
Start Pump
Conversion- Cu -I 30001= 108 Iblac; Zn -I 3000= 213 Iblac

r
-VAS SINS 1�'}lotto
Type of Visit EMomptlance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit QcRoutine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of visit: Arrival Time: �y Departure Time: County: Legion:
c
Farm Name: Owner Email:
j10Owner Natne: 0 ✓ Phone:
,Mailing Address:
Plivsical Address:
t
Facilitv Contact: 1311 U01110OhXl Phone No:
b
Onsite Representative: �' Integrator:
Certified Operator: 111 madt V Operator Certification Number:
Back-up Operator. Back-up Certification Number:
Location arFsrru: Latitude: ❑O ❑' ❑u Longitude- =o =1 ❑"
Swine
Wean to Feeder
Boars
Other
❑ other
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
_ ❑ Layer
❑ Non -La er
Dry Poultry
Other
Discharges R Siream Imtlacts
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)
Design Current
Cattle Capacity Population
❑ Dai Cow
❑
Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocket
❑ Beef Feeder
❑ Beef Brood Co
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures: ED
d. Does discharge bypass the waste management system? (if yes. notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes �RNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
N No
❑ NA
❑ NE
❑ Yes
''No
❑ NA
❑ NE
12128/04 Condreued

Facility Number:S a- —601
Date of /inspection I
[3No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
Waste Collection& Treatment
RNo
❑ NA
❑ NE
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
1p 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
Identif en
❑ NA
❑ NE
Spillw ')'r
0
Designed Freeboard(2n. f h 9 oil
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
JRNo
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed
❑ Yes
PNo
❑ 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
q No
❑ NA ❑ NE
8_ Do any of the stuctures lack adequate markers as required by the permit?
[]Yes
[RNo
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
fgNo
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
[] Yes
R No
❑ NA ❑ NE
maintenance/improvement?
]L . Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
UNo
❑ NA ❑ NE
i
❑ 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
[3No
❑ 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 determination ?
❑ Yes
'S No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
U No
❑ NA
❑ NE
18. is there a lack of properly operating waste application equipment?
❑ Yes
6a -No
❑ NA
❑ NE
Comments (refer fo question:#)o iplaWanv YES answers'anWor any recommendations ar anv other comments
:Ilse drag Ings of facility to bet , stxplam 'situations {use additional pages,as necessary)
�4
ReVlewerllnspectorName I �,Q•+M Pyki$ t� t: A.: Y�'d.:.N� Phonei�q��JDt�� I
Reviewer/Inspector Signature: �. Date: (' 1_�� I 0
Page 2 of 3 V 12128104 Continued

Facility Number: $ — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes FgNNo ❑ NA El NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes Wo ❑ NA ❑ NE
the appropriate box. ❑ W`Up ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 6 -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 C9 No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreAers on irrigation equipment?
❑ Yes
❑ No
[5�NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
PNo
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
MNo
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
''No
[INA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
ERNA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
CRNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
CE�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
ISINo
❑ 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
Z 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
IRNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
;UNo
❑ NA
❑ NE
Additional C©mtneats and/or D'r awru 1b
' li �,�. P
34, iVo "J
haat 0. records'
12/28104

jFacilify No_q�--&O Farm Name &\�4 t' v, Del j( Date
Permit _V OI NPDES {Rainbreaker PLAT Annual Cert )
Pop. Design Current FB
Type Drops
Lagoon 1 2 3 4 5 6 7
Spillway
Design freeboard
Observed freeboard in
Sludge Survey Date 4 Q
Sludge Depth ft
Liquid Trt_ Zone ft
Ratio Sludge to Treatment Volume
�E��'r/ I 1 t �� r •.
Soil Test Date
..
Wettable Acres RAIN GAUGE
pH Fields
�
WUP Dead box or incinerator
Design Width
L
Weekly Freeboard ✓ Mortality Records
Lime Applied (�
Soil Test Date
..
Wettable Acres RAIN GAUGE
pH Fields
�
WUP Dead box or incinerator
Lime Needed
L
Weekly Freeboard ✓ Mortality Records
Lime Applied (�
�
l
1 in Inspections ✓
Cu -I Zn -I
120 min Insp.
Needs P
' a j (0
Weather Codes
Crop Yield .�"
loa -jrt q Transfer Sheets
FT "WIFT.T.-MMMIll "I
see
N Amt (lb/1000 Gal)
OWN..
..
M4� •
i
Verify PHONE NUMBERS and affiliations
Date last WUP FRO?1),q(0j Date last WUP at farm
FRO or Farm Records
Lagoon #f �� s
Top Dike
Stop Pump 4a'
Start Pump 51" 1
Conversion- Cu -I 3000= 10�Iac; Zn -I 3000= 213 lb/ac
1q{
App. Hardware

