820058_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental Qual

Type of Visit: ® Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 10 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: �T Departure Time: 2.00 County: SaK
Farm Name: r Owner Email:
Owner Name: �� ¢t lµ S C. Phone:
Mailing Address:
Physical Address:
Facility Contact: LLQ
Onsite Representative:
Certified Operator: "t,
Back-up Operator:
Location of Farm:
Title:
Latitude:
Phone:
Region: ��
Integrator: �� "` r
Certification Number: / n a 7,,-7
Certification Number:
Longitude:
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (if yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes ';@ No ❑ NA ❑ NE
❑ Yes
Design Current
(] NA
Design
Current
Design Current
Swine Capacity , rPop.
i�Vet Poultry
Capacity
Pap.
Cattie Capacity Pap.
Wean to Finish
La er
Dairy Cow
Wean to Feeder
Non -La yer
"r P,aultr.
Design
Ca aci
Current
Po
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turke s
Other :,
Turkey Points
Other _
Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (if yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes ';@ No ❑ NA ❑ NE
❑ Yes
❑ No
(] NA
❑ NE
C] Yes
❑ No
NA
❑ NE
❑ Yes [:]No
❑ Yes © No
[:]Yes No
jF2]NA
E] NE
❑ NA
❑ NE
❑NA
E] NE
Page I of 3 21412015 Continued

lFacility Nstuber; Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
P No ❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): Z
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No ❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a❑
Yes ] No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes® No ❑ NA ❑ NE
maintenance or improvement? TP
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [�j No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > l0% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop
/Window Eviden of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): 1it-Lt j
13. Soil Type(s): f
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes q9 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?
t7. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes ® No ❑ NA ❑ NE
❑ Yes ® No [] NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes IrNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes f No ❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste TrInsfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑ NA ❑ NE
Page 2 of 3 2/4/2015 Continued

Facility Number: - Date of Inspection: 2 .
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check []Yes No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ® No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes (2 No
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes [P No
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the ❑ Yes [] No
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. ❑ Yes No
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes [Y?] No
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative? ❑ Yes No
34. Does the facility require a follow-up visit by the same agency? ❑ Yes [P No
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
M
❑ NA ❑ NE
❑NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
0 N ❑NE
C] NA ❑NE
❑NA ❑NE
Phone: iib y/ff- 4
Date: e0vl
21412015

1Pype of Visit: 0 Compliance Inspection 0 Operation Review O Structure Evaluation Q Technical Assistance
Reason for Visit: ® Routine O Complaint O Follow-up Q Referral O Emergency O Other O Denied Access
Date of Visit: If Arrival Time: !I :d 4-�, I Departure Time: y%C-r1 County: ,Q)"- Region:
Farm Name: Name: Owner Email:
Owner Name: e>T �'1('i Phone:
Mailing Address:
Physical Address:
Facility Contact: V0
tet!
Onsite Representative: �j,
Certified Operator: �jP '-t
Back-up Operator:
Location of Farm:
Title:
Latitude:
Phone:
Integrator: Srr7f1
Certification Number:
Certification Number:
Longitude:
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 P5 No ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes ❑ No
[:]Yes ❑No
❑ Yes?No
E] Yes No
NA ❑ NE
NA ❑ NE
p NA
Design Current
❑ NA
Design
Current
Design Current
Swine
Capacity Pap.
Wet Poultry
Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
La er
Dairy Cow
Wean to Feeder
2'O
Non -La er
Dairy Calf
Feeder to Finish
r +�
Dairy Heifer
Farrow to Wean
h Design
Cutrretrt
Dry Cow
Farrow to Feeder
D ; P,oult ;
Ca amici
P,a
Non -Dairy
Farrow to Finish
Lavers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Soars
Pullets
lBeef Brood Cow
Turkeys
Other
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify 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 P5 No ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes ❑ No
[:]Yes ❑No
❑ Yes?No
E] Yes No
NA ❑ NE
NA ❑ NE
p NA
❑ NE
❑ NA
❑ NE
7 N
❑NE
Page 1 of 3 21412015 Continued

Facili Number: Date of inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? [:]Yes �❑NA ❑NE
a. If yes, is waste level into the structural freeboard? ❑Yes ❑ No �FNA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: T
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.)
❑ Yes
No
❑ NA
❑ NE
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
No
❑ NA
❑ NE
waste management or closure plan?
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
QqNo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
C] Yes
no
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
No
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
❑ NE
the appropriate box.
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 P 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 Acce table Crop Window ❑0 Evi c of Wind Dfrift ❑Application Outside of Approved Area
12. Crop Type(s): 6:�� lJ `� A 6" �
13. Soil Type(s):
14. Do the receiving crops di er from those designated in the CAWMP?
❑ Yes
P No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
[� No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[�-No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes tM No
F-1WasteApplication ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Tr sfers
❑ 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 N
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No
[—]NA C -] NE
❑ Weather Code
❑ Sludge Survey
No
❑ NA ❑ NE
❑NA ❑NE
Page 2 of 3 2/4/2011 Continued

Facilit Number: - Date of Inspection: J 12:2 1
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 No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ YesT
No ❑ NA F-1NE
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 JNo ❑ 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 No ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes No [—]NA ❑ NE
33. Did the Reviewer/inspector fail to discuss review/inspection with an on-site representative? ❑ Yes No E]NA [:j NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes No ❑ NA ❑ NE
tf. )• A, Y, Y mendat ons or any: other comments''.
amments re er to nest on' x a n an answers an or an a Mona recom
Use drawings of. facility ta!better expla�naitdations (use additionalpa�es as necessary).'
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3of3
Phone: Sao `�1ED
Date: 21 A -
2/4/z011

