820048_INSPECTIONS_20171231

NORTH CAROLINA .�
Department of Environmental Qual

r ype or v rsu: %1 Uompnance inspection V Vperation Kevtew V Ntructure tvatuanon U 7 ecnntcal Assistance
Reason for Visit: 19 Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: I -1— f Arrival Time:FT : 3 Departure Time: County: , 4714 J Region:
Farm Name: try 4AOwner Email:
Owner Name: j� s'j?/ T� Phone:
Mailing Address:
Physical Address:
Facility Contact: G?I�NIGI Title:
Onsite Representative: SL=
Certified Operator: 4 r trl
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator: cf�*
Certification Number: />r7
Certification Number:
Longitude:
Swine
Design
Capacity
Current
Pop.
Wet Poultry
DesigNYF
Capacop.
rrent
Design Current
Cat#le Capacity Pop.
Wean to Finish
La er
Non -La er
D , P.oul
—
Design
Ca-"aci
Current
Po .
Dairy Cow
Wean to Feeder
Dairy Calf
Feeder to Finish
Sip
v
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Dry Cow
Non-DatEy
Farrow to Finish
La ers
Beef Stocker
Gilts
_
Non -Layers
I
113eef Feeder
Boars
-
Pullets
Beef Brood Cow
T - q:
Other
Turke s
Turkey Poults
Other
jOtheT
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 0 No ❑ NA ❑ NE
❑ Yes ;D No
❑ Yes {�] No
❑ Yes No
❑ Yes No
❑ Yes � No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
Page I of 3 21412015 Continued

Facility Number: z - Date of Inspection: ILI
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes td No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): / 9
Observed Freeboard (in): 7i
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 MV 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 ADDlication
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes No
D 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):
13. Soil Type(s): '' 1
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 M 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 No
❑ NA
❑ NE
18, Is there a lack of properly operating waste application equipment?
❑ Yes No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes No
[] NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes V] 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 21412015 Continued

Faciliq Number: T T - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [>�] No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes E No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? []Yes Z 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?
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑Yes ®No ❑NA ❑NE
❑ Yes � No ❑ NA ❑ NE
❑ Yes 1� No ❑ NA ❑ NE
❑ Yes f�] No ❑ NA ❑ NE
❑ Yes No
❑ Yes � No
❑NA ❑NE
❑ NA ❑ NE
Reviewer/Inspector Name: "Ir - Phonegl.d 35% ;—p
Reviewer/Inspector Signature: Date: LQ
Page 3 of 3 2/4,201S

Inspection
[Facility Number: - Date of Inspection:
Waste Collection & Treatment
4_ Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes � No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No [] NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3 q
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
❑ No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
® No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
E4 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
[6 No
❑ NA
❑ NE
maintenance or improvement?
Waste ADDlication
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
LZ No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? if yes, check the appropriate box below.
❑ Yes
O—No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or I0 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): l 1>y���Sz✓r� „_
13. Soil Type(s): � Y�/,Pr
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
J, No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[&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
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[3-No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
0 No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[j 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
E4 No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste 'transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
❑ Sludge Survey
22_ Did the facility fail to install and maintain a rain gauge?
❑ Yes
[�q No
❑ NA
❑ NE
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
® No
❑ NA
❑ NE
Page 2 of 3
21412015 Co► daued

Facility Number: - Date of Inspection:
24_ Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [No
25. Is the facility out ofcompliance with permit conditions related to sludge? If yes, check ❑ Yes [R,-No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes ® No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [ o
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑NA ❑NE
❑ NA ❑ NE
❑NA ❑-
❑NA ❑NE
❑ Yes o No ❑ NA ❑ NE
❑ Yes CEI No ❑ NA ❑ NE
❑ Yes [KNo ❑ NA ONE
❑ Yes allo ❑ NA ❑ NE
❑ Yes
[&No
❑ NA
❑ NE
❑ Yes
54 No
❑ NA
❑ NE
❑ Yes
JE—No
❑ NA
❑ NE
( q.:
Commep#s refer to u' 1; lain an' F esteon #) xp y YES answers and/or'anyladdtteona[ recommendaboos or any otiteraco�nments. it �F
_. � ggye I1. �rI
I SM ice: .y Tin .ikrd'r i"M= . . • r.' 1 III '�'i Ii�- f. �'. IC • { �eF k4, ,�.'r J 45 �i irg 1
Ilse drawings of facilllty tobet#er egplam site�ati©ns`(use!addit�onalipages:as necessary)' fi= y -.
Gvpr� �- � �j-�'o,•- � pales r��
Reviewer/Inspector Name:
Reviewer/inspector Signatut
Page 3 of 3
Phone:
Date: fO / ),--/ ;7—
2141201 S

i ype of visit: (&Mompliance Inspection V operation Keview U Structure Evaluation V 1 ectinical Assistance
Reason for Visit: G Routine O Complaint Q Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: Departure Time:County: s �( Region:
Farm Name: _ fl .1 G, 'r►"'r AK Ow`n`e`r EEm-`afl-:
Owner Name: p Phone:
Mailing Address:
Physical Address:
Facility Contact: �� �10i/.1,`j..� Title: Phone:
Onsite Representative: < < integrator: �Q
Certified Operator: C� Certification Number. .14 ZS-O
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current
Swine Capacity Pap.
Wean to Finish
Wet Poultry
La er
Design Current Design
Capacity Pop. Cattle Capacity
Dairy Cow
Current
Pop.
Wean to Feeder
on -Layer
Dairy Calf
Feeder to Finish
Farrow to Wean
Farrow to Feeder
D . P,oult P
Dairy Heifer
Design Current D Cow
C aci P. Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turkeys
Turkey Poults
Other
Discharees and Stream ImDacts
1. Is any discharge observed from any part of the operation?
❑ Yes
E2130
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
[q-NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
[] No
2-I 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
[a A
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
[Z No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
0 Yes
�o
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412015 Continued

