820019_INSPECTIONS_20171231

NUH I H UAHULINA
Department of Environmental Qual

Faciiiry Number: 8L - I i
Division of Environmental Management
Animal Feedlot Operations Site Visitation Record
Time: «F.fS'
General InfQnnation-,
Farm Name: 7leo w. Ke+v 4 Fa Y w, s T N c- - —County: _, -Lei 02S'4 N
Owner Name: • 0s c ht hone N0: 293 - 312
On Site Representative: 0 w +Y w Integrator. cmfrQW5 o 6 d s 4-"C- .
Mailing Address: o I3�,+g go i _
trJu.+.scaw- N C Z.$3y$
Physical Address&=ation:
. Latitude:
Qneration Description: (based on design characteristics)
7�pe of Swine No. of Animals Type of Poultry No. of Animals Type of Cattle No. of Animals
0 Sow D Layer 0 Dairy
* Nursery 0 Non -Layer O Beef
* Feeder -Fri► 7,0*
0ther7)pe of Livestock Number of Animals:
Number of Lagoons: 1 (include in the Drawings and Observations the freeboard of each lagoon)
FacHIM Imection:
Lagoon
Is lagoon(s) freeboard less than lfoot + 25 year 24 hour storm storage?: 7- -Pt
Yes ❑
No
is seepage observed from the lagoon?:
Yes ❑
No ar
Is erosion observed?:
Yes ❑
No Or
Is any discharge observed?
Yes O
No CE(
❑ Man-made 0 Not Man -mode
Cover Crop
Does the facility need more acreage for spmyiug?:
Yes ❑
No.IY
Does the cover crop need improvement?:
Yes 0
No Ir
( list the crops which need improvement)
Crop type: Acreage:,
r
•
Setback
.Criteria
Is a dwelling located within 200 feet of waste application?
Yes ©
No a'
•
Is a well located within 104 feet of waste application?
Yes 0.
No ET
Is animal waste stockpiled within 100 feet of USGS Blue Linc Stream?
Yes ❑
No f3'
Is animal waste land applied or spray irrigated within 25 feet of Blue Line Stream?
Yes ❑
No ar
AOI — January 17,1996

Maiateaance
Does the facility maintenance need improvement? Yes ❑ No e
Is there evidence of past discharge from any part of the operation? Yes O No car,
Does record keeping need improvement? Yes C! No M"'
Did the facility fail to have a copy of the Animal Waste Management Plan on site? Yes 0 No M"O
Cir+. NODo2io 1
Explain any Yes answers, -
Signature: Date:
—
cc: Facility Assessment Unit Use Attachments (fNeeded
JkLwings or Obseasti ns: '
V. Ste i •.'LJ :•�'1 i .
• Af {ir ,• rr
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Factltty+NumberOlDivisioa of Soil and Water Conservation it 11 Ixl
1 �1 ,li 1 f N •I!'li! l� I 1 1 �,: ,�; I
d.IS.'" 1 F 7 i•d, �,Y"i J 1 i, I A 'y. 1 'YI, p j._r.Hli' -r 1';!trlle""i-. I r ull' Ih
;.Y.. ,i•• ;, -���� •-:�!
: ' I #, J ,Yl iL ypH�II . € N t _,,dYi�
-II �,OipOtherA enCV.#.Ysrll:iifYlllil: t€l,l,.t,lr3;!illlEfi,s., 1, 11 11,...:t1ux[l11 ih'I ti� 7' rli1z,!
'1111;1�1il...'H.f-s.i«„m..rL111t,..rlllR�.'.hl Jt...1.lerlll!�,r,h�!:,r..IFII_llxNe,ii�. i,I1 ,IIx ,.iYl1, .rFe., ,a:.-., .J,:, il..'i;'+Ir�r.Lt.r1k:;rrS?i,!li:��':11_.I.lill
Type of Visit:7Routine
fiance Inspection Operation Review O Structure Evaluation 0 Technical Assistance
Reason for Visit: 0 Complaint I) Follow-up C) Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: ® Arrival Time:D'. c'7 Departure Time: County: Region: !1--7— C)
Farm Name:. �r�y rT fOwner Email:
Owner Name: 0)4 r;-- C 9> Phone:
Mailing Address: /
Physical Address:
Facility Contact: 'g`Un v, z:- J `# Title: %1 Phone:
Onsite Representative: _ �% Integrator: C
Certified Operator: zzCertification Number:
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
1 ! 1 ”'11111@1q- i I hili 'ar1=• - ... 1' 1 .If.<• 1 1, i?: ',- "• 1 a: it i3 3n 3 ,r 1 :•,.. , .
I!..- ,l`' .1 it f 1 • - � S3 ; E If , . F. ] ' 1. 1 Si .: '>." I:!
#f1: I i ,
it 1{ t.�,#i....,I(IIIN!,l#'
I i l;y I #li. l I i 1,1 Desi n Current';i !itll#'II E �! 1��1:,I I !I�,il'IIIIDesi n ° Current
�[, 3, I� , x11: ,, , h 1, l
p{ i 1111 .,Nk 31 Wu 1i k ,: ill.! i. _ :iN! �.:i.:4,iili lali.. ils q xli :i 1; ,I...lulYfk: - }
,1 il...: -,q-1 fl r xllllillkls.3 la i IIII I I !n l"E .liu I1 i.i1L! I� ,,,.: I. I,, iq� od, Vr,pulnElil { ,i'1 ;'rN l' € dit s €" Il.s li l.a rt1 11,{Il,u jl pfi 111 _a i1i,11.i V11�Y l'I
,'lI+IIII' II. Swine # I II �If � Ca aci �II lI Pa # ilk,l�:''1 " ck1 s Il WetsPoult I i Ca aci ,I i Po ' II �:;; Ciittic `I i,=„ '.Ca aci ;r Po
Ix,l 1 P , ty i P k ,. ryI;Y ' ,-P. „ tY I op y Il i1 p ty P 1,
Il,i 11 I f>.r•-.,Klxx#fi, ll i� I� 1 �� NII:7##1 I��11iHllwi;ill. II.ILulli ��11,1.,i I ,1' .I,11T:41l t:'.!!i! 113r.':•.�,.:J'hlxiklYlallU.lt....I,��NI?iie� "r,. ;,.r,ll, [II ,,^!IIIIIf.111..,. I k.l II I;rH ,i. iNllhid',�I .';:-1nr�.ir�xlil€ s:�-..SIi11r^t» r. 1:..:...7#'!IY r .,, r.kx,., uf, . I' �.�!�Ik q�
!, rr
h I' i� Y tl E'd:1
! h:
Wean to Finish Layer l
t1�:I ��� Dai Cow
Wean to Feeder i,il Non -La er;i DairyCalf° .
Feederto Finish t l� 1f ll I l I iII ' i+ Ifl? "" ` xl
�j!� I��� � ��� ��� ���I��I�IIq� ��1���(IIlu�i1�l11 Dairy Heifer
Farrow to Wean RIY' lllll�lll{ 1�DesignlCurrent )I Dr Cow (JJ
} IY, rl vliliLll ri i IY,i 111
�1 Farrow to Feeder 11� : D ;,Poult I: j Ca ac>I :1#ut„1Po#Illl ! Non -Dai
Farrow to Finish Icl Layers Beef Stocker��t�
illy Jilts �i`11I Non -Layers #�"j Beef Feeder
Boars 1!��E Pullets i Beef Brood Cow I111�1'
Turkeys
I�1� �€€;III��l1il�i!l�Ilr I .�HIII,I ill°! ' � 1 I I l it I � � I'i,��� l��' 11 P', i) ° I �+ I{ I i l 3 I � I� , !i1 •,l I, I
irlfl�Y#I,OtheGill€I�If#�III111;€�!11►I�j#Ifllli!I1I!II ITurkevPoults • Ir f" 11 I,11'd3 #'!II!rc I''� 1 ppli:��� 11i 1 11 �� I�I
I Yx I,IEII;i�I x,1; ;3c. • # � � ,'
herjI �! l l . d.> ,f . l? .ry� 1 I ,, 1.(1;
Ot r Other, , i'' 1 1. x I�1� I ,
:. ,.'.,..,,'ww,.p„I,rll:l,• l4;mc.e.;e. 11,3,.:,,„a.+-I,,.,..ill1.. ,,,, M',.3, unn.,.?:. .. ,u : lIix.�i:^:fl.� ili�'lIII!.!'fl
II i 1 1 z M
Discharges and Stream Impacts
1. is any discharge observed from any part of the operation? ❑ Yes [DNo ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application }Meld ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
❑ No
❑ NA
❑ NI,
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
[] No
❑ NA
❑ NI,
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
�o
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
allo
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 2/4/2015 Continued

