820227_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental Qua

Type of Visit: ® Compliance Inspection V Operation Review 0 Structure Evaluation O Technical Assistance
Reason for Visit:/ Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: r 0' igArrival Time: Departure Time: i County: r JA4. Region:
Farm Name: tc Mx4liis avio Owner Email:
Owner Name: i Phone:
Mailing Address:
Physical Address:
Facility Contact: Ga`c Title: Awpa." Phone:
Onsite Representative: Integrator: ,G T
Certified Operator: Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current
Design
Curient
Design Current
Swine
Capacity Pop.
Wet'Poultry
C paeity
Pop.
Cattle Capacity Pop.
Wean to Finish
Layer
DairyCow
Wean to Feeder
Non -La er
DairyCalf
Feeder to Finish
Dairy Heifer
Farrow to Wean
-
Design
Current
D Cow
Farrow to Feeder
,!!„D
, P,oult
Ca aci
Po
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
OtheWM
;;.
Turkey Points
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?
❑ Yes C� No ❑ NA ❑ NE
❑ Yes W No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWR) ❑ Yes M No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR) ❑ Yes M No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes [� No ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412015 Continued

Facili Number: - Date of Inspection:
-Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes M No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ON No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 2,4- 1 h
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes M No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require [] Yes j�(j No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
104
4-wd - ,
i
13. Soil Type(s): Al'a 1+ �� --- ;� �7GT" y 3
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [ No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes [P No ❑ NA ❑ NE
acres determination?
IT Does the facility lack adequate acreage for land application?
❑ Yes
[ No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
(� No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design [:]Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking [:]Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No [] NA ❑ NE
Page 2 of 3 2142015 Continued

Facility Number: I Date of Insaection:
•24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
No
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? if yes, check
❑ Yes
No
[] NA ❑ NE
the appropriate box(es) below.
! '
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
[] Yes
No
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
[ No
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes No
❑ Yes No
[] NA ❑ NE
❑NA ❑NE
❑ Yes EP No ❑ NA ❑ NE
❑ Yes � No ❑ NA ❑ NE
❑ Yes [A No
❑ Yes IN No
❑ NA ❑ NE
[DNA ❑ NE
Reviewer/Inspector Name: K6V T_ YVII / Fef Phone:.�C!��10�_
Reviewer/Inspector Signature: _ _ Date: ZJAZJ✓ 2'r,91
Page 3 of 3 21412015

Date of Visit: Arrival Time: Departure Time: : County: Region: l
Farm Name: �r�y, ,. t�"� Owner Email:
Owner Name:�1� �Gn %%%L7� Phone:
Mailing Address:
Physical Address:
Facility Contact: ���n r- fj'� Title:Phone:
Onsite Representative: Integrator:
Certified Operator: Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
D€sig©�
Current
Design
Current
Design Current
Swine Capaci#y
Pop.
Wet Poultry
Capacity
Pop.
Cattle
Capacity Pop.
Finish
La er
Dai Cow
Feeder
Non -La er
Dai Calf
o Finish
,I,J
Dai Heifer
o Wean
iPgi®R
i,, Design
l
Current
U Cow
to Feeder
i�31�
D . P.onit ;,E;h,:,f
,.
Ca acl
Pop.
Non-Uai
VFeedF
to Finish
Layers
Beef Stocker
Non -La ers
Beef Feeder
Pullets
Beef Brood Cow
urke s
H.
Turke Poults
Other'
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes C&No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a_ Was the conveyance man-made? 0 Yes [] No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d_ Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
[:]No
❑ NA
[] NE
2. Is there evidence of a past discharge from any pan of the operation?
❑ Yes
® No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
Dk No
❑ NA
[] NE
of the State other than from a discharge?
Page I of 3 21412015 Continued

lFacllity Number: J22= - _ `Z Z . I jDate of Inspection_T 7 j
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): Z
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
Eg No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
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 DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
.UNo
❑ NA
❑ NE
S. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
gINo
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
[:]Yes
F]-No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
EDrlo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes Eg-No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop/Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): �jfjfy�d� �0�•�5 Z-2:eQ
13. Soil Type(s): D�
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [3 No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? 0 Yes EgNo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes (-No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
1 S. Is there a lack of properly operating waste application equipment?
Required Records & Documents
[:]Yes M-No ❑ NA ❑ NE
[:]Yes [QNo ❑ NA ❑ NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
allo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check
❑ Yes
0 No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design [:]Maps [:]Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
� No
0 NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 " Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
21 No
❑ NA
❑ NE
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[21.,blo
❑ NA
❑ NE
Page 2 of 3 21412015 Continued

I' Facili Number: jDate of Ins ecdon: --/
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes Z.No ❑ NA ❑ NE
' 25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes QNo ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes [ No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ® No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
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?
f yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.'y:
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAVRAP?
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 E]-No ❑ NA ❑ NE
❑ Yes �No ❑ NA ❑ NE
[—]Yes 0No ❑ NA ❑ NE
❑ Yes Jallo ❑ NA ❑ NE
❑ Yes [1 No
❑ Yes �No
❑ Yes 0-No
NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
Comments (refer twquesttion # : ExplainanyhYES afiswersAnd/or any additional recorninendations or any othe commeni
Use draiwin of tacclt ito :betfer ex lain situattous use;additioial pages as nevi
�' Pp g
Reviewer/Inspector Name:
Reviewer/inspector Signatur
Page 3 of 3
Phone: Z/,';L f93 01-5l
Date:
21412015

Type of Visit: 0 Compliance Inspection Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: @Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: iG a Arrival Time: = �O•r Departure Time: County: �JiT Region: FP-0
Farm Name: 6-eyt e j'iA , s FA rm Owner Email:
Owner Name: Cf o, L Moi f f4 e's Phone:
Mailing Address:
Physical Address:
Facility Contact: 6-e h e- MA �44 i .s Title: P c✓ n e.T Phone:
Onsite Representative: S.trn e--
Certified Operator: fck nke-
Back-up Operator:
Location of Farm:
Latitude:
Integrator: P/es &9 �
Certification Number: 1 -.7 Ito 0
Certification Number:
Longitude:
Design
Current
Design
Current aDesign
Current
Swine a: ;,,; :,
Capacity
Pap.
Vet Poultry
Capacity
Pop.
Cable Capacity Pap.
Wean to Finish
La er
Da' Cow
Wean to Feeder
Non -La er
Da' Calf
Feeder to Finish
a 7 O
a,(Dq 7
DairyHeifer
Farrow to Wean
Design
Current
Cow
Farrow to Feeder
D . P,onl
Ca aci
P.o .
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Won -Lavers
Beef Feeder
Boars
1pullets
Beef Brood Cow
Turks s
Other
T urkex Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes ® No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes ❑ No
[:]Yes ® No
❑ Yes ® No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3 21412015 Continued