Type of Visit ® Compliance Inspection O Operation Review O Structure Evaluation V Technical Assistance
Reason for Visit *Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: g` ZZ -O Arrival Time: Departure Time: �./!` County: s Region: 020
Farm Name: Uif�/v A uc`I7�e. /calm _ Owner Email:
Owner Name: Phone:
y_ aur ��. Phone:
Mailing Address:
Physical Address:
Facility Contact:] `I>!� U4 uc� Title:
Onsite Representative: 1 . ba`
Certified Operator:
Back-up Operator:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: I--]" E__1 1 Longitude: = ° = I = "
Design Current
❑ Yes
Design Current
Design Current
❑ NE
Swine Capacity Population
Wet Poultry
Capcoty Population
Cattle Capacity Population
a. Was the conveyance man-made'?
❑ Wean to Finish
❑ Layer I
I
i Cow
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
1711 No
❑ Wean to Feeder
110 Non -Layer I
c. What is the estimated volume that reached waters of the State (gallons)?
i Calf
Feeder to Finish T 6 901398'0'"
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
[] yes
❑ Dai Heifer
❑ NA
❑ NE
El Farrow to Weant``4�"�
Dry Poultry ' � �-�='
❑ Dry Cow
❑ Farrow to Feeder
❑ NA
"""'`'"s -
❑ Non -Dairy
❑ Yes
❑ Farrow to Finish
❑ La ers
❑ NE
El Stocker
❑ Gilts
❑ Non-ts ers
E]Beef Feeder
E]
12128/04
❑ Boars
Pullets
❑ Beef Brood Co
�, - —
❑ Turkeys
Other
❑ Other
❑ Turke 'Poults
❑ Other
dumber of.°Structures:
Dischar es & Stream Impacts
1. is any discharge observed from any part of the operation?
❑ Yes
[� No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made'?
❑ Yes
�q
No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
1711 No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
ET�
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
[] yes
[ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
V1 No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
[P No
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
12128/04
Continued

1
• k
Facility Number: %'2- 41DI Date of Inspection g ZZ—O6
Waste Collection & Treatment
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
M No
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
[A No
❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
❑ NA
Structure 6
Identifier:
❑ Yes
EA
❑ NA
Spillway?:
18. Is there a lack of properly operating waste application equipment?
❑ Yes
0 No
Designed Freeboard (in):
❑ NE
Observed Freeboard (in): 3 y
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
I
6. Are there structures on-site which are not properly addressed and/or managed
❑ Yes
® No
❑ NA ❑ N E
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
7 No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
[gNo
❑ 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
P 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
9I No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or I0 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) t3e MR,u flat_ PtCk,-, 5;,.44.(/ 6rug,'.r/ ( /V4✓Se Ga[�
13. Soil type(s) NO
v a�
1�
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
M No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[9 No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
�9 No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application'?
❑ Yes
EA
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
0 No
❑ NA
❑ NE
'Comments (refer to question #l): Explain any YES answers and/or any recommendations or any other comments. ' =I
Use drawings of facility to better explain situations. (use additional pages as necessary): q
nRF —8
Reviewer/ins ector Name r—T
p i. C k WGt/S Phone: 9/a.. 330 0
Reviewer/Inspector Signature: Date: 9- xz-Zac rp
Page I of3 12128/04 Continued

s
Facility Number: 72 — Date of Inspection
Re uired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes [,I No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 20 No ❑ NA ❑ NE
the appropriate box. ❑ WUp ❑ Checklists
❑ Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [XNo ❑ 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 VNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes PNo ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[FNo
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
P 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
M No
❑ NA
EINE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
04 No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
[XNo
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
$ 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
PO 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
XNo
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
�WNo
❑ NA
❑ NE
Additional Comments and/or Drawings:
Page 3 of 3 12/28104

Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: J 3U Arrival Time: 9.'cso Departure Time: County: Seft 4se...+ Region: �i?p
Farm Name: Q://v fav Do.,e.4/c.. Owner Email:
Owner Name-, _ Q � x 'fa �a,� 11•'--- Phone: 7.'4' 'SGS
Marling Address: Mtea___ Ra,Ae__ ___zfc1 C/,',,4a , NL _203--2g
Physical Address:
Facility Contact: aa.� N . Title:
Onsite Representative:�✓1. �P�. AU -4441 /16—
Certified
16Certified Operator:
Back-up Operator: 6:4 R..,
Phone No: 9tU- "&- 9oe o
integrator: Prcw, Sfu.,�
Operator Certification Number:/G !4!
Back-up Certification Number:
Location of Farm: latitude: E--] o = • ❑ q Longitude: Q ° = =1 "
Swine
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Wean to Finish ; ❑ Layer
❑ Wean to Feeder ❑ Non -La et
('Feeder to Finish 13 6,90 1 3 8fy I-
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑
Turkeys
❑ Turkex Poults
❑ Other
Discharges & Stream Impacts
1- is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑
Dairy Calf
❑
Dairy Heifei
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocket
❑ Beef Feeder
❑ Beef Brood Co;;t_
Number of Structures: 5-1I
b- Did the discharge reach waters of the State? (if yes. notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system'? (If yes, notify DWQ)
Z. is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes D<o ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
[I NA
0 N
El Yes
C1 No
❑ Yes
C o
❑ NA
❑ NE
❑ Yes
Mlf�o
❑ NA
❑ NE
12/28104 Continued

Facility Number: 8 —6p1 Date of Inspection 3o�or
Waste Collection &'Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier:
Spillway?: /! o
Designed Freeboard (in). .:� p, y "
Observed Freeboard (in): 3 7
Kl#"h
*es [_q1Vo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
t rw+iS
5. Are there any immediate threats to the integrity of any of the structures observed? rice e' 9 -No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.) 11j"o
6. Are there structures on-site which are not properly addressed and/or managed XYes X10 ❑ 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 9VO ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
9'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
9,No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑Yes
[a'No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
Eo
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 lbs []Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift [:]Application Outside of Area
AIM Baa 3.2--ptpl
12. Crop 51►1ec�� r+ra.:, QGt�u /�c.,�TvrC
13. Soil type(s) �a ,:.c. /ila,62-0 A rcc4& Ze _
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
P - Ko
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes
9 -go
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination' El Yes
❑ No
❑ NA ❑^3dE
17. Does the facility lack adequate acreage for land application? ❑ Yes
❑ No
❑ NA D -N -E
18. Is there a lack of properly operating waste application equipment? ❑ Yes
U -1 o
❑ NA ❑ NE
Reviewer/Inspector Name �r Hid f rs,;= Phone:-
amt-Reviewer/Inspector Signature: �' Date: 3-30-vf
12/28/04 Continued

Facility Number: Date of Inspection 3- 7e•a�
Reauired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes E o ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? 1f yes, check ❑ Yes Rfgo ❑ NA ❑ NE
the appropirate box. ❑ yllp ❑ Chec>[ K' s ❑ De i ❑mss
p ❑ C+thp�-
21. Does record keeping need improvement? If yes, check the appropriate box below. Res ❑ No ❑ NA ❑ NE
/-i0.>.7.q w-19-722. '7-i->3.1
❑ ❑ Wrrkl� ❑ i rite TFa" ❑ Armwal ecitification
❑ Rdin 11 ❑ S4@akiH EFMonthly and V Rain Inspections ❑ Woathe; Code.
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes
91go
❑ NA
❑ NE
❑ Yes
Q-110
❑ NA
❑ NE
❑ Yes
2,&o
❑ NA
❑ NE
❑ Yes
2.1�o
❑ NA
❑ NE
❑ Yes
O No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
[DrgE
❑ Yes
MNo
❑ NA
❑ NE
❑ Yes
[llo
❑ NA
❑ NE
❑ Yes
D -No
❑ NA
❑ NE
❑ Yes
D -mo
❑ NA
❑ NE
❑ Yes
2 NO
❑ NA
❑ NE
❑ Yes
EgNo
❑ NA
❑ NE
,,.i{
Adttitiotial�Conaients aAdJor'©ra�Q( ""''s�lYSi
c+� a-�-A+b Ml�a.-Q'� 1�}-. J., i'; 4 �. •Y +xt�ri_T
�� / �!'Qf� •nP.il /Or
s.
12/28/04

Type of Visit g Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit t�utine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number
a. p1 Date of Visit: 04- Trine: . Dv
O =Not Operational C Below Threshold
®rmitted Q ertified 13T Conditionally Certified Q Registered Date Last Operated or Above Threshold:
Farm Name: ...' �� .1 "'�!4�... �C.r - - - - - w .w...... County:
Owner Name. ,� .--. ane No.
Mailing Address: i9Gd ....I���to�...��:. ....
Facility Contact: a Title• r%hA Phone No•
!r -- — ----- — I--.—.---
Onsite Representative•.._.OL44,Niewo�t� Integrator: E -fl -4-d.. .__ •_
Certified Operator :('a " .._.......... Operator Certification Number: ---- �_W...._.. W......----.
Location of Farm:
wine ❑ Poultry ❑ Cattle ❑ Horse Latitude • ° u Longitude • ' «
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes M No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. if discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier: .......... .......
_.....
Freeboard (inches): S
12/12103
❑ Yes ❑ No
❑ Yes 03"No
❑ Yes [v"No
❑ Yes VNo
Structure 6
Continued