Faeility Number IDate of Inspection,
Waste Col,ection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [E "" ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No E �A ❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
pp
Observed Freeboard (in):_ J
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[3"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 4fi 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
[ f No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
12<0
❑ NA
❑ NE
1 (not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
Rio
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[?No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes I 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 CropWindow❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
UJ
12. Crop Type(s): r.LIj, 'ctrr710
r
13. Soil Type(s): toJ ao J. t C-0""Ci &
14. Do the receiving crops differ from tho a designated in the CAWMP?
❑ Yes
[3"No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[;j'O'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
❑'No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
O No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
0 No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[� No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
[21No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather
Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
[:]Yes
LJ No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
0 No
❑ NA
❑ NE
Page 2 of 3 21412015 Continued

Waoility Number: - Date of inspection:
24. Did the` facility fail to calibrate waste application equipment as required by the permit? [:].Yes [3'17o ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [;�No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes [ -No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [�No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
[J-iGo
❑ 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
❑']Qo
❑ 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
D Yes
[D'No
❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
[�No
❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[TNo
❑ NA ❑ NE
33. Did the Reviewer/lnspector fail to discuss review/inspection with an on -site representative?
❑ Yes
[✓r'No
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
�o
❑ NA ❑ NE
Continents (refer to question f: 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).
C J Z "OA,-- � ^
4t, S'C--Vnf ,
at - 0 - �C (0
gp 7�0
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:`''[ ,3_
333#
Date: --A4 t
2141&5

ivi°sion of Water Resources
Facility Number ®- ® 0 Division of Soil and Water Conservation
O Other Agency
Type of Visit: ��omppliance Inspection Operation Review Structure Evaluation Q Technical Assistance
Reason for Visit: (3' outine O Complaint 0 Follow-up 0 Referral 0 Emergency Q Other O Denied Access
Date of Visit: Arrival Time: Departure Time: County: Region:
Farm Name: I` aP m jr Owner Email:
Owner Name: / Phone:
Mailing Address:
Physical Address:
Facility Contact: oiiYF-✓ /77�qv ,, -r Title:
Onsite Representative:_
Certified Operator: -
Back-up Operator:
Location of Farm: Latitude:
C, Phone:
Integrator:��
Certification Number: / AP, �f.3
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Wean to FeederL
Feeder to Finish 7
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Qther
Design Current
Wet Poultry Capacity Pop. Cattle
La er Dai Cow
Design Current
Capacity Pop.
Non -La er
Dai Calf
DairyHeifer
Design Current D Cow
D . P,oul Ga acit $o , Non -Dairy
Layers Beef Stocker
Non -Layers
Beef Feeder
Pullets
Beef Brood
Turkeys
Turkey Poults
Other
-Cow -
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 DW R)
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
❑ Yes ❑ No
[:]Yes ❑ No
[:]Yes JaNo
❑ Yes RNo
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
Page I of 3 21412015 Continued

Facili Number: Date of Inspection:j�—
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 Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Spillway?: _
Designed Freeboard (in): 5 —
Observed Freeboard (in): L %
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
EZNo ❑NA ❑NE
❑ No ❑ NA ❑ NE
Structure 6
❑ Yes allo ❑ NA ❑ NE
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
allo
❑ 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
UNo
❑ 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
allo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
MA No
[3NA
❑ NE
maintenance or improvement?
I I. Is there evidence of incorrect land application? If yes, check the appropriate box below. [] Yes E�LNo ❑ 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): m a C�Cr
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the faciliy fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ Yes
E�No
❑ NA
❑ NE
❑ Yes
allo
❑ NA
❑ NE
❑ Yes
allo
❑ NA
❑ NE
❑ Yes No ❑ NA ❑ NE
[] Yes ® No ❑ NA ❑ NE
❑ Yes ®,No ❑ NA ❑ NE
❑ Yes allo ❑ NA ❑ NE
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall []Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? [:]Yes [&No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ,!io
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facill Number: - Date of ins ection: O
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 allo
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? [:)Yes C2�No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [:]Yes allo
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 ofthe 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 r]NE
❑ NA ❑ NE
[] Yes allo ❑ NA ❑ NE
❑ Yes allo ❑ NA ❑ NE
❑ Yes ®.No ❑ NA ❑ NE
❑ Yes allo ❑ NA ❑ NE
❑ Yes M No
❑ Yes [4 No
❑ Yes [�],No
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessarv).
w, Cr2--� L
Reviewer/Inspector Name:
Reviewer/Inspector Signatur
Page 3 of 3
Phone:JJ
Date: //— /U —';�) /J_
21412015

ivis`ion of Water Resources
Facility Number � -Liwoffit'ne
r Agency
Type of Visit: ompliiance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: -/ Arrival Time: ® Departure Time: i �� County Region:
Farm Name Owner Email:
Owner Name: 1"r yrr i L- Phone:
Mailing Address:
Physical Address:
Facility Contact: -es-f Title:
Phone:
Onsite Representative: s�i Integrator: /rf S
Certified Operator: ��7 Sn1� Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design Current
Capacity Pop.
sh
raFeede!r2toFinish
Design Current
Wet Poultry Capacity Pop.
Layer
Design Current
Cattle Capacity Pop.
DairyCow
der
Non -La er
DairyCalf
Farrow to Wean
Farrow to Feeder
Farrow to Finish
/�;]
Design Current
D . P:oultr. Ca aci P,o
Layers
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Gilts
Boars
Non -La ers
Pullets
Turkeys
Turkey Poults
Other
Beef Brood Cow
NJ
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)? _
d- Does the discharge bypass the waste management system? (if yes, notify DWR)
2. Is there evidence of a past discbarge 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
[::]Yes ❑ No
[::]Yes []No
❑ Yes ❑ No
[—]Yes [:]No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
Page 1 of 3 21412014 Continued

Facili Number: - jDateof Inspection: J——/
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes EK No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 145-
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes S 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
[S 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
D. No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
allo
❑ 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
Ej No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[allo
❑ 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 l0 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): a-
cJt-r
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 allo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes r--A 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 [3 No ❑ NA ❑ NE
❑ Yes MNo ❑ 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 Jallo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I " Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ®No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [. No ❑ NA ❑ NE
Page 2 of 3 21412014 Continued