Facili Number: Date of Ins ection: 3—y4
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? 0 Yes allo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:`
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a ❑ Yes QNo ❑ 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 ZLNo ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes E[No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ® No ❑ NA ❑ NE
maintenance or improvement?
I. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes allo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > l0% or 10 lbs. ❑ Total Phosphorus p 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): »v
13. Soil Type(s): _jJ p74'
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes allo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [&No ❑ NA [] NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes �No F-1NA❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes MNo ❑ NA ❑ NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
.@ No
❑ NA
❑ NF
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
ONo
❑ 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
0 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
E2 No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
L�j No
❑ NA
❑ NE
Page 2 of 3 2/4/2015 Continued

1
[Facility Number: - / Date of Inspection: 3-
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes allo
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes allo
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 dale of first survey indicating non-compliance:
26, Did the facility fail provide documentation of an actively certified operator in charge? [:]Yes 0 No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ® 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? (Le., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
34. Does the facility require a follow-up visit by the same agency?
Reviewer/Inspector Name:��
Reviewer/Inspector Signature:
Page 3 of 3
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes [allo ❑ NA ❑ NE
❑ Yes allo ❑ NA ❑ NE
❑ Yes ®, No ❑ NA ❑ N E
❑ Yes QNo
❑ Yes [&No
❑ Yes E&No
NA ❑ NE
❑ NA [] NE
❑ NA ❑ NE
Phone:
Date:
2/4/2015

m S fit` Fx� It7 61-0
ivision of Water Resources
1 Facility Number ®- 0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit:C�ommpliance Inspection Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: (d Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: `c Departure Time: County:��
FarmName: c/'11f1 :' Owner Email:
Owner Name: IV r, -x r a4ttt t� rj¢ Phone:
Mailing Address:
Physical Address:
Facility Contact: f[.pt1t�C �t
Onsite Representative: L t
Certified Operator: L i
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
w
I lila rM
Latitude:
Region:
Phone: _ _ Q,,�
Integrator: 5^A-, �+,�V''t
Certification Number: ZL( 15
Certification Number:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
Layer
Non -La er
Design Current
Dry Poultry Capacity POD.
Layers
Non -Layers
Pullets
Turkeys
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation'?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
Longitude:
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
DrX Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes Q'No ❑ NA ❑ NE
❑ Yes ❑ No [ 1 A ❑ NE
b. Did the discharge reach waters of the State'? (If yes, notify DWIZ)
❑ Yes
❑ No
NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
❑ No
7fNA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
[7No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
[ZfNo
❑ NA
❑ NE
of the State other than from a discharge'?
Page 1 of 3 21412015 Continued

Facille Number: Date of Inspection - -r-
V°aste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate'? ❑ Yes [i].l'itf ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No E�<A ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
[DNA
Identifier:
18. Is there a lack of properly operating waste application equipment'?
❑ Yes
ENo
❑ NA
Spillway?:
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
[] Yes
[%f No
D NA
Designed Freeboard (in):
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check
❑ Yes
[f] No
❑ NA
❑ NE
the appropriate box.
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
IJ i10
❑ 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
RTNo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[-No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
[3No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [ rNo ❑ NA ONE
❑ 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 Windorw� [:]Evidence of Wind Drift ❑r Application Outside of Approved Area
12. Crop Type(s); f -a {r/yM u, A ]j.1jr, 2-e S C�
13. Soil Type(s): lb
14, Do the receiving crops differ from those designated in the CAWMP? ❑ Yes M�No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes C5"No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes [?T -No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application'?
❑ Yes
E` No
[DNA
0 NE
18. Is there a lack of properly operating waste application equipment'?
❑ Yes
ENo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
[] Yes
[%f No
D NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check
❑ Yes
[f] 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 ETNo
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [31No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment'? ❑ Yes &No
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑NA 0 N
❑ NA ❑ NE
Page 2 of 3 2/4/2015 Continued

Facility Number: jDate of Inspection: WS
24: Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes dNo
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes 52'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 ff No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? D Yes [?rNo
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ NA ❑ NE
❑ NA ❑ NE
❑NA 0 N
❑NA ❑NE
❑ Yes E?rNo ❑ NA ❑ NE
❑ Yes [�fNo ❑ NA ❑ NE
❑ Yes [� No ❑ NA ❑ NE
❑ Yes ['r No ❑ NA D NE
❑ Yes �No
❑ Yes 7[ rNo
❑ Yes CZNo
❑NA ❑N
❑NA ❑N
❑ NA ❑ NE
Cdhi*O is (refer to question'#) Explain any'!YES answers] and/or, any additional recominendations orany other comments ; `
'reaplaituationsee tionalpages: aUedawin±s of facilitoettn s necessary).t
C"(1 rvc r o -A -- 1-16-16
51._�1 Q-5d-ve7 & -� 5 • t 3.7 53
Reviewer/ Inspector Name
Reviewer/Inspector Signature:
Page 3 of 3
l � G.J IJ4' t4 Phone: 433 33
T_ )MA
Date:
21412015

ivislon of Water Resources
Facility Number - 0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit: Q;.AE'ompliance Inspection U Operation Review U Structure Evaluation U Technical Assistance
Reason for Visit: Qtoutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: % ' S D Departure Time: r6 County: EA -W— Region: F'z�
Farm Name: ti'rtgC ray !! Owner Email:
Owner Name: &) atr"OL r x tl& f'^'1 tr, Phone:
Mailing Address:
Physical Address:
Facility Contact:/l �� 1!C t h Pl-S Title:
Onsite Representative: t
Certified Operator:
Phone:
Integrator: W 3
Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current Design Current
Swine Capacity Pop. Wet Poultry Capacity Pop. Cattle
Wean to Finish
Wean to Feeder
Feeder to Finish Let
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
La er
Non -La er
rout
Non -L
Pullets
Poults
Design Current
Dischargesand 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)?
Dairy Cow
Dairy Calf
Dai Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
Design Current
Capacity Pop.
❑ Yes [no ❑ NA ❑ NE
[:]Yes 011�o
[:]Yes EfNo
❑ NA ❑ NE
❑NA ❑NE
d. Does the discharge bypass the waste management system? (If yes, notify DWR) ❑ Yes E­f"No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes [Zy�o ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters [:]Yes E No ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 2/4/2014 Continued

