760065_INSPECTIONS_20171231

r
r
-... .. .. .. - .. ... Division of Water Resources--- -- _ . .._ ...... .... ...... .._. - . ... .... .
Division of Soil and Water Conservation
❑' Other Agency
Facility Number: 760065 Facility Status: Active permit: AW1760065 ❑ Denied Access
Inppection Type: Compliance Inspection
Reason for Visit:
Routine
Date of visit:
08/2512017 Entry Tim: 10:00 am
Farm Name:
Randolph Packing Company
Owner:
Randolph Packing Co
Melling Address:
403 W Balfour Ave
Physical Address:
403 W Balfour Ave
S
Inactive Or Closed Date
County: Randolph Region: Winston-Salem
Exit Time: 12:00 pm Incident C
Owner Email:
Phone: [phone]
Facility fetus. Compliant ❑ Not Compliant Integrator.
Location of Farm: Latitude:
Off 73/74 . 2205 @exit 77. Turn right onto Spero Road and turn right onto Balfour Road.
Question Areas:
Dischrge & Stream Impacts
Records and Documents
Certified Operator:
Secondary OIC(s):
On -Site Representative(e):
24 hour contact name
On -site representative
Primary Inspector:
Inspector Signature:
Secondary Inspector(s):
Inspection Summary:
Name
Craig Hamlet
Craig Hamlet
Rebecca D Chandler
Melissa Rosebrock
Waste Col, Stor, & Treat
Otherlssues
Asheboro NC 27203
Asheboro NC 27203
Longitude:
Waste Application
Operator Certification Number:
Title Phone
Phone : [phone]
Phone: [phone]
Phone:
Date:
page: 1

•
•
•
0
•
Permit: AW1760065
Owner - Facility :
Randolph Packing Co
Facility Number:
760065
Inspection Date: 08/25/17 Inpsection Type: Compliance Inspection Reason for Visit: Routine
3. Evidence of some sediment runoff from new construction.
4. During today's inspection, Paunch trailer was not full and was not overflowing. Dryslack contained approximately 2 sq. yds
under roof and no runoff observed.
10 & 17. The fields have not been used in >10 years; evaluate next visit.
19. Check hauling records. If >1,100 tons, request revision of permit. - RECIEVED 8128/17 - slightly above volume for 2016,
shouldn't exceed 1,100 for 2017.
21. Inedible waste is still receieved by Brown Packing in Gaffney, SC.
21. Waste analysis taken quarterly.
21. Slaughter records complete; may be used as stocking information.
21. Records incomplete for waste transfer. Please send to WSRO for May -Sept 2016 and Feb -April 2017 for review. RECIEVED
8128/17 - okay
32. Manure waste typically is transferred to Neil Lindley (AWC190023) and most recently transferred to Larry Hicks (2649 Foust
Rd, Staley, NC 27355 - 336-708-0152). Brooks Composting is maintained backup facility for Neil Lindley.
Slormweter permit has been recently issued #NCG060376
page: 2

Permit: AW760065
Owner - Facility :
Randolph Packing Co
Facility Number. 760065
'Inspection Date: 08/25/17-
Iripsectiori Type:
" Compliance Inspection
-"Reason for Visit: ' Routine" -
Regulated Operations
Design Capacity
Current promotions
Cattle
Cattle -Beef Feeder 250 230
Total Design Capacity: 250
Total SSLW: 200,000
Waste Structures
Dlsignated Observed
Type Identifier Closed Date Start Date Freeboard Freeboard
Storage PAUNCH TRAILER
Wet Slack BARN SCRAPE
page: 3

