200001_Rescission Request_20230201

RECEIVED
FEB 01 2023
NIC DEQ/DWR
Central Office
As a cattle facility that is below threshold for more than 3 years and is in compliance,you are eligible to
request rescission of your permit without closing the waste storage structure prior to rescission. Your
facility would then be considered deemed permitted as long as you stay below the 100 confined cattle
threshold. if you ever wish to increase your herd to exceed the 100 confined cattle threshold,they
would be considered a new facility and would be required to meet the standards in place at that
time. The waste structure must be maintained to prevent any discharge to surface waters, but no
specific records are required. Once no longer needed/in use,the structure will eventually need to be
closed to NRCS standards.The timing of that closure is completely at the discretion of the owner.
As a deemed facility,they would not be subject to routine inspections,etc. However,the rules for
deemed facilities 15A NCAC 02T.1303 does require that the waste be applied at no greater than
agronomic rates. You have an existing waste plan, so you know what agronomic rates are, but you will
need to take waste samples for analysis and track application rates to be sure you are not over applying.
Those records would not be required for us to review, but would be for their own benefit and to
demonstrate compliance should a problem ever arise.
Below is the address to send a request for a rescission of your permit if you choose to do so.
N. C. Division of Water Resources
Water Quality Regional Operations Section
Animal Feeding Operations Program
1636 Mail Service Center
Raleigh, NC 27699-1636
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Division of Water Resources
Facility Number D O-Division of Soil and Water Conservation
�. Q Outer Agency
Type of Visit: Compliance Inspection 0 Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: O Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: 't lr': Departure Time: f�n,,� County0_&1Z ' _ Region:
Farm Name: p f �Ct� L,f Owner Email: Wks �1�c ts'� S jet I11 ' i
Owner Name: �� Phone:
Mailing Address: �' - �/\� J� 1 1IDttNqv C1 0,�p
Physical Address: 4
Facility Contact: Title: Phone:
Integrator:
Onsite Representative: �71�..�1.�u� ,������� g
Certified Operator: Certification Number:
Back-up Operator: Certification Number:
Location of Farm: EB p.1 W3 Latitude: Longitude:
Ce ttal of ice
Design Current Design Current Design Current
Swine Ca"pacify Pop. " Wet Poultry Capacity. .Pop. Cattle Capacity Pop.
Wean to Finish Laver Dair\ Cow
Wean to Feeder Non-Lai er Dai n, Calf
Feeder to Finish Dairy Heifer
Farrow to Wean Design .Current Dry Cow
Farrow to Feeder Dry Poultry Ca acuity Po. Non-Dai
Farrow to Finish Layers Beef Stocker
Gilts Non-Lavers Beef Feeder
Boars Pullets Beef Brood Cow
Turkeys
Other Turkey Poults
Other
DischarL,es and Stream Impacts
1.Is any discharge observed from any part of the operation? ❑ Yes 5 No ❑ NA ❑NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes 0 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 part of the operation?. ❑ Yes No 0 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 7 of 3 511212020 Continued

Facility Number: Date of Inspection:
Waste Collection&Treatment
4.Is storage capacity(structural plus storm storage plus heavy rainfall)less than adequate? ❑ Yes QNo ❑ NA ❑ NE
a.If yes,is waste level into the structural freeboard? ❑ Yes EdNo ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: jet 11 -
Spillway?: �jC
Designed Freeboard(in): �—
Observed Freeboard(in):
it
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�j 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 &o ❑ 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 fi6-No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10.Are there any required buffers,setbacks,or compliance alternatives that need ❑ Yes 5jNo ❑ NA ❑ NE
maintenance or improvement?
11.Is there evidence of incorrect land application?If yes,check the appropriate box below. ❑ Yes 5�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 ❑ Applicattio�nj Outside of Approved Area
12.Crop Type(s): T c'4 LT A �P — 'j oj1�
ova
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 M-No ❑ NA ❑ NE
16.Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes VjNo ❑ NA ❑ NE
acres determination?
17.Does the facility lack adequate acreage for land application? ❑ Yes 4No ❑ 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 P No ❑ NA ❑ NE
20.Does the facility fail to have all components of the CAWMP readily available?If yes,check ❑ Yes a 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 ❑ 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 dNo ❑ 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 21412015 Continued