Faell4f Number:7ED Date of Inspection: v a.
❑ Yes
No
❑ NA
❑ NE
Waste Collection & Treatment
❑ Yes
[2'1 o
❑ NA
❑ NE
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
Quo
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
E!No
❑ NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
❑ NA
Identifier: D
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
Spillway?:
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
ff No
❑ NA
Designed Freeboard (in):
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
ZNo
❑ NA
Observed Freeboard (in): 5
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[B<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
Wes
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? [0"Y�es ❑ No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes E!rNo ❑ 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 I__I '�o ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [] Yes [jR<o ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > t0% or W lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Windownn -- ❑ EvidencenofnWind Drift [3 Application Outside of Approved Area
12. Crop Type(s): ey idle YA �dR f✓o f vl. - ---
13. Soil Type(s): N0
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes 0 No ❑ NA [] NE
15. Does the receiving crop and/or land application site need improvement? []Yes ❑'ATo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes CZ -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?
Required Records & Documents
0 Yes E?'No ❑ NA ❑ NE
❑ Yes [�fNo ❑ 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
[2'1 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
[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
ff No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
ZNo
❑ NA
❑ NE
Page 2 of 3 2/4/2014 Cvndnued

40
Vacility, Number: -I at jDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes 191�0
25. is the facility out of compliance with permit conditions related to sludge? If yes, check [] Yes U3'No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge'? ❑ Yes [P'IVo
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes 01fio
Other Issues
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
[:]Yes
[DAo
r] NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
E2 No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
[ZKio
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
[ 1 Io
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[;K�o
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
❑'Nlo
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
20"No
❑ NA
❑ NE
Comments (refer to question*): Explain any YES, answers: and/or, any,.additional;,recom men dations or any other comments.
Use drawingsof facili to ,better ex lainaltuations (use addltinnalC rages asnc.cessa ): .
4
ILL
` 5 6 I: s () ee 'e Co u c� o-,
q l
J0 -41A P-4,3 q�7,,
Reviewer/Inspector Name:
Reviewer/ Inspector Signature:
Page 3 of 3
Phone: 433_3 3 3
Date: h go,—Ib
21412014
o,-
2/4/2014

Type of Visit: f(d'7Routine
pliance Inspection U Operation Review U structure Evaluation U Technical Assistance
Reason for Visit: 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time:-—_�� County: S114"
Farm Name:e�✓1��7 V- 1-1 4 1 Owner Email:
Owner Name: 1�Jtcyy6_&x 1:;"mt,�-r, C Phone:
r -
Mailing Address:
Physical Address:
Facility Contact:oi,l Z4 )j CL 1 �,.�. Title: Phone:
Onsite Representative: t ( Integrator: AE
Region: fj W
Certified Operator: b� Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design Current
Swine Capacity Pap.
Wet Poultry
Design
Capacity
Current
Fop.
Design Current
Cattle Eapacity Pop.4g
Wean to Finish
La er
a. Was the conveyance man-made?
airy Cow
[:]No
Wean to Feeder
-Layer
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
airy Calf
Feeder to Finish U 0
c. What is the estimated volume that reached waters of the State (gallons)?
Dairy Heifer
Farrow to Wean
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
Design
Current
Dry Cow
Farrow to Feeder
Dr P,oult ,
Ca act
Po .
Non -Dai
Farrow to Finish
Layers
❑ Yes
FNo
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
Turkey Poults
Other
Other
Discharees and Stream Imnacts
1. Is any discharge observed from any part of the operation?
❑ Yes
[3_WT_6 NA
❑ NE
Discharge originated at: - ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
[:]No
[r].,c"
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
❑ No
❑ 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
E3 ""
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
Ea<
❑ NA
❑ NE
3. Were there any observable adverse impacts or potentiai adverse impacts to the waters
❑ Yes
FNo
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 2/4/2014 Condnued

i acili Number: - Date of—inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 1�pL❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No 0'N -A'[] NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
❑ NA
Identifier:
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[B<o
Spillway?:
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
Designed Freeboard (in):
❑ NA
❑ NE
acres determination?
Observed Freeboard (in):�
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[3 -Na--❑ NA
❑ NF
(i.e., large trees, severe erosion, seepage, etc.)
18. Is there a lack of properly operating waste application equipment?
❑ Yes
(2/No
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
[3'110 ❑ NA
0 NE
waste management or closure plan?
19, Did the facility fail to have the Certificate of Coverage & Permit readily available?
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
[2110— ❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
E]<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
[ o ❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
2-15-o— ❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ❑ o ❑ NA ❑ NE
❑ Excessive Ponding 0 Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > l0% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑Evidenceee,4_4(—
of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): 3 e., t L� kaL 6 f>
13. Soil Type(s): N 6
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[E!rNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[B<o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
�o
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[2"N'o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
(2/No
❑ NA
❑ NE
Required Records & Documents
N
19, Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
2
[] NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
FZ/N 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 Elo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes dNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 6"No ❑ NA ❑ NE
Page 2 of 3 2/4/2014 Continued

Comments (refer to question #): Explaln any YES.answers':And/or any�additional:recommendatibns or -any other comments
Use, drawings of facility to better explain situadons',fuse.Additional ages as necessa ` ).
Cd"I
U-t'e7� '�aal — "� - q- I L( — 0 - L41
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: qS3-3�)3 q
Date: - [
1/4/2014
Facility Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[ No
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
EKNo
❑ 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
[allo
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
[g No
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
El"No
❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
2<0
❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
E3/No
❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage fond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[;'No
[] NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
[21"'No
❑ NA ❑ NE
34, Does the facility require a follow-up visit by the same agency?
❑ Yes
EfNo
❑ NA ❑ NE
Comments (refer to question #): Explaln any YES.answers':And/or any�additional:recommendatibns or -any other comments
Use, drawings of facility to better explain situadons',fuse.Additional ages as necessa ` ).
Cd"I
U-t'e7� '�aal — "� - q- I L( — 0 - L41
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: qS3-3�)3 q
Date: - [
1/4/2014

• , ` O Division of Water Quality
11 Facility Number ®- 0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit: Cot rliance Inspection Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason far
Visit: ,((Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
a e t: Arrival Time: @ n Departure Time: County:
Farm Name: �Lvl.�Yoti� t��tGA Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
�oytC& �jJ tIt w, jTitle:
Onsite Representative: t
Certified Operator: t
Integrator:
Phone:
1/fa
Region:/::::::;17_V
Certification Number: 2t(K,3
Back-up Operator: Certification Number:
Location of Farm:
Swine
Latitude:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
Wean to Finish J I Layer
Wean to Feeder I INon-Layer
Feeder to Finish 0 3
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Discharges and Stream Impacts
Layers
Non -Layers
Pullets
Turkeys
Turkey Poults
Other
Design Current
Longitude:
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
D Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
1. 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 Z ' X ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) [—]Yes ❑ No [D -NIC- ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes ❑ No ONA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes❑ 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 2/4/2011 Continued