Permit: AW1760065
Owner- Facility :
Randolph Packing Co
Facility Number:
760065
-Inspection Date: 08/25/17 - --• Inppection Type:- Compliance Inspection Reason for Visit: I Routine - -- -
Discharges & Stream Impacts
Yea No Na No
1. Is any discharge observed from any part of the operation?
❑
❑ ❑
Discharge originated at:
Structure
❑
Application Field
Cl
Other
❑
a. Was conveyance man-made?
❑
Elm ❑
b. Did discharge reach Waters of the State? (if yes, notify DWQ)
❑
Elm ❑
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)
❑
Elm
❑
2. Is there evidence of a past discharge from any part of the operation?
❑
0 ❑
❑
3. Were there any observable adverse impacts or potential adverse impacts to Waters of the
0
❑ ❑
❑
State other than from a discharge?
Waste Collection. Storage & Treatment
Yea No Na No
4. Is storage capacity less than adequate?
❑
M ❑
❑
If yes, is waste level into structural freeboard?
❑
5. Are there any immediate threats to the integrity of any of the structures observed (I.e./ large
❑
0 ❑
❑
trees, severe erosion, seepage, etc.)?
6. Are there structures on -site that are not properly addressed and/or managed through a
❑
0 ❑
❑
waste management or closure plan?
7. Do any of the structures need maintenance or improvement?
❑
0 ❑
❑
8. Do any of the structures lack adequate markers as required by the permit? (Not applicable
❑
❑ M
❑
to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑
0 ❑
❑
maintenance or improvement?
Waste Application
Yea No No No
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ ❑ ❑
maintenance or improvement?
11. Is there evidence of incorrect application?
❑ ❑ ❑
If yes, check the appropriate box below.
Excessive Ponding?
❑
Hydraulic Overload?
❑
Frozen Ground?
❑
Heavy metals (Cu, Zn, etc)?
❑
PAN?
❑
Is PAN > 10%/10 lbs.?
❑
Total Phosphorus?
❑
Failure to incorporate manure/sludge into bare soil?
❑
Outside of acceptable crop window?
❑
Evidence of wind drift?
❑
Application outside of application area?
❑
page: 4

Permit: AWI760065 Owner - Facility : Randolph Packing Co Facility Number:
760065
Inspection Date: 08/25/17 -" Inpsection Type: Compliance Inspection Reason for Visit:
' Routine
Waste Application
Yee
No Na No
Crop Type 1
Fescue (Nay)
Crop Type 2
Crop Type 3
Crop Type 4
Crop Type 5
Crop Type 6
Soil Type 1
Soil Type 2
Soil Type 3
Soil Type 4
Soil Type 5
Soil Type 6
14. Do the receiving crops differ from those designated in the Certified Animal Waste
❑
0 ❑
❑
Management Plan(CAWMP)?
15. Does the receiving crop and/or land application site need improvement?
❑
❑ ❑
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre
❑
❑ 0
❑
determination?
17. Does the facility lack adequate acreage for land application?
❑
M ❑
❑
18. Is there a lack of properly operating waste application equipment?
❑
0 ❑
❑
Records and Documents
Yee
No Na No
19. Did the facility fail to have Certificate of Coverage and Permit readily available?
❑
0 ❑
❑
20. Does the facility fail to have all components of the CAWMP readily available?
❑
❑
❑
If yes, check the appropriate box below.
WUP?
❑
Checklists?
❑
Design?
❑
Maps?
❑
Lease Agreements?
❑
Other?
❑
If Other, please specify
21. Does record keeping need improvement?
0
❑ ❑
❑
If yes, check the appropriate box below.
Waste Application?
❑
Weekly Freeboard?
❑
Waste Analysis?
❑
Soil analysis?
❑
Waste Transfers?
Weather code?
❑
Rainfall?
❑
Stocking?
❑
page: 5

Permit: AWI760065
Owner - Facility
: Randolph Packing Cc
Facility Number:
760065
Inspection Date: 08/25/17 — - - Inpsection Type: Compliance Inspection Reason for Visit: - Routine - -
Records and Documents
Yes
No Na No
Crop yields?
❑
120 Minute inspections?
❑
Monthly and 1" Rainfall Inspections
❑
Sludge Survey
❑
22. Did the facility fail to install and maintain a rain gauge?
❑
NO
❑
23. If selected, did the facility fail to install and maintain a rainbreaker on irrigation equipment
❑
❑
❑
(NPDES only)?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑
0 ❑
❑
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check the
❑
❑ E
❑
appropriate box(es) below:
Failure to complete annual sludge survey
❑
Failure to develop a PDA for sludge levels
❑
Noncompliant sludge levels in any lagoon
❑
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
❑
❑ 0
❑
27. Did the facility fail to secure a phosphorous loss assessment (PLAT) certification?
1111011
Otherlssues
res No Ne No
28. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑
❑
❑
and report mortality rates that exceed normal rates?
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 regional DWQ of emergency situations as required by Permit?
❑
0 ❑
❑
(i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility?
❑
0 ❑
❑
If yes, check the appropriate box below.
Application Field
❑
Lagoon / Storage Pond
❑
Other
❑
If Other, please specify
32. Were any additional problems noted which cause non-compliance of the Permit or
0
❑ ❑
❑
CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑
0 ❑
❑
34. Does the facility require a follow-up visit by same agency?
❑
M ❑
❑
page: 6

