470027_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental Qual

Division of Water Resources
Facility Number - ® O Divlslon of Soil and Water Conservation
0 Other Agency
Type of Visit: ompliance inspection Z5 Operation Review Z3 Structure Evaluation 0 Technical Assistance
Reason for Visit: 01foutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: U Departure Time: County:
Farm Name: G Owner Email:
Owner Name: W •^ ° (A' Phone:
Mailing Address:
Physical Address:
Region:
Facility Contact: Title: Phone:
Onsite Representative: r Integrator: s✓°'`��C�
Certified Operator: �' `�t'i Certification Number: i b 1 l ��
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design C►urrent
Design
Current
Design Current
Swine Capacity Pop.
Wet Poultry
Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
Wean to Feeder
Layer
Non -La er
Dai Cow
DairyCalf
Feeder to Finish
DairyHeifer ,t
Barrow to Wean
Design
Current
D Cow l
Farrow to Feeder
D . P,oultr.
Caaci
Pxo
Non -Dairy'
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
Turkey Poults
Other RMLIOther
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation? _, ❑ Yes [— ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes [:]No D-i*A ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
❑ No
E? ]N
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
[:]Yes
❑ No
0 A
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
[allo
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
[5 No
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412015 Continued

Facili Number: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? [] Yes 0_�� ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No F "?IA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): Z D
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
E3-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
UEJ"Ao
❑ 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
Q o
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
D--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
[3 o
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes M `fq_o' ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): 1 _,L1_1tVQ6Ce4 -5 ( 0
13. Soil Type(s): to"_
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
F-_11 Io
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
[ f1 Rio
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[a o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
E2,N'o
❑ 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
[215o
❑ 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 Q o
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Anaiysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute inspections ❑ Monthly and I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ZNo
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [21"No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3
21412015 Continued

[EadUtt Number: - jDate of Inspection:
24j Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes Flo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑moo ❑ 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 stmeture(s) and date of first survey indicating non-compliance:
i
26. Did the facility fail provide documentation of an actively certified operator in charge? [3 Yes �fo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes EDAo ❑ 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 �o ❑ NA ❑ NE
[]Yes [ o ❑ NA ❑ NE
❑ Yes [ErNo ❑ NA ❑ NE
❑ Yes [D—No ❑ NA ❑ NE
[:]Yes ❑-&o
[]Yes [ o
[:]Yes [] No
❑NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
Reviewer/Inspector Name: 1 1 '(ram J 0 A00 Phonew L6 3 3 1 J
Reviewer/Inspector Signature: Date: X _111
Page 3 of 3 21412015

\_
F cility
!
Number
# N HSi1 i II Illq bnHi "19IDn" Of WaW Resources'
llp�tl tlt
- �'7 "' DWiston of,Saf) and Water Conservation
u 1r�� Other, A�' enck��' �� lim
o, .;:_�g__..x
Type of Visit: ompliance Inspection n Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 04q'�tine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: ` Arrival Time: f Departure Time: County: Region:=r V
r Ii
Farm Name: %.J-P
' r"rW_4A_
Owner Email:
Owner Name: 4
Cr-N(
Phone: � U
62
S7 S'
1 7 t 7
Mailing Address:
Physical Address:
fv
7a
_
Facility Contact: divdi
Title: Phone:
Onsite Representative:
rt
Integrator:
Certified Operator:
j� �Q�
Certification Number:'�P�q�•.
Back-up Operator:
Certification Number:
Location of Farm: Latitude: Longitude:
q..,&
yjbt'0
Design
w
„
Current
i;utt
?1111j
i Design
f'AM r a
w�lggliltll11N11i1i
Current
pHt4�
iM
1€
esign
I!
Current
p'wNCapacty
Po.et
PaultryCapactyPap
CattleapacityPap
a�u
�,�h,w
a NI U1i„ !€�:,M
tlar.
Wean to Finish
IDairy Cow
Wean to Feeder
I!
Non -La er
DairyCalf
i
Feeder to Finish
S c( o
lj"
Dairy Heifer
Farrow to Wean
Design
Current
D Cow
Farrow to Feeder
I
Ana,se
D i'oult� ,Ca �aeit
I+6€€ts1 €
l?a
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
I
jBeefBroodCow
I„N
,�1
Turke s
�
Other,
�f.
TurkeyPoults
Other
Other
Discharees and Stream Imnacts
1. Is any discharge observed from any part of the operation?
❑ Yes
�
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
�;NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
❑ No
�A
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
[] Yes
❑ No
L21EVA
❑ NE
2. Is there evidence of past discharge from any part of the operation?
❑ Yes
�No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
[�No
[] NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 2/4/2015 Continued

Facility Numbev: - Date of Inspection:
Waste C61lection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 2-X� NA ❑ NI -
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No Q-<A ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes - <o
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
E� o ❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat, notify 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
2'1Go
❑ 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
�!o
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[2-No
❑ NA
❑ NE
maintenance or improvement?
11. is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [/] No ❑ NA
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, 7n, 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): � t�` Lc�t —Re in #-ecf c 06i -2�& .
❑ NE
r
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes E�3o ❑ NA [] NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [2"No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes E2<o ❑ 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 [;21Q0 ❑ NA ❑ NE
❑Yes �o ❑NA []NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
�fo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
❑ 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
[] No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑Stocking ❑ Crop Yield ❑ 120 Minute Inspections [:]Monthly and I" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
�o
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[]fo
❑ NA
❑ NE
Page 2 of 3 21412015 Continued

Facility Number: Q7 - '2 Date of Inspection; r.
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [ffNo
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ENo
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 ErNo
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes EfNo
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?
CA(JO.A,41 a -.1 %V 0� - �_ it
S
Reviewer/Inspector Name:
Reviewer/Inspector Signatu
Page 3 of 3
❑ Yes En/No
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
DNA ❑NE
❑ Yes eNo ❑ NA ❑ NE
❑ Yes El"'No ❑ NA ❑ NE
❑ Yes eNo ❑ NA ❑ NE
❑ Yes 1� No
❑ Yes %2—
❑ Yes 2fNo
0' 3- � P• 3r T S 0 7-
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
A3 l U Phoneq 0 ` S3
re: 1 Date: t.�A-UG
21412015

