820024_INSPECTIONS_20171231

NURTH CARCLIN
Department of Environmental Qual

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Type of Visit: omplinnce inspection 0 Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: Routine Q Complaint Q Follow-up O Referral Q Emergency Q Other Q Denied Access
Date of Visit: Arrival Time: ® Departure Time: ; / County: ,�-.j-- Region:
Farm Name: Rey �'�; t"Tr b Owner Email: —�
Owner Name: ��, } ►•�,P Phone:
Mailing Address:
Physical Address:
Facility Contact: z Title: curt-r✓ Phone:
Onsite Representative:«.. Integrator: _/ t
Certified Operator: Sc Certification Number: fry'
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
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Farrow to Wean
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Layers
Gilts
-Layers
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Discharizes and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes ❑ No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
❑ No
DNA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (if yes, notify DWR)
[:]Yes
[:]No
[:]NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
❑ No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
0 No
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412015 Continued

. IFaelli Number: - Date of Ins ection: V�
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No
a. If yes, is waste level into the structural freeboard? ❑ Yes No
Structure 1 Structure 2 Structure 3 Structure 4
Identifier:
Spillway?: I _
Designed Freeboard (in):— �N
Observed Freeboard (in): °� l >✓ _
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
❑NA ❑NE
❑ NA ❑ NE
Structure 5 Structure 6
❑Yes fMNo ❑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? IN
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 M 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) P,
9. Does any part of the waste management system other than the waste structures require ❑ Yes �] No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, 7n, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop'I'ype(s).
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NI:
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
® No
T
❑ 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 ofthe CAWMP readily available? ]fyes, check
❑ Yes
No
Pq
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather
Code
❑ Rainfall ❑ Stocking [:]Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
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
21412015 Continued

j Facili Number: - 77r, Date of Inspection:AO
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes OfNo
`" 25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
Dist structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes No
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes No
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 XNo
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below. ❑ Yes No
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes No
33. Did the Reviewer/lnspector fail to discuss review/inspection with an on -site representative? ❑ Yes rV No
34. Does the facility require a follow-up visit by the same agency? ❑ Yes ® No
fir- .' !'c ��� ��� p L� �►
Reviewer/Inspector Name:
W141 fi
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑NA ❑NE
Phone:
Reviewer/Inspector Signature: /l/t 7ZZ - J Date: zZ pegg U f
Page 3 of 3 214,12015

x
t ype of v tst[: t-�,t.ompuance inspection v uperarion tceview u arruciure Lvatuanon v i ecnnicat a►sstsrance
Reason for Visit: 0-f outine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: /7 /— f Arrival Time: / Departure Time: County: Region:D
Farm Name: Owner Email:
Owner Name: � �h n ry Phone:
Mailing Address:
Physical Address: /i
Facility Contact: C.. -` Title: Phone:
Onsite Representative: Integrator: S/ el W__�
Certified Operator: _ �`Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design Current Deslgn Current
Swine Capacity Pop. Wet Poultr*Y Capacity Pop.
Wean to Finish Layer
Design Current
Cattle Capacity Pnp.
DairyCow
DairyCalf
Wean to Feeder
j Non -La er
Feeder to Finish
DairyHeifer
rw�
u.m
Farrow to Wean
Deslgn Current
D . P.oultt. Ca aci P.
Layers
D Cow
Farrow to Feeder
Farrow to Finish
Non -Dairy
Beef Stocker
Gilts
an -La ers
Beef Feeder
Boars
11N°�
�ther ���
US
1ullets
Beef Brood Cow
Turke s
T'urke Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d, Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes ® No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes No
❑ Yes No
❑NA ❑NE
❑NA ❑NE
[DNA ❑ NE
Page 1 of 3 21412015 Continued

Facility Number: 1 Date of Inspection: �-
1
Waste Collection & Treatment
■ 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
❑ No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):�
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
❑ No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental
threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
❑ No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
❑ No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes]
No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
❑ No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [] No ❑ NA
❑ 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): .'41vtL _ /P U � GGD'� /`er' r +_ /(- >)�.T���Ie2—
❑ NE
J � e'
13. Soil Type(s): N O
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes E�JNo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? [:]Yes [g-No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes allo ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
[]Yes allo ❑ NA ❑ NE
[]Yes allo ❑ NA ❑ NE
Renuired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes RNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 0,No ❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements ❑Other:
2 1. Does record keeping need improvement? If yes, check the appropriate box below. []Yes ❑ No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections [:]Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [� o
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facili Number: - Date of Ins ection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes Z�No
25. is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ®_No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes 2-No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ENo
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 ❑ NE
❑ NA ❑ NE
❑ Yes [4 No ❑ NA ❑ NE
❑ Yes LD-No ❑ NA ❑ NE
❑ Yes Cg-No ❑ NA ❑ NE
❑ Yes CgNo ❑ NA ❑ NE
❑ Yes w, No
❑ Yes E[No
❑ Yes ED1Vo
❑NA ❑NE
[] NA ❑ NE
❑ NA ❑ NE
Comments (refer to question,#) Explain any,YES answers4nd/or any additlanair.recottimendation�;or;:any. other comments,; r
"py M k '� r yE. i. .,yi ° .. 'w rw r '•:.aa �'�.' �'' a, ':', ri r P: tlr��v� h� '�'� 'v _' h _ ; �
n 1
Use c#rawin s of'faclli to better ex lain situations(wse,additional,;pages! as; necessa ). ' a +,
Reviewer/Inspector Name:
Reviewer/inspector Signatui
Page 3 of 3
Phone:
Date: �— T f T
21412015

Type of Visit: 0 Compliance Inspection U Operation Review U Structure Evaluation U Technical Assistance I
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: . oo Departure Time: County: m Region t`o
Farm Name: qy L24ti utvf Owner Email: 47( C) J 0 J -'? T Z>
Owner Name: A" get I1_1 Phone:
Mailing Address:
Physical Address:
Facility Contact: get I1A, Title:
Onsite Representative:
t�
Certified Operator: I
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator: 1 ele14"IC-P
Certification Number: E I FIL
Certification Number:
Longitude:
Design
Swine Capacity
Wean to Finish
Current
Pop. Wet Poultry
La er
Design Current Design Current
Capacity Pop. Cattle Capacity Pop.
Dairy Cow
I I Dairy Calf
Wean to Feeder
I
INan-Layer
Feeder to Finish
1) , PLoultr.
I
Design Current
Ca R 1:0
Dai Heifer
Farrow to Wean
Dry Cow
Farrow to Feeder
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Pullets
Beef Feeder
Boars
Beef Brood Cow
Other �f[Turkey
Other Frother
Turke s
Poults
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes No ❑ NA ❑ NE
❑ Yes
❑ No
NA
❑ NE
❑ Yes
❑ No
[dNA
❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWR) ❑ Yes ❑ No E] NA ❑ NE
2. Is there evidence of a past discharge from any part of the Operation? [:]Yes [ffo�o ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes [j�No ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412015 Continued

(Facility Number: Date of Inspection:
Wavle Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
[A4ftr--❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
[] No
Q.4�W
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): �^
5. Are there any immediate threats to the integrity of any of the structures observed?
[] Yes
La 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
�o
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental
threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
2r5o
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
2,5o
[] 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
P91�o
❑ NA
❑ NE
maintenance or improvement?
Waste Aanlication
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 [E�<o ❑ NA ❑ NE
❑ Excessive Ponding ❑,Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): — .'A e./`+M u � s lv 0 CGV '
13. Soil Type(s): V p
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [✓]'1\io ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes Z_No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Re uired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily availabie? If yes, check
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑ Yes
[D-No
❑ NA
❑ NE
❑ Yes
[j No
❑ NA
❑ NE
❑ Yes
F,7;1To
❑ NA
❑ NE
[] Yes 0 No ❑ NA ❑ NE
[] Yes /Mo [DNA ❑ NE
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [/ 0
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis [] Waste Transfers
❑ Rainfail ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
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?
❑ Yes F,-.?'No
❑ Yes ErTo
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facilityumber: - Date of Inspection: floo
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ®No
►'
25. is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [c-lslo
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes [! No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes �o
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 ❑NE
❑NA ❑NE
❑ Yes [:J'No ❑ NA ❑ NE
❑ Yes [3 o ❑ NA ❑ NE
❑ Yes [;Ko ❑ NA ❑ NE
❑ Yes [3�<o ❑ NA ❑ NE
❑ Yes D14o
❑ Yes CEIN o
❑ Yes C-No
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
Q'I T
Reviewer/Inspector Signature: A AAL Date:
Page 3 of 3 21412015

�s-
Type of Visit: EYCompliance Inspection 0 Operation Review O Structure Evaluation Q Technical Assistance
Reason for Visit: outine O Complaint O Follow-up C) Referral t) Emergency O Other Q Denied Access
Date of Visit: I 1 15i " Arrrival Time: ;Z ; 3 D Departure Time: 3 County: j ez—
Farm Name: . }fir 0,./ G_ic i n -may Owner Email: `
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Cy �g; r► Y- y Title: hr►r Phone:
Onsite Representative: -.l, Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Region:
Certification Number: 42&Z
Certification Number:
Longitude:
11,
Design
Current
Design
Current
Design Current
Swine
Capacity
Pop,
Wet Poultry
Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
9qLa
er
r
Dairy Cow
Wean to Feeder
Non -La er
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
Dr, P,oult ,
Ca aci
P.o
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
,Turkeys
Other
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
❑ Yes [E No ❑ NA ❑ NE
a. Was the conveyance man-made? ❑ Yes [] No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR) ❑ Yes ❑ No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR) ❑ Yes ❑ No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes 2-1 ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes Q-Id'o' ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 21412014 Continued

Facili Number: -iEDate of Inspection; 1 —
Waste Collection & Treatment /
' * 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 2-KO ❑ 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 �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 [nNo ❑ 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 [21 o ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes ID -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 E<o ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need [] Yes [ o ❑ NA ❑ NE
maintenance or improvement?
11, Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes E] 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):*9/'iylGla(a`
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [�] o ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ❑ No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes D-No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[-I'l"vo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
�o
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[3-'No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
E]--No
❑ NA
❑ NE
the appropriate box.
❑ WUP El Checklists []Design ❑ Maps []Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [3-N
❑ Waste Application ❑ Weekly Freeboard []Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [P'No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes T[j'N'o
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑NA ❑NE
Page 2 of 3 21412014 Continued

Facili Number: a- - 2 7 JDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes Q o ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑-tdo ❑ 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 �o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes E.No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
34. 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 ReviewerlInspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
anv!Atli] ifinnall rwnnn
Reviewer/Inspector Name:
[:]Yes ga-No ❑ NA ❑ NE
❑ Yes [3-1 o ❑ NA ❑ NE
❑ Yes [ o ❑ NA ❑ NE
❑ Yes lj <o ❑ NA ❑ NE
[:]Yes
❑l o
❑ NA
❑ NE
[:]Yes
[r]"1\lo
❑ NA
❑ NE
[:]Yes
Q-No
❑ NA
❑ NE
Phone: �1> -Y33 —33-0-l",
Reviewer/Inspector Signature: , Date:
Page 3 of 3 21412014

ivision of Water Resources
Facility Number ®- ® O Division of Soil and Water Conservation
O Other Agency
ance
n for Visit: Uolkoutine O Complaint
a
Referral
re
O Other O Denied Access
Date of Visit: Arrival Time: , 3 C> I Departure Time: + _7 0 County: Region:
Farm Name: ay r rt v y Owner Email:
Owner Name: r• y Phone:
Mailing Address:
Physical Address:
Facility Contact: ]< ay► C #I 4- y Title: 1q /y ,P Phone:
Onsite Representative: Integrator:
Certified Operator: Certification Number:
Back-up Operator:
Location of Farm;
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Boars
Other
Other
Certification Number:
Latitude:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
Layer
Oo Non -Layer
La
Poults
Design Current
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
Longitude:
Design Current
Cattle Capacity Pop.
Daia Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non-DaiTy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes [KNo ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes No
❑ Yes ® No
❑NA ❑NE
❑NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
❑NA ❑NE
Page 1 of 3 2/4/2014 Continued