Facili Number: -I Date of Inspection: T
❑ Yes
[PNo
❑ NA
Waste C61lection & Treatment
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[3�No
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
Cn No ❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No E]`NAS❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
❑ NA
Identifier:
acres determination?
Spillway?:
17. Does the facility lack adequate acreage for land application?
❑ Yes
Designed Freeboard (in):
❑ NA
[] NE
18. Is there a lack of properly operating waste application equipment?
Observed Freeboard (in):
ff No
❑ NA
❑ NE
5. Are there any immediate threats to the integrity of any of the structures observed?
E] Yes
[No ❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
Q,,1Vo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
EfNo ❑ 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
dNo ❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
CEJ'*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
]o ❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Arc there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No ❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes No [] NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): 'e G1 WUC_. Sy "0
13. Soil Type(s): Al b
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
[3�No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
[] Yes
j(N o
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[�No
❑ NA
[] NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
ff No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
Q,,1Vo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
dNo
❑ 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 Eno
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall []Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes d
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes U "'�
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑NA E] NE
❑ NA ❑ NE
Page 2 of 3 214/2011 Continued

Facili Number: - &M jDate of Inspection:
24. Did tete facility fail to calibrate waste application equipment as required by the permit? ❑ YesWNo"'
❑ NA C] NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
[:]Yes El"No
❑ NA
❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes Q No
❑ NA
❑ NE
and report mortality rates that were higher than normal?
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
29. At the time of the inspection did the facility pose an odor or air quality concern?
[] Yes [TNo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
❑ Yes
[8No
❑ NA
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
[! No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
C:fNo
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[8No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
�Vo
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
E"No
❑ NA
❑ NE
lComments (referao question #): Explain any YES answers and/or any additional recommendations or any. other comments.
use dri wings,of.facility.to better explain situations. (use additional pages as.necessary). " 2
C.tG WC -N,
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
10.7_5 -- i _�_
P
Lft 3
qC3
Phone:40 3' 33
Date: f
214/2011

ivislon of Water Quality
Facility_Number ®- © O Division of Soil and Water Conservation
Q Other Agency
Type of Visit: Compliance Inspection 0 Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: 04outine O Complaint O Follow-up O Referral O Ememenev O Other O Denied Access
Date of Visit: 161 s a. Arrival Time: r' / Departure Time: /' County: c§AM WA Region: r_
Farm Name: 0 1 Owner Email:
Owner Name: 0 ASR fZ f ,n - At _hl p. Phone:
Mailing Address:
Physical Address: yQSQ Rory+ n VAmso 1a
Facility Contact: n[\M?_ S _ Title: Phone:
Onsite Representative: ay'sr N Integrator: --My 14 �1�4 N P,(.,Iw f)
Certified Operator; (S,imr, Certification Number: lglu S_
Back-up Operator:
Location of Farm:
Design Current
Swine Capacity Pop.
Wean to Finish
Wean to Feeder
Feeder to Finish O
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Certification Number:
Latitude:
Design Current
Wet Poultry Capacity Pop.
Layer
Non -La er
Design Current
ury round
Layers
Non -Layers
Pullets
Turkeys
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure [,] Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
Longitude:
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes Co No ❑ NA ❑ NE
❑ Yes
❑ No
[4 NA
❑ NE
❑ Yes
[—]No
1 { NA
❑ NE
❑ Yes ❑ No
[:]Yes No
❑ Yes No
FM NA ❑ NE
❑NA ❑NE
❑NA ❑NE
Page l of 3 214/1011 Continued

%
Facility Number: - Date of Inspection: 1& 15
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ;)A g
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):(�
5. Are there any immediate threats to the integrity of any of the structures observed? []Yes [� No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
[M No
❑ NA
❑ NE
waste management or closure plan?
❑ Yes
[Q No
❑ NA
❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
[] No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
❑ NA
❑ NE
the appropriate box.
9, Does any part of the waste management system other than the waste structures require
❑ Yes
[] No
❑ NA
❑ NE
maintenance or improvement?
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
Waste Application
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[K No
❑ NA
❑ NE
maintenance or improvement?
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
No
11. is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [M No E] 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): -P% INNSN"X4�" Sty t7
13. Soil Type(s): {�
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes] No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ YesNo [3NA E]NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
M No
E] NA
[3 NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[Q No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[�] No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[ No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
[ No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
No
❑ NA
❑ NE
Page 2 of 3
21412011 Continued

w
❑ Yes
[K No
[] NA
Facilit Number: - Date of Ins ection:
and report mortality rates that were higher than normal?
24. Did the facility fail to calibrate waste application equipment as required by the permit'?
[:)Yes
0 No
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
E� No
❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge
levels
E4 No
❑ NA
❑ Non-compliant sludge levels in any lagoon
permit? (i.e., discharge, freeboard problems, over -application)
List structure(s) and date of first survey indicating non-compliance:
31. Do subsurface tile drains exist at the facility'? If yes, check the appropriate box below.
❑ Yes
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes
D ] No
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
❑ No
� NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
[K No
[] NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the I'acility pose an odor or air quality concern'?
❑ Yes
[& No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
E4 No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility'? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
[] NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
33. Did the Reviewer/inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
[50 No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
Y] No
❑ NA
❑ NE
Comments (refer to question ##).. Explain any YES answers and/or any;additional recommendations or any other,comments
Used rawings of facility<to better explain situations (use additional pdes as necessary)
1
l 'h
Reviewer/Inspector Name:
Phone: %',39_9- ugg
Reviewer/Inspector Signature: Date:
Page 3 of 3
2/4/2011

ovs T3 w �1301(/
Type of visit: Compliance Inspection 0 Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit: (�FRoutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: jqj)_ j I Arrival Time: Departure Time: County:.SGmgs"on
Farm Name: RPM Owner Email:
Owner Name: Wlar( TV/h 16, Cb Phone:
Mailing Address:
Physical Address:
Region:
Facility Contact: Rom I)P—_ W, I I (It � ( Title: Phone:
Onsite Representative: kvvp Mthanj Integrator: �4_B
Certified Operator: RvjR± IMaaen Certification Number: igj�s-
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Discharees and Stream Imoacts
I . Is any discharge observed from any part of the operation? ❑ Yes No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State'? (If yes, notify DWQ) ❑ Yes ❑ No ❑ NA []NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge'?
❑ Yes
❑ No
❑ NA
[:]NE
f
Design Current
❑ NA
Des gn Current
De Sig Current
Swine Capacity Pop.
Vliet Poultry
Cap1aci�ty
Pop:
Cattle Capacity Pop.
Wean to I-inish
Layer
Dai Cow
Wean to Feeder
Non -La er
Dai Calf
Feeder to Finish
Dai Heifer
Farrow to Wean
Design
Curreirt
D Cow
Farrow to Feeder
ppyl P.Tint ,
Ca aci
P,o �.
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
11111
Turke s
—
OtherNNINNE
Turkey Points
Other
Other
Discharees and Stream Imoacts
I . Is any discharge observed from any part of the operation? ❑ Yes No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State'? (If yes, notify DWQ) ❑ Yes ❑ No ❑ NA []NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge'?
❑ Yes
❑ No
❑ NA
[:]NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
Page I of 3 2/412011 Continued

