820200_INSPECTIONS_20171231

NUH I H UAHULINA
Department of Environmental Qual

To ateramMurct
Irype of Visit -(Drto m-pHance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: O'ko—utine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time:1FT_.'c_5U'_1 Departure Time: County: Region:
Farm Name: /-/7-1 Ll—,?-10 Owner Email:
OwnerName: efz!'2�C7 1W L'_ & e- . P h o n e:
Mailing Address:
Physical Address:
Facility Contact: 2,d Title: 1,9W17 Phone:
Onsite Representative: Integrator: :r,-
Certified Operator:
Back-up Operator:
Location of Farm: Latitude:
Certification Number: 1/ 7 4e!� &
Certification Number:
Longitude:
Po
WCOPECUM - A.
W Wean to Finish
to
W Wean to Feeder
I
11-ayer
JNon-Layer
jDairyCo
Dairy Calf
r
V_ Feeder to Finish
ow t
FFarrow to Wean
ow t
Farrow to Feeder
Farrow to Finish
rrent
P
Layers
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Plullets
Beef Brood Cow
Turkeys
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: El Structure 0 Application Field Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
E] Yes ��o [:) NA [:] NE
Yes
[:] No
[:] NA
[:] NE
Yes
E] No
E] NA
E] NE
[:]Yes [-]No
El Yes Eallo
[:3 Yes �o
NA E:] NE
NA NE
NA NE
Page I of 3 21412015 Continued

lFacitity Number: Date of Inspection: /0
Waste Collection & Treatment
4.'Js storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? 0 Yes ErNio NA 0 NE
a. If yes, is waste level into the structural freeboard? 0 Yes 0 No NA 0 NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in).
Observed Freeboard (in)- Z) 619-
5. Are there any immediate threats to the integrity of any of the structures observed?
0 Yes
�o
[:] 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
0 Yes
fn"No
0 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 DVVR
7. Do any of the structures need maintenance or improvement?
0 Yes
F-J'g-o
[:] NA
E] NE
8. Do any of the structures lack adequate markers as required by the permit?
0 Yes
[3-<o
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 E] Yes D-N-o 0 NA 0 NE
maintenance or improvement?
Waste Avolication
10. Are there any required buffers, setbacks, or compliance alternatives that need Yes EJ-No [-] NA 0 NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. 0 Yes [2-Wo- 0 NA [:] NE
F1 Excessive Ponding 0 Hydraulic Overload 0 Frozen Ground Ej Heavy Metals (Cu, Zn, etc.)
F1 PAN [:] PAN > 10% or 10 lbs. 0 Total Phosphorus 0 Failure to Incorporate Manure/Sludge into Bare Soil
0 Outside of Acceptable Crop Window 0 Evidence of Wind Drift [:] Application Outside of Approved Area
12. Crop Type(s): Zr-;�-M,0"da An t�' ",-3 / A-��
13. Soil Type(s): '�j'9rAX9'Z&' zg.'r--
14. Do the receiving crops differ from those designated in the CAWMP? 0 Yes FTNo 0 NA [:] NE
15. Does the receiving crop andlor land application site need improvement? 0 Yes �o 0 NA 0 NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable Yes [2-No 0 NA 0 NE
acres determination?
17. Does the facility lack adequate acreage for land application?
OYes
[E��o
0 NA
F] NE
18. Is there a lack of properly operating waste application equipment?
Yes
D-Ko
[:] NA
0 NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
0 Yes
[�o
0 NA
0 NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
Yes
[3-N-o
0 NA
[:] NE
the appropriate box.
OWUP E:1 Checklists E] Design 0 Maps 0 Lease Agreements
Other:
2 1. Does record keeping need improvement? If yes, check the appropriate box below.
[:] Yes
EErl'To-
0 NA
ONE
0 Waste Application [:] Weekly Freeboard [:3 Waste Analysis Ej Soil Analysis
Waste Transfers
0 Weather
Code
n Rainfall 0 StockingE] Crop Yield [:] 120 Minute Inspections 0 Monthly and I" Rainfall Inspections
OSludge Survey
22. Did the facility fail to install and maintain a rain gauge?
Yes
E3-N-o
0 NA
[:] NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
Yes
�o
E] NA
E] NE
Page 2 of 3
21412015 Continued

lFacility Number: FD—ateof Inspection: / p -/ /
24. Did the facility fail to calibrate waste application equipment as required by the permit? D Yes [�o DNA ONE
2�. Is the facility out of compliance with permit conditions related to sludge? If Yes, check Yes [D-5o [:] NA ONE
the appropriate box(es) below.
F-1 Failure to complete annual sludge survey Failure to develop a POA for sludge levels
F-1 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 [3-ITo- [-] NA D NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? 0 Yes [J-Mb D NA ONE
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 concem?
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)
3 1. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
Ej Application Field El Lagoon/Storage Pond 0 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 0-'Ko D NA [:] NE
[:]Yes DNo D NA D NE
[:]Yes [D-No DNA ONE
D Yes [3-Vo [:] NA FINE
[:) Yes
[�JNo
D NA
D NE
D Yes
E7—No
D NA
[-] NE
DYes
ET-Tqo
NA
D NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
i<� _3
,NJ C'>-7 [,__, -e- I -) - 7- / cl--
I ow -LA- - * , L
Reviewer/Inspector Name:
Reviewer/Inspector Signatur
Page 3 of 3
Phone: 2:zp
Da Oe -,/Z-
21412015

-31-1
EW
Type of Visit: (&"Compliance Inspection U Operation Review U Structure Evaluation 0 Technical Assistance
Reason for Visit: (31io-utine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: 1 /17 Arrival Time: Departure Time: County: Region:
FarmName: Za'& /-,(/— Owner Email:
Owner Name: J5�
1�I, Ik— Phone:
Mailing Address:
Physical Address:
Facility Contact: eve Title: CLUd"x—f— Phone:
Onsite Representative: ­5 etc�
Certified Operator:
Back-up Operator:
Location of Farm:
Integrator:
Certification Number:
Certification Number:
Latitude: Longitude:
Wean to Finish
I ILayer
Dairy Cow
Wean to Feeder
jNon-Layer
I
Dairy Ca
Feeder to Finish
-If
Dairy Heifer
Farrow to Wean
Dry Cow_
Farrow to Feeder
I
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
lBeef I
Boars
Pullets.
Brood Cow
Turkeys
e
Turkey Poults
r I
L
L ther
Discharges and Stream Impacts
I. Is any discharge observed from any part of the operation?
Discharge originated at: D Structure 0 Application Field Other:
a. Was the conveyance man-made?
bL 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)?
dL Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
E]Yes 9 No 0 NA El NE
Yes
E]No
DNA
ONE
Yes
0 No
[—] NA
[:] NE
Yes
No
0 NA
NE
Yes
No
D NA
NE
D Yes
allo
ONA
ONE
Page I of 3 21412015 Continued

[Facility Number: [i)—ateof 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:
Spiliway9:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
0 Yes
0 NA
E] NE
(i.e., large trees, severe erosion, seepage, etc.)
'Q�'No
6. Are there structures on -site which are not properly addressed and/or managed through a
C] Yes
F�q No
0 NA
0 NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate pubHe health or environmental
threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
Ej Yes
JR�No
NA
0 NE
8. Do any of the structures lack adequate markers as required by the permit?
E] Yes
ZJ'No
NA
0 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
E] Yes
JEJNo
NA
NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
Yes
M No
NA
NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [3 Yes KjNo Ej NA [:] NE
Excessive Ponding [j Hydraulic Overload 0 Frozen Ground Heavy Metals (Cu, Zn, etc.)
F-1 PAN F-1 PAN > 10% or 10 lbs. Total Phosphorus M Failure to Incorporate Manure/Sludge into Bare Soil
M Outside of Acceptable Crop Window Evidence of Wind Drift El Application Outside of Approved Area
12. Crop Type(s): _ 3�e,--mc44 leg /
_57�
13. Soil Type(s): '72 1 2k 4:29
14. Do the receiving crops differ from those designated in the CAWMP? Ej Yes [R�No NA 0 NE
15. Does the receiving crop and/or land application site need improvement? [:]Yes NA NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable [:]Yes EJ'No [j NA NE
acres determination?
17. Does the facility lack adequate acreage for land application?
[:]Yes
EJ'No
[] NA
[:] NE
18. Is there a lack of properly operating waste application equipment?
0 Yes
qNo
0 NA
ONE
Reguired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
[3 Yes
RNo
E] NA
N E
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
Yes
[3,No
[:] NA
N E
the appropriate box.
OWUP OChecklists 0 Design [:] Maps 0 Lease Agreements 00ther:
2 1. Does record keeping need improvement? if yes, check the appropriate box below. [—] Yes EKJN o
M Waste Application F] Weekly Freeboard 0 Waste Analysis Ej Soil Analysis E] Waste Transfers
E]Rainfall OStockingEj Crop Yield 0 120 Minute Inspections 0 Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? 0 Yes fn No
21 If selected, did the facility fail to install and maintain rainbreakers. on irrigation equipment? 0 Yes Q No
NA [—] NE
Weather Code
[:] Sludge Survey
0 NA 0 NE
Ej NA [:] NE
Page 2 of 3 21412015 Continued

IFacHity_ Number: FDate —of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? Yes [3No [:] NA 0 NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check D Yes &No D NA 0 NE
the appropriate box(es) below.
D 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:
2& Did the facility fail provide documentation of an actively certified operator in charge? Yes allo D NA NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? Yes MNo [:] NA NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
D Yes
allo
NA
NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
Yes
ZLNo
NA
NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
Yes
allo
NA
ONE
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
No
DNA
[:) NE
Application Field Lagoon/Storage Pond F-1 Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
D Yes
KNo
D NA
D NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
D Yes
allo
DNA
D NE
34. Does the facility require a follow-up visit by the same agency?
D Yes
E5,No
[:] NA �
ONE
Reviewer/Inspector Name:
Reviewer/Inspector Signatui
Phone: 2L— _303-01-4-1
Date: eLzj�_ �J'
21412015
Page 3 of 3

Type of Visit: 0!�=omp ' nee Inspection U Operation Review Q) Structure Evaluation Q) Technical Assistance
Reason for Vi outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: County: Region: U
Farm Name roept -7 Owner Email:
Owner Name: V,2-- pL Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title: /0 Phone:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
17�__
Integrator:
Certification Number: / 7 9-t (11
Certification Number:
Longitude:
Desi
napa
W a n Finish r
L
to E[INon_
!a
0 1
W
pi tin,
joesi Iment
0
IR 4
t t P 0
Eli Ha' I V r
W a n to Feeder
±e Layer
If
eifer
Dry Cow
Non -Dan
Beef Stocker
Feeder 1, o Finish —s-Z K0
Farrow to Wean
F ow I
Farrow to Feeder
F ow I
Farrow to Finish
F ow I
Lf'ooy
Layers
Gilts
Non -Layers
Beef Feeder
0 rs
Bo ars.
Pullets
Beef Brood Cow
10ther
e
urkeys
T key Poults
#Other
Dischar2es and Stream IMDaCtS
1. is any discharge observed from any part of the operation?
E:] Yes
f2LNo
NA
0 NE
I Application Field Other:
Discharge originated at: E] Structure F I
a. Was the conveyance man-made?
[3 Yes
E] No
NA
E] NE
b. Did the discharge reach waters of the State? (If yes, notify DY*rR)
Yes
[:]No
NA
E3NE
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)
E] Yes
[:]No
E] NA
E3NE
2. Is there evidence of a past discharge from any part of the operation?
[:] Yes
JE No
E] NA
C] NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
0 Yes
allo
E] NA
E] NE
of the State other than from a discharge?
Page I of 3 21412014 Condnued

