820065_INSPECTIONS_20171231

NUH I H UAHULINA
Department of Environmental Qua
II

visRon of Water Resources
Facility Number - © Division of Snil and Water Conservation
[� 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 0 Denied Access
Date of Visit: Arrival Time: U, Departure Time: County: ��Zegion: F�
Farm Name: h1 `q/ Owner Email:
Owner Name: }��,i-� /Y�GG� .. Phone:
Mailing Address:
Physical Address:
Facility Contact: 17le &=Z Title: Q1Ur12°� Phone:
�
Onsite Representative: Integrator: f3 �yt�
Certified Operator: Certification Number: 222—,2 ?%
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
w,�
1�,31
�fl'llni�,n FYI I'. tl .:I.
�I -, .. •-
Design Currep#
�� "
Design. Currents ,'
#
I wl"' 7i1F1 '�Ip'I I��' •-
3'y� Design Current
Swine
Capacity Pop.
�wi 114r i Po W Iq
Wet Poultry Capacity Pop'
I4
Gattle ;, Capacity Pop.
wh,IlaKw„a11"
Dairy Cow
Wean to Finish
$
Layer
Wean to Feeder
G►�
Non —Layer
Dairy Calf
Feeder to Finish
Design Current
Dairy Heifer
Farrow to Wean
Dry Cow
Farrow to Feeder
D , P,oult , Ca aci Po .
La ers
Non -Dairy
Farrow to Finish
Beef Stocker
Gilts
Layers
Beef Feeder
w
Boars
Pullets
Beef Brood Cow
Turke s
5 ,...
Other F
F
II
Turkex Poults
Other
Other
'�'`
Discharges and Stream Impacts
I. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
[:]Yes
No
❑ NA
❑ NE
❑ YesFT-No
❑ NA
❑ NE
Page I of 3 21412015 Continued

lFacility Humber. - Date of Ins ection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes to ❑ 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 El"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 t eat, 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 L3-Ko ❑ 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 0-'No ❑ NA ❑ NE
maintenance or improvement?
I l . Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes 2-Ko ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ heavy Metals (Cu, Zn, etc.)
❑ PAN [] PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ` [] Evidence of Wind Drift /❑ Application Outside of Approved Area
12. Crop Type(s): C'/L IG�' fTr /��l�r5C1.�z-
13. Soil Type(s): li
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[allo
❑ 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
❑`1\ o
❑ 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
to
❑ NA
D NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[nNo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
to
❑ 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 E3<o ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis [:]Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking [:]Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [DNo ❑ NA ❑ NE
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facili Number: _ Date of Inspection: d�
24. Did the facility fail to calibrate waste application equipment as required by the permit? �❑ Yes [lN ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes E 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 EKO ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [:]Yes [-No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
❑ Yes [] No
❑ Yes [D No
❑NA ❑NE
❑ NA ❑ NE
❑ Yes D"No ❑ NA ❑ NE
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. ❑ Yes [TNo
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes E] N
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes [EtNo
34. Does the facility require a follow-up visit by the same agency? ❑ Yes [4-Nff
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of faeiiity to better explain situations (nse additional Pales as -necessary)• °" " ," ' a
Reviewer/Inspector Name:
Reviewer/inspector Signature:
Page 3 of 3
Phone: �— p j i✓1S�
Date:r
21412015

.� - '�-is i z �/
ivision of Water Resources
Facility Number ®- %ps' Nw0itv,
ision of Sail and Water Conservation
er Agency
Type of Visit: ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: tine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: ' O Departure Time: ! a County: Region:
.19V
Farm Name: Owner Email:
Owner Name: c k !�G L�rarb Phone:
Mailing Address:
Physical Address:
Facility Contact:Title: Phone:
Onsite Representative: �Sd Integrator:.���
Certified Operator: j Certification Number:
Back-up Operator:
Certification Number:
Location of Farm: Latitude: Longitude:
Design Current
Design Current
Design Current
Swine Capacity Pap.
Wet Poultry Capacity Pop.
Cattle Capacity Pop.
Wean to Finish
Layer
Dairy Cow
Wean to Feeder
]Non -Layer
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design Current
Dry Cow
Farrow to Feeder
Dr. Point , Ca aci P.o
Non-Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
113eef Feeder
jj�
Boars
Pullets
lReefHrootlCou,
Turkeys
Other
TurkeyPoults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (if yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes No ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes No
[] Yes ® No
❑NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 21412015 Continued

iFaciUty Number: - (i Date of inspection: —
6 —
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
•
❑ Yes
� No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):�
5. Are there any immediate threats to the integrity of any of the structures observed?
[:]Yes
U 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
allo
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
Callo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
allo
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
[a No
❑ NA
❑ NE
maintenance or improvement?
Application
_Waste
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[gNo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes jKLNo ❑ NA
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs_ ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): P �/ru��, �1�yfjr�s ��c: c az `911 / FSGLA Ic
13. Soil Type(s): /VpITO/fC /-^—
❑ NE
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
E] 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
M No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
® No
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements []Other-.
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ZLNo
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute inspections ❑ Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? [:)Yes allo
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ® No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facility Number. - Date of Ins ection: /
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes allo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [Z No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey [] Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes ® No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes 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 MNo ❑ 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 0 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 [E[ 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 [allo ❑ NA ❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessarv).
Reviewer/Inspector Name
Phone: %'%�'��J ��✓��
Reviewer/Inspector Signature:
Page 3 of 3
Date: ��b —_-,;I 7
21412015

(Type of Visit: j&-Complian Inspection O Operation Review p Structure Evaluation Q Technical Assistance
Reason for Visit: outia ne O Complaint O Follow-up Q Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: a'% Departure Time: / ? V E County: -
Farm Name: s/yt. alms Owner Email: —
Owner Name: —,'zr /''G!�-n� Phone:
Mailing Address:
Physical Address:
Facility Contact: �j-/�fC �%'�G`,� Title: �'� �! Phone:
Onsite Representative:
Certified Operator: ��-�—
Back-up Operator:
Location of Farm:
Latitude:
Region: /�FQ
Integrator:
Certification Number: /9`9-
.��T�
Certification Number:
Longitude:
�-
Design
Current
Design
Current
Design Current
Swine ,. ;_ .
Capacity
Pop.
Wet Poultry
Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
Layer
INon-Layer
I
Dai Cow
90
Wean to Feeder tirDO
-7Up
11
alf
Feeder to Finish
Design
Current
Dai Heifer
Farrow to Wean
Dry Cow
Farrow to Feeder
D , P,oul , -A,,Ca
aci
P.o .
Non -Dairy
Layers
I
Farrow to Finish
113eef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
r,
Turkeys
Other�
Turkey Poults
Other
gElOther
Discharges and Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
[:]Yes O No [:]NA ❑ NE
❑ Yes ❑ No 0 NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWR) ❑ Yes ❑ No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? [:]Yes [!j,No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters [-]Yes Wo ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3
21412014 Continued

