430024_INSPECTIONS_20171231

NUH I H UAHULINA
Department of Environmental Qual

type or visor frc:ompliance inspection V operation xevtew V Ntructure Evaluation V lecnmcal Assistance I
Reason for Visit: 0 Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
II
Date of Visit: Arrival Time: !t7p Departure Time:�1 County: Region:
Farm Name: Owner Owner Email:
Owner Name: ��DP ire,rrePhone:
Mailing Address:
Physical Address:
Facility Contact: 3, _6 f 6 � c�l✓� Title: Phone:
Onsite Representative: U Integrator: Ere2&00
Certified Operator: u 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 Eapacity V.
Wean to Finish
ILayer
I
I
Dairy Cow
Wean to Feeder
11 INon-Layer
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design
Dry Cow
Farrow to Feeder
D , Poultr
Ca aci
KID ,
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
Turkey Poults
Other
Other
Discharges and Stream Impacts
l . 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 CR No ❑ NA ❑ NE
[—]Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes LCI No
[] Yes (q No
NA ❑ NE
NA ❑ NE
NA
❑ NE
❑ NA
❑ NE
]NA
❑NE
Page 1 of 3 21412015 Continued

• Facilit Number: - Date of Inspection. / d-77
Waste Collection & Treatment
4, is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
f� No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
[:].Yes
❑ No
[�6NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Structure 6
Identifier: Z
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): zA 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
0 Yes
P 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
[ 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 ❑ Evidenncc���fff of Wind Drift Application Outside
of Approved Area
12. Crop Type(s):CA /' SI'+• �+��-
OL�f
13. Soil Type(s): E3 h!
14. Do the receiving crops differ from those designated in t CAWMP?
❑ Yes
[� No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[P 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
to No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
f 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.
T
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes EP 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 E0 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

� � T
Facility Number: - Date of Inspection: p
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes M No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [a 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? T
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?
Comrstents�(refer to question'#) Eiainany YE8 answers. arc
gobevrk- AQrU.< DEC? Dtj (L
�( *- Ito--b.�--��� 1
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
❑ Yes [, No ❑ NA ❑ NE
❑ Yes f�g No ❑ NA ❑ NE
❑ Yes [�j No ❑ NA ❑ NE
❑ Yes
P No
❑ NA
❑ NE
[-]Yes
�]No
❑NA
❑NE
❑Yes
®No
❑NA
❑NE
Phone: M— 33 33,w
Date: U
21412015

Type of Visit: Q-Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: (E) outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Timer County: t� Reglon��
Farm Name: r L Owner Email:
Owner Name:
Mailing Address: it ct S
Physical Address:
r
Facility Contact: J 0 t- �� IM'fi Title:
Onsite Representative:
Certified Operator: �l
Sack -up Operator:
Phone:
Phone:
Integrator: for"4e
Certification Number: `o _ 1z
Certification Number:
Location of Farm: Latitude: Longitude:
Design Cnr�rent I�' Design�Cnrrent
Design Current
Swine Capacity „Pop Wet Pouitry Capaty Pop.
Cattle Capacity Pop.
Wean to Finish Layer
DairyCow
Wean to Feeder
Non -La er
DairyCalf
Feeder to Finish
�� "`'
Resign �Currcat
Da' Heifer
Farrow to Wean
D Cow
Farrow to Feeder
D , PouIt . Capaci "
Po ..
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
113eef Feeder
Boars
-
Pullets
Beef Brood Cow
i Mill
Turkeys
Other.1 -
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)
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 [�t�❑ NA ❑ NE
[:]Yes [:)No '❑ NE
[:)Yes [:)No e'11I [] NE
❑Yes
❑No
i=J A
❑NE
[:]Yes
No
NE
[:]Yes
No
❑ NA
❑ NE
Page 1 of 3 21412011 Continued

•[Facility Number: - Date of Ins ection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): �3
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes D�N� NA
❑ NE
(i.e., large trees, sevefe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes 91?Io ❑ 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 [a-N—o— ❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes [14'To�❑ 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 0-1 loo 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): e ruy4 .-r(.� 0 6l*ze --94
13. Soil Type(s): d O Gt
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [ErRo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [fNo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable [:]Yes �To ❑ 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
❑ Yes 6—No
❑NA ❑NE
❑NA ❑NE
Required Records & Documents ,--,,�
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes [ r5oo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check [:]Yes C3'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
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes o ❑ 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 21412011 Continued

a i
Facility Number: - Date of inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [� o ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes P�M ❑ 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 Ca<o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes <o ❑ 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 No ❑ NA ❑ NE
❑ Yes B<o ❑ NA ❑ NE
❑ Yes To ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
[—]Yes M No ❑ NA ❑ NE
❑ Yes [lN ❑ NA ❑ NE
❑ YesEl-No ❑ NA ❑ NE
Comments (refer-toluestion #): Explain any YES answers and/or any additionalUse drawings of facility to. better explain situations (use dlditionapage sas necessary). recommendahos orJany.ormments.
Reviewer/Inspector Name: (4� 11 V Phonea ti 6-1�
Reviewer/Inspector Signature: Date: aJ
Page 3 of 3 21412011

Type of Visit: Q*tompliance Inspection p ration Review Q Structure Evaluation O Technical Assistance I
Reason for Visit: QR(outine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: Departure Time: County: FC Region:
Farm Name: C{iJ'(, LI U, 1/t^f Owner Email:
Owner Name: J p -G�� I'��G �l Phone:
Mailing Address:
Physical Address:
Facility Contact: �Q'1" Fir vkIrl Title: Phone:
Onsite Representative: Integrator: P
Certified Operator: Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design Current t Design -urrent
Design uricent
Swine Capacrty Pop. Wet Poul#ryt Capa�tyPop
Cattle Capacity Pop.
_.
Wean to Finish La er
Da Cow
Da' Calf
Wean to Feeder
�
Non -La er
Feeder to Finish
� T"`
�Design�Cirremt
Da Heifer
Farrow to Wean
D Cow
Farrow to Feeder
Dr, P,oul Ca c�P�o
Layers
Non -Dairy
Farrow to Finish
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
_ther
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)
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 ENo ❑ NA ❑ NE
[] Yes ❑ No [q--NA ❑ NE
[::]Yes [:]No [R I"A ❑ NE
[—]Yes
❑ No
E!J'�NA
❑ NE
❑ Yes
®moo
❑ NA
❑ NE
[:)Yes
["No
❑ NA
❑ NE
Page l of 3 21412011 Continued