Facility Number: 9�7- I Date of Inspection: 6-4-5-1-f-
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
D Yes
[g-No
DNA
D 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
Structure 6
identifier: Nrw of
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
D Yes
allo
D NA
0 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
D Yes
allo
[] NA
ONE
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?
D Yes
RNo
NA
D NE
8. Do any of the structures lack adequate markers as required by the permit?
D Yes
allo
NA
D 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
DYes
allo
D NA
NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
Ej Yes
Ir'71 No
LeZhL
[:] NA
NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. D Yes MjNo D NA D NE
Excessive Pondirig D Hydraulic Overload D Frozen Ground D Heavy Metals (CU, Zn, etc.)
PAN n PAN > 10% Or 10 lbs. Total Phosphorus D Failure to Incorporate Manure/Sludge into Bare Soil
Outside of Acceptable Crop Window Fj Evidence of Wind Drift [:] Application Outside of Approved Area
12. Crop Type(s): / v --, _!7 15-
13. Soil Type(s): MM'­ 11,22Z
14. Do the receiving crops differ from those designated in the CA"P? Yes [3-No D NA NE
15. Does the receiving crop and/or land application site need improvement? [:]Yes 2-No D NA NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable D Yes allo D NA ONE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Reauired Records & Documents
Yes [RNo D NA 0 NE
Yes [a No [:] NA 0 NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
Yes
5k'No
[:] NA
[:] NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
Yes
[��No
0 NA
D NE
the appropriate box.
DWUP [:]Checklists 0 Design 0 Maps E:] Lease Agreements
DOther:
2 1. Does record keeping need improvement? If yes, check the appropriate box be] ow-
[:] Yes
RNo
E] NA
[::] NE
ED Waste Application Weekly Freeboard E:] Waste Analysis 0 Soil Analysis
Ej Waste Transfers
D Weather
Code
M Rainfall [:]Stocking Crop Yield E] 120 Minute inspections 0 M onthly and V Rainfal I Inspections
Sludge Survey
22� Did the facility fail to install and maintain a rain gauge?
D Yes
[&No
[:] NA
D NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
[:]Yes
allo
D NA
[:] N E
Page 2 of 3 21412011 Condnued

lFacility Number: - 2a] Date of Inspection-
24, Did the facility fail to calibrate waste application equipment as required by the permit? Yes 21-No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check E] Yes [allo
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? E] Yes EjNo
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? E] Yes M No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report Mortality rates that were higher than normal?
29- At the time of the inspection did the faci I ity 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)
3 1. Do subsurface tile drains exist at die facility? If yes, check the appropriate box below,
[:] Application Field E] Lagoon/Storage Pond E] 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?
Tp "��A4 6-io"'I
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
NA NE
NA NE
F] NA Ej NE
F] NA E] NE
F] Yes [gNo Ej NA E] NE
Ej Yes No [D NA 0 NE
E] Yes r17f No [:] NA NE
C] Yes allo E] NA [D NE
E] Yes
allo
E] NA
E] NE
[:]Yes
allo
DNA
Ej NE
[:] Yes
2g_No
Ej NA
[:] NE
Phone:
Date:
21412011

I
— J 4; 5� / IL(
Type of Visit: (7-Compliance Inspection 0 Operation Review U Structure Evaluation (_-) Technical Assistance
Reason for Visit: Gqro__U_�tine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time:F'T_7'_0_Z)__j Departure Time: County: J�� Region: _j4'_T'0
J�le
Farm Name: Za c iS ln!�:Cd, F,:'� er"t Owner Email:
Owner Name: 7. ck- Me- Ca 1A.- Phone:
Mailing Address:
Physical Address:
Facility Contact: Z�' /J" Title: &t2ll ?V-- Phone:
Ne
Onsite Representative: Integrator:
Certified Operator: Certification Number:
Back-up Operator -
Location of Farm:
Latitude:
Certification Number:
Longitude:
i 1A 11''11,1211
eign
vc
Swine
11111111111
CRS
an
Wean to Finish
ayer
airy Cow
Wean to Feeder
on -La er
airy Calf
airy Heifer
Feeder to Finish
Farrow to Wean
i n
3urren
jDry Cow
,Farrow to Feeder
R.
aci
P.
INon-Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars-
I I
Pullets
Beef Brood Cow
I
ITurkeys
Other,
=Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: 0 Structure E] Application Field Other:
a, Was the conveyance man-made?
b- Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
[:]Yes CF�No ED NA E] NE
E] Yes F] No E] NA E] NE
[] Yes E3No [:] NA E] NE
d- Does the discharge bypass the waste management system? (If yes, notify DWQ) Yes [:] No E] NA NE
2. Is there evidence of a past discharge frorn any part of the operation? Yes J2!�No NA NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters [:)Yes L�g_No NA NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

Facility Number: _"!;L0 6
71 1 Date of Inspection: L_72.2--,2,0q
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
0 Yes
KNo
0 NA
0 NE
a. If yes, is waste level into the structural freeboard?
0 Yes
[:]No
0 NA
ONE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): L
Observed Freeboard (in): '33 el-919- 30
5. Are there any immediate threats to the integrity of any of the structures observed?
0 Yes
K No
0 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
0 Yes
CgNo
M NA
0 NE
waste management or closure plan?
ff 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
OLNo
Ej NA
0 NE
8. Do any of the structures lack adequate markers as required by the permit?
0 Yes
No
[:] NA
0 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
OYes
ZNo
0 NA
0 NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
Ej Yes
54 No
0 NA
[:] NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. Yes No 0 NA 0 NE
Excessive Ponding Hydraulic Overload 0 Frozen Ground Heavy Metals (Cu, Zn, etc.)
PAN Ej PAN > 10% or 10 lbs, 0' Total Phosphorus r-1 Failure to Incorporate Manure/Sludge into Bare Soil
E] Outside of Acceptable Crop Window [:) Evidence of Wind Drift 0 Application Outside of Approved Area
12. Crop Type(s): -e-,,,l
13. Soil Type(s): YJ
14. Do the receiving crops differ from those designated in the CAWMP? 0 Yes a No F] NA NE
15. Does the receiving crop and/or land application site need improvement? 0 Yes [Z No [] NA NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable [:]Yes 0 No 0 NA NE
acres determination?
IT Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
[—] Yes LA No NA NE
E] Yes Wo NA NE
Required Records & Documents
19. Did the facility fail to have the Ceriificate of Coverage & Permit readily available? Yes [E[ No NA E] NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check [D Yes [allo NA [::] NE
the appropriate box.
[:]VVUP OChecklists E] Design 0 Maps [:] Lease Agreements OOtber:
r-7i
2 1. Does record keeping need improvement? if yes, check the appropriate box below. Yes L/-�[ No
ElWaste Application El Weekly Freeboard 0 Waste Analysis 0 Soil Analysis [:] Waste Transfers
M Rainfall [:] Stocking [:] Crop Yield 0 120 Minute inspections 0 Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? [:]Yes M No
V__V'
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? 0 Yes MNo
NA [—] NE
Weather Code
Sludge Survey
NA NE
NA NE
Page 2 of 3 21412011 Continued

[Facility Number: �O jDate of Inspectiow.
24, Did the facility fail to calibrate waste application equipment as required by the permit? Yes R No NA NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [:]Yes allo NA NE
the appropriate box(es) below.
D Failure to complete annual sludge survey Failure to develop a POA for sludge levels
D 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 Q No 0 NA D NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? OYes 4No DNA ONE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document DYes RNo [:] NA ONE
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 inu-nediately.
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)
3 1. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
D Application Field E3Lagoon/Storage Pond r_1 Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss reviewfinspection with an on -site representative?
34, Does the facility require a follow-up visit by the same agency?
D Yes Z No [:] NA [—] NE
[:3 Yes [g No [:] NA C] NE
0 Yes 53-No 0 NA [:] NE
Yes M_No
Yes JKLNo
[:]Yes 29-No
NA NE
NA NE
NA NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments.
Use drawines of facility to better expWn situations (use additional oaaes as necessary). I
Reviewer/Inspector Name:
Revieweriffispector Signature:
Phone: D-C>
Date: & —,;7- z4E�211-1
21412011
Page 3 of 3

0
IType of Visit: 0 Compliance Inspection Q Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit: 42rRoutine O Complaint O Follow-up Q Referral O Emergency O Other Q Denied Access
Date of Visit: U2,01b Arrival Time:M_� Departure Time: 101 5 County: LA
Farm Name: ic pr& e i' Ft- e"-L Owner Email:
Owner Name: Z ILck W L6,& Le 6^ Phone:
Mailing Address:
Physical Address: ��! �j
Facility Contact: 4C �t�jA Title: 49'dvyi�✓Z Phone:
Region: Ff� D
Onsite Representative:
5a 44 -(
integrator:
Certified Operator:
IrL�U{ IN
Certification Number:
f/'
1Z -66
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current
'Design Curs nt
Design Current
Swiae Capacity Pop.
Wet PoultryCapacity Pop�E
y Capacity Pop.
Finish
La er
DairyCow
Feeder
Non -La er
DairyCalf
o Finish
"
DairyHeifer
UFarrowo Weanesign
Current
e
D Cow
o Feeder
r
DPoul Ca acrtvPo :
Non-Daio
Finish
La ers
Beef Stocker
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
•.
Other
Turkey Poults
w
, ..
y
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other.
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes [] No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
[:]Yes
[P^No
[DNA
ONE
[:]Yes
[2**No
❑ NA
❑ NE
Page I of 3 21412011 Continued

I/J. 1�
IFacility Number: _&T EKat-e T®rl nspection: oL-00
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? Yes PE�No [:) NA D NE
a. If yes, is waste level into the structural freeboard? [:]Yes R�<o [:INA [:] N E
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3 2
5. Are there any immediate threats to the integrity of any of the structures observed?
Yes
[!tNo
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
[I"No
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?
0 Yes
[�'No
[:] NA
NE
8. Do any of the structures lack adequate markers as required by the permit?
Yes
EgNo
D 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
0 Yes
J2-No
[—] NA
NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
OYes
EINo
D NA
D NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below, [:]Yes �o DNA E] NE
Excessive Ponding 0 Hydraulic Overload 0 Frozen Ground 0 Heavy Metals (Cu, Zn, etc.)
PAN [:] PAN > 10% or 10 lbs. Total Phosphorus E] 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): 0 rA_z_,e_
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?
Reguired 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 GErNo
El Yes [B'*No
El Yes [12rNo
NA NE
NA NE
NA NE
[:]Yes allo D NA 0 NE
[-] Yes [PNo E] NA ONE
[:]Yes [5No D NA 0 NE
0 Yes EJ/No [:] NA E:] NE
OWUP OChecklists [:] Design Ej maps 0 Lease Agreements OOther:
2 1. Does record keeping need improvement? If yes, check the appropriate box below. []Yes [1]-No
M Waste Application [:]Weekly Freeboard 0 Waste Analysis OSoilAnalysis OWasteTransfers
MRainfall F] Stocking D Crop Yield E:1 120 Minute Inspections E] Monthly and I" Rainfall Inspections
22, Did the facility fail to install and maintain a raingauge? [] Yes Ff No
23, If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? E] Yes [rZ(No
NA 0 N E
Weather Code
Sludge Survey
NA NE
NA NE
Page 2 of 3 21412011 Condnued

