820049_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental Qua

IN
j - iv'ision of Water Resources
Facility Number ®- ® ©Division of Soil and Water Conservation
Other Agency
Type of Visit: ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 01fo-utine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: '/ Departure Time: ! County Region:
FarmName: p� r1 l+ , { 4 j w ; Yt� 1�4 rn L+'�- Owner Email:
Owner Name:a, G��d Z�- rS Phone:
Mailing Address:
Physical Address:
Facility Contact: iT� �0 6��d� oaS Title: 6pe� n Phone:
Onsite Representative: �'Gr�r Integrator:
Certified Operator: Certification Number: /g %
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Swine
Wean to Finish
Design Current
Capacity Pop.
Wet Poultry
Layer
Design
Capacity
Current
Pop.
Design Current
Cattle Capacity Pop.
lDairy Cow
Wean to Feeder
S
I INon-Layer
D . P,oul
La ers
I
Design
Ga sci
Current
$o
Dairy Calf
Dairy Heifer
y Cow
Dr
Non -Dairy
Beef Stocker
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
I 113eef Brood Cow
Turkeys
Other TurkeyPoults
Other Other
Discharees and Stream Imoacts
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 KNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
[:]Yes
D No
❑ NA
❑ NE
Page I of 3 21412015 Continued

Facili Number: Date of Ins ection:
Waste Collection & Treatment
y 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [ZrNo ❑ 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): Cr
Observed Freeboard (in): I_
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? �'
Irany 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 allo ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes (a 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 [a No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
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 �2t No ❑ NA
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc_)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area ,
12. Crop Type(s):
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 facility 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 No ❑ NA
[::]Yes No ❑ NA
❑ Yes
(71 No
❑ NA
❑ Yes
list No
❑ NA
❑ Yes
No
❑ NA
❑ Yes RNo ❑ NA
[:]Yes [ONo ❑ NA
❑ 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 P No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes [FINo
❑ NE
❑ NE
❑ NE
❑ NE
❑ NE
❑ NE
❑ NE
❑ NE
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412015 Continued

t.
FaciliNumber: Date of Inspection: i -11
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 Cg-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 MNo
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ,Q 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 GAWMP?
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes S No ❑ NA ❑ NE
[]Yes C2�No ❑ NA ❑ NE
❑ Yes 'KNo ❑ NA ❑ NE
[]Yes allo ❑ NA ❑ NE
[:]Yes �No
❑ Yes No
[:]Yes �No
❑ NA ❑ NE
❑NA ❑NE
❑NA ❑NE
f
- 4
;rs . .:� al=reconimendations or:anysother codtmen�ts.
omments re er to question Exp 9atn any: YE8 answers -an addibttn
Use drawurgs�at'facd,ty Jus addihonal�pages.as,necessary).
Reviewer/Inspector Name: Phone: o J 0 a
Reviewer/Inspector Signature: Date:
Page 3 of 3 21412015

' i�i"sion of Water Resources
Facility Number ��— - y 9- O Division of Soil and Water Conservation
O+ Other Agency
F
peofVisit: ompliance inspection Operation Review O Structure Evaluation O Technical Assistanceason for Visit: 0 utine O Complaint O Follow-up Q Referral O Emergency O Other O Denied Access
Date of Visit: /—� Arrival Time: ! Departure Time: ; County: Region: FJZ'o
Farm Name: j J `,-,_ c �t rrrt Owner Email:
Owner Name: Q �;d �,� Phone:
Mailing Address:
Physical Address:
Facility Contact:Gfid CT+��-S Title:Phone:
Onsite Representative: Integrator:,; jy„�y�o,41 2l7t
Certified Operator: �_ Certification Number: /
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design Current
Design
Current
Design
Current
Swine
ap11acity Pop.
Wet Poultry
Capacity
Pop.
CattleMCIapacity
Pop.
Wean to Finish
I
ILayer
IDairy
Cow
Dairy Calf
Wean to Feeder
I jNon-Uyer I
Feeder to Finish ,60
Daig Heifer
Farrow to Wean
Design Current
Dry Cow
Farrow to Feeder
Dir-yjRoult .
Ca aci
P,o
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Beef Feeder
Gilts
Non -Layers
Boars
Pullets
Turkeys
Beef Brood Cow
Other
Turkey Poults
El Other
L
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)? T
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 Ea No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No
[:)Yes [9.No
❑ Yes [jNo
❑ NA [] NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3
21412014 Continued

Facifi Number: - Date of Inspection:
Waste Collection & Treatment
' 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
fallo
❑ 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): _ Z 91
Observed Freeboard (in): -_3 1
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
JR 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
C&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
[3 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
WNo
❑ 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 CE No ❑ NA ❑ NE
0 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): t�Orrt /1���.✓ �i�f r—v--S /�r/�to� �PfG�cl_5'��/ %�c�•
13. Soil Type(s): Zjr
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
B No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
O 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?
❑ Yes
® No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[g No
❑ NA
❑ NE
Reauired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[g 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 [A No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and l" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? [:]Yes EINo ❑ 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

'FacilityNumber: Date of Inspection.
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes f, No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [:]Yes EZ 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 Ez No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ® No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes ® No ❑ NA [] NE
❑ Yes Eg No ❑ NA ❑ NE
❑ Yes L21-No ❑ NA ❑ NE
❑ Yes No
❑ Yes ® No
[—]Yes E�J_No
❑ NA ❑ NE
❑ NA ❑ NE
[DNA ❑ NE
Phone:: y3��
Date:
21412014

Type of Visit: eTom nee Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: Moutine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: L/2-3-IXT Arrival Time: , D v Departure Time: County
Farm Name_/ 06, rt, 14 d '5 w ig -e ,{��G. _ Owner Email:
Owner Name: C-D L (�iz'le-, & ,�d�tti� _ Phone:
Mailing Address:
Physical Address:
Region: /�O
Facility Contact: � �.� e:;�,dj e,.,s Title: f?YPhone:
Onsite. Representative: S - Integrator: /IV
Certified Operator: Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Swine
De�s_ign'- Current
Capacity Po
Design Current
et Poultry Capacity Pop.
Cattle
Design Current
Capacity Pop.
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Layer
Dai Cow
Non -La er
Da' Calf
Dai Heifer
D Cow
_j- p
t�D
D , POnI , s
La ers
-
Design Current
Ca aci P,o .
Non-Dairy
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Turkeys
Turkey Poults
Other
Beef Brood Cow
Other
Other
t -
......... :.
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other: _
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes ® No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
[] NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
[:]Yes
[M-No
❑ NA
❑ NE
❑ Yes
[g No
❑ NA
❑ NE
Page l of 3
214120I4 Continued

Facility Number: jDate of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
[0 No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
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
[E 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
[g 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
[allo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
C2.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): CE3ray f {j � �� �v++ s _ f/ti.� �07 vr�srid /
s5e.rc7
7Uf
-ter
13. Soil Type(s): ,�yy%�>'r ��/•�S�—�l TD�f�
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[E�No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
fallo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
[allo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes [.No ❑ NA 0 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 [SNo ❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists [:3 Design ❑ Maps [:]Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 6�_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 Fq No
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes allo
❑NA ONE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facili Number: JDate of Inspection: 3 y
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ® No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes 10 No [] NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes C3 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
� No
❑ NA
❑ NE
and report mortality rates that were higher than normal?
29, At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
® No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
No
❑ 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
Callo
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[2 No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
E4No
❑ NA
0 NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
j�o
❑ NA
❑ NE
Comments (refer to;_question ft Expllain any YES answers and/ouany additional recommendations or?any other comments "
Use drawings of facility to better explain situations {use addltional pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date: /,; — 3 0�
21412014