FacilityNumber: jDate of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? Iffas ff Vo ❑ 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? CR'<es ❑ 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
©'!qo ,
❑ 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
2rf4o
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
ENo
❑ 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
LD•No
❑ NA
❑ NE
maintenance or improvement?
Waste ARplication
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
g],No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [:]Yes [ a-Ko ❑ NA
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate ManX.�Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): _ 46exyttio A 44 9 niLe ) 56 0
❑ NE
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
R-Na
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
ED-No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
�l�o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[!]'1qo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[q10
❑ 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 �o ❑ 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 ®'No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 03190 ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: - Date of inspection
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ❑moo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? if yes, check ❑ Yes D" ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes e<o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes 21q-o- ❑ 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, aver -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/storage Pond ❑ Other:
❑ Yes [j-PK ❑ NA ❑ NE
❑ Yes UJ-Ko ❑ NA ❑ NE
❑ Yes [2- o ❑ NA ❑ NE
[:]Yes [B'�To ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes allo ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? [:]Yes D10 ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes ❑''No ❑ NA ❑ NE
Comments (refer to qiiestion ft Explain any YES answers and/or any additional recommendations or any other comments.
Use"drawmgs;of facility.to.better explain situations (use additional pages as necessary).
BI-333
Reviewer/Inspector Name: Phone —
� [) I-
Reviewer/Inspector Signature: G, Date: ' ` 3
Page 3 of 3 2142011

d
(Type of Visit: QYCompliance Inspection U Operation Review Q Structure Evaluation U Technical Assistance I
Reason for Visit: O Routine O Complaint O Follow-up Q Referral O Emergency O Other O Denied Access
Date of Visit: tp a Arrival Time: Departure Time: :3S County: XRRI1z Region:
Farm Name: 1` eg RE i M S Owner Email:
Owner Name: pr_ VV_R 12F. t 1 Phone:
Mailing Address:
Physical Address:
Facility Contact: <pIL V'E(1(kL>> Title: C WA)ER Phone:
Onsite Representative: SA rA F Integrator: P!3€om V-_ -
Certified Operator: Aim F_ Certification Number: a 0) q 4
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Design on eat - Design Current Design C►►urreat
Swine + Capacity Pop. it;.Pa Capacity Pop. Cattle Capacity Pop.
Wean to Finish
La er
Dairy Cow
Wean to Feeder
leido
Layer
Da Calf
NFarrow
Feeder to Finish
�'
DairyHeifer
Farrow to Wean
1. Design Current
D Cow
to Feeder
i P,o .
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
1pullets
Beef Brood Cow
IIITurkey
Turkeys
Othermill"
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)
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 E f No ❑ NA ❑ NE
❑ Yes [] No ❑ NA ❑ NE
❑ Yes] No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
[—]Yes [q11qo ❑ NA ❑ NE
[—]Yes E(No ❑ NA ❑ NE
Page I of 3
21412011 Continued-*
�

t
Facili Number: �-{ 3 - aU Date of Inspection: / 0 as a
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes (3/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: 4(:1- 41p,
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): a9—
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes [TNo ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes &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 [F(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 dNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes E�(No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes O 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):
-t5-\ .-'s.lL�. U-
v __11 -
13. Soil Type(s): \.A
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [gNo ❑ 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 [r'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
[3$4o
❑ NA
❑ NE
Required Records _& Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
ENo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[30'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 dNo ❑ 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 dNo dNA ❑ NE
Page 2 of 3 21412011 Continued

w
Facility Number: LE - aq jDate of Inspection: 1(7WI?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[!3/No
[DNA ❑ 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
[grNo
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
[] Yes
0 No
ENA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
ff 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:
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 [2No
❑ Yes Eg'No
❑ Yes EdNo
❑ Yes dNo
❑ Yes, E] No
❑ Yes [�No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑NA ❑NE
Reviewer/Inspector Signature: Date: 1� aka
Page 3 of 3 21412011

t 516^5 ► o jZt 1 �v-R
` ��� n'uf Water Q ality -
acility Number 0}DIv�SiOn of N 11- nd Water Conservation
4 0� they Agency
Type of Visit: Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 401 routine 0 Complaint 0 Fallow -up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: B- `Arrival Time: Departure Time: County: Region:
Farm Name: , Owner Email:
Owner Name: —/U, ' Phone:
Mailing Address: / '? s 4) J X-Zryi Re a w- 5
Physical Address:
Facility Contact: -mil U� / Title:yccrt� Phone:
Onsite Representative: �O� _ L _ Integrator:
Certified Operator: Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design
Current
7Dgn� C Trent
1Wet,Po
Design Current
Capacity
- P,.op.
l ry ap itv� Pop. Cattle
C
Capacity Pop.
inish
rkFeeder
La er
Dai Cow
eeder
Nan -La er
Dai Calf
inish
Dairy Heifer
Farrowto Wean
Dry Cow
Farrow to Feeder
- Ca aci Po Non
D oiul
ILayers
I Beef Stocker
11 Farrow to Finish
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
I I Beef Brood Cow
LL a •^' -
Turkeys
Qther
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)
c. What is the estimated volume that reached waters of the State (gallons)?
[:]Yes fo ❑ NA ❑ NE
[-]Yes
[-]No
�(A
❑ NE
❑ Yes
[:]No
09-Kt'
❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) [:]Yes [:]No [' - A ❑ NE
2. Is there evidence of a past discharge from any part of the operation? [-]Yes �fo NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes o ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