I
Facility Number: ga — (eol
Date of Inspection j 0
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 46 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 maintenancelimprovement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Anolication
❑ Yes R(No
❑ Yes [ t'to
Cl Yes [llo
❑ Yes [91'4o
❑ Yes U<o
10. Are there any buffers that need maintenance/improvement? ❑ Yes [B"No
11. Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes NrNo
[]Excessive Poon"ding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type EX�•^E+� Srh+lE i„ t}
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management flan (CAWMP)? ❑ Yes E(No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes [v"No
b) Does the facility need a wettable acre determination? ❑ Yes [►3"No
c) This facility is pended for a wettable acre determination? ❑ Yes �No
15. Does the receiving crop need improvement? ❑ Yes v o
16. Is there a lack of adequate waste application equipment? ❑ Yes �No
Odor ls.sues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below [:]Yes dNo
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes dNo
19. Is there any evidence of wind drift during land application? 0.e. residue on neighboring vegetation, asphalt, ❑ Yes [ff/No
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional ❑ Yes [Z/No
Air Quality representative immediately.
Comuaents (refer to gnest:on #jam Exptatn guy YES �wec5 and/or any recvmnz�endattoas ar aay a r commeats. �. -�- r
;Use drr3twrngs of �ty to bettxer explasn sttaattotss. (ase additeanal pages as necessa'yry.j geld Copy ❑ ptnal Notes
t. .x. .. ..,._... "4':': t",�•+% '.Tri.-*y� :=���i .,: i:r .,... w.�:�... �...X� [P �1Y.�'c_; «�....��,s ��.T4.,:.. �5 —��..r.:.: ^. .«..-F".
CpC ar{ „D7 1•uX r4 4r �GY.
fir" @ 1. & --� s• 1s rd f,-vds.
60 crcr ,I
w
/
Reviewer/lnspector Name
Reviewer/Inspector Signature: Date; T O
12112103 1___y Continued

Facility Number: 2 — {oe [ Date of Inspection 1 0 µ
Required Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
23. Does record keeping need improvement? If yes, check the app r'op;iate ow.
❑ Waste Application [IFreeboard ❑ Waste Analy�❑ Soil Sam
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
25. Did the facility fail to have a actively certified operator in charge?
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
27. Did Reviewer/Inspector fail to discuss review/inspection with on-site representative?
28. Does facility require a follow-up visit by same agency?
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
NPDES Permitted Facilities
30. Is the facility covered under a NPDFS Permit? (if no, skip questions 31-35)
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
32. Did the facility fail to install and maintain a rain gauge?
33. Did the facility fail to conduct an annual sludge survey?
34. Did the facility fail to calibrate waste application equipment?
35. Does record keeping for NPDFS required forms need improvement? If yes, check the appropriate box below"
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After V Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
❑ Yes 2�No
❑ Yes [}'No
❑ Yes 3, 0
❑ Yes [�No
❑ Yes [llo
❑ Yes Uaj�o
❑ Yes 9110
❑ Yes a<
❑ Yes [R'fqo
v❑JYes ❑ No
❑ Yes Gl"No
❑ Yes [KTo
[9 Yes ❑ No
[+"Yes ❑ No
❑ Yes 9No
Eir No violations or deficiencies were noted daring this visit You will receive no €umber correspondence about this visit.
ddtvonal Cvmtnentsancl/or Urawtngs - r - - - =� �"" �=
5"�f �``'-1+►><t.. bey �
�K .., s r+c 'tar S.. !s
,
S �� aye
if R 1V^S AA S ��Uf r0
�`Y�, 6AV C
12/12/03