Type of Visit: Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: I H/l``��LL,,t rrival Time: Departure Time: County: O1 hRegion: 'Yk5PZ
pp
Farm Name: `1�.(LCKAu h A.0'14l V1q r Owner Email: crq:tj - rQnd e4jft-
Owner Name: J . Cry' 1q km le,+ Phone: (i ► 5 3 — 0$6 ii
Mailing Address:
Physical Address:
Facility Contact: Vila + Title:
Onsite Representative: f10.rn1e,jit
001 a ►lllr=-1'
Certified Operator:
Back-up Operator:
Location of Farm:
Phone: W 672-— /q7(n
Integrator:
Certification Number:
Certification Number:
Latitude: Longitude:
U5 220 so ( n_
xl Our Five
o pero PU t f 77)q'turn 6t1�
o Fa�i li Qv,
Design
Swine Capacity
Wean to Finish
Current
Pop. Wet Poultry
Layer
Design
Capacity
Current
Pop.
Design Current
Cattle Capacity Pap.
Dai Cow
Wean to Feeder
Non -La er
IDai
Calf
Feeder to sh
Dai Heifer
Farrow to an
Farrow to Feeder
Farrow to Finish
Dr,+ P.oultr.+
Layers
Design
Ca tacit
Current
P,oP.Non-Doi
D Cow
eef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turkeys
Turkey Poults
Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes N<0 ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes EUNo ❑ NA ❑ NE
❑ Yes � No ❑ NA ❑ NE
Page I of 3 21412014 Continued

Facili Number: - • Date of Inspection: to
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ❑ No XNA ❑ 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: fV�'✓f'
Spillway?:
Designed Freeboard (in): it% 7i Observed Freeboard (in): „R/ ,.,,
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes p� I No ❑ NA ❑ NE
P (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 NrNA ❑ 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 W 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 ❑ No ; NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes ❑No 1?5�NA ❑ NE
Elj/
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 pRrNA ❑ NE
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 frNo
0
❑ Yes
❑NA ❑NE
❑ NA ❑ NE
❑ Yes
[. No
❑ NA
❑ NE
❑ Yes
)J*I�o
❑ NA
❑ NE
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check
, the appropriate box below. ❑ Yes No ❑ NA ❑ NE
[3*1m -PreebtSIIrd �Y Waste Analysis �te Transfers ❑'::�a�iR,��-
Rainfall Stocking [—}frelrYieM 20 Minute Inspections onthly and 1" Rainfall Inspections ge-Snrwey-
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes Jiro ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No 'NNA ❑ NE
Page 2 of 3 21412015 Continued

]Facility Number: 17 f. - 65f I• Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ❑ No YA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑ No Q-11A ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a PDA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes jalloV NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes []No Q 'A ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes �!(No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes �o ❑ 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 MNo ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes Sj]'5o
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes Iil'No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes ,PT"No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
[-]Yes P!(No
❑ NA
❑ NE
,Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments. '
se drawines of facilitv to better ezulain situations (use additional oaees as'necessarv).
kyu
am1-f -fm h renewed Sep+. Zo 160 . I�(.c+� �x�rl-r-fhb ir►cri se
-neA% b Ie i �a5 i-E Cbar1 e3, v i5e�, mea-i'Sa-�s owes. t o zwnrtq II'1 (° A�'�'net� ,SC. A Moun-i'/olay ? j- IOc�S Qc°.rd�a
zI • Woad a.vt j y .515 w/ i n 60 lour o-F - r&45 ►°o r-% of
ftVLAUrt I� r. U rtd l n �ha �W►a urn CQ �5 _ 9 0
� D �
oil �-Q� h rein-5 7<2So head/�/5 ja �s Pe.• we,�l�
tLIMS 4ei-i� i n. Zo SB W&'5+e, IS v►11cxu
l✓�►r►c1 dw� Chi imam r IeY! �
17. Land- &PPlikt 51'4-e-5 acvet, i (able? "y645 q2s�,ue- 8 ro
(Vo l oL n A `DPP t lc zaAr i. on � n last q-toy r5 .
3� Dr y -tmv,5 rn be; over- i, loot'
1 t rtn (YI Q j way-b2+ "--1 sa i tnC�re -Fo I, s (m i n n eta
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: -771a - q 6 q q
Date: 7 1 201
21412014

