820086_INSPECTIONS_20171231

NORTH CAROLINA
�J
Department of Environmental Qual
II

i ype or v isit. %&.; ommpuance inspection V vperatnon Keview lJ arructure Evatuanon V i ecnmcai Assistance
E
Reason for Visit: Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: _%, w Arrival Time: Departure Time: County -,Ca S apt Region: /`-1
Farm Name: , �`aY`�^'LS Owner Email: --
Owner Name: J t/ �- 1�t t. �t+ b Phone:
Mailing Address:
Physical Address:
Facility Contact: CU.gl 1 f Gaai " Title: Phone:
Onsite Representative: L i Integrator:
Certified Operator: 4; ry 6--A
Back-up Operator:
Location of Farm:
Latitude:
Certification Number: T'T Z Z CS
Certification Number:
Longitude:
Design Current
Design
Current
Design Current
Swine
Capacity Pop.
Wet Poultry
Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
La er
Dairy Cow
Wean to Feeder
Non -Layer
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
D . PTu'l
Ca aci
P,oP.
INon-Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
III -
Turk e s
Other
Turkey Poults
Other
I 10ther
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes [-i o� ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? [—]Yes [:]No Q-i ❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWR)
❑ Yes
❑ No
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
❑ No A
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
C3,i ❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
E3>6' ❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412015 Continued

Facili Number: - jDate of Inspection:
Waste Collection & Treatment
4. Is storaZ-e capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
NA
❑ NE
a. If yes, is waste level into the structural freeboard'?
❑ Yes
❑ No
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
1
Observed Freeboard (in): Z' i
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
t''lq_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
CZJ_N f
❑ 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
S
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
©-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
,�
I �1,--�J o
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[34o
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? if yes, check the appropriate box below_ ❑ Yes o ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): C
13. Soil Type(s): Llk Dv vp�r -1-0 ✓�
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
FC a
❑ 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
[:Do
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
ElYes
[Zjbie
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[t]>o-
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below_ ❑ Yes ©-N'6 ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 " Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [`�No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes �To ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

lFacility Number: - Pf Date of Inspection: ;-_A/
24'Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes Eq-156 ❑ NA ❑ NE
25. Is the out of compliance with permit conditions related to sludge? if yes, check ❑ Yes U 1To ❑ 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? 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
10
❑ NA
❑ NE
❑ Yes
[].X6
❑ NA
❑ NE
❑ Yes
[g-No
❑ NA
❑ NE
❑ Yes NA ❑ NE
❑ Yes ['�fo ❑ NA ❑ NE
❑ Yes [D'No ❑ NA ❑ NE
❑ Yes
E2
❑ Yes
D O
❑ Yes
E?qo
❑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).
ry 1 �'� s - ! L s'I� �'ti-su -- /I - a y-- 17
: I c7o
Reviewer/Inspector Name: 11; t 1I Dp
Reviewer/Inspector Signature: ".
Page 3 of 3
Phone. - 43 3 3 3 y
Date:
21412015

(Type of Visit: t-Compliance Inspection Q Operation Renew(-) Structure EvaluationO Technical Assistance I
Reason for Visit: Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: f�j {�yr j / Arrival Time , Oa Departure Time: County: Region: C LW
Farm Name: ' — rot s_- Owner Email:
Owner Name: 1E.] Ga� Phone:
Mailing Address:
Physical Address:
Facility Contact: �?��-u•6 Title: {�
Onsite Representative:
to
Certified Operator: t2j e- �f p
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator: W1
Certification Number: /ef - 13 z
Certification Number:
Longitude:
DexignCurren#DeStgn
ri
Current
MMENEW9Wean
Design Current
Swine Capacity" -Pop.
t
Wet P try CanaciiiV66 :1'opry
oul
Cattle Capacity Pop.
Wean to Finish
La er
DairyCow
to Feeder
on -Layer
Dairy Calf
Feeder to Finish
(p
�* "
DesgnCirtent ';'
Dairy Heifer
Farrow to Wean
D Cow
Farrow to Feeder
D . Poultry Cap` ci Poi
Layers
Non-I.a ers
Non-DaILY
Farrow to Finish
Beef Stocker
Gilts
Beef Feeder
El Boars
Pullets
Turkeys
Beef Brood Cow
a
Other =`a
-
TurkeyPoultsr
Other
Other
Disebames and Stream Impacts
1. 1s any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other.
a. Was the cotiveyance 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? (ifves, 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 EaN"- ❑ NA ❑ NE
❑ Yes
❑ No
[ A
❑ NE
❑ Yes
❑ No
=A
❑ NE
❑ Yes ❑ No LrJ 'vt' ❑ NE
❑ Yes [ 7No ❑ NA ❑ NE
❑ Yes E!I—No ❑ NA ❑ NE
Page I of 3 21412015 Continued