(Type of Visit: ®'tom ance Inspection O Operation Review O Structure Evaluation O Technical Assistance j
Reason for Visit: Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access I
Date of Visit: I / —/ —Jq I Arrival Time: l�J Departure Time: County: Region: E
Farm Name: QS t vL. 14 i a~ ( Fxlm !r e-• Owner Email:
Owner Name:, L Phone:
Mailing Address:
Physical Address:
Facility Contact: �GZ�r e'nS Title: Phone:
Onsite Representative: Integrator:
Certified Operator: Certification Number:jg�(o1�
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
- - sign Current Design Current
Swine Capacity Pop. Wet Poultry Capacity Pop.
Design Current
Cattle Capacity Pop.
Wean to Finish
La er
Dairy Cow
Wean to Feeder
-Layer
Design Current
D . 1'onl Ca aei P,o P.
ILayers
Dairy Calf
Feeder to Finish
Farrow to Wean
Farrow to Feeder
DaiEX Heifer
Da Cow
Non -Dairy
Farrow to Finish
Beef Stocker
Beef Feeder
Beef Brood Cow
Gilts
Non -La ers
Boars
Pullets
Turke s
Other = Turkey Poults
Other Other
.
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
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 471 No ❑ NA ❑ NE
[:]Yes
[:]No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
[:]Yes
[:]No
❑ NA
❑ NE
❑ Yes
KC No
❑ NA
❑ NE
❑ Yes
F2 No
❑ NA
❑ NE
Page 1 of 3 21412014 Continued

Facifi Number: - 4 jDate of Ins ection: / - -
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure i- Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Spillway?:
Designed Freeboard (in): % 4
Observed Freeboard (in): 33 _
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
C3.No ❑ NA ❑ NE
❑ No ❑ NA ❑ NE
Structure 6
❑ Yes ® No ❑ NA ❑ NE
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
5g 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
0 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
F&I 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 IR No [DNA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc_)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): G{ J , rI1
13. Soil Type(s): l t �z i IIr �;L�-�G'" I AlDrADItc-
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
XNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
®. No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
CZ No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
RNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
CE�No
❑ NA
❑ NE
_Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
L&No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check
❑ Yes
CE�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 jg-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 XfNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 5a No ❑ NA ❑ NE
Page 2 of 3 21412014 Continued

• FF—acility Number: JDate of inspection: —
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
CgL 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
E: No ❑ 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
No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
No ❑ 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
Q Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
L& No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
E0 No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
OC No ❑ NA ❑ NE
Comments (refer to question.#): Explain any YES answers. andloryany additional recommendations ar;any other comments
Use°drawings of facility to better explain situations (use addthoaal pages as necessary AVOW �# .
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: p— 33cp
Date: ` —/ p�fl /L
21412014

Jus 6 1 W I(US/ )ObJI13
i ype or visa: W Uompuance inspection V Vperation Review U Ntructure Evaluation V Technical Assistance I
Reason for Visit: ® Routine 0 Complaint 0 Follow-up O Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: [ 3 Arrival Time: Departure Time: ]�Dp !Q County:
Farm Name: R05�1
r l Fa/XSr,G Owner Email:
Owner Name: Phi We LAO fiLdsoo Phone:
Mailing Address:
Region: ' ^4_
Physical Address: w4 Pony Ni M W42, 6l0ve_
Facility Contact: �Q(� b �pri�d�l� Title: Holwjd Ar Phone:
Onsite Representative: ke— Integrator: `
Certified Operator: .70tob ins Certification Number: (aa
Back-up Operator: phliilP ffV�S&7 Certification Number: Wgo/t
Location of Farm:
Latitude:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Current
Wet Poultry Capacity Pop.
La er
Design Current
Cattle Capacity Pop.
Dai Cow
Wean to Feeder
EEDesign
Non -La er
Dai Calf
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
D . P.oult , Ca aci P,o ,
Layers
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Gilts
Non -Layers
Boars
Pullets
Beef Brood Cow
Other
Other
Turke s
Turkey Poults
Other
_D_ischar2es and Stream Imnacts
1. Is any discharge observed from any part of the operation?
❑ Yes
No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does 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?
0 Yes
® No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
[] Yes
R] No
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

99 (")
Facili Number: - I Date of Inspection: j 3
Waste Collection & Treatment Rlsln W I I
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes N No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ 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 5a 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 P 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 to No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes fp No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes 15a 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): Cpai'm 1 0604AL %yg6tair_ Small Qrokl : CiVA. lVhtt?f
OJ& . TrVCr Ctq�1
13. Soil Type(s):
4
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ® No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes No ❑ NA ❑ NE
acres determination?
IT Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Renuired Records & Documents
[:]Yes U-No ❑ NA ❑ NE
[:]Yes 0 No ❑ NA ❑ NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
5 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.
JK] Yes
❑ No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall [:]Stocking ® Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
8 No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
® NA
❑ NE
Page 2 of 3 21412011 Continued

Facili Number: Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes (a No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes 2 No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes fK 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
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:
❑ Yes n No ❑ NA ❑ NE
❑ Yes 15? No ❑ NA ❑ NE
❑ Yes C�j No ❑ NA ❑ NE
❑ Yes U No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
53 No
❑ NA
ONE
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative? ❑ Yes
0 No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes
2 No
❑ NA
❑ NE
01, plea, 'P_ fort Goe l t e Id_
1, Excellett la can Cover'
c000 -GvoI, -RM.4 reeds,
Reviewer/Inspector Name:
Reviewer/inspector Signature:
Page 3 of 3
9 — M'4 `
- -
Phone: %-4 ►�i-3.3 do (OTC-0
Date: �G+ !�' Do 1,3
21412011

Facility No. _Farm Name R03L4 itrl] Date 101 E5-I t3
Permit _ / COC ­1 OIC NPDES (Rain breaker PLAT
r•tr• we:+�
Annual Cert Daily Pipe)
Lagoon Name, S forspillway
1
2
3
4
5
6
7
Design Freeboard / Last Recorded in
Observed freeboard
Sludge Survey Date
Sludge Depth ft
Liquid Trt. Zone ft
3.
Ratio Sludge to Treatment Volume if> 0.45
,
Date out of compliance/ POA?
—Actual 11(arn.
Soil Test Date j
pH Fields
Lime Needed Z
Lime Applied
Cu-I ✓Zn-I ✓
Needs S (57<25) kO
Crop Yield
Wettable Acres
WUP
Weekly Freeboard
1 in Inspections
120 min Insp-_
- ..-
0_0 n Ent M��
oil
Transfer Sheets
N GAUGE
ea x or incinerator ✓
rtality or
Check Lists
Storm Water
mom..
..
601,
MTVter:
idolTI�
It ME MOA-
RM
r1
WA 0 / l
i. 1Mi.
/
Mf(I�fi i31- I(oS' �i{�t3,hu: �D�, Mille�u�a�7
Verify PHONE MBIRS And affiliations
Date last WUP FRO II Qefcp? FRO or Farm Records
Date last WUP at farm Lagoon # 5�
App. Hardware Top Dike
Stop Pump,
Start Pump 5s
Conversion- Cu-1 3000= 108 lb/ac; Zn-I 3000= 213 lb/ac
UcmeiM 0 tr&WICp 11W4
aw
(- �i�P