M Division of Water Resources
El Division of Soil and Water Conservation
❑ Other Agency
Facility Number: 760065 Facility Status: Active
Inppection Type: Compliance Inspection
Reason for Visit: Routine
Date of Visit: 10/23/2015 Entry Time: 11:40 am Exit Time
Farm Name: Randolph Packing Company
Owner:
Mailing Address:
Physical Address:
Randolph Packing Co
403 W Balfour Ave
Facility Status: E Compliant ❑ Not Compliant
Location of Farm:
Question Areas:
Dischrge & Stream Impacts
Records and Documents
Certified Operator:
Secondary OIC(s):
On -Site Representative(s): Name
24 hour contact name Craig Hamlet
On -site representative Craig Hamlet
Primary Inspector:
Inspector Signature:
Secondary Inspector(a):
Permit: AW1760065 ❑ Denied Access
Inactive Or Closed Dale:
County: Randolph
1:00 pm
Integrator:
Latitude:
Waste Col, Slor, & Treat
Otherlssues
Region: Winston-Salem
Incident #
Owner Email:
Phone: [phone]
Asheboro NC 27203
Longitude:
Waste Application
Operator Certification Number:
Title Phone
Phone: [phone]
Phone: [phone]
Phone: `10c-
9I
Date: fJ
Inspection Summary:
17. Neal Lindley receives 120 tons of a mix of paunch material and manure each month. Marlin's Meat (910.567.6102) in
Sampson County has not received waste in last year, but is a "back-up" receiver.
18. Brooks Composting in Chatham County has not received waste in last year but is a "back-up."
19. Permit will need to be renewed in September 2016,
21. Monthly slaughter records are complete.
21. Need to sample waste within 60 days of the transfer of waste to Mr. Lindley. Is only once per year now.
21. About three tractor trailer loads of inedible waste (bones, visera, meal scraps, etc.) are transported to Brown Packing
Company in Gaffney, SC each day.
24. Since all manure and paunch material is given to Mr. Lindley to apply onto his land (per permit and CAWMP) Mr. Lindley
calibrates his own waste application equipment. Five to six loads, of 20-22 tons each, go to Mr. Lindley each month. Transfer
records are complete.
33. Mr. Hamlet's nephew, Drew, was also present for the inspection.
page: 1

Permit: AN760065
Owner - Facility :
Randolph Packing Co
Facility Number: 760065
Inspection Date: 10/23/15
Inpsection Type:
Compliance Inspection
Reason for Visit: Routine
Regulated Operations
Design Capacity
Current promotions
Cattle
Cattle -Beef Feeder 212
Total Design Capacity:
Total SSLW:
Waste Structures
Dlsignated Observed
Type Identifier Closed Date Start Date Freeboard Freeboard
Storage PAUNCH TRAILER 72.00
Wet Stack BARN SCRAPE 72.00
page: 2

• •
Permit: AWI760065 Owner - Facility : Randolph Packing Co Facility Number: 760065
Inspection Date: 10/23/15 Inpsection Type: Compliance Inspection Reason for Visit: Routine
Discharges & Stream Impacts
Yea
No No No
1. Is any discharge observed from any part of the operation?
❑
❑
❑
Discharge originated at:
Structure
❑
Application Field
❑
Other
❑
a. Was conveyance man-made?
❑
0 ❑
❑
b. Did discharge reach Waters of the State? (if yes, notify DWQ)
❑
0 ❑
❑
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)
❑
0 ❑
❑
2. Is there evidence of a past discharge from any part of the operation?
❑
0 ❑
❑
3. Were there any observable adverse impacts or potential adverse impacts to Waters of the
❑
M ❑
❑
State other than from a discharge?
Waste Collection. Storage & Treatment
Yee
No No No
4. Is storage rapacity less than adequate?
❑
❑
❑
If yes, is waste level into structural freeboard?
❑
5. Are there any immediate threats to the integrity of any of the structures observed (I.e./ large
❑
0 ❑
❑
trees, severe erosion, seepage, etc.)?
6. Are there structures on -site that are not properly addressed and/or managed through a
❑
0 ❑
❑
waste management or closure plan?
7. Do any of the structures need maintenance or improvement?
❑
0 ❑
❑
B. Do any of the structures lack adequate markers as required by the permit? (Not applicable
❑
❑ 0
❑
to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑
0 ❑
❑
maintenance or improvement?
Waste Application
Yes No No No
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑
❑ ❑
maintenance or improvement?
11. Is there evidence of incorrect application?
❑
❑ ❑
If yes, check the appropriate box below.
Excessive Ponding?
❑
Hydraulic Overload?
❑
Frozen Ground?
❑
Heavy metals (Cu, Zn, etc)?
❑
PAN?
❑
Is PAN > 10%/10 Ibs.?
❑
Total Phosphorus?
❑
Failure to incorporate manure/sludge into bare soil?
❑
Outside of acceptable crop window?
❑
Evidence of wind drift?
❑
Application outside of application area?
❑
page: 3