Facili Number: Date of Ins ection: —
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ® No ❑ NA ❑ NE
i�
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 Frecboard (in): y�
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
O 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
Z No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental
threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
® No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
® No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
[7,No
❑ NA
❑ NE
maintenance or improvement?
_Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
rNo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [KNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s)`!'
13. Soil Type(s): 1L3 On- _
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes EE�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 [gNo ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes RNo ❑ NA ❑ NE
❑ Yes FM ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes [ gNo ❑ 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 [5�No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
22, Did the facility fail to install and maintain a rain gauge? [:]Yes ® No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 0 No
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412014 Continued

Facili Number: Date of Inspection: J O— l
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes [&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? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
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 ❑ NE
❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes ® No 0 NA ❑ NE
❑ Yes E&No ❑ NA ❑ NE
❑ Yes ZI No ❑ NA ❑ NE
❑ Yes allo
❑ Yes allo
❑ Yes 2 . No
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
Comments (refer to question #) Explain any YES answers;and/or any additional recommendations or"any other comments
Use drawings.of facility to'b'etter eiplain sifiiations.(useiadditional"pages as,neeessary):
Reviewer/inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Z. LYUr Ls i
Phone:
Date:
21412014

r
(Type of Visit: (EMompiiance Inspection O Operation Review p Structure Evaluation O Technical Assistance I
Reason for Visit: �outlne O Complaint 0 Follow-up 0 Referral 0 Emergency O Other O Denied Access
Date of Visit: Arrival Time: : Departure Time: 3 D County:
Farm Name: �� y �� i #.. y Owner Email:
Owner Name: Phone:
Mailing Address:
Region: �jK 0
Physical Address:
Facility Contact: gag �er y Title: Q)(,LJ/j-,�✓ Phone:
Onsite Representative: Integrator:
Certified Operator: �6�-+C� _ Certification Number: Z9 -'�L
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design Current
Swine Capacity Pap.
Wean to Finish
Wet Poultry
La er
Non -La er
Design
Capacity
Current
Pop.
Design Current
Cattle Capacity Pap.
Dairy Cow
Dairy Calf
Wean to Feeder b
Feeder to Finish
Ur, P.■oultr,
Design
C■_a aei
Current
Flo
Dairy Heifer
Farrow to Wean
Farrow to Feeder.
_Pry_ Cow
Non-Dal
Farrow to Finish
Layers
Non -Layers
Beef Stocker
Beef Feeder
Gilts
Boars
Pullets
Turke s
Turke Poults
Other
I Beef Brood Cow
Other
Other
Discharees and Stream Imnacts
1. Is any discharge observed from any part of the operation?
[]Yes
E,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)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
® No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
ESNo
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

Facility Number: Date of Inspection:
— 1
Waste Collection & Treatment
" 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
[]Yes
® No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
[:]Yes
[:]No
❑ NA
❑ NE
Structure l Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):�
5. Are there any immediate threats to the integrity of any of the structures observed?
[]Yes
C&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
UK No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental
threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
CgNo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
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
[2ZNo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
2gNo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? if yes, check the appropriate box below. ❑ Yes 2[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 WindDrift
n Application Outside of Approved Area
12. Crop Type(s): iLCsr�ez /DyC/.S}'s�d / �i n�>/jT i►�nra-Q ��'74Y<�+--�.
13. Soil Type(s): I h
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes JZJ No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes E,No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes ,LNo ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes E] No ❑ NA ❑ NE
❑ Yes UNo ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the 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 appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes CEkNo
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
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?
❑ Yes !�kNo
❑ Yes DOr.-No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
[DNA ❑NE
❑NA ❑NE
Page 2 of 3 21412011 Continued

Facility Number: Cia - Date of Inspection: 3
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes C!�No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes O"o ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey []Failure to develop a POA for sludge levels
C] Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26, Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No ❑ NA ❑ NE
Other lssues
2$. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, aver -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond 0 Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
[:]Yes RNo ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes allo ❑ NA ❑ NE
❑ Yes gj No ❑ NA ❑ NE
❑ Yes No
[:]Yes ® No
❑ Yes No
❑NA ❑NE
❑ NA ❑ NE
❑NA ❑NE
Cominents.:(refer to question ft Explain any YES answers and/or any additional recommendations or any other comments.
Use°dri win'gs offacility to better explain situations (use additional pages as necessary),
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 2
Date:
21412011

ivision of Water Quality
Facility Number ®- l O Division of Soil and Water Conservation
O Other Agency
Type of Visit: o="tine
ce Inspection Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: O Complaint O Follow-up Q Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time; . pa Departure Time: . 00 County: Region:
Farm Name: j� �-y %� rI y Owner Email:
Owner Name: ! [ % Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Agz J' matePhone:
Onsite Representative: Jr'<��� Integrator:
Certified Operator: jr---� J Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Latitude:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
Layer
U t Oo (i$�p't+ Non -La er
Pullets
Other
Pau
Design Current
Discharges and Stream impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
Longitude:
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dai Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes J&No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes ❑ No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes [L No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes RNo ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

Facilit Number: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 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
E'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
8 No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑Yes
k= No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit`?
❑ Yes
No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
[] Yes
[LNo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
KNo
❑ NA
❑ NE
maintenance or improvement?
11. is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
�lo
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals
(Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into
Bare Soil
❑ Outside of Acceptable Crop/ Window ❑ Evidence of Wind! Drift ❑ Application
Outside of Approved
Area
12. Crop Type(s) 1 /FtYtf'S�Y�/ fit, ri 6t,2t5
/Sery,6
s
13. Soil Type(s): _AL2 A I L,z
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes J,No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement'? ❑ Yes JZ No ❑ NA ❑ NE
16, Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes rM 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'?
❑ Yes ® No ❑ NA ❑ NE
❑ Yes allo ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes allo NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes eq-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 [A 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 ,&C No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment'? ❑ Yes [a No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: jDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [5CNo
25. Is the facility out of compliance with pennit conditions related to sludge? If yes, check ❑ Yes lv 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 (L No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification'? ❑ Yes ZNo
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 -tip visit by the same agency?
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes ®, No 0 NA ❑ NE
❑ Yes [&No ❑ NA ❑ NE
0 Yes ®-No ❑ NA ❑ NE
❑ Yes [5?,No 0 NA ❑ NE
❑ Yes 2�,No
❑ Yes P�kNo
❑ Yes EkNo
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question 4) Explain any ES answers and/or any i ddMonAIxecommendatibns{or any other comment9 irk �
lsc dra*,vins ofiacilitv'tn beE'tor explain situations'(u5c:adilitional'pa�es as necessarvl ° `: l k`; 11; '7,
ND-r� . f r ��� �YG�� �'�`. L-v CIS
Reviewerllnspector Name:
Reviewerllnspector Signature:
Page 3 of 3
Phone: 5 f d yT3 o
Date: T ,- fy
2/4/2011

Date of Visit: Arrival Time: �?._ Departure Time: r s ' CountyRegion:
Farm Name: R ct- (, :� '. Owner Email:
Owner Name: - Phone:
Mailing Address:
Physical Address:
Facility Contact: Ua+ i Title: 04"' yr V_- f.' Phone:
Onsite Representative: ����_ lntcgrator: �l x"J
Certified Operator: _ '_5*,'�_ Certification Number: /'�y
Back-up Operator:
Certification Number:
Location of Farm: Latitude: Longitude:
Design Current Design Current Design Current
Swine Capacity Pop. Wet Poultry Capacity Pop. Cattle Capacity Pop.
Wean to Finish 1:1La er Dai Cow
bdVean to Feeder o ]Non -Layer Qai Calf
Feeder to Finish Dai Heifer
Farrow to Wean Design urrcnt~, Dry Cow
Farrow to Feeder D > P,oult Ca act Po Non -Dairy
Farrow to Finish ILayers Beef Stocker
Gilts Non -Layers Beef Feeder
Soars Pullets Beef Brood Cow
M
Turke s
Other Turkey Poults
Other Other
Discharges and Stream Impact
I. Is any discharge observed from any part of the operation? ❑ Yes RNo ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No [DNA ❑ 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) ❑ Yes ❑ No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes No ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

Facility Number: Date of Inspection:
t `
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
E�No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): �31 �-
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
® No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental
threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
E�Z No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
R No
[DNA
❑ 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
Z No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
ELNo
❑ NA
❑ NE
maintenance or improvement?
11. is there evidence of incorrect land application? If yes, check the appropriate box below, ❑ Yes O_No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload [] Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. [] Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of,Approved Area
12. Crop TYpe(s): �u066 /[3r���5rr�/ Zs;& c zZ �G[l r v�lr J '
13. Soil Type(s): _AZ6Q _
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 (4 No [] NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable [:]Yes []� No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes ® No
❑ Yes ZNo
❑ NA ❑ NE
❑ 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
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ® No
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

r
Facility Number: - Date of Inspection:
24, Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑ No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26, Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes ® No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes 9 No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
24. 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 ❑ NE
❑ NA ❑ NE
❑ Yes � No ❑ NA ❑ NE
[] Yes [2 No ❑ NA [] NE
❑ Yes ®.No ❑ NA ❑ NE
❑ Yes ® No [DNA ❑ NE
❑ Yes ® No
❑ Yes ® No
❑ Yes Q No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments
Use drawings,of facilltyto better:explain situations (use additional pages as'necessarv).
Reviewer/Inspector Name:
Reviewer/inspector Signature:
Page 3 of 3
Phone: 2-14—
Date: 9±212—�� f
21412011

J
f
ivision of Water Quality
Facility Number O Division of Soil and Water Conservation
O Other Agency
Type of Visit
omn�pliance Inspection
0 Operation Review 0 Structure Evaluation
0 Technical Assistance
Reason for Visit
��
CC outine 0 Complaint
0 Follow up 0 Referral 0 Emergency
0 Other ❑ Denied Access
Date of Visit: — ti Arrival Time: : D Departure Time: ' d O I County: Region:
Farm Name: G Owner Email:
Owner Name: a ± n r Phone:
Mailing Address:
Physical Address:
Facility Contact: _ !e% CT� �� "� y Title: 92-M2 a r-#e Phone No:
Onsite Representative:. . Integrator: Z31axe=
41
Certified. Operator: S,
Back-up Operator:
Location of Farm:
Swine
Latitude:
n°
Operator Certification Number:
Back-up Certification Number:
0 Longitude: 0° 0 T 0
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
6 00 ❑ Non -Layer
❑ Wean to Finish
Wean to Feeder
El Feeder to Finish
El Farrow to Wean
El Farrow to Feeder
El Farrow to Finish
El Gilts
❑ Boars
Other
❑ Other ji
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
El Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: El Structure El Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
Design Current
Cattle Capacity Population
❑
DairyCow
❑
DairyCalf
El
Dairy Heifer
❑
D Cow
El
Non-Dairy
El
Beef Stocker
El
Beef Feeder
❑
Beef Brood Cow
Number of Structures:
e. What is the estimated volume that reached waters of the State (galions)?
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 RNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
El Yes
[I No
[I NA
[I NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
�RNo
❑ NA
❑ NE
❑ Yes
Rio
❑ NA
❑ NE
Page 1 of 3 12128104 Continued

Facility Number: — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes UNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Rtnrctnre 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
(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 thrre5a-t-, notify DWQ
7. Do any of the structures need maintenance or improvement? CR Yes AjNn ❑ 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 [,RNo ❑ 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?
I. 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 l0 lbs ❑ Total Phosphorus ❑ Failure to incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) zne_' _K±�
13.
Soil type(s) �'
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
EgNo
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
LNo
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
[R No
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
IgNo
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
RN
❑ NA
❑ NE
wing"s.of facility to better explain situations. {use.additional pages as necem
cT�--
y): k
e--S-
�r
Reviewer/Inspector Name * , .. " �� .1', rM,�i= Y� Phone: /O" 3�00
ReviewerAnspector Signature. Date: _ 1— 126
Page 2 of 3 IZ/Zd/ug c.anrinueu