Facili Number: - Date of Inspection: jp
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): I�q
Observed Freeboard (in): a
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
® No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental
threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
[ No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
KA No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
® No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes 0 No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): & (in 0 d A. Zo t/ C free i _
13. Soil Type(s):
14_ Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
[:]Yes
® No
❑ NA
❑ NE
❑Yes
®No
❑NA
❑NE
❑ Yes
jffl No
❑ NA
❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
[:]Yes DD No ❑ NA ❑ NE
❑ Yes Eff No ❑ NA ❑ NE
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. [:]Yes RI No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ® No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [@ No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facili ' Number: OLa 7 jDate of Inspection: D a (p
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes 0 No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes JK No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? [:]Yes � No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes CM No ❑ NA [] NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes CoNo ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility`? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
Reviewer/Inspector Name:
Reviewer/Inspector Signatut
Page 3 of 3
❑ Yes E@ No ❑ NA ❑ NE
❑ Yes M No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
[:]Yes
® No
❑ Yes
( No
❑ Yes
No
Phone:
❑ NA ❑ NE
DNA ❑ NE
❑NA ❑NE
Date: /co L 'V/l (p
T ff
21417015

Type of Visit: t:'C:oZUtine
nee Inspection U Operation Review U Structure Evaluation U Technical Assistance
Reason for Visit: 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: / D' Departure Time: CountyO`— Region:
Farm Name _ r ,fr y`�cz d w� Owner Email:
Owner Name: ���r� Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: j Title:J�lY� Phone:
Onsite Representative: w•L� Integrator:
Certified Operator: Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design Current
Design
Current
Design Current
Swine Capacity Pop.
Wet Poultry
Capacity
.Pap.
Cattle
Capacity Pop.
Wean to Finish
iry Cow
Wean to Feeder
Layer
Dai Calf
O
iry Heifer
Feeder to Finish
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
I) . P,oul
Ca aci
P,a
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other _ W
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes JA No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑Yes
❑No
❑NA
❑NE
❑ Yes [] No
❑ Yes ® No
❑ Yes No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 21412014 Continued

Facility Number: KIL Date of Inspection: ,(.5--
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 0 No ❑ NA ❑ NE
a a. If yes, is waste level into the structural freeboard? [:]Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):+�
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ® No ❑ NA ❑ 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
$4 No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
allo
❑ NA
❑ NE
8_ Do any of the structures lack adequate markers as required by the permit?
❑ Yes
S No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
�No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
❑C , No
❑ NA
❑ NE
maintenance or improvement?
11. is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes NNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu., Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): j__r 1. / j6� / 0 V rr-! ' --�
13. Soil Type(s): _ jj O & l LZ3 D-3
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes .. No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes allo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑Yes [� No ❑ NA ❑ NE
acres determination?
17_ Does the facility lack adequate acreage for land application?
[—]Yes
allo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
RNo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[allo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[&No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21 _ Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
fffNo
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
Pq No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
L,No
❑ NA
❑ NE
Page 2 of 3
21412014 Continued

Facility Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ®-No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes RNo ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes Wo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [-]Yes [:� No ❑ NA NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? if yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
[:]Yes CKNo ❑ NA ❑ NE
❑ Yes R No ❑ NA ❑ NE
❑ Yes (! No ❑ NA ❑ NE
❑ Yes
[allo
❑ NA
❑ NE
❑ Yes
[Z No
❑ NA
❑ NE
❑ Yes
allo
❑ NA
❑ NE
❑ Yes
IF—
❑ NA
❑ NE
Comments (refer to question #f) Explain any YES. answers and/or any additional recommendations oT any�other�catnments ' 'r
Use drawings of facility to.better explainsituations lose additional pages as riecessarv).,. N%:y 3
Reviewer/inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:yJ�',y
Date: ,9>
21412014

Type of Visit: ompliance Inspection Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit: Routine O Complaint O Follow-up Q Referral Q Emergency O Other O Denied Access
Date of Visit: Arrival Time: : a r7 Departure Time: Countyyin�Region: a =� o
Farm Name: 0-&,na e'p,r Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: &-rrx r— jf%t�4 Title: Phone:
Onsite Representative: Integrator:
Certified Operator: Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Desigu
Current
Design Carreut
=Desiimcgfegl
apacity Pop.
Wet Poultry
Gapaci#y
Pop.
Cat#le
Capacity Pop.
Wean to Finish
La er
Da Cow
Wean to Feeder
Non -La er
Da Calf
Feeder to Finish % p
Da' Heifer
Farrow to Wean
Design
Current
Cow
Farrow to Feeder
D : �Poultr
Ca ac'
P,p ,
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Otbe
urkey Poults
Other
10ther
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes allo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
d. Does the discharge bypass the waste management system? (if yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes
❑ No
❑ NA
❑ NE
[:]Yes
5 No
❑ NA
❑ NE
[—]Yes
[allo
❑ NA
❑ NE
Page 1 of 3 21412014 Continued

i
Facili Number: - Date of inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [5a No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ® No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
El No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
® No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
® No
❑ NA
❑ NE
S. Do any of the structures lack adequate markers as required by the permit?
[—]Yes
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
❑ Yes
RjNo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
gL No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [A No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 101bs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): r/�1 r� L !l ✓—e_5 ^
13. Soil Type(s): ILV DA/-
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes 21 No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes RNo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable [-]Yes [,No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
® No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[, No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
R] No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
q No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes M No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? [—]Yes ® No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes ® No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412014 Continued

f ~ti
Facility Number: r 2 LDate of Inspection: 1a
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [Z No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ® No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
[] Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail 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 -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
No
❑ NA
❑ NE
[:]Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
[:]Yes 4 No ❑ NA ❑ NE
❑ Yes E4 No ❑ NA ❑ NE
❑ Yes Z No ❑ NA ❑ NE
❑ Yes [a No
❑ Yes ® No
[:]Yes [&No
❑NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
Comments (refer to question #): Explain any. YES answers and/or}any additional recommendationor any other comments:'-
Use drawings of facility to better explain situatioris'(use ad Pages as tlecessary).
lor So 11 `477/` �;>w u'r
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 22L!�_ 7S-300
Date:
21412014

Date of Visit: //'� 17�I Arrival Time: Departure Time: County: F.���� Region:
Farm Name: C;,--yd 62/ts-, Owner Email:
Owner Name: o'l- 1 Phone:
Mailing Address:
Physical Address:
Facility Contact: 1 �"� /%7 /77,,:S Title: j9e cart rr/ Phone:
Onsite Representative: � s _ Integrator: ;P/>,L�
Certified Operator: Certification Number: %-7 0
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design Current
Swine Capacity Pap. Wet Poultry
Wean to Finish La er
Wean to Feeder Non -La er
Feeder to Finish / V --aDairy
Farrow to Wean
Farrow to Feeder D-9 P,outtr
Design Current
Capacity Pop.
Design Gnrrent
Cattle Capacity Pop.
Dairy Cow
Daig Calf
Design Current
Ca aci P,o
Heifer
D Cow
Non -Dairy
Farrow to Finish
ILayers
I
113eef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
jPullets
I Beef Brood Cow
tj Turkeys
Other Turkey Poults
Other Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
[:]Yes Z No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
[:]No
O NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
Ca No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
® No
[] NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

. Facility Number: Date of Inspection: —
7 " /3
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
ENo
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): j
Observed Freeboard (in): 2
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
® No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
E[ No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
JR] No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
ZLNo
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
0 No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
Ig No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. []Yes M No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground [] Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): feel Iola,
13. Soil Type(s): % ia"-f / 'n"X
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes Eg No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ®No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes ® No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
[]Yes ® No ❑ NA ❑ NE
❑ Yes Q No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes S No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [0-No ❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes RINo
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? [—]Yes g] No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes tZ No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Condnued