Facility Dumber: a. - Date of Inspection:
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
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier: IR
Spillway?: _
Designed Freeboard (in):
Observed Freeboard (in):� _
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
No ❑ NA ❑ NE
❑ No ❑ NA ❑ NE
Structure 6
❑ Yes ® No ❑ NA ❑ NE
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?
❑ Yes
® No
❑ NA
❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
LQhj No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
❑ NE
the appropriate box.
9. Does any part of the waste management system other than the waste structures require
❑ Yes
M No
❑ NA
❑ NE
maintenance or improvement?
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
No
Waste Application
❑ NE
❑ Waste Application ❑ Weekly freeboard p Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
®No
❑ NA
❑ NE
maintenance or improvement?
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment'?
❑ Yes
❑ No
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [—]Yes rR No ❑ NA ❑ NE
❑ Excessive Ponding 0 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
—
1 19
12. Crop Type(s):
1
13. Soil Type(s): 0,b I k I ( VOA
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 [2 No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes We No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
® No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
® No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
® No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No
❑ NA
❑ NE
the appropriate box.
❑ WUP []Checklists [:]Design ❑Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly freeboard p 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
n No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment'?
❑ Yes
❑ No
® NA
❑ NE
Page 2 of 3
21412011 Continued

Facility Number: -I Ct Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ® No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [5g 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'?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification'?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
❑ Yes
R No
❑ NA
❑ NE
❑ Yes
❑ No
[$j NA
❑ NE
❑ Yes
� No
E] NA
E:] NE
❑ Yes ro No ❑ NA ❑ NE
❑ Yes [-No ❑ NA ❑ NE
31. Do subsurface the drains exist at the facility'? If yes, check the appropriate box below. ❑ Yes
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative? ❑ Yes
34. Does the facility require a follow-up visit by the same agency? ❑ Yes
N No ❑ NA ❑ NE
®No ❑NA ❑NE
®No ❑NA ❑NE
®"No ❑ NA ❑ NE
Comments (refer to question #) Explain any:YES Answers Andlor:'any additlona,l ree6mnien'dations or'oany other�coniinents
Use drawinPs Of facility to hetter:explain situations (use additionnl,paees;as necessary).
i .
.
@3� S14je- ro-Bo it at o. q g s1,d j e -o sj&j?? je, Yvfj I nfed C [,eaI A* In a
Reviewer/Inspector Name: EiF
Reviewerhnspector Signature:
Page 3 of 3
Phone:
Date:
1412011

Facility No. -6a—(q Farm Name 16arlfd� Date
Permit ✓ COC OIC_ NPDES (Rainbreaker PLAT Annual Cert )
Pop. Design Current FB
Type Drops
Lagoon 1 2 3 4 5 6 7
Spillway
Design freeboard
Observed freeboard in
Sludge Survey Date I
Sludge Depth ft
Liquid TrL Zone (ft)_
Ratio Sludge to Treatment Volume
Calibration Date 1 r 3 2 3 4 5 6 7 8
Design Flow
Actual Flow
Design Width
Actual Width
Soil Test Date ID 100 Wettable Acres RAIN GAUGE
pH Fields WUP Dead box or incinerator
Lime Needed--- Weekly Freeboard Mortality Records
Lime Applied 1 in Inspections
Cu -I L,1n-I 120 min Insp.
Needs P Weather Codes ✓
Crop Yield Transfer Sheets
:. ..
..ZRM
Verify PHONE NUMBERS and affiliations
Date last WUP FRO!5)'Al04 Date last WUP at farm
FRO or Farm Records
Lagoon #
Top Dike ri
Stop Pump 1.1 c ^
Start Pump
Conversion- Cu -I 3000= 108 lb/ac; Zn -I 3000= 213 Ib/ac
App. Hardware

Fbrvls S -1 Z Z o l o
!vision of Water Quality
Facility Number 2_—J / O Division of Soil and Water Conservation
0 Other Agency
Type of Visit G-Co_rnpliance 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: Arrival Time: 19# WA*" I Departure Time: S: / f County: Region:
Farm Name: rew"a. ` �' - # Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: F;�» Ap^te c.d� Phone No:
Onsite Representative: Integrator: %weevo�.�.
Certified Operator: �6 NN i t fid wta , Li 11rx A.S' Operator Certification Number: Z�14 /.s3
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
LJ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Back-up Certification Number:
Latitude: =0 =
0= I Longitude: =0=1 001
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑
Layer
❑
Non -Layer
Other
❑ Other I_ J
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 Stocker
❑ Beef Feeder
❑ Beef Brood Cow
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 2No ❑ NA EINE
❑ Yes
❑ No
O NAA
❑ NE
❑ Yes
❑ No
["}"NA
❑ NE
iA
[:1 NE
❑ Yes
[:1 No
Yes
[:1y
LN"o
NA
El NA
NE
ElYes
2N o
❑ NA
❑ NE
Page I of 3 12/28/04 Continued

,f
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: ,# t?
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
22'�
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 d� ❑ NA ❑ NE
❑ YesNo ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes No ❑ NA ❑ NE
❑ YesNo ❑ NA ❑ NE
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 9<0 ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks) /
9. Docs any part of the waste management system other than the waste structures require C3 Yes [2<o C3 NA C] NE
maintenance or improvement?
Waste ARPlication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes NA ❑ NE
maintenance/improvement? ,�
11. Is there evidence of incorrect application? If yes, check the appropriate box below. El Yes 3<0 ❑ 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 Wind/ow ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) j?>ew .►e �a, (� Y� . L o• S
13. Soil type(s) NoA
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement'?
❑ Yes
❑ Yes
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
17. Does the facility lack adequate acreage for land application'? ❑ Yes
18, Is there a lack of properly operating waste application equipment? ❑ Yes
�No ❑ NA ❑ NE
[ to
[I NA ❑N
[� N ❑ NA ❑ NE
�0�[0:1
NA E]NE
NA ❑ NE
;:'::'1 RfAi�.. ��F,H t-i;'{;�,,wa k'rP7dlFh';'rci6".k 9�-�e'�{3'F.,.°k5t��:Nii�!;"k
Comments (refer to question,#) Eiplaln'any+YESEunswcrs,and/a ny recammendation4 ar any other comments:; E'
1sc drawings,of facilii to f e' ', :cX "lain situation : (use nildiiional a es'as necessary)
y p .'i o lg p a g
�gJb- f/33.33a aReviewer/Inspector Name $s
Reviewer/Inspector Signature: Date: Jb —Zd/(]
12/28/04 Continued

Facility Number: Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check
the appropriate box.
❑ WUP ❑Checklists ❑Design ❑Maps ❑Other
❑ Yes El No❑ NA [:1NE
❑ Yes No ❑ NA ❑ NE
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
No ❑ NA
❑ NE
28.
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
O No
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I"
Rain Inspections ❑ Weather Code
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
No
❑ NA
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
No ❑ NA
❑ NE
30.
At the time of the inspection did the facility pose an odor or air quality concern?
El Yes
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ NA
❑ NE
24,
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
;V7NNp, ❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ NA
❑ NE
26.
Did the facilityfail to have an actively certified operator in charge?
Y P g
❑ Yes
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
b No ❑ NA
❑ NE
Other Issues
AL
7
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
O 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?
El Yes
P o
❑ 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
[__1 NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/]nspector fail to discuss review/inspection with an on-site representative?
❑ Yes
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
No
❑ NA
❑ NE
,r, � .,.
,Fk!"',
Additional Commenfsandlor Drawin[[��s; ! J� y�^^II1�JJ�� ,g1&r7
4 .f] ;la xf�'n�A- 9 IT A'I�iE�"i. l vNil%1 rvlrin V C" i 1dk {A .� C ... - r�
AL
7
Page 3 of 3 12/28/04