Facility Number: — Date of Inspection'
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes SNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check []Yes tgNo ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes (6 No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
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 of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal? -
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes
CRNo
❑ NA
❑ NE
❑ Yes
EZ No
❑ NA
❑ NE
❑ Yes
®,No
❑ NA
❑ NE
❑ Yes
[K No
❑ NA
❑ NE
❑ Yes
R5No
❑ NA
❑ NE
❑ Yes
(3No
❑ NA
❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes E,No ❑ NA ❑ NE
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes MNo ❑ NA ❑ NE
❑ Yes
PLNo
❑ NA
❑ NE
❑ Yes
[No
El NA
❑ NE
Additional Comments andlnr, Dra�vin is p {';' s.- "t �'
o. v,AA k.$h.1�ePi.�{�4�...-
i
Page 3 of 3 12128104

�ivislon of Water Quality � � ✓
Facility Number -� O Division of Soil and Water Conservation 9V
O Other Agency
Type of Visit ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit outine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of 'Visit: Arrival Time: ,j Departure Time: County: Region:
Farm Name: 4? �LC r r'L '� Y Owner Email:
Owner Name: n8WatV ` Gcy vt Cv ,,.._ Phone:
Mailing Address:
Physical Address: /�
Facility Contact: ;_� L'T,N— � K�Title: Phone No:
Onsite Representative: J` �^—{! Integrator:/'zs ors
Certified Operator: v Operator Certification Number:
Back-up Operator:
Location of Farm:
Swine
Back-up Certification Number:
Latitude: 0 c 0 { Longitude: = o = 4 = 11
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
Mayer
N�❑ Non -Layer
Other
❑ Other T x W
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharees & 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
❑
Dai Heifer
❑
D Cow
❑
Non -Dairy
❑
Beef Stocker
❑
Beef Feeder
❑
Beef Brood Cow
Number of Structures: 1
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 XNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
01'4'o
❑ NA
❑ NE
❑ Yes
allo
❑ NA
❑ NE
12128104 Continued

Facility Number: Date of Inspection
^� Waste Collection & Treatment
4, Is storage capacity (structural plus storm storage plus heavy rainfali) less than adequate? ❑ Yes UNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes 5,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 g,No ❑ NA ❑ NE
(iel large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes V�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 ERNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit'? ❑ Yes � No ❑ NA [I 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 E.No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 0,,No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[]PAN ❑ PAN > 10% or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13.
Soil type(s)
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
5Q No
❑ NA
❑ NE
15,
Does the receiving crop and/or land application site need improvement'?
❑ Yes
Eallo
❑ 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
[KNo
❑ NA
❑ NE
18,
Is there a lack of properly operating waste application equipment?
❑ Yes
[KNo
❑ NA
❑ NE
r4 L. 4,. F4 F t4 .4 ;"'--
Cammcnts�(reerto!queshonz#} Ezpolamany�YES answersiandlorany recommendations or a�tt�hero'mments.„,
:Use drawings of.fucllity Ito' better'gxpiainjsjruaTlans Music a�dditionaiaplaS, I ec�essnry};
a{. ,:�:�.`"•f`�.,.v�_-
Reviewerllnspector Name - —
"�--� ;� Phone:
3 �d
,y-
Reviewerlinspector Signature: Date: -- --
a 9`
d 12128104 Continued

{ Facility Number: — Date of Inspection — --c>
y Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes [9 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes R No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes allo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
RNo
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
RNo
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
® No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
WLNo
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
Z,No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
RNo
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
RNo
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
ZNo
❑ 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
RNo
❑ 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
E.No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
[a No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
aNO
❑ NA
❑ NE
12128104

Type of Visit d<ompliance
Inspection
0 Operation Review 0 Structure Evaluation
0 Technical Assistance
Reason for Visit
outine 0 Complaint
0 Follow up 0 Referral 0 Emergency
0 Other ❑ Denied Access
Date of Visit: n� Arrival
Time: Departure Time: County: Region:
.01
Farm Name: I r L/ 'tea' �'r-- Owner Email:
Owner Name: C 1 l R em %d R O_LSx I +A r- y Phone:
Mailing Address:
Physical Address:
Facility Contact: � &cr 4-1 y Title:
Onsite Representative;
Certified Operator: ��-
Back-up Operator:
Location of Farm:
Design Current
.a.T tic 1—Upaciiy rupulauuu
❑ Wean to Finish
Wean to Feeder p
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Phone No:
Integrator•.._y _"4r a;r--
Operator Certification Number:
Back-up Certification Number:
Latitude: = o = 6 Longitude: 0 0 = ` 0 "
Design Current
Wet Poultry Capacity Population
❑ Layer
❑ Non -Layer
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharees & 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
❑ Daia 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?
Page 1 of 3
❑ Yes C, No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA Cl NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
RNo
❑ NA
❑ NE
❑ Yes
[.No
❑ NA
❑ NE
12128104 Continued

Facility Number: — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ONo ❑ 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 R 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 XNo ❑ 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 MNo ❑ 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 Z No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? if yes, check the appropriate box below. ❑ Yes NNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drib ❑ Application Outside of Area
12.
Crop type(s) / '/'1'lZt � f' .��Sk.-, ✓4 �'l' 'os
//.0 1 -17or r`t7�rrr��JC
13.
Soil type(s) rn-
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
P No
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable
acre determination?❑ Yes
g No
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
KNo
❑ NA
❑ NE
18,
Is there a lack of properly operating waste application equipment?
[:]Yes
4 No
❑ NA
❑ NE
Nj , you C r I W e' l , B-'1- �le / -'�S
Reviewer/Inspector Name T— Phone:
Reviewer/Inspector Signature: Date:
Page 2 of 3 12128104 Continued

W
Facility Number: — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes �o ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes I!TNo ❑ NA ❑ NE
the appropirate box. ❑ WDP ❑ Checklists ❑ Design ❑Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 9,,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
allo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
N�No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
f � No
❑ NA
El NE
25,
Did the facility fail to conduct a sludge survey as required by the permit?
El 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
[XNo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
RNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
PNo
❑ 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
5kNo
❑ 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
CKNo
❑ 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
RNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
QNo
❑ NA
❑ NE
Page 3 of 3 12128104

Ird
ion . of Water Quality!``
Facility Number O Division of Soil and Water Conservation
0 Other Agency
Type of Visit eH®rnpliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit e-Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: +. (7 Departure Time: ! 00 County: Region: ��
Farm Name: t Z� Owner Email:
Owner Name: a L �� `� Q r h Phone:
Mailing Address:
Physical Address:
Facility Contact: Rd* �/ �`���j� Title: Phone
No:
Onsite Representative: y+ ___ Integrator: &'t'SJa
Certified Operator: .sue—� Operator Certification Number:
Back-up Operator:
Location of Farm:
Swine
Back-up Certification Number:
Latitude: = o❑ 1 a Longitude: = o❑ 1
Design Current . Design Current
Capacity Population Wet Poultry Capacity Population
ElLayer
DO �-- ❑ Non -Layer
❑ Wean to Finish
Wean to Feeder
El Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
El Gilts
ElBoars
Other
❑ Other
Dry Poultry
❑ Layers
ElNon-Layers
El Pullets
❑ Turkeys
❑ TurkeyPoults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: El Structure [I Application Field El Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ DairyCow
El Dairy Calf
❑ DairyHeife3
❑ D Cow
ElNon-Dairy
El Beef Stocker
[I Beef Feeder
El Beef Brood Cow
Number of Structures: 143
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 allo ❑ NA ❑ NE
❑Yes
El No
El NA
El NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
12128104 Continued

Facility Number:
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
2!.No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
LNo ❑ NA ❑ NE
Oe/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not property addressed and/or managed
❑ Yes
9No ❑ 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
4 No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
[4 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
2�,No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
4 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 Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
XNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
Yes
WNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
10 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
5?1-No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
�zV&"0& n�®ar rr�2 a�
`
r
Reviewer/Inspector Name Phone: �/D y33-33Da
ReviewerAnspector Signature: Date:
12128104 Continued

0
i Facility Number: Date of Inspection / J
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes V] 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. ❑ WUP ❑ Checklists ❑ Design [I Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 5jNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
�&No
❑ NA
❑ NE
23,
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
1,'R No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
CR No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the pen -nit?
❑ Yes
�R No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
IRNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
P�No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
]Z No
❑ NA
❑ NE
29.
Did the facility tail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
XNo
❑ 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?
ElYes
0 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
�KL No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
1@ No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
R1No
❑ NA
❑ NE
Additional Comments and/or
12128104

Type of Visit
ompliance Inspection
0 Operation Review 0 Structure Evaluation
0 Technical Assistance
Reason for Visit
Routine 0 Complaint
0 Follow up 0 Referral 0 Emergency
0 Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: County: __ Ir= Region: G 9 0
Farm Name: ._--r�_--��_��__ Owner Email:
OwnerName: ��J4 6L L61^e�x aa Phone:
Mailing Address: %�,� 1 �; o r� AV C . 2 6� 73,Ek_-_�_
Physical Address:
Facility Contact: 4,z,,n ey Title: Phone No:
Onsite Representative: __ __ Sctr,.t .._____ __ _ Integrator:
Certified Operator: Operator Certification Number: /9.v?t
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: 00 = 0" Longitude: D o = 1 =
11
Swine
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
ElLayer �yla p D ❑ Non -La et
❑ Wean to Finish
ER Wean to Feeder
[I Feeder to Finish
El Farrow to Wean
El Farrow to Feeder
El Farrow to Finish
❑ Gilts
El Boars
Other
❑ Other
Dry Poultry
ElLayers
ElNon-Layers
[I Pullets
ElTurkeys
El Turkey Puults
El Other
Discharees & Stream Impacts
I. Is any discharge observed from any part of the operation?
Discharge originated at: El Structure El Application Field El Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
Design Current
Cattle Capacity Population
ElDai
Cow
❑
DairyCalf
El
Dairy Heifer
El
Da Cow
El
Non-Dairy
❑
Beei' Stocket
El
Beef Feeder
El
Beef Brood Cow
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures:ID
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 allo ❑ NA ❑ NE
❑ Yes
RNo
❑ NA
❑ NE
❑ Yes
®.No
❑ NA
❑ NE
❑ Yes
[ZNo
❑ NA
❑ NE
❑ Yes
CR No
❑ NA
❑ NE
❑ Yes
J,No
❑ NA
❑ NE
12128104 Continued

FacilityNumber: —
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [X No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes RNo ❑ NA ❑ NE
Stntctnre I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 4No ❑ NA ❑ NE
(iel large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes KNo ❑ 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 R No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ERNo []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 [9-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 MNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drifi ❑ Application Outside of Area
12. Crop type(s)
Yi
13. Soil type(s) /V f�Z
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[KNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[P No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination'![] Yes
MNo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
E� No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
9LNo
❑ NA
❑ NE
t•SDOI at:S1 ✓rit_
ReviewerlinspectorName i`.'"' °` s '�'�r `k Phone: �v%sill
Reviewer/Inspector Signature: Date:
12128104 t..onttnuea

Facility Number: SyL— Date of inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes RNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [gNo ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps [I 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 ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and l" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge'?
❑ Yes
ER 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
[B No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
U No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
[Z No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
[SNo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
N No
❑ NA
❑ NE
29,
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
�@ 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
C,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
KNo
❑ 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
Callo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
C,No
❑ NA
❑ NE
Addltiooal Comments.andlor""-Drawings
12128104
12128104

