820045_INSPECTIONS_20171231

NUH f H UAHULiNA
Department of Environmental Qual

.: ..._ - ..... _ �. .. _ ter.... ...'
. � Division of Water Resources
Facility Number - Z , J O Division of Soil and Water Conservation
� Other Agency
Type of Visit: Compliance Inspection 0 Operation Review O Structure Evaluation O Technical Assistance
Reason for Visir M Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: /Arrival Time: 0 Departure Time: F
Farm Name: (i ��j�l-C Owner Email:
Owner Name: )D L4{7W[,�.� ,1 iiJ � ,p fL Phone:
Mailing Address:
Physical Address:
County: Region:
Facility Contact: j� iV (�Le Ta? Title: aw kxe Phone:
Onsite Representative: < Integrator:
Certified Operator: _ Certification Number:-��
Back-up Operator: Certification Number:
Location of Farm: Latitude:
Longitude:
Design Current Design., Current
Design Current
Swine " Ca City Pop, N4.Wet Poultry Capaacity Pop.
Cattle
Capacity Pap.
.', N'
Wean to Finish
Layer
iry Cow
Wean to Feeder
Non -Layer
Design Current
iry Calf
Feeder to Finish
airy Heifer
Farrow to Wean
D Cow
Farrow to Feeder
1? , Pouf
Ea aci P.o
Non -Dairy
Farrow to Finish
'
La ers
Beef Stocker
Gilts
-Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
a,
Other
11 1 MTurke
Poults
Other J
Other:
Discharges and Stream Impacts
I. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other: _
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify 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
7®No
DNA
❑NE
[]Yes
❑NA
❑NE
❑ Yes
� No
❑ NA
❑ NE
❑ Yes
O No
❑ NA
❑ NE
❑Yes
®No
❑NA
❑NE
Page I of 3 21412015 Continued

FaciIi Number: Z - j jDate of Inspection: AbLIg
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 M NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): z�
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 q 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? 0
11. is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes 9 No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN [_1 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): �Q si.�(� i�l��/1l�fJ�i� el,*41j-
��„
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 NNo ❑ 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 [] NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below_ ❑ Yes No
❑ 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 No
Page 2 of 3
DNA ❑NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
21412015 Continued

Facili Number: Z - Date of Inspectian:TvwZpl
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[� No
[DNA ❑ NE
25.1s the facility out of compliance with permit conditions related to sludge? Ifyes, check
❑ Yes
[� No
❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey []Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
C] Yes
CA No
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
10 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_
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? Ifyes, 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 CA WMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes A No ❑ NA ❑ NE
❑Yes VNo ❑NA ❑NE
❑ Yes P, No ❑ NA ❑ NE
❑ Yes No
❑Yes No
❑ NA ❑ NE
❑ NA ❑ NE
Reviewer/Inspector Name: Phone: 3 15;�
Reviewer/inspector Signature: Dale: /01/7 a
Page 3 of 3 21417015

Type of visit: ompliance Inspection 0 Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: outine O Complaint O Follow-up O Referral p Emergency O Other O Denied Access
Date of Visit: CArrival Time: Departure Time: D d County:�s Region: [�
Farm Name: _ C / GZ f`rY`. Owner Email:
Owner Name: ^ �IJ �LUro� l'L-QW I s5 V�— (f
Mailing Address:
Physical Address:
Facility Contact: (_ ar"f 'cam Title: 60f7Phone:
Onsite Representative:
Certified Operator: --<1
Back-up Operator:
Location of Farm:
Latitude:
Integrator:
Certification Number:
Certification Number:
Longitude:
Swine
sign, "Current
Capciac�ty�;:, Pop.
Design
Wet Poultry Capacity
Current
Pop.
Design Current
Cattle Capacity Pop.
Wean to Finish
Layer
airy Cow
Wean to Feeder
HNon-Layer
aja Calf
eeder to Finish
ac7
Dai Heifer
Farrow to Wean
Farrow to Feeder
D . P,oul.
Design
Ca aci
Current
PLo
Dry Cow
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Pullets
Turkeys
Beef Feeder
Beef Brood Cow
Boars
-
tier MOO x
Other
Turkey Poults
10ther
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?
❑ Yes 0No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
MNo
❑ NA
❑ NE
❑ Yes
[No
❑ NA
❑ NE
Page 1 of 3 21412015 Continued

Facility Number: - Date of Inspection: 7
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure 1
Identifier:
Structure 2 Structure 3 Structure 4 Structure 5
® No ❑ NA ❑ NE
❑No NA ❑NE
Structure 6
Spillway?:
Designed Freeboard (in): 6
Observed Freeboard (in): 3�
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
�SNo
❑ 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
[Z 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 [allo ❑ 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): �ylr-n."J&- l Qv l�Sc rd'
13. Soil Type(s): W D
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
Callo
❑ 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
[a No
❑ NA
❑ NE
acres determination?
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
2 No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
® No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[&No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ® No
❑ 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 [2 N
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [S N
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
o ❑NA ❑NE
o ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facili Number: - Date of inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes C3 No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [Z No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes ® No ❑ NA ❑ NE
27. Did the facility fail.to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [R No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes ❑ No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
[ No
0 NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
(2 No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAW MP?
❑ Yes
[�No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
[:]Yes
CR No
❑ NA
❑ NE
34_ Does the facility require a follow-up visit by the same agency?
❑ Yes
[F]-No
❑ NA
❑ NE
o7''? F 7 -0/ p �Tr
Reviewer/Inspector Name:
Reviewer/inspector Signatur
Phone:/Z� 3a3 t 1S(
Date: �3? 17
21412015
Page 3 of 3

S6.*A5
Type of Visit: C'Y-Compliance Inspection O Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit: 91koutine O Complaint p Follow-up O Referral O Emergency O Other Q Denied Access
Date of Visit: Arrival Time: Departure Time: i.> County: _ Region:%
Farm Name: ra-t kt Owned Email:
Owner Name: D 6LQ(.
Mailing Address:
Physical Address:
Facility Contact:
C 1 4, P4
Onsite Representative:
Certified Operator: L
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator:P"5li
Certification Number: 17 U 1
Certification Number:
Longitude:
Swine
Capacity Pop. i'V�et Poultry Capacity ' I.op
Cattle
Wean to Finish
Layer
Dairy Cow
Wean to Feeder
Non -La er _
Dairy Calf
Feeder to Finish
;'j'I'
Dairy Heifer
Farrow to Wean
Des2g Current
Dry Cow
Farrow to Feeder
D . P-_oul Ca aM =
Non -Dairy
Farrow to Finish
Layers -
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
' .._.: Turke s
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:
a. Was the conveyance man-made'?
Yes No ❑ NA ❑ NE
❑ Yes ❑ No EnA ❑ NE
b. Did the discharge reach waters of the State'? (If yes, notify DWR)
❑ Yes
❑ No
L�T A
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
❑ No
[5NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
[ffll�o
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
[[J NNo
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412015 Continued