Permit: AW1760065 Owner - Facility: Randolph Packing Co Facility Number:
760065
Inspection Date: 10/23/15 Inpsection Type: Compliance Inspection Reason for Visit:
Routine
Waste Application
Y¢s No No No
Crop Type 1
Crop Type 2
Crop Type 3
Crop Type 4
Crop Type 5
Crop Type 6
Soil Type 1
Soil Type 2
Soil Type 3
Soil Type 4
Soil Type 5
Soil Type 6
14: Do the receiving crops differ from those designated in the Certified Animal Waste
❑
❑ ❑
0
Management Plan(CAWMP)?
15. Does the receiving crop and/or land application site need improvement?
❑
❑ ❑
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre
❑
CIE
❑
determination?
17. Does the facility lack adequate acreage for land application?
❑0
❑
❑
18. Is there a lack of properly operating waste application equipment?
❑
❑
❑
Records and Documents
Yea
No No No
19. Did the facility fail to have Certificate of Coverage and Permit readily available?
❑
MCI
❑
20. Does the facility fail to have all components of the CAWMP readily available?
❑
MCI
❑
If yes, check the appropriate box below.
WUP?
❑
Checklists?
❑
Design?
❑
Maps?
❑
Lease Agreements?
❑
Other?
❑
If Other, please specify
21. Does record keeping need improvement?
0
❑ ❑
❑
If yes, check the appropriate box below.
Waste Application?
❑
Weekly Freeboard?
❑
Waste Analysis?
Soil analysis?
❑
Waste Transfers?
❑
Weathercode?
❑
Rainfall?
❑
Stocking?
❑
page: 4

Permit: AWI760065 Owner - Facility: Randolph Packing Co Facility Number: 760065
Inspection Date: 10/23/15 Inppection Type: Compliance Inspection Reason for Visit: Routine
Records and Documents
Yes No Na No
Crop yields?
❑
120 Minute inspections?
❑
Monthly and 1" Rainfall Inspections
❑
Sludge Survey
❑
22. Did the facility fail to install and maintain a rain gauge?
❑
0 ❑
❑
23. If selected, did the facility fail to install and maintain a rainbreaker on irrigation equipment
❑
1:10
❑
(NPDES only)?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑
❑ 0
❑
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check the
❑
❑ E
❑
appropriate box(es) below:
Failure to complete annual sludge survey
❑
Failure to develop a PDA for sludge levels
❑
Non -compliant sludge levels in any lagoon
❑
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
❑
❑N
❑
27. Did the facility fail to secure a phosphorous loss assessment (PLAT) certification?
❑
❑ 0
❑
Otherlssues
Yee
No Na Ne
28. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑
0 ❑
❑
and report mortality rates that exceed normal rates?
29. At the time of the inspection did the facility pose an odor or air quality concern? If yes,
❑
0 ❑
❑
contact a regional Air Quality representative immediately.
30. Did the facility fail to notify regional DWQ of emergency situations as required by Permit?
❑
0 ❑
❑
(i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility?
❑
0 ❑
❑
If yes, check the appropriate box below.
Application Field
❑
Lagoon / Storage Pond
❑
Other
❑
If Other, please specify
32. Were any additional problems noted which cause non-compliance of the Permit or'
❑
0 ❑
❑
CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑
❑
❑
34. Does the facility require a follow-up visit by same agency?
❑
N ❑
❑
page: 5