i ype of visit: w uompuance inspection v uperatton mevtew v btructure Gvaiustion v iecnmcai Assistance
Reason for Visit: • Routine O Complaint O Follow-up Q Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: &__q ,,_-c Departure Time: C1 j p v�. County: S. l Y1 Region: =ta
Farm Name: AJU vSR,.-_ Owner Email:
Owner Name: P� k W
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: I—, LA
Certified Operator:
Back-up Operator:
Title:
Location of Farm: Latitude:
Phone:
Phone:
Integrator: �&&Ze l
Certification Number: Un _
Certification Number:
Longitude:
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
❑ Yes �No [3 NA E] NE
a. Was the conveyance man-made? ❑ Yes ❑ No E� NA ❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWR) [:]Yes ❑ No ? NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR) ❑ Yes ❑ No 52 NA [] NE
2. Is there evidence of a past discharge from any part of the operation? ❑ YesNo ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters F]Yes No ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 21412015 Continued
Design Current
Deslgn
Current
Design Current
Swine
Capacity Pap,
Met
CapacityCattle
apacity Pop.
Wean to Finish
I Layer
Dairy Cow
Wean to Feeder
2b ►
[Non -Layer
Dairy Calf°
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
D . Poiiltr,.
Ca aci
P.,o .,
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
t: _
Non -Layers
Beef Feeder
Boars
Pullets
113eef Brood Cow
Turkeys
Other
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
❑ Yes �No [3 NA E] NE
a. Was the conveyance man-made? ❑ Yes ❑ No E� NA ❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWR) [:]Yes ❑ No ? NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR) ❑ Yes ❑ No 52 NA [] NE
2. Is there evidence of a past discharge from any part of the operation? ❑ YesNo ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters F]Yes No ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 21412015 Continued

Facili .Number: Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes No NA ❑ NE
St ruc re 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 IP No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a ❑ Yes 0 No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes 7 No ❑ NA ❑ NE
maintenance or improvement?
Waste Aunlication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ YesNo ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes fo No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.
❑ PAN ❑ PAN > 10% or 14 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): —OCAP r
❑ Yes
F No
❑ NA
❑ NE
14. Do the receiving cropsliffer from those designated in the CAWMP?
❑ Yes
1P No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[P No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yesiii
No
1p
❑ NA
❑ NE
acres determination?
❑ Yes
No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
M No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
�3 No
❑ NA
❑ NE
Reauired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
F No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
T No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Tra
sfers
❑ 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
® No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
[:]Yes
Tn No
❑ NA
❑ NE
Page 2 of 3 2/4/2015 Continued

acil _Number: Z Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? []Yes No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes 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 [ No
❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes No
❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes No
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes No
❑ NA ❑ NE
Comments refer to question #} ,Etplsln any YES'anwers' !'andlor any additional recommendations. or any other comments ...
Use drnwings of Nellitylo better explain`situatlotss (use additional pales as'necessary),
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: '�Ga
Date: A -P
2/4/20]5

1104
0 Division of Water Resources
11 Facility Number - O Division of Soil and Water Conservation
O Other Agency
Type of Visit: ® Compliance Inspection Q Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: a Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: 1[ Arrival Time: cqp Departure Time: County�rGi'" • Region
Farm Name: Owner Email:
Owner Name: �f
Mailing Address:
Physical Address:
Phone:
Facility Contact: L /,) Title: Phone:
Onsite Representative: Integrator: p-
Certified Operator: Certification Number: �O
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Certification Number:
Latitude: Longitude:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
Layer
Non -La er
rout
Pullets
Turkey Poults
Other
Design Current
Dischart=es and Stream Imnacts
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)?
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
.Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑Yes
epNo
[3 NA
❑NE
[:]Yes
❑No
rpNA
E]NE
[:]Yes
❑No
P NA
❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWR) [] Yes ❑ No NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes No ❑ NA ❑ NB
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes No ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 2/4/7014 Continued

Facili Number: 49- Date of Inspection: .
Waste�Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes P No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No �TNA ❑ 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? ❑ YesNo E]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 rO No ❑ NA ❑ NE
waste management or closure plan? Ym
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 E] 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 P No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ YesjNo ❑ NA [-]NE
maintenance or improvement? 9
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes P 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 W'
jpO Drift ❑ Application Outside of Approved Area
12. Crop Type(s): Wa �ilgr 5e-
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[N No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
® No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
1� No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
�N 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 PS 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? ❑ YesNo
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? E -]Yes No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 2/4/2014 Continued

Facili Number: I Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No [3NA E]NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No [DNA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
[] Yes®
No F] NA
E] NE
and report mortality rates that were higher than normal?
r
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
JhNo ❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ YesDM
No ❑ NA
❑ NE
33. Did the Reviewer/Inspector 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
nmmepts (refer to questipn ' Explain n4an YI answers, -and or
#). Exp y, any additionallrecomtnendatibns or any other comments
.
Use drawings of fac�iity to,better.explain situations (use additional `paHes:as.necessary)
t
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date:
21412014

O Division of Water Quality
Facility Number ® 0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit: -0 Compliance Inspection 0 Operation Review 0 Structure Evaluation O Technical Assistance
Reason for Visit: 0 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: <op County: `4} Region:
Farm Name V✓ T Owner Email:
Owner Name: 5 �1 v�tSr . Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator: .2
Back-up Operator:
Location of Farm:
Swine
Phone:
Integrator: 11A_ —b q
Certification Number: /gffl 7
Certification Number:
Latitude:
Design Current Deslgn Current
Capacity Pop. Wet Poultry Capacity Pop.
La er I I :::]
0 O Non -La er
Wean to Finish
❑ NE
Wean to Feeder
❑NE
Feeder to Finish
❑NE
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
t)ry routtry
Layers
Non -Layers
Pullets
Turkeys
Turkey Poults
Other
Design Current
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ED Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
Longitude:
Design Current
Cattle Capacity Pop.
Dai Cow
Dai Calf
Dai Heifer
D Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
[D Yes N No E] NA [3 NE
❑ Yes [-]No
E] Yes E] No
❑ Yes 0 No
❑ Yes No
[:]Yes No
�G] NA [-]NE
[P NA E] NE
NA
❑ NE
❑NA
❑NE
❑NA
❑NE
Page 1 of 3 2/4/2011 Continued