Facili Number: - 4i Date of inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes E;-Ntr- ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No k2-NA D 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?
(i.e., large trees, severe erosion, seepage, etc.)
❑ Yes 71.No ❑ NA ❑ NE
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
UJ ?Wb
❑ 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
Io
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
8- o
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
[g-4o
❑ 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 0 o [DNA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window
❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): D e'-1'+� (,1.�` s ('j L
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[j3-'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
❑ Yes
[�fNo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
Cql4o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[2"7No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[ N0
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
L2N'o
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes dNo
❑ 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 [Zf'No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ErNo
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
DNA ❑NE
Page 2 of 3 21412015 Continued

lFdcility Number: Date of Inspection: 16 nu 14-]
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes Z3'1Qo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [] Yes 2To ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes []!'No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes E .No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document [:]Yes [ o ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes [?3"No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the ❑ Yes ®-Ko ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. ❑ Yes __Lq-Qo ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes [�No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes fNo ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes Ej No ❑ NA ❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
G
44�
Sj ,� - 3- 15-�16 0- 3, 5 S 3
o- /41 Val Ic.;, p je
st�� oP 'I
F
Reviewer/Inspector Name:
Reviewer/Inspector Signatur
Page 3 of 3
d( It ui,- 30&- 6 � 51
Phone:([!- S, 33
Date: _1 (2 -AV A
21412015

(Type of Visit: sD'Com Ilia ce Inspection O Operation Review p Structure Evaluation O Technical Assistance I
Reason for Visit: outine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: I ez&z/_,EArrival Time:E7 23 Departure Time: County: Region:
Farm Name: %C rL o .U_� �� �y /ht C Owner Email:
Owner Name: r rr w 3 ��-Tr-r grin f 1 L Phone:
Mailing Address:
Physical Address:
Facility Contact: ; / � � rd` [rr� Title: D-Cu rt Phone:
Onsite Representative: 5'4::a_� Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Certification Number:
Longitude:
Design
Current
Design
Current
Design Current
Swine
Capacity
Pop.
Wet Poultry
Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
ILayer
IDairy
Cow
Wean to Feeder
Non -La er
I
Dairy Calf
eeder to Finish
' S,
Dairy Heifer
Farrow to Wean
D , P.oultr,
Design
Ca acit
`C'u'rren
Po p.
Dry Cow
Farrow to Feeder
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Beef feeder
Beef Wood Cow
Gilts
iers
Boars
Pullets
Turkeys
Other
Turkey Poults
Other
I 10ther
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 PNo ❑ NA ❑ NE
[—]Yes [:]No ❑ NA ❑ NE
[] Yes ❑ No ❑ NA ❑ NE
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 g, No [] NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters [:]Yes M No [] NA ❑ NE
LAW -
of the State other than from a discharge?
Page l of 3 21412014 Continued

Faci.i Number: - 14= Date of Ins ection: -/
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure 1
Identifier:
Structure 2 Structure 3 Structure 4 Structure 5
Spillway?:
Designed Freeboard (in): 9-
Observed Freeboard (in): ,3k
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
P.No ❑ NA ❑ NE
❑ No ❑ NA ❑ NE
Structure 6
❑ Yes ® No ❑ NA ❑ NE
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
[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
RNo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
54No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
4. 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
P No
[] NA
[] NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [] Yes [A 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 Drift ❑ Application Outside of Approved Area
12, Crop Type(s): A_� Al
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? [:]Yes SNo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes FNo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
M No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
Z No
❑ NA
❑ NE
Required Records & Documents
14. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
R No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
JNo
❑ 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 E&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 21412014 Continued

Facility Number: jDate of Inspection: e47— ZE
24. Did the facility fail to calibrate waste application equipment as required by the permit? [:]Yes allo ❑ NA ❑ NE
■ 25_ Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes EKLNo [DNA ❑ 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 fast survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
Callo
❑ NA
❑ NE
[-]Yes
Jallo
❑ NA
❑ NE
❑ Yes
0 No
❑ NA
❑ NE
❑ Yes k No [DNA ❑ NE
❑ Yes Eallo ❑ NA ❑ NE
❑ Yes
r No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
!� No
❑ NA
❑ NE
[-]Yes
ER -No
❑ NA
❑ NE
Reviewer/Inspector Name: ,li>✓ �4y,% Phone:
Reviewer/Inspector Signature: Date:
Page 3 of 3 21412014

Type of Visit: (9,Compliance Inspection V Operation Review U Structure Evaluation C3 Technical Assistance
Reason for Visit: tine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: ,30 Departure Time: County:fo�
FarmName: 1S Cv.'t �'�� /JrG Owner Email: �—
Owner Name: kr7n ,,, (S C'arf'r: �s�rrt- /I c- Phone:
Mailing Address:,
Physical Address: / 1
Facility Contact: �L i��0'" �o�Tr� ��� Title: yr/ Phone:
Onsite Representative: Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Certification Number:
Longitude:
Region:
llllllllllllllllllg1Qesign
Swine
Current
Capacity Pop.
Design Current
Wet Poultry Capacity Pop.
Cattle
Design Current
Capacity Pop.
Wean to Finish
Dai Cow
Wean to Feeder
FLaer
-La er �'�JPo
D Calf
ceder to Finish
SS'D
DairyHeifer
Farrow to Wean
Farrow to Feeder
D . P,oult , 7aci
D Cow
Non -Dairy
Farrow to FinishroLayers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Turkeys
Turkey Poults
Other
j
Other
E
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 g] No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
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 21412014 Continued

Facility Number: - Date of Inspection -—
Waste Collection & Treatment
`. 4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
5jNo
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
M 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
0 No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
®No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
® No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? if yes, check the appropriate box below. ❑ Yes ® No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): 2; rm VL /� v r✓ Y�
13. Soil Type(s): 9C"V
14. Do the receiving crops differ from those designated in the CA WMP?
❑ Yes
�-No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
® No
❑ NA
❑ NE
16, Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
53 No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
Jj�j No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
® No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
® No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
53 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 ICJ 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 21412014 Continued