[Facility N••mber: dl - Date of Inspection:
i
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):
Observed Freeboard (in): 3Z
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 arc not property addressed and/or managed through a
❑ Yes
No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
�No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
[:]Yes
eNo
❑ 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
Rio
❑ 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): a,,G_ 6 , 4/o F
13. Soil Type(s): i6a/h� (AAt, , 6;p.X_ I. r'Y6­6
14. Do the receiving crops differ from those designatedh 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
[:]Yes
[f No
❑ NA
❑ NE
[:]Yes
[ o
❑ NA
[] NE
[:]Yes
B'1`iO
❑ NA
❑ NE
❑ Yes is
❑ Yes Vo
❑ NA ❑ NE
❑NA ❑NE
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
22. Did the facility fail to install and maintain a rain gauge? [:]Yes <o ❑ NA!"O NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes [::]No A ❑ NE
Page 2 of 3 21412011 Continued

[Facility N mber: jDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes EYNo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ETNo ❑ 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 iE
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:
❑ Yes E 7 ❑ NA ❑ NE
[:]Yes E j T�'o ❑ NA ❑ NE
❑ Yes [V]' i�o ❑ NA ❑ NE
[:]Yes No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWNIP? ❑ Yes [D o ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? [—]Yes Fo ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? [:]Yes [✓]'fVo ❑ NA ❑ NE
Comments (refer to question ft Explain any YES:answers and/or any. additional Use drawings of facility to better explain situatio s (u a additional pages as mentfatto�ns or a'tlier
necessary) cant comments:
Reviewer/inspector Name:
Reviewer/]nspector
Page 3 of 3
Phone: 3 L
Date: 6 za
21412011

Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint �0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: ZCI Arrival Time: % - Jv Departure Time: 13 . County: Region:
Farm Name: Owner Email:
Owner Name: p4w-re_ Phone:
Mailing Address:
Physical Address:
Facility Contact: ��-✓�'� Title:
c•l
Onsite Representative:
l�
Certified Operator:
Back-up Operator:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: ❑ e ❑ f =, Longitude: = ° = { = u
Design Current Design Current
Design
Onrrent
Swine
Capacity Populaa ''on 'et Puu ltry Capacity Population
@attle Capacity
Population
El wean to Finish ElLayer
❑ Da" Cow
R Wean to Feeder
B0 A ❑ Non -Layer
❑ Da' Calf
El Feeder to Finish
"`
El Dairy Heifer
El Farrow to Wean
"''
:DryPonlfry��,;�"
El Da Cow
❑ Farrow to Feeder
ElNon-Dairy
ElFarrow to Finish
El La ers
❑Beef Stocker
❑ Gilts
. Non -Layers
❑ Beef Feeder
❑ Boars
El Pullets
❑ Beef Brood Co
5 ❑ Turkeys
Other
❑ Other
.
❑ Turkey Poults
1 10 Other
Number of Structures:
Discharges & 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
OPNA
❑ 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
RTo
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
)DNo
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
12128104
Continued

Facility Number: — Date of Inspection ZO
Waste Collection & Treatment
4_ Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ONo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ;9 NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
L
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 6No ❑ 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? ❑ 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 JQ 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 �QNo ❑ 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 Cr Window El Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) LK7 VYU � , pQ�) �ye, . 10 a-O�
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?
❑ Yes
❑ 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 lack of properly operating waste application equipment?
❑ Yes
FNo
❑ NA
❑ NE
E�No
❑ NA
❑ NE
V3 No
❑ NA
❑ NE
�INo
❑ NA
❑ NE
U9No
❑ 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,):
Reviewer/Inspector Name i ^ Phone: �} 3
Reviewer/Inspector Signature: JA A. W1 Date: a
Page 2 of 3 12128104 Continued

Facility Number: — Date of Inspection
Required Records & Documents
19. Did the facility fail to have 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 ❑ Other
❑ Yes IFNo ❑ NA ❑ NE
❑ Yes nNo ❑ NA ❑ NE
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 ❑ 120 Minute Inspections [:]Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other lssoes
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29_ Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes
1PNo
❑ NA
❑ NE
❑ Yes
PNo
❑ NA
❑ NE
❑ Yes
ONo
❑ NA
❑ NE
❑ Yes
'0 No
❑ NA
❑ NE
❑ Yes
14-No
❑ NA
❑ NE
El Yes
�No
El NA
El NE
❑ Yes
V No
❑ NA
❑ NE
❑ Yes
tpNo
❑ NA
❑ NE
❑ Yes
§3No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
V No
❑ NA
❑ NE
o* `k
Additional Comments and/or Drawings:
Page 3 of 3 12/28/04

Q-Division of Water Quality
Facility Number `�3 D Q Y 0 Division of Soil and Water Conservation
_... . _. _ 0 Other Agency
Type of Visit WCompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit (5r2outine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: �I Arrival Time: % h Departure Time: County: n Region: �R0
Farm Name: F-eine I �Famf_ Owner Email:
OwnerName: 0i'1 W✓ �: Phone:
Mailing Address: ii 1g5- h;r
x,91 ) . CQaL I
Physical Address:
Facility Contact: 1 CJ,ah r) Title: Less C'Pf Phone No: l'
Onsite Representative:` ! 1 P��t�Fa r,n Integrator:
Certified Operator: T6'e Operator Certification Number- AY 2MU_
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = o = t = « Longitude: = o = s = 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
❑ C a er
(&0$0 IS5:Z$ I IF—]Non-Layet
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b_ Did the discharge reach waters of the State? (If yes, notify DWQ)
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Da
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures: ®'
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 JRNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes El No ❑ NA ❑ NE
❑ Yes KNo ❑ NA ❑ NE
12128104 Continued