Facility Number: - Date of Inspection: — l3
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ® No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes V] No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? [:]Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [-]Yes No ❑ NA ❑ NE
ACS
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes ® No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? if yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes gj No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes JR No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
�No
❑ NA
❑ NE
33. Did the Reviewerlinspector fail to discuss review/inspection with an on -site representative? ❑ Yes
® No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes
Z[ No
❑ NA
❑ NE
Comments (refer. to question #):.Explain any YES answers and/or any additional recommendations or any, other comments r "
Use drawings of facility to better explain situations (use additional vases as necessary).
t e' Zv q'rr GU4-%t � 8 -� � o�Pv--�- k5, Wow o��- L as fts Crm ��
Reviewer/Inspector Name:
Phone:
Reviewer/Inspector Signature: a � � Date: — 7 —
Page 3 of 3 21412011

Type of Visit: Co�om��pliance Inspection Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: (Routine O Complaint O Follow-up O Referral Q Emergency O Other O Denied Access
Date of Visit: fr Arrival Time:Departure Time:[ County: Region: �-0Farm Name:?�;,r� ; 5 �Q<y+'4� Owner Email:�111­
Owner Name: %}i Phone:
Mailing Address:
Physical Address:
Facility Contact: &C
Title: FW Yr Phone:
Onsite Representative: [j Ep W y �`%lo-17%t . 5
Certified Operator: b 7414 1
�- a5
Back-up Operator:
Location of Farm:
Latitude:
Integrator:
Certification Number: f 7
Certification Number:
Longitude:
Design Current Desigu NEKLC*
,j�DesignjTCurrent.
Swine . Capactty Pop Wet Pa It ry
F
Cap ityP per. Cattle CapacityPop.
Wean to Finish
La er
DairyCow
Wean to Feeder
I iNon-LayeT
I
'Design CurrentDry
Dairy Calf
Feeder to Finish
Dai Heifer
Farrow to Wean
Cow
Farrow to Feeder
D . P,oult :
..-
Ca aci Po . -
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
yers
Beef Feeder
Boars
Pullets
Turkeys
Beef Brood Cow
.-._ .
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
[-]Yes 2.No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes ❑ No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes [j�C No ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Condnreed

. Facility Number: k,2, - ZZ 7 Date of Inspection:
Waste Collection & Treatment
i 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
�. o
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
®, No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
Q No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
M No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[,No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
C,Yes
❑ No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
EjNo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes Eallo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu., Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): U a ('sV¢7-t ZZ
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ® No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes [RNo ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Reauired Records & Documents
❑ Yes [ No ❑ NA ❑ NE
❑ Yes a No ❑ NA ❑ NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
Z No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
allo
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and l" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
[allo
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
Callo
❑ NA
❑ NE
Page 2 of 3 21412011 Continued

. Facility Number: - 7 Date of Inspection: ` D 17--
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [&No
' 25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes 0 No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes f,No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [:]Yes gqNo
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately_
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34_ Does the facility require a follow-up visit by the same agency?
Reviewer/Inspector Name:
Reviewer/inspector Signature:
Page 3 of 3
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ Yes allo ❑ NA ❑ NE
❑ Yes [ANo ❑ NA ❑ NE
❑ Yes 54 No ❑ NA ❑ NE
❑ Yes RNo ❑ NA ❑ NE
❑ Yes PS -No
[:]Yes VQ No
❑ Yes Ca No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Phone: 9/- P 2�,� 33so-
Date: V—S D D 1v�-
2/4/2011

(Type of Visit: 4DTompliance Inspection O Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: C foutine O Complaint O Follow-up O Referral 0 Emergency 0 Other O Denied Access
Date of Visit: L Arrival Time: : OD Departure Time: ; O County:
Farm Name: G� Min--� Owner Email:
Owner Name: 3ni L7 Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator: 15-1e—
Back-up Operator:
Location of Farm:
Title:Phone:
Latitude:
Region:
Integrator: If �
01
Certification Number: 117e6p
Certification Number:
Longitude:
Design
i Design
Current
Design Current
Capacity
Pop.
Wet Poultry
Capacity'
Pop.
Cattle Capacity P.
Wcan to Finish
I
11-ayer
Da' Cow
canto Feeder
Non -La er
I
lf
Feeder to Finish
O
- - '`
: s
Da' Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
D . P,oul
Ca ac
P,o
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
r ..
TUT Key Poults
Other
Other
Discharees and Stream ImDaCtS
1. Is any discharge observed from any part of the operation?
[:]Yes
E.No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
[] NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
DNA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
a No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
EK� No
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3
21412011 Continued

tFacility Number: - Date of Inspection: Z;s !/
Waste Collection & Treatment
i 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 25No
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No
Identifier:
Spillway?:
❑ NA ❑ NE
❑ NA ❑ NE
Structure l Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Designed Freeboard (in): 111�
Observed Freeboard (in): - t
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes E, No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes r51741 No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ®.Yes ❑ No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes C. No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes LR No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need []Yes ® No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ZLNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): �rv�J.-- rr. j
13. Soil Type(s): bii
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes MNo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ® No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes [Z No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Reauired Records & Documents
[:]Yes [0 No ❑ NA ❑ NE
[:]Yes Callo ❑ NA ❑ NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
[-]Yes
D[_No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
[:]Yes
[gNo
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
[RNo
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
®,No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [R No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

�Fac�Wtyumber: - I Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[�No
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
E] No
❑ NA [] NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes
No
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
[—]Yes
No
❑ NA ❑ NE
Other Issues
28. Did the facility fail to property dispose of dead animals with 24 hours and/or document
[—]Yes
�No
❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
JR] No
❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
5Z No
❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, aver -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
C No
❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[� No
❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
[ No
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
� No
❑ NA ❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or- any_ other coifimeuts. "
Use drawings of facility to better expiam sitnations (use additional pages as necessary). = �'
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date: /9 16--2�170 t
21412011

Type of Visit 49-Co—mpliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit (111outine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: I Arrival Time: .'O b Departure Time: t) County: Region:./ [�-
Farm Name: Cie y u me i Sa+'f Owner Email:
Owner Name: Z 0 bb�� %%1a �..5 _ Phone:
Mailing Address:
Physical Address: /,
Facility Contact: r�:•.tr1 17`l�? iS _ Title: Phone No:
Onsite Representative: Integrator:
11011
Certified Operator: _�� Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: =1 e = ` 17:1 u Longitude: = °.= f ="
Design Current Desig*=1LcityApzP
ulation Wet Poultry Capacopulation
Cattle
Capacity Population
❑ Wean to Finish
10 Layer
❑ Dairy Cow
❑ Wean to Feeder
ILI Non -Layer
❑ Dairy Calf
tA Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
O 0
Dry it.
❑ Layers
❑ DaiEx Heifer
❑ Dry Cow
❑ Non -Dairy
El Beef Stacker
❑ Gilts
❑ Boars
Non -Layers
❑ Pullets
❑ Beef Feeder
❑ Beef Brood Co
❑ Turke s
Other ❑ Turkey Poults
❑ Other ❑ Other
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes RNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
C3.No
❑ NA
❑ NE
❑ Yes
D3-No
❑ NA
❑ NE
Page 1 of 3 12128104 Continued