✓ P,z►vtS //- ZJ -ZOO 9
®'1r' of Water Quality
n.
rv�sio -.
Facility Number : S Z. /. U0 Division of Soil and Water Conservation
Other Agency
Type of Visit
ompliance Inspection
O Operation Review O Structure Evaluation
O Technical Assistance
Reason for Visit
outine O Complaint
O Follow up O Referral O Emergency
O Other ❑ Denied Access
Date of Visit: Arrival Time: /a : Qm Departure Time: County: Region:
Farm Name: KGNAle14 ICz ~�- 41'-% Owner Email:
Owner Name: __ &43 rra. ,v 5_c%J A/ c- Phone:
Mailing Address:
Physical Address:
Facility Contact: A00yAu'c. 'Jilte'l S Title: ±4 )" . _ Phone No:
Onsite Representative: e0AN) e_ k%ltf'r° "` s integrator: Af -'a
Certified Operator: kl0.1Ajf _ Operator Certification Number:
Back-up Operator: _ f� �rG l d IJO ✓V Back-up Certification Number:
Location of Farm: Latitude: =0 =1 =11 Longitude: = °
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
�, ❑
Layer
❑ Non -Layer
Other
❑_Other
Dry Poultry '
Non -L,
Pullets
Poults
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑
Dairy Calf
❑
Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
Number of Structures. Ell
K 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 3 o ❑ NA ❑ NE
❑ Yes
❑ No
E3<A
❑ NE
❑ Yes
❑ No
E3<A
❑ NE
Q NA
❑ NE
❑ Yes
❑ No
❑ Yes
ET<o
❑ NA
❑ NE
❑ Yes
LJ No
❑ NA
❑ NE
12/28/04 Continued

1.
Facility Number: 13 1 9
Date of Inspection //'/9-0
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2
Identifier: Z
Spillway?: A10
Designed Freeboard (in): 1 I Z
Observed Freeboard (in): Z 3
Structure 3 Structure 4
❑ Yes L'7 No ❑ NA ❑ NE
❑ Yes [30<o ❑ NA ❑ NE
Structure 5 Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes Z 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 ]o ❑ 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 [3<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 B o ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [TN ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes G?<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 Hare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) %+�rw•�c�c� (Gtr�ycr, �w<11 (nuc-iw IQ, S•—)
13. Soil type(s) NO /a-
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
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? []Yes
17. Does the facility lack adequate acreage for land application? ❑ Yes
18. Is there a lack of properly operating waste application equipment?
❑ Yes
D"No ❑ NA ❑ NE
,�No El NA ❑ NE
I1 No ❑ NA EINE
To ❑ NA ❑ NE
d A.G1p:;. A. , ..��i.x �k�ll:,sw�til��
Comments�(refer to!�question.#) IExplai!Nany+,Y,EN;answe�rs andf.or any_Lr�eco t nd> ons or any other comments.
Use drawings<of.facilIty to better explain?s{/itgations (useraddihonaI�pages ns!necessary)Nt
T
Reviewer/Inspector Name j err ERL';[5 : '', ,`'�`,,�4 Phone 9/0, 4t33.33o O
Reviewer/inspector Signature:
Date: 1/-1 i 200 %
12/28/04 Continued

Facility Number: 62 —/ 9 Date of Inspection 1,
Beggired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes L1No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes f=1 No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design g ❑Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 2<o ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield [:1120 Minute inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
EYNo
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
�lo
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
B No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
[3 No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
[3 o
❑ 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? ElO Yes No ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
B No ❑ NA
❑ NE
and report the mortality rates that were higher than normal?
34. At the time of the inspection did the facility pose an odor or air quality concern?
❑ YesNo
❑ 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
Flo ❑ 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
L_fNo NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
o ❑ NA
❑ NE
12128104

r
16 Division of Water Quality
Facility Number gZ g 0 Division of Soil and Water Conservation
O Other.Agency
Type of Visit it Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit ® Routine Q Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: /Z -I -07 Arrival Time: Departure Time: Z :30 County: ^'IDSBw/ Region: /cid
Farm Name: G1P_wwl4d�, Owner Email:
Owner Name:__— 6eav/c1 LJ0II_r Phone:
Mailing Address:
Physical Address:
Facility Contact: IZONNr G-. LJA'flh ►s Title: /Ca-+ e�& t" - Phone No:
Onsite Representative: jeDNNf e_ w<</%e,.s Integrator: Rrc_ i 'q �T� ✓�'t s
Certified Operator:
Back-up Operator:
Location of Farm:
�o
Latitude:
Operator Certification Number:
Back-up Certification Number:
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population
❑ Wean to Finish ❑ Layer
❑ Wean to Feeder JEI Non -Layer
® Feeder to Finish 170 410
ILJ Farrow to Feeder I I I
Gilts
Boars
Other
❑ Other
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ TurkeyPoults
❑ 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?
Longitude:
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heife+
❑ Dry Cow
❑ Non -Dai
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
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)?
Number of Structures: �.
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
0
❑ Yes [9 No ❑ NA ❑ NE
❑ Yes
®No
❑ NA
❑ NE
❑ Yes
[� No
❑ NA
❑ NE
❑ NA
C3 NE
❑ Yes
M No
❑ Yes
[� No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
12/28/04 Continued

! y
Facility Number: SZ —
Date of Inspection 2-21-07
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? [:]Yes (A No ❑ NA EINE
a. If yes, is waste level into the structural freeboard? [-]Yes EMNo ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?: 14 /X
Designed Freeboard (in):
Observed Freeboard (in): _ �40
5. Are there any immediate threats to the integrity of any of the structures observed'? ❑ Yes [ No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed ❑ Yes No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes [A No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ® No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes E4 No ❑ NA ❑ NE
maintenance or improvement?
Waste Aaalication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes N No ❑ NA ❑ NE
maintenance/improvement?
11. is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes [R No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drifl ❑ Application Outside of Area
12. Crop type(s) c... ice,
13. Soil type(s) &A
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [8 No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes
[1 No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
[2 No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes
P No
[INA
❑NE
18, Is there a lack of properly operating waste application equipment? ❑ Yes
ZjNo
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/inspector Name i eJ G S Phone: 9/0, X33. 33y o
Reviewer/Inspector Signature: Date: /Z—Z/— Z007
12/28/04 Continued

Facility Number: $Z —1 q7 Date of Inspection Z—ZI—O
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 0 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropirate box. ❑ W -Up ❑ Checklists
❑ Design ❑Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
[ No
❑ NA
❑ NE
23.
if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[� No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
VJ No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
[;?No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification`?
❑ Yes
�YNo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
VNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
0 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
[,2 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
[:1 NA
1:1 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
12/28/04