�G V
DPisslon of Water Resources
Facility Number - © O Division of Soil and Water Conservation
j � �thcr Agency
Type of Visit: Compliance Inspection Operation Review Structure Evaluation Technical Assistance
v Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: %XI' In Arrival Time; Departure Time: County:? ir[C Region
FarmName: Ga,5 Owner Email:
Owner Name: iu a�''GCy`�� Phone:
Mailing Address:
Physical Address:
Facility Contact: �� Title:
Onsite Representative:
(�
Certified Operator: A4U0 4 r--,, e:'( er
Sack -up Operator: _&U C94Aey�
Location of Farm:
Latitude:
Phone:
Integrator: A T-S
Certification Number: i
Certification Number:
Longitude:
Swine
Wean to Finish
Design Current
Capacity Pop.
Wet Poultry
Layer
Non -La er
D . P.oult
Layers
Non -Layers
Design
Capacity
Design
Ca aci
Current
Pop.
Current
P,a
Design
Cattle Capacity
DairyCow
DairyCalf
DairyHeifer
Current
Pop.
Wean to Feeder
Feeder to FinishS7
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Giits
&0'
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Boars
Other
Other
Pullets
Beef Brood Cow
Turkeys
Turkey Poults
Other
Discharges and Stream Impacts
I. Is any discharge observed from any part of the operation?
❑ Yes
�o
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
[g-NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
❑ No
[ A
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
❑ No
[75A
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
C 3,.Afo
❑ 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 21412015 Continued

Facili Number: - Date of l�s ection:U
Waste Collection & Treatment
4. IsAtorage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 02,NT' ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No 2,'<A ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ED-1510 ❑ 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 2 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 [E'No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes E24o ❑ 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 EIONo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes g3llTo ❑ 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): •1] G t) �/ ro
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[].-Ho
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
' CD -No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
[ -Vo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
3 o
❑ NA
❑ NE
19. Is there a lack of properly operating waste application equipment?
❑ Yes
�' o
❑ 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
4,d 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
L?lgO
❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
[] Waste Transfers
❑ Weather Code
❑ Rainfall [:]Stocking ❑ Crop Yield ❑ 120 Minute inspections ❑ Monthly and 1" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
E Noc
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
EO*No
❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facili Number: Z1 I - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes I__I N-o' ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ± No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes 10 ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes C20 ❑ 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?
ll ' (6 '(5
C1 _q - lc
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
❑ Yes No ❑ NA ❑ NE
[:]Yes No ❑ NA ❑ NE
❑ Yes [2 °"" ❑ NA ❑ NE
[:]Yes IVo ❑ NA ❑ NE
❑ Yes fNo
❑ Yes 2No
❑ Yes FfNo
P-- 3-'f
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
Phone:
Date: &,.,TI
21412015

Type of Visit: UCo liance Inspection V Uperation Review U Structure Evaluation U "lecnnical Assistance
Reason for Visit: 7utine Q Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other O Denied Access
Date of Visit: aw Arrival Time: Departure Time: { Countq: c
Farm Name: ���a �Q �`�f Owner Email:
Owner Name: l Ce ►mcr cn Phone:
Mailing Address:
Physical Address:
Facility Contact: 9 � 11 am"O.", Title: Phone:
Onsite Representative: 1. � Integrator: PA (s
Region: t-1to
Certified Operator: 5e_�_5 Certification Number: !�011 f ?4 d
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design Current DesignkU
rrentapacity Pop. Wet Poultry Capacityop.
Cattle Cap city
Pop.
ek'r
Wean to Finish
Layer
Dairy Cow
Wean to Feeder
I
INon-Layer
I
Dai Calf
Feeder to Finish
Farrow to Wean
Farrow to Feeder
7
D
Design Current
Dt, P,oul Ca aci P.o
Dairy Heifer
Dry Cow
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Pullets
Turke s
Turkey Poults
Beef Feeder
Boars
Beef Brood Cow
Other
Other
I IOther
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes [EVNb ❑ NA ❑ NE
❑ Yes ❑ No [ A ❑ NE
❑ Yes ❑ No [3.-NA ❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWR) ❑ Yes ❑ No aNA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? [—]Yes [R o ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes tNo ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 �,� 21412014 Continued

Facility Number: - Date of Inspection: '
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes Q_Wv--r NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑Yes ❑ No [5 1T NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes �oE] ❑ 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 2<0 ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
[5"No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the pernlit?
[D Yes
E] 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
E31C
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10, Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[:j"No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes IJ 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): G e✓ Ay 4 U'(4,, 1L G !'D 7yC
13. Soil Type(s): ' V
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
E3/No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
Yes
[2'<o
❑ NA
0 NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[jj'Tqo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[D-No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[Z]No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
[] Yes
_ 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 2-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 Q No ❑ NA ❑ NI:
Page 2 of 3 21412014 Continued

FaTifit umber: - Date of Ins ection: Su
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes WIo
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes []�<o
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 [�o
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [Blo
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? ❑ Yes �No ❑ NA ❑ NE
33, Did the Reviewer/inspcctor fail to discuss review/inspection with an on -site representative? ❑ Yes [ jNo ❑ NA ❑ NE
34, Does the facility require a follow-up visit by the same agency? ❑ Yes E�No ❑ NA ❑ NE
Comments (refer to question #) Explain anyYES answers,land/oriany additional 'recommendations or any other comments
Use'drawings of facdlitv:to better�explainisituations (use,addit onahpaaes.as;neeessary).
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑NA ❑NE
!VLAA7y__�
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
[] Yes Q*�4o ❑ NA ❑ NE
❑ Yes �No ❑ NA ❑ NE
❑ Yes [5"No ❑ NA ❑ NE
[:]Yes E:fNo ❑ NA ❑ NE
Phone: �- l 3 3
Date:
21412 dl4

Division of Water Quality
Facility Number - O Division of Soil and Water Conservation
0 Other Agency
Type of Visit: Cam Hance Inspection Operation Review 0 Structure Evaluation Q Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral O Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: County: Region:
Farm Name_ a��{ IPA rt�-�i Owner Email:--'—`-`_
Owner Name: t Ce-cn Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative:
Certified Operator:
Back-up Operator: It ( (,Lt'i 4r S
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Latitude:
Phone: 7 ^
Integrator:
Certification Number:
Certification Number:T f b
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
La er
Non -La er
Nan-L
Pullets
Other
Poults
Design Current
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)?
Longitude:
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes 12<0 ❑ NA ❑ NE
❑ Yes ❑ No [Z�NA ❑ NE
[:]Yes ❑ No [Vr�4A ❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes 0 No Q NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? 0 Yes WX0 ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes Cg�<o ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