? i3 M .) I .-
61 FFa—cility Number: 0 r- - 4��20 1 Date of tnspection-
24. Did the facility fail to calibrate waste application equipment as required by the permit? E] Yes [�Ko [D NA 0 NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check El Yes UTNo [D 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?
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-appli cation)
3 1. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
F1 Application Field 0 Lagoon/Storage Pond F1 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 �o NA NE
Yes CtrNo NA NE
E] Yes CgNo DNA NE
[:] Yes [B<o [:] NA C:] NE
Ej Yes FL;rNo E] NA [:] NE
T.-
0 Yes [R'No [:] NA [:] NE
Yes rtT_N0
Yes [g'No
Ej Yes Eg"'No
NA NE
NA NE
NA NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments.
Use drawinim of facilitv to better exotain situations (use additional Daims as necessarv). I
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
�
OukLo
Phone:
Date: 1b
Oil

I
i ype oi v isit: wo-iuornpnance trispecoon k_i uperauon Keview u :5trucvure rvaivation. k_; i ecnnicai Assistance
Reason for Visit: &�outine 0 Complaint_O Follow-up 0 Rererral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: �� County: Region: C)
FarmName: 7-10 OwnerEmail:
Owner Name: A16 Phone:
Mailing Address:
Physical Address:
F
Facility Contact: -7- - k -'e Title: 25)tu,.7 Phone:
A,, Z'/
Onsite Representative: ZL?_
integrator:
101,
Certified Operator: Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Desi! G
. . . . . . . . . . . . . . . . .
_S'
ourrent
09 u nt
Pol
P_
ci It
. I
'e.t! G It �apa it
00.
N C vacitUME, V.
• Finish
Layer
airy Cow
• Feeder
I INon-Layer I
airy Calf
Dairy Heifer
ee er to Finish
Farrow to Wean
Des! pKdl�-q
Dry Cow
Farrow to Feeder
-apaci
ers
p-
Non -Dairy
Beef Stocker
Beef Feeder
Farrow to Finish
Gilts
Boars
B e ef Brood Cow
Turkeys
e
Turkey Poults
er
Dischar2cs and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: E] Structure [:3 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 ER No E] NA E:] NE
Yes
No
NA
NE
Yes
No
NA
NE
Yes
No
NA
NE
Yes
No
NA
NE
Yes
No
NA
[:3 NE
Page I of 3 21412011 Continued

lFacility Number: 0 Date of inspection:
Zt,�
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? E] Yes No D NA D NE
a. if yes, is waste level into the structural freeboard? Yes No [] NA D NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): 19-
Observed Freeboard (in): 5�7_ J,
5. Are there any inunediate threats to the integrity of any of the structures obsmed? 0 Yes [E No E] 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?
D Yes
[N No
DNA
D NE
8. Do any of the structures lack adequate markers as required by the pen -nit?
[—]Yes
CK No
DNA
D 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
D Yes
(a No
E] NA
[] NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
Yes
g�[ No
D NA
D NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [:] Yes Qj�.No [—] NA D NE
M Excessive Ponding E] Hydraulic Overload E3Frozen Ground E] Heavy Metals (Cu, Zn, etc.)
n PAN D PAN > 10% or 10 lbs. Total Phosphorus [:] Failure to Incorporate Manure/Sludge into Bare Soil
n Outside of Acceptable Crop Window Evidence of Wind Drift D Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s): 12 rZ
14. Do the receiving crops differ from those designated in the CAWMP? [:]Yes [Z No D NA D NE
15. Does the receiving crop and/or land application site need improvement? Yes [g No NA D NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable Yes 0 No NA D NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operuting waste application equipment?
Reauired Records & Documents
[:] Yes ED No [:] NA [:] NE
DYes [allo E3NA [:3N]E
19, Did the facility fail to have the Certificate of Coverage & Permit readily available?
[D 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.
DV*rUP F]Checkfists D Design E] Maps D Lease Agreements
DOther:
2 1. Does record keeping need improvement? If yes, check the appropriate box below.
D Yes
Co No
D NA D NE
Waste Application E] Weekly Freeboard E] Waste Analysis 0 Soil Analysis
0 Waste Transfers
E] Weather Code
Rainfall [:] Stocking D Crop Yield E] 120 Minute Inspections E] Monthly and V Rainfall Inspections Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
[:]Yes
Callo
[:INA [-] NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? D Yes �Z No D NA [] NE
Page 2 of 3 21412011 Condnued

Facility Number: Date of Inspection:
- _ 5- - / -72-
24. Did the facility fail to calibrate waste application equipment as required by the permit? 0 Yes (3 No NA 0 NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check 0 Yes B No NA 0 NE
the appropriate box(es) below.
F-1 Failure to complete annual sludge survey 0 Failure to develop a POA for sludge levels
F-1 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? 0 Yes M No NA NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? 0 Yes [A No NA NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately,
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, OVeT-application)
3 1. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
0 Application Field E] Lagoon/Storage Pond F1 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?
0 Yes Q No E] NA 0 NE
0 Yes CZ No 0 NA 0 NE
0 Yes [Z No E] NA 0 NE
0 Yes Rj No [:] NA [:] NE
[:]Yes No
[] Yes No
0 Yes [K No
NA NE
NA NE
NA ONE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary). I
Reviewer/Inspector Name
7-- 9/ &9
Phone:
Reviewer/Inspector Signature:
Page 3 of 3
Date:
21412011

Type of Visit: QlCompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: 100 Departure Time: County: q?W0--
e G �, /lam F m ~ 7-1 r �—
Farm Name: rtr d/y Owner Email;
Owner Name: �- %'1� G ��� %%;� Phone:
Mailing Address:
Physical Address:
Facility Contact: G C_tfrL Title: G(J C/" Phone:
Onsite Representative: - �S Integrator: _.22zaZ&e,
117
Certified Operator: T ��j'1 - Certification Number:
Back-up Operator:
Certification Number:
Location of Farm: Latitude: Longitude:
Region:
III
Design @urrent
Design
Current
Design Current
Swine
CapacityPopc.
Wet Poultry-
Capactty
P p -
Cattle Capacity Pop.
Wean to Finish
La er
Dairy Cow
Wean to Feeder
Nan -La er
DairyCalf
Feeder to Finish"
Dairy Heifer
Farrow to Wean
esign
Current
Dry Cow
Farrow to Feeder
D , P,oult
Ca aci
1?0
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
... `
Turkeys
Other
z s
Turkey Poults
Other
ta
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)?
❑ Yes [No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑Yes
❑No
❑NA
❑NE
d. Does the discharge bypass the waste management system'? (If yes, notify DWQ) ❑ Yes ❑ No ❑ NA ❑ NE
2_ is there evidence of a past discharge from any part of the operation? ❑ Yes No 0 NA ❑ NE
3_ Were there any observable adverse impacts or potential adverse impacts to the waters 0 Yes JRNo ❑ NA ❑ NE
of the State other than from a discharge?
Page l of 21412011 Continued

IFacilit jDate of inspection: 1—/ -1
y Number: 9;X_ - ;PD/
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? 0 Yes PNo
a. if yes, is waste level into the structural freeboard? 0 Yes 0 No
Structure I Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
E] NA 0 NE
[-] NA 0 NE
Structure 5 Structure 6
[:] Yes N No [—] NA E:] NE
6. Are there structures on -site which are not properly addressed and/or managed through a
Yes
ED No
[:] NA
0 NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
0 Yes
[RNo
0 NA
[:] NE
8. Do any of the structures lack adequate markers as required by the permit?
0 Yes
M No
ONA
ONE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
[—]Yes
KNo
0 NA
[:] NE
maintenance or improvement?
Waste Application
10. Are there any required bUffCTS, setbacks, or compliance alternatives that need
0 Yes
2 No
[:] NA
0 NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [:]Yes 5jNo 0 NA 0 NE
Fj Excessive Ponding [] Hydraulic Overload 0 Frozen Ground [:] Heavy Metals (Cu, Zn, etc.)
F-1 PAN [] PAN > 10% or 10 lbs. Total Phosphorus E] Failure to Incorporate Manure/Sludge into Bare Soil
M Outside of Acceptable Crop Window 0 Evidence of Wind Dfift 0 Application Outside of Approved Area
12. Crop Type(s): Z=tLa:t� /,17 __1/ Z I Zf Zo 4LIZ
t3. Soil Type(s): Aa 2± ZL,9,- o / to 'en -A
14. Do the receiving crops differ from those designated in the CAWMP? Yes [�] No 0 NA [—] NE
15. Does the receiving crop and/or land application site need improvement? E] Yes [Q No 0 NA 0 NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable Yes jo No 0 NA 0 NE
acres determination?
17. Does the facility lack adequate acreage for land application?
Yes
[Z No
0 NA
0 NE
18. Is there a lack of properly operating waste application equipment?
Yes
n No
0 NA
E] 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
0 NA
NE
the appropriate box.
[:] WLTP []Checklists Ej Design [:] Maps 0 Lease Agreements [:]Other-
21 . Does record keeping need improvement? If yes, check the appropriate box below, [—] Yes [Z No
El Waste Application 0 Weekly Freeboard [:] Waste Analysis 0 Soil Analysis E] Waste Transfers
MRainfall OStockingO Crop Yield 0 120 Minute Inspections [:]Monthly and I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? [:] Yes [!�No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? 0 YesQ No
NA [3 NE
Weather Code
Sludge Survey
0 NA NE
[:] NA NE
Page 2 of 3 21412011 Continued

IFacility Number: �.� - 4'�Q C> I Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? DYes [a No
25. Is the facility out of compliance with perTnii conditions related to sludge? If yes, check D Yes 0 No
the appropriate box(es) below.
D Failure to complete annual sludge survey E] Failure to develop a POA for sludge levels
F-1 Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? Yes 0 No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? E] Yes [Z No
Otberlssues
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)
3 1. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
D Application Field 0 Lagoon/Storage Pond F-1 Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss TeView/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
D NA D NE
D NA D NE
NA D NE
NA D NE
Yes [RNo D NA D NE
0—
[:] Yes 0 No D NA F] NE
Yes No D NA [::] NE
DYes [ZNo DNA DNE
Yes
1`7 No
$Oak
D NA
[:] NE
0 Yes
CR No
D NA
E] NE
[::]Yes
f&No
[:] NA
[::] NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawines of facilitv to better explain situations (use additional onees as necessarv). I
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date: e,
21412011