Facility Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes 5 No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes 0 No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? [:]Yes ® No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes `R 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.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes Ig No ❑ NA ❑ NE
❑ Yes 70 No ❑ NA ❑ NE
❑ Yes allo ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes 9 No
❑ Yes jo No
❑ Yes 0 No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer twquestion:#) ­Eaplain any YES answers andlor :anpadditional recommendations or any other'comments " �g:'*:
Use drawings of facility_ to•bet#er explain situations -(use additional;pages::as_necessary), t ,
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Pho
Date y�3—
21412014

Type of Visit: (-Compliance inspection O Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: Qrlfoutine 0 Complaint 0 Follow-up 0 Referral O Emergency 0 Other 0 Denied Access
Date of Visit: 3] Arrival Time: ; CJa Departure Time: County: Region:
Farm Name:_ 1 \rt p �,(� �Y5 _�t�i_ Fg11? � L LC Owner Email:
Owner Name: n uJ 1 r Ca. -- Fit/mc 1 L G Phone:
Mailing Address:
Physical Address:
Facility Contact: Lti �T-e "`- avy�✓ Or- Title:Phone:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Integrator: /'t A
10,
Certification Number:
Certification Number:
Longitude:
D'
esign Current = _ Design Current . , _
Swine Capacity Pop °Wet Poultry.- Capacity Pop.
Cattle
Design Current
Capacity Pop.
Wean to Finish La er
Dairy Cow
Wean to Feeder
�
/'*'*_Dairy
Non La er I
Curren
Design t
D -Pontaaci
Dairy Calf
Feeder to Finish 1J
Farrow to Wean
Farrow to Feeder
Heifer
..Dry
Cow
Non -Da'
Farrow to Finish
ti.
La ers
Beef Stocker
Gilts
Boars
Non -Layers
Pullets
Beef Feeder
Beef Brood Cow
_ v.
Turkeys
Other
Other
L
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes 0 No ❑ NA ❑ NE
[:]Yes [] No
[:]Yes [] No
❑ Yes ❑ No
❑ Yes �(] No
[:]Yes ® No
❑NA ❑NE
❑ NA [] NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 21412011 Continued

Facility Number: - Date of Inspection: —
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
ELNo
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): l
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
n No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
® No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
® 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
®' 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 L&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): Leo"MIZO& Z&/C/S
13. Soil TYpe(s): M2
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [0 No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes 0 No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
fK No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
allo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
S 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 R 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 allo
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes E!3-No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑NA ❑NE
Page 2 of 3 21412011 Continued

Facili Number: - I Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes J&No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check] Yes g 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 r No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes Ej 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 J21 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 RLNo
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes Pg No
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes jo No
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes � No
34. Does the facility require a follow-up visit by the same agency?
❑ Yes ,® No
❑ NA ❑ NE
[] NA ❑ NE
❑ NA ❑ NE
❑ NA 0 NE
❑ NA ❑ NE
❑ NA 0 NE
❑NA ONE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ONE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawinits of facility to better explain situations (use additional oaues as necessarv).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date: 1s21120 3
21412011

i ype of visit: Cyt:omptiance inspection V operation ]Keview U structure Lvaluation V technical Assistance
Reason for Visit: outine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: rrival Time: ? J p 0 Departure Time: , o c7 County: Region
Farm Name: r-s �drr/�` � Owner Email:
Owner Name: j-t'y»/,c� �.�5 Ga•,r��� ��/rst / /G Phone:
Mailing Address:
Physical Address:
=X a
Facility Contact: Title: Phone:
Onsite Representative: Integrator:
Certified Operator: Ste_ Certification Number:
a —
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Swine
Wean to Finish
Design Current Design Current Design Current
Capacity Pap. MetCapacity Pop. Cattle Capacity Pap.
La er Dairy Cow
Wean to Feeder
Non -La er
Dairy Calf
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
pp
" ` - ' - Dairy Heifer
Design Current Dry Cow
D , P,oultr Ca aci P,o . Non -Dairy
Layers Beef Stocker
Gilts
Boars
Non -Layers
Beef Feeder
Pullets
Beef Brood Cow
Othe
Other
Turke s
urkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c- What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
[—]Yes �&No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
[:]Yes ❑ No
[:]Yes [0 No
❑ Yes ER No
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
Page I of 3 21412011 Continued

[Facility Number: jDate of Ins ection:
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): �Z
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[A 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 DWQ
7; Do any of the structures need maintenance or improvement?
❑ Yes
No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
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
KI No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [:]Yes allo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc_)
❑ PAIN ❑ 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): gg Zr-,-rr! k
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes LK No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [R No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes [Q_No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
R No
❑ NA
❑ NE
18. is there a lack of properly operating waste application equipment?
❑ Yes
Callo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
E3.No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CA WMP readily available? If yes, check
[:]Yes
[ o
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? if yes, check the appropriate box below. []Yes [&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 �o
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [B—No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑NA ❑NE
Page 2 of 3 21412011 Continued

Facili Number: - Date of inspection: �� y
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes Callo
' 25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes 0 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 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 EINo ❑ NA ❑ NE
❑ Yes N No [DNA ❑ NE
❑ Yes 54 No ❑ NA ❑ NE
❑ Yes [�j No
❑ Yes [,No
❑ Yes E,No
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional DaQes as necessarvl.
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: ��. %5.3-33 a
Date: '�
21412011

Type of visit: An<ompliance Inspection O Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: ; 00 Departure Time: 00 County: Region:
Farm Name: rs/�r `qr /�� Owner Email:
Owner Name: r N CJ to/ L-S Caey.- Ile— Phone:
Mailing Address:
Physical Address:
Facility Contact: �.-��e�r Title:Phone:
Onsite Representative: �.,r �� Integrator: = -C
01
Certified Operator: Certification Number: TS—//
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
�Den gn Current Design
Design C►urrent
Swine wCapac�tyPop. Wet Poultry Capacity" Pop.
Cattle Capacity Pap.
. •* :,
Wean to Finish
Wean to Feeder Non -La er
airy Cow
Dairy Calf
airy Heifer
eeder to Finish
"-,?
Farrow to Wean
_ Design Current
Dry Cow
Farrow to Feeder
i
Dr, Po ultr :� -a ac:Po
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -La ers
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:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
[:]Yes 23,No [DNA ❑ 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 ® 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: - j
VK jDate of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes allo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure i Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in).
Observed Freeboard (in): TO
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
❑ Yes & No ❑ NA ❑ NE
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
EkNo
❑ 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
5Q No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
64 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
2§,No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [:]Yes &No ❑ NA ❑ 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): jVs"Vr "'16,
13. Soil Type(s): .]Pp ff
14. Do the receiving crops differ from those designated in the CAWMP? [] Yes [a No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes Eq No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes [R No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes K No ❑ NA ❑ NE
[—]Yes PP No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes [UJ 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 ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ZI 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 j5d'No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes J4 No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