_.
Facili Number: - Date of Inspection: hV
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Identifier.
Spillway?:
[r No ❑ NA ❑ NE
❑ No ❑ NA ❑ NE
Structure 6
Designed Freeboard (in):
Observed Freeboard (in): � 5__
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes [B 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 [k<o ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ®'Nlo ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes O o ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes G�Ko ❑ NA ❑ NE
maintenance or improvement?
Waste ADplication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes Q'Ko ❑ NA ❑ NE
maintenance or improvement'?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes a<o ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): C �3
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
13. Soil Type(s): L} (OL-L� ,, Jii-* 4 ) d (
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
Q No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
`b '
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
[;],Wo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[�io
❑ NA
❑ NE
18. is there a lack of properly operating waste application equipment?
❑ Yes
QKo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes �Vo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes <o
❑ 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 [Rio
7 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 [R o ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facili Number: - Date of inspection-
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes D o ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes B<0 ❑ 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 [g-Ko"' ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [] ,M ❑ 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 the drains exist at the facility? if yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes [] No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes Ga<o ❑ NA ❑ NE
Comments (refer to question #}: Explain Any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
Cat 16 r (9
611y adg-o
d�f=�
❑ Yes
[Ko
❑ NA
❑ NE
❑ Yes
NA
❑ NE
❑ Yes
2<0
❑ NA
❑ NE
[:]Yes
Vo
[] NA
❑ NE
Reviewer/]nspector Name: Phon I I B
c rja�
Reviewer/Inspector Signature: Date: I n N
Page 3 of 3 2/4/2 11

4_1
Type of Visit: (g'Compliance Inspection O Operation Review Q Structure Evaluation Q Technical Assistance I
Reason for Visit: GkIloutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: y I anld Arrival Time: I Jg2wonDeparture Time: a! 3L'J County: _Aoy%,�_ Region: � R�
Farm Name: nelt.AZAE Q .yAmv� Owner Email:
Owner Name: , `1� (�P_. A%b Nl Phone:
7-
Mailing Address:
Physical Address:
Facility Contact: J�)X k \ C A'CrE �UfI'! Title: Phone: --
Onsite Representative: Integrator: M�]R�h.l L��RGt�1J
Certified Operator: / o S Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
g- '� rr_ � '.'-,' Siff �t • r `' .. �f '
Design Current Design Current' _' __ Design
Swine Capacity PER Wet Poultry CapAcity Pop Cable CapCity
:..
Current'
Pop. '
Wean to Finish
La er
Dairy Cow
Wean to Feeder
Layer
Dairy Calf
h
Feeder to Finish
raILL43
Design Current
Dry P,Uultr, Ca aci P,o
Layers
Dairy Heifer
Farrow to Wean
Dry Cow
Farrow to Feeder
Farrow to Finish
Non -Dairy_____
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Turkeys
Turkey Poults
01 Other
Other
Discharees and Stream Impacts
I. Is any discharge observed from any part of the operation'?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other: _
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
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 E3"No ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes [�rNo
❑ Yes Ea"No
Q"NA ❑ NE
Q'NA ❑ NE
[�NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
Page 1 of 3 21412011 Continuer!

Facili Number; - Date of Inspection: I 1'
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes r%—^o ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes [J No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[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
[VTNo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
D/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
gNo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10, Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
�io
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [:]Yes &No [DNA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ 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): k�]F.C�CRupA i tt�lP*t ,[RAZ �\ a�.C�.('�•
13.Soil Type(s):C��h4�i
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [2"No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [g/No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes [2"'No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Reauired Records & Documents
❑ Yes [TNo ❑ NA ❑ NE
❑ Yes [TNo ❑ 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 [2"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 [D No
[DNA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Trans Ifers
❑ 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 ❑ No <A ❑ NE
Page 2 of 3 21412011 Continued

1
Facility Number: 'A-1 - Date of Ins ectioR:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes CD'No
25. Is the facility out of compliance with permit conditions related to sludge`? If yes, check [] Yes ❑'No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes []"No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [9'No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the 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 CAVIWMP?
33. Did the ReviewerMnspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency'?
❑NA ❑NE
❑NA ❑NE
❑NA ❑NE
[]NA ❑NE
❑ Yes [9No ❑ NA ❑ NE
❑ Yes Callo ❑ NA ❑ NE
0 Yes CD�No [DNA ❑ NE
❑ Yes [910 ❑ NA ❑ NE
❑ Yes E3"No
❑ Yes [gNo
❑ Yes FE]/No
❑NA ❑NE
❑ NA ❑ NE
❑NA ❑NE
Reviewer/]nspector Signature: Date: LlI ( I
Page 3 of 3 21412011

aff-Ls 1i1rel rl
Type of Visit: UrCompliance Inspection 0 Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: &,routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time:— IT41L County: Region: 112-4
Farm Name: �iG _ Owner Email:
Owner Name: l� i. - ,�/� �j�,i,.p�� Phone:
Mailing Address:
Physical Address:
Facility Contact: // ��—Title: Phone:
OnsiteRepresentative: V/C �lJ�r L'/, j 7t2,,RS Integrator: �//�r
6 /'�/
Certified Operator: �/� C�� � Certification Number: 91J_ 771p
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design
Current
Design
Current
Design Current
Swine
Capacity
Pop.
Wet Poultry
Capacity
Pap.
Cattfe Capacity Pop.
Wean to Finish
La er
Dairy Cow
Wean to Feeder
on —Layer
Dairy Calf
Feeder to Finish
DairyHeifer
Farrow to Wean
Design
u.rre R
Dry Cow
Farrow to Feeder
DPoultr
". Ca aei
Po_
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
F'
Turkeys
Other
Turkey Poults
Other
I Other
Discharaes 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 '`'o ❑ NA ❑ NE
❑ Yes ❑ No VA ❑ NE
❑Yes No NE
❑ Yes
❑ No
�'NA
❑ NE
❑ Yes
�o
❑ NA
❑ NE
❑ Yes
Ud <
❑ NA
❑ NE
Page I of 3 21412011 Continued

i..
Facility Number: jDate of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ®'1Qo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No Q� ❑ NE
Struct r I Structure 2 Structure 3 Structure 4 Stricture 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes <o ❑ 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 Qlloo ❑ 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 Quo ❑ NA ❑ NE
S. Do any ofthe structures lack adequate markers as required by the permit? ❑ Yes E lKo ❑ 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 L,dof ' ❑ NA ❑ NE
maintenance or improvement'?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes NA ❑ NE
maintenance or improvement'?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes E1110110, ❑ 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 Rare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ Trot those designated in the CAWMP? ❑ Yes No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ED N ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes EE'No ❑ NA ❑ NE
acres determination'?
17. Does the facility lack adequate acreage for land application? ❑ Yes 0'<o ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes to ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available'? If yes, check ❑ Yes E30<o ❑ 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 Surrey
22, Did the facility fail to install and maintain a rain gauge? ❑ +❑' Yes No ❑ NAB❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No [�1�A ❑ NE
Page 2 of 3 21412011 Continued