Type of Visit ® Compliance Inspection U Operation Review U Structure Evaluation U Technical Assistance
Reason for Visit *Routine O Complaint O Follow up O Referral O Emergency Q Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: County: 5-,Region: Vf Xb
Farm Name: clk y+t,� �arw� -_ Owner Email:
Owner Name: 4,� s,f Phone: — g fo_ 3 $ & a'f
;Mailing Address: VIA, �1 -C 1 i •+ i'a w��/�%' +� g 3
Physical Address:
Facility Contact:
Title:
Onsite Representative: P,{ �pc,,e�••�
Certified Operator: _Q �1�t' _,_ ._- - _G- i+�. c21
Back-up Operator:
Location of Farm:
Swine
Phone No:
I ntegrator Pr r3_
Operator Certification Number: i G 21$
Back-up Certification Number:
Latitude: = o = 6 = Longitude: = ° = 6
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Laver
oa S7�F ❑ Non -La et
❑ Wean to Finish
Wean to Feeder
El Feeder to Finish
El Farrow to Wean
❑ Farrow to Feeder
El Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Dry Poultry
❑ Lavers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ TurkeyPoults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: El Structure ❑ Application Field El Other
a. Was the conveyance man-made?
Cattle
Design Current`.
Capacity Population
ElDai Cow
El Dairy Calf
ElDairy I-leifei
El Dry Cow
ElNon-Dairy
El Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
b. Did the discharge reach waters of the State? (Ifyes, 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?
MM
❑ Yes N No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
[.'I No
❑ NA
❑ NE
❑ Yes
% No
❑ NA
❑ NE
12128104 Continued

F! lity Number: 9,Z Y Date of Inspection G /Se •
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [N No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes [R No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: 1
Spillway?: 2F /9
Designed Freeboard (in): .j 4 t�
Observed Freeboard (in): 361
`'
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes P 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 5LNo ❑ 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 5No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes roNo ❑ NA ❑ NE
(Not applicable to rooted pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes [2No ❑ 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 91 No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drifl ❑ Application Outside of Area
12.
Crop type(s) 1w� 14
13.
Soil types)
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[,X 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,
El Yes
® No
❑ NA
❑ NE
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
5E No
❑ NA
❑ NE
Reviewerlinspector Name 1K'�5 _':,,� ;fk'[ /j / Phone:
Reviewer/Inspector Signature: >1 Date: { /3D
12128104 Continued

Fa- lity N.Vmber: 8 — a Date of Inspection G/?e%o
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Pen -nit readily available? ❑ Yes ® No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes (3 No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design El Maps [I Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ® No ❑ NA ❑ NE
.61.) L. 7
❑ Waste Application ❑ Weekly Freeboard El 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
[]5 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
® 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
❑ No
[E NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[R No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
R No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
® No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
5fl No
❑ NA
❑ NE
General Pen -nit? (iel discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
® No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency'?
❑ Yes
[9 No
❑ NA
❑ NE
�3.mt. GC�r,�
'`s
prt�c�-E-
pi4VtrLwQ d`�
ti���'G-�tO1�
GY�.rts.
Jam. S 1 � s.
g "_ V �-aa.
i �% nw� �o c
C.o v.oQ L��t ti�
:7 �i
O G F .
12/28/04

Type of Visit ® Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Date of Visit: Time: P
rO Not O erational 0 Below Threshold
alrermitted (3t ertified ©Conditionally Certified © Registered Date Last Operated or Above Threshold:
Farm Name: Ray G,g. n6'4 FGrm County: SGr.Vsan FX 0
Owner lame: 2-aadPay—
Gam` Phone No: cJ/O .S 33 -3s 0 5�,
Mailino .address: , �31 3 �,`.,d �Da�� �.'.; Te+vt NC 1 g.3
Facility Contact: Title: Phone No: 9l U /4/- S$a 3
Onsite Representative: Ra.' Integrator: ._ r'ts1c, if
Certified Operator: Op n alel Rd), fa, rOperator Certification lumber: � y $.2 c!__
Location of Farm:
EI'Gine ❑ Poultry ❑ Cattle ❑ Horse Latitude Longitude �• �'`
Design Current Design Current Design Current
Swine Capacity Population Poultry Capacity Population Cattle Ca acity Population
can to Feeder 1❑ Laver I 1 1[:] Dairy
❑ Feeder to Finish ❑ Non -Laver I JEJ Non-Dain'
❑ Farrow to Wean
❑ Farrow to Feeder Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ Boars Total SSLW
Number of Lagoons I 1 I ILJ Subsurface Drains Present fIIJ Lagoon Area IU Spray Field Area - I
Holding Ponds / Solid Traps ; ° ❑ No Liquid Waste Management System
Discharges 8 Stream Impacts
1. Is any discharge observed from any pan of the operation? ❑Yes
Dischar_e ori;inaled at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the convevance man-made? ❑ Yes o
b. If discharge is obsen,ed, did it reach Water of the State? (If yes, notify DWQ) ❑Yes ❑
c. if discharge is observed, what is the estimated flow in gal/min? .�
d. Does discharge bypass a lagoon system? (If yes, notify, DWQ) ❑ Yes D-Ko
2. Is there evidence of past discharge from any part of the operation? ❑Yes Oho
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes EIND
Waste Collection &- Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes s4qtf
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: 1
Freeboard (inches): ! //
05103101 Continued

Facility -Number: — .
Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ic/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes 9<00
❑ Yes [` -50—
❑ Yes 0-KO
❑ Yes ❑'KO'
❑ Yes [No
Wa de Application
10. Are there any buffers that need maintenancelimprovement? ❑ Yes ONO
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes M NO
12. Crop type fl /Q
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes
14. a) Does the facility lack adequate acreage for land application? ❑ Yes ©-Idb
b) Does the facility need a wettable acre determination? ❑ Yes Q-No
c) This facility is pended for a wettable acre determination? ❑ Yes EINo
15. Does the receiving crop need improvement? ❑ Yes Q-No
16. Is there a lack of adequate waste application equipment? ❑ Yes U-No
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes U40
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design ma s, etc. ❑ Yes 0 -wo
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports) ❑ Yes
20, Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes ❑'Ko-
21. Did the facility fail to have a actively certified operator in charge? ❑ Yes EXb
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes 0•90—
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes 0<0
24. Does facility require a follow-up visit by same agency? ❑ Yes ONO
25, Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes [9-Ko
No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Gomments #):E'zploii} YES and/iir ony rec�mmendatione or cuamments�.
(refctouesa any answers any other ,'
-rx„
Use drawings of facility to better explain situations. (use additional pages as necessary): teld Copy ❑Final Notes
A41-. eG:rley S1a1rc( fAe,1 e /lay S���f .�00 L/ s S6 le
! Grr'm 40/�S C d4�.
ReCQrA ore well
.,,'ui d+ "� ` _ ;a i is
ReviewerAnspector Name rw cal �:;; I.o
Reviewer/Inspector Signature: Date:1
05103101
Continued

- tnforAnatioi4 contained in this database is from non agency sources and is considered unconfirmed.
Animal Operation Telephone Log
DWQ Facility Number 82 —24
Date 7-14-2003
Farm Name Ray Gainey
Time 3:30pm
Caller's Name IDonaid Ray gainey
Control Number 3539
© Reporting O Complaint
Region JFRO
Caller's Phone # [phone]
Access to Farm
Laioon Ouestiuns
Farm Accessible
Breached JOYes O No
from main road
10 Yes O No
Inundated 10 Yes O No
Overtopped 10 Yes O No
Animal Po elation
Water on
Outside Wall O Yes O No
Confined
O Yes O No
Dike Conditions O Yes O No
Depop
10 Yes O No
Feed Available
10 Yes O No
Freeboard Level
Mortality
10 Yes O No
Freeboard Plan Due Date Date Plan Date Freeboard
Inches (? equals blank) Received Level OK
Lagoonl 18.5'. 7/16/2003 .r 172-3 -'] 43
Spray Availabilitv
Lagoonl
Pumping
Equipment
O Yes ONO
Lagoon3
Lagoons
Available
Fields
O Yes O No
Lag oon5 �
Lagoon6
ked Mr. Gainey for calling and advised him to send a POA and to call back when he is out of the
_..1: ...
R.t.�.... i..:!.t:....... ..... ......
............................................................................................................................................................................................................... ..
Comments2

PLAN OF ACTION (PoA) FOR HIGH FREEBOARD AT ANIMAL FACILITIES
Facility Number: 6L County: _ Am 5DA)
Facility Name:- —QAT (�14rNeT-
Certified Operator Name: -�o �#G _ !�. �_AiNEY - Operator#._ _ ` g7aq
1 Current liquid levels) in inches as measured from the current liquid level in the lagoon to the
owest point on the top of the dam for lagoons without spillways; and from the current liquid level
in the lagoon to the bottom of the spillway for lagoons with spillways.
00 I Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
L�agbod,Name/ldentifier (ID):
Spillway (Yes or No):
Level (inches): %g..5
2. Check all applicable items
Liquid level is within the designed structural freeboard elevations of one or more structures. Five
and 30 day Plans of Action are attached. Hydraulic and agronomic balances are within
acceptable ranges.
+� Liquid level is within the 25 year 24 hour storm elevations for one or more structures. A 30 day
Plan of Action is attached, Agronomic balance is within acceptable range.
Waste is to be pumped and hauled to off site locations. Volume and PAN content of waste to
pumped and hauled is reflected in section III tables. Included within this plan is a list of the
proposed sites with related facility number(s), number acres and receiving crop information.
Contact and secure approval from the Division of Water Quality prior to transfer of waste
to a site not covered in the facility's certified animal waste management plan.
Operation will be partially or fully depopulated.
- attach a complete schedule with corresponding animal units and dates for depopulation
- if animals are to be moved to another permitted facility, provide facility number, lagoon freeboard
levels and herd population for the receiving facility
3. Earliest possible date to begin land application of waste: r7 170 ~ 4at?t #&x
I hereby certify1hat I have reviewed the information listed above and included within the attached Plan
of Action, and to the best of my knowledge and ability, the information is accurate and correct.
ml
Facil
FaciliQ Ownerft
(print)
(signature)
Phone: 9/0 ^ S3 3 --3 go c/
Date; - s--o3
PoA Cover Page 2121/00

PLAN OF ACTION (PoA) FOR HIGH FREEBOARD AT ANIMAL FACILITIES
THIRTY (30) DAY DRAW DOWN PERIOD
1. TOTAL PAN TO BE LAND APPLIED PER WASTE STRUCTURE
1. Structure Name/Identifier (ID): 0q r
2. Current liquid volume in 25 yr.124 hr. storm storage & structural freeboard
a. current liquid level according to marker
b. designed 25 yr.124 hr. storm & structural freeboard
c. line b - line a (inches in red zone) =
d. top of dike surface area according to design
(area at below structural freeboard elevation)
e. line c x line d x 7.48 gallons
-
12 ft3
10-1 S inches
11 inches
• -T inches
y z o00 ftZ
3. Projected volume of waste liquid produced during draw down period
0,?9 gallons
f. temporary storage period according to structural design /Sy days
g. volume of waste produced according to structural design LI (a Fez ft3
h. actual waste produced = current herd # x line g = �(� ��`Z_ ft3
certified herd #
i. volume of wash water according to structural design ft3
j. excess rainfall over evaporation according to design
k. (lines h + i +j) x 7.48 x 30.days
line f
4. Total PAN to be land applied during draw down period
I. current waste analysis dated !G Lo 3
m. lines e + k x line I =
1000
REPEAT SECTION I FOR EACH WASTE STRUCTURE ON SITE
T � Y�-p o ft3
S'91 7 3 gallons
a- 1 Ib/1000 gal.
3,�" lb PAN
PoA (30 Day) 2/21/00 1

v
It. TOTAL POUNDS OF PAN STORED WITHIN STRUCTURAL FREEBOARD AND/OR 25 YR.124
HR. STORM STORAGE ELEVATIONS IN ALL WASTE STRUCTURES FOR FACILITY
1. structure ID: _ A line m = Z 3S' ib PAN
2. structure ID:
3. structure ID:
4. structure 1D:
5. structure ID:
6. structure ID:
n. lines 1 +2+3+4+5+6 =
line m =
lb PAN
line m = Ib PAN
line m = lb PAN
line m = lb PAN
line m = lb PAN
Z 3 Ib PAN
111. TOTAL PAN BALANCE REMAINING FOR AVAILABLE CROPS DURING 30 DAYDRAW DOWN
PERIOD. DO NOT LIST FIELDS TO WHICH PAN CAN NOT BE APPLIES DURING THIS 30 DAY PERIOD.
o. tract #
p. field #
q. crop
r. acres
s, remaining
IRR-2 PAN
balance
(lb/acre)
L TOTAL PAN
BALANCE
FOR FIELD
(Ibs.)
column r x s
u. application
window'
S O
A
S
�•�
d
&-, -/�6
1.0
am 2q3
2-3
-der.
7-4
o
2 A"
2. C-
D
Z
2-1/7
2 h
-0
2 3
Z 3
,0
163
Ida
2
Q
63
63
Z
I-°
3
1°
1, q 5
T y3
zq3
2
ZL
1.°
2,q3
Zsl
'State current crop ending application date or next crop application beginning date for available receiving crops
during 30 day drawn down period
v. Total PAN available for all fields (sum of column t) lb. PAN
PoA (30 Day) 2121100 2