[Facility Number: - Ds ectiou: /
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 C,No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes 1101 No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliancc of the permit or CAWW?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
Reviewer/Inspector Name.
Reviewer/inspector Signature:
Page 3 of 3
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes E4 No ❑ NA ❑ NE
❑ Yes C4 No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
[:]Yes BNo ❑ NA ❑ NE
❑ Yes V No
❑ Yes QC No
❑ Yes � No
❑NA ❑NE
❑ NA ❑ NE
❑NA ❑NE
Phone:
Date: / -z —,,;z p .s
21412011

I
K
Type of visit ' ��Com��pliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Q<O-U-tine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: — p -- t7 Arrival Time/: .'c(7 Departure Time: t i7� County: 9"z-^ Region: �--
Farm Name: I \VLC�r.U�r9 C.-ae4- �rr- I-L C Owner Email:
Owner Name: I�JA c W I �S 0AW-Irr L-.LG Phone:
Mailing Address:
Physical Address: ��
Facility Contact: Title: Phone No:
Onsite Representative: Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = u = I = « Longitude: = o = 6 =] 46
Design Current
Swine "t C•apacity Population
Design Current Design Current
Wet Poultry Capacity Population Cattle @apacity Populafion
❑ Wean to Finish
La er
Dairy Cow
❑ Wean to Feeder
on -Laver
❑Dai Calf
Feeder to Finish
=li❑
O
❑ Dairy Heifer
Dry Poultry ❑ Dry Cow
❑ Non
❑ Farrow to Wean
❑ Farrow to Feeder
❑ N ers
❑Non -La ers
-Dairy
❑ Farrow to Finish
❑ Beef Stocker
❑ Gilts
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures:
❑ Pullets
❑ Turkeys
❑Turke Points
❑OtherI
I
❑ Boars
Other
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
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 A.So ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
4-No
❑ NA
❑ NE
❑ Yes &o ❑ NA ❑ NE
Page 1 of 3 12128104 Continued

Facility Number: ZZ— Date of Inspection a/o
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes P-NO
❑ NA ❑ NE
a. if yes, is waste level into the structural freeboard?
❑ Yes ❑ No
❑ NA ❑ NE
Structure 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 B-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 I.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 KNo
❑ NA ❑ NE
& Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes EgNo
❑ 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 KNo
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes MNo
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect 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 Area
12. Crop type(s)
13. Soil type(s) _
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
®,No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
0 No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
14 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
ONo
❑ NA
❑ NE
Reviewer/Inspector Name =UL Phone: =3
Reviewer/Inspector Signature: Date: /L7`- li(
Page 2 of 3 12128104 Continued

Facility Number: Date of Inspection 0
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ALNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes PS -No ❑ NA ❑ NE
the appropriate box.
❑ WUP El Checklists El Design ❑Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 0-wo ❑ 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 N No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
FkNo
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
„q No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
qNo
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
RNo
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
U[No
❑ NA ❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
FkiNo
❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
KNo
❑ 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
KNo
❑ 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
tRNo
❑ 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
gNo
❑ NA ❑ NE
Page 3 of 3 12/2"4

Type of Visit Q'Eompliance Inspection Q Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit (b4to"utine Q Complaint () Follow up O Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: --I=�• �„ Arrival Time: t? 07 Departure Time: County: � sf"' Region: �o
Farm Name: " L r tr' m-a e G Owner Email:
y&
Owner Name: 1 � Yl O[.t_ f tr 5 - c6t'-try Fa / 1 I C Phone:
Mailing Address:
Physical Address:
r
Facility Contact: _ L P "Tf3 « "7'G" Title: /ZLw. � >- rs Phone No:
Onsite Representative: Integrator: �/ rg / t
Certified Operator: Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: 0 O = f = 6f Longitude: 0 ° 0 i 0
WDesign Current
Desi�Hcllu_eng
Design Current
Swinecity Population Wet Poultry
ulation
Cattle
Capacity Population
❑ Wean to Finish
❑ La er I
1
❑ Dairy Cow
❑ Wean to Feeder
❑ Non -Layer
❑ Dairy Calf
S Feeder to Finish
❑ Dairy Heifer
❑ Farrow to Wean Dry Poultry
❑ Farrow to Feeder
❑ Farrow to Finish ❑ La ers
❑ Gilts ❑Non -La Non -Layers
❑ Pullets
❑ Boars Turke s
❑
❑Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
El Beef Brood Co
Other ❑ Otherrke Poults ❑
Number of Stnectures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
[&No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ 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 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 adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
❑ANo
❑ NA
❑ NE
other than from a discharge?
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 RNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes ❑ No ❑ NA ❑ NE
Stricture I Stricture 2 Structure 3 Structure 4
Structure ; Structure 6
identifier:
Spillway?:
Designed Freeboard (in):q
Observed Freeboard tin): _ �(
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 [N 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 [2 No ❑ NA ❑ NE
8. Do any of the stuctures 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 0No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [.No ❑ NA ❑ NE
maintenancelimprovement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes (9 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) ' ' r jv
13. Soil type(s) �l
14, Do the receiving crops differ from those designated in the CAWMP? ❑ Yes CgNo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ERYes ❑ No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination%❑ Yes
19 No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes
[ZNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes
(2 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):
r r j j
r
Reviewer/Inspector Name
Phone:
Reviewer/Inspector Signature:
Date: 2—U�}
12128104 C,'onUnued

Facility Number: — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes B 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 appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ?& No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Cade
22. Did the facility fail to install and maintain a rein gauge? ❑ Yes ff 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
allo
❑ 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
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
F.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
151 No
❑ NA
❑ NE
General Permit? (ic/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
ULVo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
ClNo
❑ NA
❑ NE
12/28/04