76 Dik5 grlj j I­�.
Type of Visit: 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: IgRoutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Q; Departure Time: r County:.
Farm Name: 1r rr\ I �. �1byi [. C� Owner Email:
Owner Name: fl .I to [p, NAal Phone:
Mailing Address:
Region: _fM�
Physical Address: W L( Pot'k kla,4o., Gips _
Facility Contact: T DCOb (o iQ�L�f�tS Title: Hh04 ff' Phone:
Onsite Representative: (� Integrator:
Certified Operator: V d a-D b idd-A C Certification Number:
Sack -up Operator: K 191'a RVd S0/1 Certification Number: q Kr O f f
Location of Farm:
Latitude:
Longitude:
Design Cprrent$$s
Swine Capacity
Wean to Finish
Design Current
�Wet Poultry Capacity Pop.
:.
Design Current
Cattle Capacity Pop.
Layer
Dairy Cow
Dairy Calf
DairyHeifer
D Cow
Wean to Feeder
Feeder to Finish
Farrow to Weanj
".
Non -La er
., Design Current
D , P,oult . Ea aci P,o P.
Farrow to Feeder
Farrow to Finish
Non -Dairy
Beef Stocker
Layers
Non -La ers
Gilts
Beef Feeder
Boars
Pullets
Beef Brood Cow
other
Other
Turke s
Turkey Pouets
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
CR No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
[g No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
Ef No
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

Facility Number: - 14 jDate of Ins ection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
rV( 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
C37No
❑ 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
(n'No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[3No
❑ 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
[�7No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
C'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 D PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable ❑ Evidence ofi Wind Drift ❑ Application
Outside of Approved Area
4Croo�p�Windoow
12. Crop Type(s): Q2 4 1i7i1�7c�±�-- 6/01,P� `SMill't 7/010' 0-JAf�
- —
r
13. Soil Type(s): &Aryyi I�� . p6i-bi kbr(�� 11
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
NNo
❑ 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 No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
allo
❑ 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
[Z No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
2 No
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [5�No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall C] Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I " 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 ❑ No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
[`NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: jDate of Ins ection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes &No [] NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes U No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
24. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
to question ft Explain any YES answers and/or any
[Use drawings of facility to better explain situations (use additional pages as necessary).
❑ Yes
allo
❑ NA
❑ NE
❑ Yes
❑ No
J}NA
❑ NE
❑ Yes
PINo
❑ NA
❑ NE
❑ Yes B No ❑ NA ❑ NE
❑ Yes M-No ❑ NA ❑ NE
Ldo
❑ Yes §a -No ❑ NA ❑ NE
❑ Yes No
❑ Yes No
❑ Yes No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
or any other comments.
as. Sj1j* rai p s cr+ �1 g(o , VV i [ Mfed, � c%lo-4- h Hh►1q a rears of ,f h`
sd'fo .
7,Gaa-r�90hCovel-
fim ff,,M i/laied- cAoc YVH_� TfffL_ 0 (vt✓
ICoa--Colm, -q,e(4 Ad �-em _r,
Reviewer/Inspector Name: ti _ �r the -ei
Reviewer/Inspector Signature:
Page 3 of 3
Phone: qlQ-433-33M [IIfT7tt)
Date: o�
21412011

17
Facility No. qD`4!q--� �_-Farm Name I /� Date ' i Permit v COC OIC� NPDES (Rainbreaker PLAT Annual Cert Daily Pipe)
uri►ulrsliil ��E'611�---------
i� r 1P1�---_---_--
Lagoon Name, S forspillway
1
12
3
4
5
6
7
Design Freeboard 1 Last Recorded in
Observed freeboard
Sludge Survey Date
Sludge Depth ft
3rS
Liquid Trt. Zone ft
3,
Ratio Sludge to Treatment Volume if> 0.45
Date out of compliance/ POA?
Purh-.
Calibration Date
Soil Test Date ��� f Crop Yield Transfer Sheets n ��
pH Fields Wettable Acres ✓ RAIN GAUGE
Lime Needed WUP ✓ Dead box or incinerator
Lime Applied Weekly Freeboard 'C Mortality Records
Cu-I ✓ Zn 1 in Inspections _�� Check Lists
Needs S (S-1<25) `t`t edS 120 min Insp. —� Storm Water
NPPf{C P J'El n Wanfhor r'nrlac
Soil Test Date ��� f Crop Yield Transfer Sheets n ��
pH Fields Wettable Acres ✓ RAIN GAUGE
Lime Needed WUP ✓ Dead box or incinerator
Lime Applied Weekly Freeboard 'C Mortality Records
Cu-I ✓ Zn 1 in Inspections _�� Check Lists
Needs S (S-1<25) `t`t edS 120 min Insp. —� Storm Water
NPPf{C P J'El n Wanfhor r'nrlac
..ON74
tiI
MA
Me
/.I i
Verify PHONE NUMBERS and affiliations
Date last WUP FROG FRO or Farm Records
Date last WUP at farm Lagoon #
App. Hardware Top Dike
Stop Pump
Start Pump
�vrr1�4� ��OU `F6! `�`'�C(0�fJSO���I ��9� �• �1
Su
Conversion- Cu-I 3000= 108 lblac; Zn-1 3000= 213 Iblac

1. :
_ DIMS Uv1 K 111111
x''A allivision of Water Quality -
)Facility Number �a, - ® ® Divisionof Soil and Water Conservation
- ®tither Agency
Type of Visit: Q Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 0 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: LI[J Arrival Time: Departure Time: ; 0 County:�C(
Farm Name:hill Owner Email:
Owner Name: Le Phone:
Mailing Address:
Region: I O O /�
Physical Address: f ►*11(grove—
Facility
Contact: [��J �r Title: Phone:
Onsite Representative: J 2(�b �p lXto j _ _ Integrator: 1 _ B
Certified Operator: p b dfar _ Certification Number: $$� 1a
Back-up Operator: ' 't t 0 r v (jam Certification Number: q� 1
Location of Farm: Latitude: Longitude:
Design Current
Design Current
Current
DesignIn
Swine Capacity Pop.
Wet Poultry Capacity Pop.
Cattle C*apacity Pop.
Wean to Finish
airy Cow
Dairy Calf
Dairy Heifer
Wean to Feeder
Non -La er
Feeder to Finish
a
Farrow to Wean
Design: Current
D Cow
Farrow to Feeder
Dry P,oult'.
Ca' -a_ci P,o ,
Non-Dai
Beef Stocker
Farrow to Finish
Layers
Gilts
Non -La ers
Beef Feeder
Beef Brood Cow
Boars
Pullets
Turkeys
Other
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other.
❑ Yes ® No ❑ NA ❑ NE
a. Was the conveyance man-made? ❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWQ) ❑ Yes ❑ No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (if yes, notify DWQ) ❑ Yes ❑ No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes ® No ❑ NA ❑ NE
of the State other than from a discharge'?
Page I of 3 21412011 Continued

Facili ; Number: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus stone 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): 19
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
0 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
5j 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
P No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
f5a No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
E] No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
'R No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
[R No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate
Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops diNer 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 facility 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
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes Rj No ❑ NA ❑ NE
❑ Yes JK] No ❑ NA ❑ NE
❑ Yes �g No ❑ NA ❑ NE
[:]Yes S No ❑ NA ❑ NE
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ZFYes ❑ 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 0 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
aNA ❑ NE
Page 2 of 3 21412011 Continued