Facility Numher: 93 Date of inspection l5
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 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): I �9
Observed Freeboard (in): _
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes N 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 NJ 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? ❑ Yes W No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? El Yes No El 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 15JNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 12 No ❑ NA ❑ NE
maintenance/improvement?
IL . Is there evidence of incorrect application? if yes, check the appropriate box below. ❑ Yes NNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN [--IPAN > 10% or ] 0 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable ,Crop Window ❑ Evidence
�orf Wind Drifl [:]Application Outside of Area
12. Crop type(s) Cm-W I V'�1mJ�2, pGlA �-L SG mS
13_ Soil type(s)
14- Do the receiving crops differ from those designated in the CAWMP4
❑ Yes
RNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
U'No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑
Yes
JRNo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
W No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
WNo
❑ 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):
Reviewer/Inspector Name Zmej s 1F Phone: Q& 433-33CDXW $
Reviewer/Inspector Signature: Date: F b CD
1212R/04 Continued

I acuity Number: 43 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 No ❑ NA ❑ NE
the appropirate box.
❑ WUF El Checklists ❑Design [I Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard PSWaste Analysis ZRSoil 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
5�No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
N NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
W No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
JKNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
CR No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
CRNA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMF?
❑ Yes
XNo
❑ NA
❑ NE
29_
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
WNo
❑ 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
BNo
❑ 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
allo
❑ NA
❑ NE
General Permit? (iel discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
'KNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
RNo
❑ NA
❑ NE
Additional Comments and/or Drawings: t .
t. Ntet wmp_ Aral s ► 3- oT s ooh 0ii pots: 6 l -e
LO,f rvojie ey, A>-,d ivar -N, ��j
OAr-��C so; ( Oh Iy5'ls � f _" e( ao� .
kale, p jcls io'64r- ,t-qe- 0Ic cow1�e_ 1n
��rte1l s cels-e
D9rble. [ydlgwve G eai� `P4rms �eyQ f led
Pale
Now n�} f m$ Cary
his � nn4H=1kAW.s„;,re-d, PaAg o trs,
Page 3 of 3 12128104

. Facility No. q3-M) Y Farm Name 'F&'re-(� Date
Permit COC
Pop.Type Design Current
OIC
NPDES (Rainbreaker PLAT Annual Cert )
C
Lagoon
1
2
3
4
5
6
7
Spillway.
Design freeboard
Observed freeboard in
of
Sludge Survev Date f
Sludge Depth ft & %
�,
3
Liquid Trt. Zone ft
G:•lDil� �:� ��
Desig,Actual
•���-----
Flow
1,esign Width
Actual Width
Soil Test Date 1 in Inspections
pH Fields Crop Yiefd 120 min Inspections
Wettable Acres
Lime Needed ��`t 4-� Weather Codes
Lime Applied 5 t,i WUP Transfer Sheets
Cu Zn Weekly Freeboard RAIN GAUGE
Rainfall >1"
Needs P
"'ale(* qj -:JfI
. 000
Pull/Field
Soil
Crop
RYE
PAN
Window
Max Rate
Max Amt
1a
3
Verify PHONE NUMBERS and affiliations
Date last WUP FRO 5103 Date last WUP at farm ,h
FRO or Farm Records P v'
Lagoon # ya �1
Top Dike `4 5- Hiss
Stop PUMPAo 55;e- Ar
Start Pump 43.3 yD•�
App. Hardware

Facility Number
'58tDivision of Water Quality 0 A
Q Division of Soil and Water Conservation
O Other Agency
Type of Visit 19LCompliance Inspection O Operation Review O Structure Evaluation Q Technical Assistance
Reason for Visit pRoutine O Complaint O Follow up O Referral 0 Emergency O Other ❑ Denied Access
Date of Visit: G Arrival jTime: C1 Departure Time: %s County:
Farm Name: '�1'G @F'%%IS Owner Email:
Owner Name: C t__PX%Gll Phone:
Mailing Address:
Physical Address:
Region: P7e--Z
Facility Contact: �- 1�t'- Title: w � P ne No:
Onsite Representative: 6t� F re / Inte �ratar: ' �'
j €; ,tom
Certified Operator: "" e- � fie ! 1 Operator Certification Number:
�61 (O
Back-up Operator:
Location of Farm:
Back-up Certification Number:
Latitude: [= c =1 Longitude: = o = F =
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population Cattle
❑ Wean to Finish
can to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
❑ La er
❑ Non -Layer
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turke s
❑ Turkey Poults
❑ Other
Discharzes & 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)
Design Current
Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stockei
❑ Beef Feeder
❑ Beef Brood Co
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures: ®'
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 XNo ❑ NA ❑ NE
❑ Yes
❑ No
'KINA
❑ NE
❑ Yes
❑ No
MIA
❑ NE
❑ Yes
❑ No
IONA
❑ NE
❑ Yes
C�PNo
❑ NA
❑ NE
❑ Yes
allo
❑ NA
❑ NE
12128104 Continued

I•acility Number: — Date of Inspection O
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?
❑NA El NE
❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: i
Spillway?:
Designed Freeboard (in):_
Observed Freeboard (in): O
5. Are there any immediate threats to the integrity of any of the structures observed? El Yes ANo ❑ NA ❑ NE
(iel large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes XNo ❑ NA ❑ NE
through a waste management or closure plan?
❑ Yes N No
❑ Yes %No
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 stuctures lack adequate markers as required by the permit? ❑ Yes Wo ❑ 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 t&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'?
H. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes W: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)
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ 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 lack of properly operating waste application equipment?
❑ Yes
�X No
KY No
On No
M No
V,No
Comments (refer to question ft Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewertinspector Name �5 �NL AMO Phone:
Reviewerhnspector Signature: Date:
El NA ❑NE
El NA El NE
El NA El NE
El NA ❑NE
El NA ❑NE
12128104 Continued