FoUlity tl4umber; - Date of Inspection: ?
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No (W NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
13. Soil Type(s):
Spillway?:
14. Do the receiving crop iffer from those designated in the CAWMP?
❑ Yes
No
❑ NA
Designed Freeboard (in):
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
Observed Freeboard (in):
T
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
No
❑ NA
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ YesNo
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
a No
❑ NA
❑ NE
waste management or closure plan?
Required Records & Documents
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)
T
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
_Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes �RNo ❑ 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 M Evidenc f Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): �Qs�wT t, p` an) . _ el 1J4'S /
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes P 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 tn No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [P No
❑NA 0 N
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑NA ❑NE
Page 2 of 3 2/4/2011 Continued
13. Soil Type(s):
14. Do the receiving crop iffer 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?
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
[] Yes
[7) 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 P 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 tn No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [P No
❑NA 0 N
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑NA ❑NE
Page 2 of 3 2/4/2011 Continued

liacili 'Xumber: Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE
25. is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey [] Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately,
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
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 [n No ❑ NA ❑ NE
❑ Yes T No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes P No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative? ❑ Yes �2 No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes [0 No ❑ NA ] NE
q ) p y and/or an additional recommendations or an other comments:
(refer to uestion # : Ex Iain an YES answers ro
nt s of facility to better explain situations (use additional epees as necessarv).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date:
2/4/2011

W Division of Water Quality t
Facility Number ®- 0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit: • ! Compliance Inspection 0 Operation Review 0 Structure Evaluation t) Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: 1 Arrival Time: l.' Departure Time: O : County: Region:
Farm Name: /1/�t:.C,trS�,rti, Owner Email:
i
Owner Name: Ca s vv do r S ' Phone:
Mailing Address:
Physical Address:
Facility Contact: { Title: Phone:
Onsite Representative:
Certified Operator:
Integrator:
Certification Number: g 960 77
Back-up Operator: Certification Number:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Other
Other
Latitude:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
4Layer = ---dNon-Layer
Pullets
Other
Poults
Design' Current
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
Longitude:
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes �No ❑ NA ❑ NE
❑ Yes
❑ No
M NA
❑ NE
❑ Yes
❑ No
[n NA
❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes ❑ No ;5 NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes "071 No ❑ NA ❑ NE
Pjj
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes W No ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 2/4/2011 Continued

Facility Number: IRA - jDate of Inspection: / 2
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No
❑ NA ❑ NE
�NA ❑ NE
St ruc ure 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? ❑ YesNo [:]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 tn 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, notifv DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes 0 N ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes PZNo ❑ 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 J�VNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes Y3 --No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes �o ❑ NA ❑ NE
❑ Excessive Ponding ❑ 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 ❑] I'svidence off fWii�d, Drift ❑ Ap Ii tion Outside of Appr ved Area
12. Crop Type(s): TJ'� �1�ilt" "}" -�ss
— jI1J0.8
13. Soil Type(s):
�crt�-iffcr
14. Do the receiving, from those designated in the CAWMP?
❑ Yes
[P�No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
R No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
M No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[�)No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[3; No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
P No
0 NA
[] NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[�a No
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists [] Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 0 No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge" ❑ Yes No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 2/4/2011 Continued

;racili Number: - Date of Inspection:
❑ Yes
[)J'No
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
No ❑ NA ❑ NE
the appropriate box(es) below.
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ NA
❑ Non-compliant sludge levels in any lagoon
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
List structure(s) and date of first survey indicating non-compliance:
C] NA
E] NE
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes
"r" No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
FM No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
P 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
F 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
[)TNo ❑ 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
[)J'No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
TT
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[A No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
rG No
C] NA
E] NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
UNo
[] NA
[] NE
(Comments (refer to question #): Explain any YES answers and/or any Additional recommendations or any other comments I
Use drawiings of facility to better explain situations (use additional. pages as necessar_y).
Reviewer/inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
l!i Phone: rte '53ov
Date: I fiqla
2J412 01' 1

(Type of Visit: 49 Compliance Inspection O 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: Arrival Time:f® Departure Time: h County: S"SOr%J Region:
Farm Name: /V Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
✓
Onsite Representative: it
Certified Operator:
Back-up Operator:
Location of Farm:
Title: Phone:
Latitude:
Integrator: �� vd —A7z04„*1
Certification Number: 7
Certification Number:
Longitude:
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation'?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other: _
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any obsen able adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes 5!] No ❑ NA ❑ NE
❑Yes
Design Current
QaNA
Design
Current
Design Current
wine
C•apacI Pop.
Wet Poultry
Capacity
Pop.
Cattle C*apac[ty Fop.
ean to Finish
Layer
Dai Cow
ean to Feeder
Non -La er
Dai Calf
eeder to Finish
rj.
Dai Heifer
arrow to Wean
Current
D cow
arrow to Feeder
Dr- I;oultr ':
WD,sign
acit
pop.Non-Dairy
arrow to Finish
La ers
Beef Stocker
ilts
Non -La ers
Beef Feeder
oars
Pullets
1
Beef Brood Cow
furke s
Other
Turke Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation'?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other: _
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any obsen able adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes 5!] No ❑ NA ❑ NE
❑Yes
No
QaNA
❑NE
❑ Yes
❑ No
[� NA
❑ NE
[:3 Yes
No
PNA
❑NE
[:]Yes
No
❑ NA
❑ NE
[]Yes
[)§No
❑ NA
❑ NE
Page 1 of 3 2/4/2011 Continued

Facility Number: Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 1�0 No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? [:]Yes ❑ No jj� 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 [T No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
M No
[:]NA
❑ NE
waste management or closure plan?
❑ NA
❑ NE
❑ Yes
@ No
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
j No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
TT''
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement'?
Waste Allelication
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
f� 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 ofAcceptable
/
ablle Crop Window ❑ Evidence [:]off Wind Drill Application Outside of Approved Area
12. Crop Type(s): ��-�`'ILI L �' r4i. ).,5 L'' `�'�'A
13. Soil Type(s):
14. Do the receiving crops Aer 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
PNo
❑NA
❑NE
❑ Yes
[o No
❑ NA
❑ NE
❑ Yes
@ No
❑ NA
❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
[3 Yes No DNA ❑NE
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes C] 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 P No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes EP No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑ NA ❑ NE
Page 2 of 3 214/2011 Continued

Facilit Number: - Date of Ins ection: tl
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes fU9 No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No
Other Issues
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
[?FNA ❑ NE
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes ER No
[DNA F]NE
and report mortality rates that were higher than normal?
TT
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes TQ 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 the drains exist at the facility? If yes, check the appropriate box below.
❑ Yes No
❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes No
❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes No
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes No
❑ NA ❑ NE
i y : s and/or any additiohat. recommendations or.any otlie.r` comments *n �`"`
Use drawings of
of facil ty tobetter explainrsituations (use addittonat pages as;-necessa"ry).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date: qA,
2/4/2011