. . . S 4 1
IV. FACILITY'S PoA OVERALL PAN BALANCE
w. Total PAN to be land applied (fine n from section II) = Z3r lb. PAN
x. Crop's remaining PAN balance (line v from section Ili) = Y70b lb. PAN
y. Overall PAN balance (w - x) _gYZ 3 lb. PAN
Line y must show as a deficit. If line y does not show as a deficit, list course of action here
including pump and haul, depopulation, herd reduction, etc. For pump & haul and herd
reduction options, recalculate new PAN based on new information. If new fields are to be
included as an option for lowering lagoon level, add these fields to the PAN balance table and
recalculate the overall PAN balance. If animal waste is to be hauled to another permitted
facility provide information regarding the herd population and lagoon freeboard levels at the
receiving facility.
NARRATIVE:
PoA (30 Day) 2121100 3

e
IType of Visit ® Compliance Inspection O Operation Review O Lagoon Evaluation j
Reason for Visit ® Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number ,� Date of Visit: ;3o V. Time: = � O
F
* ^O Not O erational Below Threshold
Permitted M Certified ❑ Conditionally Certified 13 Registered Date Last Operated or Above Threshold: ... ........ ..
Farm Name: ............ ...4.�/r4..................I........ County: - ,r c :J....__.--.... .................
Owner Name: .---•--o.a�wG _--- - 'k�r .-Gl.�/r✓ - - Phone No:. :
Mailing Address:
Facility Contact: ............J.. ��*..'!�................. Title: ............................................... Phone No:
Onsite Representative: __-_-- Nr(---------•----------------------.---- Integrator:._2`7_1
Certified Operator C7 ............ ...................... I— Operator Certification Number: 1
Location of Farm:
7
❑ Swine [I Poultry [3 Cattle ❑Horse
Latitude •' t ...........- u Longitude I
Design.:. ` Current:€::.€ Desl g n g Current : Deslgn Curirent
Swine Ca acit . Po .ulatioti .: poultry :.Capacity •Population. . Cattle Capacity :.Population..
Wean to Feeder
g5r!/Qp
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (if yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min'?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes ❑ No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ❑ No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ❑ No
Structure I Structure 2 Structure 3 Structure 4 Structure S Structure 6
Identifier:
/r
Freeboard (inches); ... ,_,,,

s
Facility Number: 82 — 7.Y Date of Inspection "
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes BNo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes ,�[No
(li any of questions A-b 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 (K No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes RNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes XNo
Wits
10. Are there any buffers that need maintenancelimprovement? ❑ Yes RNo
11, Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes �lo
12. Crop type-
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes ,qNo
14. a) Does the facility lack adequate acreage for land application? ❑ Yes XNo
b) Does the facility need a wettable acre determination? ❑ Yes R No
c) This facility is pended for a wettable acre determination? ❑ Yes FNo
15. Does the receiving crop need improvement? ❑ Yes 'No
16. Is -there a lack of adequate waste application equipment! ❑ Yes 1KNo
Reguired
Records & Documents
17.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
)5(No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ W 1 checv_11 desi�m f, etc.)
❑Yes
No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
:Tlo
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
;SrNo
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
KNO
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes
[8[No
(ie/ discharge, freeboard problems, over application)
23,
Did Reviewer/inspector fail to discuss review/inspection with on -site representative'?
❑ Yes
In No
24.
Does facility require a follow-up visit by same agency?
❑ Yes
.K No
25,
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
91 No
No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
^n A a2iE�lN ��? .: aaw- aiiara 2nwry s�wsza�_ty
Cpetn M#(rfer¢t4;getestionF#) plaltanyYEsanrandlo'^>y rec°�mnne n�da#on or:�tnyotiner catgm�nta " r•�t
Use drawings of fac[IIty to he�tter`e=plain situatidnnC dse.add(donai'pages afn.�e;�cesaarFy)s _ ❑ Field Copy ❑ Final Notes
r
y�tj
a
Reviewer/Inspector Name Ne:t,,
Reviewer/Inspector Signature: Date: Oe,
05103101
Continued

•
Facility Number: YZ — zf
Date of inspection �O
Odor h1pes
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
27, Are there any dead animals not disposed of properly within 24 hours?
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
29, is the land application spray system intake not located near the liquid surface of the lagoon?
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
31. Do the animals feed storage bins fail to have appropriate cover?
32..Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
19 Yes ❑ No
❑ Yes ,8 No
❑ Yes ® No
❑ Yes ESNo
❑ Yes [S No
❑ Yes 91 No
❑ Yes N No
05103101

o
gat �. y�}, ee.,n'if!"5�� rtq !• i 9 `' /�/,
Type of Visit tkCompliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit 0 Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
F 10 Facility Number Date of Visit: 77'ab 01 Time:30(7
Not Operational Q Below Threshold
Permitted 1% Certified 13 Conditionally Certified 13 Registered Date Last Operated or Above Threshold: .........................
FarmName: ............ �3a ` n/............................................. County :........ ct............................ . �..........
Owner Name:..... ?t1R R!...... 1�t.................. �y............................................. Phone No; ......Jr..33:'3/............................................. ....
Facility Contact: �.... ...��....J.11 �............... Title; ..... ewsn5, ..................................... Phone No: ..................................... »............
Mailing Address:....... s2!.......k+'�..S.....�#......... ......... .........CJ.,N.6.n......�1.�................................. .a�'� ...
OnsiteRepresentative: ........ %.4 ....... ............................................................ Integrator:........ `.4L..................................................
CertifiedOperator:....... t, .fit.........................:!KY..................................... Operator Certification Number:.........,.X .................
Location of Farm:
19Swine' ❑ Poultry ❑ Cattle
❑ Horse Latitude
Longitude �•
��
Desigtn;:' Cucreat Design
Current: ,:. Design
Curresit '
Swine Ca' aci
:Pa ulation , Poultry ;Ca' aci
Po utation : Cattle Ca'
ct Po elation '€
Wean to Feeder AW
❑ Layer
❑ Dairy
a: Feeder to Finish
❑ Non -Layer
❑ Non -Dairy
❑ Farrow to Wean
' ❑ Farrow to Feeder
❑ Other
I I ❑Farrow to Finish
Total Design CApacity"
❑ Gilts
❑Boars
Total S9LW
i:;, , ,,
,Number of Lagoons �, i e€ ,�
Holdiog,Poiids / Solid Traps'=
❑ Subsurface Drains Present Lagoon Area
❑ Spray Field Area tr;,
t '
❑ No Liquid Waste Management System f , I €� Y 9' r
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
❑ Yes
❑ No
b. if discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
❑ Yes
❑ No
c. Ifdischarge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
❑ Yes
❑ No
2. Is there evidence of past discharge from any part of the operation?
❑ Yes
1XNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes
P-No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
❑ Yes
No
Structure I Structure 2 Structure 3 Structure 4 Structure S
Structure 6
Identifier: ........., .........................................................................................................................................................................................................
JJ
Freeboard (inches): i3
5/00
Continued on bank

w
Facility Number: 89, — a Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑ Yes
No
seepage, etc.)
6• Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
❑Yes
� No
(If any of questions 4-6 was answered yes, and the situation poses an
Immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenancelimprovement?
❑ Yes
No
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes]
No
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes
60 No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
❑ Yes
0 No
12. Crop type MUJa Alb4 1 S Gra,�n oS
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
19 No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
b) Does the facility need a wettable acre determination?
❑ Yes
❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes
❑ No
15. Does the receiving crop need improvement?
❑ Yes
No
16. Is there a lack of adequate waste application equipment?
❑ Yes
No
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
j No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
No
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
No
20• Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
No
21. Did the facility fail to have a actively certified operator in charge?
❑ Yes
No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
discharge, freeboard
❑ Yes
09 No
(ie/ problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
No
24. Does facility require a follow-up visit by same agency?
❑ Yes
No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
1�No
• �c1� •Y�P1at�>�s:o#��f e�e��� ire ��:e�• �u{`t>�� ��tis:visit; • 'Y:o� ��i•see�if� �4 ��'t��r
6 ies• o deuce: ab;bu* this :visit:
ficiz : Rr, C,••`n j wi if Qon - roncsrr, �ti i IJ1�5i o/� r �p„ L� �/!k [1 /
of �►•� j��- Wos�c sar+.plC�. V J
r.I
C7
r I�r �- ��,, { - i,r�l, ;�i `'�?�.j:,iil # y�,iF(Yi¢:+t{ lrt t 7`�, ``lEE �� t�I-_ 1�- � ,;tE iYi ar ri `1 � ll��"�� •i r�i � Itl�"' {��p���i°� rI r��,.' < ;,� �rs iz,� s• � ° f �;.'{fr � r �� l,{ 'T tr ra�itir
Reviewer/Inspector Name Reviewer/Inspector Signature: Date: q` 2to 0j S100

Facility Number: Date of Inspection
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below []Yes []No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes lNo
28, Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes tj No
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? El Yes J!fiNo
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) 0 Yes IV No
31, Do the animals feed storage bins fail to have appropriate . cover? El Yes No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? Yes ❑ No
AdditionauCamments andl/or;Drawings:,'t Jov ki�' [;T? � 1�1' - ' I �'
J"
A,
5/00

r
I y� II
Still
11 - -i h !
�'.. 1
•hh I!Ih�iai41 - p" }I }�, 4, nl tl
9jAivinston Of S(�oil aln!d Water, Conservation ;
herAge�s eN - 9d 3{il Ix t)✓1H�F31tiiRi 1,,,1:�i..-�16i!IIHI�t30:IfI11p1iI�Rl:��tp !
N
;�
I
i ? {:i- I I
;��'
i
Type of Visit 0 Compliance Inspection 0 Operation Review 0 Lagoon Evaluation
Reason for Visit O Routine 0 Complaint 0 Follow up 0 Emergency Notification 0 Other ❑ Denied Access
Facility Number Date of Visit: 12/14/2 000 Time: 10:00 Printed on: 12/20/2000
p Not Operationalp BelowThres o
Permitted 0 Certified p Conditionally Certified p Registered Date Last Operated or Above Threshold :.........................
FarmName: Ray..±Gainey...................................................................................................... County: Sampsan........................................... FRO.............
OwnerName: Donald.Ray.......................... GaitW...................................... .................. Phone No: 53.1-38.0.4 ...................................................................
FacilityContact:fvner.................................................................Titie:............................................................... Phone No:....................................................
MailingAddress: 2323.Klng.Rd........................................................................................ Alitttau.NC......... .................................................... 283.28 ..............
Onsite Representative: Owner............................................................................................ Integrator* Priatage.F.arras.....................................................
Certified Operator:Dnnalii ................................... Gainey .............................................. Operator Certification Number: 19.829.............................
Location of Farm:
.03 South rom Clinton. Farm about miles on right. Lefton 1752. A
•
® Swine p Poultry ❑ Cattle ❑ Horse Latitude ©• ®' ®"
:91hDeftw! IIiCnrrexn
I` Swore } - ,;';I, , ''I Capacity�liPopulattonF '," ,,, ltry �,aCapacity,'„Populi th
® Wean to Feeder
6400
❑ Feeder to Finish
❑ Farrow to can
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
❑ ayer
❑ Non -Layer
Longitude ®• ©G ®44
on-Ua
} 3'
)esign-Capacity 6,400
.,Tothjss "W- 1, 192,000
1. 1s any discharge observed from any part of the operation? p Yes ® No
Discharge originated at: p Lagoon ❑ Spray Field p 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 K No
c. If discharge is observed, what is the estimated flow in gal/min'? NIA
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? p Yes ® No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge'? ❑ Yes ® No
Waste Collggfion
4. Is storage capacity (freeboard plus storm storage) less than adequate? 0 Spillway . p Yes ® No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard(inches): ..............32........................................ ............. .................................... ....... I........................... ........ I.......................... ............. I.....................
51no ('nnlinnod an hark