Facility Number: - Date of Ins action:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes Jallo D NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check Yes r. No D NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey Failure to develop a POA for sludge levels
�] Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
❑ Yes
RNo
❑ NA
D NE
Yes
ff No
NA
NE
Yes
V[No
NA
NE
❑ Yes RNo [DNA D NE
Yes 0 No ❑ NA ❑ NE
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. Yes ® No
Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? Yes �allo
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? Yes Q No
34. Does the facility require a follow-up visit by the same agency? [—]Yes No
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
❑ NA ❑ NE
[DNA []NE
NA NE
[DNA NE
Phone: g33 3-Keo
Date: //—/fir fl /5--
1/4a014
Page 3 of 3

Inspection
Facili Number: - Date of Inspection: / dJ,-v2O)Jf
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):`
Observed Freeboard (in).
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes [Z 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 0[ 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 �4 No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes allo ❑ 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 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): bt/ y� 16
v
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? r] Yes [Q No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable C] 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 RL No ❑ NA ❑ NE
❑ Yes 0 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:
►t
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes allo
❑ 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 [a No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes P No
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑NA ❑NE
Page 2 of 3 21412011 Continued

Facili Number: - Date of Iris ection: /
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes R No
25. is the facility out of compliance with permit conditions related to sludge? If yes, check [::]Yes ® No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes DI No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes j34 No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
ES -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
R1 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
®. No
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
0No
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
f. No
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
PLNo
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
®-No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
Comments (refer to,xquestion #0: Explain any YES answers and/or. any additional recommendations or any other m coment`§:
Use:drawin s of facrli g ` _ty to better explain situations (use additional. pages, as necessary).g ter_
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date: AT791-ri�0/y/
21412011

Type of Visit: Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: CD xcoutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: ' D Departure Time: 0 q_ County:
Farm Name: t�yfP Y �irn 'r 14 ra !!'1'" Owner Email: -
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: &r e r r M zo.r' r Title:
Onsite Representative: �Ac-rsC�
Certified Operator: ileo"t S7?" i
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Region: F/Z o
Integrator:
Certification Number: 1�y3a�
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
-
�►'et Poultry
Layer
Non -Layer
'' "` '
D . Poul
Layers
Non -Layers
Pullets
Turkeys
Turkey Poults
Other
Design
Capacity
Design
Ca aci
Current
Pop.
Current
P,o .
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
_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 pan 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
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes ❑ No
[-]Yes RNo
[] Yes (i No
❑NA ❑NE
❑NA ❑NE
DNA ❑NE
Page I of 3 21412011 Continued

Facili Number: Z2L - ki Date 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):
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
[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
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
Z No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
[:]Yes
to No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [3 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
ff of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): I =Lm V oi^ 1 ego
13. Soil Type(s): /+' /' u; [1 �-
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes §�JNo ❑ 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 ❑ Yes [gNo ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes Na ❑ NA ❑ NE
❑ Yes �No ❑ NA ❑ NE
❑ Yes R No
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [Z No
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—_1 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
❑ NA ❑ NE
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
DNA ❑NE
❑NA ❑NE
Page 2 of 3 21412011 Continued

Facility Number: jDate of inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [3§ No ❑ NA 0 NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes � No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
❑ Yes
� No
❑ NA
❑ NE
❑ Yes
[A No
❑ NA
❑ NE
❑ Yes
CA No
❑ NA
❑ NE
❑ Yes 5g No ❑ NA ❑ NE
❑ Yes q No ❑ NA ❑ NE
31. Do subsurface tile drains exist at the facility? if yes, check the appropriate box below. [a Yes
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes
34. Does the facility require a follow-up visit by the same agency? ❑ Yes
Reviewer/Inspector Name:
1�
[. No ❑ NA ❑ NE
bg No ❑ NA ❑ NE
No ❑ NA ❑ NE
[E.No ❑ NA ❑ NE
Tb k,-+ w;
Phone: cY10-433 3—)013
Reviewer/Inspector Signature:
Page 3 of 3
Date: g ::� q 0
21412011

4
t ype of visit: (`Mompliance Inspection U Operation Review U Structure Evaluation O Technical Assistance I
Reason for Visit: outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: /p-- / rrival Time: .'jp Departure Time: County: Region:
Farm Name: ��//� y .Sig ��/vy�- Owner Email:
Owner Name: �z't1`� .Sm-,� a t- Phone:
Mailing Address:
Physical Address:
Facility Contact: %`z yr /7?aa.^_-_ Title:
Integrator: ,' /�
Certification Number: /�3�
Onsite Representative:
Certified Operator: Yd j777%
Phone:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
DesignCrrent
Cap city Pap..
Desiga Current
Wet Poultry l apacity�P,op: =
Design Current
Cattle Capacity Pap.
airy Cow
7Swine
Wean to Finish
La er
Wean to Feeder
Feeder to Finish
Gc�
Non -La er
r -si
zDesignCitrrent;==.
Dr, P,oult , Ca aci P,o
airy Calf
airy Heifer
D Cow
Non -Da
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
La ers
Beef Stocker
Beef Feeder
Non -La ers
Boars
Pullets
Beef Brood Cow
Other �_ f
Other
Turkeys
TurkeyPoints
Other
Discharges and Stream Impact
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 'WNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes ❑ No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes allo ❑ 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 l 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
E&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
® No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
� No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
4 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
RNo
❑ 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 gLNo
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground
❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑
Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift
❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes ELNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes 4 No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes 0 No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
❑ Yes [a -No ❑ NA 0 NE
❑ Yes �No ❑ NA ❑ NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
allo
❑ NA
❑ NE
20. Does the facility tail to have all components of the CAWMP readily available? If yes, check
Ej Yes
[M 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
0 No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
[-]Yes
[3,No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
E]-No
❑ NA
❑ NE
Page 2 of 3 21412011 Continued

Facility Number: jDate of Inspection: / 'Y
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes R No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? if yes, check ❑ Yes allo ❑ 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 0 NA ❑ NE
27_ Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes (allo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes 5a'No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
24. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
ENo
❑ 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
0 Yes
),No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
® o
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
0,No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
PkNo
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
EK No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessarv).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date: /
214/2011

inspection
` facility Number: I Date of Ins ection:
14
Waste Collection & Treatment
• 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
CE�No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):�
Observed Freeboard (in): 3 L
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
54 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
[g 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
KN 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): ,�,^r 0J'1L_ /v"ri—" Sj
13. Soil Type(s): Yi
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 ❑ Yes E[ 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 GZ-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 10 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 Callo
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [Z No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑NA ❑NE
Page 2 of 3 21412011 Continued