Type of Visit 1�compli Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit outine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: Arrival Time: ; �( Departure Time: (7 (� County: Region:
Farm Name: A 19 ul I ?-- 5 c"tee 111!�/n J Owner Email:
Owner Name: Lnp r_�arfey__ Fd r S l >' G_ Phone:
Mailing Address:
Physical Address: 1
Facility Contact: cl A C/�✓t. _�t��rr��Title: Phone No:
Onsite Representative: Integrator:
Certified Operator: _f Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: 0 e 0 g = Longitude: 0 ° = I = W
DesigC rre ' Des�g etrrent DesignE0.6rrent
SwineCapacttyPopuahan
Wet Poultry
CapacityPopulahon attle Capacitpulation
n to Finish
❑ Layer
❑ DairyCow
n to Feeder
❑Non -Layer
❑Dai Calf
er to Finish
D
';"'� ❑ Dairy Heifer
w to Wean
Dry Poultry
❑ D Cow
"ems ' `
w to Feeder
❑Non-Dai
w to Finish
FE
❑ Layers
❑ Beef Stocker
Non -La ers
❑ Beef Feeder
s
❑ Pu]]ets
❑Beef Brood Co❑
Turke s
❑ Turke Poults
❑Other
Number of Structures:
__
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
[9 No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
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 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 adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
®,No
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
12128104
Continued

Facility Number: r0Z — j Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 2No ❑ 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
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes [ZNo ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public stealth 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
oNo
❑ 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
[ZNo
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
J,No
❑ NA ❑ NE
maintenance/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 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) _Z°llyiuO_/-
13. Soil type(s) 13 oz
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
❑ No
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes
❑ No
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ 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
❑ No
❑ NA ❑ NE
Reviewer/Inspector Name f Phone: 9/p
Reviewer/Inspector Signature: Date:
Page 2 of 3 12128104 Continued

0
F
Facility Number: — Date of Inspection 0,4K
Re uired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ® No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 9 No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ZNo ❑ 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 J4 No ❑ NA ❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
Wo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
9No
❑ NA
❑ NE
26,
Did the facility fail to have an actively certified operator in charge?
❑ Yes
L&No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
[NNo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
�. o
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
[2FNo
❑ 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
[9No
❑ 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
C.No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
®No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
® No
❑ NA
❑ NE
Page 3 of 3 12128104

40r—Division of Water Quality 7-3' a7�
Facility Number r 0 Division of Soil and Water Conservation
- 0` Other Agency
Type of Visit Gr m�pliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 4!J Koutine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: i Departure Time: l7 County Region:
Farm Name: _ K ✓w w I- & —' _eCa r 1 C Owner Email: -}
Owner Name: Kn b UJ L e-i C�C l-rr Y ,ai mj 1 ! � _ Phone: r� 3zI7-30a
Mailing Address:
Physical Address:
Facility Contact: [Ll_1pr� d� „ Title: _ Phone No:
Onsite Representative: _.� ®ti+ Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator:
Location of Farm:
Swine
Back-up Certification Number:
Latitude: = o ❑ S =" Longitude: = 0 = =
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
❑ Non -La ei
❑
Wean to Finish
❑
Wean to Feeder
Feeder to Finish
D
O
❑
Farrow to Wean
❑
Farrow to Feeder
❑
Farrow to Finish
❑
Gilts
❑
Boars
Other
❑ Other
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation'?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Daia Cow
❑ DaiEy Calf
❑ Daia Heifei
❑ Da Cow
❑ Non-Dai
❑ Beef Stockei
❑ Beef Feeder
❑ Beef Brood Co
Number. of Structures:
b. Did the discharge reach waters of the State'? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3_ Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes RNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
CR'No
❑ NA
❑ NE
❑ Yes
JKNo
❑ NA
❑ NE
12128104 Continued

is
Facility Number: 6`1— Date of Inspection —a
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in): _
Observed Freeboard (in): /a
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.),
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑Yes 99No El NA El NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes W No ❑ NA ❑ NE
❑ Yes [9 No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes 95 No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes 19 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 J9No ❑ NA ❑ NE
maintenance/improvement?
11.
Is there evidence of incorrect application? If yes, check the appropriate box below. [:]Yes
W No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence Wind Drift ❑ Application Outside of Area
12.
/of
Crop type(s)
13.
Soil type(s) ()B
14.
Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
RNo
❑ NA ❑ NE
15.
Does the receiving crop and/or land application site need improvement? ❑ Yes
W No
❑ NA ❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
[4 No
❑ NA ❑ NE
17.
Does the facility lack adequate acreage for land application? ❑ Yes
CR No
❑ NA ❑ NE
18.
Is there a lack of properly operating waste application equipment? ❑ Yes
® No
❑ NA ❑ NE
Comments (refer to question ##): Explain any YES answers and/or any recommendations or any other comments. I
Use drawings of facility to better explain situations. (use additional pages as necessary):
al. U1 u� fi�� �3��rru/�� W % ^O� t�rU �1�m /ylar� �4��� • f�as Ca!'/re:GLr.,
(:vim he., sa d1 �3 Wad qC /�:y�ra`• dt- W i 1 i u�odc �i �` �� ri-.
Reviewer/Inspector (Name rvt� Phone: g/D-j,0j3 ;33DD
Reviewer/Inspector Signature: Date: _Z='z-,;90a1
121218 04 Continued

Facility Number: — j Date of Inspection
t
' Required Records & Documents
19_ Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 3No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWNIP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropiate box. ❑ WUP ❑ Checklists ❑ Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. Yes ❑ No ❑ NA ❑ NE
R1 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
0 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
r10, No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
ED No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
W No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
[A 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
5Z No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
Z[No
❑ NA
❑ NE
Additional Comments and/or Drawings:
12128104

Type of Visit PfCo�mpliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit tine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: : D"0 Arrival Time: I x T j O Departure Time: County: D"" Region:
Farm Name: _ 1K A D i j.2` 1 c S e a e to r- 62r ►ru ll C Owner Email:
Owner Name: rQ h c uJ L» e— i c` r- / C Phone:
Mailing Address:
Physical Address:
Facility Contact: GL C,2/_1VC r_ Title: Phone No:
Onsite Representative: 5 Integrator: t-_5 a p Y
Certified Operator: J Operator Certification Number: Z --7
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = O = I = " Longitude: = ° = I = k
Swine
a , "'
SDesggn, Current
:.�
Capac�tyl?opulation
Wet Poultry
Design Current
Capacity Population
Design Current
Cattle Capacity Population
❑ Wean to Finish
❑ Laver
❑Dai Cow
❑ Wean to Feeder
❑Non -La er
❑Dai Calf
Feeder to Finish
` "= "
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry`
`'�` -'
❑ Dry Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
❑ La ers
.
El Beef Stocker
Gilts
❑Non -La ers
Beef Feeder
PCIBoars
❑❑
Pullets
❑ Beef Brood Co
NP �s r
Other —c f�
❑ Turkeys
❑ Turkey Poults
❑ Other
❑ Other
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
ANo
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
[qNo
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
D4 No
❑ NA
❑ NE
c_ What is the estimated volume that reached waters of the State (gallons)?
r
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
❑ Yes
KNo
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
NNo
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
KNo
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12128104
Continued