Facility Number: - Date of Ins ection: — 6
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes E�J_No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes [) No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 7
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
S No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
Q 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
CEJNo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
0 No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
E. No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
allo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land'application? If yes, check the appropriate box below. ❑ Yes [allo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): Gf�/r't /K�S �4J%d���s /r/`x�-p/.�/ 4—rjLrSGG/
13. Soil Type(s): lLV
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? Elyes ❑ No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes Cg No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
CZ No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
allo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[, 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 K71 No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking [] Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
22, Did the facility fail to install and maintain a rain gauge? ❑ Yes � No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes MA
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
DNA ❑NE
Page 2 of 3 21412014 Continued

Facility Number: - Date of Inspection: — 7
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes 0,No ❑ NA ❑ NE
L 25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes allo ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes [S No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes allo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
[!I 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
CE� No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
®, No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
Callo
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32_ Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
� No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
0 No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
allo
❑ NA
❑ NE
Comments (refer to question ft Explain any YES answer.sland/or any additional recomthendatiions or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signatur
Page 3 of 3
Phone:
Date: ILI" �C�l
21412015

Type of Visit: O'Cozoutine
nee Inspection U Operation Review U Structure Evaluation Q Technical Assistance
Reason for Visit: 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: / / Arrival Time: Departure Time: County: Region:
Farm Name: Owner Email: �^
Owner Name: l"� L /01d Phone
Mailing Address:
Physical Address:
Facility Contact: ��tle: 4!fj��j2r./! Phone:
Onsite Representative: Integrator: ,Piers.
Certified Operator: Certification Number: 95y 3
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current
Swine Ca aci Po
p ty P•
Wean to Finish
Wean to Feeder
Feeder to Finish j
Farrow to Wean
Farrow to Feeder
Design Current
Wet Poul Capacity Pop.
�y
Design Current
Cattle Capacity M Pop.
JLayer
iNon-La er I
D , P,oult a a i l;o
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non-Dai
Farrow to Finish
Layers
Beef Stocker
Gilts
Non-Laye
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Turkeys
Turkey Poults
Other LjOther
Discharves and Stream Imuacts
1. Is any discharge observed from any part of the operation? ❑ Yes allo ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR) ❑ Yes ❑ No ❑ 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)
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
❑ Yes No
❑ Yes No
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3
21412014 Continued

Facili Number: - r Date of Ins ection:
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
Identifier:
❑ NA ❑ NE
❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):�
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes PF�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 allo ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
0 No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
allo
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
Z No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
D No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [:]Yes E,No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Cr/op Window❑`Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): e.Or'"K A/4i�/[ A/_g1.1d�._1_.1r / /xe,_071-4 /�vz�5j L'r�`�5,11 }-
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 S 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
E4 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
LZ 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:
2) . Does record keeping need improvement? If yes, check the appropriate box below. [-]Yes LKNo
❑ 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 [a No
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

F'acili Number; - Date of Ins ection:�5-
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes C&No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [&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 D§ No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes EZ No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
[0 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
[O 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
Eg 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
5� No
❑ NA
❑ NE
33. Did the Reviewer/lnspector 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
S No
❑ NA
❑ NE
Comments (refer to.question #-): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawines of facility to better explain situations (use additional Daecs as necessarv).
Reviewer/inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date: -- f 3��
21412011

Ej
(Type of Visit: -O Co nce Inspection U Operation Review O Structure Evaluation Q Technical Assistance I
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Fq- _ D� fl Arrival Time: Departure Time: .13'A County: Sary��•Y
Farm Name: �►n J�6trms Owner Email:
Owner Name: !xr`��_ �-� %%%., ,, Phone:
Mailing Address:
Physical Address:
Region: tzo
Facility Contact: Oe-/_ Title: 9T-2�
Onsite Representative: ,Si�z._ p , Integrator: Ir-17
Certified Operator: Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
.Delia Current d ` DesCurent
IM��
Design Current
Swi p �* Ma _A
ne Capacity PoWet Poultry'' CapacrFop.
Cattle
Capacity Pop.
Wean to Finish
Layer
DairyCow
Wean to Feeder
o
I
Non -La er
DairyCalf
Feeder to Finish
gm i _
DairyHeifer
Farrow to Wean
2
" Design*Current
D Cow
Farrow to Feeder
-.
tDrPoul Ca ce �.Po
Non -Dairy
_
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
_
`
Turkeys
Other - _ _ �_...�- �
-
TurkeyPuults
Other
Other
Discharf!es and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes ®.No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes ❑ No
[:]Yes 6 No
❑ Yes [a No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 21412011 Continued

Facili Number: - Date of Inspection: D
` Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [ '1Qo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): r `3-
Observed Freeboard (in): 3y
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
Q o
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
EJ 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
�o
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[3-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
EflVo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[]-1l0
❑ 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 0 PAN 7 10% or 10 lbs. ❑"Total Phosphorus [] Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence/of Wind Drift
j [] Application Outside of Approved Area
12. Crop Types):
13_ Soil Types):
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ Yes
Ej-<
❑ NA
❑ NE
❑ Yes
C]_�No
❑ NA
❑ NE
❑ Yes
[3-<
❑ NA
❑ NE
❑ Yes [J-No ❑ NA ❑ NE
❑ Yes [D'1io ❑ NA ❑ NE
❑ Yes E]_'No ❑ NA ❑ NE
❑ Yes [-No ❑ NA ❑ NE
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [TN-o
❑ 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 ErNo
23_ If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [ No
❑ NA ❑ NE
[] Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

[Facility Number: - (� Date of ins ection: a i
{ 24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [7 No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes Q No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes io
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes E No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ Yes hJ "o [DNA ❑ NE
❑ Yes [f No ❑ NA ❑ NE
❑ Yes [3-No ❑ NA ❑ NE
❑ Yes [J fro ❑ NA ❑ NE
❑ Yes Savo
[:]Yes QNo
0 Yes E:t�o
❑ NA ❑ NE
❑NA ❑NE
❑NA ❑NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date: n',R-0 Jy
21412011