[Facility Number: - Date of Inspection: r
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ® No
the appropriate box(es) below_
Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes � No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ® No
Outer Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes No
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes No
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the ❑ Yes C!�No
permit? (i.e., discharge, freeboard problems, over -application)
31 _ Do subsurface tilt drains exist at the facility? If yes, check the appropriate box below. ❑ Yes 19 No
Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes No
33. Did the Reviewer/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 ZLNo
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ONE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
0 NA ❑ NE
❑ 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 pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date:
21412011

Type of Visit
ompliance Inspection
0 Operation Review 0 Structure Evaluation
0 Technical Assistance
Reason for Visit
outine 0 Complaint
0 Follow up 0 Referral 0 Emergency
0 Other ❑ Denied Access
Date of Visit: -- ,D Arrival Time: pZ Departure Time: r D County: Region:
Farm Name: eOwner Email:
Owner Name: _Lelai ram/` - Phone:
Mailing Address:
Physical Address:
Facility Contact: _7B,-/'/' ti S Title: 6WP'- Phone No:
Onsite Representative: �/'Y r �'1 t�i7y Y Integrator:
rl
Certified Operator: Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: [= o [= , = Longitude: [= o = t = i,
Design Current Design
Swine Capacity Population Wet]Poultry Capacity
Current Design Current
Population Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
E]Dry Cow
❑ Non -Dairy
❑ Beef Stocker
El Beef Feeder
❑ Beef Brood Cow
Dumber of Structures:
❑ an to Finish
❑ Layer I
❑ an to Feeder -
❑ Non -La er
Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
Dry Poultry
❑ Layers
El Farrow to Finish
❑ Gilts
,.
❑ Non -Layers
❑ Boars
❑ Pullets
❑ Turkeys
Other ❑ Turkey Poults
❑ Other ❑ Other
Discharses & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
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 10No ❑NA [I NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes M No
❑ Yes W No
Page 1 of 3 12128104
[I NA ❑NE
❑ NA ❑ NE
Continued

Facility Number: — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
CgNo
❑ 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): / g
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
0 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
9 No
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes 9 ,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 El NA ❑ NE
maintenance/improvement?
I 1. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ®.No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wined Drift ❑ Application Outside of Area
12. Crop h'Pe(s)��- �f�r•�e/`��+�rl� _
13. Soil type(s)
14. Do the receiving craps differ from those designated in the CA WMP?
❑ Yes [allo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [-7 No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes 0 No ❑ NA ❑ NE
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
IMNo
❑ NA
El NE
Comments (refer to question #): Explain any YES answersiand/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/Inspector Name Phone:
Reviewerllnspector Signature: Date: ZD
Page 2 of 3 12128104 Continued

Facility Number: — 81 Date of Inspection
f
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 allo ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes U-No ❑ 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 0 No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain raiabreakers on irrigation equipment? ❑ Yes ANo ❑ NA ❑ NE
24, Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
RNo
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
f &No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
f;�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
B No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
[] Yes
OkNo
❑ 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
[XNo
❑ 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
ONo
❑ 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
Qallo
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
KNo
❑ NA
❑ NE
Additional Comments and/or Drawings:
Page 3 of 3 12128104

nr l __ --71-fI
Type of Visit aCompliance Inspection O Operation Review Q Structure Evaluation O Technical Assistance
Reason far Visit Q Routine O Complaint 0 Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: County: �ii`l1l'� Region: -lo
j� V
Farm Name: t�/I•� J!h Fl '1 't'U�!!�1 Owner Email:
Owner Name: �!f y �n���i�, :" . Phone:
Mailing Address: ' I-yt k+,, y
Physical Address:
Facility Contact: S�'1 Title: l�wn,9^ Phone No: / 7�
Onsite Representative: Integrator:
a! /
Certified Operator: ��rr( Operator Ccrtiication Number: Ah-A I�Yl
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: E-1 0 0 0" Longitude: [= ° =+ 0 1i
Design Curren#
Design C•urreut
Design C•nrrent
Swine Capacity Population
Wet Poultry Capacity Population
Cattle Capacity Population
❑ Wean to Finish
❑ La er
❑ Da'Cow
❑ Wean to Feeder
❑ Non -La er
❑ Dai Calf
Feeder to Finish '=j`] Q
❑ Dai Heifer
❑ Farrow to Wean
Dry Poultry
❑ Cow
❑ Farrow to Feeder
❑ La ers
❑ Non-Dai
❑ Farrow to Finish
[IBeef Stocker
❑ Gilts
❑Non -La ers
❑ Beef Feeder
❑ Boars
❑ Pullets
❑ Beef Brood Co
❑ Turkeys
Other
❑ Other
❑ Turkey Poults
❑ I
(lumber of Structures:
Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
C'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
MNo
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
[:]Yes
'g—No
❑ NA
❑ NE
other than from a discharge`?
12128104
Continued

Facility Number: C. — 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
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): Cj
Observed Freeboard (in): 33
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes MNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes allo ❑ 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 C_?kNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes allo ❑ 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 15�No ❑ NA ❑ NE
maintenance or improvement?
Waste Apolication
10. Are there any required buffers; setbacks, or compliance alternatives that need ❑ Yes 1�kNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes C 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 ElEvidence of Wind Drift ❑ Application Outside of Area
12. Crop typeis) 1 PlAi u d a, A L'1, - S'17/
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
CgNNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
5RNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
ER No
❑ NA
❑ NE
IT Does the facility lack adequate acreage for land application?
❑ Yes
RTIo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment'?
❑ Yes
5Vo
❑ NA
❑ NE
Comments (refer to:gaestion #): Explain anytYES answers and/or any recommendations or any other c ents .Y
Use drawings of facility to better explain sitQ on's: (use additional pages as neces
Reviewer/Inspector Name �� S Phone: ro ��
Reviewer/Inspector Signature: _�'�lY Date: a
12128104 Continued