Facility Number: — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
X No
❑ NA ❑ NE
a. if yes, is waste level into the structural freeboard?
❑ Yes
Q[No
❑ NA ❑ NE
Structure I ' Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): .12
Observed Freeboard (in): 3
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
K 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
M No
El 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
PtNo
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
[q 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/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 > I0% or l0 Ibs ❑ 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.
Sail type(s)
l4.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
Jallo
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
RNo
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination',[:]
Yes
ri-No
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
R� No
❑ NA
[:1 NE
18.
is there a lack of properly operating waste application equipment?
❑ Yes
.] No
❑ NA
❑ NE
Reviewer/Inspector Name �� [� f8� Phone: y �L fjr�x
Reviewer/Inspector Signature: Date:
12128104 Continued

Facility Number: ra Date of Inspection D�
Re uired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes PQ 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 approprrate 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 I " Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes Ej No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 4 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
Ae No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
W No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
ER No
❑ NA
❑ NE
Other issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
EM No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
r-7 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
9No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
[ No
Cl 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
Xy No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
[K No
❑ NA
❑ NE
Add�boQa1 C mm ntssand/ar Drawings "� tic W-
461
12128104

Type of Visit 40 Compliance Inspection O Operation Review O Structure Evaluation Q Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: y Arrival Time: ' Departure Time: County: 0Re tFarm Name: K 1' �_r_ Owner Email:
Owner Name: 11o_w ie s - C CM_ i o.,... L. C Phone:
iMailing Address:
Physical Address: nn oy e-xn2 �,,
Facility Contact:
Onsite Representative:
Title:
Phone No:
Integrator:
Certified Operator: M. C- +TM z Operator Certification Number:
Back-up Operator:
Location of Farm:
Back-up Certification Number:
Latitude: 0 e =' ❑ Longitude: 0 ° ❑ 0
Design Current Design Current
Swine Capacity Population Vet Poultry Capacity Population
❑ Wean to Finish
❑ Wean to Feeder
© Feeder to Finish lxsko '7 fa
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
❑ Laver
❑ Non -Layer
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Pou Its
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a_ Was the conveyance man-made?
Design .. Current
Cattle Capacity Population
i
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy.Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker i
❑ Beef Feeder i
❑ Beef Brood Cow
Number of Structures:
b. Did the discharge reach waters of the State'? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge'?
❑ Yes X No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
IM No
❑ NA
❑ NE
12128104 Continued

F>icility NiAmber: gig— Date of Inspection .?o
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
[0 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: i
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): y ��
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
® No
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
® No
❑ NA
❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
Dd No
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
W 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/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 ❑ PA.N > 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) �G r�.rudi��. �a s 6 .— Os - — -- —
13. Soil type(s) 13o.8
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes ® No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes
® No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination%❑ Yes
® No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes
Q1 No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes
01 No
❑ NA
❑ NE
1 Reviewer/Inspector Name Phone:
Reviewer/Inspector Signature: &Eoc
4 Date:
I2/2&04 Continued

Facility Ndmher: — y/,� Date of Inspection • /�
Required Records & Documents
19_ Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes M 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 [l Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ® No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes M 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
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
® No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
[A 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
T No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
3 L
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
[j] 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
U No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
go No
❑ NA
❑ NE
Additional Commen"ts�andlor Drawings: � ' �.. &,,.�,', �,,�, ,� � _ . , �„ • �,� _
12128104

Type of Visit • Compliance inspection O Operation Review O Lagoon Evaluation
Reason for Visit i Routine O Complaint O Follow up Q Emergency Notification O Other ❑ Denied Access
Facility Number yf �r� Date of Visit: I7-o Tune:
0 Not OfIrationall 0 Below Threshold
04"eirmitted EKrtified 0 Conditionally Certified© Registered Date Last Operated or Above Threshold: ----- --
Farm Name: ... ka O w 1 e.�..- .. CGC l .....F�t! T �...�.... L ..... _. County:.....�c%�a .�4 ap.. » ......... .... ...�� a.. .
..... ......
Owner Nacre:.. �rur lsrl�,I..:.rG<.... !CQl.. [�. S. i LL .. _-. _ ........ Phone No:...1..Q -... r�`J.- zl12%..........._................
Mailing Address:.. �_. �'��Se lL';131.......1
Facility Contact:....ff.............. __Title:.........._-- .... ---................ _.................... PhoneNo:
Onsite Representative: --------__ --.-_- Integrator:
Certified Operator:. (�; ,� A& �G r Pf.-._.--.-------------T_._._._._._ Operator Certification Number:
Location of Farm:
0'Sw ne ❑ Poultry ❑ Cattle ❑ Horse Latitude �• �` �" Longitude �• ��°
'Swine ..
Ctirrent
Pnesitlahnn `- =Poitltry .
Wean to Feeder
19feeder to Finish
S a
S p
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Current -
opniatio : Cattle
Discharges & Stream I. mpacts
1. 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 Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
❑ Yes ❑ mo-
❑ Yes
EKo
❑ Yes
UQo
❑ Yes
❑.fo
❑ Yes
[t -No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes 2No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ❑-Ko
Structure i Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: .. ...............
Freeboard (inches):
12112103 Continued

Facility Number: —
Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
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 maintenancefimprovement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11, Is there evidence of over application? If yes, check the appropriate box below.
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type 6
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours?
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional
Air Quality representative immediately.
❑ Yes 9-No
❑ Yes ❑-No
❑ Yes [3­No
❑ Yes Q_No
❑ Yes allo
❑ Yes U44
❑ Yes 9-No
❑ Yes B-No
❑ Yes P-Wo
❑ Yes UNo
❑ Yes [moo
❑ Yes
❑ Yes D—N6-
❑ Yes ❑ No
❑ Yes &11-0o
❑ Yes 13mo
❑ Yes aM
G4- reld Copy ❑ Final Notes
SC,„,e c✓eEj CamP�7•r•'oi a�/as 6Pgl�ln,'�' i-1 1hE �a�R �Jf/��. J✓t� �nan,�or O.rcl
S1° euY a.S 4eea ew,
S�afrr.� t4l/ is over Seep Ord S%io✓l� beand
cu�
Reviewer/Inspector Name
ReviewerAnspector Signature: �% ., �Date: S 1 '7 - 0 5/
1 u� �rv.� a.uruurracu