(Type of Visit: 'Moptpliance Inspection U Operation Review O Structure Evaluation 0 Technical Assistance I
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit:
/Q
Arrival Time:
Departure Time: 00
Farm Name:
1.
/ AA &I
Owner Email:
U
Owner Name: U .' Phone: s3 — g� 6
I
Mailing Address: �i63 �P.IC ,gJ Qivpt,L{fir', N�- a ��o_
Physical Address: `✓
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone: W & % oZ — j / 6
Integrator:
Certification Number:
Certification Number:
Longitude:
Design
Swine Capacity
Current
Pop.
Design Current Design Current
Wet PoultnY Capacity Pop. Cattle Capacity Pop.
Wean to Finish
La er
Dai Cow
Wean to Feeder
Non -Layer
Dai Calf
Feeder to Finish
Dai Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Design C•unrent D Cow
Dr, P,oultr, Ca aci =Pao P. Non -Dairy
La ers eef Stocker
Gilts
Boars
Non -La ers
Pullets
Beef Feeder
Beef Brood Cow
Q
Qther
Other
Turke s
Turke Points
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?
Page I of 3
[:]Yes dNo ❑ NA ❑ NE
❑ Yes ❑ No
[-]Yes [-]No
❑ Yes ❑)Vo
❑ Yes �;'No
Jo
[]Yes
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
21412014 Continued

Facility Number: - • Date of Inspection: 0
O
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 0NA ❑ NE
�"'
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
❑ Yes
❑ No NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑Yes
❑ No NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
Cja�o ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
[(No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
TT`"`
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
N No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
�No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
4� Yes
No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
%No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
�No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers:and/orany{ additional recommendations or any other comments.
Use drawings of facility to better explain situations (use' additional' ages as necessary). ,
I � • N �� � t� � Il�o�t�1
NOTtnJ�Aw ? �n�hwm ure.10
oad51 �
`-� Ul A,P • Ci.&.C� ,�Gd a o - a a T S— (o ltii m o,
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
r07916
Phone: , �C� ' I(U 0 1
Date: J D a3 ;z 0 Is
Page 3 of 3 �J I �/) „ „ „J' / , ,/ E

Facili Number: Date of Inspection: Q
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 l Structure 2 Structure 3 Structure 4
Structure 5
Structure
6
Identifier: _01-(1.)zfe_ unch r& e,r
Spillway?:
Designed Freeboard (in):
Observed Freeboard lC�
(in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
aTo
❑ 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
6�No
❑ NA
❑ NE
waste management or closure plan?
threat,
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environ;rNo
notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
❑ No
`I of NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
Y1
9. Does any part of the waste management system other than the waste structures require
❑ Yes
JrNo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
❑ No
ZNA
WE
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):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ No
❑ NA
jn'1GE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ No
❑ NA
D; 19E
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
❑ No
N NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA
9NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
XNo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
fia No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
W/Yes
❑ No
❑ NA
❑ NE
the appropriate box.
❑ WUP []Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need iimmpprrovement? If�ea eh
Ca��Pcsle�6w LIa Waste Analy ' Soil An
Rainfall Stocking Crop Yield Monthly a
22. Did the facility fail to install and maintain a rain gauge?
Yes No ❑ NA ❑ NE
alysis Waste Traqgfers (� "'P she. _ r (ode
Neal Lind le�
Page 2 of 3
21412014 Continued

Type of Visit: qkCompliance Inspection 0 Operation Review Q Structure Evaluation 0 Technical Assistance
Reason for Visit: Routine 0 Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: �,ytatpt„7.pµt� Arrival Time: Departure Time: 0 County: RAAJj6 Region:
Farm Name: �acinATp�p''� lC�y�Q C�. Owner Email:
1
Owner Name: DI w 1 0 Ho-k t Phone:
��++ T
Mailing Address: qQ3 Wg s - �1Your Ayela /tsheboro, NL a% 0203
j�
Physical Address: `I
Facility Contact: �rAl4 11A �E I Title: Phone: W -- to l 020 l o
Onsite Representative: /t 0 Integrator:
Certified Operator: N /a Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
pis P-a
Design Current
Swine Capacity Pop.
Wean to Finish e
Wean to Feeder
Wet Poultry
La er
Non -Layer
Design
Capacity
Current
Pop.
Cattle
Dai Cow
Dai Calf
Design Current
Capacity Pop.
Feeder to Finish
Farrow to Wean
Dt.+ P.oult .
Layers
Non -Layers
Design
Ga aci ,
I
Current
$o .
Dairy Heifer
Dry Cow
on- airy
Beef Stocker
Beef Feeder
Farrow to Feeder
Farrow to Finish
Gilts
�50 SO
Boars
I
Pullets
Beef Brood Cow
Other
Other
Turkeys
TurkeyPoults
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
J�'No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes XNo ❑ NA ❑ NE
❑ Yes PNo ❑ NA ❑ NE
Page I of 3 21412014 Continued