4
Type of Visit @eC;o'mpIj
ce Inspection
0 Operation Review 0 Structure Evaluation
0 Technical Assistance
Reason for Visit
(� Zutine 0 Complaint
0 Follow up 0 Referral 0 Emergency
0 Other El Denied Access
Date of Visit: Arrival Time- Departure Time: FV _Dq_x_,qCoU12ty: %!2ffj,-g= D-2— Region:
Farm Name:2— a, d< - n �r_ ),--a- /.,y L t: y/ Owner Email:
Owner Name- 2i C- k m", cl �, Phone -
Mailing Address:
Physical Address:
Facility Contact: 6 C-U� �E'Title. Phone No:
Onsite Representative: Integrator: TZ6 j---
.1 -
Certified Operator: Operator Certification Number: /Z�61
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: 1--] 0 =I =" Longitude: = 0 = I = "
Di—esi u;ren
NMI@
;,jent
Mes' grJent
��t�
_
e -i fiftR
021t:
I tie
can to Finish
F0 _Laye_r____
El Dairy Cow
can to Feeder
1[--] Non -Layer
El Dairy Calf I
Feeder to Finish
Iry
r
El Dairy Heifer
El Farrow to Wean
El Dry Cow
El Farrow to Feeder
a ers
El Non-DaiTy
El Farrow to Finish
on -La ers
El Beef Stocker
Gilts
.r
El Beef Feeder
Boars
Pullets
El Beef Brood Cowl
I
El Turkeys
Other
El Turkey Poults
0 Other
It
E
OEM
Discharges & Stream Impacts
1. Is any dischaTge observed from any part of the operation?
Discharge originated at: El Structure El Application Field El Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system'? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge'?
0 Yes &NO 0 NA C1 NE
El Yes
D No
EINA
El NE
E]Yes
El No
El NA
El NE
[j NA
El NE
[I Yes
[__1 No
El Yes
allo
Ej NA
[I NE
El Yes
Z_No
El NA
[IN F
Page I of 3 12128104 Continued

Facility Number: 01
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
El Yes
2INo El NA [] NE
a. If yes, is waste level into the structural freeboard?
El Yes
0 No El NA El NE
Structure I Structure 2 Structure 3 Structure 4
Structure
5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): ? e7
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
0 Yes
JgNo [INA El NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
ElYes
ER No El NA 0 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?
E]Yes
1KNo ONA ONE
8. Do any of the stuctures lack adequate markers as required by the permit?
0 Yes
Jallo 0 NA 0 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
El Yes
[ANo El NA [:1 NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
OYes
[9 No [j NA 0 NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
0 Yes
IL No 0 NA El NE
El Excessive Ponding 0 Hydraulic Overload El Frozen Ground El Heavy Metals (Cu, Zn, etc.)
DPAN [:IPAN>10%orl0lbs El Total Phosphorus El Failure to Incorporate Manure/Sludge
into Bare Soil
El Outside of Acceptable Crop Window 0 Evidence of Wind Drift 0 Application Outside
of Area
12. Crop type(s) / Df5, /
13. Soil type(s)
14. Do the receiving crops differ ftorn those designated in the CAW M P?
0 Yes
En No
[I NA
F-1 NE
15. Does the receiving crop and/or land application site need improvement?
El Yes
9 No
0 NA
El NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
Yes
[N No
[:1 NA
0 NE
17. Does the facility lack adequate acreage for land application?
Yes
1Z No
El NA
ONE
18. Is there a lack of property operating waste application equipment?
[:1 Yes
CB -No
[:1 NA
0 NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
PeteP rCMVVr_')'
I if-gl­ haJ 51-4-e-n-
Reviewer/] rispector Name Phone:
Reviewer/inspector Signature: Date:
Page 2 of 3 i V.Z&W Continued

Facility Number: Date of Inspection
Reguired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? E]Yes 19 No El NA [] NE
20- Does the facility fail to have all components of the CAWMP readily available? If yes, check El Yes JR No 0 NA ED NE
the appropriate box. El WUP El Checklists 0 Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. [:]Yes JgNo []NA EDNE
El Waste Application 0 Weekly Freeboard E]WasteAnalysis E]SoilAnalysis [I Waste Transfers El Annual Certification
E]Rainfall E]Stocking E]CropYield [:1120 Minute Inspections 0 Monthly and I" Rain Inspections E]WeatherCode
22, Did the facility fail to install and maintain a rain gauge? El Yes ESNo El NA El NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? E]Yes [9 No El NA [__1 NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
[:1 Yes
E9 No
El NA
El NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
E] Yes
0 No
El NA
El NE
26- Did the facility fail to have an actively certified operator in charge?
El Yes
M—No
El NA
El NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
E]Yes
E[No
EINA
EINE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
El Yes
Callo
El NA
El NE
29-
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
El Yes
M No
El NA
ED NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
El Yes
ER No
[I NA
[:1 NE
If yes, contact a regional Air Quality representative immediately
3 1.
Did the facility fail to notify the regional office of emergency situations as required by
Yes
No
[I NA
[] NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/inspector fail to discuss review/inspection with an on -site representative?
El Yes
No
El NA
El NE
33.
Does facility require a follow-up visit by same agency?
El Yes
tRNo
[I NA
[I NE
Additional Comments and/or Drawings:
Page 3 of 3 12128104

7
Type of Visit Ot-o-moiance inspection 0 Operation Review 95-Structure Evaluation 0 Technical Assistance
Reason for Visit *O-U-iine OComplaint OFollowup OReferral OEmergency 46ether El Denied Access
Date of Visit: Arrival Time: Departure Time: County: Sa-wvg*'� Region: Y�-­Rb
I - - OF
Farm Name: -0& k Ina C-1k Ile--, ?-I r-> Owner Email:
MC_ Q&f
Owner Name: c, d-, A?-- Phone:
Mailing Address:
Physical Address:
Facility Contact: Z ze "'k- A1CCZe14--L TitIe:&_&.)/1eW"_ Phone No
Onsite Representative: Integrator: Omz_�_
Certirted Operator: Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: [=O =1 =is Longitude: =0=6 =66
NOW
ON
Design 5mot
urren
ine
We P
low, I �oUjt
�C*�Yfi—aeijzpffn—ufiftiou
��pacityPUQ-515'fi en
El Wean to Finish
11:1 Layer I
1
0 Daia Cow
El Wean to Feeder
10 Non -Layer
0 Dairy Calf I
Feeder to Finish 67-AfID
El Dairy Heifer
El Farrow to Wean
El DEy Cow
0 Farrow to FeedeL
El Non -Dairy
0 Farrow to Finish-
Ej Laers
El Beef Stocker
Ej Gilts
El Non -Layers
0 Beef Feeder
I 1013oars
0 Pullets
El Beef Brood Cowl
Turkeys
0 Turkey Poults
0 Other
Num e u res: �F_3
Dischary-es. & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: El Structure 0 Application Field El Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
2. is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
E]Yes allo [:1 NA El NE
El Yes
[I No
0 NA
El NE
El Yes
E]No
El NA
El NE
[3 NA
El NE
El Yes
El No
El Yes
KNo
El NA
El NE
[I Yes
13�No
El NA
El NE
Page 7 (if 3 12128104 Continued

Facility Number: Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? 0 Yes 2�No El NA [I NE
a. If yes, is waste level into the structural fTeeboard?
[I Yes
[I No
El NA
El NE
Structure I Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3 6-69- 32
5. Are there any immediate threats to the integrity of any of the structures observed?
[]Yes
NNo
EINA
EINE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed andJor managed
[:1 Yes
LE No
El NA
El NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
El Yes
:&No
El NA
[I NE
8. Do any of the stuctures lack adequate markers as required by the permit?
El Yes
0 No
El NA
[:1 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
El Yes
(3 No
[I NA
El NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
El Yes
9 No
El NA
El NE
maintenance/improvement? -
11. Is there evidence of incorrect application? If yes, check the appropriate box below- 0 Yes I&No El NA [:1 NE
El Excessive Ponding El Hydraulic Overload El Frozen Ground 0 Heavy Metals (Cu, Zn, etc.)
[] PAN [] PAN > 10% or 10 lbs El Total Phosphorus El Failure to Incorporate Marture/Studge into Bare Soil
El Outside of Acceptable Crop Window 0 Evidence of Wind Drift El Application Outside of Area
12. Crop type(s) zv.� zz2z �-4�
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? El Yes ER No [] NA El NE
15. Does the receiving crop and/or land application site need improvement?
[] Yes EKNo [] NA El NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? 0 Yes 0 NoEl NAD NE
17. Does the facility lack adequate acreage for land application?
18. Is there a lack OfPTOperly operating waste application equipment?
El Yes R No El NA [_1 NE
E]Yes JgNo EINA EINE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
�V­ W
5 K
77D
Reviewer/inspector Name F
Phone:
Reviewer/11 nspector Signature:
Date:
Page 2 of 3 12128104 Continued

i
[Facility Number: 3�71_ :jA Date of Inspection Le__�__/14170
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? El Yes 2�No El NA El NE
20. Does the facility fail to have al I components of the CAWM P readi ly available? I f yes, check El Yes 0 No El NA [:1 NE
the appropriate box. El WUP 0 Checklists El Design 0 Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. El Yes [8 No El NA [:1 NE
El Waste Application El Weekly Freeboard El Waste Analysis El Soil Analysis El Waste Transfers El Annual Certification
El Rainfall El Stocking 0 Crop Yield El 120 Minute Inspections [I Monthly and V Rain Inspections [3 Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
[:1 Yes
9No
El NA
F-1 NE
23,
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
D Yes
ZNo
El NA
0 NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
0 Yes
9 No
0 NA
EINE
25,
Did the facility fail to conduct a sludge survey as required by the permit?
[:1 Yes
9 No
El NA
Ej NE
26.
Did the facility fail to have an actively certified operator in charge?
El Yes
12 No
El NA
El NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
El Yes
CgNo
El NA
El NE
Otherlssues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
El Yes
ONo
El NA
El NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
El Yes
0 No
El NA
[I NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
El Yes
0 No
El NA
El NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
El Yes
LR No
El NA
[I NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewerl] nspector fail to discuss review/inspection with an on -site representative?
El Yes
KNo
El NA
El NE
33.
Does facility require a follow-up visit by same agency?
El Yes
2-No
[I NA
[__1 NE
Comments and/or Drawings:
Page 3 of 3 12128104

Type Of Visit (&,,e$mpIi nce Inspection (-) Operation Review () Structure Evaluation 0 Technical Assistance
Reason for Visit (9 zoutine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: County: <4xwg5ZV-- Region:
Farm Name: k Ille-el-& is-a-ii-,an- I -el, -2 -/ Q Owner Email:
Owner Name- 2CA 4d< A
Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: [—] ' =' = " Longitude: = 0 [=' = "
D
Design Ure I
ire
e 7pj
�C.
g -p— Ifft
'ReitmPo'
�C6gfi­cit_ t6n—ulffflon
. _q_ 011
El Dairy Cow I
El Wean to Finish
JEJ Layer
El Wean to Feeder
10 Non -Layer
El Daia Calf I _j
El Dairy Heifer
El Dry Cow
El Non -Dairy
El Beef Stocker
El Beef Feeder
[0 Feeder to Finish
I ve"
I
Layers
El Farrow to Wean
I
El Farrow to Feeder
El Farrow to Finish
Ej Gilts Non -Layers
0 Boars
Pullets
0 Beef Brood Co�
-
El Turkeys
otl
FI---]Oiher
El Turkey P ults
0
Discharims; & Stream Impacts
1. Is any discharge observed from any part of the operation?
El Yes
;8,No
0 NA
El NE
Discharge originated at: ElStructure El Application Field 0 Other
a. Was the conveyance man-made?
El Yes
El No
[] N A
[I NE
b� Did the discharge reach waters of the State? (If yes, notify DWQ)
El Yes
El No
[I NA
El NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
E]Yes
El No
El NA
[I NE
2. Is there evidence of a past discharge from any part of the operation?
[_1 Yes
RNo
F-1 NA
[j N E
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
0 Yes
RNo
[__1 NA
El NE
other than from a discharge?
12128104
Continued