Division of Water Quality
Facility Number _ Division of Sol! and Water Conservation
Q Other Agency
Type of Visit 9 Compliance Inspection O Operation Review ()Structure Evaluation O Technical Assistance
Reason for Visit 0 Routine 0 Complaint Q Follow up 0 Referral 0 Emergency O Other ❑ Denied Access
Date of Visit: i t 0 Arrival Time:r Departure Time: County: 50 Region: Pfy
Farm Name: a�e,i� A1{ Ltfj�-/l-r Owner Email:
Owner Name: s w Wes r,;.► c-, Phone:
Mailing Address:
Physical Address: ! I
Facility Contact: '06 kti A �`uvicr d Title:
tl
Onsite Representative:
Certified Operator:
Back-up Operator:
A� Phone No:
Integrator:
Operator Certification Number: 9M&P
Back-up Certification Number:
Location of Farm: Latitude: =0
= =14 Longitude: = o = i =t4
I N�
Swine
Design Current
s.
,,.
Wet Poultry
Design Cu t Design Current
Ca�ttlie�
❑ NE
Capacity P�oputa isan
C'a'd city Popuiutionr`
�. , Capa itY:.P�opulstion
❑ Wean to Finish
a. Was the conveyance man-made?
❑ Layer
❑ No
'"
❑ Dairy Cow
Wean to Feeder
❑ Yes
Non -La er
INA
❑ NE
❑ Daia Calf
Feeder to Finish
❑ Daia Heifer
❑ Farrow to Wean
❑ No
Dry Poultry
❑ NE
❑ Dry Cow
❑ Farrow to Feeder
1P No
❑ NA
❑ NE
❑ Non -Dairy
❑ Farrow to Finish
tZ'No
❑ Layers
❑ NE
❑ Beef Stocker
❑ Gilts
❑ Non -Layers
❑ Beef Feeder
❑ Boars
Continued
❑ Pullets
❑ Beef Brood Cow
I
❑ Turkeys
Other
❑ Other
�
❑ Turkey Poults
Other
t
r �� �Y,r�cf
�trycfuresf
r:1
Discharges & Stream impacts
I. Is any discharge observed from any part of the operation?
❑ Yes
M No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
PNA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
INA
❑ 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
1P No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
tZ'No
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12/28/04
Continued

Facility Number: — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [�PNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No -E�4NA ❑ NE
Str cture I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): ?/
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed ❑ Yes 12PNo ❑ NA CINE
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
oNo
❑ 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)
W No
❑ NA
9. Does any part of the waste management system other than the waste structures require ❑ Yes
91 No
❑ NA ❑ NE
maintenance or improvement?
❑ NE
17. Does the facility lack adequate acreage for land application?
Waste Application
❑:No
❑ NA
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
r�7No
❑ NA ❑ NE
maintenance/improvement?
❑ NA
❑ NE
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
P No
❑ NA EINE
❑ 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 El Evidence of Wind Drift El Application Outside of Area
12. Crop type(s) C�'QS` ( (.9la4l, ol!`"l
13. Soil type(s) - WAQr0eK-
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[gNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
W No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination'? [3 Yes
NbNo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑:No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
�ZNo
❑ NA
❑ NE
r,�� 5h` ilh:,. ���97'Ftsfi�- IF,� � �F9�{.-3�'� :f4wS' /"'Z vi�3R�1^Ixt.4.-� ,si'�' a"�� _.
@omme is (ire e�ta�qu�estfo } plain any Y S answerers,and16rr ny Uommendutlans or any other comments.
Use drawings of facilltyta better e:rplin situations. (use additlanal pages as neIII!cessary): .
wW "� LL vnb
Reviewer/Inspector Name Phone: `I/0:33-33co
ReviewerAnspector Signature: Date: 1-*1,-Z1r`/D
Page 2 of 3
1228/04 Continued

Facility Number: Date of Inspection 1 '
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes T No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? 1f yes, check ❑ Yes ® No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists
❑ Design El Maps [:1 Other
21. Does record keeping need improvement'? If yes, check the appropriate box below. ❑ Yes 9i No [:INA ❑ 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
15 No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
® No
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
V3 No
❑ NA
EINE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
0 No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
�1 No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
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?
❑ YesNo
Iff
[:1NA
[:1NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
No
❑ NA
[:1 NE
General Permit`? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/]nspector fail to discuss review/inspection with an on-site representative?
❑ Yes
[0 No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
M No
❑ NA
❑ NE
Addiitional'Comments andlor Drawings:, ; f _
Page 3 of 3 12/28/04

5
Division of Water Quality
Facility Number _ — J 0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit 0 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: I tthWO9 I Arrival,�Time: :Ot�R.+► Departure Time: 12,p0 County: A?vW-SB") Region: F^p
Farm Name;��� r�1 lowser%4 Owner Email:
Owner Name: 4 w r "" "45 G Phone:
Mailing Address:
Physical Address: ,, f
Facility Contact: ry t Title:
Onsite Representative:
Certified Operator: &:q -e `x �
Phone No:
Integrator:
Operator Certification Number: / q
RS0 If7
Back-up Operator: Back-up Certification Number:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Latitude; = o =I 0 Longitude: = o = d
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
CO] La er
% ❑ Non -La er
Other r/
❑ Other _.— �. - --------�
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharp-es & 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 Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures:
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes ❑ No IMNA
EINE
❑ Yes ❑ No NA
❑ NE
❑ Yes ❑ No NA
❑ NE
❑ Yes No ❑ NA
❑ NE
❑ Yes No ❑ NA
❑ NE
12/28/04 Continued