Type of Visit: Q Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: Q Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: 1_611 i Arrival Time: Departure Time: 5 County: �� Region: Fko
Farm Name: J5 M fblmS _ Owner Email:
Owner Name: N-e—k Me-[ftn b Phone:
Mailing Address:
Physical Address: aS jv{ i-' jYS 1,(l�t,e QSf Iro
Facility Contact: L b Title: Phone:
Onsite Representative: 1. oy L Q-W/1 �IC L6,1 b Integrator: �(r''7 pq to
Certified Operator: %QJft( HcL66, h Certification Number: islog
Back-up Operator: I8jtlrLOA h Certification Number: Is qOQ
Location of Farm:
Latitude:
Longitude:
ds
11111111111 LJJ�DHiggCu�"rrent nt
we�Pop � Wet�Poul�tryry Gapactty .Pop.
Design Current
Cattle Capacity Pop.
o Finish
La er
Dai Cow
o Feeder
g
Non -La er
Da' Calf
to Finish
Design Curre..nt
D , P2oul Ca aci P.o
DaHeifer
to Wean
to Feeder
rGilts
D Cow
Non -Dairy
to Finish
La ers
Beef Stocker
Non -La ers
Beef Feeder
ti
Pullets
Beef Brood Co-,
Other
Turke s
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 observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes [allo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
CR'No
❑ NA
❑ NE
Page I of 3 21412011 Continued

Facili umber; - Date of Ins ection: �
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Spillway?:
No ❑ NA ❑ NE
❑ No ❑ NA ❑ NE
Structure 6
Designed Freeboard (in): R v
Observed Freeboard (in): 3'5— —
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
®No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
E�"No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
[:]Yes
CR No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
[:]Yes
C'No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
[>�rNo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10, Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
C'No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [:]Yes & No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop
11Window
��``'� ❑ Evidence of Wind Drift 0 Application Outside of Approved Area
12. Crop Type(s): kv iLJ f 0skle C , Lv = -S-44 A _
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
U�'No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
CErNo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
CR No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
allo
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [`Xi�No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
s❑ 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 C'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
[N'NA ❑ NE
Page 2 of 3 21412011 Continued

Wacility Number: - Date of Insp ectian:
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 allo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No &I NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes [S No ❑ NA ❑ NE
❑ Yes C�TNo ❑ NA ❑ NE
❑ Yes U No ❑ NA ❑ NE
❑ Yes
ER No
❑ NA
❑ NE
❑ Yes
&'No
❑ NA
❑ NE
❑ Yes
CR No
❑ NA
❑ NE
❑ Yes
CK'No
❑ NA
❑ NE
Comments (refer to question # ): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
?, SMa1l a��fc le��cc- �y�l why �+ ���d�� r fo4S ladLr,�-
p2'w
X'j
Ram ol- re(Wr are wo ym.
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: C1j"'�,y_ 3_—M
Date: H&TA
21412011

No
tj
-3 lid 1,
Facil ii,
a
N' me, Da
Permit
:U:
01C NPDES(Rainbreaker- PLAT. ,i'Annual Cert DailyPipe)
FB Des
7
mum
M�
M01
"1811
J104120
wwdu
La don Name-Sfb
1
2
3
4
5
6
71.
Design'Fre;6b'paM."/Ust.RbbordW (in)
Sludge
A
Sludoe Dej)th!'(ftj11*�,'N1'Nfl
P
Liquid Trt.
Ratio S udge tb':T e r1i 6 ht'WIUM&
if> 0.45
Date'f; ufof-W 0 . TiOl[;MWIMA-?"�
77777,7.
Soil Test Da Crop Yield ull Transfer Sheets
pH Fields, i;gi[A 1;: Wettable' Acres! ✓ RAIN GAUGE [#VW�
WUP
7�7
Lime Dead box or incinerator
Lime Applied1 I Weekly Freeboard Mortality Records
Cu-I
4 f.
11 1 in Inspections, -1 Check Lists
120 min Insp. Needs :i lil N Storm Water
S7S7- ill 1 .1.1 1 is 4.1
Nppdr. P � I a IF 111 1 1 'Waather Codes
IMMMM
111MMUS
-107MEMMM
�MHMWMIH�
0
M
M
EAU I
M
I -ply!
Verify PkJONE]NUh
Date lastwt) ll"i F'',
Date last wor., a fi
App.Haiidw6
Conversion-!QU1
;ij
S
dailiations
FRO or Fairm Records
Lagoon#
Top Dike
Pump
Stop
N
Start Pump
1
8 Ib`/ Z.fi-I
3000= 213 lblac
i) IV-

_ bi�•ision of Water Quality
FactlityN�mber ®- COr ®Division of Soil and Water Conservation
•Q Other Agency
Type of Visit: f5Compliance Inspection 0 Operation Review Q Structure Evaluation 0 Technical Assistance
Reason for Visit: (2F Routine 0 Complaint O Follow-up 0 Referral 0 Emergency Q Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: ,(� County: Spl►t J
Farm Name:_HcLo,mb 15( TrG Owner Email:
Owner Name: L ofr -t [" 1�CLa b Phone:
Mailing Address:
Physical Address: )V J
Region:
Facility Contact: . a C b Title: 16•-6 Wr -, r Phone:
Onsite Representative: Lb_q.LO/N H[,",b integrator:
Certified Operator: I&V Certification Number: Ig qo$
Back-up Operator: 640— MGLarlb Certification Number: I$ qoq
Location of Farm:
Latitude:
Longitude:
Design Current
- • P ty P
WeantoFinish Ca aci Po WU roultry
LayerDai
Design Current Design Current
Capacity Pap. Cattle Capacity Pap.
Cow
Wean to Feeder
ygoo
3!?%
Non -La cr
Dai Calf
Feeder to Finish
°
D . P.oult ,
Design Current
@a achy P,o .
airy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Dry Cow
Non -Dairy
Layers
Beef Stocker
Gilts
Non -La ers
1pullets
Turkeys
Turkey Poults
Beef Feeder
Beef Brood Cow
Boars
MGM dmmi _.
Other
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
® No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a_ Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
[] No
❑ NA
❑ NE
c- What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (if yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
n No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
& No
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 21412011 Continued

Facility Number: ea jDate of Inspection: a
--Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate'?
❑ Yes
f'No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): _ q _
Observed Freeboard (in): _3
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
f'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
CkNo
❑ 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
J'No
❑ NA
0 NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
r'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
PSL-No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
GJ7No
❑ NA
❑ NE
maintenance or improvement'?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
t$j"No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application
Outside of Approved Area
12, Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP7
❑ Yes
�?No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
CffNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
G�r No
❑ NA
0 NE
acres determination?
17_ Does the facility lack adequate acreage for land application?
❑ Yes
M No
❑ NA
❑ NE
18_ is there a lack of properly operating waste application equipment'?
❑ Yes
�No
❑ NA
❑ NE
Required Records & Documents
19_ Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
CR`No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWM P readily available? If yes, check
❑ Yes
r5a'1Vo
❑ 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 I'No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and l" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [WNo
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
rS�NA ❑ NE
Page 2 of 3 21412011 Continued