Facili Number: - pate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes g] No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes Gj No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, aver -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below_
Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes
'® No
❑ NA
❑ NE
❑ Yes
❑ No
NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes '®No ❑NA ❑NE
❑ Yes & No ❑ NA ❑ NE
❑ Yes IR No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
® No
❑ NA
❑ NE
33. Did the ReviewerA n spector fail to discuss review/inspection with an on -site representative? ❑ Yes
" No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes
® No
❑ NA
❑ NE
_ y 'a
( 9 ) P Y y_ . n _ omments.
lUii'drit�Vinksl-orfacilio,to better ex'viam,situahons.(ose additional:nat'es as neeessan) ::--. ans or an other c
omments re er to question Ex Iatn an YES.a€tsvrers;and/or;an addthonaltrecotnimez<da
pte,�e Vi Cali hva dk -�r� t° of I q? � �� iMead Cf- a©s-
bat �j w&,P-. SWf_ okof 0,
il 'Im roved JAL
V well maHvj `Pm, qqd- ©d— recadf,
N mt rh s ra rr � s r'ACe- lar�-� I dve -o o 11111
41 ► nn��tiye S • ,I��, .
Reviewer/inspector Name: &h i Phone: ta�j Ac)`e
Reviewer/Inspector Signature: Date: A�/,� p 0
Page 3 of 3 21412011

I
Facility No. Farm Name
Permit COC
OIC_ NPDES (Rainbreaker PLAT Annual Cert )
.M.WjMr,I1:lIr ��MIN
Lagoon
1
2
3
4
5
6
7
Spillway
Design freeboard
Observed freeboard in
Sludge Survey Date
1
Sludge Depth ft & %
Liquid Trt. Zone ft
3,
q3
ign
DesActual
Hit
Flow
Design Width
Actual
a_s_
-----
""-vs� aor oI (Pp- a
Soil Test Date i0 l t J Crop Yield 120 min Inspections
pH Fields p''��,.�: Wettable Acres Weather Codes
Lime Needed `'� ��7=IkVUP ✓ Transfer Sheets
Lime Applied Weekly Freeboard ✓ "db
GE
Cu Rainfall >1" �� or incinerator
Needs P VQ 1 i Inspections 1
W Mee Go 1 l� la- a I WN—Wok4p SPawA- -�sT7 &;,"in Pd
Waste Analys s Dat-
all.
. 000 _
..
..
103
monA
l,�,J
�. , :
► ,�QQ�i
. ,
Iwo
M�
FK�
Verify PHONE NUMBERS and affiliations
Date last WUP FRO Date last WUP at farm
FRO or Farm Records
Lagoon #
Top Dike
Stop Pump
Start Pump
1
App. Hardware

'sdrnrnf-40"Ifill
Wt*
Igo+
cd6b l '�c
Cur
fq���
T(in�
et-9
o fejk -
�co_��-
r -�let
d
130
7Y � A�
$1 _ aoC SAr
ao
�0 fbS
wz� I Fy
Ary ]0�
No )H�

6fN5 zvs 100-11c'o
Division of Water Quality
=acifitymber y Q 0 Division of SjilffiEffionservationA
Type of Visit
Compliance Inspection
0 Operation Review 0 Structure Evaluation
0 Technical Assistance
Reason for Visit
Routine 0 Complaint
0 Follow up 0 Referral 0 Emergency
0 Other ❑ Denied Access
Date of Visit: � �Arrival Time: 11, 30 Pil I Departure Time: -�.#ir County: _5041 eSL'h Region: ER40
�}
Farm Name: F 0Sin T111 TOMS _ Owner Email:
Owner Name: N l y Phone:
Mailing Address:
Physical Address:
Facility Contact: �� C(� �7 �[�► j Title: � fJ- Phone No: c�J�
Onsite Representative: (,�I/i i im0lMQ CIO d ©AMO Integrator: ht-y
Certified Operator: _O'Co�a _ 1�� Uperator Certificatiou Number: gobla
,j
Back-up Operator: Nfi VuSQ'1 Back-up Certification Number: CN$(0<<
Location of Farm: Latitude: ° Longitude: ° u
WHIR
lation Wet Poultry
Capacity
Current Design
Population Cattle Capacity
Current
Population
❑ Wean to Finish
❑ Layer
F❑ Non -Layer
❑ DairyCow
❑ Wean to Feeder
❑ DairyCalf
eeder to Finish
❑ Farrow to Wean
Dry Poultry
❑ Layers
❑Non -La Non -Layers
El Pullets
❑ Turke s
❑Turke I'oults
❑Other
❑ DairyHeifer
❑ D Cow
❑Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl I
Number of Structures:
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made'?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes 5d No ❑ NA ❑ NE
El Yes
❑ No
❑ NA
❑ NE
El Yes
El No
[I NA
El NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
0 No
❑ NA
❑ NE
❑ Yes
[&No
' ❑ NA
❑ NE
Page I of 3 12128104 Continued

Facility Number: — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): y3
❑ Yes JR No ❑ NA ❑ NE
El Yes El No El NA El NE
Structure 5 Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 19 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 [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 ❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes [RNo ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes 19 No ❑ NA [I NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [kNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes V] 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 } L
El Outside of Acceptable Crop Window El Evidence of Wind Drift ❑ Application Outside of Area f'If 1� f1 S%pf 11
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
W No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
JE§ No
❑ NA
❑ NE
16_ Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
§a No
❑ 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
5allo
❑ NA
❑ NE
[Qra 348—f�Ss-1 (�
Reviewer/Inspector Name �CZ Cil Phone q10933-33V0X333-3
Reviiewer/Inspector Signature: •%&,"' >&A.nA t Date: (k�w- -a 0 [0
Page 2 of 3
I212RNJ4 C'nntisrrmd

Facility Number: — Date of Inspection ffim
Required Records & Documents
14. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 15JNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 5iNo ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design El Maps El Other
21. Does record keeping need improvement? 1f yes, check the appropriate box below. ❑ Yes IRNo ❑ 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 C&No ❑ NA ❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
RNA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
CKNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
29 No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
N"No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
RNA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
F�rNo
❑ NA
❑ NE
24.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
E: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
5kNo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
$'No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
C9No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
P No
❑ NA
❑ NE
-T V 1 & e_ wa k-on bat S f ab on b11(CSbr cmd Mdes I oee- Go 1(' S'i% 09>7 .
15, toy S�' -Q etds YY$e * d)ecked - sevi-e_ '1r1'QAur�^�
1,ewSjj s�✓e be6ae 4
Qs'?ea�e �d�
Oc
v - �i0
Y o� me. 1^afr o � 3'
UQaobcrddat ol_e=�owfldv"r �ns�e 'a�-fie booker ovt-
Cood record Ce-e I
s sl n a-b Went
�m ��e~ y
Page 3 of 3 12128104

Facility No. $a�`Farm Name
Permit ✓ COC
OIC
W / Date
NPDES (Rainbreaker PLAT Annual Cert )
i�
lQll�i
ml-I fi-
Cm"0
i� f►J i 9
Lagoon
1
2
3
4
5
6
7
Spillway
Design freeboard
Observed freeboard in
Sludge Survey Date
)Day
Sludge Depth ft
Liquid Trt. Zone ft
3
Ratio Sludge to Treatment Volume
0,�
-0t(b
Calibration Dalte—ME"s
Soil Test Date Ia " r� 4l' Y)? Wettable Acres ✓ SR UGEpH Fields 3pji WUP ✓ b or incineratorLime Neede V�t Weekly Freeboard ✓ ity Records
Lime Applied -ZD - 1 in Inspections
Cu-I ✓ Zn-1 -� �`� 120 min Insp. -�
Needs P Weather Codes —
Crop Yield
Waste Analysis Date-�':
Soil Test Date Ia " r� 4l' Y)? Wettable Acres ✓ SR UGEpH Fields 3pji WUP ✓ b or incineratorLime Neede V�t Weekly Freeboard ✓ ity Records
Lime Applied -ZD - 1 in Inspections
Cu-I ✓ Zn-1 -� �`� 120 min Insp. -�
Needs P Weather Codes —
Crop Yield
Waste Analysis Date-�':
NAmt(lb/100OGal),
Pull/Field-
AM
.. �+
fj
t�
•� J
w5tf 6 Pain CD�or) v'64
VW PHONE NUMBERS and affiliations D 105
Date last WUP FRO 11I((p J(� Date last WUP at farm 111)Ofo)
FRO or Farm Records
Lagoon #
Top Dike
Stop Pump
Start Pump
Conversion- Cu-1 3000= 108 Iblac; Zn-I 3000= 213 Iblac
Ap� Hardware ,
-e1d $'had ► �,, q lJ0 'Y/,y al l
lJu orsaI'ran
��,-Ap(
!ao
'A �`,p,�4� Sufis
tsum n-8��,1�
11 t� J/j Lly� 140
Ca c- /so
Ciw
9 `w SP
4� -gq /,/y
CE �co
Ed
-?s-