Facility Number: = Date of Inspection rS
Required Records & Documents
19_ Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes UNo ❑ NA ❑ NE
20_ Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ yes UNo ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. Yes. ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard A 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
' 1K No
❑ NA, ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
ANA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
ZNo
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No
❑ NA
JKNE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
X No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
>(NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
VNo
❑ 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
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
KNo
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
1�,No
❑ NA
❑ NE
Additional Comments and/or Drawings:
& �u r c -to ha.v e a UCH d c.wca�a noa[ 6( a- l �
►n even
Caau bra �- M die ';-Icoe
c %00i15 , (l e )GCe.Iie-n7 5 -rd co ►e- ,
12128104

facility"No. �J Time In Time Out Date
Farm Name rI ry' r Integrator
Owner �1 z3'� T Site Rep xx
Operator (.� �`�/) -- No. o�U(z cc;;
6
Back-up No.
COC L Circle: General or NPDES
Desi n
Current
Design
Current
n — Fe
-- � —'
Farrow —Feed
Wean — -inish
Farrow — Finish
Feed — Finish
Gilts 1 Boars
Farrow — Wean
Others
FREEBOARD: Design L19
Sludge Survey tor,
Crop Yield
Rain Gauge Soil Test ✓/ W ttable Acres
Weekly Freeboard V7 Daily Rainfall
Spray/Freeboard Drop
Weather Codes
Waste Analysis:
120 min Inspections
Date Nitrogen (N)
r . �}I
t 23
Observed )6
1.
Calibration/GPM 1
Waste Transfers
Rain Breaker _�
PLAT —
1-in Inspections V
Date Nitrogen (N)
Pull/Field Soil Crop Pan Window
Q
c �
y

Type of Visit I Compliance Inspection Q Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit_ 4 Routine Q Complaint Q Follow up Q Referral Q Emergency Q Other El Denied Access
Date of visit: �f ` r� Arrival (Time:, -` Departure Time:
Farm Name: e Tf f.
Owner Name: �Qti,1C l _ �� Ird I
Mailing Address:
County:
Owner Email:
Phone:
Region:_
Physical Address: p--�
Facility Contact: �7�0_st Title: 1`? �I`� f _ Phone No:
Onsite Representative: 41C��LcJt'1 �Qi"rP.I l Integrator: L-S�Q�
Certified Operator: V 1 Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: [= o [= 4 [=dc Longitude: = ° = d = W
Swine
Design Current
Capacity Population
Design Current
Wet Poultry Capacity Population
Design
Cattle Capacity
Current
Population
canto Finish
❑ Layer
❑ Dairy Cow
[:]Wean to Feeder
❑ Non -Layer
❑ Dairy Calf
[:]Feeder to Finish
`1]ry
❑ Dairy Heifer
❑ Farrow to Wean
Poultry Mb ° '<:�.
❑ Dry Cow
❑ Farrow to Feeder
❑ Non -Dairy
to Finish
❑ Beef Stocker
EiFarrow
Gilts
❑ Beef Feeder
❑ Boars
❑ Beef Brood Cowl
Other
❑ Other
Numher of Structures:
y
` ❑ Layers
❑Non -La ers
❑ Pullets
❑ Turkeys
❑ Turkey Pouets
❑ Other
Discharges & Stream impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
19 No ❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made'?
❑ Yes
❑ No kNA
❑ 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)?
r---
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No�A
❑ 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
o ❑ NA
❑ NE
other than from a discharge?
Page I of 3
12128104 Continued

Facility Number: — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? Yes ,ONo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes KNo ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 19
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No [INA ElNE
(ie/ large trees, severe erosion, seepage, etc.) 0
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes ;VNo ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No [3NA ❑ 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 0 Yes 17;qNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes YNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes *o ❑ NA ❑ NE
El Excessive Ponding El Hydraulic Overload El Frozen Ground El Heavy Metals (Cu, Zn, etc.) !!!!!!//////
❑ PAN [--IPAN > 10% or ] 0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window❑ Evidence of Wind Drift ElApplication Outside of Area
12. Crop type(s) moo, — rl�J ! u,y` - Sfn Gy- V �.� A0*4A4
13. Soil type(s) lwN,_B -1 1 U 1� C . r7c, A
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
�Wo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
K)No
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
o
ElNA
[INE
18. Is there a lack of properly operating waste application equipment?
ElYes
o
❑ NA
❑ NE
Comments (refer to question ft Explain any YES answers and/ouany recommendations or any other comments: d
c
.Use drawings of facility -,to better explain situations. (use additional pages as necessary): r
M,-, jq 0`706 CP1S
Reviewer/inspector Name
Reviewer/Inspector Signature:
Phone: —1 1 U 7J J�
Date: n b 101 _r5w-7
Page 2 of 3 12129104 Continued

Facility Number: —, Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes )P�o ❑ 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 ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes PNo ❑ 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 T-;ANo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes ❑ No
I'WNA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes )4,No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes XNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes KI' o
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes ❑ No
tNA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CA WMP?
❑ Yes )XNo
❑ 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 ,jNo
❑ 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 PJ&o
❑ 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 *
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes �o
❑ NA
❑ NE
Additional. Comments and/or Drawings:r
�11 / _` i
C.LYJ f c�.'r nPCk i t`S�t l I , n aT r o ck Gt,�tICJ 7 107�`c •� J
F� e� Cyr 4 e CK vat"-k r 1,
Plc ; GA rea-d 1 tr no need 40 PVy_ Sr_
roc! Ua. t ( C
O 50 //, 3 CV4 --1)C4
CLI
Suet _� ��, n PS
i S
I f1c�CM�I a &'), .
-ea d, ov b'ca-ems
S1 u - mt.�-��
1
Qt?� z
c� n�rnQ�do-
5 ! �l �k n re�CUPz
t9)
"VkuMA
VfJn !fJ , �c
i�2 c
A Ca. 5 c cj a [ .
Page 3 of 3 12128104