Facili Number: - Date of Inspection:
x24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes Cg'l1o/❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [�.Pd6 ❑ 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 tail 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 ❑ NA gd�
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?
Ifyes, 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 QXlf ❑ NA ❑ NE
❑ Yes [2-1115 ❑ NA ❑ NE
❑ Yes Ko ❑ NA ❑ NE
❑ Yes
[a}6
❑ NA
❑ NE
❑Yes
[9 o
❑NA
❑NE
❑ Yes
E3�o
❑ NA
❑ NE
Yes
&?-<7'_
❑ NA
❑ NE
Comments (refer to question #): Explain any YES onsv ers And/or anyadditional recommendations or any other comments 0
Use drawings of facility to hetter.explatn sjtupttons (use additional pages as necessary).,"! " , w
6,� "67 2/3 / I;W
Reviewer/inspector N
Reviewer/inspector
Page 3 of 3
Phone: 9l
Date:
21412011

(TDivislon of Water Quality
Facility Number Y-7 � L7 O Division of Soil and Water Conservation
----- O Other Agency
Type of Visit ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit outine 0 Complaint O Foilow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: �3d�t'O Arrival Time: : B0 Departure Timc: / 04 County: �C Region: ��d
Farm Name: 46 a b& DC , �'4V� _ Owner Email:
�W.
Owner Name: •. &[ Ca if Yd A.1 Phone:
Mailing Address:
Physical Address:
Facility Contact: 0"Me a Title: 01 lAle- ✓ Phone No:
Onsite.Representative: (// G a� �' 1��( �'U �G.$ Integrator: �/6�6��y �%//✓
Certified Operator:_ ��l v �+ %ue�`TG"1 Operator Certification Number. -
Back -up Operator:
Back-up Certification Number:
Location of Farm: Latitude: ❑ o = 4 = f1 Longitude: = o = d =
dg
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -La er
ILJ Farrow to Finish I 1 II
Other
❑ Other -- — — - — -
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ urkey 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?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
E]Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
I
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 ErNFo ❑ NA ❑ NE
❑ Yes
❑ No
NS�A
El NE
❑ Yes
,CJ..,,
El No I�-lvA
❑ NE
❑ No ❑ NA
❑ NE
❑ Yes
❑ Yes
o NA
❑ NE
ElYes;�No
❑ NA
❑ NE
Page 1 of 3 12128104 Continued

Facility Number: 4 ] - Z % Date of Inspection w- O-
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes o NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes�No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 541
5. Are there any immediate threats to the integrity of any of the structures observed'? ❑ Yes ffNo ❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes ❑ 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 D Yes No ❑ NA
❑ NE
maintenance or improvement?
Waste Application
,_.,�
10. Are there any required buffers, setbacks, or compliance alternatives that need ElM Yes o ❑ NA
❑ NE
maintenance/improvement'?
11. Is there evidence of incorrect application'? If yes, check the appropriate box below. ElYes 2<0 ❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[:]PAN ❑ PAN > 10% or l o 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) 0,4j �... � '� r_4��+t,� r.,...��t't�a�� 4" rr4.�.✓ _ �D�S . J
13. Soil type(s) 18 /Q
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
Mo ❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
��No ❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
ElNA
❑ NE
17. Does the facility lack adequate acreage for land application'?
ElYes
;N�❑ NA
ElNE
18. Is there a lack of properly operating waste application equipment?
ElYes
No ❑ NA
❑ NE
,Comments-(refer.to question #) Fitplain any YES;'answers and/or any, recommendations or any othercomnnents lA 4g
Use drawings of facility to hetter`explain situations', (use additional pages as necessary)iP
Y}�'�'
Reviewer/inspector Name t� Phone: 910 • .3-3- 33�7c
r
Reviewer/Inspector Signature: Date: fj - 30 -Z 010
Page 2 of 3 12128104 Continued

Facility Number:'] —27 Date of Inspection fit'
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
nNo ❑ NA
❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design El Maps El Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
rrNo ❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1"
Weather Code
Rain Inspection�No
22.
Did the facility fail to install and maintain a rain gauge?
El Yes
❑ NA
❑ NE
No
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
El Yes
,,�
" ❑ NA
[3 NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
?No❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
IdNo ❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
[3 No ❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
L7 No ❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
ElYes
B No ❑ NA
❑ NE
29.
Did the facility fail to property dispose of dead animals within 24 hours and/or document
❑ Yes
L?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
Io ❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
3 No ❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
El Yes
�No❑ NA
❑ NE
Page 3 of 3 12128104

lilf"+S ro--a9- Zoo
Facility Number
ivision of Water Quality
O Division of Soil and Water CiiMeiwation
0 Other Agency r
Type of Visit er�ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit outine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: %'23 Arrival Time: /,�,�'8 Departure Time: /2.01? County: 06C Region:
Farm Name: bout it. C kY�'1� S Owner Email:
Owner Name: —_(.LJ- Clr,�Y,(��! /r__ Phone:
Mailing Address:
Physical Address:
� ! �c� r-� s c7 �.J ^� �-ti
Facility Contact: +,�l, Title: Phone No:
Onsite Representative: �� %1 �—a wtt ✓e �✓ _ Integrator: iyu! h � �+✓
Certified Operator: Rtv C:% t1 e-t --Ai Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Other
❑ Other
Latitude: = o � Longitude: = e ❑ 6
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
. ❑ La er
I I ❑ Non -La ec
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?
Design Current
Cattle Capacity Population;
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stockci
❑ 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 ffNo ❑ NA ❑ NE
❑ Yes
❑ No
E3<A
❑ NE
❑ Yes
❑ No
[5NA
❑ NE
3A
❑ NE
❑ Yes
❑ No
❑ Yes
3 o
❑ NA
❑ NE
❑ Yes
D NNoo
❑ NA
❑ NE
12128104 Continued

Facility Number:
_�47 — 2� Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 0 /o ❑ NA ❑ NE
a. Ifycs, is waste level into the structural freeboard? ❑ Yes D<o ❑ NA ❑ 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 o ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed El Yes
�,
EKo ❑ 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
LS No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
214o ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes
R<o ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need El Yes
�,,�
L_7 No ❑ NA ❑ NE
ma intenance/ improvement'?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
<o ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑`Evvidence1of Wind Drifl [I Application Outside of Area
12. Crop type(s) 43�,04 ec}� LP4
13. Soil type(s) �vc nl c-�j �vtYV4i viz&
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ NA
El NE
15. Does the receiving crop and/or land application site need improvement?
El Yes
,ErNo
l_�'No11" NA
El NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
o ❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application'?
❑ Yes
NA
❑ NE
18. is there a lack of properly operating waste application equipment?
ElYes
[L2 u 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):
c� 9io.3og, �srs-/
Reviewer/Inspector Name Phone: 1910, e133. 3
Reviewer/Inspector Signature: Date:
12128104 Continued