Facility Number: :a Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus stonn storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural fteeboard?
Structure I Structure 2 Structure 3 Structure 4
El Yes L3No 0 NA El NE
E]Yes El No [__1 NA [:1 NE
Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): 7L
Observed Freeboard (in): X�;'
5. Are there any irnmediate threats to the integrity of any of the structures observed?
0 Yes
J9 No
[]NA EINE
(ic/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not property addressed and/or managed
E]Yes
CRNo
[:3 NA EINE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
D Yes
MNo
El NA El NE
8. Do any of the stuctures lack adequate markers as required by the permit?
El Yes
IN No
D NA El NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
E]Yes
[3No
EINA ONE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
E-1 Yes
JR No
El NA [:1 NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
0 Yes
KNo
D NA 0 NE
El Excessive Ponding El Hydraulic Overload El Frozen Ground El Heavy Metals (Cu, Zn, etc.)
EIPAN El PAN > 10% or 10 lbs El Total Phosphorus El Failure to Incorporate Manure/Sludge into Bare Soil
El Outside of Acceptable Crop Window El Evidence of Wind Drifi El Application Outside of Area
11 Crop type(s) , 1 'y! /
13. Soil type(s) )(/,2,* f,. Z -p 4
14. Do the receiving crops differ from those designated in the CAWMP?
El Yes
D No
EINA El NE
15, Does the receiving crop and/or land application site need improvement?
E]Yes
El No
El NA El NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?E] Yes
[I No
[:1 NA [-_1 NE
17. Does the facility lack adequate acreage for land application?
D Yes
El No
[:1 NA El NE
18. Is there a lack of properly operating waste application equipment?
0 Yes
El No
0 NA El NE
Comments (refer to question ft- Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/inspector Name 6�61,le �V__ Phone: 2?0:V-
Reviewer/Inspector Signature: Date: 90 C 9
- 1 12128104 Continued

FFacility Number: &�7
Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? [I Yes [RNo El NA El NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check [__1 Yes Z No El NA El NE
the appropriate box. 0 WUP 0 Checklists El Design El maps El Other
21. Does record keeping need improvement? if yes, check the appropriate box below. El Yes [KNo El NA [] NE
F-1 Waste Application 0 Weekly Freeboard El Waste Analysis [:1 Soil Analysis El Waste Transfers El Annual Certification
[1 Rainfall El Stocking El Crop Yield El 120 Minute Inspections El Monthly and V Rain Inspections El Weather Code
21
Did the facility fail to install and maintain a rain gauge?
El Yes
95No
0 NA
El NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
El Yes
L3 No
[:1 NA
El NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
El Yes
[2No
ONA
[I NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
El Yes
[9 No
El NA
[I NE
26.
Did the facility fail to have an actively certified operator in charge?
El Yes
B No
El NA
El NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
El Yes
[9 No
El NA
El NE
Otherlssues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
D Yes
ER No
El NA
[:1 NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
El Yes
10 No
El NA
[I NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
El Yes
CINo
El NA
El NE
If yes, contact a regional Air Quality representative immediately
3 1.
Did the facility fail to notify the regional office of emergency situations as required by
E] Yes
CgNo
El NA
El NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
El Yes
[R No
El NA
[:] NE
33.
Does facility require a follow-up visit by same agency?
0 Yes
EKNo
[3 NA
[I NE
I d/.: r1win
gs,
12128104

I
Type of Visit (5tompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit ak�outine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other [I Denied Access
Date of Visit: Arrival Time: Departure Time: County; Region:
-d
Farm Name: Ile-_ 77V Owner Emafl:
Owner Name: 7— ct 64,- Phone:
Mailing Address:
Physical Address:
FacilityContact: 19IC-C-4ellerl Title:
Onsite Representative: 7-42 Q-k #7 e- Cij IL El.
Certified Operator:
Back-up Operator:
Location of Farm:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: =0 =1 =1 Longitude: = 0 = =
to Finish
VM'gHU0;*"Cf U HEM
eUP61.11 P i6n--
W -T-1 G A .11 at,
OP A
Layer
_'
129"NO.M.M. ECIPI.Frent
n
Design LQ-UrTent
ig
31 e M E I IN-; I 211-tc,
Cattle a-- n
'C
Dairy Cow
to Feeder
Non-Laveri
[71
Dairy Calf
Feeder to Finish
?/V
ers
[71
Dairy Heifer
El Farrow to Wean
El
Dry Cow
El Farrow to Feeder
0 Farrow to Finish
Gilts
Boars
D
Noin-Dairy
[71
Beef Stocker
-Layers
El
Beef Feeder
El Pullets
El
Beef Brood Cow -
Turkeys
El Turkey Poults
El Other
es.
Um e istructures: F�q
mi
Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: [I Structure El Application Field 0 Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
El Yes RNo EINA El NE
El Yes
El No
El NA
0 NE
El Yes
El No
[I NA
0 NE
F
77-7-71
El NA
[I NE
D Yes
El No
E1 Yes
L&No
El NA
El NE
E]Yes
f&No
[:INA
El NE
Page I of 3 12128164 Continued

Facility Number: Date of I nspectio n
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
El Yes
25No EINA El NE
a. If yes, is waste level into the structural freeboard?
El Yes
El No El NA El 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
IgNo [:]NA [:INE
(ie/ large trees, severe erosion, seepage, etc.)
6- Are there structures on -site which are not properly addressed and/or managed
Yes
0 No Ej NA El NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental thre notify DWQ
7. Do any of the structures need maintenance or improvement?
Yes
M-Wo [:1 NA [__1 NE
8. Do any of the stuctures lack adequate markers as required by the permit?
Yes
01 No [__1 NA [:1 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
D4 No [I NA El NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
[:3 Yes
Z No El NA [I NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. El Yes 0 No 0 NA [I NE
0 Excessive Ponding El Hydraulic Overload [I Frozen Ground Lj Heavy Metals (Cu, Zn, etc.)
El PAN EIPAN > 10% or 10 lbs El Total Phosphor -us D Failure to Incorporate ManUTe/Sludge into Bare Soil
0 Outside of Acceptable Crop Window El Evidence of Wind Drift 0 Application Outside of Area
12. Crop type(s) ze_e""� /,V;,, Z;z-"'�Awlf
13. Soil type(s) M.1-J5 10r.if-
14. Do the receiving crops differ from those designated in the CAWMP? D Yes UjNo 0 NA El NE
15. Does the receiving crop and/or land application site need improvement? E]Yes
RINo
[:INA
[I NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?0 Yes
EKNo
El NA
[I NE
17. Does the facility lack adequate acreage for land application? El Yes
RNo
0 NA
[_1 NE
18. Is there a lack of properly operating waste application equipment? El Yes
j5LNo
[I NA
[I NE
,�omftcn c9sr
Ato
lquestion IINKELiplwn anVIVESTan= andforilanvireceinmendationsforianyoolitn comments
(use MOM
srofifacewt=vto b-e—ft-e-rTex—vliii-nTsitu-ationsiI -IR
coortt —Iw e
IV
Reviewer/Inspector Name Phone:
Reviewer/Inspector Signature: Date:
Page 2 of 3 "1 12128104 Continued

FFacility Number: 37z��`ffl Date of Inspection ai�Efle
Reguired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? El Yes N No El NA El NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check El Yes S-No [I NA El NE
the appropriate box. 0 WUP D Checklists [I Design El Maps El Other
21- Does record keeping need improvement'? If yes, check the appropriate box below- 0 Yes X No El NA El NE
El Waste Application El Weekly Freeboard El Waste Analysis 0 Soil Analysis [:1 Waste Transfers [I Annual Certification
0 Rainfall 0 Stocking El Crop Yield El 120 Minute Inspections El Monthly and I" Rain Inspections [I Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
E]Yes
5R No
E] NA
[:1 NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
E]Yes
C�LNo
E] NA
[] NE
24.
Did the facility fail to calibrate waste application equipment as required by the pennit?
El Yes
KNo
[I NA
[:1 NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
El Yes
EgNo
[I NA
D NE
26.
Did the facility fail to have an actively certified operator in charge?
[] Yes
E[No
0 NA
E] NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
El Yes
KNo
0 NA
El NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
El Yes
Ej No
El NA
EINE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
[:1 Yes
ERNo
El NA
[I NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
El Yes
[4No
El NA
EINE
If yes, contact a regional Air Quality representative immediately
3 1.
Did the facility fail to notify the regional office of emergency situations as required by
El Yes
29 No
El NA
EINE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewerlinspector fail to discuss review/inspection with an on -site representative?
[:1 Yes
91 No
El NA
El NE
33.
Does facility require a follow-up visit by same agency?
0 Yes
5Q No
[1 NA
El NE
7--
.WWI.
jAdditional'�C- in-e-n�_9,'and/or-Drawings:
Page 3 of 3 12128104

a
EY'Division of Water Quality
1 Facility Number 0 Division of Sail and Water Conservation
0 Other Agency
Type of Visit
mpliance Inspection
0 Operation Review 0 Structure Evaluation
0 Technical Assistance
Reason for Visit
&.,routine 0 Complaint
0 Follow up 0 Referral 0 Emergency
() Other D Denied Access
Date of Visit: ffzo:�d Arrival Time: �� Departure Time: County Region: t4=?->
Farm Name: 7.a,,,.k Mle-Cidlen rarn-L Z-) 0 Owner Email:
Owner Name: 7-,a e­k' Me- Cu. // 0 r%- Phone:
Mailing Address:
Physical Address:
Facility Contact: 7__tXe�� R Titl Phone No:
Onsite Representative: Integrator: �21 - E__4_ M__
Certified Operator: Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: =0 =1 =sj Longitude: =0=1 =11
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Design Current Design Current
Capacity Population WetPoultrY Capacity Population
IE]Layer I I
IE] on-Lavei I I
Other
JE1 Other —I I
Dry Poultry
Lavers
Non -Layers
El Flullets
0 Turkevs
El Turkey Poults
10 Other
Discharges& Stream Impacts
1. Is any discharge observed from any pail of the operation?
Discharge originated at: El Structure El Application Field El Other
a. Was the conveyance man-made?
Design Current"::
Cattle Capacity Population., I
El Dairy Cow
El Dairy Calf
Dairy Heifei
Dry Cow
El Non -Dairy
0 Beef Stocker
El Beef Feeder
El Beef Brood Cov.1
Number of Structures. M
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system'? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
E]Yes RNo EINA ONE
DYes
E]No
[:INA
[:INE
EjYes
[]No
ONA
EINE
[:1 NA
El NE
El Yes
0 No
El Yes
ER No
El NA
El NE
El Yes
ERNo
[] NA
El NE
12128104 Continued

Facilitv Number: C5 Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
[:]Yes [9No [:INA EINE
a. If yes, is waste level into the structural freeboard?
El Yes El No El NA [__1 NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): 19
Observed Freeboard (in): 6;1 -'1-3
5- Are there any inunediate threats to the integrity of any of the structures observed?
El Yes V[ No El NA D NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
El Yes 0 No El NA El NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
[:1 Yes [Z No El NA [I NE
& Do any of the stuctures lack adequate markers as required by the permit?
El Yes 0 No El NA El NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
[:1 Yes [0 No El NA El NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
0 Yes 0 No El NA El NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. 0 Yes M No 0 NA EINE
0 Excessive Ponding [:1 Hydraulic Overload El Frozen Ground El Heavy Metals (Cu, Zn, etc.)
Ej PAN [__1 PAN > 10% or 10 lbs El Total Phosphorus El Failure to Incorporate Manure/Sludge into Bare Soil
El Outside of Acceptable Crop Window 0 Evidence of Wind Drift [] Application Outside of Area
12. Croptype(s) J30rrktjAeja_ Zou_�eSe&j
13. Soil type(s) �j 0- A / (nZIB
14. Do the receiving crops differ from those designated in the CAWMP? El Yes CE�No Ej NA El NE
15. Does the receiving crop and/or land application site need improvement? [:1 Yes CKNo 0 NA El NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?E] Yes [KNo EINA EINE
17. Does the facility lack adequate acreage for land application? 0 Yes No El NA El NE
18. Is there a lack of properly operating waste application equipment? [I Yes No [j NA El NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
652 J��? R 6-R- i"D rm WA e f-,, _W LL)C(
Aj & _5
62;M'3 ;,-L,
Reviewer/] nspector Name 5" Te've 4z Phone:
Reviewer/Inspector Signature: Date: �9'—
IZIZ61W uonrinuea