0 ( of '6 h l oq t) of
Type of Visit 'Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit's Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: RY ] Arrival Time: p Departure Time: County: Region: EM
Farm Name: Ralr w Owner Email:
Owner Name: Phi I r rf f2 LPro TT i 03 Phone:
Mailing Address:
Physical Address:
Facility Contact: �(Lcob _( I [ d &-- Title: /I i` Phone No: QQ, -1 St 7
Onsite Represent lve: J1'g b ro idd -ej 'M t-I Integrator: WV A� - )3/014r)
f/PW 1 O 9Q}Qr, S t3
Certified Operator: � - 0jaAI Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = = A =ds Longitude: = ° = 1 = w
Design
Swine Capacity
Current
Population Wet Poultry
Design
Capacity
Current
Population
Design GJurrent
Cattle Capacity Population
❑ Wean to Finish
❑ La er
❑ Dairy Cow
❑ Wean to Feeder
❑Non -La er
❑ Dairy Calf
Feeder to Finish
"
Dry Poultry
❑ Dairy Heifer
❑ Farrow to Wean
❑ Farrow to Feeder
El Dry Cow
ElNon-Dairy
El Farrow to Finish
El Layers
El Beef Stocker
❑Non -La Non -Layers
❑ Pullets
❑ Gilts
❑ Beef Feeder
❑ Boars
❑ Beef Brood Co
❑ Turkeys
Other
❑ Other j❑
Humber of Structures:
❑ Turkey Poults
Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
I'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
N No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
159"No
❑ NA
❑ NE
other than from a discharge?
12128104
Continued

. Facility Number:$ — Date of Inspection
Waste Collection & Treatment �T
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Stricture 2 Structure z Stricture 4
❑ Yes �kNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure i Structure G
Identifier:
Spillway?;
Designed Freeboard (in):
Observed Freeboard (iny
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
'R No
❑ NA ❑ NE
(iel large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
[5�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
❑ No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑Yes
-No
❑ NA El NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
4. Does any part of the waste management system other than the waste structures require
Yes
� No
El NA El NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
I'No
❑ NA ❑ NE
maintenance/imiirovement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
[5�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 W' d Drifl [:]Application Outside of
J�l
Area
12. crop type(s)� �r-e ' ' Coln " C
Sree
C 2barto
13. Soil types) A (A(x iyi l le
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
KNo
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination%❑
Yes
-jQ No
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
tKNo
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
VNo
❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/inspector Name v j u Phone 10 33-P
Reviewer/Inspector Signature: Date: 3
V 121281M Continued

I-�
FacilityNumber: Date of Inspection ' RM�N
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes RNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check []Yes RNo ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes t@ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I " Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge'? ❑ Yes N No ❑ NA ❑ NE
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? El Yes ❑ No [51'NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
GkNo
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
U No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
RNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
(RNA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
MNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
[RNo
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
RNo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
2 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
'gNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
VNo
❑ NA
❑ NE
Additional Comments and/or Drawings:.
7, t Y6e- Uvorkrr h"-Ffob 1n Iaiaa,, NI U. Veej -�ngO,sped (I mach , 80f #an /), / �
�
1 Flue ha►tr SwMCorr) 4`6? fo Oddt�L-bra �
Oo -b, . crops_
Z ieC4 n[ c -Fof'ki' a•, o I � c- d 0() ek, 01 e bi -6y d- Of s ft1bsoi Is,Par,
`l
a�. Reed bed re�&ek +oddy,
0q,all
Page 3 of 3
12128104

Facility No. `_ )-49 Farm Name
���
I
Date
Permit �� COC ✓
OIC-2p
�e1
PDESainbreaker PLAT Annual Cert }
Lagoon
1
2--T
3
4
5
6
7
Spillway
Design freeboard
Observed freeboard in
Sludge Survey Date
Sludge Depth ft & %
S
Liquid Trt. Zone ft
Q.1; Q.p _.-.x Ir
Calibration Date
1 jQ
2 v
4
5
6
7
8
Design Flow
a D
Actual Flow
Design Width
2 0 J
Actual Width
.)7 j
Soil Test Datep0)"�� rop Yield >�
pH Fields C4 ettable Acres
Lime Needed �i — O C(Iq acre WUP
Lime Applied Flo Weekly Freeboard
Cu ✓ Zn / Rainfall >1"
Needs P 0 1 in Inspections
120 min Inspections
Weather Codes
Transfer Sheets
RA1GAUGE
Dead x or incinerator'
..
..
0 am
mill
mop, IV,
►
F
,L[3
pia
�i
Verify PHONE NUMBERS and affiliations OWD, D5,5
Date last WUP FRO i I Date last WUPUL It�da! tJ)
FRO or Farm Records
Lagoon # QR
Top Dike�-
Stop Pump
Start Pump 51' (0(1 n0 �sj�QM
App. Hardware
§W e4�:\ (0-0
�Cp S'J�rA444D 10S
),�0

Nj b rMl ui13if Q - -
L\�
Type of Visit Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit WRoutine 0 Complaint 0 Follow up O Referral O Emergency 0 Other ❑ Denied Access
.r rr
Date of Visit:11 1 g Arrival Time: Departure Time: .�Q County: Region:_
Farm Name: Rahn A I l FOfm1 . Owner Email:
Owner Name: Ph t0 L 14vdj 12, Phone:
Mailing Address:
Physical Address:
Facility Contact: zm e0 G lddf , r Title: M CW e Phone No:
Onsite Representative: Integrator: Sm -
Certified Operator: �� T7LGC76s Operator Certification Number: l US�OI l
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: EJ o E=I ' = Longitude: = ° u
'17es►guCurrentDesrga
Current
Design Gnrrent
Swine Cap city Popula 'on
Wet Poultry
Capacity Papulitt_ion
Cattle Capacity Population
❑ an to Finish
❑ La er
❑Dai Cow
❑ an to Feeder
❑ Non -Layer
iry Calf
Feeder to Finish
tE.
❑ Dairy Heifer
❑ Farrow to Wean Dry Poultry
El D Cow
❑ Farrow to Feeder
- -
❑ Non -Dairy
ElLaers Farrow to Finish
❑
El Beef Stocker
❑ Gilts
on -Layers
❑Beef Feeder
❑ Boars
❑ Pullets
❑ Brood Co Beef
'
Ottie�
❑ Turkeys
❑ Turkey Pouets
„
❑ Other
JE1 Other
Number oftStruiitures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
�lo
❑ 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? (1f yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
Wo
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
6'No
❑ NA
❑ NE
other than from a discharge?
Page l of 3
12128104
Continued