Site Requires Immediate Auention: _&_0
Facility No. ,z; Z/o
DIVISION OF ENVMOl�71VIENTAL MANAGEMENT
A��. FEEDLOT OFERATIONS SITE VISITAnON RECORD
DATE: 1/? 1995
Time: ) x 3
Farm Name/Owner: I
Mailing Address: leiGo RowoQL_ i 'C ,LcaaRg
County -
Integrator -
Phone: CLO --S5 j -QJ 15
On Site Representative: Phone: _ C71O �35Y -dict
Physical Address/Location:i D CL .+r►� yrs 5 of—U�_�
Type of Operation: Swine Poultry tittle
Design Capacity: 3[*Q F -J JL%_ Number of Animals on Site: �&=t
DEI Cerrification Number: ACE �,u DEM Certification Number. ACNEiV_„�„�
Latitude: �S - �i7 ter " Longitude: ?_' !j�S "
Circle Yes or No
Does the Animal Wasm Lagoon have sufficient freeboard of I Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches) �r No Actual Freeboard: -& .Ft. Inches
Was any seepage observed from the lagoon(s)? Yes oreWas any erosion observed? Yes o (9
1s adequate land avail for spray? Ye r No Is the cover crop adequate? Yes or No
Crop(s) being utilize
Docs the facility mcct SCS minimum whack criteria? 200 Feet from Dwellings? e or No
100 Feet from Wells? Dor No
Is the animal wa.5re stockpiled within 100 Feet of USGS Blue Line Stream? Yes orNo
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes or SO
Is animal waste discharged into waters of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes or'No If Yes, Please Explain.
Docs the facility maintain adequate waste managernent records (volumes of manure, land applied,
11
spray irrigated on specific acreage with cover crop)? Yr dor No
Inspector Name Signature
cc: Facility Assessment Unit Use Attachments if Needed.

ur 2l;LL WAS'I3 1CLXAGE2fENT PLXX CMATTFiGT2ON FOR NrSP OR =23=2D F-w-m-wLoTS
Please =eturn the complated fo= to the nivision of MMV!_ox= &Mtal Hanagemaat at
the ad --eos an the =&Varna side of thin fora.
Name of {{P�1 e print
T 1 VDXI 8 CLINTON
BILLY RAY DAEIGHTRY
?hone No _ : `�o-5bTd7F
county: __ sAm2sw
=aril location: Latitude and Longitude:31 ]L 06,,, /.a �L Q4- (required) Aso,
please attach a copy o£ a county road map with location identified.
Type of operation (swine. -layer, dairy, etc.) : SWINE
Design capacity (number of animals):
Average size of operation (12 month population avg.):
,average acreage needed for land application of waste (acres) 53.1
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Tac!:& cal specialist cartification
As a technical specialist designated by the North Carolina Soil and Water
Conservation Commission pursuant to ISA NCAC 6 .0005, i certify that the new or
expanded animal waste management system as installed for the farm. named above
has an animal waste management plan that meets the design, constzsction,
operation and maintenance standards and specifications of the Division of
Zzivironmental Management and the USDA -Soil Conservation service and/or the North
Carolina Soil and Water Conservation! Commission pursuant to ISA NCAC 21H-0217 and
15A NCAC 6r .0001-.0005. The following elements and their corresponding minimum
criteria:--have__1;ee: _,re_ified by me or other designated tec-apical specialists and
are included in =he plan as applicable: minimum separations (buffers); line's or
equivalent for lagoons or waste storage ponds; waste storage capacity; adequate
quantity and amount of land for waste utilization (or use of third party); access
or ownership of prcper waste application equipment; scaedule for timing of
applications; application rates; loading rates; and the control of the discharge
of pollutants from stormwater runoff events less severe than the 25 -year, 24-hour
sr -o=. 1& 11
Name of Technical S -par (Please ?tint)
Affiliation: F
Address (Agency): Phone No
Signat=e: 5 Date:
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Oder/xAna'aa.r Ag_-9Ymea1_-
I (we) understand the operation an maintenance procedures established in the
approved animal waste management plan for the farm named above and will implement
these ^rocedures . 2 (we) know• that any additional expansion to t'. -a existing
design.capacity of the waste treatment and storage system or conistructi.on of new
facilities will require a new certification to be submitted to the Division of
Environmental Management before the new animals are stocked. 1 (we) also
understand that there must be no discharge of animal waste from this system to
surface waters of the state either through a man-made conveyance or through
runoff from a storm event less severe than the 25 -year, 24-hour storm. The
approved plan will be filed at the farm and at the office of the local Soil and
Water Conservation District. 1 ::�7'
Name of Land Oxaar (Please pro' C
Signature: Date -
Na=a of M'aaager, if different from owner (Please print):
Signature: Date:
Nate: A change in land ownership requires notification or a new certification
(if the approved plan is changed) to be surf teed to t. -,e Division of
Znvirormentai Ma.-lagement within 60 days of a title transfer.
��D� USE ONLY:A=TEW#�
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Fa s A tray e ger
Mailed on May 22, 1995 by Doug Niemand, TDM

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