[Facility Number: $ - Date of Inspection: 3
—24. Did the facility fail to calibrate waste application equipment as required by the permit'? ❑ Yes E,:JNo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [5;t'No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification'?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern'?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit'? (i_e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility'? I f ycs, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewerllnspector fail to discuss review/inspection with an on -site representative'?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
5�7No
❑ NA
❑ NE
❑ Yes
❑ No
[5�NA
❑ NE
❑ Yes
kNo
❑ NA
❑ NE
❑ Yes allo ❑ NA ❑ NE
❑ Yes [allo ❑ NA 0 NE
❑Yes (2No ❑NA ❑NE
[:]Yes [�rNo
❑ Yes tffNo
❑ Yes MNo
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
ne4_ fo call bole- Wyw- ord,
7, SM q[I br-e 5f 0-alta, r (hte tM6 leaks When
©Il�Qakt.'ofsoO f� ref ace w44 Ckaj6^ *eSo) . �- o0 1u�0�+ covPr
Is 6 �oA sho ff, 6oad h o4
Retadrod fwr In j00�sly fe. Eim doff nofy-mf rnvc/.
Reviewer/Inspector Name:
Reviewer/inspector Signature:
Page 3 of 3
Phone: 107g33-33 DO
Date: 0
21412011

Facility No. <:,;D"tarFarm Name Mct6�,?b r,►VJ� Date 3f
Permit `r COC `f OIC c- NPDES (Rainbreaker PLAT Annual Cert )
FS
Drops
Lagoon
1
2
3
4
5
6
7
Spillway
Design freeboard
Observed freeboard in
Sludge Survey Date
Id
Sludge Depth ft
Liquid Trt_ Zone ft
Ratio Sludge to Treatment Volume
,
Calibration Date
1
2
3
4
5
6
7
8
Design Flow
�?f0
Actual Flow
()
7r
Design Width
Actual Width
R (� ���lj��Pit ✓ A/& 1v o, R(
Soil Test Date Wettable Acresl/_ RAIN GAUGE
pH Fields WUP ✓ %�f Dead box or incinerator
Lime Needed D,3 Weekly Freeboard �� Mortality Records
Lime Applied 1 in Inspections o/
Cu-I �lZn-I 120 min Insp.
Needs P ✓ Weather Code
Crop Yield Transfer Sheets n ��
.Waste AnalTs-WsDate
Pull/Field
Pull/Field
Soil
Crop
Acres
PAN
Window
Max Rate
Max Amt
{'
A
119
&-, L ei
M,
1'
5-0
-Na
3
N�
�W Go t
Verify PHONE NUMBERS and affiliations
Date last WUP FRO SI los Date last WUP at farm Sor�p_
FRO or Farm Records
Lagoon #
Top Dike
L,1$10
Stop Pump
41.
4b3 I ���
Start Pump
Conversion-
Cu-1 3000= 108 Iblac; Zn-I 3000= 213 Iblac
App. Hardware

F
\)v)
' - Division of Water Quality
Facility Numbeonservation
® Other Agency
Type of Visit: (5 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: (5Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit:
-J Arrival Time: $'
Departure Time:
County: go&VjO)
Farm Name: HL
LAM}
blm-7heri lry--
Owner Email:
Owner Name:
Phone:
Mailing Address:
Physical Address: 9r W111,04►i L41.'P � 44
Region: 2D
Facility Contact: I-Atfl( ML Lj* �7 Title: Oyyt7e-l- Phone:
'' -- r�ay Nc tm O
Onsite Representative: U H(Ja" 1 Integrator: ptei'"ldaP
Certified Operator: Ldenw NddiiU Certification Number:
Back-up Operator: W&_ Hcla b _ Certification Number: 146 Lod
Location of Farm: Latitude: Longitude:
+ Design Current
Swine x, Capacity Pop.
6Design Current
Wet Poultry Capacity Pop.
Design Current
Cattle Capacity Pop.
W4±an to Finish
La er
Dairy Cow
to Feeder
L�
Non -Layer
Dairy Calf
Dai Heifer
N'
Fccder to Finish
Design Current
Dr, IPoultr Ca aci PO; .
Farrow to Wean
Farrow to Feeder
Dry Cow
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Othcr
Turkeys
- -
I
Turkey Poults
10ther
Discharees and Stream ImDAetS
] . Es any discharge observed from any part of the operation?
❑ Yes
t@ No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
n No
0 NA
0 NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

' Facility NNumberDate of Inspection:
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
❑ No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat,
notify DWQ
7. Do anv ol'the structures need maintenance or improvement?
CR 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
0 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
tR No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application
Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the
W MP?
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?
❑ Yes
[g No
❑ NA
❑ NE
[:]Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes No
❑ Yes No
❑ Yes L No
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ® No
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps [:]Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment'? ❑ Yes ❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ NA
❑ NE
❑NA
❑NE
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
C'NA ❑ NE
Page 2 of 3 21412011 Continued

Facilihy Number: - (pj 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
2T Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes ❑ No
NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes J)_� No
❑ NA ❑ NE
and report mortality rates that were higher than normal?
24. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes 5a 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 15�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
C'No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CA WM P?
❑ Yes
N 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
CRNo
❑ NA
❑ NE
snts.(re, er to que
� , rb fsoj I wo f- pput 6n I ayco, Coy; a I � t�+. BG--e qoa Cre siv-�)
y
�� d�ur�� 1�Pa �- � � Cow rid V "A
_
is , pay f wery a r s r[ ylAc� ri Ith C i m maro? i n a i�2 Av9 L),`t~,
word o Ji- srtldy� '� sfdray� �o co ��x�s�+�ye ss ove .
� y
h�21 i aI)Iig1r4 --por11', 0 nd�90A recor .
r�o�e-his I-ev dve-io& Watlyr,
Reviewer/Inspector Name: Too, Skhn-pi-er
Reviewer/Inspector Signature: �(&� 4' ,(Q,-
Page 3 of 3
Phone: 9[ 0— q�-333 { Q1(_9
Date -SA ); J 0 JL
21412011