2
Facility Number: Date of Inspection
Reguired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available'? ❑ Yes �o ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ETNo ❑ NA ❑ NE
the appropirate box.
❑ Wt]P ❑Checklists El Design El Maps El Other
21.
Does record keeping need improvement`? If yes, check the appropriate box below,
❑ Yes
Z'No ❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Sail Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and l"
Rain Inspections ❑ Weather
Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
LSNo ❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ NA
El NE
24,
Did the facility fail to calibrate waste application equipment as required by the permit'?
❑ Yes
,�,�Io
DNo ❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the pen -nit?
❑ YesEI`No�
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
o ❑ NA
❑ NE
27,
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
ElB Yes
,3
No ❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
Cl Yes
No ❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
No ❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern`?
❑ Yes
ETNo ❑ 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
El Yes
�,�
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
, _,
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative`?
El Yes
L�'No NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑Yes
No ❑ NA
❑ NE
Additl6na1 G.6inments wings k ri t nn b . Ifd'I
Page 3 of 3 12128104

Divistiin of Water Quality
Facility Number O Division of Soil and Water Conservation [ a
0 Other:Agency �
Type of Visit *, Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit IN Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: i � Arrival Time: ® Departure Time: County: a kQ- Region: Flo -
Farm Name: Dd � �+ FOLV M5 Owner Email:
Owner Name• — _ 1 ` „ , „ , , ,_.._._. Qd ti .,,.., Phone:
Mailing Address:
Physical Address:
Facility Contact: I O Title: wrpu- Phone No:
Onsite Representative: l �_�_ Integrator:
Certified Operator: C].z4 ` I ��.1�1'le1`CA Operator Certification Number:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Back-up Certification Number:
Latitude: E o =1, ❑ longitude: = ° = 1
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
❑ Non -La et
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkex Poults
❑ Other
Discharees & Stream Impacts
I. Is any discharge observed from any part of'the operation'?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
Design Current
Cattle Capacity Population
❑
Dairy Cow
❑
Dairy Cal F
❑
Dairy Heifer
❑
Dry Cow
❑
Non -Dairy
❑
Beef Stocker
❑
Beef Feeder
❑
Beef Brood Cow
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures: FT
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 IgNo ❑ NA ❑ NE
❑ Yes
❑ No
1� NA
❑ NE
❑ Yes
❑ No
JPNA
❑ NE
❑ Yes
❑ No
n NA
❑ NE
❑ Yes
qO No
❑ NA
❑ NE
❑ Yes
10 No
El NA
El NE
12128104
Continued

1
Facility Number: Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus stoma storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
Identifier: d
Spillway": p�
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes INo ❑ NA ❑ NE
❑ Yes [XNo ❑ NA ❑ NE
Structure 5 Structure 6
Cl Yes ;RNo ❑ NA ❑ NE
❑ Yes W No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threal, notify DWQ
7. Do any of the structures need maintenance or improvement? 'Yes [ ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes 0 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 Aimlication
W. 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 TIM ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.) //
❑ PAN ❑ PAN > 10%or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop �Window El Evidence of Wind Drift El Application Outside of Area
12. Crop type(s) &M UL~ P I zi-n G r Q/S
13. Soil type(s) ._. '6/0 II&A 4t, 4rN_.✓; flo. _
14. Do the receiving crops differ fromylose designated in the CAWMP?
❑ Yes ; No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? Yes
❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
QkNo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes
PNo
[]NA
❑ NE
19, Is there a lack of properly operating waste application equipment? ❑ Yes
LD No
❑ 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):
-7. Work on ba--ye, a r cA s . L ; ow- a.o lu d . n&d sit
4 f so►1, Sc.e d l rn w /c4
L
er/Inspector Name Q t14 . S Phone: I O 443333oo
er/Inspector Signature: Date: A aM
1212RI04 C.andnu

FIcility Dumber: — Date of Inspection L o
Re uired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes JANo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes JgNo ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes t No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
Wo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
�9NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[� No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
JKNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
4NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
N No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
�RNo
❑ 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? (iel discharge, freeboard problems, over application)
l
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
[j�No
❑ NA
❑ NE
Additional Comments and/or Drawings:
Owner Ptan S _�o YeP/a►v&,�A �n eU on
;
tCcS 5 1 n f eA % (,�� S � LJ v #t Ct, �
12128104

Facility No, 1 Time In Time Out
a
Farm Name a—V Integrator
Owner „! . && �� Q7 Site Rep.
Operator K).yJ No.
Back-up No. _
COC Circle: Genera or NPDES
MIN
Date . T// /6 ?
Design
Current
Design
Current
Wean — Feed
Farrow — Feed
We — ish
Farrow — Finish
eed — Fini
Gilts 1 Boars
Farro—w— Wean
Others
FREEBOARD: Design / "/ `��� Sludge Survey
Observed �'� Calibration/GPM
Crop Yield Waste Transfers
Rain Gauge Rain Breaker
Soil Test Wettable Acres PLAT
Weekly Freeboard
Spray/Freeboard Drop
Weather Codes
Daily Rainfall 1-in Inspections
120 min Inspections
Waste Analysis:
Date Nitrogen (N)
Date Nitrogen (N)
Pull/Field
Soil
Crop
Pan
Window
V
v U

Division of Water Quality1�
=FA�ffityumber o Z 0 Division of Soil and Water Conservation
0 Other Agency
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: Arrival Time: � o- � Departure Time: County: � Region:
Farm Name: �_ �)� 1K-- -_ 1 0.I 1`R ST, .,, Owner Email:
Owner Name: ,� �l�l �1'� `i { Phone:
Mailing Address:
Physical Address:
Facility Contact: Y1� 11 x= Title; l iJV Phone No:
Onsite Representative: „ ] . V'L � X 61(� Integrator: :24 em,,,,,,.
Certified Operator: �_1 !__ �lA 1rirP�( U� Operator Certification Number: I `�
Back-up Operator:
Location of Farm:
Swine
Back-up Certification Number:
Latitude: = D = d = Longitude: = o = ,
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -Layer
❑ Wean to Finish
❑ Wean to Feeder
eeder to Finish
D
5 2
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Dry Poultry
❑ La ers
❑ 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 Heifei
❑
Dry Cow
❑
Non-Dair
❑
Beef Stocker
❑
Beef Feeder
❑
Beef Brood Cow
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures: 51
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 0 No ❑ NA ❑ NE
❑ Yes [:]No 9 NA
❑ NE
❑ Yes ❑ No b?NA
❑ NE
❑ Yes ❑ No NA
❑ NE
❑ Yes ANo ❑ NA
❑ NE
❑ Yes A No ❑ NA
❑ NE
12128104 Continued