Facility Number: a —
Date of Inspection "
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
Identifier:
❑ Yes JgNo Cl NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
Spillway?:
Designed Freeboard (in): 13
Observed Freeboard (in): 4
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
19 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
5ZNo
❑ 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?
IS Yes
❑ No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
Wo
❑ 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
(5No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
'M No
❑ 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 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑f Application Outside
of Area
12. Crop type(s) COdt"_A I term •fit i P) , '�; 6 ,0 & O f n IA rt711 ) I �Vn4i
mmn ij.
q
13. Soil type(s) Ay B i s ' B oB S ' W�A Is
_-
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
1.$3 No
❑ NA ❑ NE
t
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
1�1No
❑ 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
® No
❑ NA ❑ NE
18. Is there a lack of property operating waste application equipment?
❑ Yes
XNo
❑ NA ❑ NE
-aCxa - ..: a,�—.1�,r'::>sr i�!ti�u3;i.d
Comments (refer to,questton #) 'EYplatnFany YES'answe� ^{ u
rs and/ r.
�` -- ala a es as nmessaafions or any othereoniments.l�
Use drawtn s of facthty to better a plain sifua_#eons`y., (usetaddttton p g ry):�
A s --torsi 3�_.`,ii1�1t
Reviewer/Inspector Name S' E I Phone. 10 33-
Reviewer/Inspector Signature: Date: 7 aq
Page 2 of 3 v 12178104 Continued

Facility Number: $a — Date of Inspection f7 Wt 109
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes P No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ® No ❑ NA ❑ NE
the appropirate box.
❑ WUP El Checklists ❑Design ❑Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes (9 No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
159 No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
5d NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
1PNo
❑ NA
❑ NE
25_
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
R 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
N NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CA WMP?
❑ Yes
allo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
O 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
CRNo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
3 I.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
[3 No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
�1No
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
KNo
❑ NA
❑ NE
Additional Comments -and/or Drawings:
;
_�MV ft
�,Tns�de. I q� yoa, w41 is wee .smede(. - h s yri� bL4d 1 d �01 � jrow w,e11 ��-e'f� •
oar weatfiir&-, �P1�e k4eep hV+A ©n
,14, C0 bIA "h -00" 0 OM Cwr , r bit W/ck c o,+,�t� N n�er fkilte fP4
��'N IT y,
X, 1 6r, s ur f was d om P_ VO� aOo7, wi l l7
Tokm U?k ieo-ds
Page 3 of 3 12128104

Facility No. _Farm Name
Permit �_ COC
Date
OIC^ NPDES (Rainbreaker PLAT Annual Cert)
FB Dro s
Sjudge - r _ - Perm .
E�►�------.
In ., .. - Dept
Date
DesignCalibration
-------
Actual•
Q.'-------
A
Soil Test
pH Fields ✓pH Lagoon
Lime Needed �rfrl
Cu
Zn 04erg AQ�'�?
Wettable Acres ✓
Crop Yield —1It9
Rain Gauge
Weekly Freeb and
Rainfall >1"
1 in Inspections
120 min Inspections
Transfer Sheets ,X
• 111
allQfl�"'
L. '1
. • f .
-■ 1 il'. ter'

Type of Visit 'Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance I
Reason for VisitRoutine O Complaint 0 Follow up O Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time- C Departure Time: Coun Region:
Farm Name: OS�yl t't , t l �Q v m 5 iqc, Owner Email:
Owner Name: l 11 L Phone: Mailing Address: �� 9"0"! V
d.V' �' l 1l�'_ f LAun �(�
1AA c
Physical Address: Facility Contact: _S0.C�0} 7 G i O} " Title: .O �1 Phone No: ,
Onsite Representative: �Q C� integrator: r�
Certified Operator. �0.C-db • �1`'_ @.11 5 Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = 0 =' =" Longitude: 0 ° ❑ g =
66
Design
`
Current
-Design Current
Design Current
S«'ine Capacity
Population Wet PoultryCapacity Population
Cattle Capacity Population
❑ Wean to Finish
❑ La er
❑ Dairy Cow
❑ Wean to Feeder
❑Non -La er
❑ Dairy Calf
S�Peeder to Finish `7 o
Dairy Heifer
❑ Farrow to Wean
Dry Poultry �"
El Dry Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
+ ❑ La ers
❑ Beef Stocker
❑ Gilts
❑ Beef Feeder
❑ Boars
ElPullets
❑Beef Brood Cow
-
❑ Turkeys
Other
❑ Other
❑ Turkey Poults
❑Other
Numher of Structures:
Discharges & Stream impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Fieid ❑ 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
1Po
❑ NA
❑ NE
❑ Yes
❑ No
'P NA
❑ NE
❑ Yes
❑ No
ONA
❑ NE
❑ Yes
❑ No B NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
Page I of 3 12128104 Continued

Facility Number-Number-Y = — Date of Inspection r U
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes KN.
❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes J�2 No
❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3 c�
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 ,DVo
❑ 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 AlNo
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes J�LVo
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes ft!qo
❑ 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��Outsiide of
Area
12. Crop type(s) C" 1! C r' qS
cot h
13. Soil type(s) A I-& , 60
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
PNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement'?
❑ Yes
PljNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
�9 No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
�gNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
bg No
[j NA
❑ NE
Reviewer/Inspector Name
Reviewer/]nspector Signature:
Phone:
Date:
Page 2 of 3 12128104 Continued

Facility Number: — Date of Inspection bIT / 11
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes �o ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 1�No [INA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ 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 l" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
'1�-No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes
[20No
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
o
tN
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
ElYeso
❑ 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
❑ NA
❑ NE
Other Issues
'5bo
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?
I -
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
�bNo
El NA
El NE
If yes, contact a regional Air Quality representative immediately
ll
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
�No
El NA
El NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
q No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
No
❑ NA
❑ NE
Additional. Comments and/or Drawings:.
'
K)o+e . New Pe-v-M; �u3 m4 vtd . Uld
furm;4 kqU4 cr"
sz; �� . N etd `tb VCAA' w, Cen-�vcl` csz�
Nice rQryA
�-
Page 3 of 3 12128104

<: '- -L( G
Fadllity No. �Time In �� Time Out
Farm -Name , r,
Owner P
Operator C. vt.0
Integrator
Back-up l No.
COC I�]o� t�y/� Circle: Gene or NPDI=S
Date /
Design
urrent
Design
Current
Wean Feed
Farrow — Feed
Wean — Finish
Farrow — Finish
Feed, Finish
Gilts 1 Boars
Farrow — Wean
Others
FREEBOARD: Desig Observed
Sludge Juniey Calibr fiin !GPM
� V
Crop Yield Waste Transfers
Rain Gauge Rain Breaker
Soil Test PEAT Wettable Acres
f
Weekly Freeboard Daily Rai all 1-in Inspections -lf
Spray/Freeboard Drop V t / .
Weather Codes 120 min Inspections
Waste Analysis:
Date Nitrogen (N) Date Nitrogen (N)
1 Z -
Pull/Field Soil Crop Pan Window
Ily
�iY

Type of Visit 41 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Q Arrival Time: P 6 Departure Time: LI ,J County: ""�� Region: *" 20
Farm Name: St rmcx 31-JSM i+t Owner Email:
Owner Name: "Pk; 1 ud&D' Phone: C) E(e
Mailing Address: f 3!5_a> g' YI.- N .1 1 "U C�.�"� � r� it �_ QZ3(o U
Physical Address: !'1' F L Esc. 1 �1e W7bYl G r0�_
Facility Contact: C_O �_�e r�s - Title: © Phone No SID
Onsite Representative: .S Integrator:
Certified Operator���b G ,&Ip ns Operator Certification lumber: L
Back-up OperatorBack-up Certification Number: a`��
Location of Farm: Latitude: o Longitude: ❑ o = , ❑
m • S w v4 �J 0-r-) ZL 1pqs-- , rr� ►fi n c cr+-•
Design. Current
Swine Capacity Population
❑
Wean to Finish
❑
Wean to Feeder
eeder to Finish 1571p0
5
❑
Farrow to Wean
❑
Farrow to Feeder
❑
Farrow to Finish
❑
Gilts
❑
Boars
Other
❑ Other
Design Current
Wet Poultry Capacity Population
❑ Layer
❑ Non -La er
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application,Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifei
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures: M_J
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?
(Dyes ,mil. No ❑ NA ❑ NE
❑ Yes
❑ No
[(NA
❑ NE
❑ Yes
❑ No
O(NA
❑ NE
�—
❑ Yes
❑ No
WA
❑ NE
❑ Yes
W1 No
❑ NA
❑ NE
❑ Yes
Ar No
❑ NA
❑ NE
12128104 Continued