44'
Facil!,q Number: Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes g-N-6 ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 7/' V
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
❑ Yes g�'No ❑ NA ❑ NE
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes [71 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 [DTo ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes [3'�Io ❑ 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 [3"No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes �o ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [.]'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): A -g,6 D C 6Cjg
13. Soil Type(s): fA
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
I(Q'"o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[! l o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
�o
❑ NA
❑ NE
acres determination'?
17. Does the facility lack adequate acreage for land application?
❑ Yes
iff"No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
E:�No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the 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
[211sio
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other.
21. Does record keeping need improvement? if yes, check the appropriate box below. ❑ Yes dNo
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis [:]Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑Stocking [:]Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 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 ff No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑ NA ❑ NE
Page 2 of 21412015 Continued

Facility Number: - Date of Ins ection:
24_ Did the facility fail to calibrate waste application equipment as required by the permit? tl❑ Yes E&<o
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [3:: o
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 2g-Ko
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes CD -No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
Reviewer/Inspector Signatur
Page 3 of 3
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
[] Yes [DNe ❑ NA ❑ NE
❑Yes L�N0_ ❑NA ❑NE
[:]Yes �- ❑ NA ❑ NE
❑ Yes [,ll<% ❑ NA ❑ NE
❑ Yes �o
❑ Yes [ *'50
[:]Yes D<o
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Date•
214 015

(Type of Visit: Q-Compliance Inspection O Operation Review 0 Structure Evaluation O Technical Assistance I
Reason for Visit: routine 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 Name:-
Mailing Address:
Physical Address:
Facility Contact:
G� �i►!.{J� Title:
Onsite Representative: ? ~�
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Owner Email:
Phone:
Integrator:
Phone:
,q,13 _S
Certification Number:
Certification Number:
Longitude:
Design Current
Design
Current Design Current
Swine Capacity Pop:
Wet Poultry
Capacity
Pop
Cattle Capacity Pop.
Wean to Finish
La er
Dairy Cow
Wean to Feeder
Non -La er
Dairy Calf
Feeder to Finish ro
"
Dairy Heifer
Farrow to Wean
Design
Cprrent
Dry Cow
Farrow to Feeder
D . P,oultE.
Ca aci
Po :'
Non-Dai
Farrow to Finish
La ers
Beef Stocker
Gilts
on -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turke s
Other
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
❑ Yes [ r5o Q NA ❑ NE
a. Was the conveyance man-made? [:]Yes []No []rVA ❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWQ) [:]Yes ❑ No ETNA ❑ 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 [2 No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters [:]Yes dNo ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

Fac itity Number: - Date of Inspection:
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
❑NA ❑NE
❑No � ❑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 Ug-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 [61 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
�To
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
❑14o
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
[.]0No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
Ef No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
EfNo
❑ NA
❑ NE
❑ Excessive Ponding 0 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 ❑ Evidence of Wind Drift ❑lA,pplication Outside of Approved Area
Wind"%owl,,
12. Crop Type(s): Cat ct[,dU', S`&
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
[:]Yes
[;Jol o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑o<o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
[;J.4o
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[ZW10
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[ r o
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
Quo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
ErNo
❑ 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 Ej.1qo
❑ 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 21<0
❑ NA ❑ NE
[] Weather Code
❑ Sludge Survey
❑ NA ❑ NE
0 NA ❑ NE
Page 2 of 3 21412014 Continued