Facility No. 7(,1T Farm Name NC�dnb rvDihe`� Date bD
Permit COC `f OIC_ NPDES (Rainbreaker PLAT Annual Cert )
M-MM
FB
Drops
Lagoon
FB
Drops
Lagoon
1
2
3
4
5
6
7
Spillway
Design freeboard
Observed freeboard in
Sludge Survey Date
r
Sludge Depth ft
Liquid Trt. Zone (ft),
Ratio Sludge to Treatment Volume
Calibration Date
Design Flow
0 Mom- '
s'"ila��-------
Soil Test Date 0
pH Fields
Lime Needed
Lime Applied
Cu-I Zn-I ti0Q /4
Needs P
Wettable Acres `g (,o
WUP
Weekly Freeboard ✓
1 in Inspections
120 min Insp.
Weather Codes
RAIN GAUGE
Dead box or incinerator
Mortality Records
Waste Analysis Date
. 000 _
_
lW�ri�
f
�-
MA FMWM�
Verify PHONE NUMBERS and affiliations
Date last WU P FRO Date last WUP at farm
511im �rislQr
FRO or Farm Records
Lagoon #
Top Dike
Stop Pump
Start Pump
Conversion- Cu-I 3000= 108 Ib/ac; Zn-I 3000= 213 Ib/ac
App. Hardware

Type of Visit 0-Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit § Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: Arrival Time: .r Departure Time: ib2tt lCounty: So" � q
aVj
Farm Name: hUOol ? �r �/' Owner Email:
Owner Name: I 4alrLiL_L(i►'l�? Phone:
Mailing Address:
Region: Fkc)
Physical Address:
Facility Contact: aT(q HLLa,.nb Title: OW Phone No: 30.5-7 q7 _
OnsiteRepresentative: 1 It1T U& _ HcLa ib 'CQ' QWf 19t _ Integrator: ReJ1&j2,e
Certified Operator: Larf ` Mc � _ Operator Certification Number: IT Lto25
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: [= o [= , = « Longitude: = ° = 4 ❑
gg
Desiglllln - Current
Design Current
ign Current
Swine Capacity _
Pyapulation
Wet Poultry
Capacity Population
CattleEDes
apacity Population
❑ Wean to Finish
❑ La er
❑Dai Caw
Wean to Feeder 1 4S Q
❑Non -La er I
I❑Dai
Calf
❑ Feeder to Finish
Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
❑ La ers
❑ Beef Stocker
❑ Gilts
❑Non -La ers
❑Beef Feeder
El Boars
❑ Pullets
❑ Beef Brood Cowl
❑ Turkeys
Other
❑ Other
❑ Turkey Poults
❑ Other
I
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes t"No ❑ NA ❑ NE
❑ Yes
[--]No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
[--]Yes
❑ No
❑ Yes 5�No
❑ Yes CR No
❑ NA ❑ NE
El NA El NE
12128104 Continued

Facility Number: %. —(, Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes tj�No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Struchure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 4�
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[RNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
IgNo ❑ 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
5'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
Wo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
PNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
JRNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn,
etc.)
[--]PAN ❑ PAN > 10% or 10 lbs [:]Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of WindDrift❑ ApplicationOutside of Area
12. Crop types) &ti VVN& ,Soy :7t'Lhj '. t ood a) I7 t'rn„ /1 RQ&v q we -
Fe 4_
PoA&e
13. Soil type(s) � r Is 1 ' 1 fb
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
Callo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
iR No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
[,;R No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
PNo
❑ 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):
t IO -� 5-
ReviewerfInspector Name Lj 0,kJ Phone: l Q�Ly�3�AI�C33'
Reviewer/Inspector Signature: Date: WVM
Page 2 of 3 U 12/28/04 - Continued

Facility Number: ��—(�;'j' Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes [5kNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes tgNo ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. 5'Yes ❑ No ❑ NA ❑ NE
5rWaste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes C'No ❑ NA ❑ NE
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No E)-kNA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
C;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
Igio
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
L5kNA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
9No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
N.No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
CRNo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
�R No
❑ NA
❑ NE
General Permit? (iel discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
J�tNo
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
5INo
❑ NA
❑ NE
V J
Q, ri or k an a dew be'-2 sfo'% a,'l , JPPj_s0 -top�, S or
S 'i 4 rAulck � use okQ r� h � rnv� '„ l
�} (;)-F q aUabf�2_
p�Aje v3e, curr-en+ wi t? I,eve (s of re(o�d1
�l�_ojt- hare_ ca I', br o,) oik Svdie s'urve d o2 � end eta%cetnber.,
60A records 0V Well
C
of c. back q -�b'm iw d - I n
12128104

Faf,ility No�3 �' Farm Name H4tdMb &Q+n1f _ Date
Permit COC OIC ✓ NPDES {Rainbreaker
L
PLAT Annual Cert }
Lagoon
1
21
4
5
6
7
Spillway
Design freeboard
Observed freeboard in
Sludge Survey Date
Sludge Depth ft
3
Liquid Trt. Zane ft
4
Ratio Sludge to Treatment Volume
,
Design Wi.1�----�-�
Actual
Soil Test Date[}
pH Fields
�`
Lime Needed
Lime Applied
Cu-I ��
Zn I
Needs P�
Wettable Acres
WUP ✓
Weekly Freeboard
1 in Inspections
120 min Insp.
Weather Codes
L.rop Yieia i ransrer aneeis
Waste Analysis Date
-60Day
+ 60 Da
N Amt. (Ib/1000 Gal) 11 1 i, 1 i_ u
RAIN GAUGE
Dead box or incinerator
Mortality Records
..
..
Verify PHONE NUMBERS and affiliations
Date last WUP FRO Date last WUP at farm
FRO or Farm Records
Lagoon #
Top Dike
Stop Pump
Start Pump
Conversion- Cu-1 3000= 108 Ib/ac; Zn-I 3000= 213 Ib/ac
k ro'e vo &ow; Ad
App. Hardware
�
1prrr Cell
qr (9 .-3o5-,7y7y

'&r S i0 -07-z60 7
799
eililv'i'sion of Water Quality
Facility Number 102 (p 5 O Division of Soil and Water Conservation
0 Other Agency
Type of Visit (3-to-mpliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit &F routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: /S 09 Arrival Time: !Z'r0 Departure'rime: ��� County: So oiV Region:
Farm Name: I C iP/0 — Gs �/LCS�d Owner Email:
Owner Name: /jyC/a•5rz A!5�pS-y am' Phone:
.1&
Mailing Address:
Physical Address:
Facility Contact: 86ty'J. "LK Title: % r * Phone No:
Onsite Representative: Integrator: C6 k,
g I�rL / Y
f�Nr_/G.-. ,Q-w.4 i 5�
Certified Operator: 4,ar Operator Certification Number: wd zZl3 /
d lLfc���.-�.h
Back-up Operator: ,�i.J t-- Back-up Certification Number: AW,4 iIr
Location of Farm: Latitude: = O = 6 [= Longitude: O n 0 i =
di
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Other
❑ Other
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
4 BAD 1 0 ti I ❑Non -La ei
Dry Poultry
❑
Lavers
❑
Non -Layers
❑
Pullets
❑
Turkeys
❑
Turkey Poults
❑
Other
Dischames & 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?
.1�
Design-::,,. Current:';'
Cattle Capacity Populatiow
❑ Dairy Cow
1
1..
❑ Dairy Calf
❑ Dairy Heifei
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocket
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d_ Does discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
El NA
[:1 NE
El Yes
❑No
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
12128104 Continued