5/00 Continued on back
s '
Facility Number: 82_24 Date of Inspection ® Printed on: 12120/2000
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
W#yte Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
12. Crop type Coastal Bermuda Small Grain
❑ Yes ® No
❑ Yes H No
❑ Yes ® No
❑ Yes ® No
❑ Yes ®No
❑ Yes H No
❑ Yes H No
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes H No
14. a) Does the facility lack adequate acreage for land application'? ❑ Yes ❑ No
b) Does the facility need a wettable acre determination? ❑ Yes []No
c) This facility is pended for a wettable acre determination? p Yes p No
15. Does the receiving crop need improvement?
16, Is there a lack of adequate waste application equipment?
$eauired Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
1 S. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement'? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20, Is facility not in compliance with any applicable setback criteria in effect at the time of design'?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
p Yes ® No
❑ Yes ® No
❑ Yes H No
❑ Yes ® No
❑ Yes Ig No
❑ Yes ® No
❑ Yes ® No
❑ Yes H No
❑ Yes H No
[]Yes ® No
❑ Yes ® No
d: - Ndvinlitions:aY. clefiri ncies:were nrntecl during:this:visit. - of kvill•rece'ive'ria' further.:.
rSes�onden a aboirf this.visit;. ....
Comments�(teter to!gtiestioni#): Explain"any YES'ansrtiers and or,any iecolinmendatioris
, uul�gii x'ifa,:(i![IR1!II1IeHII i !r;,;€E".,IIi�.3 E iG 111M9�!FEetll IIEI.!u..r,[r1�(�plw- ItuIv:WIiPEEirF 6�r #f'.�rIr4 UWl'"�i":u"iiVll!E-,% [riillt;+FFli�lV3!ii 131W � r'��S-�,MCS1i'"'
or'any;lother
{Mg6ppj(�
camrrierynts:l}1
fip19�yII
Usle_I�EtdrawingsllPof cility,,,to)1{bett% expiainlsituatruns+ {use addrtianalipages as necessary).
f fats;1,
, ..,.
�Il
t
ImulPt4NC6kRilial$tHllwngEltl§I$,$i..lPjlEfwllN„n3.i4 ElI{g1111!Itlu1NlF1 1!',lL.sU(Sk!![llillliFININI11111hMdiE I, n.t�, Ei..Ni Mlilll�l{NBtltliiil!hs.... ,,;R!4i, ,WR11 1�'�if�f!_lh.Ek,J,€.:,}{z,4416ia�t•r.}Fi.
: I , ,...�":.Sf,�Itl�
klal�faax! I�ib'.#4�:.
li
Eiil! fl I
19?!''" Gn Pu
t.�.'�1, �nll
reduce�thtsinextwyn
{sryy[LtI[B(,(f&'�!1(1B'ov&sed(�din
iskfllllti'IHII'AAil}?`
I�tt flfl""CIIII�Si�S{1f5
rAL
�t
idl.iE
wasi!follownig�oldrPAN'for�!Marchl22�f1999P
a ryectSa�jmm{yen
.:I ''j!E! Il:-1�1�Ii IIjIN
ili�i �'fo
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l�i�k� ��17'1
".1ne�e �s1'tbna ri:80 1 s"only
�I 1h4�1�,��;13 INf I
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Reviewer/Inspector Name bgjf qqn It1{gltE I t �i� ` title i I i y f }: 1 't i� i 3 I$ t iM i F 5 $;4t ffE]i(jE Fr 3j'Ii II4n[F7 Y 114P ip
RickylRevclsEfl�i . E .� t ��iE,u EE;,I '''tti
Fnv:man.•lrver.nn�ne C:rrr.ok...•n. il..a...

Reviewer/Inspector Signature: Date: 5100
act t y Number: 82_24 Date of Inspection ® Printed on: 12/20/2000
Odor Issue
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge attor below © Yes p No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? p Yes ® No
28. Is there any evidence of wind drift during land application'? (i.e. residue on neighboring vegetation, asphalt, p Yes ® No
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? p Yes Cl No
M Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc,) D Yes ® No
31. Do the animals feed storage bins fail to have appropriate cover? p Yes ® No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover'? p Yes p No
171
5/00

I
Facility Number Date of Inspection 4 ;jy
lime of Inspection 8" � 24 hr. (hh:mm)
Permitted ■ Certified 0 Conditionally Certified [3 Registered JE3 Not Operational Date Last Operated:
Farm Name: ........ jf� ......4!!!''�,r....~'`'�,....County-..,.!�i✓................................................
Owner Name:........ p...'C^..4 ....�A�•Jay...................................................... Phone No:...(9/Q>....S3s.....,,��a.................
Facility Contact: ...... P....... 7riLr AF...�....,)..................'Citle/:................. D......�...D.................. Phone Na:.................................................,.
Mailing Address: ......r.1 .Z.3..,1tr ..,..�G2?!.. .. 1! ,/.. ��... Q.. !'.................................................................... ..........................
Onsite Representative:.......: f..,w!'a..................................... I........... Integrator: ...... t xoc... ...... ......................
Certified Operator:.......... / ...... Operator Certification Number: 19r 9..............
Location of Farm:
...................................................................................................................................................................................................................................
Latitude . • 6 Longitude "
Design Current i ? Design' Current Design Cui ent
CattlCa acit Po ulakion aaciCapacity. Population
' Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
x ❑ Farrow to Finish
❑ Gilts,
❑ Boars
❑Layer ❑ Dairy
❑ Non -Layer ❑Non -Dairy
❑ Other
Tonal M§i$tl Capacity. �•
if' it �1, rE't}
n t,
Total'SSLW
+ Number 4,1agoons� Subsurface Drains Present ❑ Lagoon Area ❑ Spray Field Area
Ho116 Ponds./Solid Teas ' ii I ❑ .....
p �. ❑ No Liquid Waste Management SystemI , ' ' s
Discharges & Stream Impacts
Is any discharge observed from any part of the operation? ❑ Yes [IgNo
Discharge originated at: []Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes 9 No
h. If discharge is observed, did it reach Water of the State'? (If yes, notify DWQ) ❑ Yes f'No
c. if discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes [KNo
2. Is there evidence of past discharge from any part of the operation? ❑ Yes $j No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes PNo
Waste Collection & Treatment
4. Is storage capacity (freebodrd plus storm storage) less than adequate? ❑ Spillway ❑ Yes J9No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard(inches): .............. z.` ............ ................................................................................................................................................................................
5. Are there any immediate threats to the integrity of any of the structures observed? (ic/ trees, severe erosion, ❑ Yes ;j No
seepage, etc.)
3/23/99 Continued on back

Facility Number: 8,t — .'Z Date of inspection
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
❑ Yes
Q No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
❑ Yes
No
8, Does any part of the waste management system other than waste structures require maintenarice/improvement?
❑ Yes
No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
NrNo
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes
IR No
11. Is there evidence of over application? Excessive Ponding ❑ PAN
❑ Yes
gNo
//❑
12. Crop type �EpwkO'.rt .. 3fi,.s�/r�P.l�
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
gj No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
XNo
b) Does the facility need a wettable acre determination?
❑ Yes
2No
c) This facility is pended for a wettable acre determination?
❑ Yes
XNo
15. Does the receiving crop need improvement?
❑ Yes
,� No
16. Is there a lack of adequate waste application equipment?
❑ Yes
No
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
(9 No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes A No
19,
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
VINo
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
WO
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
)K No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
KNo
23.
Did Reviewer/Inspector fail to discuss reviewlinspection with on -site representative?
❑ Yes
H No
24.
Does facility require a follow-up visit by same agency?
❑ Yes
XNo
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
12 No
3/23/99

J
Facility Number:Date of Inspection
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes( No
2& is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes 51 No
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes [6No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc,) ❑ Yes J] No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes [S No
32. Do the flush tanks lack a submerged fill pipe or a permanenUtemporary cover? ❑ Yes 1K No
3/23/99

Division of Soil and Water Conservation ❑Other Agency R�
a Division of Water Quality
Fg
.�� r: �. . �i'•tp•�r.�.".i,.?".'a°!�.r�,v..�...,?IEti`�iTT'"`:.` � � ...: w . "9T 4.. i . S E'i3.`i`P � ?f!`� K V'..
O Routine O Complaint O Follow-up of DWQ inspection O Follow-up of DSWC review O Other
Date of Inspection
Facility Number Time of Inspection ' p 24 hr. (hh:mm)
Registered 0Certifiied [3 Applied for Permit [3Permitted D Not O erational Date Last Operated:
FarmName: .....................!.� ,. .......4? IJI.C:.q........................................................... County:............... Sc? J! ..............................
Owner Name:..... (la A� .......... q.1 e...........................I...... Phone No:................ 21.-...�`���3'~...3......90.....40........
Facility Contact: ................. GIV1nn...... .�.f...i...�f.4�. . Title:..........,..................................................... Phone No:...................................................
MailingAddress: .................aj.......... 1.1,1A...........!.`�C�............................... ............. .1...... fi.,4......,I..� ......................... .o a
Onsitc Representative: ............ ` f!1n............Jl.: rC ? L.....,......................... Integrator:............... C.. ............. 4-A'i-�........
Certified Operator,........, .. ........ g,.............. 1.✓.i.� Operator Certification Number;,....,..,.
9� !
.......................... .............................
Location of Farm:
Latitude Longitude �• �' �"
'Design'' Current
3 Design •'`'Current •
Design' ` Current
Poultry Capacity Population Cattle W
Capacity `Population
.. .
❑ Layer ❑ Dairy
!i ❑ Non -Layer ❑ Non-Dairy
-� ❑ Other
Total Design Capacity
x
.3x
T'atal-SSL'W
. ,.
Nttmber of Lskoons / lding Ponds
❑Subsurface Drains Present
❑Lagoon Area
❑ Spray F,etd Area
ANdo. �, r
Vim. my
❑ No Liquid Waste Management System
Capacity Population
}
Wean to Feeder
-'� Feeder to Finish
Farrow to Wean
'- El Farrow to Feeder
❑ Farrow to Finish
w ❑ Gilts
-, Boars
General
1. Are there any buffers that need maintenance/improvement?
❑Yes
0 No
2. Is any discharge observed from any part of the operation?
❑Yes
4 No
Discharge originated at: ❑ Lagoon ❑Spray Field El Other
a.. If discharge is observed, was the conveyance man-made?
El Yes
�] No
b. If discharge is observed, did it reach Surface Water? (If yes, notify DVS'Q)
El Yes
� No
c. If discharge is observed, what is the estimated Flow in gaUmin?
d. Does discharge bypass a lagoon system? (if yes, notify DWQ)
El Yes
�I No
3. Is there evidence of past discharge from any part of the operation?
❑Yes
O No
4. Were there any adverse impacts to the waters of the State other than from a discharge?
❑Yes
a
S. Does any part of the waste management system (other than lagoons/holding ponds) require
El Yes
rNo
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑Yes
No
W
7. Did the facilityfail to have a certified operatorin responsibEe charge?
YesA
No
7/25/97