Facility Nember: - Date of Inspection:
24.�Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [�io ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes To ❑ 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 _L2--f4o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [3"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
L2'&o
❑ 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
[;3"rNo
❑ 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
[?rNo
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
0 Yes
Q'Ffo
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
[ZNo
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
❑'1\io
❑ NA
❑ NE
Comments ref r to -question ft Explain any YES answers and/or any additional recommendations or.: any other coitaments. ki=
Use drawin(seii
g_ f facility to better explain situations (use additional pages es necessary).
C
(L{d` Sl Le/
Cj6 "r -tb
k "' A'-_' 60
F-tee
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
U
Phone: 1 ,33 3
Date: A
2✓412011

i ype of visit: �m ance Inspection U Operation Review Q 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: Arrival Time: Departure Time: County: (�dm
Farm Name: �] L PIK- lti Owner Email:
r�
Owner Name: {tom Phone:
Mailing Address:
Physical Address:
Regiodf
Facility Contact: —S -fir. �Qc%Gvi Title: Phone:
Onsite Representative: _ Integrator: ilf /3
Certified Operator: �A_elll ca w- Certification Number: r f 1.3 L
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design Current
_ Design
Current
Design Current
Swine Capacity Pop.
Wet Poultry -
C mac ty
Pop.
Cattle Capacity Pop.
Wean to Finish
Wean to Feeder I
Feeder to Finish
Layer
INon-Layer
I,.. '�`
�'
Dai Cow
Dai Calf
Dai heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
D , 1'oultr
Ca aci
P,o
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Beef Brood Cow
Boars
Pullets
Turkeys
_.
Other
Turkey Pouets
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes [picr—❑ NA ❑ NE
❑ Yes
[—]No
aNA
❑ NE
[—]Yes
[:]No
[]-OVA
❑ NE
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
❑ Yes [no
[:]Yes �No
E3'NA [,] NE
❑NA ❑NE
❑ NA ❑ NE
Page I of 3 21412011 Continued

Facili Number: ' - Date of Inspection: 46
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes HFN ❑ 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 I31V O ❑ 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
U'No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
I]'Xu
❑ 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
Q'Na
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
o
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes 040 ❑ 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 �o+f Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): r-'A✓� 0141`] allk G -0 1u is
13. Soil Type(s): cam. I��J`� fir, to
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
��
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[E "o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
1_ _ 11-o
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
Ej<o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[A`N-o—
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[]'96—
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
❑'i o
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑ Checklists [—]Design [:]Maps [:]Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes Q No [DNA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [:3"'No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes Ef No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

f
Fatiliq Number: ' - Date of Ins ection: '
F
24. Did the facility fail to calibrate waste applicarion'equipment as required by the permit?
❑ Yes
2-5-o— ❑ NA
❑ NE
25. is the facility out of compliance with permit conditions related to sludge? If yes, check
[] Yes
Q-1C ❑ 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
B l"o ❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
[:]Yes
[2-N- ❑ 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?
to question # ): Exp
acility to better exp
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
ers and/or any additional
additional pages as neces:
❑ Yes ErNo ❑ NA ❑ NE
❑ Yes [jNo ❑ NA ❑ NE
❑ Yes 0 1"O ❑ NA ❑ NE
❑ Yes ETNo ❑ NA ❑ NE
❑ Yes
[:]�o
❑ NA
❑ NE
❑ Yes
[�No
❑ NA
❑ NE
❑ Yes
[Er'&o
❑ NA
❑ NE
Phone:���
Date:
V412014