6
Facility Number: — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 0 N ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No P NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: I
Spillway?:
Designed Freeboard (in): p
Observed Freeboard (in): 7
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
0 No
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
❑ NE
15. Does the receiving crop and/or land application site need improvement?
6. Are there structures on-site which are not properly addressed and/or managed ❑ Yes
ONo
[INA ❑NE
through a waste management or closure plan?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
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
Q9No
[:INA ❑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)
❑ Yes
EpNo
9. Does any part of the waste management system other than the waste structures require ❑ Yes
tpNo
[:INA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
No
[:INA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
T No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > l0% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
Crop Window El Evidence of Wind Drift
❑ Outside of Acceptable Crop Application Outside of Area
El
12. Crop type(s) Cm-s4rvI Awnti Jq S1N' kt91 �
13. Soil type(s) JW/ ara j"—
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No
(�
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
EpNo
❑ NA
❑ NE
Continents (refer to question #): Explain.any YES answers and/or any recommendatidns orfany other�comments
Use drawings of facility to better explain situations. (use additional pages as necessary)c ;
Reviewer/Inspector Name
-r 0— d�
' $. ��''a;; ';; �''1; �� y Phone:
0 _�
Reviewer/Inspector Signature:
Date: jf 1 Oq
12/28/04 Continued

Facility Number: Date of Inspection �Q
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes IFNo ❑ NA ❑ NE
20. Does the faciiity fail to have ail components of the CAWMP readily available? If yes, check ❑ Yes 0 No ❑ NA ❑ NE
the appropriate box. ❑ W'Up ❑ Checklists ❑ ❑ Maps Design g p ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ?)No [INA ❑NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
No
❑ NA
Cl NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
JpNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
P No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
ONo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
1P No
[INA
❑NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes�No
El NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
No
❑ NA
❑ NE
General Permit? (ie/ discharge, Freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
JP No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
P No
❑ NA
❑ NE
A�ditianal m rents andlar Drawings:
12/28/04
12/28/04

Division of Water Quality
Facility Number Sg 0 Division of Soil and Water Conservation
O Other Agency
Type of Visit 46 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: dl 6 Arrival Time: �'t 1� Departure Time: ����LYJ County: �uPsdA� l
A Region: - -
Farm Name: eanetw7 Owner Email:
Owner Name: 8 � &'"" 5 � C, Phone:
Mailing Address:
Physical Address:
Facility Contact: nk« k%to "Cti 't Title: Phone No:
k
Onsite Representative: , I
Certified Operator: �-e �'f , Pio
Back-up Operator:
Location of Farm:
integrator.
Operator Certification Number: 91yS&7'7
Back-up Certification Number:
Latitude: =0 =
0=i= Longitude: =° 0 i
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population
❑ Wean to Finish
Wean to Feeder /
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
F
La er Non -La er
Dry Poultry
❑
Layers
❑
Non -Layers
❑ Pullets
❑ Turke s
❑
Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
Number of Structures: ELI
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? (Ifyes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes OlNo ❑ NA EINE
❑ Yes
❑ No
A
❑ NE
❑ Yes
❑ No
A
❑ NE
J}NA
❑ NE
❑ Yes
❑ No
❑ Yes
XNo
❑ NA
❑ NE
❑ Yes
YNo
❑ NA
❑ NE
12128/04
Continued

Facility Number: $x.58 Date of Inspection t! 6
PNo
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? [:]Yes
Waste Collection & Treatment
❑ NA ❑ NE
S
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
No ❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
El Yes
[]No = NA
EINE
Strugture I Structure 2 Structure 3 Structure 4
Structure
5 Structure 6
Identifier:
❑ NA [:INE
maintenance/improvement?
Spiilway'?:
11, Is there evidence of incorrect application? If yes, check the appropriate box below. []Yes
jRNo
[INA ❑NE
Designed Freeboard (in):
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
Observed Freeboard (in): `
12. Crop type(s) �Q S #�.t r +'ni p a t l S ( ..Sin . �., Pye✓�
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
$dNo ❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
No
El NA El NE
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?
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes
No
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
PNo
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? [:]Yes
�Z 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
PIVo
❑ NA ❑ NE
maintenance or improvement?
Waste Aualication
10. Are there any required buffers, setbacks, or compliance alternatives that need []Yes
JjNo
❑ NA [:INE
maintenance/improvement?
11, Is there evidence of incorrect application? If yes, check the appropriate box below. []Yes
jRNo
[INA ❑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) �Q S #�.t r +'ni p a t l S ( ..Sin . �., Pye✓�
If
13. Soil type(s) j
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
No
El NA El NE
15. Does the receiving crop and/or land application site need improvement? ElICI Yes
�X
No
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
[RNo
❑ 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
No
❑ NA ❑ NE
Reviewer/Inspector Name J Phone: 7^33C0
Reviewer/Inspector Signature: 'fv( Date: 01 oS3
Page 2 of 3 12/2$/04 Continued

- 1
Facility Number: — 8 Date of Inspection
Required Records & Documents
AA
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes [ No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes // No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists
❑ Design El Maps E:1 Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes DPNo ❑ 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
VINo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
J!§No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
&o
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
KINo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
PNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
O�PN0
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
J�No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
PNo
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
FNo
❑ 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
VINO
❑ 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
MNo
❑ NA
❑ NE
Page 3 of 3 12/28/04

41 Division of Water Quality
Facility Number O Division of Sail and Water Conservation
Q OtherAgency
Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit *Routine 0 Complaint O Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Arrival Time: � Departure Time: /0;/ County: S/aS Region: _A�
S y� Owner Email:
Facility Contact: ��'"'`0 Title:
Lr
Onsite Representative:
Certified Operator: T,
Back-up Operator:
Location of Farm:
�7 Phone No:
Integrator:
I""' S`
Operator Certification Number: ?6'9,0-7?
Back-up Certification Number:
Latitude: =10
=1
=11
Longitude: 0 0 =' =
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population
❑ Wean to Finish
99 Wean to Feeder 12 20Oen
Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
; I❑ Layer :�j I =:J
❑ Non -La er
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turke s
❑ Turkey Poults
❑ Other
Discharges & Stream Imuacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current I
Cattle Capacity Population
❑
Dairy Cow
❑
Dairy Calf
❑
Dairy Heifer 4
❑
Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder E
❑ Beef Brood Cow
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes P No ❑ NA ❑ NF
❑ Yes
❑ No
E NA
❑ NE
❑ Yes
❑ No
[?3 NA
❑ NE
P NA
❑ NE
❑ Yes
❑ No
❑ Yes
R] No
ElNA
ElNE
❑ Yes
PNo
❑ NA
❑ NE
12128104 Continued