Facility Number: jDate of Inspection: to — go
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 1;6 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 fi4'No ❑NA ❑NE
27.Did the facility fail to secure a phosphorus loss assessments(PLAT)certification? ❑ Yes &ZNo ❑ NA ❑NE
Other Issues
28.Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes FA 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 E4,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 �1 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 4No ❑ 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).
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Reviewer/Inspector Name: Phone:
Reviewer/Inspector Signature: Date: /(i'f '�Z
Page 3 of 3 511212020

Facility Number: jDate of Inspection: 10 :
24.Did the facility fail to calibrate waste application equipment as required by the permit? [:] Yes ❑ NA ❑NE
25.Is the facility out of compliance with permit conditions related to sludge? If yes,check ❑ Yes ? No
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
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 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 ❑ 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).
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ate.
Reviewer/Inspector Name: 4 t c
Reviewer/Ins ector Signature: r Ip Y � l` l"U�t�' Pone:
Date:
Page 3 of 3 , �� J7 / �j'�j', 511212020

Division of Water Resourc
Ft'Ality Number ® - ® i 0 Division of Soil and Water t-nervation
0 Other Agency
Type of Visit: ®Compliance Inspection Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 0 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit:� �� Arrival Time:I 1p::: eparture Time: 2 �County:6 blrlea_Region: 19621
Farm Name: "6?y-,;,T Owner Email:
Owner Name: W(c M-4 - Shc G-d-s Phone:
Mailing Address: (5 Xl I �vL�(Y �U
Physical Address: t�5 I .'/2 /�C�
Facility Contact: Title: Phone: C:) ia
Onsite Representative: 2) . n 1 E Integrator:
Certified Operator: Certification Number:
Back-up OpeatPJU Certification Number:
Location of Farttm: Latitude: Longitude:
t4,c;DEOI ANR
Design Current Design Current Design Current
Swine Capacity Pop. Wet Poultry Capacity Pop. Cattle Capacity Pop.
Wean to Finish Layer Dairy Cow ZD
Wean to Feeder Non-Layer Dairy Calf
Feeder to Finish DaiiA Heifer
Farrow to Wean Design. Current Dry Cow
Farrow to Feeder Dry Poultry Capacity Pop. Non-Dairy
Farrow to Finish Layers Beef Stocker
Gilts Non-Layers Beef Feeder
Boars Pullets Beef Brood Cow
Turkeys
Other Turkev Poults
Other Other
Discharaes and Stream Impacts
1.Is any discharge observed from any part of the operation? ❑ Yes N�No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State?(If yes,notify DWR) ❑ Yes ❑ No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State(gallons)?
d. Does the discharge bypass the waste management system?(If yes,notify DWR) ❑ Yes ❑ No ❑ NA ❑ NE
2.Is there evidence of a past discharge from any part of the operation? ❑ Yes 5Z'No ❑ NA ❑ NE
3.Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes 64,No ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412015 Continued

FacilitN Number: - 0 Date of inspection:
>'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 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: �kb-
Spillway?: iJQ
Designed Freeboard(in): 194
Observed Freeboard(in): N
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 EX-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 E4-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 �No ❑ NA ❑ NE
maintenance or improvement?
11.Is there evidence of incorrect land application?If yes,check the appropriate box below. ❑ Yes bg�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 ofApproved Area �—
12. Crop Type(s): (��Q CAL —�i��
f� �
13. Soil Type(s):
14.Do the receiving crops differ from those designated in the CAWMP? ❑ Yes EfkNo ❑ 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 gNo ❑ NA ❑ NE
18.Is there a lack of properly operating waste application equipment? ❑ Yes -�k'No ❑ NA ❑ NE
Required Records&Documents
19.Did the facility fail to have the Certificate of Coverage&Permit readily available? ❑ Yes QNo ❑ NA ❑ NE
20.Does the facility fail to have all components of the CAWMP readily available?If yes,check ❑ Yes F%)-4-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 Ej�V0 ❑ 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 E;_�_No ❑ NA ❑ NE
23.If selected,did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 'E�Wo ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facility NumPer: jDate of Inspection:
24. Diu the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes E Nr ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes,check ❑ Yes E�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 P>o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments(PLAT)certification? ❑ Yes rNo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes 5 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 RNo ❑ 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 ❑NA ❑NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative? ❑ Yes [4 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).
lure -f�yc
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Reviewer/Inspector Name: F !C —fm';r::) Phone: "y? /(Coy
Reviewer/Inspector Signature: L � Date:
Page 3 of 3 511212020