Facility Number: 8 _ y s Date of Inspection -o
Rectuired Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
22. Does the facility fail to have all co nents of the Certified Animal Waste Management Plan readily available?
(ie' WU/P, ch tsts, de� s, etc.)
23. Does record keeping need improvement? If yes, check th appropriate box below.
❑ Waste Applicaggf ❑ Freeboard ❑ Waste ysis ❑ So'aamnDling
1.'7 �7-7ol.r,q it ra, 5J
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
25. Did the facility fail to have a actively certified operator in charge?
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
27_ Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
28. Does facility require a follow-up visit by same agency?
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
32. Did the facility fail to install and maintain a rain gauge?
33. Did the facility fail to conduct an annual sludge survey?
34. Did the facility fail to calibrate waste application equipment?
35. Does record keeping for NPDES required forms need im vement? If yes, check the appropriate box below.
❑ Stocking Forte ❑ Crop Yield Fdrm ❑ Raittf�l ❑ inspection After l" Rain—
❑ 120 Minute Ins ons ❑ Annual Certification Foun"'
[:]Yes �o
❑ Yes ®-Nb
❑ Yes E3-N`8`__
❑ Yes 9Wo
❑ Yes U-No
❑ Yes Q-KO
❑ Yes 9-No
❑ Yes EFN`6­
❑ Yes ❑c -Ah�
es ❑ No
❑ Yes R14D
❑ Yes Elo
❑ Yes U-Mo
❑ Yes ONO
❑ Yes E�No
12112103

Site Requires Immediate Attention:
Facility No. YY
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD_
DATE: J 1995
Time: I b 41) A"A%
Farm Name/Owner: G r A44 5
Mailing Address: 41 _ P r ✓rn /I fL A-p
County: p Sam
Integrator: Phone?to Z 3 9 3d2,0 _
On Site Representative: r'-+r Phone:
Physical Address/Location:
Type of Operation: Swine t/ Poultry Cattle
Design Capacity: Number of Animals on Site: _L. ves!
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: 2 ° 53� Longitude:
Does the Animal Waste
(approximately 1 Foot +
Was any seepage observed
Is adequate land available
Crop(s) being utilized:.__
Does the facility meet SCS
Circle Yes or No
Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
7 inches) es or No Ac Freeboard:Ft. ° Inches
from the lagoon(s)? Yes or W Was any erosion observed? Yes or N
for spray? e- r No Is the cover crop adequate? 00 or No
1�� l� 4,frAA(d4-- 7
minimum setback criteria? 200 Feet from Dwellings9 &A or No
100 Feet from Wells? lesor No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or NO
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line: Yes ordo
Is animal waste discharged into water of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes or6cl 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)? ?es or No
Additional Comments:
T) t % 1
Inspector Name
0
Signature
cc: Facility Assessment Unit Use Attachments if Needed.

P��
KCRTa CAROLngA DEPARTXENT OF , MALTZ a NATURAL RESOMCFS
DIVISION OF 22MMOM2NTAL IMMMMT
Fayetteville Regional Office
Animal Operation Compliance Inspection Form
El Yw
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'."Y.:J.iW �i.�1L Y-y„'`.»•-:'FARi�i.i�'ta�t�'°;
"i 61Siz ;iV'i�7.�/.VA�V.�iS- a
i::.w
C -Farms nbW les
r�"1ia"/�l'7i'►I�.ZN{�:,:��iT%R�i °"i"F
-ea�-0�+�"�'�_-
Y�'i��„r A•4.iLI�i'�AL
.�A.+.'�"�..,`-F.f,
�,,..1'.' �-�
r+++�.t�0+�+ :11 Y�'iD�.
d z 3z
9a -003
All questions answered negatively will be discussers in sufficient detail in
the,Comments Section to enable the deemed Permittee to perform the appropriate
corrections:
SEMQN i -
Animal Operation _ TV2e : �j n� S h
Horses, cattle, wine, poultry, or sheep
Y I N I COKMPMS
i. Does the number and type of animal meet or exceed
the (.0217) criteria? [Cattle (100 head),
horses (75), swine (250), sheep (1,000), and
poultry (30,000 birds with liquid waste
sysfa�)�
2. Does this facility meet criteria for
Animal operation XEGISTRATII
3. Are animals confined fed or maintained
in this facility for a 12-month period? -
4 _ Does this facility have a czgnFISD AiiIM
WASTE MANAGEMENT
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 5CS minimum
setback criteria for neighboring houses,
Wells, etc?
t

' SECTION III
Field Site Management
i. Is animal waste stockpiled or lagoon
construction within 100 ft. of a USG5
Map Blue Line Stream?
2. is Animal waste lased applied or spray
irrigated within 25 It. of a USG5 Map
Blue Line Stream?
3. noes this facility have adequate acreage
on which to apply the waste?
4. Does the land application'site have a
cover crop in accordance'with the
CZR IFICATION FLAN?
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
(BMP) of the approved MTTFICATIO ?
7. Does animal waste lagoon have sufficient
freeboard? How much? {Approximately }
S. Is the general condition of this CAFO facility,
including management and operation,
satisfactory?
SMION IV
Commemts
On

f•
K & C FARMS
D U P! N C O LI N T Y From 421 Feed Mill, take 421 south about
= 2 miles. Turn right onto State Road 1146
and go 2 1/2 miles to crossroads, continue
straight and go about 2 miles, Farm is on •
I' MI the left.
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s
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r
106
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py mow✓ too
(( °' ..+
10
r+:
,• � f , [`A �i � : ice•_ �
a J
1
f' •op
J pop I
= �► J'406
s v =
w► r,'
It*
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,d 4
2