Facili Number: Date of Inspection: ii9evan,
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? [—]Yes P(No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: In WQ P0.UIsCrGt t
Spillway?: �T'
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
I YI 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
XNo
❑ 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
XNo
❑ 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
0 NA
❑ NE
❑ Excessive Pending ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application
Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ No
NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ No
❑ NA
" NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
❑ No
NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
0 No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
ONo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
P No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
E] No
NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? �ppreprieEe Hex below. 1� A
nYes
ONo
❑ NA
❑ NE
Weekly Pwaboerd-- Waste Analysis ❑ Soil Atnrilysts
Waste Transfers
D449hff-E0dc
Rainfall Stocking S Grop Yield [3]Monthly and V Rainfall Inspections
OSlxdge
SYwey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
Dno
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
M NA
❑ NE
Page 2 of 3
21412014 Continued

Facility Number: Date of Inspection: JWO o20
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No E�rNA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
❑ No C2(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
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
o ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
No ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
�[
I Jti 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
XNo ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
No ❑ NA ❑ NE
Comments (refer to question #): Explain any, YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
. Pa�hch amovnks2�cc,r4,23 t:orMe-il�
1 IJeal Lindley1o�S6-7-6 10
own spreader-trucy-?
18, 'Broov-s Col a5Eir�q ? K�t� CChakV'a_V.)
v.)a.5fe ahalySlS llw/in d 1at�5 0 del'tvea-� }0 (U, Cl►NAlet(
Mon-th t j s la.L_I ht, r ? 2co ra%S m �'� °mod Fi b. f Ms� �. a261q
9
M.i s5 a ✓L
Ga�� 3/�[aC&rCd 5 5�5 �1 (�u�o�e�
Cal[hr�-Ei©n - Tv-0- -7-71- SoaO
Reviewer/InspectorName: P,�1550.�SE�vpC_� Phone:
Reviewer/Inspector Signature: � )Cp�p �a Date: s a0 oZ�
Page 3 of 3 21412014

P5T& 5AKPLE w/in (00(A l ,54'delive \f,
Type of Visit: Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: X Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: tl•� f-�--I Departure Time: ounty: hRegion: J1JS P-6
61 r Farm Name: Rana Pnlcl y1 Q11 Co , Owner Email:
Owner Name: D. (' rt3U 4 0.iLl l eA Phone: Ci - Q 5 3 Q g6 Q
Mailing Address: �%� 3 W eS+ Bal a U r A V2 . As he b 6 f-O., N L 2,7 a 6 j
Physical Address:
•
Facility Contact: r-00 Q H O Iftj e+ Title: Phone: W (e a I q 70
Onsite Representative: A / /� Integrator:
Certified Operator: / V /n Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude: Longitude:
Design
Current
Design Current
Design
Wean to Finish
Layer
DairyCow
Wean to Feeder
Non -La er
DairyCalf
Feeder to Finish
"4
DairyHeifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Design Current
Da P,oultr. Ca acit P.o
Layers
Dry Cow
Non -Dairy
Beef Stocker
jrrenlo
Gilts
Non -Layers
Beef Feeder
Q
Boars
Pullets
I
jBeefBroodCow
Other
Other
Turkeys
Turkey Poults
Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes ONo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
E�r No
❑ NA
❑ NE
❑ Yes
XNo
❑ NA
❑ NE
Page 1 of 21412011 Continued

Facility Number: - A• jDate of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus stone storage plus heavy rainfall) less than adequate? ❑ Yes ANo ❑ 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: DE9 — LL3Q--SFC ti�Ury�ji
Spillway?: �e T rou let•
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes X7C ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes >No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? [:]Yes 54No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes ❑ No �NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes �No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ❑ No NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ❑ No NA V 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): Q��L4-
a ice, I VX-0-K
Lte!i -
0J"
X-"f" W-V-f
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ No
❑ NA
0 NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ No
❑ NA
;RrNE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
❑ No
A
❑ NE
acres determination?
T
17. Does the facility lack adequate acreage for land application?
❑ Yes
0 No
❑ 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
X No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
❑ No
ONA
❑ NE
the appropriate box.
❑ WUP El Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑]Otthheeti
21. oes record keeping need improvement? [ bex�aie Ds ❑ No ❑ NA ❑ NE
ante Applic n rd Waste Analys'� L,YLotl Analysis Waste Transfers Weather Code
[VRainfall Stocking Crop Yield 20 Minute nspections 53rmonthly and 1" Rainfall Inspections dgaSuwey -
22. Did the facility fail to install and maintain a rain gauge? [:]Yes YNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No 9NA ❑ NE
Page 2 of.? 21412011 Continued