Facility Number: —} Date of Inspection KAO
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes �9No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes �No ❑ NA [I NE
the appropiate box. ElWUP El Checklists ❑ Design ❑ Maps El Other
21. Does record keeping need improvement? I f yes, check the appropriate box below. ❑ Yes ';�No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and t" 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 A No ❑ NA ❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
55 No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
f'*o
❑ 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
tfo
❑ 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
06 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
IQ 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 tail to discuss review/inspection with an on -site representative?
❑ Yes
No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
OrNo
❑ NA
❑ NE
n4e�alv_ Gzn4QC y'
__L�
e �1 nu CD'[a {Sw-sw,t c., .� ar ,'n
WMS a se.
6Dd
12128104

Facility Number: 2 g Date of Inspection o
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
❑ Yes No ❑ NA El NE §
❑ Yes o ❑ NA ❑ NE tit
Structure 5 Structure 6
Identifier:
Spillway?:
t�
Designed Freeboard (in):
Observed Freeboard (in): aC
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 OkNo
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes V(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 A No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 4a No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 1,No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Man urelSludge into Bare Soil
❑ Outside of Acceptable Crop Window El Evidence Wind Drift ElApplication Outside of Area
� '+of
12. Crop type(s) Wf n 1 CO 1VVN
13. Soil type(s) Pl V �r % I.' 11
^�
1 L�-� iY?��i._, r �+ of to
r
14. Do the receiving crops iffer from those designated in the CAWMP?
❑ Yes
*o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
kNo
❑ NA
❑ NE
16_ Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes _WNo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
Vf No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
04No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendati6ns or comments.
Use deawiiogs of facility to better explain situations. (use additional pages as necessary}
a. rn
WC)'A c %PL_r .
w ; n 6 o fa t
n
� �
p
el Cor rcS Pd n
W , f)AOU3
Reviewer/Inspector Name C�-i .lST,4j pip � Phone: q 10 � 3 �rGM
Reviewer/Inspector Signature: Date: �s�►`�
Page.e of .f 12128104 Continued

Type of Visit • Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit • Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: -/O. Os Arrival Time: p® Departure Time: County: n __ Region: `______a
Farm Name: so Htrrc.0-"� Owner Email:
Owner Name: J-Wl.0!n %/r/�'.;.i� Phone:
Mailing Address: o` D 41 O R e G•eve- Nf— 03 L%
Physical Address:
Facility Contact: volson Herr i,, Title:
Onsite Representative: 11015o H
Certified Operator ?golf st„ Reri-.'.,)
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Veeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Phone No:
Integrator: praIr,�',,.,s �� �
Operator Certification Number:
Back-up Certification Number:
Latitude: = o =1 a Longitude: = ° =1 I= u
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
❑ Non -Layer
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults FEE]
❑ Other
Discharges & Stream Impacts
l . Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current "
Cattle Capacity Population. .
❑ Dairy Cow
❑ Dairy Calf
❑
Dairy Heifer
❑
Da Cow
❑
Non -Dairy
❑
Beef Stocker
❑
Beef Feeder
❑
Beef Brood CovA
Number ofStructures
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached .eaters 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 2<0 ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
21�o
❑ NA
❑ NE
❑ Yes
2 No
❑ NA
❑ NE
12128104 Continued

Facility Number: — .tj Date of Inspection D
Waste Collection & Treatment ,,!
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? El Yes i� 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?: �p
Designed Freeboard (in): .Z O.
Observed Freeboard (in): .3,
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes [xNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes 9"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? El Yes E No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
ZNo
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9_ Does any part of the waste management system other than the waste structures require ❑ Yes
ErNo
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
[xNo
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below_ ❑ Yes
2<o
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12, Crop type(s) 14,4 &Q
1-1;- .27r 7-,»f SP
13. Soil types) y 0 G
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
Ca'NNo
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes
Lam{ 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
aNO
❑ NA ❑ NE
18. -Is there a tack of properly operating waste application equipment'? ❑ Yes
0'No
❑ NA ❑ NE
0_6 WltG 0/11bef I-- tAe As141 of yoec( s�4n(� tdas �o�rtr,�f` 6v7` %fir opt/r
Reviewer/Inspector Name ��. �1 Qrr f f 8.11 1 Phone'1t4/ Sri 7�p
Reviewer/Inspector Signature: Date: 3 /d1dy
r 7n ¢roll !'A,.r;""Od

Facility Number: $.9 — k gy Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 21q'o ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 0-< ❑ NA ❑ NE
the appropirate box. ❑ ❑ ChP�ists ❑ I n ❑ 11 aas ❑ Qslcr-
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes Eivo ❑ NA ❑ NE
LI s �s�fers 'on
❑ R-iufa1l []stt-fang ❑ CrQp-Yield ❑ L ns ❑ y tions 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?
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? (iel 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?
Ad'VdehonallrComments and/oir Drawings Ax
❑ Yes
❑'No
❑ NA
❑ NE
❑ Yes
0'No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
E ' o
❑ NA
❑ NE
❑ Yes
21 o
❑ NA
❑ NE
❑ Yes 21�o ❑ NA ❑ NE
❑ Yes ❑'1Cfo ❑ NA ❑ NE
❑ Yes ago ❑ NA ❑ NE
❑ Yes
E No
❑ NA
❑ NE
❑ Yes
O'No
❑ NA
❑ NE
❑ Yes
O No
❑ NA
❑ NE
❑ Yes
["lo
❑ NA
❑ NE
12128104

Type of Visit i9'Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit outine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number $ Date of Visit: Tune:
Q Not Operational Q Below Threshold
ermitted C e;t fled © Conditionally Certified © Registered Date Last Operated or Above Threshold:....._ .... W. .
County:
Farm Name: �Sati ..... tY� ...,...._. s°`......... ................ ...... ..........
W ......
Owner Name:... _. TK d5o� �''' Ph ne No• 9 —/1a %
Mailing Address: p� D 9 0l j... k°.d ki a ro _ d Ale 19MI C
Facility Contact: .... T`�S?'?....... .. Tide: _._ _..•---....... PhoneNo:
Onsite Representative:..K df oh �rr�, k _._.. ._ .. Integrator: r'G�► ; w.. S dr��l �W_�_____
Certified Operator:. , , _................ _ .. Operator Certification Number:
Location of Farm:
J-gw�ine ❑ Poultry ❑ Cattle ❑ Horse Latitude • 1 66 Longitude • 4 "
lijli n Current
Swine i'anarrf�* �Fnnulzifinii �
El We Feeder
13-Fe-eder Finish
13 Farrow to Wean
Farrow to Feeder
Farrow to Finish
El Gilts
El Boars
Num_be3r ol-L4
00i4s
:Ha1d�nQ':Fondc'% Cnliei':'1"ranc''.'
Design Current'
Y Ca ci 'Po ulation.. Cattle
Layer W" ❑ Dairy
Non -Layer m ❑Non-Dair
Other -- -
_ Total Design Capa6tV
- TotaI=SSLW
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. if discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any pats of the operation?
�71e v
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
❑ Yes gNu—
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes B-MQ
❑ Yes [IbIa-
❑ Yes EJ o�
Structure 6
Identifier: .......... ........................ ..— _—
Freeboard (inches): a �I
12112103
Continued