. is
Facility Number: — Date of Inspection 6�
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes n No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes 0 No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): aZ�1
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
)Q 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
�g 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
P No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
PNo
❑ 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
91 No
❑ NA ❑ NE
maintenance or improvement'?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
)_01. No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
In 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 Evidence of Wind Drifi ❑ Application Outside of Area
�Acc�ce�ptable jCropf�Wind`ow C❑
12. Crop type(s) o i'"`,Ja_ No,, ] l+'`^ �x am.Tsui
13. Soil type(s) WaF
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[0 No
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
® No
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑
Yes
ER No
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
tR No
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
MNo
❑ 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 le Phone:
Reviewerllnspector Signature: Date: YZ44 i
12/2814 Continued

Facility Number:Date of Inspection !
Required Records & Documents
19. Did the facility tail to have Certificate of Coverage & Permit readily available? ❑ Yes 19No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes %No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes P No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes �9No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ® No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
Uf No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit'?
❑ Yes
Eallo
❑ 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
E,�No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
49 No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
CTNo
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
&No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
F3 No
❑ NA
EINE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
�No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
[WNo
❑ NA
❑ NE
Comments and/or Drawings:
12/28/04

Type of Visit 0 Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit 0 Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: Arrival Time: 0, '�0� Departure Time: r D County: M7'w 4W
Farm Name: rr-- nn __ V g Owner Email:
Owner Name: f -,N i° . AOV P 40C� Phone:
Mailing Address:
Region: F)to
Physical Address:
Facility Contact: �� Iyt Title: ,Q Phone No,,:,,[[,,,, �
Onsite Representative: U Integrator: PAMtQW Stccna(�
Certified Operator:
Back-up Operator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: ❑ O =i
= Longitude: =0=' ❑
Design Current
Swine C*opacity Population
Design,
V4'et Poultry" CaY�pacity
Current Design Current
Populao'u Cattle Capa�ci�ty Populatlon
❑ NA
❑ Wean to Finish
10 Layer
❑Dai Cow
® Wean to Feeder
I❑ Non -Layer I
Calf
❑ Feeder to Finish
® NA
❑ Dairy Heifer
❑ Farrow to Wean
pry Poultry
❑ Dry Cow
❑ Farrow to Feeder
❑ NE
❑ Non -Dai
❑ Farrow to Finish
❑ Layers
El Beef Stocker
❑ Gilts
❑Non -La ers
❑ Beef Feeder
❑ Boars
❑ Pullets
❑Beef Brood Cow
Other
❑ Turkeys
❑ TurkeX Poults
f� No
❑ Other
❑ Other
i'Number'of,Structures:
❑ Yes
W No
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
M No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
® NA
[--IN I,
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 ofthe State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
P NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
f� No
❑ NA
❑ N E
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
W No
[INA
❑ NE
other than from a discharge?
Page I of 3
12/28/04
Continued

Facility Number: a— Date of Inspection !D
Soil type(s) k4 B
- . ,.
Waste Collection & Treatment
14.
Do the receiving crops differ from those designated in the CAWMP?
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
P No
[INA ❑ NE
a. If yes, is waste level into the structural freeboard?
[--]Yes
❑No
JRNA EINE
Structure I Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier:
[Pf No
❑ NA
❑ NE
Spillway?:
Does the facility lack adequate acreage for land application'?
❑ Yes
No
Designed Freeboard (in):
❑ NE
18,
Is there a lack of properly operating waste application equipment?
at
Observed Freeboard (in): -
No
❑ NA
❑ NE
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
P 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
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
P No
[:INA ❑NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[ j'No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
® No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu,
Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop types) 5&Peyk4 41", 50 ak( 1'� af'c.'�
13.
Soil type(s) k4 B
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[�No
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
® No
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
[Pf No
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application'?
❑ Yes
No
❑ NA
❑ NE
18,
Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Comments (refer to question #) Explain any YESanswers and/or any--recommendatlons or any other comments
.Use drawings of facility to better explain situations: (useiadditional pages as necessary):
A,
I
r
Reviewer/inspector Name _ W _ - - — ---- - - ----� Phone•
Reviewer/Inspector Signature: I Date: O12 5/'9
Paee 2 of 3 12/28/04 Continued

Facility Number: — � Date of Inspection
Required„Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes �RNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? 1f yes, check ❑ Yes ❑ No ® NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists❑ Design El Maps ❑ OtherVON
fflh1
21. Does record keeping need improvement? If yes, check the appropriate box below. El Yes �No NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1” Rain inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
1�9 No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
$1 No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
® No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
[� No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
Q9 No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No _'NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[P No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
q No
[:1 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
E] 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
[P 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
[9 No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
[5 No
❑ NA
❑ NE
Additional Comments and/or.Drawings:
jj
Page 3 of 3 �i�612128104

Type of Visit 4D Compliance Inspection 0 Operation Review 0 Structure Evaluation O Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: L2�" Arrival Time: Departure Time: County:50.k= 0-%c.) Region: rP—O
I
Farm Name: ° � N w rs � t� Owner Email:
Owner Name: wr } i_t s tN_av_r c,N Phone:
Mailing Address: oSi(/G as'3f
Physical Address:
Facility Contact:
"ritie:
Onsite Representative:—,Q�zc�9�Ct1��r�orrc:�
Certified Operator: __ f _ ur_t..3.7 6 Arr v
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
`i6iher
❑ Other
Phone No:
Integrator: I.Repr?.fj�&L .�b,slk
Operator Certification Number: .2 (. P4� p
Back-up Certification Number:
=O =1 g ❑o=, �«
Latitude: Longitude:
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
w I i Layer I I --d
i I JLJ Non -La er
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ TurkeyPoults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation'?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dai a Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocket
❑ Beef Feeder
❑ Beef Brood Cow
Number of Structures:
b. Did the discharge reach waters of the State? (Ifyes, notify DWQ)
c. What is the estimated vokume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If ves, 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 IG No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
[X No
❑ NA
❑ NE
❑ Yes
UqNo
❑ NA
❑ NE
12/28/04 Continued