Facility Number: Date of Inspection
Required Records & Documents
19, Did the facility fail to have Certificate of Coverage & Permit readily available? 0 Yes 19 No El NA El NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check El Yes Cl No El NA El NE
the appropirate box. 0 W`UP D Checklists El Design El Maps El Other
21, Does record keeping need improvement? if yes, check the appropriate box below. &Yes Wo'-_E] NA [I NE
6waste Application El Weekly Freeboard EtWaste Analysis El Soil Analysis El Waste Transfers [I Annual Certification
El Rainfall El Stocking El Crop Yield El 120 Minute Inspections [3 Monthly and I" Rain Inspections El Weather Code
22. Did the facility fail to install and maintain a rain gauge? [I Yes [9 No El NA [I NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? 0 Yes R No El NA [I NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
E]Yes
No
[__1 NA
[__1 NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
El Yes
0 No
El NA
[:1 NE
26. Did the facility fail to have an actively certified operator in charge?
[:1 Yes
P No
[I NA
[I NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Yes
ZI No
0 NA
EINE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
Yes
[R No
[I NA
NE
29,
Did the facility fail to property dispose of dead animals within 24 hours and/or document
[I Yes
[9 No
El NA
NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor Or air quality concern?
Yes
[9 No
El 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
[I Yes
[a No
El NA
NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/1nspector fail to discuss review/inspection with an on -site representative?
[I Yes
&No
El NA
El NE
33.
Does facility require a follow-up visit by same agency?
[I Yes
5No
[I NA
El NE
Comments and/or Drawings:
12128104

Type of Visit fDr-Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 4410-u-t-ine 0 complaint () Follow up 0 Referral 0 Emergency 0 Other El Denied Access
Date of Visit: Arrival Time: Departure Time: F47 C o u n ty: 0"� Region:
Farm Name: c_C,,,_&,-L_ __ Fa-e-17-L k-li, ;7-10 Owner Email:
OwnerName: 2""k —Phone:
Mailing Address: D ;7 /U (f
Physical Address:
Facility Contact: _2ask:: Me e�k&ef`-- Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Phone No:
Integrator: /�
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: [=O =L =6. Longitude: = 0 =I = "
MM-6co Fen [CA-
e MillillillillillilliLuLapactu&ropuiation
I I n
r11
El an to Finish
��2
W!ea
10 Layer
El
Dairy Cow
-W ntoFeeder
E e
IE] Non -Layer
I
Dairy Calf 1 —1
Feeder to Finish
El Dairy Heifer
El Dry Cow
0 Non -Dairy
Farrow to Wean
Farrow to Feeder
El Farrow to Finish
El Layers El Beef Stocker
El Non-Laxers El Beef Feeder
El Pullets. El Beef Brood Cowl
El Turkeys
FGilts
E113oars
otl
El Turkey Poultsl
FE1 Other
El Other I N m f St
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
E]Yes
RNo
El NA
[I NE
Discharge originated at: 0 Structure 0 Application Field 0 Other
a. Was the conveyance man-made?
E]Yes
E[No
El NA
EINE
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
El Yes
K'No
El NA
[-I NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
El Yes
PQ No
EINA
[I NE
2. is there evidence of a past discharge from any pail of the operation?
El Yes
No
El NA
El NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
[:1 Yes
No
El NA
[:1 NE
other than from a discharge?
Page I of 3
12128104
Continued
mk_"

Facility Number: Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? E]Yes KNo El NA El NE
a. If yes, is waste level into the structural freeboard? El Yes [gNo El NA D NE
<-Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 22 �2_
5. Are there any immediate threats to the integrity of any of the structures observed? El Yes UR.No El NA [] NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed Ej Yes C�No El NA El NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement'? Yes jo No NA NE
8. Do any of the StUCtUTes lack adequate markers as required by the permit? Yes rV1 No NA NE
(Not applicable to roofed pits, dry stacks and/or wet stacks) V1(
9. Does any part of the waste management system other than the waste structures require Yes RNo El NA NE
maintenance or improvement?
Waste AI)plication
10. Are there any required buffers, ' setbacks, or compliance alternatives that need El Yes U&No El NA El NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. El Yes Wo El NA El NE
E3 Excessive Ponding [:1 Hydraulic Overload El Frozen Ground [I Heavy Metals (Cu, Zn, etc.)
[:IPAN E1PAN>I0%orl01bs 0 Total Phosphorus El Failure to Incorporate Manure/Sludge into Bare Soil
El Outside of Acceptable Crop Window 0 Evidence of Wind Drift El Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14� Do the receiving crops diffier from those designated in the CAWMP?
El yes
&N o
El NA
E] NE
15. Does the receiving crop and/or land application site need improvement?
0 Yes
9No
El NA
D NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination,
El Yes
RNo
El NA
0 NE
17. Does the facility iack adequate acreage for land application?
El Yes
P9 No
El NA
0 NE
18. Is there a lack of properly operating waste application equipment?
El Yes
X1 No
0 NA
0 NE
2/0 - Y_3�25��
Reviewerlinspector Name I _5r�_V_e 9� Phone:
Reviewer/Inspector Signature: Date: ;Z2Z2C>6
12128104 Continued

Facility Number: ol Date of Inspection
Required Records & Documents
19, Did the facility fail to have Certificate of Coverage & Permit readily available? El Yes C5No El NA El NiE
20. Does the facility fait to have all components of the CAWMP readily available? If yes, check El Yes KNo El NA El NE
the appropirate box. El wup El Checklists El Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below- El Yes KNo El NA El NE
El Waste Application El Weekly Freeboard El Waste Analysis 0 Soil Analysis El Waste Transfers El Annual Certification
EIRainfall OSIocking E]CropYield El 120 Minute Inspections 0 Monthly and I" Rain Inspections E]WeatherCode
22.
Did the facility fail to install and maintain a rain gauge?
El Yes
ff�No
El NA
0 NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
[:1 Yes
E4,No
0 NA
El NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
El Yes
9 No
[I NA
[:] NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
Yes
rO No
El NA
El NE
26.
Did the facility fail to have an actively certified operator in charge?
El Yes
14 No
C1 NA
El NE
2T
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
El Yes
2 No
El NA
El NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
El Yes
[&No
El NA
El NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
El Yes
9No
El NA
[3 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?
0 Yes
LQ No
El NA
0 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
0 Yes
r�7 No
W4
0 NA
El NE
General Permit? (ie/ discharge., freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
E] Yes
D4 No
El NA
El NE
33.
Does facility require a follow-up visit by same agency?
El Yes
C2�No
El NA
[:j NE
12128104

Type of Visit 40 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
5
Date of Visit: Arrival Time: Departure Time: Countv: _.d?CV-f5QP.
Farm Name: _4ask__ Lk , 1- 1 Owner Email:
Region: F P-6
OwnerName: Za%r, - YW'C..._\\c-j �J%Z. Phone: S52- 33-ZI
Mailing Address: 100a L%.4.R f;z� V. C_ C.46 Nc- a? 9'3-2,k
Physical Address:
Facility Contact:
Title:
Phone No:
Onsite Representative: Z - c,�_ Integrator: 91f ra-bi" -r-
Certified Operator: Operator Certification Number:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
10 Other
Back-up Certification Number:
Latitude: =' =' =" Longitude: = 0 =I =
Design Current Design Current
Capacity Population WetPoultry Capacity Population
ElLayer
10 Non-Layei__
Dry Poultry
1:1 Layers
0 Non -Layers
El Pullets
El Turkevs
0 Turkev Poultsl
El Other
I
I
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation'?
Discharge originated at: El Structure El Application Field El Other
a. Was the conveyance man-made?
Design CUri6nt`-rJ,..,,�
Cattle Capacity Poiul�tifin..c`i
0
Dairy Cow
0
Dairy Calf
0
Daiij Heifej
El
Dry Cow
El
Non -Dairy
El
Beef Stockei
Beef Feeder
HBeef
Brood Col
I
Number of Structures:
b. Did the dischar-e reach waters ofthe State'? (If yes, notify DWQ)
c. What is the estimated volurne that reached waters of the State (gallons)?
d. Does dischar e bypass the wastc management system'? (Ifyes, notify DWQ)
9
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse inipacts to the Waters ofthe State
other than from a discharge?
El Yes No E] NA 0 NE
El Yes
[:) No
[__1 NA
0 NE
D Yes
El No
El NA
El NE
El NA
0 NE
El Yes
E]No
El Yes
[A No
0 NA
El NE
0 Yes
N No
El NA
El NE
12128104 Continued

d: '%l 1, �
Facility Number: Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rairifall) less than adequate?
a. If yes., is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
Identifier: OuL iz V-% -A 3, V%
Spillway?: Z21-7 19� q /14 1 /TIP 5% 3. C%4
Designed Freeboard (in): ..Illl V .-Iq a N
Observed Freeboard (in): '201 of 0201,
El Yes [K No El NA El NE
ElYes 0No ONA El NE
Structure 5 Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed? El Yes [9 No E-1 NA El NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed [I Yes EN No El NA [:1 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? [A Yes El No El NA El NE
8. Do any of the stuctures lack adequate markers as required by the permit? El Yes [N No El NA [:1 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 [:1 Yes [91 No El NA El NE
maintenance or improvement?
Waste Application
10, Are there any required buffers, setbacks, or compliance alternatives that need 0 Yes [A No El NA El NE
maintenance/improvement?
IL Is there evidence of incorrect application? If yes, check the appropriate box below. El Yes N No El NA El NE
0 Excessive Ponding 0 Hydraulic Overload El Frozen Ground El Heavy Metals (Cu, Zn, etc.)
[]PAN EIPAN>10%orl0lbs El Total Phosphorus El Failure to Incorporate Manure/Sludge into Bare Soil
Outside of Acceptable Crop Window D Evidence of Wind Drift El Application Outside of A-rea
12. Crop type(s) ge in- !g *-,% X "'o j S
13. Soil type(s)
14- Do the receiving crops differ from those designated in the CAWMP?
El Yes
[T No
El NA
0 NE
15. Does the receiving crop and/or land application site need improvement?
El Yes
UNo
[:1 NA
El NE
16, Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination,
El Yes
[A No
[:1 NA
El NE
17. Does the facility lack adequate acreage for land application?
El Yes
N No
[_1 NA
El NE
18. Is there a lack of properly operating waste application equipment?
[] Yes
C9 No
0 NA
0 NE
Uts EklerAtol an$_Werslanc_UqrianvirecommendU:lUoinLS*IllollI r k'a'11111 n111111 'Illy lottlericumments
questionl1f)A.Mp n �nn
se 0 Fe-t-t-e-rre0iiii-nTsifu—ati-o-uW(u-5e7a-ddifign—alivnizesiasinecessar-Y)_
-7-)
0 r, r_ a A C_ T C_ V. 4- U S OCP V, CL.3 61 �C.
Reviewer/Inspector Name 9- 1 � Phone:
Reviewer/Inspector Signature: W_,a�-a Date:
I / 12128104 Confinued