Facility Number: a — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes J'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 appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? if yes, check the appropriate box below. ❑ Yes RNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
E'No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
CRNA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
ONo
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
IgNo
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
[3No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
[] Yes
® No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
�a 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
19 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
IgNo
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
W-No
❑ NA
❑ NE
lsr Llvywd in Ha-ch aooq
is shown 4 g °�o s �� � ra+{ o `E Q 4reM m,9tc' vo[r.M-e, �I �1
0000d `4�ajj 4 f PCorC& ,
l2/2VO4

Facility No.' ,) Farm Name
Permit COC
--I
Date 41aso�
01C� NPDES {Rainbreaker PLAT Annual Cert )
r • • IrKIlN3�Y�ta1r.TL'�7■
La oon
1
2
3
4
5
6
7
Spillway
Design freeboard
Observed freeboard in
Sludge Survey Date
}a r tog
Sludge Depth ft &
Liquid irt. Zone ft
3,
[NW_4 V3"IlTE.z0MIW�lIM.
Design Wi•
.11
MA
---
---
Soil Test Date
pH Fields
Lime Needed
Lime Applied
Cu -" Zn ✓
Needs P '44,dd4"
CroD Yield
Wettable Acres
WUP
Weekly Freeboard
Rainfall >1"
1 in Inspections _
120 min Inspections
Weather Codes
Transfer Sheets ^%
RAIN GAUGE
Dead box or incinerator
Mortality Records
a w-IMIRIMP-310,0*7
art
•
VAXF
Pull/Field
Soil
Crop
RYE
PAN
Window
Max Rate
Max Amt
f,i�L.
!r4'Ti"T
3 iJ
I�,�a C vaa,�za
Verify PHONE NUMBERS and affiliations fJ 03,Y 0
Date last WUP FRO Date last WUP at farm App. Hardware
FRO or Farm Records
Lagoon#
Top Dike���
Stop Pump
Start Pump
Conversion- Cu-I 3000= 108 Ib/ac; Zn-I 3000= 213 lblac
gIvSzk'fJ�- _I iM 3 SAT
I01a
3 4-M
601

1--a l bib
ipl

inspection
Facility Number: -a' — 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
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes CaNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes JR 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? gYes ❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes allo ❑ 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 JRNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [RNo ❑ NA ❑ NE
maintenance/improvement?
1 I . is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes [�JNo ❑ 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 r
�A++c__ce��ptable Crop Window ElEvidence❑ce of Wind Drift Application Outside of Area
12. Crop typeL_.
s) iJ0&1 bftM"d l_ 6aC.lS �> I I S6 OJ — --
13. Soil type(s)
Kv_.1� EM
14. Do the receiving crops differ from those design ted in the CAWMP?
❑ Yes
VNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
19 Yes
X No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
UNo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
RNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
INNo
❑ NA
❑ NE
Reviewer/Inspector Name 1 r SG ,� t Phone: c?jp_ I33-33Q0
Reviewer/Inspector Signature: Date:f14 1 aQ OR
Page 2 of 3 I2128104 Continued

Facility Number. Q, a— t Date of Inspection TD
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes fa No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes NNo ❑ NA ❑ NE
the appropirate box.
❑ WUP ❑Checklists ❑Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes I -No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes R No ❑ NA ❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
5'NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
C+Io
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
5d No
❑ 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
❑ No
ERNA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
CRNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
5 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
[N 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
RNo
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32_
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
RNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
f'No
❑ NA
❑ NE
Vork� OA bfoff- On Lair , 4h beer) SeR ln9 �rn&,jcA1�
I � I -+lame Yw-ede C.
S �
i1 cuTf4i ruAlie- 01Ar',5 '10 VolP�ih
ay4aS- S[td�Q s,���e% c�- ca I i IifAo, 4o Yedo, e- e Pnd, 9Fpc,, 0014No i
� loo, 7 �
oveseei (norm 1) f ore fi old
W�d maP,4,2,�eoC-Avm 4 re(&&.
Page 3 of 3 12128104

Facility No. 1;a-yg" Far Name 1" t Date 11d11f f og
Permit COC "" !C_ NPDES (Rainbreaker PLAT Annual Cert )
Pop. Type Design Current
Lagoon
1
2
3
4
5
5
7
Spillway
Design freeboard
Observed freeboard in
Slud a Survey Date Perm Liquid ft
Sludge Depth ft
REPI 'Manna
to
Actual +Fesig
------
Width
ActualWidth
Soil Test Date q it
pH Fields
Lime Needed �^
Lime Applied,4qj
Cu r Zn �G
Needs P N
/N-nt-faedQo+re
Cro Yield
Wettable Acres
WUP
Weekly Freeboard
Rainfall >1"
1 in Inspections
120 min Inspections
Weather Codes
Transfer Sheets
RAIN GAUGE
Date of last WUP FRO 140 Date of last WUP at farm App. Hardware Max Rate Max Amt
Pull/Field Soil Crop RYE PAN Window
G I -
Verify phone numbers and affiliations
s1G-� r y-). 3 = o-

— e. .
Division of Water Quality °
µ Facility Number. O Division of Soil and Water Conservation
0 Other Agency V
Type of Visit a4 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit V Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: County: Region:
Farm Name:
61
Owner Name:
Mailing Address:
Physical Address:
Owner Email:
Phone:
Facility Contact: , 1 Title: i1 Phone No:
Onsite Representative: r [ 4 Integrator:
Certified Operator: Of, _ Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm:
,Design Current
5winex Capacity Population
❑ Wean to Finish
❑ Wean to Feeder
,
eder to Finish I Z
5Zi d
❑ Farrow to Wean I
❑ Farrow to Feeder
❑ Farrow to Finish
Latitude: = e = = Longitude: = ° E]L =
Design Current
Wet Poultry . Capacity Population
❑ Layer j
Non -Layer
Dry Poultry
Non -La
Pullets
Other
Puuets
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?
77.7
Cattle
❑ Dairy
-Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Stru
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes *o ❑ NA ❑ NE
❑ Yes
❑ No
�NA
❑ NE
❑ Yes
❑ No
�TA
❑ NE
---
WA
❑ NE
❑ Yes
❑ No
❑ Yes
V AUo
❑ NA
❑ NE
❑ Yes
❑ No
A
❑ NE
12128104 Continued