Facility Number: — ,-,'r
rmG,
1 Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
❑ No
❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: i
5-'l3 S Spillway?:
Designed Freeboard (in): J y "
Observed Freeboard (in): ') i
5. Are there any immediate threats to the integrity of any of the structures observed'?
❑ Yes
No
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed
❑ Yes
N No
❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
M Yes
N No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
[9 No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
[& No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No
❑ NA ❑ NE
mai ntenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes]
No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu,
Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) A,-,rn,clop, /74.c4, s,r,.1ti
13. Soil type(s) "19
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
R No
❑ NA ❑ NE
15. Does the receiving crop arid/or land application site need improvement?
® Yes
❑ No
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination%❑
Yes
© No
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
m No
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[X] No
❑ NA ❑ NE
COC, Fe_j , 4-j Se:t z/�.—+r1 lilay p r J
$Ohn +y PO VC.j7 ie, C0"1f-r d-3
/�S= ,C3Gr,n,.�a �crs weet o„J �,�+ 11 h �i J-1
ReviewerAnspector Name ,,, t r2poc.; ' � �'. ? " y Phone
•
Reviewer/inspector Signature: Date: •
12/28/04 Continued

Facility Nuinber: ,� —st1' Date of Inspection Oy o
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ? [--]Yes ❑ No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [JI No [:INA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists
❑ Design El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ® Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ® Monthly and l" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge'?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge`?
27. Did the facility fail to secure a phosphonis loss assessment (PLAT) certification?
Other issues
28. Were any additional problems noted which cause non-compliance ol'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 wore higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern'?
]f 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 Pennit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
❑ No
® NA
❑ NE
❑ Yes
❑ No
❑ NA
® NE
❑ Yes
❑ No
❑ NA
N NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes ❑ No ❑ NA ZINE
❑Yes
No
El NA
El NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
[ No
❑ NA
[:1 NE
❑ Yes
E ] No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
Adydihnn'i 6mm'en6 and/or Drawings:
O v� O -i O r ri--•a �C f�J �O P a J <-Cg 6
`C"q%
ra c,. n -l- p v-e_r it re��; r� i n '� n 1 l `^� S hc�;C 1 tiJsP�c-�
� '� �' � c G h�'t tr � W G-.► -� � f r cn� n-. G +�'�' S Y S r c w. -
I a.
12/28/04

f
Type of Visit GeCompliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit & utine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number
Date of Visit: 1 r� Time: : b O
�'
=Not erational O Below Threshold
�'ermitted 0frtified 13 Conditionally Certified Q Registered Date Last Operated or Above Threshold: .........................
FarmName: ........%%b��.` ..W.... u................................................................................. County:...... Set'' p5*""","**",*..,"",*,,*,,***" ,,*.-----,'-'-
Owner
.........,'. '...
Owner Name: ....vt S...... ?!?...... "1................................................................. Phone No:.... 910 at..37..—..6(e........................................
Mailing Address; ....! 6 °r�....�T h^......Sri'" "L' !..... :................................ - .... .. _-... ��.as°! . ........................,............... IP
Facility Contact: ....5.,r!!�l`.}t`5.....i/..%am!.'............................ Title:.. .........H`... Phone No:...................................................
1�
Onsite Representative:. �Q....1!.'e�^"q.��........................................................... Integrator: ....�tY.wi�cr..,......�..`!."^�..............................
r
Certified Operator:-........CVAJi.s......... .......................................................... Operator Certification Number: .................................... _....
Location of Farm:
wine ❑ Poultry ❑ Cattle ❑ Horse Latitude �• �' ��� Longitude �• �' �«
llt r`'Ca" aci Po' ul hon' '' +C
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?
❑ Dairy .
'E ❑ Non -Dairy
gn€Capacity
Total ssLW '
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
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
Identifier: ................................... ......................................................
Freeboard (inches):
12112103
Current E
op ulation
°1
I !.
❑ Yes 9'No
❑ Yes Coo
❑ Yes WHO
❑ Yes
» L
❑ Yes
G3"No
j Wean to Feeder T7
6 7 570
;' i ❑ Layer
❑ Feeder to Finish
❑ Non Layer
[] Farrow to Wean
�;!s:�i .. _<:. r, , t , . , +I: • I ,
r :,, I ..:,
❑ Other
❑Farrow to Feeder
❑ Farrow to Finish
ll Sf,iS3£iii£ f�f
' ;= i
fi
Total Desi
❑ GiltsI
❑ Boars
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?
❑ Dairy .
'E ❑ Non -Dairy
gn€Capacity
Total ssLW '
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
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
Identifier: ................................... ......................................................
Freeboard (inches):
12112103
Current E
op ulation
°1
I !.
❑ Yes 9'No
❑ Yes Coo
❑ Yes WHO
❑ Yes
❑ No
❑ Yes
G3"No
❑ Yes
[jrNo
❑ Yes Q'No
Structure 6
Continued

Fac' 'ty Number:
Date of Inspection
S. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
b. 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?
1 I . 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
13. Do the receiving crops differ with thod 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 tissues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge actor below
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours?
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional
Air Quality representative immediately.
❑ Yes 2140
❑ Yes [j'No
❑ Yes ER No
❑ Yes [a'No
❑ Yes P No
❑ Yes EkNo
❑ Yes [i IKO
❑ Yes lifNo
❑ Yes � f7 No
❑ Yes RrNo
❑ Yes O No
❑ Yes �No
❑ Yes Sno
❑ Yes 21�o
❑ Yes ❑ No
❑ Yes j�No
❑ Yes Zfio
+u+sr:{-'tu;.rsata.l,n.,.,,:isEr'a:r,n .91: s ;n+;r,s f .-}L'IY sR:i w.:.b,.:N!.1.!7L< l;.,..�! C1M 9r; : .:-..s.L:,dr-.L,.. •V. .!, 1 E...,:: z ..;, r .,::r;s :_i .iiI1M>
Comments.0" et to question #) i:Explatn any,YE&answers and/or.anyirecommendatsons,ar,'an othercommeats.
TV,'?, til; 4"/41 rl .Sil.€. �. s ++ktau�8f1 "itNw+ is + !^ YY i+��, :" r °i+ iiY,i�ifi li'�t'i ''%°'!Mtiill. l9ifil srl:jsM�,��+�, ' •=:w: �+� r �'y .�i +:
{Use drawing.of faciity,to better:ezplam situations{use additional pages as necessary)
,, , N. �� teld Copy ❑ Final Nates
{?�! �i.r,1��'�'�'' �t, }�l��(�'E. i'sj�� i .: Al it, rte{ 4' -ttt�� ,tJ�'� ry,{�I, r
i!H'!�rl�.E�s�iU??V.?��tla{�Ilii{.�iN�:r�. �HItL�Nfilis.�airF'ix., ,.trt�r:e€{�istA.:ei'tY!wliihtLtO�tia�n�tr���d>r!r�t?�:v'�:n,•esr..,,Jl.i."
A,
€ jt "�j" ,,,,.c � ,; s "Ifl "tM ,,�`�j� ', .11'y 1 ! 4...,�... Ii ! „;t q,,' 31, �1y f
jS'
Reviewer/Inspector Name i1 1 tali.1€ti?d,f
7 ,l .n7..F.:r11�+I.
Reviewer/Inspector Signature: Date:
12112103 6.11
Continued