Facility Number: — Date of Inspection 19IL2 7—/
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
%No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): / 9
Observed Freeboard (in): a'},
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
E4 No
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
JRNo
❑ NA
❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
PLYes
❑ No
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
,@ No
❑ NA
❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
0 No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
5Q No
❑ NA
❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes KNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)p f} L3 O
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes U!�No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
17. Does the facility lack adequate acreage for land application? ❑ Yes
18. Is there a tack of properly operating waste application equipment? ❑ Yes
MU No El NA ❑ NE
UZ No ❑ NA ❑ NE
RNo ❑ NA ❑ NE
53 No ❑ NA ❑ NE
* �} S ensurers andlor any recomrrrendatrnns or and ;Comments refer to - ueshon # Et teen an YE tt:„ comment s Use drawingsof facility -to better explain situations (use a_dditronal pages as necessary)
� l �
7 ��``r'r�z' GvOn/� �'� � G�J��s-tom ,��5', l.(Jv/ Y �Or� r- Gpv its Q'��•
(' a•ti ��z-vim-,- art' 41 3 �/ - eO /W AJ To / ib /i s At
O I a •
Reviewer/Ins ector Name ^' �' +' - ao
P rt> .... t Phone: O .33
Reviewer/inspector Signature: Date:
Page 2 of 3 LZIY&va c.onunuea

Facility Number: — Date of Inspection 7--/
• Reuuired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ® No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes UjNo ❑ NA ❑ NE
the appropriate box. ❑ WUp [] Checklists ❑ Design El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. [Yes [__1 No ❑ NA ❑ NE
2 Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soi] Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
E'No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
® No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
fR No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
ULNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
M No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
PNo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
J9 No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
CKNo
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
® No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
0 No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
® No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
R No
❑ NA
❑ NE
Ad'diteonal Comments.andLor_Drawinlis.�,«„ T.
� j Guj-t llJaS rVk,esv► )('4.
Page 3 of 3 12.128104

Type of Visit
om��pliance Inspection
0 Operation Review 0 Structure Evaluation
0 Technical Assistance
Reason for Visit
0-1routine 0 Complaint
0 Follow up 0 Referral 0 Emergency
0 Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: 0.'/ J� County: Region: :2o
Farm Name: I� Owner Email:
Owner Name: B Q L h X -ce if Phone:
Mailing Address:
Physical Address: -
Facility Contact: r5__c.4 Le Title: ! [Jt2 t� �� Phone No:
Onsite Representative: — Integrator: -� r_.! I �
01
Certified Operator: Sul ems Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: = o = 6 = 6f Longitude: 0 ° = 1 = "
Design Current
Design Current
Design
Current
tion
Cattle Capacity
Populati
inish
M�e
❑ La er
❑ Dai Cow
eeder
❑Non -La er
Dry Poultry
❑ Dai CalfFinish ❑ DairyHeifer
❑ D Cow
Non -Dairy
w to Wean
w to Feeder
w to Finish
La ers❑
Non -La ers❑Beef
Beef Stocker
Feeder
Pullets
❑ Beef Brood Co❑
Turke s
❑ Turke Points ❑ Other
Number of Structures:
Discharges & Stream Impacts
I. Is any discharge observed from any part of the operation?
❑ Yes
® No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
10 No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
ONo
❑ NA
❑ NE
other than from a discharge?
12128104
Continued

Facility Number:
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier:
❑ Yes W No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
Spillway?:
Designed Freeboard (in): j g
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes [8 No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes 9No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? [2� Yes ❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ® No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ® No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ® No ❑ NA ❑ NE
maintenance/improvement?
11.
Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
[$No ❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[]PAN ❑ PAN > 10% or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12.
Crop type(s) A& 1-in a a l 42V e, ^SY-J
_
13.
Soil type(s) A%14 j��$
14.
Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
,[No ❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement? ❑ Yes
Lallo ❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
91 No ❑ NA
❑ NE
17.
Does the facility lack adequate acreage for'land application? ❑ Yes
[a,No ❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment? ❑ Yes
QjNo ❑ NA
❑ NE
Comments (refer_to question #) Ezp any YES ansRersand/or anyrecommendations or anvtheircomments _
Mot
Use drawings of facility' to better esplain'sttieadons. (useadili�ttoaal pages as necessary}: ,,�-_--
tkbf'k 7 &-y-L
f, Sn �� i �'- t Uj ed er6U -e .
/ d� 9
Reviewer/Inspector Name I 3�- g ` Phone.• 13.�-3300
Reviewer/Inspector Signature: Date:
12178104 Continued

Facility Number: — Date of Inspection l
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes [9No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check ❑ Yes ® No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps
p El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield Cal 20 Minute inspections ❑ Monthly and 1" Rain Inspections Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
IgNo
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
CHNo
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
CNo
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
1No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
qNo
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
RNo
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
® No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
�&No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
KNo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
qNo
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
(RNo
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
0 No
❑ NA
❑ NE
72128104

f
Type of Visit IZnompli Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit outine O Complaint O Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: I —.)—fv Arrival Time: �f7`.O Departure Time: Q County: zr_ Region:
Farm Name: [-T eU2 4 „ l " : M�C-frV­ _ Owner Email
Owner Name: S Phone:
Mailing Address:
Physical Address:
Facility Contact: _ D Y aT Th c S Title: Phone No:
Onsite Representative: S` .-t _ Integrator: Pr
Certified Operator: Ste - Operator Certification Number: _/�� D
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = e 0 ' = u Longitude: = ° = 1 = "
Design Current
Design Current
Design C►ur - _ t
Swine Capacity Population
Wet Poultry : Capachty Population
Cattle Capacity Population
❑ Wean to Finish
❑ Layer
❑ Da Cow
❑ Wean to Feeder
❑ Non -Layer
❑ DairyCalf
Feeder to Finish 2720
DairyHeifer
❑ Farrow to Wean
Dry Poultry
❑ D Cow
❑ Farrow to Feeder
Non -Dairy
❑ Farrow to Finish
❑ Layers
❑ Beef Stocker
❑ Gilts
❑ Non -Layers
❑ Beef Feeder
❑ Boars
El Pullets
❑ Beef Brood Co
❑ Turkeys_
Other _
❑ Other
❑ Turke PouIts
❑ Other
Number of Structures: 1
Discharges & Stream Impacts
I. Is any discharge observed from any part of the operation?
❑ Yes
R[No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d_ Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. is there evidence of a past discharge from any part of the operation?
❑ Yes
® No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
® No
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12128104
Continued

Facility Number: V — Date of Inspection oT
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in): f
Observed Freeboard (in):
❑ Yes ® No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes W No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes (9 No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? 0-Yes ❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
® No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes
JK No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
® No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
N No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s) p E
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
0No
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes
�0 No
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
® No
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes
® No
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes
9No
❑ NA ❑ NE
CommQ49(ereferto`gnestion #). EspYESnswersand/or any recommendations flr any other commene dras offacilih to better explain situatiionadditioual pages as necessary). _ .
I
, &,prepQ_3
�
1W
Reviewer/Inspector Name Phone:
Reviewer/Inspector Signature: Date: 2_- f p — Z) e
Page 2 of 3 12128104 Continued