1• acitity Number:R5 -- oQ 4
S. Are there lagoons or storage ponds on site which need to be properly closed?
St�ctures.(Lagoons.fl ldin�Ponds, Flush-Pits._etc )
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure 1 Stricture 2 Structure 3 Structure 4
❑ Yes [�No
❑ Yes A No
Structure 5 Structure 6
Identifier:
Freeboard(tt):........... AY..f1............................................................................................................................................................................................
10. Is seepage observed from any of the structures? ❑ Yes k]0 No
11. Is erosion, or any other threats to the integrity of any of the structures observed? ❑ Yes No
12. Do any of the structures need maintenance/improvement? ❑ Yes No
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers? ❑ Yes No
!Waste Application
14. Is there physical evidence of over application? ❑ Yes No
(If in excess of WMP, r r off entering waters of the State, notify DWQ)
15. Crop type ........lnjy
..................... . r,..
V717�
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)? ❑ Yes r,11 No
17. Does the facility have a lack of adequate acreage for land application'? ❑ Yes( No
18. Does the receiving crop need improvement? 4 Yes ❑ No
19.
Is there a lack of available waste application equipment?
❑ Yes
0 No
20.
Does facility require a follow-up visit by same agency?
❑ Yes
10 No
21,
Did Reviewer/lnspector fail to discuss review/inspection with on -site representative?
❑ Yes
No
22.
Does record keeping need improvement?
❑ Yes
No
For
Certified or Permitted Facilities Only
23.
Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑ Yes
No
24.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
(` No
25.
Were any additional problems noted which cause noncompliance of the Permit?
❑ Yes
❑ No
0 • No.vitilAonsvor. deficiencies. were noted during this:visit.- :Yo'u ill receive. no furthierr :
�ederespi)Wence Eottt this:visit:, : :.. .. .: : ; . ' ' . ' ; ; ` : i
IF, na.e bl soMo� s,,,n �,,.J d5 15�u
7/25/97
Reviewer/Inspector Name
Reviewer/Inspector Signature:

, _T
Division of Soil and Water Conservation ❑ Other Agency
('Division of Water Quality
atoutine O Complaint O Follow-up of DWO inspection O Follow-up of DSWC review O Other
O�"
Facility Number Date of Inspection �
Time of Inspection E= 24 hr. (hh:mm)
0 Registered Certified 13 Applied for Permit 0 Permitted 10 not Opera€ional Date Last Operated:
c
Farm Name:........a-+....................Gl.r County: ..,,,.�p5.w!a................ ...... .......................
�.n, .1..... t . ��..�1... ..... ..:,.,..- 3
Owner Name:......... �. ... l'hotic No:
Facility Contact: . ................................................ Title: ,,,,, Phone No:
Mailing Address:.....�.3.2:�......14..! .....,....................................................... .. ..i.(�la .Ijl.....!'1.C........................... ����
Onsite Representative:... L. -- .-...... Integrator: .... ..................I"...."......................
J..................................................... GG
p nQ.1(� ... Operator Certification umber;..........!. �Z�`
Certified Operator �` � .....i"'.,,..,..,..,
Location of Farm:
R!: ...... a...... C!71 t.. ...S.Qu...........P.........i.. l..r!....................... ...........................+....,t.�...:5:�... ..........,..,........... `1,......t....,. r5ec. off- ...'
C
Latitude Longitude �• �' �"
Destgtt Current :,. �3. Design $ Current .3 , ' Designs Ctirrent,
Swine ' '$_ Capt<c ty„ Populiitton ,Poultry , p; .Ca1 Acity Po{ ulateon Cattle g Capacity Pppulaaon; �
to Feeder ` ❑ Layer ❑ Dairy
PWean
[3 Feeder to Finish ❑Non Layer Non -Dairy
Farrow to Wean
❑ Farrow to Feeder ❑Other
❑ Farrow to Finish ' Total Design' Capacity y+
❑ Gilts ,
7 ($ y
�aO�^a
t ❑ 17
`Nam er of 1 ag 4ns 1 Holdtng Pnnds ❑Subsurface Drains Present ❑Lagoon Area 10 Spray Field Area 74
x�c. ar F ❑ No Liquid Waste Management System„ �y
t
General
1. Are there any buffers that need maintenance/improveinent?
' 2. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
A. Does discharge bypass a lagoon system? (If yes, notify DWQ)
3. is there evidence of past discharge from any part of the operation?
4. Were there any adverse impacts to the waters of the State other than from a discharge?
5. Does any part of the waste management system (other than lagoons/holding ponds) require
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
7. Did the facility fail to have a certified operator in responsible charge?
7/25/97
❑ Yes No
❑ Yes No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes A No
❑ Yes R(No
❑ Yes ANo
❑ Yes lANo
❑ Yes )9�10
❑ Yes NNa
Continued on back

II . T'
Facility Number: z -- Z
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (I aeoons,Holdine Ponds, Flush Pits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure 1 Structure 2 Structure 3 Structure 4
❑ Yes XNo
❑ Yes Pg�,No
Structure 5 Structure 6
Identifier:
Freeboard(ft):........2.'............................................................................................................................................. ..............................................
10. Is seepage observed from any of the structures? ❑ Yes �No
11. Is erosion, or any other threats to the integrity of any of the structures observed? ❑ Yes No
12. Do any of the structures need maintenancelimprovement? ❑ Yes A �No
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
Waste Application
14. Is there physical evidence of over application?
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type .......Beryu".4 '��C.�4)..>....................................................................................................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
22. Does record keeping need improvement?
For Certified or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
25. Were any additional problems noted which cause noncompliance of the Permit?
No:vialations,ar. deficiencies were noted during this'. visit'. You.will receive.no ftirtlie� ::
eorrespo &0e dUout this:visit.• ::. :. ... ,
❑ Yes ANO
❑ Yes PNo
❑ Yes XNo
❑ Yes No
❑ Yes Io
❑ Yes No
ElYes No
❑ Yes KNo
❑ Yes P(No
❑ Yes XNo
❑ Yes NNo
❑ Yes ❑ No
CoMmeitts (refer=tn que`stion #1.. Fxplain�anyi I S,answet s acid/ar tiny recomnat ndattons o nygother cot tmen& # � ,
f .*.,. S 33 .
[1se drr�lwings#of factlrty tst better ex!:ainsitualtul 5., MCA �dditional pa`g gas nt essurY) M �
7/25/97
7
Reviewer/Inspector Name w _ r,�. -t�
�,.�.rt- �` '- O:Q ;.�°` i�, 'c.-�n ,Y...x-::t
Reviewer/InspectorSignature: Dale: 14-22 `97
0 If

State of North Carolina
Department of Environment,
Health and Natural Resources
James B. Hunt, Jr., Governor
Jonathan B. Howes, Secretary
November 13, 1996
Donald Ray Gainey
Ray Gainey
Rt 5 Box 246
Clinton NC 28328
SUBJECT: Operator In Charge Designation
Facility: Ray Gainey
Facility ID#: 82-24
Sampson County
Dear Mr. Gainey:
F.
`e e
E)aHNF;Z
NOV 19 1996
Fr'WE l � EVIL-
NEG. OFFiCE
Senate Bill 1217, An Act to Implement Recommendations of the Blue Ribbon Study
Commission on Agricultural Waste, enacted by the 1996 North Carolina General Assembly,
requires a certified operator for each animal waste management system that serves 250 or more
swine by January 1, 1997. The owner of each animal waste management system must submit a
designation form to the Technical Assistance and Certification Group which designates an
Operator in Charge and is countersigned by the certified operator. The enclosed form must be
submitted by January 1, 1997 for all facilities in operation as of that date. Failure to designate a
certified operator for your animal waste management system is a violation of 15A NCAC 2H
.0224 and may result in the assessment of a civil penalty.
If you have questions concerning operator training or examinations for certification, please
contact your local North Carolina Cooperative Extension Service agent or our office.
Examinations have been offered on an on -going basis in many counties throughout the state for
the past several months and will continue to be offered through December 31, 1996.
Thank you for your cooperation. If you have any questions concerning this requirement please
call Beth Buffington or Barry Huneycutt of our staff at 919/733-0026.
Sincerely,
A. Preston Howard, Jr., P.Fw-Bi tar
Division of Water Quality
Enclosure
cc: Fayetteville Regional Office
Water Quality Files
P.O. Box 27687, �?�Raleigh, North Carolina 27611-7687 vaCAn Equal Opportunity/Affirmative Action Employer
Voice 919-715-4100 _ 50% recycled/10% post -consumer paper

Facility Number: 8 2 - Z E
Division of Environmental Management
Animal Feedlot Operations Site Visitation Record
Date: Z - r 2 9
Time: i 4 05
enngroUnformation:
Farm Name: Ru &,aimeu unty: Sate seN
Owner Name ba"O l d Rw � G �,'NG ti Phone No: (9/0) 53 33801_
On Site Representative: Integrator: s
Mailing Address:. -z 3 L3 Kim,; Rd
(ili,y r /VC -z13 Z-
PhysicalAddress/Location: Addsers) .
Latitude: _ J. 1 Lon 'tude: I 1
Operation,Descriptigm (based on design characteristics)
Type of Swine No. of Animals Type of Poultry No. of Animals Type of Cattle No. of Animals
❑ ow O Layer ❑ Dairy
UffNursery (0400 ❑ Non -Layer ❑ Beef
❑ Feeder
OtherType of Livestock Number of Animals:
Number of Lagoons: (include in the Drawings and Observations the freeboard of each lagoon)
Facift Inspection:
Lagoon
Is lagoon(s) freeboard less than 1 foot + 25 year 24 hour, storm storage?: (3, 5 P+)
Yes ❑
_/
No G(
Is seepage observed from the, lagoon?:
Yes ❑
No
Is erosion observed?:
Yes ❑
No l2(
Is any discharge observed? -
Yes ❑
Noe
© Man-made ❑ Not Man-made
Cover Crop
Does the facility need more acreage for spraying?:
Yes ❑
No.—�/
Does the cover crop need improvement?:
Yes ❑
. No C/
( list the crops which need improvement)
Crop type: &,j C►z es 4 8e wuJa.._ lWak, Acreage: 2 5
Setback Criteria
Is a dwelling located within 20O feet of waste application?
Yes ❑
-No M/
Is a well located within 100 feet of waste application?
-Yes ❑
No E9r .
Is animal waste stockpiled within 100 feet of USGS Blue Line Stream?
Yes ❑
No
'Is animal waste land applied or spray irrigated within 25 feet of Blue Line Stream?
Yes ❑
No ar"07
AOi .- January17.1996
rt- .