Facility Number; f(� IOU] Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? 0 Yes JA No 0 NA 0 NE
20. Does the facility fail to have all components of the CAWNIP readily available? If yes, check F-1 Yes W No 0 NA 0 NE
the appropirate box. El WUP 0 Checklists El Design 0 Maps El Other
21, Does record keeping need improvement? If yes, check the appropriate box below. ffYes 0 No El NA 0 NE
[A Waste Application El Weekly Freeboard [:1 Waste Analysis [:1 Soil Analysis 0 Waste Transfers 0 Annual Certification
El Rainfall 0 Stocking OCropYield El 120 Minute Inspections 0 Monthly and I" Rain Inspections El Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
El Yes
[9 No
El NA
El NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
El Yes
El No
[I NA
0 NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
El Yes
[ig No
El NA
El NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
0 Yes
[V No
0 NA
0 NE
26.
Did the facility fail to have an actively certified operator in charge?
El Yes
[A No
El NA
ONE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
0 Yes
00 No
0 NA
NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
0 Yes
[2 No
El NA
El NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
El Yes
[3 No
El NA
0 NE
and report the mortality rates that were higher than normal?
30.
At the tirne of the inspection did the facility pose an odor or air quality concern?
El Yes
59 No
El NA
El NE
If yes, contact a regional Air Quality representative immediately
3 1.
Did the facility fail to 130tify the regional office of emergency situations as required by
El Yes
@ No
0 NA
El NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/inspector fail to discuss review/inspection with an on -site representative?
0 Yes
[91 No
0 NA
El NE
33.
Does facility require a follow-up visit by same agency?
El Yes
[K No
El NA
El NE
ddiflohaj,"Comments,,"Wor D rawhigs�
4
:?-N 4 49MM
C L
G -4r.
V-' k C� a :S� Q_
- — . a.
Mk_p IPJ r
A-�ek<_
QX C—b V. —A
_t�VC- Te—Lob-ok% Cwj%-- AA%4_- spr'..KA
057, Cr6p
CLAC�Ic_
12129104

it
Type of Visit 0 Compliance Inspection 0 Operation Review 0 Lagoon Evaluation
ReasonforVisit 4PRoutine OComplaint C)Followup 0 Emergency Notification 0 Other Denied Access
Facilitv Number
ate nr visit:
Time: ��
=Not Operational 0 Below Threshold
EYP-e-rmittedErCertified MConditionally Certified
E3 Regisitered
Date Last Operated or Above Threshold:
Farm Name: Zclr4 A -le
v_1_100n F4
County: -SO=eSepi rAP0
Owner Name- -ea
Aen
Phone No: 210
Mailing Address: loo 17 L /,.X,/
A/C .283-28
F2Cilit\- Contact- .2c, C le
In e
Title:
Phone No: 1/0- egg-O/
Onsite Representative- Zar
Inte-rator: &I r-
Certified Operator: Za C-le
Operator Certification Number: /7 9(, -^7
Location of Farm:-
4&
0/swine El Poultry C1 Caffie
El Horse Latitude
Longitude
15
Design Current
Swine r3mnritv Pnnuhtinn
El Wean to Feeder
I
I
�eeder tc Finish
1 S-6 SIC)
El Farrow to Wean
El Farrow to Feeder
Farro,.x- to Finish
Gilts
Boars
Design Current Design Current
Poultry Capacitv Population Cattle Capacitv Popw[atiou
10 Laver I Dairy I
El Non-Dairy I
IEJ Non -Laver I I E
10 Other I I
Total Design Capacity
Total SSLW
Number of Lagoons -3 Subsurface Drains Present�:]10 Lagoon Area 10 Sprav F
Holding Ponds I Solid Traps _j No Liquid -Waste Management System
Discharaes & Stream Impacts
1. Is an%, discharge observed from any pan of the operation?
Dischame orizinaTCd ar.' Ej LaLoon El Sprav Field 0 Other
B� If disch?ruc is obsen.-ed, was the conveyance man-made?
b� If discharee is obsen-ed, did h reach Water of the State? (if yes. notif�, DWQ)
c� If dischar2e, is observed. what is the estimated flow in galimin?
d. Does discharge bypass a lagoon sysiem? (If yes, iiotif�! DWQ)
2. Is there evidence of past discharge from any pan of the operation?
3. Were th--re amy adverse impacts or poiential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm sterage) less than adequate? Spillwav
Structure I Structure 2 Structure 3 Structure 4
Identifier: / Cld .2 m el 3 ve,.
Freeboard (inches): _30-
05103101
Structure 5
EJ Yes 21�-_
EJ Yes Q-1qo­
0 yes 21 or
El Yes EJ_No
0 Yes 2<0
EJ Yes E3-No
El Yes B-No
Structure 6
Confinued

lFacility Nunxbe�j&a —jc7o
Date of Inspection Fif—TI-77-1-71
5. Are there any inimediate threats to the integrity of any of the structures observed? (ie-( trees, severe erosion, Yes 0,90
seepage, etc.)
6. Are there structures on-sitc which are not properly addressed and/or managed through a waste management or 0 Yes Urgo
closure plan? (If any of questions 4-6 was answered yes, and the situation poses an
immediate public hrWth or environmental threat, notify DWQ)
7. Do any of the structures need mainteriancelimprovement? 0 Yes ET&o
8. Does any part of the waste management system other than waste structures require maintenance/improvement? 0 Yes B�N-o
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level 0 Yes B'Ao
elevation markings?
Waste Application
10. Are there any buffers that need maintenancelimprovement? El Yes Ellqo-
11. Is there evidence of over application? If yes, check the appropriate box below. El Yes Gillfo—
El Excessive Ponding [] PAN El Hydraulic Overload 0 Frozen Ground 0 Copper and/or Zinc
12. Crop type 160ro"C'ell .5"-'MjW7er 4A.6119t/
&// oaee."�lj
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWW)? Yes �o
14. a) Does the facility lack adequate acreage for land application? Yes UNO
b) Does the facility need a wettable acre determination? 0 Yes MR0
c) This facility is pended for a wettable acre determination? 0 Yes UNo
15. Does the receiving crop need improvement? [I Yes 9'1q'0-
16. Is there a lack of adequate waste application equipment? El Yes 03No
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below [-]Yes [I No
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? Yes Elq4o
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, D Yes Bfio
CP 47
roads, building structure, and/or public property)
C,
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional 0 Yes 3,90
Air Quality representative immediately.
�ield Copy 0 Final Notes
mr, Ile'7
'00 U 7L
�'qq -Iee-soil 0,1 So #1 e
64, �5 LA"e
4pa/
j a *' &/ ".3
1"' a 'C'0 r
W4P el- C-vep 14 e,,, Au �o r7;�- g
r-o" see"I I.
eil. � /' -� 4 '9 " 'd
0 rv-U C a %le /-,
ReviewerAnspector Name
Reviewer/Inspector Signature: Date:
13
12112103 Continued

. It
Facility Number: g..;L -_?C)o Date of Inspection
Required R cords& Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
El Yes
ONO
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WU�, checklists, desi&TL maj�s, etc.)
Yes
Dlqo
23. Does record keeping need improvement? If yes, check the appropriate box below.
Yes
9,5o
[3 Waste Application- 0 Freebogd- [] Waste Analygi�' 0 Soil Sampling'-
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
0 Yes
9-No
25. Did the facility fail to have a actively certified operator in charge?
[I Yes
9-No
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
[I yes
Eg-No
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
El Yes
9No
28. Does facility require a follow-up visit by same agenry?
0 Yes
[3140
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
0 Yes
B-9-0-
INI'DES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35) S'Ves 13 No
31, If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? 9-fes [:1 No
32, Did the facility fail to install and maintain a rain gauge? El Yes 2f;o
33. Did the facility fail to conduct an annual sludge survey? 0 Yes 9No
34. Did the facility fail to calibrate waste application equipment? 0 Yes EM
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below. El Yes 9-No
[I Stocking Forrri'��[] Crop Yield Fo6 0 RainfaIr [I Inspection After 1 " Raiff ---
El 120 Minute Inspections -0 Annual Certification Form----
12112103

Site Requires Immediate Attention: AJo
Facility No. ZZ91
04 DIVISION OF ENVIRONMENTAL MANAGEMENT 3,,e,
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: 1995
Time:
43
Tf wf FaTris L *z" J�q
FarmName/Owner: - -eA , t M -, CU 5 , -?_10
Mailing Address: -ZW-7 /Zed'al r—
County: tn02=-!o'V -_ - Z
Integrator: B­2!-�w Phone:
On Site Representativew: e-, 10�""' Phone:
Physical Address/Location:
Type of Operation: Swine Poultry Cattle
I t Number of Animals on Site: % s7D
Design Capacity: "13 Z . :yl " '3
DEM Certification Number: ACE,_ DEM Certification Number: ACNEW
Latitude:— Longitude: — 0 — I
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of I Foot + 25 year 24 hour slorm event
(approximately I Foot + 7 inches) Qbr No tf �Actkw Freeboard:_�L_Ft. 4 _Inchesjf,/ 4J_r y-!97r4
Was any seepage observed from the lagoon(s)? Yes or(OWas any erosion observed? Yes or
Is adequate land available for spray? pes r N Is the cover crop adequate? Yes or No
Crop(s) being utilized: )>'E%r A4 Ujc;
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwell1n s" 0 or No
100 Feet from Wells'7*or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes okp
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line: Yes or6b
Is animal waste discharged into water of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes or If Yes, Please Explain.
' T_1_0j
Does the facility maintain adequate waste management recorlLs (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? � �esr No
_r4 A 4 lvq ir P
Inspector Name
cc: Facility Assessment Unit Use Attachments if Needed.

f '%
WORTH CAROL330L DIKPARTM=a OF ENVIRO , WMLTH & X&TURAL RESOMtCES
DWISION OP E2MMONMEWAL PUAWZWENT
Fayetteville Regional Office
Animal Operation Compliance znspection Form
ION
:FAR
Cut len jr-/;ZXr_ 0AI
100-7 tz222 2-9Z> 23
NID) 59 z - 332
All questions answered negatively will be discussed im sufficient detail in
the -Comments Section to enable the deemed Permittee to perform the appropriate
corrections:
SECTION- I
Animal Oi>dration Tvl>a: -5 n i -S�_
Horses, cattle, poultry, or sheep
SECTION IT
Does the number and type of animal meet or exceed
the (.0217) criteria? (Cattle (100 head),
horses (75), swine (250), sheep (1, 000), and
poultry (30,000 birds with liquid waste
systam)] -
2. Does this f�acility meet criteria for
Animal Operation XEGI�TIQKO
3. Are animals confined fed or maintained
in this facility for a 12-month period?
4. Does this facility have a CERTE= ANIMAL
WASTE MAN&GEMZW
5. Does this facility maintain waste management
records (Volumes of manure, land applied,
spray irrigated on specific acreage with
specific cover crop)?
6. Does this facility meet the SCS minimum
setback c=iteria for neighboring houses,
wells, etc?
T I N I COMMENTS
I

g=01q III
1!12ld Si&e Manaq=%at
1. Zo animal WaLW sLuckpilad Or lagoon
construction within 100 ft. of a USCS
Xap Blue Line Stream?
2. Is animal waste land applied or spray
irrigratad wi*h4n 25 9t. of a UGGO Map
Blue Line Stream?
3. Does this facility have adequate acreage
on which to apply the waste?
4. Does the land application -site have a
cover r-rop in accordance with the
MTTYIQ.TTg" PLM?
5- Is animal waste discharged into waters of
the state by man-made ditch, flushing system,
or other similar man-made devices?
6. Does the animal waste management at this
f arm adhere to Best Nanagement Practices
(S") of the approved QMUUCAT3:M?
7. Does animal waste lagoon have sufficient
freeboard? How much? (Approximately _ )
Is the general condition of this CAro facility,
including management and operation,
satisfactory?
§WL9ff_1Y
CgMents
eer�_Ffca�cvl
kr htwst--s 1-4 c"Id '7-10 ,
I-q reglskfed previously