Facility Number: a Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes J0 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check ❑ Yes 0 No ❑ NA ❑ NE
the appropirate box. ❑ WUp ❑ Checklists ❑ Desig
n ❑ Maps
p ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 0 No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes VR No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 0 No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[&No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
CRNo
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
19 No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
9 No
❑ NA
❑ NE
Other Issues
29.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[Z No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
® No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
0 No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
fR No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
E.No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
CK No
❑ NA
❑ NE
nal Comments and/or
12128104

eL-
ision of Water Quality s/7c
Facility Number 0 Division of Soil and Water Conservation f��a c� c77 ;
- 0 Other Agency
Type of Visit
Inspection
0 Operation Review 0 Structure Evaluation
0 Technical Assistance
Reason for Visit
,,��ommp�pliance
routine 0 Complaint
0 Fallow up 0 Referral 0 Emergency
0 Other ❑ Denied Access
Date of Visit:
I Y_�_D
Arrival Time:
Departure Time: County
Region:
&I-
Farm Name: ers1 r_
In" --A s gfr-C
rr_- Owner Email:
GG12
Owner Name: � j$h
_ tie
Phone:
Mailing Address: /�"L
l'/la r, L'� v ��.
�L.M. tQ.,t- C •
AS- V-k-
Physical Address:
Facility Contact: ,C211 Y flZ1 iS Title:
Onsite Representative:
Certified Operator: s—
Back-up Operator:
Phone No:
Integrator., a
Operator Certification Number: ��� O
Back-up Certification Number:
Location of Farm: Latitude: E] o =' F-1 « Longitude: = e = f
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
❑ Non -La et
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
I. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
Design '
Cattle C a Welty
c. What is the estimated volume that reached waters of the State (gallons)?
Dairy Cow
Dairy Calf
Dairy Heifej
Dry Cow
Non -Dairy
Beef Stockei
Beef Feeder
Beef Brood
Number of Structures: C
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes ZNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes ER No ❑ NA ❑ NE
❑ Yes KNo ❑ NA ❑ NE
12128104 Continued

J
Facility Number:?, Date of Inspection �%
' Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
JR3 No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[SNo
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
R No
❑ NA
❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental
notify DWQ
7. Do any of the structures need maintenance or improvement?
Ew Yes
ltthreat,
NNo ❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
ig No
❑ NA
❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
[,N No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[SNo
❑ NA
❑ NE
maintenanceli mprovement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes M-No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[]PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) '&or.'v�
13. Soil type(s) .& * r ./ 25 j5
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes ® No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes
®No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
i4 No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes
KNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes
RNo
❑ NA
❑ NE
Comments (refer 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):
l EYDSry`+- lj=''-�J4�i1' Sia 8 D' .V
";?- 0%rhr'
Reviewer/inspector Name Phone: /p-G T3 - 33aa
Reviewer/Inspector Signature: Date: --
i 12128104 Continued

r
Facility Number: $�` Date of Inspection
' Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes $21 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CA WMP readily available? If yes, check ❑ Yes � No ❑ NA El NE
the appropirate box. ❑ WUP El Checklists El Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. 9Yes ❑ No ❑ NA ❑ NE
Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
[9No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
RNo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
® No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
® No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
® No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
P No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
®No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
Q9 No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
P No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
[3 No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did ReviewerAnspector fail to discuss review/inspection with an on -site representative?
❑ Yes
® No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
99 No
❑ NA
❑ NE
Comments and/or Drawings:
12128104

Type of Visit __C,,,,om��pliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
eT Reason for Visit Routine O Complaint O Follow up O Referral O Emergency Q Other ❑ Denied Access
Date of Visit: o t_eg Arrival Time: Departure Time: ; p i7 County: Region:
Farm Name: % e /2 -e AM � i5 �Q��f Owner Email:
Owner Name: �C- �fi �: s Phone:
Mailing Address: d- n S'�� e
Physical Address:
Facility Contact: Title:
Onsite Representative:
Phone No:
Integrator: 9/rs -�
Certified Operator: jrldnn 14— Operator Certification Number: Z7A!7a a
Back-up Operator:
Location of Farm:
Back-up Certification Number:
Latitude: EJ 0 0 , = « Longitude: =1 ° ❑ , = a
Design Current
Design Current
Design Current
Swine Capacity Population
Wet Poultry Capacity Papnlation
Cattle Capacity Population
❑ Wean to Finish
❑Layer
_
❑Dai Cow
❑ Wean to Feeder
❑Non -La er
❑ Da Calf
Feeder to Finish
D
I
Dairy Heifer
❑ Farrow to Wean
pry Eaulfry
❑ Dry Cow
Farrow to Feeder
El
El❑ Farrow to Finish
❑ ers
El Beef Stocker
❑ Gilts
El N ayers
❑ Beef Feeder
❑ Boars
Nets
❑Pullets
❑ Beef Brood Co
- -
--
El Turkeys
Otber
❑ Turkey Poults
Number of Structures:
❑ Other
❑ Other
Discharges & Stream impacts
1. Is any discharge observed from any part of the operation'?
❑ Yes
KNo
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
Pq No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
KNo
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
❑ Yes
KNo
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
R(No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
RNo
❑ NA
❑ NE
other than from a discharge'?
Page l of 3
12128104
Continued

Facility Number: — Date of Inspection t'
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
(K No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
JZ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier: 1
Spillway?: 1
Designed Freeboard (in): I
Observed Freeboard (in): --
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
M No
IN
ElNA
[INE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
Z No
❑ NA
❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental
threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
Z Yes
❑ No
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
4 No
❑ NA
❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
® No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
C,No
❑ NA
❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes &No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) (� ",)a S 2tLL 27rrm u04Groo r � �1.�-rCr,_� � au
13. Soil type(s) yAl ep
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes N No ❑ NA ❑ NE
15_ Does the receiving crop and/or land application site need improvement? ❑ Yes QNo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes ® No ❑ NA ❑ NE
IT Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes KNo
❑ Yes J&No
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question ft Explain any YES answers and/or any recommendations or. any other comments.
Else drawings of facility to better explain situations. (use additional pages as necessary):
7l`7n�e 1�4rk K� e�-• �a.-�s
T
Reviewer/Inspector Name p Phone: fc�3
Reviewer/Inspector Signature: Date:
Page 2 of 3 V12128104 Continued