Facility Number: q a _ g Date of Inspection 1 O
Required Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes O No
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 [�No
23. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes RfNo
❑ 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
[ No
25.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
ONo
26.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
[ 'No
27.
Did Reviewer/Inspector fail to discuss review/inspection with on-site representative?
❑ Yes
VNo
28.
Does facility require a follow-up visit by same agency?
❑ Yes
[ No
29.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
["No
NPDES Permitted Facilities
30.
Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
❑ Yes
ErNo
31.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
32.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ No
33.
Did the facility fail to conduct an annual sludge survey?
❑ Yes
❑ No
34. Did the facility fail to calibrate waste application equipment? ❑ Yes [:]No
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After 1 " Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
t' r }Itk•l. I I�t. i% tS.'�i4 all -' }.�'li j ''_ � �N. } f �{� 1. ��r U _ _t�} Yi �.�}Im. ! i �`YiH'.x., - p --. i £'!: } ! 1 Fe x iiC F{!7'. '!'F' N H "! 3'F"} i. i- I .'h3 .}I.
ddrttVnal((��1�13�1Vi14J ""W"'Di"" l�awt�^¢Sr. . k. p5 )� 1{g d L} :} 1 rhi3 IU i ��f ; 1`t jir {pj 1S f}Ij3 }` I I }. ]f� 'i£k �< 1 ! 4, . t i 3 d'. [} �1}.i SIt. �! }) 1 . F 5 }
r j3. �: 4 . V � ry5. 1 i )��i._�_F�i (333 t- fl. -f t 1 a " 1 'e,t�}[{H���i1�i{ T1"�1 ;,TVi} y'�}at�,."ii liFris �S}f F4 } (. 3`S� 4 !� i tiipy��'3 } }ii- ;- f -.8 "V3 > �} i (iil � lF'€q1 - it(} rR.ji$E Fj$ - i3 f: frW.
_V.[3r!'ii'j'}1,i,.f3F1'1ji:)F&'T73!'.F7'il'.1iIi7191„Ao.ofgfj..dllFRl.;;F$:Efi}.��.Titi.3..it43�iiI IimL.,,i.��.LS13.i�i!}::-lw.E..�.{;>a.Nre3ffii„3
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12112103

Site Requires Immediate Attention:
Facility No. E�- B
DIVISION OF ENVIRONMENTAL MANAGEMEN7
AND AL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: g 1 i —,1995
Time:IV . "5-�
Farm Narne/OWner:
T D >h 1 On E �(Ly-V
.' rsesy
lvla'1' Address 11�U 5 GdSh�r hu+rc� [�� h4w n G+roU�, !')C. a YZ66
1 Iltg
County: s0.rn Spry
Integrator. Phone: cl lO-,SS y -O�l S
On Site Representative: •, , �o� t- Phone: -C) t
Physical Address/Location: — 3 h,e„ M .lit/._ _ t�� - Cp 1' c�en, v�+, S.R
r73 I
Type of Operation: Swine nut • Poultry &ttic
Design Capacity: 3��y Number of Animals on Site: S4.t
DEM Certification Number: ACE. . DEM Certification Number. ACNEW.
Latitude _' c _,• Longitude "��' , ,' �Q,"
Circle Yes or No
Does the Animal Waste Lagoon hav sufficient freeboard of I Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches) Yes r No Actual Freeboard: . a Ft. Q Inches
Was any seepage observed from the lagoon(s)? Yes o No as any erosion observed? Yes or�
Is adequate land available for spray? Ye r No Is the cover crop adequate? Yes or of
Crop(s) being utilized: • N -ro �� R T�
Does the facility meet SCS minimurn setback criteria? 200 Feet from Dwellings? Ye or -No
100 Feet from Wells'(Y� or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or 9
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes No
Is animal waste discharged into waters of the state by man-made ditch, gushing system, or other
similar man-made devices? Yes o(F)If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? Yes or No
Additional Comments:
VA �c.rn
Inspector Name
cc: Facility Assessment Unit
0
o
Signature
c_ c_ r E__ Cr
Use Attachments if Needed.

REGISTRATION FORM FOR ANIMAL FEEDLOT OPERATIONS
Department of Environment, Health and Natural Resources
Division of Environmental Management r
water Quality Section
if the animal waste management system for
your feedlot operation
is
designed to serve more than or
equal to
100 head
of cattle,
75
horses, 250 swine, 1,000 sheep,
or 30,000
birds that
are served
by
a liquid waste system, then this
form must
be filled
out and mailed
by December 31, 11093 pursuant to
15A NCAC
2H.0217 (c)
in order to
be
deemed permitted by DEM. Please print clearly,
Farm Name : _ 3ch,re--�oot NVV'S—Z.r.V _.__ T Q M— . !0t
Ma i Ling address
County:
Owner (s) Name: Lacrg R.Tay --
manager (s) Name
Lessee Name:
Farm Location (Be as specific as possible: road names, direction,
milepost, etc.): __ 3 w,� les _-1�1'�r� u.e st' o f G,:re,llz Ova
Latitude/Longitude if known: Q R6 P # %,S -la -;Z!i-'Zo
Design capacity of animal waste management system (Number and type
of confined animal (s)) : .51. 0_ 4,e __ Llo Fr-je"-
Averarge animal population on the farm (Number and type of animal (s)
raised) .. xl `y to h ".�U"ia i'o Ee t.,-
Year Production Began:__l 43 L ASCS Tract No.: r�
Type of Waste Management System Used: oo
Acres Available for Land Application of waste:
Owner (s) Signature (s)
f DATE:
71