type or visit: tUxbmpliance inspection V Operation Review V Structure Evaluation V Technical Assistance
Reason for Visit: outine Q Complaint O Follow-up O Referral O Emergency 0 Other Q Denied Access
Date of Visit: Arrival Time: Departure Time: 1� County:
Farm Name: B4`L�5 _ Owner Email:
Owner Name: LAC_ Phone:
Mailing Address:
Physical Address:
Facility Contact: /'
&.- 415
�Ct�(� [L t Title:
C
Onsite Representative:
it
integrator:
Certified Operator: 9�} �W cei %d'QL[
Back-up Operator:
Location of Farm:
Phone:
`Y " -9
RegioF7F�o
Certification Number: I 0 / 3 2—
Certification Number:
Latitude: Longitude:
estgnCucrent Design �Cgrrent Design Current
Swme j93ctYap _Pop. Wet Poultryd Capacity` Pop -- Cattle Capacity Pop.
Wean to Finish
La er
Dairy Cow
Wean to Feeder
Non -La er
Dairy Calf
Feeder to Finish
Farrow to Wean
VW Desigurrent
D .. P,oul � Ca ci ` ' P,o : "
La ers
Dairy Heifer
Dry Cow
Farrow to Feeder
Non -Dairy
Beef Stocker
Farrow to Finish
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Turke s
Beef Brood Cow
`: `
Other
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
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 tQ-- ❑ NA ❑ NE
❑ Yes o 23-CX- ❑ NE
❑ Yes ❑ No [ A ❑ NE
[-]Yes [-]No
VIVA ❑ NE
[:]Yes o ❑ NA ❑ NE
[]Yes No ❑ NA ❑ NE
Page I of 3 21412011 Continued

[Facility Number: 113ate of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [5-S o�T] NA ❑ NE
a_ If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ETNA ❑ 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 E3-Nu— ❑ 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 Eg rN , ❑r .NI- ❑ 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 25o ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
(not applicable to roofed pits, dry stacks, and/or wet stacks)
❑ Yes g lvO ❑ NA ❑ NE
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 ❑`N—o ❑ NA ❑ NE
maintenance or improvement?
11. is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes JP ❑ 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): oe C—LU 15
13. Soil Type(s): to cltlt j_ Gr' e L
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.
04-1
❑ Yes
o
❑ NA
❑ NE
❑ Yes
�o
❑ NA
❑ NE
❑ Yes
[E"No
❑ NA
❑ NE
❑ Yes
❑ Yes
[- fo
Fn<❑
❑ NA
NA
❑ NE
❑ NE
❑ Yes
❑ Yes
E3 "'o
To
❑ NA
❑ NA
❑ NE
❑ NE
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste 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 ]� ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes rTNo ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facili Number: a I I Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes e'NQ DNA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? if yes, check ❑ Yes L3 io 0 NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
Reviewer/Inspector Name:
❑ Yes ®'Flo ❑ NA ❑ NE
❑ Yes C3' ❑ NA ❑ NE
[:]Yes ZJ go ❑ NA ❑ NE
[:]Yes o ❑ NA ❑ NE
❑ Yes 10 b NA ❑ NE
❑ Yes tf No ❑ NA ❑ NE
❑ Yes
❑ Yes
❑ Yes
[T'No ❑ NA
2_90 ❑ NA
C?Ko ❑ NA
❑ NE
❑ NE
❑ NE
Reviewer/Inspector Signature:
Page 3 of 3