Facility Number: — Date of Inspection
Required Records & Documents
• 19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes tK No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check 0 Yes MNo ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps [I Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes KNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
,9 No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
W No
❑ NA
❑ NE
24_
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
IR No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
J] No
❑ NA
❑ NE
26_
Did the facility fail to have an actively certified operator in charge?
❑ Yes
J4 No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
A No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CA WMP?
❑ Yes
No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
MNo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No
❑ NA
❑ NE
33,
Does facility require a follow-up visit by same agency?
❑ Yes
XNo
❑ NA
❑ NE
Addrtionsd Comments andlair Drawin s: z � k ��� "`,.��*"��,� � � i -
12129✓04

m
Type of Visit ® Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit ® Routine O Complaint O Follow up Q Referral O Emergency O Other ❑ Denied Access
Date of visit: Arrival Time: g % �i S Departure Time: County: 5 t1" Region: _ F►r't,
Farm Name: 5r. rq Q
e( a �,-, Owner Email:
Owner Name: -R-0 i6-b-te —_ mnt Phone: Sgy - -2IL
Mailing Address: %�`� ---- CAA IV11 3
Physical Address: S CZwn.. C� o, a -4,6C" e_ _
Facility° Contact:
Title:
Onsite Representative:_ _ � e +- e— rn a o,�,+ • s
Certified Operator: _ B �66 ,( Cc,_ +'v► a4 -� . s
Back-up Operator:
Phone No:
Integrator: Pre _n1±-_ * r
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: F-1 o= 1 0 u Longitude: ❑ 0 0' 0 u
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Laver
❑ Non -La et
Dry Poultry
Non -I -a
Pullets
Turkew
Poults
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity- Population` <.;
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocket
❑ Beef Feeder
❑ Beef Brood Cow
Dumber of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters ofthe State
other than from a discharge?
❑ Yes [2 No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑NA
El NE
El Yes
El No
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
W No
❑ NA
❑ NE
12128104 Continued

Facility Number: ,Z — ,�.Z % Date of Inspection 14421/071
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:
/ 4
Spillway?:
Designed Freeboard (in): dAf t /o/lq/ g�
Observed Freeboard (in): d 7 It '
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ yes U No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes ® No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? [N Yes ❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes N No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes R No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 14 No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ® No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drifl ❑ Application Outside of Area
12. Crop type(s) , S C,
13. Soil type(s) No /� L- da
14, Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
09 No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
® No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination,
El Yes
® No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
[29 No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
® No
❑ NA
❑ NE
7- Cat, +'r K\n`e fio wo r k o r� ( a q ao1J bA r' SPS. M r . rvn -+4k a
Or> r b c ir-_ ..r.dQj::%
'--o ti w%lc r s -, er �%'s a _s4 c KJ2.
Reviewer/Inspector Name ,'� Phone:
Reviewer/Inspector Signature: Date: �'/2 Lbw
12128104 Continued

s
Facility Number: 82 — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ® No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes N No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design
� ❑ Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ® No ❑ NA ❑ NE
a.9, ,q
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall [:]Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
® No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
N Yes
❑ No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
91 No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
ED No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
D] No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
[9 No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
® No
❑ NA
❑ NE
29.
Did the facility fait to properly dispose of dead animals within 24 hours and/or document
❑ Yes
® No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
EO No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
® No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
® No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
® No
❑ NA
❑ NE
,23 - ) M r . i • `�T"�`� - j ,l ✓
P : SE ice' '� p�lt�.r
1
1 va E;. {
I
Pu ► pr �tcy e ve of�
Al o p u k-., r ,- n a,L
1 c c.,o C:;X/o�
l r_ MA4-4 1 5�-
12128104

Type of Visit 4' Compliance Inspection O Operation Review O Lagoon Evaluation I
Reason for Visit 0 Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Bate orvisit: T-une H q o : :'f.S
Facility Number 2. Z
Q Not O erational Q Below Threshold
Permitted 0 Certified [a Conditionally Certifed [3 Registered Date Last Operated or Above Threshold: ...... �.
Farm Name: 5 jt►�....� .� S �ac'vv4 County: . .... . ...... ------- ------- .....-----
bb
Owner Name: ~-
............................`.#........----------................ AAp_C�.��.�....!.r�.....�................... Phone No:...........9�Q........S9Q.�`�.�.�.Z�__....
Mailing Address:.....ill'} .� !g ._...._ . G ; K�icV
Facility Contact: —------- Title: _.. Phone No:
Onsite Representative:._. ei�2�._ !1�a �. ..._.............. _._.. Integrator: ............. ��� �' .�_._ �.__�_ ......
Certified Operator: .....�b�a.. M AAA& S Operator Certification Number. S (PQ
Location of Farm:
❑ Swine ❑ PouFtry ❑ Cattle ❑ Horse Latitude ' 4 69 Longitude • 4 «
_
Desij 3
-�Cu3
S Caiac�ty -PoDii
Wean to Feeder
Feeder to Finish
,Z2-G-
Ej Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
El Boars
=H�
:` LJlSZgn Glirreiii=' �. _'
aci Po isia6ora Cat i
rDairy
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/rain?
❑ Yes A No
❑ Yes KNo
❑ Yes IR No
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes %No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes RNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes NJ No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes JKNo
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ..._.... -.e .1.................... ........ ........... .......... .......... _....... ......... .......... .......... ..... _...... .............................. ......... ......... ...... ...... -...
Freeboard (inches): 7 it
12112103 Continued

Facility Number: g Z _ Date of Inspection
Required Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes M No
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ W1O1',_checklW! rdesig< mp,( etc.) ❑ Yes ;KNo
23. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes jo No
❑ Waste ApplicatiG�i ❑ Freeboard--Cl Waste Analysis❑ Soil Samplirk,--_
24.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
XNo
25.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
19 No
26.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
MNo
27.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
HNo
28.
Does facility require a follow-up visit by same agency?
❑ Yes
K No
29.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
O No
NPDES Permitted Facilities
30.
Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
y Yes
❑ No
31.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
,,Yes
❑ No
32.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
J$No
33.
Did the facility fail to conduct an annual sludge survey?
❑ Yes
JK No
34.
Did the facility fail to calibrate waste application equipment?
❑ Yes
%,No
35.
r
Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below.
❑ Yes
J& No
❑ Stocking Fo*Rs❑ Crop Yield Fakfr' ❑ RainfAIr ❑ Inspection After V Rem
❑ 120 Minute Ingot ons ❑ Annual Certification Fdmrt>-
12112103

Facility Number: 8z — ZZ-+
Date of Inspection y ►j
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. is there evidence of over application? If yes, check the appropriate box below.
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type
❑ Yes 1KNo
❑ Yes RNo
❑ Yes )ANo
❑ Yes Xj No
❑ Yes XNo
❑ Yes MNo
❑ Yes P(No
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes Olo
14. a) Does the facility lack adequate acreage for land application? ❑ Yes 0 No
b) Does the facility need a wettable acre determination? ❑ Yes 9[ No
c) This facility is pended for a wettable acre determination? ❑ Yes 14 No
15. Does the receiving crop need improvement? ❑ Yes J,No
16. Is there a lack of adequate waste application equipment? ❑ Yes 91No
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes 14No
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes KNo
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional ❑ Yes RNo
Air Quality representative immediately.
❑ Final Notes
74_ Mr. Iwrta+[k.,. s 4-o seeA k" a-,ea-s ov, - q, of to -loon.
Reviewer/Inspector Name -
Reviewer/inspector Signature:
Date:
12112103
Con_dnued

Site Requires Immediate Attention:
Facility No. —
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: 7 /9 , 1995
Time:
Farm Name/Owner: ��—.✓� My�'
Mailing Address: Q o ui- q AvY 4: Z
- S4D-I-
County: S
Integrator: v� — t�r�s�ag� Phone:
On Site Representative: 4--P /<.',y Phone:
Physical Address/Location: r442 d,,4dLv v
Yi
Type of Operation: Swine ✓ Poultry Cattle
Design Capacity: Number of Animals on Site: 710 ft-c T=✓s1r
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: °' ip" Longitude:
Circle Yes or No
Does the Animal Waste - Lagoon have, sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches)
Was any seepage observed from the
Is adequate land available for spray?
Crop(s) being utilized: CG d
Does the facility meet SCS minimum
or No Actual Freeboard: V SFt. Inches
on(s)? Yes or( 19 Was any erosion ob ed? Yes ordi
Nor
or No Is the cover crop adequate? No
setback criteria? 200 Feet from Dwellings? Mis or No
100 Feet from Wells? 61 or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or N6
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line: Yes orb
Is animal waste discharged into water of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes or(!9 if Yes, Please Explain.
Does the facility maintain adequate waste management recors (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? 64or No
Additional Comments:
A T• Jac.i.S
Inspector Name
if..� - � '
'90��
Signature
cc: Facility Assessment Unit Use Attachments if Needed.