Facility Number:
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
Identifier:
❑ Yes 'E No
❑ Yes ❑ No
Structure 5
❑ NA ❑ NE
NA ❑ NE
Structure 6
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 010
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes pt'_ 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 FhNo ❑ NA El NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes �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) 'v
9, Does any part of the waste management system other than the waste structures require ❑ Yes -� No ElNA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes [�No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[:]PAN ❑ PAN > 10% or I 0 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 fromntlr6se designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
❑ Yes No
❑ Yes No
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes P9 No
17. Does the facility lack adequate acreage for land application? ❑ Yes NNo
18. Is there a lack of properly operating waste application equipment? ❑ Yes 9No
El NA El NE
❑NA ❑NE
El NA El NE
❑ NA ❑ NI
❑ NA ❑ NE
j Comments (refer to question #1): Explain any YES answers and/or any recommendations or any other comments. I Use drawings of facility to better explain situations. (use additional pages as necessary): I
Reviewerllnspector Name N�S NyTp Q Phone: `1 }�) "1U
Reviewer/Inspector Signature: Date: �AP ZM�
12128104 Continued

Facility Number: q 3 — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes N No ❑ NA ❑ NE
20. Does the facility tail to have all components of the CAWMP readily available'? If yes, check ❑ Yes 51 No ❑ NA ❑ NE
the appropriate box. ❑ WDP ❑ Checklists ❑ Design ❑Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [jNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
[2 No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
&No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
0,,No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
[P No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge'?
❑ Yes
Wo
ElNA
[INE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
[IYes
5`V'o
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
�&No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
DNo
❑ 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
ElNA
❑ 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
)14 No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
A No
❑ NA
❑ NE
Additional Comments and/or Drawings:. .
r 1L cel ke
eNe tom' Q rc)s,w
12128104

Faciltty No. Time In Time Out Date
Farm Name 7curv.SIntegrator
Owner _QgkrNQv an �_ � Site Rep
Operator No, Z
Back-up No.
COC Circle: General or NPDE
Design
Current
Design
Current
Wean —'Feed
Farrow — Feed
We
Farrow — Finish
eed, Finish
(a
Gilts 1 Boars
— an
Others
FREEBOARD: Design
Sludge Survey
Crop Yield �'—
Rain Gauge
Soil Test PLAT
Observed
CM!ibration!GPM
Waste Transfers
Rain Breaker
Wettable Acres
Weekly Freeboard Daily Rainfall�I 1-in Inspections
Spray/Freeboard Drop
Weather Codes ✓ 120 min Inspections �r
Waste Analysis:
Date Nitrogen (N)
Date Nitrogen (N)
Pull/Field
Soil
Crop
Pan
Window
1
I - '$o
fl —3 3
G
I
2
r
r

♦ ��..t� � lX.
0

i
a
Type of Visit 0 Co fiance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit oRoutine O Complaint O follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: • d 2 Departure Time: County: L- Region: IKQ
Farm Name: 0 -,t th or Lki -! a: l''l�Owner Email:
Owner Name: �,. jr _� J) Phone:
/i��CJIcb6 , f
Mailing Address: . � l:
Physical Address:
OFacility Contact: � I 1 �&KJ2Y .n(n A Title:UX't Phone No:
OnsiteRepresentative: ao Integrator:TTe—rr)NLXl'I"1 31 CL
Certified Operator: CQOperator Certification Number: PQ
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = e =' = Longitude: O n =' ❑ „
DesiINGurrent Design Current Design Currentulation Wet Poultry Capacity Population: Cattle. Capacity Population
_. :.
❑ Wean to Finish
airy Cow
Wean to Feeder
❑ Non -Layer
', ❑Dai Caif
❑ Dairy Heifer
`s: ❑ Dry Cow
❑ Non-Dai
, Beei'Stocker
I� ❑
❑ Beef Feeder
[IBeei' Brood Cow
I
Numbet of Structures:
Feeder to Finish
s' % (ob ��
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
D , Pou![
❑ ers
❑ Non -Layers
N
❑ Gilts,-
❑ Boars ❑ Pullets
❑ Turkeys
Uthe 10Turke Poultsl
❑ Other ❑ Other
Discharges & Stream Impacts
Is any discharge observed from any part of the operation'? ❑ Yes 10 No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a, Was the conveyance man-made'?
❑ Yes
❑ No
051 A
❑ NE
b. Did the discharge reach waters of the State`? (if yes, notify DWQ)
❑ Yes
[:]No
7NA
❑ NE
e. 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
ONA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
o
ElNA
ElNE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
El
o
El NA
El NE
other than from a discharge?
Page 1 of 3
12128104
Continued

Facility Number: qj —a Date of Inspection
' Wash Collection &Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
El Yes No
X
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
ElYes ❑No
%NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
tl
Designed Freeboard (in):
?^
Observed Freeboard (in): �! 1
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes �o
❑ NA
❑ NE
(iel large trees, severe erosion, seepage, etc,)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes ;�PNo
❑ NA
❑ NI:
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? ❑ yeslo ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part orthe waste management system other than the waste structures require ❑ Yes �-tAo ❑ NA ❑ NE
maintenance or improvement? V
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need [:]Yes 'ONo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes )4 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 El Application Outside of Area
12. Crop type(s) U t m L !Ai-OLYSEV—d.
13. Soil type(s) LL1j v t I
14, Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
PNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
INo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yesv No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
A No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
XNo
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other cbntmerits. '
,Use.drawings of facility to better explain situations. (use additional pages as necessary):
. - I pare a.re-- Smrna t -r-/f , No eAo S-cam ct " -k4,., �
0 w� W, Ra ;�, �a �� �o s"Ld& .
Reviewer/Inspector Name iL. �t (�) Phone:gjD 1133
Reviewerllnspector Signature: Date: (O
Pa«e 2 of3 1212 4 Continued

Facility Number: 1747 — Date of Inspection
`Requirttd 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 JjNo ❑ NA ❑ NE
the appropirate box. ❑ WCP ❑ Checklists ❑ Design [I Maps El Other
21. Does record keeping need improvement? if yes, check the appropriate box below. ❑ Yes N No ❑ NA ❑ NE
❑ Waste Application ❑ Weckly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections []Monthly and I" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
r9kNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
,,WNo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
Po
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
'RtNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
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
)ZNo
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
$ No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
UNo
❑ NA
❑ NE
cdOd U-W `,(L&
Vqu� 1v1Au
12128104