Facility Ndmber: Date of Inspection 1 Z 0
r
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
Rj No
❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
Wo
❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): ,
Observed Freeboard (in): 3
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No
R
ElNA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
RNo
❑ 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
19 No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
12[No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
ANo
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? if yes, check the appropriate box below.
❑ Yes
�4 No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 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) (�" m u .Aak_ sm C`J1l< US
13. Soil type(s) 0 V, Q_k A
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
KNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes
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
NLNo
❑ NA
❑ NE,
18. Is there a lack of properly operating waste application equipment?
❑ Yes 5�No ❑ NA ❑ NE
IComments (refer to question ft Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
+S �11SL 1/e'1�`-� �V0 S ►
Reviewer/Inspector Name Phone: g 10 Ll ���3 33 OP
Reviewer/Inspector Signature: Date:
12128104 Continued

Facility Number: a — Date of Inspection 7 4
Required Records & Documents
19_ Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes �No ❑ NA ❑ NE
20_ Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes X
No ElNA ElNE
the appropirate box. ❑WUP ElChecklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes Wo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes it No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
(:]No
XNA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
X 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
P►No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
No
❑ NA
❑ NE
General Permit? (ie/ discharge. freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
1�No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
P No
❑ NA
❑ NE
Additional Comments and/or Drawings:
S �Xv vt)': LV'f- -to & W" �tw 6� 34 /o
12128104

Facinty 110. :)L— 4%
Farm Name QJ{ 1
Owner
Operator VQA t
Back-up
COC
1
Time In
a
Circle: General or
Time Out Date I z,,/ � Jo7
Integrator
Site Rep p
No. [
No.
NPDES
Design
Current
Design
Current
Wean — Feed
Farrow — Feed
—
Farrow — Finish
Feed -- FM is
Gilts 1 Boars
— can
Others
FREEBOARD: Desig 10 `
Sludge Survey = Vag, 44c—'
Crop Yield
Rain Gauge 1�
Soil Test Wettable Acres
Weekly FreeboardN_ Daily Rainfall 4�
Spray/Freeboard Drop
Weather Codes 120 min Inspections
Waste Analysis:
D to Nitrogen (N)
Ica . c0
Observed /y
Calibration/GPM
Waste Transfers
Rain Bre
PL
1-in Inspections ��
Date Nitrogen (N)
r3
Pull/Field Soil Crop Pan Window

Inspection
Facility Number: J —0 Date of inspection �7
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes M No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No [ANA ❑ 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 $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 �INo ❑ 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 C No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes Wo ❑ NA ❑ NE
maintenance/improvement?
I i. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.) r
❑ PAN ❑ PAN > l0% 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) 6-4-M U dA `11� GVd1iv4, 0 /S
13. Soil type(s) tq Lk 0', JqU
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
I�ANo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
to No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
Jallo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
9No
❑ NA
❑ NE
Comments (refer to..que.stion f: Explain any YES answers and/or any!recommendations or any other co meats.
Use drawings of facility twbetter explain situations. (use additional pages -as necessary):
Reviewer inspector Name L {�j�-� N! f Phone: `'1 }Q' j C7u
Reviewer/Inspector Signature: Date: CK--T ZMCQ
Page 2 of 3 12128104 Continued

Facility lumber: Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 14No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes A 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 [VNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes No
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes J)_�No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes P�No
❑ NA
❑ NE
27_ Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes'gNo
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes *rNo
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes NNo
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes T No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes [S No
❑ NA
❑ NE
Additional Comments' and/or Drawings:
40T Co r. d 4"Uy\
0 wne,r ti s
Page 3 of 3 12128104

q L
Facility No. 00% Time In _ Time Out Date
Farm Name Integrator
Owner Site Rep
p
Operator iJU11 1\ 'rYl No.
Back-up
COC -j.,!< -
c
No.
Circle: General or DE
Design
Current
Design
Current
Wean - Feed
Farrow - Feed
WeanZFFin
Farrow - Finish
eed
5
Gilts 1 Boars
arroan
Others
FREEBOARD: Design c Observed j
Sludge Survey ✓ Calibration/GPM ✓ 1 I r
Crop Yield _ Waste Transfers
Rain Gauge Rain Breaker
Soil Test 1—'`" PLAT ZL,,-/ Wettable Acres t
Weekly Freeboard
SpraylFreeboard Drop _
Weather Codes 1-1
Waste Analysis:
Daily Rainfall 1-in Inspections
f, S I-Lo. 4 /3 W 1 30
120 min Inspections
Date Nitrogen (N) Date Nitrogen (N)
(o NOW /-_Z , n z::,7•i
F 1z , i _z/z.d
1 l C)Z-
Pull/Field Soil Crop Pan Window
u a-

Type of Visit Q Compliance inspection () Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit 0 Routine O Complaint O Follow up O Referral O Emergency Q Other ❑ Denied Access
Date of Visit: Arrival Time: 1 r 00 DepartureCounty: S o4— Region: ;eo
Farm Name: doacex S 6Owner Email:
Owner Name: Ste+% lr Phone:
Mailing Address: _ /Q o QOX G !ly L
Physical Address:
Facility Contact: Pam% SM'A Title: Phone No:
i
Onsite Representative: . St,,, Integrator: CGrra /S
Certified Operator. Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = o [ & [ dg Longitude: ❑ o = ( = «
Swine
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
h ❑ Layer
❑ Non -Lave!
❑ Wean to Finis
❑ Wean to Feed
[Rfeeder to Finish
p
SOoO
El Farrow to Wean
El Farrow to Feeder
El Farrow to Finish
El Gilts
❑ Boars
Other
❑ Other
Dry Poultry
ElLayers
ElNon-Layers
El Pullets
ElTurkevs
[EllTurke Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: El Structure [I Application Field ❑ Other
a. Was the conveyance man-made'?
Design Current
Cattle Capacity Population
ElDai Cow
El Dairy Calf
El Dairy Heifer
El Dry Cow
ElNon-Dai
El Beef Stocket
El Beef Feeder
❑ Beef Brood Cow
Number of Structures:
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes. notify DWQ)
2. Is there evidence of a past discharge from any pan 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 Ej<o ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
[ ' o
❑ NA
❑ NE
❑ Yes
51"'No
❑ NA
❑ NE
12128104 Continued