RMTH CAROLIM DSPARTlD, qT OF , BHALTE & mATaRAL RESQURCM
DrVISION OF E'lMTROI' MTAL MAIVIGMEMT
Fayetteville Regional Office
Animal Operation Compliance inspection Form
�.rr�..'G'•e3..:r -. : �: : �-- - 'c?�' � .,,a...u, ,a- rp °r�si= r ±: .:a-ywr,+�;.�.r�`-i,:::.�...
Gene, Mci*hi s
w.�my •:ov+ ..;.-«:....:i:e- ..�-.ct ;' �+'i "r-,.,.yi .,.r:uti..
.. ,. .�. /�� y�}������►� .�»r�
:�w i�>:. ti
1. A
� �o-.� �T7j .'^-�w �.an.-^�S ^^•' r `^'.. - Ho�.::.� ,
P...c.w• fK.iVi1i:�..i •S1{JRn�
JNJ_a�.+-i�V ..11tliAiLG►J�7 47°M
.at F+��uVa�F ?"
R+ 4 Clinfnn KC, 2P3zs
CWclIq-5Q0-Z$z7
All questions answered negatively Will be discussed in sufficient detail in
the - Comments Section to enable the deemed Permittee to perform the appropriate
corrections:
SE=ION I
Animal 0oaration Feecier -to RniSh
Horses, cattle, tine, poultry, or sheep
SECTION II
T I N I CO>C1TS
1. 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
2. Does this facility meet criteria for
Animal Operation TiF_6ISTRATION?
3. Are animals confined fed or maintained
in this facility for a 12-month period? -
4. Does this facility have a CERTn=— AHIl�AL
idA,SIE MANA�iT Imo..
5. Does this facility maintain waste management
records (Volumes of manure, land applied,
spray irrigated on specific acreage with
specific cover crop)?
5. Does this facility meet the SCS minimum
setback criteria for neighboring houses,
wells, etc?

..1
xM 1XI
kiRld Site Managnment
1. Yo animal rablw sLuckpilM OV iagoon
construction within 100 ft. of a BSGS
Map Blue Line Stream?
2. Is animal waste land applied or spray
irrigatod w4 *1%'n 25 ft. of a U500 flap
Blue Line Stream?
3. boos this facility have adequate acreage
on which to apply the waste?
4. Does the land application -sits have a
cover crop in accordance with the
ONTIFICATLM
S. Is animal Waste discharged into waters of
the state by man-made ditch, flushing systeM,
or other similar man-made devices?
5. Does the animal waste management at this
farm adhere to Best Management Practices
(BMP) of the approved CpTIFsC71TI ?
?. Does animal waste lagoon have sufficient
freeboard? How much? (Approximately -)
$. Is the general condition of this CAFO facility,
including management and operation,
satisfactory?
&E lam ry
Cmments
Or�ginod
C e- 1, -K e-ed
fo�.�-m reg+steed;
8'3� �q4
A en addition was re�; s4cr-ed ,; Ro+h

.1Y�+ 71AS:'3 ` .VAG `iT ?L.IN G :sZ��?�:..Z�= :'� ?OR N3W Can �A2T--9...-` ?ram.:=?5
P=eaae =at= = t.!.e ccsplatad _*== to the Olv sion of P�..T+ c to"_ '.ia.-_:saaaat at
tie zz.= asa as the=rtvars+ side of LN' s ; a=.
`✓aide of far-_ (?Lease print) : Ge'nO MA7rI41
nc = es s
147'On 8325 - ?hone No.: /a a- s z'v
Cou:.ty- P"JO2211 _
-a_= Lac_tior.: t=race and Long itude:10';Et Aza"/Ur l$".�` (required) Also,
:ease a=zaca a c_py of a county _=ad map with. location identified.
Ty7e of operation Cs-.r=:_e, layer, dairy, att.) 3wIela --
Desi;. _apac_:,r of and als) 1 ' 7r o FE - my
_ijerage si=e o ge=acion (1 =cn 7cpt.;_acicn avg.) 1710 FEE -Fen
nvezayre acreage needed for land application of waste (acres) Z L
sasaeasaaaa�tasaa:as:asasasaaasaaaaaaaaaaa�atasaasaaasasaasaaaneaazasaaseanaaaaaaas
:'ee�ca� Spoe_il!at Ca��f_aatioa
As a tec: z_ca? specialist designated by the Normh Carolina Soil and 'flare--
Cznserrac_on W=miss_or_ pursuant to WA N114 67 .0005 I cer__fy that the new or
expanded ars_:at waste management systam as installed for =:--e fa--: named above
::as an maze masaSemenZ plan tOMt meets the design. ccr_st_.:c_ica'
:ezac'_an and =ai= tana.-_ce statld=r s and s ecifiCacions of the Division of
Z_-r--_or•_ ental :!---agamenz and t .e UWA-Sail Cznservac,on Se=-.--ce and/or the Nc=z.
Carolina Sal_ and Water Cz serration Cc=.issicn ;-u=zuaxt to 15A WIC ZH_02=7 and
_=A MaAc 67 .000i-.0005. The follcwW e` mencs and their corresponding
.ww*ew-:a-sheen;re=ifiad by me or ocher designated techwf=ai specialists an
are _,eluded in the plan as applica:;ie: mi±. um separations (buffers) ; liners or
equi-raler_t for lagoons or waste storage Ponds; waste storage Capacity; adequate
quantity and amet:ac of Lard for waste util_catior_ (or use of third parry) ; access
c_ avnership of proper waste application equipment; sc-.edule for timing of
acplic„ions; application rates; loadl=g races; and the control of the dischaxSe
of pollutants fry sto==uwtsr rsnoff events less severe than the ZS-_year, 24-hour
star=. -
-Vamo of tech=lcal speelaalst {please Print) : G• akin n _ C� i 7prf
=il_atian:_ PEt�r,e66 r.�i2M5 ,� S.,c_
Arld.-ess (Agency) AeCc 14Tr Phone No. g/o - -Xy.X . 5-771
a;aaaaaaasaaaasaaaasaaa=a aaa�aassasasaaasaaassasaa:asaasassasaaaaaa�a
C'`.w/=er/Ya.�aQer ��semeat:
(we) vrdersma d the operation_ ar_d mai_:tanance procedures established in the
approved animal waste =.anagemert plan for the fa_-m named adove and will im_lemen=
_: ese �_ccedu;es. 's (we) know Chat ar_y additional mansion to rise esting
design: capaciCy of the wasta treaa=ent and storage sys=eta or c=rst=sct_on of new
facilities will =equ_re a new ce=--_-cation Za be suI:=itted =o =ne Division of
,_ri,orrental Management bero_a M_e .-_lr as OWLS are stocked. _ (we) also
,gin derswand tat t era must 4e no d'_schw a of animal :paste fwm this system to
su=zace -waters of tie s:.ata ejt ;er t z=Qgh a man-made ccaveye,nce or through
-off from a scorn event less severe t an the Z5-_rear, 24-:^_our stoz-B. T~e
aq_ osedr_an will :e __red at the A== and at the office of the local Sail and
";a,er Canser-ration Dist_
21a=e of ;and Owr-e=
(Please Print) -Ago64
GeNC
Aa 717LA•�
S_;nature-
s
_.
Q
Date:
ja=0 of meager, if
different from owner
(Please
prat)
i nat_=e:
,U : A C arse in land ownership requires
(__ the approved plan is changed) to
z;:ivi =r=entat Management" '. i=hin 60 days of
Date:—
ccif cacion or a ,ew certification
he sut.^itted to the �-%-rision of
a .:_:le transfer.
L.'_i Us 0N'LY:iG1rri