Ll - loot
Facility Number �� Date Time N Out
Owner LN
Farm Name'?�.ti�l�l
-)192O.I.0 No.
C.O.C. General D
Design Current Design Current
Wean to Finish Wean to Feeder
Feeder to Finish Farrow to Wean
w to Feeder . Farrow to Finish
Boars
er
Soil types
Crop Types &A-mLPGobua4 Pan [ oZ Window toll
Soil Test Plat
Designed Freeboard Observed Freeboard
Rain gauge Rain breaker Daily Rainfall Waste Transfers
Calibration of spray equi ment`'
Sludge Survey Crop Yield
1 in. Rain inspections
. P
Pumping time
G.P.M. ;I 3D
120 Minute inspections
Weather code Weekly Freeboard
Waste Analysis % & Month _7/3 !
Comments

Type of Visit ® Compliance Inspection O Operation Review Q Lagoon Evaluation
Reason far Visit 0 Routine O Complaint O Follow up 0 Emergency Notification. Q Other ❑ Denied Access
Facility Number Ilate of Visit: 9- -e I Time:
Not O e a ional Q Below Threshold
©Permitted [3 Certified j] Conditionally Certified © Registered Date Last Operated or Above Threshold:
Farm Name: A r-w- County: 1_4 A `e U
Owner Name: W -- Phone No: 9 U F7.r y9�
Mailing Address: 3 •
Facility Contact: Title:
Onsite Representative: Integrator:
Phone No:
Certified Operator: Operator Certification Number:
Location of Farm:
03 Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude Longitude
r „
❑ Wean to Feeder
❑ Farrow to Wean
❑ Farrow to Feeder
�AU Boars f
Number of JLagoons
L
:Current 1}esign "'.,Current l: !Design ;0irrent
1'b ulatton ° "; Paultn Ga acity ' Po" utntian Cattle , :,`Ca` acitr r'Po 'ulal on
t; [] Layer F[:DairyNon-La er Non -Dairy ;
h
❑ Other
No Liquid Waste M
Area
J Sprav Field A
Discharges & Stream Impacts
1. is any discharge observed from any part of the operation? ® Yes ❑ No
Discharge originated at: ❑ Lagoon ® Sprav 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 ves, 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 l Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: .7 P
Freeboard (inches):
05103101 Continued

Facility Number: %� — , Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? Oe/ 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 other than waste structures require maintenancehimprovement? ❑ 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 maintenancefttnprovement? ❑ 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? ❑ 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 LRsues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes ❑ 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.
aau�Lllr,ttOtleSbQ�v. Ei
"'rr �; rtaap+ Y +� st �:allf�Gt'an
sa 1t000ml�etl�a�ifl�5.Or �� +OeI�CDrIARllent5. t,. _` i <� t h
�'• ��3fi 9't'tdi t34,M$Tl �r ''� •:SiVwi'"W'.1Mi".�iill4'e'.Hl '1€1 Is�++ Ic„ +aa ,`i,litN b:aL^ ,f 4inww..c.:G+e::.=...-.r_sas:::;.+.�.s_.»:.rs-r' :,4...' i{`
' ' ESRi€tii:T "Gi;3s t".r .6N'Sit!}f^.f:Sfip" �`
Use eisswiagsofrtas�ctysto6etter�expaibuatioas.{ose addtlialnal as aea?') ° ❑ Wield COPY ❑Final Notes . r
Abi
Reviewertor Names
Reviewer/Inspector Signature: Date: -10 O
I2112103 Cowed

Facility Number Date ol'Visit: "�7 '' Timc: ��
Not O erational Q.Below Threshold
® Permitted ® Certified 0 Conditionally Certified [3 Registered Date Last Operated or Above Threshold:
Farm Name: _ 11J k . Cr VIA CPQ Q ��, �- ' r►M1n County: �-
Owner Name: Phone No: J3
Mailing Address: 3 +7- Inc) i . kLt �X' 3 7-C
Facility Contact: Q . l�, C.f. Title:
Phone No:
Onsite Representative: Integrator: _..l9n4. ,r_N r_o 7-cry, e
Certified Operator: LJ , W , LL. 111e-r- I" Operator Certification Number: I
Location of Farm:
M Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 0' 04 0 - Longitude 0' 0
Design
Swine Capacity
Current
Po ulatioi
❑ Wean to Feeder
® Feeder to Finish
G O
❑ Farrow to Wean
�Farrowto
❑ Farrow to Finish
❑ Gilts
❑ Boars
Number of Lagoons
Holding Ponds / Solid Traps
C
Design Current Design Current
Poultry Capacity Population Cattle Ca acitV Population
❑ Laver I 1 1 JE3 Dai
Non -Laver ❑ Non -Dairy
❑ Other
Total Design Capacity
Total SSLW
Di c ar es 8 Stream Impacts
1. Is anv discharge observed from any part of the operation?
Discharge oriainated at: ❑ Lagoon ❑ Svrav Field ❑ Ocher
a, if discharge is observed, was the conveyance man-made?
b, if discharge is observed, did it reach Water of the State? (If yes, notify DWQ )
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of 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?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Freeboard (inches):.
05103101
❑ Yes P No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes
❑ No
❑ Yes
5INo
❑ Yes
MNo
❑ Yes
F�lNo
Structure 6
Continued

Facility Number: , -- Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (icl trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
Immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
❑ Yes JP No
❑ Yes W No
❑ Yes 1�1 No
❑ Yes Ep No
❑ Yes CR No
❑ Yes [59 No
❑ Yes [P No
12. Crop type ' e- f d , i,
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes `0 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?
16. Is there a lack of adequate waste application equipment?
Reauired Records &Dsteuments
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc,)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21, Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ic/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes No
❑ Yes No
❑ Yes ®No
❑ Yes No
❑ Yes [� No
❑ Yes No
❑ Yes No
❑ Yes ® No
❑ Yes ® No
24. Does facility require a follow-up visit by same agency? ❑ Yes [ No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes No
© No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.