Facility Number:
Date of Inspection
Waste Collection & Treatment
4_ Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
OrNo ❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
BNo ❑ NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 2 ,�
5. Are there any immediate threats to the integrity of any of the structures observed'?
❑ Yes
2<o ❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
ElYes
�
3 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 ET
No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes [f N ❑ 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 El Yes [No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10_ Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 0<0 ❑ 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) //r/V — t'J4 ��7� — so Z., .4S rrtc� d c- lC ��{ t�� 'A e5,wG . Sru, r= •:•r CO, S_
13. Soil type(s) /1 ,9 r-,Q f k fiJ4J_,l ' -a
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
15. Does the receiving crop and/or land application site need improvement? ❑ Yes
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ Yes
d❑ N A
�7NgElNA
No ❑ NA
N;21*,El
❑ NA
NA
❑ NE
❑ NE
❑ NE
❑ NE
❑ NE
Comments (refer to,gnestion #): 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):
ReviewerAnspector Name r'C y Q,u'� Phone: 9r�. 3 - j7
_
Reviewer/Inspector Signature: Date: y—/S -Zd0 D
Page 2 of 3 12128104 Continued

Facility Number: 82 -� 5 Date of Inspection -JS-
Reguu-ed Records & Documents
19_ Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes to ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes L4110 ❑ NA ❑ NE
the appropiiate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
No ❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V
Rain Inspections ❑ Weather
Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
No ❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
do ❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
WO ❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit? ❑ Yes B o ❑ NA ❑ NE
26. Did the facility fail to have an actively certified operator in charge? ❑ Yes 0 <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?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
Comments and/or Drawings:
El Yes
BNo
El NA
El NE
❑ Yes
2 No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
ElYes
No
❑ NA
❑ NE
12128104

6/z9/08 a—
ivision of Water Quality
Facility Number �Z �S 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: g /2',-49 Arrival Time: %2t%S Departure "Time: Z; j�Q County: S?K- 3-ar.I Region: f,R®
Farm Name: NC1aw1(Q gr Owner Email:
Owner Name: /rr C/'' Ej Phone:
Mailing Address:
Physical Address:
Facility Contact: Cu,*--A s ( rt,sic.l- Title: - �ideL Phone No:
Onsite Representative: COP- ?5- Integrator: CC ZQ i-k L
Certified Operator:
Back-up Operator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: = o = I E] 11 Longitude: = ° =
Design Current Destgn Current ! Design Current
Swine CapacityFopulat.on Wet Poultry Capacity Population �,Csttle Capacity Population
❑ can to Finish ❑ Layer ❑Dai Cow
P
Wean to Feeder Q0 S' Z ❑ Non -Layer
❑Dai
Calf
• Feeder to Finish, '`"
❑ Farrow to Wean Dry PoultryZL��5
DairyHeifer
El
Cow
❑
Non -Dairy
❑ Farrow to Feeder
= ❑ Layers
❑
Beef Stocker
❑ Farrow to Finish
❑ Gilts ❑ Non -Layers
❑Beef
Feeder
❑Pullets
oars
❑
Beef Brood Co
Br
.:. „ ., . ,.... ❑ Turkey
.
❑keys
Othe ur Poults
Number of+Structures: !
❑ Other ❑Other
;.
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made'?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes CI No ❑ NA ❑ NE
❑ Yes
[3<o
❑ NA
❑ NE
❑ Yes
❑ No
D' A
❑ NE
LSivA
❑ NE
❑ Yes
❑ No
❑ Yes
[ k<
0 NA
❑ NE
❑ Yes
E I'No ❑ NA
❑ NE
Page I of 3 12128104 Continued

Facility Number: Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
El Yes
�,/
❑ NA
El NE
a. If yes, is waste level into the structural freeboard?
El Yes
,ETNNo
L[' No
❑ NA
❑ NE
Structure i Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
j�
Observed Freeboard (in): 7
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
2<o
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
Q No
❑ NA
❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? El Yes ET/NNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? El Yes 0 o ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ETNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
maintenance/improvement?
❑ Yes D o ❑ NA ❑ NE
11. is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes Ell�o ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) CC7K�A/ . fJJ k er,� t $p y 6�s�I-Mu da i.�
AA
13. Soil type(s) XD H AA-8 4o
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ Yes
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
17. Does the facility lack adequate acreage for land application'? ❑ Yes
18. Is there a lack of properly operating waste application equipment? ❑ Yes
[TNNo ElNA
2<0 ❑ NA
[] No ❑ NA
[No El NA No ❑ NA
❑ NE
❑ NE
❑ NE
❑ NE
❑ 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):
V
Reviewer/Inspector Name :e- -,, Phone: �l� 5�3� • 330
Reviewer/inspector Signature: Date: 7 %Z -?0D 8
Page 2 of 3 12128104 Continued

Facility Number: Date of inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes Q No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check [--]Yes B No ❑ NA ❑ NE
the appropiate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other //
21. Does record keeping need improvement? If yes, check the appropriate box below. El Yes B No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
ElNA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
ElYes
_2<o
[13 o
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
El NA
El NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
El Yes
,�<
oo
El NA
El NE
26.
Did the facility fail to have an actively certified operator in charge?
El Yes
,,L�_,f
o
❑ NA
❑ NE
27_
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
El Yes
,I
[? o
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
LYNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
D o
❑ 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
D o
❑ 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
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
,
L9'No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
0'No ❑ NA
❑ NE
Additional Comments and/or Drawings:
12128104