Facility Number: fr
Date of Inspection a`
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? If yes, check the appropriate box below.
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type
Yh a
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours?
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional
Air Quality representative immediately-
0 Yes ET1vo
❑ Yes
❑ Yes N�o
❑ Yes �'No
❑ Yes No
❑Yes �N�o
❑ Yes 2'N0
❑ Yes
UX06
❑ Yes
&4 o
❑ Yes
to�
❑ Yes
L,�1Vo
❑ Yes
S-No
❑ Yes ❑.Nb
❑ Yes Mto
❑ Yes Sw6
❑ Yes [WO—
❑ Yes p'o
Comments (refer to guesbon #) Exlatn aay YFS aasw anillor aay ecomn4en�lat:vns or any Gommen . r __ _-;
:Use dra�`' '� poi _ to better� �" stt a o use addi� iisl as �f T
H,
�� y � _ i � > ry) geld Copy Fatal Notes � w�
W
Reviewer/Inspector Name ' Reviewer/Inspector Signature: Date: 515 3 0

Faciliky Number: f Qz _ Date of Inspection
Required Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes ❑Xo-'
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?#�
(ie/ WUP, checklists, design, maps, etc.) ❑ Yes
23. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 01140_
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes Leo
25. Did the facility fail to have a actively certified operator in charge?
❑ Yes
(-#o'
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
El Yes
❑�
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
E]t-
28. Does facility require a follow-up visit by same agency?
❑ Yes
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
ONNa
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
es
❑ No
3I . If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑o-
32. Did the facility fail to install and maintain a rain gauge?
❑ Yes
I—+o
33. Did the facility fail to conduct an annual sludge survey?
❑ Yes
9No
34. Did the facility fail to calibrate waste application equipment?
❑ Yes
04o
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below.
❑ Yes
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After V Rain
12112103

Site Requires Im=wdiate Attention:
Facility No. �2— -Yy
DIVISION OF ENVIRONMENTAL MANACxF1VWT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: 10, 1/ 1995
Time: r'
Farm Name/Owner. fl M O. t J 1 i)2 Y �- 1 a Q Y 11'1 C{ -
Mailing Address:
a OG 6 k d Go %bam Py7 w 7on Grove. , n c a (83bb
County: _ _. b G.r`ns_-., .. ,
Integrator. r ag Phone: ab - 554- 9a14
On Site Reprosentative: Ar-Phone: 910 - L5Yt-oai 5
Physical Address/Location: 1 y .
Type of Operation: Swine t`+'n Poultry — 6ttic
Design Capacity: 37ba FeJZ Pin Number of Aaimals on Site: -s�e
DEM Certification Number: ACE _____ DE.M Certification Number. ACVEW
Lautueid: y�,�' _ 0•1 " Longitude: a'�
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches) (ONNo Actual Freeboard: _.0)_Ft. Inches
Was any seepage observed from the;17,QrNo
n(s)? Yes or galas any erosion observed? Yes No
Is adequate land available for spray? Is the cover crop adequate? Yes or No
Crop(s) being utilized:
Does the facility me--t SCS minimurn setback criteria? 200 Feet from Dwellings?�r No
100 Feet from Wells? ? YY or No
Is the animal waste stockpiled within 100 F of USGS Blue Line Stream? Yes or'No
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes or ED
Is animal waste discharged into waters of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes or No If Yes, Please Explain.
Does the facility maintain adequate waste management records (volurnes of manure, land applied,
spray irrigated on specific acreaee with cover crop)? Qor No
Inspector Name
Signature
cc: Facility Assessment Unit Use Attachrrmts if Needed.

07,31i95 13:36 FMHA CLINTON NC - 13105S41912 002
Ali. *MjT; JMXAQ*6*T gldlx[ CXRT.Z..TXCA%T= P= MW OR =A==D r;tntoss
Plea• cetera the ee�3,ete� lass'. to the alrisiasa or savirvamta�l Iceas�4esaat at
the adgmess as the swVia rse "side oUChia f osa.
Name of farm (*I•a"*' rint) +
Q
C. ZVIIEL Phone l P
Costttt]t + b
Farms location: Latitude and Lon9ian4d: -a if '/21 20Z (required) . Also.
plaase attach a copy of a county road map with 4kcion idontified.
Type of operation (swine, layer, dairy, etc.)
Design rapacity (Mober or animals): b
Average size of operacion'(12 month population avg.): 57LO he, Makc-
Averaga acreage needed for land application of waste (acres)r
era r� � sai���i�tfa�a�i��ss�isi�4��.�riM�s�ir.rA•�r�S�iMfili�w�if�i�Sa�aaiwM
?"baiaal apeaialiss C iSi.aatifam
As a teefttic" 'specialise designated by the.: North Carolina Soil and Water
Cormezvation CazmLssSen pursuant to 'UA NCAC 6F .0003. I certify that. the now or,
emanded animal waste mattgemeat system .a• Uatalled tor. -the faara+ maned above
has an animal vast* management plan that sneers the design. construction.
operation and maintenance standards ers8 specifications of the Division of
Environmental management and the USDA -Sail Conservation Service and/or the North
Carolina Soil and Water Conservation Commission pursuant to JSA N= 2H.0217 and
1SA NCAC 6F .0001-.000S. The following •rants and their corresponding mialw
criteria -lea vmrifiad by me or other designated technical specialists and
are included in tha-plan as applicable: minimum nations (buffers); liners or
equivalent for lagoons or waste storage pondsr'vast• storage eapacityx'adequate
quantity and amount of land for waste utilizat on. (or use of Baird party): access
or ownership of proper vast* application egulpbent: schedule for timing of
applications; application V^Ces i loadinq rates, &Ad the control of the discharq*
of pollutants from stonmmweer r=aff events lase severe than Lase 25-year. 24-hal
atoms. -
Maas of z at (Please Print) :d���, 71R.ia3
Affiliation:
llddress (Agd17c7t) : Phone No.
Sigaa - - .. "UW (9 r-milld - - Bate+ Az— S - 9
=ssmsaaas am a asrsasas sae sacsy. =Mumma•
olrs•r/Mazagr= Acrumommm
I tw,) understand, the, operation and *aintenance procedures established in the
approved animal waste management plan for the fam maned above and will impleMOUt
these procedures. I Me) know that any additional expansion to the existing
design capacity of the waste treatmexst and etorepe system or construction of n*V
facilities will require a new certification to be submitted to the Division of
Environmental Management before the now animals are stocked. I (we) also
understand that there must be no discharge of aniseed Vast* from this system to
surface :raters of the state either tbraugh a mars -made conveyartcs or throuwh
runoff from a storm event less s,svere, than the 2S-year, 24-hour storm. The
approved plans will be filed at the farm and at the office of the local Soil gad
Water Conservation District.
firm+ of 1.=A owner (Please Print) +__AJ6at� HUriv-% _
Sutures aziddZ-
Name of V"ag*r. if different from owner (Pliass'Drint)r
Signature- Date;
Zata: A change in land'arnershig rwrAl;es notification ora new certification
Utv the approved plan is changed) to be submitted to the Division of
Environmmatal ManaQem,mt within 60 days of a title transfer.
D s3 K USE CNLY:ACNIr O
JLJL-31-1995 14:44 910 590 3092 93/.
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