Facility No.
Farm Name Fe....
e....[
Owner
Operator
Time In Time Out Date
('x _ Integrator Y
/-1 _ _ Site Rep
•eA No. J✓
Back-up No. _
COC — _ Cirde: eneral or NPDES
Desi n
went
Design
Current
can - Feed
[
Farrow -Feed
Farrow - Finish
Feed - Finish
Gilts 1 Boars
Farrow - Wean
Others
FREEBOARD: Design H /
Sludge Survey
Crop Yield -----
Rain Gauge
Observed
Calibration/GPM
Waste Transfers
Rain Breaker
Soil Test PLAT Wettable Acres
Weekly Freeboard Daily Rainf 1-in Inspections ✓
Spray/Freeboard Drop
Weather Codes ✓ 120 min Inspections
Waste Analysis:
Date Nitrogen N)
G �
I1Field I Soil
u
Date Nitrogen (N)
,3
L7
Pan i Window
d

`. ivisian of Water.Qitahty
Facility. Number /� 0 Division of Sail and Water Conservation
Y
0 Other Agency
Type of Visit Q}Compliance Inspection 0 Operation Review Q Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine Q Complaint 0 Fallow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: G6 Arrival Time: .��a Departure Time: tea _ County: Qr C^
FarmName: �� ��r�7s _— Owner Email:
Owner Name: ��C�S��7Yi'lz� �� Phone:
Mailing Address:
Physical Address:
Facility Contact: /' O"'��/r�� Title:
Onsite Representative:
Certified Operator -.—
Back-up Operator:
Location of Farm:
Swine
Region: '�ffg U
Phone No:
Integrator:
T'
Operator Certification Number: t�
Back-up Certification Number:
Latitude: ❑ c ❑ i ❑ « Longitude: ❑ ° = 4 ❑ 6f
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
ElLayer
i
D ❑ Non -La et
❑ Wean to Finish
® Wean to Feeder
El Feeder to Finish
El Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Dry Poultry
❑ Layers
ElNon-Layers
El Pullets
❑ Turkeys
❑ Turke Puults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: El Structure El Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ DairyCow
Ela Dai Calf
El Dairy Heifej
El Dry Cow
ElNon-Dairy
❑ Beef Stocker
El Beef Feeder
❑ Beef Brood Cowl
Number 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 of the State
other than from a discharge?
❑ Yes �RLNo ❑ NA ❑ NE
❑ Yes
9LNo
❑ NA
❑ NE
❑ Yes
KLNo
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
M No
❑ Yes
91 No
❑ NA
❑ NE
❑ Yes
&No
❑ NA
❑ NE
12128104 Continued

L. • ,
Facility Number: o?
Date of Inspection 7D6
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: 2
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
(icl 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? ❑ Yes [9 No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes C4 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 ;K No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ZNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 tbs ❑ 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) .r 6,-, : , f R T r
13. Soil type(s) Wa 1,VOZ
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes 0 No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes
a[No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination%❑ Yes
9No
❑ NA
❑ NE
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
EA No
El NA
❑ NE
TXC Joo1.1
bid
Reviewer/inspector Names Phone: /S 1 v�
Reviewer/inspector Signature: Date: 2 1 iNo
12128104 Continued

Facility Number: A13 — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes [HNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ®.No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. C,Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield [3 120 Minute Inspections ❑ Monthly and V Rain Inspections R]Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [0-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
CKNo
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
Sd No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
E4No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
J&No
® NA
❑ NE
Other Issues
05`
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[9No
❑ 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
W 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
W No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/]nspector fail to discuss review/inspection with an on -site representative?
❑ Yes
IR No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
[K No
❑ NA
❑ NE
/k� t'—& -- ,
12128104

Type of Visit 0 Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit O Routine O Complaint O Follow up O Emergency Notification 0 Other ❑ Denied Access
Facility Number 3 Z Date of Visit: q 0 Time: = OQ
O Not Operational O Below Threshold
Permitted © Certified © Conditionally Certified 13Registered Date Last Operated or Above Threshold:
Farm Name: 3o e F e-r re 1( l — q ... _ County: _ R& r-we'++ _
Owner Name: _ __. . ._ Phone No:
Mailing Address:
Facility Contact: ___ _ .............. Tiitle:._.. Phone No:
Onsite Representative:
Integrator_
Certified Operator: T Operator Certification Number. -
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude �• ��� Longitude �• ��' �u
Mesign
Currazat ') Cnrr�nt. Desegn Cnrreat
Swinecamd <Po 'on Pou3' .. Po on. Cattle
Wean to Feeder r Layer Dairy
Feeder to Finish Non -Layer Non -Dairy
Farrow to Wean _
Farrow to Feeder Other
Farrow to Finish a
T
_ '
Gilts __ 0ta1
Boars Tc3ta1 SSIW
Number o#Lagooas Z- `' '�'
F.
Diischames & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes ❑ No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a- If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min'?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes ❑ No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ❑ No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ❑ No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard (inches): jL
12112103 Conlrnued

Facility Number. q 3 — Z.Y Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes ❑ No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑yes ❑ No
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? ❑ Yes ❑ No
8. Does any part of the waste management system outer than waste structures require maintenancelimprovement? ❑ Yes ❑ No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes ❑ No
elevation markings?
Waste Aunlication
10. Are there any buffers that nerd maintenancelmiprovement? ❑ Yes ❑ No
11. Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes ❑ No
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes ❑ No
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge attor below
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours?
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building saucture, 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
Air Quality representative immediately.
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No