9-28-67 RR_
Facility Number
® Division of Water Quality
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: Arrival Time: ;O Departure Time: ,'ZS` County: o t% XdA1 Region:
Farm Name: /v`cIa .BYaAP, V-C ZAIC, 1 Owner Email:
Owner Name: Thn fim.5 /KZ,4a ,,6 Phone:
Mailing Address:
Physical Address:
Facility Contact: COV-k5 8nrult e_I[ Title: • 2,111 J , Phone No:
Onsite Representative: /34 k 1,11 c oe _ Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Far -row to Finish
Gilts
Boars
Other
❑ Other
Operator Certification Number:
Back-up Certification Number:
Latitude: = o ='
[:�] Longitude: = o ='
=
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
_ ❑ Layer
41YOD 1-6190 ❑ Non -La et
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation'?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Cattle
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifei
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocket
❑ Beef Feeder
10
Beef Brood Co
Number of Structures:
b. Did the discharge reach waters of the State" (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation`?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes q No ❑ NA ❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
No
❑ Yes
[�f] No
❑ NA
❑ NE
❑ Yes
[� No
❑ NA
❑ NE
12128104 Continued

w
Facility Number: $� — �OS Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
❑ Yes ;X No ❑ NA ❑ NE
❑ Yes (9No ❑ NA ❑ NE
Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in).
Observed Freeboard (in): 2-7
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
W[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
W 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
ID 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
rVb No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No
❑ NA
❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
WNo
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[:]PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drill ❑ Application Outside of Area
12. Crop type(s) C S e rx� �►
5
►'tv ✓fDJ� r ~�
13. Soil type(s) _11DA- Ws
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[A No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
P 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
[4 No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
i
Reviewer/Inspector Name WLY_ F e-v e-LS Phone: 2tO - Y33 0
Reviewer/I nspector Signature:9AL-�.ra.�� Date: 2 - z ] — Z O0 7
12128104 Continuer!

Facility Number: Date of Inspection — z 7 -0 7
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes [A 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 El 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 (1No ❑ 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
P9 No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
WNo
❑ 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
�4 No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
B 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
;M 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
ff No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
RNo
❑ NA
❑ NE
Comments and/or Drawings:
12128104

Type of Visit 0 Compliance Inspection CV Operation Review V Structure Evaluation U Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: County: 5S4_
Farm Name: %Zj= Ldrs__ti.t, L� vc,�t �r� TIC _ Owner Email:
Owner Name: TL. i3„t,.z,� __ Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone No:
Onsite Representative: _ 4 5 E, a rt_w_t <<K _ Integrator: cn �k tri .t _
Certified Operator:
Back-up Operator:
Location of Farm:
Design Current
Swine Capacity Population
❑ Wean to Finish
Wean to Feeder r O
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Operator Certification ;dumber:
Back-up Certification number:
Region: _-e�
Latitude: ❑ o ❑ [� Longitude: ❑ o ❑
Design Current
Wet Poultry Capacity Population
❑ Layer
❑ Non -La et
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Dischar1jes R Stream Impacts
1. Is any discharge observed from any part of the operation'?
Discharge originated at: ❑ Structure ❑ Application Field ElOther
a. Was the conveyance man-made?
Design Cor'rei
Cattle Capacity Pupuliti
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures: ;
I
b. Did the discharge reach waters of the State? (If yes. noti ly 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 ® No ❑ NA ❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
® No
❑ Yes
[P No
❑ NA
❑ NE
❑ Yes
[P No
❑ NA
❑ NE
12128104 Continued

r�
Facility Number: $2 — 495
Date of Inspection
Waste Collection Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I
Identifier:
Structure 2 Structure 3 Structure 4
Spillway?:
rl
Designed Freeboard (in): q
e
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage. etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes X No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes ® No ❑ NA ❑ NE
❑ Yes 4 No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ® No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ® No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes JR No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ® No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes X 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) Coo- ,i - ►- ('1i-a
13. Soil type(s) /�py, , %a� Q r _ _ _ — -• — —
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [X No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [A 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
[3No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes
W No
❑ NA
❑ NE
Comments (refer to question #): Explain_any YES answers and/or any recommendations or any othieebminents.
Use drawings of facility to better explain situations. (use additional pages -as necessary):
Reviewer/Inspector Name r� e.��' �� �. Phone:
Reviewer/Inspector Signature: Date: p 5 -O/ - ZOD (n
12128104 Continued

Facility Number: Date of Inspection aYE —Q
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes JYNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes CA No ❑ NA ❑ NE
the appropirate box. [:1 WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 0 No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes 'No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ® No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit'?
[:]Yes
❑ No
(ZNA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
® No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
® No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
N No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
N No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
9K No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
® No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
® No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative'?
❑ Yes
® No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
W No
❑ NA
❑ NE
12128104

i
-- — M
ivision of Water Qualityj—_Factlity Number S ��vision of Soil and Water Conservationther Agency
Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit ® Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: % O j Arrival Time: Departure Time: County: �Sa f. nscii4 Region:
Farm Name: _ ��a dC2e_L,, r.LC.. _ Owner Email:
Owner Name: % Li D M Q 3 Phone:
Mailing Address: 31 � P, n a__ Fof
Physical Address: _&✓1 1,1r a_�1 __ J, L
Facility Contact:
Title:
Onsite Representative: �i.�%s,L�� , s., < < l�
Certified Operator: d 1'1'iL a
Back-up Operator:
Location of Farm:
Design Current
Swine Capacity Population
❑ Wean to Finish
® Wean to Feeder
e
7G3
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Phone No:
Integrator: o h A, 1 ff
Operator Certification Number: 24:2 13
Back-up Certification Number:
Latitude: [= 0 01 ❑ Longitude: = ° ❑ 6
Design Current
Wet Poultry Capacity Population
❑ Layer
❑ Non -La et
Dry Poultry
❑ Layers
❑ Non -Lavers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure El Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑
Dairy Cow
71
❑
Dairy Calf
❑
Daia Heifei
❑
Dry Cow
❑
Non -Dairy
❑
Beef Stocket
❑
Beef Feeder
❑
Beef Brood Cowl
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 [ja No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
V No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NF
12128104 Continued

i
Facility Number: Z — Date of Inspection 3Ts' / a3"
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes [,A 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 ❑ Maps ❑ Desi ❑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 ElStocking VU Crop Yield ❑ 120 Minute Inspections [X Monthly and I" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ 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
X NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
® No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ NA
NNE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
ERNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
® No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
❑ No
❑ NA
❑ NE
[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
❑ 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
® No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
0 No
❑ NA
❑ NE
Additional Comments and/or Drawings:.
Plen.'r- QppY:;.:tSL
Ir�l
1m o •. k-1-, 1� a a- 1 C a.� -� v rL � cr c1... �- t�lr.�. c_ YL �ti
r a r�
12128104