Type of Visit ® Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit ® Routine 0 Complaint 0 Follow up 0 Referral O Emergency O Other ❑ Denied Access
Date of Visit: $ aS'Ow Arrival Time: Departure Time: Q County:a,
Farm Name: +nN��+d 1,140{�O, f Owner Email:
Owner Name: C". ict. L'Ja.ktre.N Phnnr!
Region: /AZO
Mailing Address:
Physical Address:
Facility Contact: 21"'b ii -t— WLJJanS Title: ��Y��y . Phone No:
Onsite Representative: RONN3 t=.. _ ���+��-5 integrator: 1�1�G+��u+� Slid. /5—WV'0".5
Certified Operator:
Back-up Operator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: = c ='
= Longitude: = n = t =
td
Design Current DesignC►urrent
Swine G WD—a c i t�yj Papulation Wet Poultry Capacity Population
❑ Yes
P No
❑ NA
Design Current
Cattle Capacity Papulation
Discharge originated at; ❑ Structure ❑ Application Field ❑ Other
❑ Wean to Finish
10 Layer
I
-Dairy Cow
a. Was the conveyance man-made?
❑ Wean to Feeder
❑ Non -Layer
❑ NA
❑ Dairy Calf
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
Feeder to Finish `t Z
❑ Farrow to Wean Dry Poultry
❑ Farrow to Feeder
❑ Farrow to Finish ❑ Layers
❑Gilts Non -Layers
❑ Pullets
❑ Boars El Turkeys
Other ❑ Turkey Pouits
❑ Other ❑ Other
❑ Dairy Heifer
❑ Dry Cow
❑ NA
❑ NE
ElNon-Daily
El Beef Stocker
❑ Beef Feeder
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Beef Brood Cow
(allo
❑ NA
Number of Structures:
Discharges & Stream impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
P No
❑ NA
❑ NE
Discharge originated at; ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
O No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
[NNo
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
(allo
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
[ RNo
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
WNo
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
12128104
Continued

Facility Number: Z /
Date of Inspection ZS'
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier: LtS $
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): T�
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 [XNo
❑ Yes VNo
Structure 5
[__1 NA El NE
❑ NA ❑ NE
Structure 6
❑ Yes ONo [INA ❑ NE
[-]Yes N No ❑ NA ❑ NE
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 C9 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 1 0 No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[ No
❑ NA ❑ NE
maintenance/improvement?
11.
Is there evidence of incorrect application`? If yes, check the appropriate box below.
❑ Yes
No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Win``dow ❑ Evidence of Wind Drift ❑ Application Outside of
Area
12.
Crop type(s) _og_c tlt d1L_ / ''CrI"e in! CO s
13.
Soil type(s) IVp ,4
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
(M 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
No ❑ NA ❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
4 No
❑ NA ❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
% No
❑ NA ❑ NE
Comments'(refer-to question #)c Explain any YES.answers and/or any recommendations or any other comments:
IIUse drawings `of,facility to better explain situations.. (use additionalpages as necessary):
Reviewer/Inspector Name -- - �V .t: S — - Phone: aV_AJ U -333a
Reviewer/Inspector Signature: Date: Xy Z S/24a6a
Page 2 of 3 12/28/04 Continued

Facility Number: �Z — / Date of Inspection ZS' o
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ["mNo ❑ 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 El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [� No [INA ❑NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
FO No
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
[I Yes
[,XNo
❑ NA
ElNE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
1�1No
❑ 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
EXNo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
M 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
[g 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
[ANo
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/[nspector fail to discuss review/inspection with an on-site representative?
❑ Yes
M No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
ONo
❑ NA
❑ NE
Additional Comments and/or Drawings:
Page 3 of 3 12/28/04

►1
Type of Visit 0 Compliance inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit • Routine Q Complaint Q Follow up 0 Referral 0 Emergency O Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: County: n Region: 6&42
Farm Name: leenn e ,,, Farms Owner Email:
Owner Name: Phone:
Mailing Address: P oK 7�� Ner..t�o., G►�,rr 7VC------ -
Phvsical Address:
Facility Contact: Ay n"e <✓ /%i'n...; Title:
?e0*n,'e
Onsite Representative: W,
Certified Operator: - Aw �i/arrrn
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
Gifts
Boars
Outer
❑ Other
Phone No:
Integrator: __6_dom-Z
Operator Certification Number: 19/y F_
Back-up Certification Number:
Latitude: 0 0 = ` 0 11 Longitude: =0=6
o=6 =
it
Design Current Design "Current
Capacity Population Wet Poultry Capacity Population
[--]Layer
�I ❑ Non -Layer
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑
Turkeys
❑ Turkey Poults
❑ Other
Discharses & 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 Heifet
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocket
❑ Beef Feeder
❑ Beef Brood Cow
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 [3fo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
El Yes
[2N*o
El NA
❑NE
El Yes
2<)
❑ NA
❑ NE
12/28/04 Continued

Facility Number: S2 — r Date of inspection -» o
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 005o ❑ 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?: 46
Designed Freeboard (in): q,, "
Observed Freeboard (in): (� "
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 2—Mo. ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed ❑ Yes ZNo ❑ 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 allo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
ZNo
❑ 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
�10
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10, Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
2No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below,
❑ Yes
O'No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
A 9- S0
12. Crop type(s) _ &errrlsr4t' Sl" f4f'� 6ru.'n
13. Soil type(s) �h, id
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
ON o
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
ON
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination[]
Yes
❑ No
❑ NA 21] E
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA Q'NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
2&o
❑ NA ❑ NE
Qe5-�,q, f Feeegov,W S %9.� �� ��+�•`ewt� 7�Ij,'f wyii /�i'r: 4J ��ia.,S
Reviewer/Inspector Name �ar'/( ;(� ,n f�*y,' Phone: 110-10 _-,Tw af 1
Reviewer/Inspector Signature: Date: '» O 5
12/28/04 Continued

Facility Number: Date of Inspection •» ai`
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 914o D. NA ❑ NE
20. Does the facility tail to have all components of the CAWMP readily available? If ycs, check ❑ Yes C o ❑ NA ❑ NE
the appropirate box. ❑ 1yje� ❑ c >,Pkrsts ❑ Can ❑ >aT , ❑ 9,L4&
21. Does record keeping need improvement`? [f yes, check the appropriate box below. [�Kyes ❑ No ❑ NA ❑ l NE
,--,/ V -11P 7►.'1-n-M
2 aste Application ❑ Weeltl' Freebvrc�#-,/❑ ❑iris El1irstt-'f�, s ers El Annual Certification
❑ tt'- ❑ tng Crop Yield l-7 l20 Minute Inspections ❑ . ' ns 'Weather Code
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment`?
24. Did the facility fail to calibrate waste application equipment as required by the permit'?
25. Did the facility fail to conduct a sludge survey as required by the permit`?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance ofthe permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal'?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional offiee of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/inspector fail to discuss review/inspection with an on-site representative?
33. Does facility require a follow-up visit by same agency`?
❑Yes
DN o
0 N
[:1 NE
❑ Yes
[2rNo
❑ NA
❑ NE
❑ Yes
ONo
❑ NA
❑ NE
❑ Yes
[,Z No
❑ NA
❑ NF
❑Yes
IJNo
0 N
C:1 NF
❑ Yes [--]No ❑ NA Ca'N E
[--]Yes ,�lo ❑ NA ❑ NE
❑ IJ Yes No ❑ NA ❑ NE
❑ Yes ONo ❑ NA ❑ NE
❑ Yes ET'No ❑ NA ❑ NE
❑ Yes
tT 1No
❑ NA
❑ NE
[:]Yes
Q No
❑ NA
❑ NE
AdditionO'Commenti and/or Drawings -
1P.21 Ole Sp file A44 Z7,e a r, '!N � `yj I ✓� T� P L✓GelTh fi a -le C O &-,-, MK
�7� wl.d✓!! ��3/le. bryrj /¢',t✓fd ��trft 4�! 44e ecegv •,i-�� / dep11.
12/28/04