.+�v�c yr rvUl ri I LLa Vrli au
Depc tr ent or, Environment,
Hec?jh cnd NCturd Rnsources
Civisicn cE Envircnrn entci rMcncgelnenr
.lcrrles S. Hurt, jr.. Gcverncr
;c:.-es. �ecretc
A. rrestcn Hcwcrt. Ir., P.E.. Dire&cr
::ISTRLTC :CNS =C.!j C= :'—=CA-0N CF d,PPRC77 M-Z-.--Xr4 riAS E PLANS :CR
Nr:r CR =n;NM= AII�1AL. i7, S: MA:SYS-12,214-5 SERVT'+iG ;-='LCTS
Mems
3r arter to ce cee-mec e_ t_et. r _-he D'_ '_s ,.. of Envi.=or=enr-al Ala.^.agemert
^.Ye owner of aay new or exraaded an.: a ; waste management system
c_nst_Uc_ed afte_- u'ar_ua=y 1. 1994 :r�:c. is desigr:ed to se_* -re greater than a
eg• al to t;:e a:. a ;� Z:apulat'_ors Listed below is to sutm.it a 3-4 q,.ed
car-_ificatiori farce to DEi bef-zi-s the new ar- -ma s are szac)Cad on the fad.
?ast.=e cperatior-s ara exempt -_om the ;eq•.�irement to be certi-fied.
100 head o.Z cattle
75 hars+s -
250 sw3z. '
1, 000 sh+ep
20,000 b4 --d vtth a '14 CUl d vast* systa�
The cewti;icacioa must be signed by the owner of the feedlot. (and manager if
di=rarsr~t :E_oza the owr_er) and by any cac- ,; cal specialist desig:sated b'y the Soil
and race; Ccrser-ratyors Commission pursuant to ISA NCAC 67 .0001-.0005. A~
tec rical spec=a? isc =zz verity by an on -sits 'inspection that all applicable
design and ccrsstruc_ion standards and sneci__c--cions are met as installed and
chat all alpizcabie ope=at4on_ and mai :tersancs staT�and specifications cane -
be met.
Al trough we actsal nu-s_^,er of ansmais at the fac4l;t.1 may *racy f,om Cie to ti=e,
the desig=s capac;t-Z of the waste hand_: g system should be used to dere-nine if
a `arm is subject to the certification requiremeat. For example, if the waste
s-Jstam for a feed? of is designed to handle 300 hogs but the average copulation
will be 200 hogs, then the waste management system requires a ceriyicacian.
M s ca--tificat_on is =wired by regulations gover..izq ani=a? waste managemenr-
syscam$ adopted 'y the nvirorsaencai management Cccmission (EF!C) on December 10,
1292 (Title 1SA NCAC 7.H .0217) .
Cry -re reverse side of this page is the certification fo W- which =sc be
si=:=:=e=• to Dc i before new anima's ara stocked an the farm- Assistance in
ccLr:P?ec_cg the - car- be obtai.:ed __cm cne of t: a local agric%;ltr ra? agencies
sz;ah as c he soi: and �acar consa_^ration_ d_sc_ict, the CSOA-Sail Ccasa=,ratiors
Se�rice, or the N.C. C_cYe,ac_ve Extension Senrice. The form should be sent ton
Dec&r--enc of Sean_h and
Di vision of M: r;rmr=er_tai Mar agerent
water Quaii-,y 5eo:rioa, Planning Branca
P.O. Box 29 S3 5
Raleigh, N.C_ 27 626-053S
Phone- 919-73 3 -5 C 33
Form 10 : A.(=M 019 4
Nat.cra : Resources
Steve W. Tedder, Chief
Water Qu-ality Section
Date: &
P.C. 3cx 29-"S- Rdelsh. NcrI- Caro rtr,.i27525-C6I5 Te+e.ghone 919-733-77015 =AX 9"9-;-s3-2496
An e:Cuct A K-m�ve Ac~cn cr+e!eyer 544 recyCaC/ 1 CY --c:er

REGIS'TRAKON =OR_EM FCR ANIMAL FEEDLOT OPE'RAT_ONS
Department of Environment, Health and Natural Resources
Division of Environmental Management
Water Quality Section
if tie animal waste management system for your feedlot operation is
designed to serve more than or equal to 100 head of cattle, 75
horses, 250 swine, 1,000 sheen, or 30,000 birds that are served by
a liquid waste system, t_^_en this farm :rust be filled cut and mailed
by December 31, 1993 pursuant in 15A NCAC 2 .0217 (c) in order to be
F deemed permitted by DE.`".. Please print clearly. F
Farm Name:Gece�
Mailing Address: VY
County: Qi ry n _ Phone No . 39;; - lore iy UO-zra?
Owner(s) Name:
Manager(s) Name:
Lessee dame:
Farm Location (Be as specific as possible: road names; direction,.
milepost, etc.) 'on ±x_jhCa�
(-;nr[nnrl . _Ttir n I �-� ntf Ems- t,VtPr-­, r'� . r.; o't-wr.►rt
Lat=nude/Longitude if known: _Qjis�3-Cal-Ga-�1-('
Design capacity of animal waste management system (Number and type
cf confined animal (s) } iaun F�P11Pr - �o1-, h
Average animal population on the farm (Number and type of animal(s)
-raised) : 6)(ICaQ Q1._Ph"e.
Year Production Began: /90 ASCS Tract No. 7d 19
Type of Waste Management System Used: jae'rf'o �Jvn cn{it�'rl
U
Acres Available for Land Application,of Waste: .26 aZA-00
Owner (s) Signature (s) :
own 93
DATE,

17
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-
r
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_.Ica _�4�,
:CL
c =.'w�
- -zz= Na. e . _ (_d e/L
_azSae :V== :
(Be as Z=aC ===es, ���3' �G«•
, -2__�, :elL, c-=_cam if :c �c r::_ 0&2E
of Ia_ i a? wasL, ma^_ce-e--
c: =a ;a--- c:
WS
le a:: 'rL�C-_ac, YC .
S..-St .W used'
rc==s ova; l at=a _c= La_;d waste:
OAS