Facility Number: ,Z— �� Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate'?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in)_ o?[j •{' 4/ % A
Observed Freeboard (in): 9 �'
❑ Yes [M No ❑ NA ❑ NE
❑ Yes [D No ❑ NA ❑ NE
Structure 5 Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes ® No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ® No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
® No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
® No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[Z No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
[U 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 ❑ Evid_ence of Wind Drift ❑ Application Outside of Area
12. Croptype(s) ��v, soc, rcu.A-0"'-14 •c���.+]� 5 CUB c�my—Rk
gt_azc--Q,.
Fe. -ic,Lc
13. Soil type(s) /Vo 14 A/. t6
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
[9 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
9 No
❑ NA ❑ NE
Comments {refer to gpesaon.� Explarn an
Coenmewin of facility to bet#er Explain
situ YES ,answers and/or any -recommendations or any other comments.
drawings ty ations..(use additional pages as necessary): ?,
Reviewer/Inspector Name .,[Q � a � ; Phone: TIa d04 /:F±Z
Reviewer/Inspector Signature: Date:
1 1 12128104 Continued

Mac (of Visit:-=F-f-�i=--s-� Timc: a b
Facilin� dumber � Da
hot O erational 0 Below Threshold
0 Permitted C/� eyr�tified M ConditionaIly Certified 0 Reggistered Date Last Operated above Threshold:
!'�
Farm lame: ��� County:
/
Owner Name: /'brM� � "4It'-L Phone No:
Mailing Address: J� 1v r,-,e &rr5'� f�_•. _ RVqLOOa /Y O g D ap.
Facility Contact: i L - Title: Phone No:
Onsite Representative: �uri5 ��-w;G _ __ Integrator:
Certified Operator:
Location of Farm:
Operator Certification Number:
❑ Swine D Poultry ❑ Cattle ❑Horse Latitude ' = Longitude ' �• ��
Design Current
Swine C'anaciry Ponulation
lean to Feeder
D o
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Number of Lagoons
Holding Ponds / Solid Traps
Design Current Design Current
Poultry Ca acitti Population Cattle Ca acitV Po ulation
❑ Laver I 1 10 Dairy I I —::::d
❑ Non -Laver I I ILI Nor, -Dairy
❑ Other
Total Design Capacity
Total SSLW
Discharges S Stream Impacts
1. Is any discharge observed from any part of the operation?
P
Dischame originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify. DWQ)
c. If discharge is observed.what is the estimated flow in eallmin?
d. Does discharge bypass a lagoon system? (If ves, notify DWQ)
2. Is there evidence of past discharge from any parr of the operation?
3. Were there anv adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste ollection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Freeboard (inches): i.Je 5
05103101
J Spray Field Area
❑ Yes
L}<vo
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
DAo
❑ Yes
E1W
❑ Yes
[g o
Structure 6
Continued

AL 4
Facility Number: ? —
Date of Inspection pa`1
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(if any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvemcnt?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11_ Is there evidence gf over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
12_ Crop type *%C A C. , t,�ct T , (brrl
❑ Yes Fa No
❑ Yes [--] No
❑ Yes �D-No LI
❑ Yes No
❑ Yes E! No
❑ Yes ❑.#ti"
❑ Yes [94�ii
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes CQ-Ia
14. a) Does the facility lack adequate acreage for land application? ❑ Yes D-No—
b) Does the facility need a wettable acre determination? ❑ Yes E No
c) This facility is pended for a wettable acre determination? ❑ Yes [5<o
15. Does the receiving crop need improvement? ❑ Yes 044o
16.
Is there a lack of adequate waste application equipment?
❑ Yes
Required Records & Documents
17.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
[9'110
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
❑-1�0_
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
Q'go
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
�
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
[}lam
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
No
23.
Did Reviewer/lnspector fail to discuss review/inspection with on -site representative?
El
�
G3w
24.
Does facility require a follow-up visit by same agency?
❑ Yes
[9,90
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
ff No
© No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Comments (refer to question # ): Explain any YES answers and/or any recommendations or any other comments.
Use driwings of facility to better explain situations. (use additional pages as necessary): Feld Copy ❑ Final Notes
"foil � twL-L C. t/� .n &6 a�IrpGt
if
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Reviewer/Inspector Name
Reviewer/Inspector Signature: Date: o-qa O
05103101 U Continued

1
Site Requires Immediate Attention: tr?
Facility No. aZ . Cos'
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: -1 z-Q 1995
Time: Z so
Farm Name/Owner: �w �•� re'tt,«r s
Mailing Address:_ 31X V! b n. z$3$Z
County: 5(-knnw o,►, - -
Integrator: CAPhone: 55-Z_- o\�S
On Site Representative: Phone: SG-1 - 2\45 z
Physical Address/Location: _ W , ll ,..,��. lr.�c �. - S la- kL i-7 G Ej&ram *«-K
Type of Operation: Swine Poultry Cattle
Design Capacity: R8ao Number of Animals on Site: k$ao A1.,.cse ry
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: Longitude: "
Circle Yes or No
Does the Animal Waste Lagoon tLu sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches)( Ye or No ual Freeboard: Z Ft. Inches
Was any seepage observed from the 1 n(s)? Yes r No as any erosion observed? Yes or No
Is adequate land available for spray? Ye or No Is th over crop adequate? Yes or No
Crop(s) being utilized:
<1 .,y __ l
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwell' Yes r No
100 Feet from Wells. Y o
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes o
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line: Yes or No
Is animal waste discharged into water astate by man-made ditch, flushing system, or other
similar man-made devices? Yes oQ4o 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: -Z. 3 t dd, s
1 %L,4A
M.O... C_t \.JCr
Inspector Name
cc: Facility Assessment Unit
Signature
Use Attachments if Needed.
\'

REGISTRATION FORM FOR AbrINAL FEEDLOT OPERATIONS
Department of Environment, Health and Natural Resources
Division of Environmental Management
Water Quality Section
I; 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 sheen, or 30,000 birds that are served by
a liquid waste system, then this form must be filled out and mailed
by December 31, 1993 pursuant to 15A NCAC 2H.0217 (c) in order to be
deemed permitted by DEM. Please print clearly.
- Farm Name:
Mailing Ad
Owner (s) Name: Iri C'/17 4
Manager (s) Name: S
Lessee Name:
Farm Location (Be as specific as possib1��Y`oad names, di ctionti,
m,} GnosL,. etc ) i�! !1 ;et "t-5 �� e. '7 (f fi'1RV0-0 r nff M ► 1,
C
Latitude/Longitude if known:
Design capacity of animal,y� aste manage. :fit system Number and type
of confined animal (s) ) l�LL 1^St✓rtl )a s " �, goo
Average animal opulation TJ
he farm (Nu ' er and type of animal (s)
-raised) ,TnL'r 5►
Year Production Began: I9J13) ASCS Tract No.:
Type of Waste Management System Used: -7-rr 6n
Acres Available for Land
Owner (s) Signature (s) ;
9'�-
ligation of Wa te:
23 DATE: la - I/7
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