Facility Number: Date of Ins ection:
24. Did the facility fail to calibrate waste applien 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 14i NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [:]Yes []No `7[�� NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes{j
No
❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
�[
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
%
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
TTTTTT
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
se drawings of facility to better explain situations (use additional pages as necessary).
t VY'+a vuipC�/Vf�� 1 UYMI"
manv re- d0.m o u nt s i D0-+e-5 ?
p�DlooA t +0 GS5�D C_bro wvx IPc_C1L►
1$ HML U2. �-)16 r 6 w r\ 5 re&aea {-r-u c.U- 2 t° S
91*CC>0V-S e'o " os p !o' o I
ba�� N as -u ?
No c� 4�t� Sotto t�2� JL�® Cu c�-2 need o-ue u �/ bu-j
O
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
O
Phone
Date: e.
244 011

for Visit: 0 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: lArrival Time: Departure Time: County: Fal2do% h Region: L& P_C)
Farm Name-Rp ncto 1p6 Pb_c4 nG Co e t I:n G.• Owner Email: ) r QC
Owner Name: D • rQN 4 H04LL 12-i- Phone: � 1 J _ p � 100
1
Mailing Address: q03 YJp.S{ plod tour f} VC • . l4 U-bara , NCB a % 103
Physical Address:
Facility Contact: C,rQ_t� � J-h Title:
OnsiteRepresentative: roL4
Certified Operator: t i i A
Back-up Operator:
Location of Farm:
Latitude:
Phone: r I q -70
Integrator:
Certification Number:
Certification Number:
Longitude:
Swine
Design
Capacity
Current
Pop.
Design Current
Wet Poultry Capacity Pop.
La er
CattleCapacity
Design Current
Pop.
Wean to Finish
Dairy
Wean to Feeder
Non -La erw„
Dairy
Feeder to Finish
Farrow to Wean
Design Current
I)�, P,oultr. Ca eci P,o
La ers
Dairy
D Co
Farrow to Feeder
Farrow to Finish
Non -Dairy:
Beef S
Gilts
Non -Layers
eef F
Boars
Pullets
Beef B
Other
Other I
IOther
Turkeys
Turke Poults
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field
a. Was the conveyance man-made?
❑ Yes dNo ❑ NA ❑ NE
❑ Other:
❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes [:]No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Page I of 3 21412011 Continued

Facili Number: Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes �No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: T . . YaStio Yq.�[
Spillway?: 5/ pf q I f
��
Designed Freeboard (in):
Observed Freeboard (in):�
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
ZNo
❑ 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
R 'o
❑ 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
CR"&o
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
❑ No
CS�IOA
❑ 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 ❑ No [ dNA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.) TT
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes �No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes 0No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes ❑ No JS�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?
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.
❑ WUP [:]Checklists ❑ Design [:]Maps ❑ Lease Agreements
21. Does record keeping need improvement? 14 belmr. i ,
SP plic r � rd V
❑Stocking,, CroplYtiKldfacility ai to install and 4/nla`i�ntain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
Page 2 of 3
❑ Yes
;RrNo
❑ NA
❑ NE
❑ Yes
RIo
❑ NA
❑ NE
❑ Yes
C� No
[—I NA
❑ NE
❑ Yes
❑ No
5T1A
❑ NE
]Other:
Yes
No
❑ NA
❑ NE
rite Transfers j ©_ ether Code ,
Ir V7_ C
IIYh§p coons
Yes
❑ No
❑ NA
❑ NE
❑ Yes
No
7T
❑ NA
❑ NE
21412011 Continued

[Facility Number: • Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑ 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?
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?
❑ NA ❑ NE
WA ❑ NE
❑ Yes
❑ No
D�rNA
❑ NE
❑ Yes
❑ No
WA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes XNo ❑ NA ❑ NE
❑ Yes No
❑ Yes I
❑ Yes t�(No
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
(Comments (refer to question #): Explain any YES answers and/or any additional, recommendations or any other comments..::
Use drawines of facility to better exulain situations (use additional paees as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 2 �f
Date:
21412011