Division of Water Resource
Faciti$y Number - t� y 0 Division of"Soil and Water%...aservationx
0 Other Agency
Type of Visit: •Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 0 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access n ,
Date of Visit: l0 Arrival Time: 0%00 14, Departure Time: =a7/+cam County:4 � AOAd Q_ Region:
Farm Name Owner�CJ � �i� �1 �� Owner Email: A
� �
Owner Name,14 ��1 i (�u� :� IL LL Phone:
� a
Mailing d dress: LS ()Ala f2j 06- '2-0 k-
oEa�o. n I
Physical tr�s oce :j�-r j�'2-1 K- t,+ P6"
Facility Contact: mil,b Lti 11�(,� ��cb� Title: Phone:
Onsite Representative: Sl1'ASS Integrator:
Certified Operator: Certification Number:
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
..Design Current Design" Current Design Current
Swine Capacity Pop. Wet Poultry Capacity Pop. Cattle Capacity Pop.
Wean to Finish ILayer I Dairy Cow 00 �
Wean to Feeder I jNon-Layer I Dairy Calf
Feeder to Finish Dairy Heifer
Farrow to Wean Design :Current Dr\ Cow
Farrow to Feeder Dry Poultry Ca aci Po-.. Non-Dain
Farrow to Finish Layers Beef Stocker
Gilts Non-Lavers Beef Feeder
Boars Pullets Beef Brood Cow
Turkeys
Other Turkev Poults
Other
Discharges and Stream Impacts
1.Is any discharge observed from any part of the operation? ❑ Yes �No ❑NA ❑NE
Discharge originated at: ❑ Structure ❑Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No ❑ NA ❑NE
b. Did the discharge reach waters of the State?(If yes,notify DWR) ❑ Yes ❑ No ❑ NA ❑NE
c. What is the estimated volume that reached waters of the State(gallons)?
d. Does the discharge bypass the waste management system?(If yes,notify DWR) ❑ Yes ❑ No ❑ NA ❑NE
2.Is there evidence of a past discharge from any part of the operation? ❑ Yes r-1 No ❑ NA ❑ NE
3.Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes DdNo ❑NA ❑NE
of the State other than from a discharge?
Page I of 3 511212020 Continued

Facility-Number: 0 - n I jDate of Inspection: /v
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 ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: Qbrr- D
Spillway?: 00
0—
Designed Freeboard(in): e2,q _
Observed Freeboard(in): Aaa
5.Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes R 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 I No ❑ NA ❑ NE
8.Do any of the structures lack adequate markers as required by the permit? ❑ Yes allo ❑ 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 RNo ❑ 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 IQ 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): �©(L r.) �i �SGE(¢. 'f ?a c� 3 r 1 ru
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
LICW
16.Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes R 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 FZ No ❑ NA ❑ NE
20.Does the facility fail to have all components of the CAWMP readily available?If yes,check ❑ Yes F71 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 [4 No ❑ NA ❑ NE
❑Waste Application ❑Weekly Freeboard ❑Waste Analysis ❑Soil Analysis ❑Waste Transfers ❑Weather Code
❑Rainfall ❑Stocking ❑Crop Yield ❑120 Minute Inspections ❑Monthly and 1"Rainfall Inspections ❑Sludge Survey
22.Did the facility fail to install and maintain a rain gauge? ❑ Yes .�4 No ❑ NA ❑ NE
23.If selected,did the facility fail to install and maintain rainbreakers on irrigation equipment? [:] Yes allo ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

p / flFN Dateof Inspection:
24.Did to facility fail to calibrate waste application equipment as required by the permit? ❑ Yes 'Q No ❑ NA ❑ NE
25`"Is the facility out of compliance with pen-nit 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 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 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 tg�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 ❑ NA ❑ NE
33.Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative? ❑ Yes E No ❑ NA ❑ NE
34.Does the facility require a follow-up visit by the same agency? ❑ Yes K No ❑ NA ❑ NE
Comments(refer to question ft Eglain any =answers and/or any additional recommendations ar atiy other comments;
Use drawings of facility to better e-plain situations,(use adclitionaFpages t[ necessary),.
CL tAv �-l..
�vv,-bd 2oi t,voiAj 2� 7�
Reviewer/Inspector Name: / Phone: ���
Reviewer/Inspector Signature: Date: ld,�
--r—
Page 3 of 3 21412015