Maintenance
Does the facility maintenance need improvement? Yes ❑ No Sri
Is there evidence of past discharge from any part of the operation? Yes ❑ No �7
Does record keeping need improvement? . _ Yes ❑ No
Did the facility fail to have a copy of the Animal Waste Management Plan on site? Yes ❑ No O'
C,,, x 8000330
Explain any Yes answers„
cc: Facility Assesment Unit
Drawings or Observation;,
Date: 44 - 07 - 9 &
Use Attachments if Needed
_ '_ � .. _ � nn{y 7+�}f ..a•r. _ _ •n Zs.�- _.t St' nirc��..rii4lc�i•r'LTr:asrJai +.rr:. n-'`9=-__'_ '
`fr.f .��.n-.7•+,,. t. R \,i•7....-
AOI — J'ahuary 17,1"6

R
t Site Requires Immediate Attention: A)j�
/ Facility No. 2- z
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: l 1995
Time: l-z Do
Farm Name/Own
Mailing Address: Pt h , !. 2.4
County:._o�a,.�
Integrator:_ P o 5j�"p ,�'a r.�► - Phone
On Site Representative. Phone:
Physical Address/Location: 5. ,D .
Type of Operation: Swine Poultry Cattle i
Design Capacity: _ 6g,-. Number of Animals on Site: y.vorroo 13,V,Ld J
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
(approximately 1 Foot + 7 inches) YC� or No Actual Freeboard:_I Ft. Inches
Was any seepage observed from the lMes
n(s)? Yes o I� Was any erosion observed? Yes or(M
Is adequate land available for spray?or No Is the cover crop a equate? for No
Crop(s) being utilized: C4>w " V r+ K� lC04
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings? ®or No
100 Feet from Wells? .ae or No
Is the animal waste stockpiled within 100 Feet of USGS Blue -Line Stream? Yes orca
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line: Yes or(:S
Is animal waste discharged into water of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes or(!§) 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)? e�r No
Additional Comments:
�1
ictor Name
Signature
cc: Facility Assessment Unit Use Attachments if Needed.
event

ti
f
WORTH CAROLnM DBPARTM= OF ENVIROMCMT, HICALTH & NATURAL RBSooRCE.S
DIVISION OF ENVTRONMMT)LL KMG81KMT
Fayetteville Regional Office
Animal Operation Compliance Inspection Porn
::a:a :;•$• '>wi` . �.:vo�. oia '•`Y': .aza'
.:xx .�rJ:,rv+�;;:.�«u. ..
::.' io-:e:Y•�v';..r,•a`A'..'.'cvr^^'::::..:.,.
.M+v:�.� ..Sin :',-r4Kr�'Y�n'e4'N•
DB
,INSPP.Q'IQP��`TE:'
l 1
naf: t+-}rw fP;;aw
', y Y, � .i'ti0.Y< �:fn� .;�'k��i:P`
�, �;M '•iHt psw.Wlk°�t" Y;:�sy.,} a»e^ ,.t•.n r�?!;'S.`.:..%:..r.
`fi-`� °r• YY i- ~ "{a' ro
�������y/��
+". ^.�'4•r : iSAI3.� ;.i1Q���Q ;•�., ..:�.:�'�`.
lifer J.rL7 M'�.�.i/V,�t �.,p,� ...{I.i. W�l.1:•'
nr.,<itw'.�l1CiLITY:.''rEi.EPiiO��¢
"� •17 Ui'lO�.
SVU4 62 Clan n 2
All questions answered negatively will be discussed in sufficient detail in
the -Comments Section to enable the deemed 8ermittee to perform the appropriate
corrections:
SRCrION I
Animal Operation Tom: N orwq
Horses, cattle, skins poultry, or sheep
SECTION .II
Y I N I COKKKNTS
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
poult (30,000 birds with liquid waste
system]
2. Does this facility meet criteria for
Animal Operation RE ISTRATZOH?
3. Are animals confined fed or maintained
in this facility for a 12-month period? -
d. Does this facility have a CERT
WASI >~ WGF.I992ff PLAp?
5. does this facility maintain waste management
records (Volumes of manure, land 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?

Y I N
rigld Sit a Mans em nt
1. Is animal waste stockpiled or lagoon
construction within 100 ft. of a USC5
Map Blue Line Stream?
2. is animal waste land applied or spray
irrigated within 25,ft. of a USGS !up
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 accorda.nce'with the
CERTIrICATIQR
5. is -animal waste discharged into waters of
the state by man-made ditch, flushing system,
or other similar man-made devices?
6. Does the animal waste management at this
farm adhere to Best Management Practices
(SHP) of the approved gMTIFICATI ?
7. Does animal Waste lagoon have sufficient
freeboard? How much? (Approximately _)
8. Is the general condition of this CAFO facility,
including management and operation,
satisfactory?
SB ON IV
Gotnm=s

raccoon `s noted for the
4.the face and the ,hlgck
tii. The rest of the fur is
Ray Gainey
illy nests in a hollow tree,
ter. Raccoons eat a wide
th 'int and animal. They From Clinton take 403
s, �ects, crayfish, frogs toward Faison go .5
ccoon does not actually mile turn left on SR 1751
s many people believe. Farm is 3.5 miles on right
in play with their food in on SR 1742.
er nearby.
f D U P L I N C O U N T Y
i!
too 90 ISO
00
lip
qqW
9 f► " s
4
J• �, J/ � .. � .'r� ..,+ '� yr
WO
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IP
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lop
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1100
�� yr � .,V "r',v � ,►�C � + ,� � �'J,�•

.urtwM� �www 4�wT�I a�+� �ti+w r•+w� iiR, ads rssw:rs
lrleew+ s�rra e�i�wi~� *+e tie Divislea •!' at�]p�na�ewtt�at`+� .
Keoa o l: tas'ar Ei 1 ' p ti P�
z 3 Phone No.: 5 d 733 -3
county r G I-
Far
m m location. Latitude .and Longitude: _'5 -L "/ ►?' �•• (rs�.tzr+d} . Also,
please attach a copy of a county road map vita location identified.
7Pe of operation (swine. layer. da.ir'f, arc.) : +n
-.asign capacity (=zmbar of animals) : . G `# 0 o w 4ra n.- pre E a
Average site of cp*atiori (IZ month populaclon avg.) : -�dAo _wFen- FED
,average acreage needed for land application of waste (acres) :„_ 12.ea
■rrrrrrrrrrrarrrrrrrrrarrrrrairrrrrrrrrrrsrrrrrarrrrrrirr=srr�rrrrwarrrrarraar
T%CJIIwCa-L sgeaialiat
i.s a tech -pica; sprci :1st desiy atsd 1--y the 110=h car3lina. SOLI &:nd 'Water -
Cons er*rarzi on Camission pursuance to ISA NCAC 6i .0005, 1 ca=t;ff that t~a eew or
ex-,anded animal vasta martagamer.t system as installed for t!:e fay: named above
'pals an animal waste management ,plan that meats the design. corst_sct_on.
cperacion and aat:nmatr;anc• standards and 2prcificat4on3 of the Division of
=nviroraental xasagement and t.'ie USCA-Soil Csnserrat:on Serr_ce anal/ar th *4orth
Carolina Soil and water Conser-ration (=--ammission pursuant to I5;. NCAC 2Ii.02;7 and
1_5A NCAC 67 .000I-.0005. The folwowi..q eiaments and t: sir c___espa ding ni..'::�tt,3
c_iteria-)sa�a,_been verif_ed by me or ocher designated tec;:aical specialists and
are incl;sded �n the plan as applicable: separations {:-u;=ars) ; liners or
equivalea: for lagoors.s or waste storage ponds; waste storage capacity; adequate
quantity and amount or land for waste ut;l'_tacion (or use of third party) , access
or ownership of proper waste a"I' cat:ian oquipmant; scheduie .for tiz4:.,q of
applicac4ons; application rates; loadL rates; and the cz,t:al of the discharge
a., ? oollutztz from starmwater ruaofw events lass severe than the- 25-year, 24-hour.•-_.
storm. - __.�Y g i�
x4ow vt 3`eabaiaal areas a1.3 (Please p��ztt) : G . G �_ P n�. C c. FTovt _ - a %
Affiliation: pALys rdca Fa,e„ms • _'..�. -;
Adrwess (Age^.cf)L ! phorze Na. grc_--
XF
sigaar.:-.:��,,,..., Date
rrsrr:sr=ssrrrrrrrsrrrrrwrrrrsrrrrssrnowMOsrrssseWrrrrsrrsarsrrrsrrasssr.l­
a- rz•t:`
I (we) understand t:te operation and maint4nancs procedures established in the =-n.
approved animal waste mariagament plats for the farm named above and will itaplaaent
::ese r._ocedul'as. r (we) know that hay addltional axparsiom to the ax4.stinq-
design capacity of t!-a waste and storage systma or ccnscrsct:on of new
facilities Will require a new car_ifzcacior. to be submitted to the "'i.V%siots of
Envi_ormental Management before r-he new anaaals awe stacked. I (we) also. _
understand that vhere must be no disc; -.a ye of ani-mml waste from _!%is system to
surface waters of t_~• stare ei,her t`.rough a ::tart -shade cc-vevarca or t.'..rough
Z_^.3 a Stc: r event less severe zee 25-yeax, Tut
approved plam will -a !;lad at t:;a fa_-= ar.d at t!ts off_cs a! the kcal SO --;I and
Water Cor:sezration DisCr,: t.
Yame of Land owner (?_ease P_i.'tt;} :� �0J7iJ �A f`Gi
Signacu;w:��� A41110W Z b�arx1�* - _ Cate:
Yame of Xaaaper, if dy,fe.rent fr= owner (Please pri-mc)
S igtsa►cs:wa : Date :
gaffs: A change in land ownership requires aocificatian or a new cart ificacian-;
approved plan is G':anged) to be submitted ca the Div:#ion of .
rzviyonmental Management within 60 days of a title transfer.
DE-S USE

Ud�QI?TY1ant of Et Worir1Mt,
Hwith and Nc"cs RSour�
Jones 3. Hunt. Jr.. G rvvr or
CMMtTI!iPTnXTTC1W
MST.
EICT:CNS FOR C tw-=:CATION OF APFRCVM AitMiAL WASTE PI.1NS FOR
NE'.I OR = AM= AN--V.AL WASIZEr :RAN..MMr:' SYST°. W SERV-":G ''=LCTS
is order to be deemed persitted by the Divis:.7 of ;~tv""oraental Managanent .
(MI. C:;e owner of any new or expanded 'an;mal waste management system
cansc=ucted afar jams ry I, 1994 which is designed to serve greacar than or
equal to the animal pvpulatiaus listed below is required to s-k-it a signed,
carcification form to D t hat= the new animals are stacked on, the ferret.
?nets=* operations are exaept :rant the regtiti-mant Co be car_ified.
3.00 head of eatt7.a
73 bmuse
2S4 rerlaIS -
%. NO siau
24,000 bid viiX a '_Iqa' d casts orrtan
f - to certification rest be siSDI d by the amen of the feedlot (and s umaer i.1
i _0
different frost the oweer) and by =W technical specialist designated by the Sail and Kacar Conservation Cammissiam pursuant to IU N= 67 -0001-.0005. ,:JL
technical specialist asset verity by as on -sits inspection thae all applicabt b-UU • .
drim.and consimcrion standards and specificatiaae are met' as ixauilsd'andasha•-=
that.&LI- avplicablo operation and nsintenamast standards' and' speaificationscaa-.=^;'��.
be mac_ __
Although the actual. =robe+ of aninais- at the'.acility =W vary time:'to ti3w,.
the design capacity of the waste handling systast should be used to detaralne. if �..�}w -
a :xr:tt is subject to the- certification rnr.- For exsmgle, it the waste.. --
system for a feedlot Lv designed to handle 3Q0 hogs but the average population .� aair_•�
will be 200 hogs, Caen the waste- mata4anent system regmires
Mist cer tifZGdtwQn is requi ed by regulations goVer'LL:q il1,=AZ Jis=a ID=Agetwenc. =.
systatas adopted by -h• Zmvirormwntal ManKsmaat C==issian ("`"'I ost,.acsmaar 10.•
1391 ('title ISA N= 28 .0217) . _.
Ca =he reverse side of this page is the for,-- Which --usC be
su'=iC_ed Ca OM-4. before new animals ace stacked an the !s--. Assistaace in
camplecing :a= can be obtained !ram one of the local ar,;;rsi_;:ral agencies
such as :he soil are- wacar caraerration, d scrict. the QSZX-Soil Cznsarvatioa ;
Service, or the N.C. Cooperative M)c----:Lon Sox -rice. :'aa fa= s»ouwd be tan: to:
Oepar=ent of Ma- irat=ent. health and Natural Resources
Division of Management
water Quality SoCcion. Planssiaq Branch
F.O. Box 2SS35
Raleigh, N.C. 27625-0535
Phone: [phone]
Steve W. Tedder. Chief
'dater Quality Section
Fora :O : AGVE',JG z9 4
race: Apr - ;-.t da „---!
P.Q. Sox 29535. Rdeigh. North Ccminz 27626OW T«ephone 9Z9.717-J015 FAX [phone]
An Eau= CpOWU-Ay Af*rM=W Ac%on Gre6arer 50%r4CyCAW ICM pair-CWVSJ W pap++