Type of Visit 0 Compliance Inspection O Operation Review O Lagoon Evaluation
Reason tar Visit O Routine O Complaint O Follow up O Emergency Notification Other ❑ Denied Access
Facility Number z Date of Visit: 0 Time: I(�]
B—No=WrationW 0 Below Threshold
0 Permitted © Certified [] Conditionally Certified D Registered Date. Last Operated or Above Threshold:
Farm Name: 6 �.'f-( �LB ro S County:
Owner Name: __.. _ . 'Phone No:
-Mailing Address:
Facility Contact: -- ---- Title:. Phone No:
OnAte Representative: Integrator.
Certified Operator: _ _ _ _ _ Operator Certification Number:
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • ' " Longitude • "
Desk .Curient = -Design Cnrrcai.:.- ?�
Ngmber of L�googs
fj>"
Discharees & Streamhu acts
i _ Is any discharge observed from any part of the operation? ❑ Yes ❑ No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gatimin?
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 ❑ No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ❑ No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ❑ No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 5
Identifier:
Freeboard (inches): �J
12/l2103 Continued

Facility Number: j- 2 Date of Inspection t--t.L Eno
5L Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ yes ❑ No
seepage, etc.)
6. Are there strictures on -site which are not properly addressed and/or managed through a waste management or ❑yes ❑ No
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? ❑ Yes ❑ No
S. Does any part of the waste management system other than waste structures require maintenancerimprovement? ❑ Yes ❑ No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes ❑ No
elevation markings?
Waste application
10. Are there any buffers that need maintenancelnnprovement? ❑ Yes ❑ No
11. Is there evidence of over application? if yes, check the appropriate box below. ❑ Yes ❑ No
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWN P)? ❑ Yes ❑ No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes ❑ No
b) Does the facility need a wettable acre determination? ❑ Yes ❑ No
c) This facility is pended for a wettable acre determination? ❑ Yes ❑ No
15. Does the receiving crop need improvement? ❑ Yes ❑ No
16. Is there a lack of adequate waste application equipment? ❑ Yes ❑ No
Odor L;sues
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?
1$. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes ❑ No
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes ❑ No
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional ❑ Yes ❑ No
Air Quality representative immediately.

Type of Visit ® Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit O Routine Q Complaint_ O Follow up Q Emergency Notification O Other. ❑ Denied Access
Facility- Number
Date of ViMt: 3 3 Time:
ro �
?dot Operational 0 Below Threshold
® Permitted ® Certified 0 Conditionally Certified O Regristered Date Last Operated or Above Threshold:
Farm Name: Ne-rf P.4� 0.�ry_C _ County:_Lrt'te+� O
Owner Name: 3 O9Q (I C-e PC& Phone No: C44
Mailing Address: 5 5 Y o rt t2 D CL�(A C'0
Facilit%- Contact: .l oe_ Ee_ca li Titie: Phone No:
Onsite Representative: -I o e. Fe,rrP 1M Integrator: jArY64-e_ .
Certified Operator: _ ji 6e _ _l�e �rre 1 i Operator Certification Number: AD IS �
Location of Farm:
19 Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 4 4. Longitude ' •
Design Current
Design Current Design Current
Swine Capacity Population
Poultry
Capacity Population Cattle Ca acity Population
® Wean to Feeder
O
10 Laver I
I
Dairy
❑ Feeder to Finish
ID Non -Laver I
I
on-Dain,
❑ Farrow to Wean
❑ Fanou to Feeder
❑Other
❑rowFinish
Total Design Capacity
❑ Gilts
❑ Boars
Total SSLW
Number of Lagoons ID Subsurface Drains Present ❑ Lagoon Area Spray Field Area
HoldingPonds / Solid Traps g -
p ❑ No Li rid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ yes No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other ,
a. if discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b_ If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. if discharge is obsen-ed, what is the estimated flow in gal/min?
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 No
3. Were there anv adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes No
Waste Collection 8- Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
IdentiFicT:
r
Freeboard (inches):i
OSIV3101 Continued

Facility Number: — Date of inspection 3 3 D
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes [?Q No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? El Yes � No
(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 treed maintenance/improvement? ❑ Yes No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes ® No
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes No
12. Crop type (3 C' (~v" , , d e__ - -- �"' . con �-" n . S
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
b) Does the facility need a wettable acre determination?
❑ Yes
❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes
❑ No
15. Does the receiving crop need improvement?
❑ Yes
No
16. Is there a lack of adequate waste application equipment?
❑ Yes
M No
Re uir d. Records & Documents
17.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
(21-No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
® No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
i No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes 1R No
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes Q No
24. Does facility require a follow-up visit by same agency? ❑ Yes 0 No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes ® No
0 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit
iqa pages;as necessary. �„��, - ❑Field Copy ❑Final Notes
�e cA rd-j J ►�. �— (� Lck-'
ej � �+.Y.f.�a-r � �,� � �G v crs-� �-�'4 c�-o,r/' � �. ►,r. P i•n. r c.
�l
Reviewer/Inspector Name !
Reviewer/Inspector Signature:
Date:
05103101
Continued

Facility Number: tF 3 - a Date of inspection 3 O
Odor Issues
26. 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?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes © No
2& is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation_ asphalt. ❑ Yes ONO
roads. building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes ® No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters. etc.) ❑ Yes ® No
31. Do the animals feed storage bins fail to have appropriate cover. ❑ Yes ® No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ❑ No
Additional Comments and/or Drawings:
J
05103101

.'State of North Carolina
Department of Environment,
Health and Natural Resources • •
Fayetteville Regional Office
James B. Hunt, Jr., Governor � C
Jonathan B. Howes, Secretary C
Andrew McCall, Regional Manager
DIVISION OF ENVIRONMENTAL MANAGEMENT
Water Quality Section
November 28, 1995
Joseph Ferrel
Rt 2 Box 495
Coats, N.C. 27521
SUBJECT: Animal Feedlot Operations Site Visitation
Joseph Ferrel Swine Farm
Facility No. 43-24
Harnett County
Dear Mr. Ferrel:
Thank you for access to your farm. Please find attached a copy of the Animal Feedlot
Operations Site Visitation Record for the site visit conducted November 28, 1995.
It is the opinion of this office that the subject facility was in compliance with 15A NCAC
2H, Part .0217 at the time of the inspection.
If you have questions regarding this matter please do not hesitate to contact me at (910)
48G-2541.
1
Paul E. Rawls
Environmental Specialist
Enclosure
cc: Facility Compliance Group
Wachovia Building, Suite 714, Fayetteville, North Carolina 28301-5043 Telephone 91&486-1541 " * FAX 91"86-0707
An Equal Opportunity Affirmative Action Employer 50% recycled/ 10% post -consumer paper