Facility Number: ;Z — Date of Inspection G®
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier: i
Spillway?:
Designed Freeboard (in): ! j'
Observed Freeboard (in):
❑ Yes C11110 ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
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 ❑<o ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes 9-!Ro ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
D'&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
2 No
❑ NA ❑ NE
maintenance or improvement?
Waste Apolication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
2'fqo
❑ NA ❑ NE
maintenance/improvement?
l I. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
[ o
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ FaiIure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drill ❑ Application Outside of Area
12. Croptype(s) Pr'MUdri__ __._ .S0"9k l,.,.,Te.,p
13. Soil type(s) AV CA 14
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
Q Ko
ElNA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes
[q<
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination%❑ Yes
❑ No
❑ NA ❑XE
17. Does the facility lack adequate acreage for land application? ❑ Yes
❑ No
❑ NA 9'IqE
18. Is there a lack of properly operating waste application equipment? ❑ Yes
21 o
❑ NA ❑ NE
#} Eiiplaut'any YES.,
ttereicplain situations.
Ole edse- InenJor 4-1el rBlOp,fr loPre a/<4s Grob.Yt+i //Y OJ 7 bS /f CCllxw yr .7" r/ J
9raJJ cover / 1oi-✓e^A [Iecr`Il
/►1 ". Sw1,`A P /ails d 51p rar
t-6r AP' Cs.,A- wt S
Reviewer/Inspector Name Phone: 7a -IgiC ISLfl
Reviewer/Inspector Signature: Date:
12128104 Continued
L

Facility Number: 6, t — Y Date of Inspection ®O
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes Elilo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes E- No ❑ NA ❑ NE
the appropirate box. ❑ vn, ❑ Csts ❑ ❑ ❑ Othef
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes B-KO ❑ NA ❑ NE
❑ AfnccftSm ❑ ❑ ? a / oi__ Ejs@4A afysis ❑ rr af-nar f, ❑ n
mil' 04sl❑-e+d ❑ ❑ ❑-e,
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
/ 7.9-
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
A dd>ihciial Commentsand/or Drav6uigs:.'
rn }dal► s P1e ,e o- 3 y-9
n
❑ Yes
[-KO
❑ NA
❑ NE
❑ Yes
[qNo
❑ NA
❑ NE
❑ Yes
5;,Ko
❑ NA
❑ NE
❑ Yes
Dl o
❑ NA
❑ NE
❑ Yes
E]dQo
❑ NA
❑ NE
❑ Yes
❑Xo
❑ NA
❑ NE
❑ Yes
2$Jo
❑ NA
❑ NE
❑ Yes
Zlo
❑ NA
❑ NE
❑ Yes
2No
❑ NA
❑ NE
❑ Yes
[ rNo
❑ NA
❑ NE
❑ Yes
[2No
❑ NA
❑ NE
❑ Yes
0'No
❑ NA
❑ NE
12128104

Type of Visit 0 Compliance Inspection 0 Operation Review 0 Lagoon Evaluation
Reason for Visit 40 Routine 0 Complaint 0 Follow up 0 Emergency Notification 0 Other ❑ Denied Access
Facilih. Number Date of Visit: Time:
ro
,,
?dot Operational Below Threshold
E3'Yermitted Certified 0 Conditionallly Certified ❑ Registered Date Last Operated or Above Threshold:
Farm !Name: _&r y S,.:11i_ Fc,, , Count-: DLO' i,—. Fl)0
Owner Name: T 7- Phone No: rf _ 3 3 3
Mailing Address: P. 0, d X I ,,4e IV ( 12
Facility Contact: to-Prr v It, rh Title: Phone No:
Onsite Representative: loer ;z Sj". 1, Integrator: Car.•..I S _
Certified Operator: goer Ir Y S;-, 411 _ Operator Certification Number: Aq 3 _
Location of Farm:
M-$wine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' w Longitude
Design Current
Swine Cnnarity Ponnlation
❑ W,ean to Feeder
[gle-ederto Finish 157&0
1 5-.1IG
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Design Current Design Current
Poultry Ca acit Population Cattle Capacity Population
❑ Laver ❑ Da'
❑Non -Laver ❑ Non -Dairy
❑ Other
Total Design Capacity
Total SSLW
Number of Lagoons _I 1 I ❑ Subsurface Drains Present ❑ Lagoon Area JE1 Spray Field Area
Holding Ponds / Solid Traps ❑ No Liquid Waste Management Svstetn
Discharges 8- Stream impacts
I _ Is anv discharge observed from any pan of the operation?
DischarL-e oricuinated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If dischar_e is observed, was the conveyance man-made?
b. lfdischarze is observed, did it reach Water of the State? (If yes, notifi- DWQ)
c. If discharge is observed, what is the estimated flow in eat/min?
d. Does discharge btipass a lagoon system? (If yes. notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
i
Freeboard (inches): 3 '
05103101
❑ Yes io
❑ Yes 0 N o
❑ Yes 0'N o
❑ Yes 0 c,
❑ Yes ©'No
❑ Yes UNo
❑ Yes [a'f o
Structure 6
Continued

Facility Number: g,; — y
Date of Inspection r O
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes U-N-0,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑ Yes l N-6
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ) , ,
7. Do any of the structures need maintenance/improvement? ❑ Yes iI"tvo
8. Does any part of the waste management system other than waste structures require maintenancelmprovement? ❑ Yes ETKo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes ETN-
elevation markings?
Waste ARplication
10. Are there any buffers that need maintenance/improvement? ❑ Yes GNo-
I 1. Is there evidence of over application? If yes, check the appropriate boa below. [--]Yes ONO
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type 111,M✓du ra(s , SmA II a ra "irl
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes El-wo
14. a) Does the facility lack adequate acreage for land application? ❑ Yes -
b) Does the facility need a wettable acre determination? ❑ Yes M-No
c) This facility is pended for a wettable acre determination? ❑ Yes 9-90
15. Does the receiving crop need improvement? ❑ Yes 0' 0
16. Is there a lack of adequate waste application equipment? ❑ Yes E RK'--
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes B-Ko
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes U-Ko
roads, building structure, and/or public property)
20_ At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional ❑ Yes 0-No
Air Quality representative immediately.
=.CammenLs (safer to questson lI) F.zplata any YF.S aaswe s aad/or precomnueadations or:any othei comments: = , r =
_Use drawrngs of faciLty to better explaw s tnatrons. {use additlarial pages as necessary} ' [ .Fit<ld COPY ❑Final Notes
A.
e
h
RevEewer/Inspactor Name`Q
ReviewerAnspector Signature: % Date: 7 + 0
r 7mm ?