.XNZ *AT• W ST3 Fi.XX CXR_=7=CAT_-CN PCii NWA OR =2.UTD%_= PE»DICTs
21aase ;Stu= the ec=pletsd fo=n to tie Div3sfoa of 3mv4_ror_-u*=tab Hanagamaat at
`.:e add= ass an tso reverse side of tea ; oa.
,lame of farm (Please print} !C CFARrit_^-
Addr ess (r..-7 P. R
CurtTon 2- ?hone No. :91c 5 9 Z - C7d3
County:_ 5AI"PSOn
Farm location. :acitsde and ;among;tude-jj- 55. �o" /ZR° &* 3O," red) . Also,
please at_aca a copy of a county road map with location ide_cif!ied.
Tfie of operation (swine, layer, dairy, etc ) .5WInC
�esig� =apaci=y (ru=:-er of animals) J=/�15H _
Average size of operas' -on {12 ncnc : popu'lat_or. avg.) 5d&Q
ALverage acreage needed for land application of waste (acres)
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_ecsr.ical Specialist Cer ificatioa
As a z_c: nical specialist desig-nated by the North Carolina Soil and 'Hater
Conser'rac;on Commission pursuant to i5A NCAC 6r .0005, I ce-tifr that the new or
expanded animal waste management system as installed for t: a fa=-:t za...ed above
has an animal waste management plan thhat meets the design, construction,
operation and maintenance star:dards and specifications of tie Division Cr
H.zvizo=ental Management and the USDA -Soil Conse=;-ation Serrice and/or the North
Carolina Soil and Water Conservations C:.=nissicn pursuant to 1SA NCAC 2H.0217 and
1=A NCAC 6= .0001-.0005. The fol=owing e:ements and their correspording :ainin-lum
criteria-:eer. verified by me or ot.zer designated tec^nicai specialists and
are inc?uded in the plan as applicable: minimum separations (buffers); liners or
eY:i-rale_nt for lagoons or waste storage ponds; waste storage cacacitr; adequate
4•sarti=y an amount of lard for waste utilization (or use of th-J= parry) ; access
or ownership or proper waste application equipment; schedule for timing of
applications; application rates; loading rates; and the control of the discharge
of pollutants from stoz--water runoff events less severe than the 25-year, 24- :our
storm.
Naoe of Tacl=: cal Specialist (Please Print) G CitEn/1 CLI�rOrt
Aatior_ ORE�)7-A6E fARMs Inc _ _�
address (Agency : P . 60 4 �fAT37r1C Z8Phone No. 9+0- 592-'S7-71
S;ynat ._ , • 'a. adL't..... G4 t:"_j Cate- S/1-5195
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Cs�rter/�Sa.:.ager a�•asmeat
(we) understand the operation and maintenance procedures esta.hl s ed in te
approved animal waste ma.ragesaent plan for the fa*= names above and will _:.plement
_`.ese -roceda=es. I (we) 'Know that any additional xoansion to the exist:Lng
desig^ capacity of the :taste treatment and storage system or c_nstrcc,'_on of new
facilities r+i_i =equi=e a new cer..-ficatior. to be su mitted to the Division of
vironrental Management before the new animals are szacked• . _ (we) also
understand that there must 'ce no discharge of animal waste fr.....=, this system to
sun --face waters of the state either th-ough. a man-made conveyance or thrcug1l
z-.a.rof= _=ors a stor:n evert less severe than the 25-_rear, 24-hour store. The
approved plan. will _e filed at the fa_-m and at the office or a local Soii an:
%pater Conservation Dist__=.
*Ia=e c f =.a
Signatt_r e :
NaL•e of Xaaasar, if different from owned (Please print) .
Signature: Date .
:iota: A change 4­:1 land curersnip requires ^cci_-cation or a new pet it=_cation
(-f the approved plan is changed) to be su::mitted to ---e Di•rision of
=:t•r__ mental `�a.nageme_nt .1i thin 50 days of a title transfer.
DRI USE' ONLY;

Deperlmentof Environment,
Health and Naturcl Resources
Divisicn ct Envircnmentei Mcncgement
Jcmes B. hunt, Jr., Governer
Jonethcn B. Hcwes, Secretary
A. Prestcn Hcwcrd, Jr., P.E., Directcr
FOR DTP."A OR`=ZA"MED ?1-N i * !--MnLOTS
2IIST-RUCT:CNS FOR Ct__R'='IF ICATICN OF AP PROV= ANIMAL W S M' MMAGMIEMNT PLANS FOR
Nrr'; OR _--�C2AhT'7i EO ?u'`r'_X_AL WASTE MA.,UAGZ24_—r' SYST=4S SZRV'=NG PLOTS
:n order to be deemed permitted by Whe Division or F..-ivironmental Management
(DEM), the owner of any new or expanded animal waste management system
ccrstructea after January 1, 1944 whicz is designed to serve grn eater than, or
equal to t!.e ani.=al popularions listed below is required to submit a signed
certification form to OEM before the new animals are stocked on the farm.
Pasture operations are exempt .'ram the requirement to be certified.
100 head of cattle
73 horses
2 S 0 swig.
1,000 sheap
30,000 bjj =d vtth a liquid vast& system
The certification must be signed by the cwne-T of the feedlot (and manager if
different from the owner) and by any tecrsaical specialist designated by the Soil
and 'Hater Ccnse^ration Commission pursuant to 1SA NCAC 6F .0001-.0005. A
technical specialist must verify by an on -site inspection that all applicable
design and conscruc_ier_ standards and specifications are met as installed and
that all applicable operation and mairte.*zance standards and specifications can
be met.
Although the actual ruasber of animals at the facility may vary from time to time,
the design capacity or the waste handling system should be used to determine if
a farm is subject to the certification requirement. For exa=le, if the waste
system for a feedlot is designed to handle 300 hogs but the.avesage population
will be 200 hoes, _hen the waste management system requires a.ce_tificat:on.
T`*.is certif nation is required by regulations governi.'xg animal waste management
systems adopced by the Environmental Management Commission (M-IC) on iecemher 10,
1992 (Title I5a NCAC 214 .0217).
c�=27 -*-nu _paw
Cn the reverse side or this page is the certification form which =ast be
s!;,mitted to OEM before new animals are stocked on the far=;. Assistance in
cac:Pleti.g the to= can he obtained :ram one of the local agricultural agencies
such as the soil and water car_serrat;or. district, the U5CA-Soil Corset -ration
Service, or t o N.C. CocPerat;ve Sxtersion Service. The form should be sent to:
Depaz=ent of Z.viror.ment, health and
Division of Zavirorme_ mal Management
Water Qualit-y Section, Planning bran-h
P.Q. Box 29535
Raleigh., N.C. 27626-0535
Phone: [phone]
Fo= 70: AC:rc,;0194
Natural Resources
Steve W. Tedder, Chief
Water Quality Section
Cate: &ZF
P.C. -Te�epnane 9T9-7334015 FAX [phone]
An E,LcS Ccwcrrtnrry A`°rma:ive Ac cn Enolcyer 5:%recyc!ed/ ICE pcs -c=nsur^er pcoer