Farm Name/Owner-
Mailing Address:—
Couttty:
integrator:
On Site Representati
Site Requires immediate Attention:
Facility No. 43--d4 •—
DIVISION OF F.N'VIRONN F.TTrAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: 11 28 11995
Phone:
_ Phone: 9 0 9 c
Pbysical Address/Location:. _ S 9
Type of Operation: Swine ,g Poultry - Cattle
Design Capacity: Number of Animals on Site: a Barn s
DEM Certification Number: ACE_ DEM Certification Number: ACNEW
Latitude• 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) Yes or No Actual Freeboard:—±5—'Ft. o Inches
Was any seepage observed from the Iagoon(s)? Yes or No Was any erosion observed? Yes or No (Seepage Was
Is adequate land available for spray? Yes or No Is the cover crop adequate? Yes or No Not Evaluated)
Crops) being utilized: (Spray Field or cover crop was not evaluated
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellin s? or No
100 Feet from Wells? or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes ore@*
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue line: Yes or No
Is animal waste discharged into water of the state by man-made ditch, flushing system, orbther
similar man-made devices? Yes or q FLO If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? Yes or No(waste management records were not
Additional Comments:
_ his was a very brief inspection, as more thorough inspection will be conducted in the future.
Please contact-..DEM should an condition arise that poses a danger to surface waters.
* This farm was not located on a USGS TOPO map to determine `.'Blue Line" status.
..e
aW
If you have questiois concernYng this report please do not hesitate to .contact the inspector
at [phone]. Please contact the inspector if the above information is incorrect.
CiJ Q6✓ a�J a �f S
Inspector Name Signature
cc: Facility Assessment Unit Use Attachments if Needed.

ivi ion of ;trRacsources
n of Soand Water Conservation
L _0 Other Agency
Type of Visit: ompliance inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: �utine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: LDeparture Time: ounty: Region:
Farm Name: �.,1_rJ/yt Owner Email:
�Owner Name: ( r • C! / Phone:
Mailing Address: 1� �S�xw) /(/� �?sc>
Physical Address:
Facility Contact: �Tc� ''�'� Title: 0,)&ter Phone:
Onsite Representative: L.J(1&rVr_1 I _ Integrator:
Certified Operator: �b �y�r�� Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
ENEEMEMMM100,
ignCurrentw
Design Current Design Current
Swine
acity ,Pop Wet Poultry
C•apacityPoplfle Capacity Pop.
La er
*'= DairyCow
Non La er
DairyCalf
} 4;- DairyHeifer
��. Design urrent Dry Cow
D �Poult .
Ca actFPo Non -Dairy
Lavers
Beef Stocker
r Non -Layers
Beef Feeder
Pullets
Beef Brood Cow
— Turkeys
'
Other
,6 Turkey Poults
Other
Other
r..... ::..
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
El Yes
No
❑ NA
❑ NE
Discharge originated at: ❑Structure ❑Application Field ❑ Other:
a. Was the conveyance man-made?
❑Yes
❑ No
—LP<A
❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWR)
❑Yes
❑ No
—&,rA'
❑ 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 DWI}
❑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
<o
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 2/4/2015 Continued

Facili Number: - Date of Inspection:
Waste` -Collection & Treatment
• 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
g+-t '
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No "
❑ NE
Structu I Structure Structure 3 Structure 4
Identifier: Z_
Structure 5
Structure
6
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
Q5,'"
❑ 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
Io
❑ 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
L_'n"v
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
❑ 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
❑ NA
❑ NE
maintenance or improvement'?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
E;?<o
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? 1f yes, check the appropriate box below. ❑ Yes R2o?4 ❑ 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 ofAcceptable
Crop Window ❑'Evidence of Wind Drift ❑ Application Outside of Approved Area
L�
12. Crop Type(s). .1A-6 . T i,
13. Soil Type(s):
14. Do the receiving crops differ from those designated in Me CAWM16f,
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
th 4 b
❑ Yes
CR<o
❑ NA
❑ NE
❑ Yes
[2`5o
❑ NA
❑ NE
❑ Yes
E3 o
❑ NA
❑ NE
❑ Yes [�o ❑ NA ❑ NE
❑ Yes [QN ❑ NA ❑ NE
❑ Yes to
❑ Yes
❑ NA ❑ NE
❑ NA ❑ NE
e appropnate ox. -
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes `lam - [j 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 Z4A ❑ NE
Page 2 of 3 21412015 Continued

Facili Number: - Date of inspection: /
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes eNo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes J24 ❑ 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 o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No G41T& ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes L20110 ❑ 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 [;�< ❑ 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 M Ko ❑ 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 ETKo
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes } ]fib
33. Did the ReviewerAnspector fail to discuss review/inspection with an on -site representative? ❑ Yes 040
34. Does the facility require a follow-up visit by the same agency? ❑ Yes & ']
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
CExplain any YES answers and/or any additional recommendations or any other comments *,1-0.
Use drawtn s of fact_ tobetEer a lain situations use additional< a es as necessary).
ty , =P ( p g
1�G�, j CcrU 0 L s
_3A &A(o_
Aoqvc L, �c_, 1A, 2d (o
t�
Reviewer/Inspector Name:
Reviewer/Inspector Si
Page 3 of 3
Phone: ft --
Date: f
21412015