V/10
.XY=VLL W;L�- Pm-"*.N ?CR MM OR =2X=z= ?M=LCTS
Maxna MntU==. %he ca=jletad W= so She =7imi== of 3=7W*==xmMa-' 1EB--Aqa=a=W ar.
the ad4raza cc= t.'L* =ftVW=Mft aide 04 thiA Iz=.
Nar-e of f az-- (Please :
AdWess: /007 LLQUIP S7 7
eLirlrbal ne --.L 9 -3 2: A Phcne No.: c4-10 - 592— 33Z 1
Wuncy: 1WAPSUrl
Far= 1ccanicn: Ucimude and Lonqj=UdeX5: -1 j j!" /IE7 I&' is" (zWX;i=ed) Also.
pleaze atzach a c=yy of a ccunC7 road =ap with location idenzified.
-:re 'Z�! ope=acioa Oswi=e' laye--, daj=-
'j, at=.)
Cesign capacity of anl=als) Z9100 IM-0 - Mr -I
Average si=e Cf Cpe=at!Cn' (12 Mc=th pcpulacicn avg.) : 09, *0 —EED -PI'I
A%erage acreage mee-ced f�o= land application of waste (ac=es)
Tftc�=iczl SP'ftC:LAI!-A1M Ca=---"ICAt-4Q=
As
a cec�,.nical specia-a-,sc designated by the Naroh Cazolina Soil and Wj=e=
Cznservaticn Czmmission qu=Tuanc to 15A ZTC;�C 67 OOOS, Z cermify that the new or
E,janied ar.�:-. wasce =anaga=e--= system as inscalled :-a= t-te fez--- na=ed a]=ove
has an a=!=al waste wmagemen= plan that meecz thet design,
zywacion and m&i==anance standards and specifications of the! Division of
zn�i==M=enzal Managemenc and the USZA-Soil Waservacion Servtce and/or the
Cazmlina Soil and Wacar Wnservacion Co=Mssica pursuans to 15A NCAZ 2H.0217 and
15A NCAC W .0001-.0005. TT:e follcwf=g Qemencz and their corresponding mIM-0==mL=m
ve=ified bry =a or other designated technical specialists and
aze included in the plan as applicalle: mlni=�- sepa=ations (buff ; Uners or
eqVivalenc for lagccns or waste storage ponds; waste storage capacity; ar:&Tzata
4yanticy and xmcun= of land for wasta utilization (oz7 uset of whi=d 7azzy) ; access
cz ou=wship of pr=pwr wouste applicatIon equipment; schedule for timi=g of
applica=icnz; application races; loadazq races; and the ccnc=ol of the discharge
of polluzar-Z5 f=MM s=zz--Watar =.:zIozf events less save=0 tha= the Z5-year, 24-hcuz
szor=.
Nazza 03f svecdatIlat (Please
445e
A.ffilfacicn:— PRES7ZIM ;=AAMS
Address (Age=C71
i : A 6zenn
Phonm No.
_Ag "61-In7-0M ABS28
3ig=atW=e: da-L -- Date:
==MMMMMMMM
cw--
Z (we) understand the operation and =ai-ncenanca procedures esta-blished i= the
apgroved &01�=a waste =Lanagemenc plan for the K=a named alone and will L=plament
zhase jrzcedu=es. Z (-.;e) )mow chac any add"tionall. expansion to the existing
design caPaci=7 of the waste t=eac=ent and storage SYSTM or construction of mew
facilities will zequi=% a new cwtifiazzica to be SLL!:=itted to =.-.a Division of
Wvi=w==ental Mnaage=ent befcra the new anizads aze stocked. Z (we) also
undersmand that there =as= ite no disciaz7e V anOul waste Wc:z this sYsZeM to
zu=lace waters of the state either C."=Cugh a =az-.--jade C=nveyance or =hz=I-'gh
znncff f=w= a sco= e-,renc less severe tha--j the 25-yeax, 24-hcu= sta==- The
approved plan will to filed at the faz= ant at she office K the local Soil and
N&=M 0i La=d Wwa=wz 1 4 1
ease ?Zint) : 2AC q C L
sig=atuza: Date--7- .5-
.1a=A of MI=(411r, if dif f went f == owner (Mase P=Int)
11;natwe - . Cace:
as,�: A change in land o-nez3hip t-equizes nocificacion or a new certification
jif the approved plan is changed) ta !:a sub=.ittad to Z:-:e Division of
Zoviwnmenzal Management wizhir. 60 days =E a .:-4=Ie transfer.
CEZ� USZ CN-LY:AC.IrZ,;-i

DePqrfrment cf Envirpnment,
HeCith and Ncturc! Rescurc.=s
Dvisicn ct Envircr.rnertcl Mcncgernert
Jcm- es B. Hurt Jr.. Gcverncr
Jcnc,ijncn S. HCw9s. Sec.-etcry
a___oe AZ —
A. Presitn '-'Cwc,-C. -fr., RE. Directcr
LTC-::C:NS TCR CF �,PPIZCT, =­ A&q� '0;AS—jZ_ %GL�MC;MI�4�r PtAss FOR
UZZ .7 S' T - "10
CR M:U-UM= X*61 :�L WA-S­�- ZMAZi r-%=T M=15 SFMV_ -7- =-L--TS
Z.-
order to be dee.--ed -zex-=itted '_�-y th�e 0-4-ris-4�:n oi! Mivizonmental Njanagement
e C'- r. e = 0 f any new or expanded ar.=a' wazte ma-agement syscem
==C=t-cIted at=er jannwzf 1., 1.394 whi=t js des4q-_ed to se= -re g_eata- th� or
eq.;al to =_he ari=a.L ;populacicas listed below 45 ZeqU,;Z-d to SUL---mi a S-V ed
cez-zifIcacicri !o= to Z)ZM jj�_ the new an�_-%als Cana stocked on the fa=-
?ascuze C;:ez:BLt_4or_S ara e-xe=pc --he =eCzui.=%menC to 1:e cez-=iZied.
100 head cL;E catzle
7 5 bzr2am
250 Mwixuft
1,000
Z0,000 bl-d vtth a 2_4qu4A wasts sysr-ma
The car-_-4ficacion be signed by the owner of Ittte feedlot (axv-4 manager iI
d-i-`fa=9r_= !=== the owneLr) are- by any te-ch-nical specialist designated by the Scil
and ',;ace= Cc=ae_-,rac_-'or% Commission pu=suanc to ISA UCAC 677 .0001-.0005. A
cechnical s7ec_`al_-;zt =ust verity by an an-sice �Lmspec=ian that a.11 appIicahle
design and conzt=uc=_-nn scandard-s and s-;Lecificaclons are met as installed and
=hac all a;:p I -iczLble opezat-Jon and -texiance, szandax-ds and wpecifications c=
;Ll"ough the ac=ual er of Animals at the fac--lit-y may
va=.r time to ti--'
t:'e desi—I,__ capacity oE the wasce haw-4-7-i-mg system should be used to dete_r_-LL-_e if
a :a= is subjec-t to the cerr-ifiCat4on requizeme=c- Far example. --f the waste
system for a feedlcc ia designed to handle 300 hogs but che average population
."i-. I I-e 200 hogs, then the waste maxiagement system requires a cer-_4 f I -
=�'s ce=t_-fication is =9,qzi=ed by regulations gc-urern—in-9 ani=al wasce managemenc
syscam adopted by the, Sr.v-iza=enca_L 14-anagemenc Cc==ission (MIC) on Dec —he= 10,
1_992 (Tit -le ISA NCAC 2H .0217).
Cn the reverse side of this page is the certification which =urt be
s-a!:=_4Z=aci to 0=-N- before new animals are st;�ckzed on the fa=. Assis=ax-'r-a in
cc='ec_4z_q the f== am-r- ---e obta:Lned -F'=== one of the lccal agenc=-;es
suc= as t:---e soi-I and; wacer cor-se=-j�acior. disc=ict, the USZ)A-Soil Czr.se=­,rac_,a=
Ser?ice, or the C=cpezative Zx-zar_sion Sez-,rice. The fa= sh.ould be sent to:
0eoa-=-_-enc of Z=�ri=mn=ent. Health and matu--a-I qesau_-=es
oi,�r4s 4 or
of Z=*.r-_4=a=entaI. Manage-enc
Wazar Qual-ilcy Sea= --;on, Plaanizq B=anc=
P.O. Box 29535
Raleigh.. N.C. 276Z6-053S
Phone: [phone]a3
st'eve W. Te-:de=, Chief
Water Quality Sec=_Jon
Fa= 1D.
P.C. Bcx 29SZ-5. Pdeigh. Ncrrlh C4=crir_,
An E-ILa CC==r-'"r%rrY A tf.rnc'.'ve Actar. Emq�cyer SCM r0C-.o'C!8C/ I C% of =C=G(

OLI SO Cer-+i -P(Z!7d
I - Lj
REGISTRAT:ON FCRM FOR ANIMAL FSEDLOT OPERATION
Department of Envizonment, Health and Natural Resources
Oivision of Eavironmental Management
Water Quality Sec=i.an
14: the animal waste management system for your feedlot opwaticn.
is
designed to serve more than or
equal t,: 100 head
of cattle,
75
horses, 230 swine, 1,000 sheep,
or 30,000 birds that
are served
by
a liquid waste system, tMen this
form must !:e filled
cut and mailed
by Decemher 31, !993 puzsuanz =a
15A NCAC 2H.0217 (c)
in crier zc
be
deemed permizzed by OEM. ?lease ;rinc ciearjy.
Farm Name: 7—L\'L'k� VkA
Mailins Address: � ��'D
Clunzy,
Owner(s) Name:
Manager (s) Name:
Lessee Name:
?hone No.
Farm Location (Be as specizic as passIm-'e: road names dizection,
milannst, etc-) - 5�_�A CLJLK��000�'-.3
1 Tim, INS I -'\ ( f -1 LJ � N -rCTK 9-- 1 CIX?T- 0061*�i -1 &A I
La=!z=de/Lcngi=ude if known: (7N)
Design capacity of animal waste
cf confined animal; (s)
management system (Number and type
Average animal populazion an the
waised) A!"d - On I GOAL
farm (NUMLbe= and
type
of anizml(s)
Year Production Began: ....... ASCS Tract No. : of;
Type of Waste Management System Used:1'1�'�_�
CC) 77
9
?I
Acres Available for Land plicacioV�n:o; Wa e:
Ap
� ��a _,�
Owner (s) Signature (s)
DAIE:
DA70

LMW
vftg

'I'At9., *Sbl%L ,'tin
ry w
ppw-
1M `
l

,restage Farms
Z. MCCULLEN
318