Type of Visit QVCompliance Inspection 0 Operation Review 0 Lagoon Evaluation
Reason for Visit 040'utine 0 Complaint 0 Follow up 0 Emergency Notification 0 Other ❑ Denied Access
Facility Number �? 9 I,)ate of Visit: 9 0 Time:
Q Not Operational Q Below Threshold
© Permitted [3 Certified [3 Conditionally Certified [3 Registered Date Last Operated or Above Threshold: .....................
FarmName: ...... i1Cn n G�............�ar.!..................�.................................................... County:.........5! '" N ............................... .......................
Owner Name:........JQlith F&r'...... . Com" Phone No:...... g �................................................
............... ......................... .........
Mailing Address: .. '. �'.... °!4.. .°!.3. ........................................... ... /lcw4on......Orm NC A34 6........
... ...... ........ ... ................... ... ..................
1
Facility Contact: ........&1'!.I A ................. Title: ....... M"A:IS R ................................. Phone No:...................................................
Onsite Representative: �ry,(t....... c,1 �N,S Integrator:...... ar�tn / Pnrw„uw� v�c�a(Q
..............................................................................................................
Certified Operator:....... ...&!.... W+ �'&+++ I .... Operator Certification Number: ... i isl....................
Location of Farm:
&Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • & L .J� 44 Longitude ' ° id
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes eNo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/ntin?
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 Mo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes [INo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
❑ Yes [ INO
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ............. .................... ................................................................................................................................................................................
Freeboard (inches):
12112103 Continued

Facility Number: Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes L3 No
seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a waste management or ❑ Yes 91 o
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 dNo
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes 9No
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 maintenance/improvement?
❑ Yes"No
o
11. Is there evidence of over application? If yes, check the appropriate box below.
❑ Yes
B"No
❑ Excessive ❑ PAN [:]Hydraulic Overload []Frozen Ground [I Copper and/or Zinc
/Ponding }
12. Crop type i ¢a 1 , W 7r�'FN o�+►+tat4 f �Y�t� ^PefsCJ�
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
[Of4o
b) Does the facility need a wettable acre determination?
❑ Yes
ERNo
c) This facility is pended for a wettable acre determination?
❑ Yes
[a'No
15. Does the receiving crop need improvement?
❑ Yes
09'1�0
16. is there a lack of adequate waste application equipment?
❑ Yes
�10
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes [�No
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes 2,140
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes El<o
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 3l0
Air Quality representative immediately.
C] Final Notes
"J look$ Uors
14 amts. ;S Let, JoW ',yi CoasAJ 4,j w; 1t Lr aim `Iv rian b.+ce
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Date: a;1 ori
12112103 // Continued

•• Facility Number: Date of Inspection
Reauired Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes ff<O
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.) ❑ Yes QlTo
23. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 21 o
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes 9 -No
25. Did the facility fail to have a actively certified operator in charge? ❑ Yes 2<0
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes 2No
27. Did Reviewer/Inspector fail to discuss review/inspection with on-site representative? ❑ Yes [a-10
28. Does facility require a follow-up visit by same agency?
❑ Yes
PNo
29.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
2f4o
NPDES Permitted Facilities
30.
Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
[94es
❑ No
31.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
Q,Ko'
32.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
0-1ro
33.
Did the facility fail to conduct an annual sludge survey?
❑ Yes
[�o
34. Did the facility fail to calibrate waste application equipment? ❑ Yes [moo
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below. ❑ Yes Mdo —
❑ Stocking Form [:]Crop Yield Form ❑ Rainfall [:]Inspection After V Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
JW No violations or deficiencies were noted dewing this visit. You will receive no further correspondence about this visit.
n� i .p,.z��,y> d//ys a',, 1. 'i � 3".tl�: _i"ta 9j l'ri0 € i cF:�:'€4.I. 1 Pt'3":,tli�; ;eE§:Brrf� a..• i � S ' '+G f . - ii€i {- ^� i i, 1 2` �Si' j Fj Ii t
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'l.�ieb�a,l-+D+n S��u�C� w1� JVD%h Anw.�. �� a'Y•Ys'
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C�►-c a�rir�� � �tc.;�ic. r'a`�ey
12/12103

i
Site Requires Immediate Attention:
Facility No. 5'2 2v
va t
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: , 1995
Time:
�'GJr/N f ,SEE/✓ ���5
Farm Name/Owner: P r0f 7' : a
Mailing Address: �a. AOA qj) �450W .,vc_ ;j?s'
County: saw
Integrator: s r` p phone:
On Site Representative: Phone:
Physical Address/Location;
Type of Operation: Swine �Z Poultry Cattle
Design Capacity: Number of Animals on Site: %a
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: Longitude: "
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches)es r No Actual Freeboard:Ft. Inches
Was any seepage observed from the In(s)? Yes or No Was any erosion obs ed? Yes or No
Is adequate land available for spra ? r or No Is the co er crop adequa ? or No
Crop(s) being utilized:
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellin'� es r No
100 Feet from Wells? es o
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream?s or
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue 14rrf e: Yes o 90
Is animal waste discharged into water of state by man-made ditch, flushing system, or other
similar man-made devices? Yes or 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)? (ff�r No
Additional Comments:
Inspector Name
Signature
cc: Facility Assessment Unit Use Attachments if Needed.

JUL 14 11:=E-rM
NORTH CAROLIM DEPARTMENT OF FSNIRON MMi SZXLTH & NATURAL RPSOURC ES
DMSION OF ZiMONKENTAL KANAGCENT
Fayetteville Regional Office
Animal Operation Compliance Inspection Porn
k
PAM ':K 70WIo E ..�i��t" SN5pEGTION "D8T'S :FARlM Lt@�FSA '`'
.:-',
V
XA1ZiNG ADD S •* a?: TELFFHDN MTI+�PR
.,
o
3 rz4-
All. questions answered negatively will be discussed in sufficient detail in
the Comments Section to enable the deemed Permittee to perform the appropriate
corrections:
E
Animal _0 _P -ration T
Horses, cattle, win poultry, or sheep
SE'MON SI
1. Does the number and type of animal meet or exceed
the (.0217) criteria? [Cattle (100 head),
horses (75), swine (250), sheep (1,000), and
poultry (30,000 birds with liquid waste
system)]
2. Does this facility meet criteria for
Animal Operation MOISTRATION?
3. Are animals confined fed or maintained
in this facility for a 12 -month period?
4. Does this facility have a MTTYTM AMU
NM= 98MMUNT FLAW
S. Does this facility maintain waste management
records (Volumes of manure, lased applied,
spray irrigated on specific acreage with
specific cover crop)?
6. Does this facility meet the SCS minimum
setback criteria for neighboring houses,
wells, etc?
I✓
M

SECTIQNfTxI --
Field Site Manaaem%3t
I. Is animal waste stockpiled or lagoon
construction within 900 ft. of a RSCS
Map Blue Line Stream?
2. Is animal Waste land applied or spray
irrigated within 25 ft. of a USCS Map
Blue Line Stream?
3. Does this facility have adequate acreage
on Which to apply the waste?
4. Does the land application'site have a
cover crop in accordance with the
MTIP1CATIQN 2I.AN?
S. Is animal waste discharged into waters of
the state by man-made ditch, flushing system,
or other similar marl -made devices?
b. Does the animal Waste management at this
farm adhere to Best Management Practices
(BMP) of the approved CEtt=XrAjLW.
7. Does animal waste lagoon have sufficient
freeboard? How much? (Approximately )
S. is the general condition of this CAFO facility,
including management and operation,
satisfactory?
SECrIQN IV
Comments
JUL 14 '95 11:4bH

0