)Facility Number: g — Date of Inspection
Required Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
EP<o_r
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ dmeklists, desit<miafps, etc.)
❑ Yes
M—Ko
23. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
E'o
❑ "Wan ❑ FFeebeanl- ❑ VhwW-An*sis ❑-S piing--
,-ad-0it-7 -)- /& - 04/ 77. 3 &- I-_-? IY9
24_ Is facility
❑ Yes
044-o
wi
not in compliance any applicable setback criteria in effect at the time of design?
25. Did the facility fail to have a actively certified operator in charge?
❑ Yes
C3-Id'6
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
Yes
O mo
(iel discharge, freeboard problems, over application)
❑
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
❑-NO,
28. Does facility require a follow-up visit by same agency?
❑ Yes
❑ No
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
Mw6
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
es
❑ No
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
pqNtr
32. Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ wo
33. Did the facility fail to conduct an annual sludge survey?
❑ Yes
9-Ko
34_ Did the facility fail to calibrate waste application equipment?
❑ Yes
Q-No
35. Does record keeping for NPDES required farms need improvement? If yes, check the appropriate box below.
❑ Yes
EWo
❑•Steelting-l~orm ❑ Cfog-Yield Fars„ ❑ Rain all- ❑ Inspee ion A er4"--Rain
❑ s ❑ ation Ferro
113 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
12112103

Site Requires Immediate Attention:
Facility No. 8 2- - ` J3
82,- "[8
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: _5 k -2-5 , 1995
Time: l O : o z
Farm Name/Owner: PP ga
Mailing Address: -Lf Ct-3 _ -
County: !S
Integrator: C.n f-czo Phone: t O S- o Lt t
On Site Representative: Phone: Q k o - S -- B —j-_
Physical Address/Location: _ S c' a 1 on
e
Type of Operation: Swine Poultry Cattle
Design Capacity: s 6- 0 Number of Animals on Site: 5 o
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: 0 Longitude: "
Circle Yes or No
Does the Animal Waste Lagoon hFaU
e sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches) es r No Freeboard: Z Ft. Co Inches
Was any seepage observed from the n{s}? Yes or oas any erosion obWj. ed? Yes No
Is adequate land available for spray? Ye r No Is the cover crop adequate? Yes r No
Crop(s) being utilized: - -a c r
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwell' Yes r No
100 Feet from Wells? Y or o
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes o No
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue ine: Yes o No
Is animal waste discharged into water of hce state by man-made ditch, flushing system, or other
similar man-made devices? Yes or o If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? Y or No
Additional Comments: yy
q_?_ Ie_ r r,, S
Z-
M.c.t-,
Inspector Name
Signature
cc: Facility Assessment Unit Use Attachments if Needed.

WORTH CAROLINA DEPfuRMEMT OF ENVMO.ITt=', BF-AL:'E & NATURAL AF$0UnCE5
DIVISION OF EWi;O&W-E-r L MJLNA=
Fayetteville Reg_cnal Office
Animal operation Cozpliarxe Inspectics.-i For
yFAR1Y H ►1Sf i fR,- . -
-ILZ14AS
=-IfiI5PEG3'IQN DE'*S << IFAcZY eLI
PAY m cry
.' • 2SxI3.I.*iC 1DDR. SS '4i's e. -
".' `• FACILITY".XMIZ7 Yt7Pffi riDNS. .. Fes':>•;_:..-. _.,
PA cxc 6 R ,C 9 e 9Z -- St. 7 z
A1? . questions answered negatively will be discussed in Sufficiesit 2eta4I in
the Comments Section to enable the deemed Permittee to perform the approp=late
corrections:
. CTION 3:
&mmnal_Omeration Tyne:
Hoses, cattle, swine, poultry, or sheep
SECTION 11
M I N I COMMENT S
1 . Dces the nuaber and type of animal meet or exceed
the (.0217) criteria? (Cattle (100 head),
horses (75), swine (250), sheep 0 ,000), and
poultry (30,000 birds with liquid waste
system)] •
2. Does this facility meet criteria for
Animal. [operation REGISTRATIG i?
3. Are animals confined red or maintained
in this facility for a 12-manth period?
4. Does this facility have a ANIiAL
WASTE KAMG72U:NT PLAN?
5. Does this facility maintain Waste management
records (Volumes of manura, lard applied,
spray irrigated an specific acreage With
specific cover czog)?
6. Does this facility meet the SCS minzmum
setback criteria for neig!Lbcring houses,
Wells, et--?

Y I N I C0Y_W__3v :'S
Field Site
1. Is aninal waste stockpiled or lagoon
costrzctian witakn 100 ft. A a IISGS
Map Blue Line Stream?
2. Is animal waste land ayplied or spray
irrigated within 25 ft. of a QSGS Man
Blue Line Stress?
3. Does this facility have adequate acreage
an whir—h to apply the waste?
4. Does the land applicat_on'sits have a
cover i=rcp in accordance With the
CMTIPICATION PI.Aii?
S. Is animal waste discharged into waters of
the state by ma« -made ditch, flushing systen,
or other sizmilar man-made devices?
6. Does the animal waste management at this
fa: adhere to Best Management Practical
WP) of the approved C Tr*It' 'IOct?
7. Does animal waste lagoon have sufficient
freeboard? How much? (Approximately )
S. Is the general condition of this WO facility,
including management and operation,
satisfactory?
SECTION IV

map