Division of Water Resources
Facility Number ? - O Division of Soil and Water Conservation
O Other Agency
Type of Visit: Q Compliance Inspection 0 Operation Review O Structure Evaluation Q Technical Assistance
Reason for Visit: O Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
- "1 e"
Date of Visit: o =>; � Arrival Time: �;;� : .:. Departure Time: i ;�,: „g,n County ,��.' ;a`° �> Region: ;I--u,,I
9 t sue`
r `
Farm Name: `d , 1 Owner Email: �� y tY
Owner Name Phone:
Mailing Address: p a }i�a ` . � �A N! '� "t �a r+.a' y
Physical Address: �. C` " i�, Y q., .I
Facility Contact: Title: Phone:
e 1
Onsite Representative: Q p,'v4 y ,� a €� Integrator:
Certified Operator: Certification Number:
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Desi ent Design Current Design Current
Swine Capacity Pop. Wet Poultry Capacity Pop. Cattle Capacity Pop.
Wean to Finish Laver DairyCow
Wean to Feeder Non-Laver Dairy Calf
Feeder to Finish Dairy Heifer
Farrow to Wean Design Current Dry Cow
Farrow to Feeder Dry Poultry Capacity Pop. Non-Dairy
Farrow to Finish Lavers I 113eef Stocker
Gilts Non-Layers jBeef Feeder
Boars Pullets 113eef Brood Cow
Turkeys
Other Turkey Poults
Other
Discharges and Stream Impacts
1.Is any discharge observed from any part of the operation? ❑ Yes 9�_,No ❑NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑Other: r
a. Was the conveyance man-made? ❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State?(If yes,notify DWR) ❑ Yes ❑ No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State(gallons)?
d. Does the discharge bypass the waste management system?(If yes,notify DWR) ❑ Yes ❑ No ❑ NA ❑NE
2.Is there evidence of a past discharge from any part of the operation? ❑ Yes Z No ❑ NA ❑NE
3.Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes ❑No ❑NA ❑NE
of the State other than from a discharge?
Page 1 of 3 511212020 Continued

Facility Number: ��_� - ;,;� ,r Date of Inspection: f3.'c-4e� �.
Waste Collettion&Treatment
4.Is "storage capacity(structural plus storm storage plus heavy rainfall)less than adequate? ❑ Yes EJ No ❑ NA ❑ NE
a. If yes,is waste level into the structural freeboard? ❑ Yes gNo ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: �'�JiN-
Spillway?: ,: e "
Designed Freeboard(in): "=f
Observed Freeboard(in):
5.Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes V No ❑ NA ❑ NE
(i.e.,large trees,severe erosion,seepage,etc.) V.
6.Are there structures on-site which are not properly addressed and/or managed through a ❑ Yes Ej 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)
6
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 o ❑ 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 ❑ NE
15.Does the receiving crop and/or land application site need improvement? ❑ Yes r1A.No ❑ NA ❑ NE
c
16.Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes Vj No ❑ NA ❑ NE
acres determination?
17.Does the facility lack adequate acreage for land application? ❑ YesEJ No ❑ NA ❑ NE
18.Is there a lack of properly operating waste application equipment? ❑ Yes [�_No ❑ NA ❑ NE
Repuired 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 1"Rainfall Inspections ❑Sludge Survey I
22.Did the facility fail to install and maintain a rain gauge? [:] Yes EkNo ❑ 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 21412015 Continued
1�
I

Facility Number: C - ci�" 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 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 0 No ❑ NA ❑NE
27.Did the facility fail to secure a phosphorus loss assessments(PLAT)certification? ❑ Yes Q No ❑ NA ❑ NE
Other Issues
28.Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes ❑-No ❑ NA ❑NE
and report mortality rates that were higher than normal?
29.At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes [26No ❑ 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 dp�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 ❑NA ❑ NE
33.Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative? ❑ Yes ❑r,,No ❑ NA ❑NE
34.Does the facility require a follow-up visit by the same agency? ❑ Yes No ❑ NA ❑NE
a'
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).
� r
Reviewer/Inspector Name: - Phone: �_`r`''
Reviewer/Inspector Signature: * ° Date:
Y 7
Page 3 of 3 511212020

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 ❑No ❑ NA ❑NF.
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:
y
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 �] 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: y
32.Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes s No ❑ NA ❑NE
N
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 comments.
Use drawings of facility to better explain situations(use additional pages as necessary).
i
I
Reviewer/Inspector Name: j Phone:
Reviewer/Inspector Signature: Date:
Page 3 of 3 511212020