Facility Number: Date of Inspectinn 0�
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours?
28, Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
�29. Is the land application spray system intake not located near the liquid surface of the lagoon?
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.c, broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
31. Do the animals feed storage bins fail to have appropriate cover?
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes ❑ No
❑ Yes © No
❑ Yes No
❑ Yes ® No
❑ Yes ® No
❑ Yes No
❑ Yes ❑ No
Additional Coinments�andlor Drawings: „ j"".,
05103101

State of North Carolina
Department of Environment,
Health and Natural Resources
Fayetteville Regional Office
James B. Hunt, Jr., Governor
Jonathan B. Howes, Secretary
Andrew McCall, Regional Manager
�EHNR
DIVISION OF ENVIRONMENTAL MANAGEMENT
Water Quality Section
August 14, 1995
Mr. Carl Little
Dogwood Farms, Inc.
Post Office Box 49
Clinton, N.C. 28328
Subject: Concentrated Animal Feeding Operation
Inspections
Dogwood Farms, Inc. Facilities
4HokeAand Scotland Counties
Dear Mr. Little:
Thank you again for interrupting your schedule to assist in
the inspection of Dogwood Farms, Inc. swine facilities in Hoke and
Scotland Counties August 10, 1995.
Attached please find a copy of the inspection forms for the
facilities visited. We ask that you forward a copy of the forms to
the appropriate farmers with our thanks for allowing timely access
to their farms.
Again, thank you and Mr. Brian Spell for assisting in the
inspection process. If you have questions concerning the
inspections please do not hesitate to contact me at (910 ) 486-1541.
er ,
aul E. Rawls
Environmental Specialist
cc: DEM Facility Assessment Unit
FRO Regional Files
Wachovla Building, Sulte 714, Fayetteville, North Carolina 28301-5043 Telephone 914-48&1541 FAX [phone]
An Equal Opportunity Affirmative Actlon Employer 60% recycled/ 10% post -consumer paper

Site Requires Immediate Attention: NO
Facility No. 47-1
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANINIAL FEEDLOT OPERATIONS SITE VISITATION RECORD
Farm Name/Owner:
Wailing Address:
County: JJnke
On Site Represftative:.(-,!,
Physical Address/Location:
DATE: o , 1995
Time: /1): rfl
C.
Phone:, �1 10 _ 10 4 ..
Phone: n I S1 2 . ;L to
!es S"L.) 52 1.114 A-112.i5.
Type of Operation: Swine -z— Poultry Cattle
Design Capacity: s'7(. o Number of Animals on Site: 67 (-c, rw•�sl,
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: 35 0 o t ' Longitude: 71 ° _6X_'_j4 '
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) to r No Actual Freeboard: L 2Ft. o inches
Was any seepage observed from the lagoon(s)? Yes orq§)Was any erosion observed? Yes of d (Seepage Was
Is adequate land available for spray? Yes or No Is the cover crop adequate? Yes or No Not Evaluated)
Crop(s) being utilized: -- (SRray, Field -or cover crop was not evaluated
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings? for No
100 Feet from Wells?,Q or No
*Is the animal waste stockpiled within 100-Feo-1 f USGS Blue Line Stream? Yes orQ&*
* 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, or -other
similar man-made devices? Yes o 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: reviewed)
s e mo a thqXough ins a tion yJ11 b"on-ducled in the future.
Please contact.-..DEM should any condition arise that poses a danger to surface waters. ,
* This farm was not located on a USGS TOPO map to determine `.'Blue Line" status.
If'you have questions concerning this report please do not hesitate to.contact the inspector
at [phone]. Please contact the inspector if the above information is incorrect.
Inspector Name
cc: Facility Assessment Unit
Signature
Use Attachments. if Needed.

Site Requires Immediate Attention:
Facility No. 7
DMSION OF ENVIRONMENTAL MANAGEMENT
ANDAAL FEEDLOT OPERATIONS STTB VISITATION RECORD
JA\k
Farm NwWOwner:
7►+Idit Addmts:--j'
County: LAke
On Site Represkfntative:_(.,�,
Physical AddresslLocation:
DATE: , 1995
lime: /0:I'D
Phone: (9 io) S-n-A , 2!d4
Type of Operation: Swine x Poultry Cattle
Design Capacity: 5_7(- a Number of Animals on Site: see. Q +
DEM Certification Number: ACE_ DEM Certification Number: ACNEW
Latitude: 3s ° .E.L' jL' 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) W r No Actual Freeboard:_`-.ZFt. o Inches
Was any seepage observed from the lagoon(s)? Yes or&Was any erosion observed? Yes oiSb (seepage was
Is adequate land available for spray? Yes or No Is the cover crop adequate? Yes or No Not Evaluated)
Crop(s) being utilized: (Spray_Fi.eld or cover crop was not evaluated) _
Does the facility meet SCS minimum setback criteria? 200 Feat from Dwellings? for No
100 Feet from We1ls?Z15EPor No
* Is the animal waste stockpiled within 100.-Faff-o-f USGS Blue Line Stream? Yes orb
* 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 o1Q VIQ.> If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray inmgated on specific acreage with cover crop)? Yes or No(Waste management records were not
Additional Comments: - reviewed)
thorou&b i s e conducted In the Euture.
Please contact .DEM should any condition arise that poses a daffier to surface_ waters.
* This farm was not located on a USGS TOPO map to determine `.'Blue Line" status.
If you have questions concerning this report please do not hesitate to.contact the inspector
at [phone]. Please contact the inspector if the above information is incorrect.
Inspector Nam
cc: Facility Assessment Unit
P_J
Signature
Use Attachments -if Needed.

Site Requires Immediate Attention:
Facility No.
DMSION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS STYE VISITATION RECORD
DATE: to , 1995
Time: V : SS'
Farm Name/owner: G • ; rM -G: . G
*Maid Address: 2gs4 (b�3 � - 41-71
County: ag'
integrator:�.� rri _ Phone:
On Site Representative: Phone:
Physical Address/Locadon: 39 JLTR
Type of Operation: Swine _x- Poultry Cattle
Design Capacity: _ mod _ Number of Animals on Site: 23eg) 1;71 .,:d„ N4
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude:_a ° _--t$` .�" Longitude:, ° _&'U"
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) t& or No Actual Freeboard:''- c-Ft. ,,,,_Inches
Was any seepage observed from the lagoon(s)? Yes or l�o Was any erosion observed? Yes 01;;&E�seepage Was
Is adequate land available for spray? Yes or No Is the Cover crop adequate? Yes or No Not Evaluated)
Crop(s) 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? %r No
* Is the animal wash stockpiled within 100 Feet of USGS Blue Lute Stream? Yes orb
* 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 orlCi_) 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
AddidofW Comments: - revigwed)
This was a very brief insuction. a more thorough inspection will be conducted in the future.
Please contact.DEM should any condition arise that poses a danger to surface waters.
* This farm was not located on a USGS TOPO map to determine t'Blue Line" status.
If you have uestions concerning this re ort please do not hesitate to.contact the inspector
at [phone]. Please contact the inspector if the above information is incorrect.
2"1 / R.-I
Inspector Name
cc: Facility Assessment Unit " i l
fit.
Signature
Use Attachments if Needed.