i ype of visit: tYt-ompuance inspection t) uperanon Kevtew V atructure Lvaivation u i eenmcat Assistance I
Reason for Visit: 04outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: y Arrival Time: M Departure Time: /.'/ /t'� County: qtn a Region: f RO
Farm Name: Owner Email:
Owner Name: fy1t jAmbPhone:
Mailing Address:
Physical Address:
Facility Contact: �A't�SgR WIC IC Title:
Onsite Representative:
Certified Operator:_�XATCAItRd 1
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator: M�tta�.r �1i2owa
Certification Number: 1q1,L-1
Certification Number:
Longitude:
01
RIODesign Current; Design
Current
Design Current
Swine s . Capacity Pop. .Wet Eoultry Capacity
Pop.
Cattle
C>apacity Pop.
in to Finish
R
Layer
Dairy Cow
1
in to Feeder
_
Non -La er
Dairy Calf
Feeder to Finish
Oki RO
I(x7
'` ° . Design
Daia Heifer
Farrow to Wean
Current
Dry Cow
Farrow to Feeder
Il > Poult e C$pa ei
P,o
Non -Da'
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Turke s
Beef Brood Cow
Turkey Poults
Other
I
Other
Discharges and Stream Impacts
. 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)
e. 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)
Z. 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 B No ❑ NA ❑ NE
❑ Yes [:]No
❑ Yes ❑ No
❑ Yes
❑ No
❑ Yes
©"No
❑ Yes
ff No
C3NA ❑ NE
[DNA ❑ NE
2"NA ❑ NE
❑NA ❑NE
[] NA ❑ NE
Page I of 3 21412011 Continued

4 1
Facili Number: jDate of Inspection: l�
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
[�yNo ❑ NA ❑ NE
❑ No QNA ❑ NE
Structure 6
Spillway?:
Designed Freeboard (in): i
Observed Freeboard (in): Q>
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes gNo ❑ 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 ff 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 F1 rNo ❑ NA
❑ 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 MNo ❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes [DNo ❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes gNo ❑ 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 Antable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop TYPe(s) g €R1`nvS�P I GR�z� l ! c� _lam_ •1 _003 -- New C�r�en
►.�in�itrt SnvbE ranS . t.> Fie pn+
13. Soil Type(s): '��\\ _ �r Cg�CI f� . �C�O[ec�r�n n?
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [yNo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [yNo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes [gNo ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Reauired Records & Documents
❑ Yes [13No ❑ NA ❑ NE
❑ Yes Ba"No ❑ NA ❑ NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes E:(No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [gNo ❑ NA ❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall O Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [g/No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No NA ❑ NE
Page 2 of 3 21412011 Continued

1
Fa H Number: 75ZN - g Date of Inspection:
I 1
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[]/No
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
M 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
[Vf No
❑ NA [] NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
❑ No
�TA ❑ 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 the 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 [+ (No ❑ NA ❑ NE
❑ Yes [g No ❑ NA ❑ NE
❑ Yes [g No ❑ NA ❑ NE
❑ Yes gNo ❑ NA ❑ NE
❑ Yes D"No
❑ Yes [DINo
❑ Yes [i(No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Reviewer/Inspector Signature: © _ ,� _ Date:
Page 3 of 3 ll-21412011

type of visit: t!7 compliance inspection U Operation Review U Structure Evaluation U 7 echnicat Assistance
Reason for Visit: eyxoutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: -/QIQ County:
Farm Name: LOwner Email:
Owner Name: �I L" Phone:
Mailing Address:
Physical Address:
Region:
Facility Contact: aur4L�L [' Title: Phone:
Onsite Representative: p Integrator:
Certified Operator: � �er�-- 0 r-t-v L Certification Number: 'LI _
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
esign
_. DCurrent_, Design �Cu�rent
w
Design Current
Swinej� Pop. WetiPoultrysCapacitvtPop.
Cattle Capacity Pop.
Wean to Finish La er
Da Cow
Dai Calf
Wean to Feeder
Non -La er
Feeder to Finish
dot
Dai Heifer
Farrow to Wean
r Deng i k'C•urrent
Dry Cow
Farrow to Feeder
D Poult Ca ci Po .
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Beef Brood Cow
Pullets
�t "
Turkeys
Other �y
Turkey Poults
Other
Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a_ Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify 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 2<0 ❑ NA ❑ NE
[]Yes
[:]No
[E'i
❑ NE
[—]Yes
[]No
0�
❑ NE
❑ Yes []No NE
❑ Yes io ❑ NA ❑ NE
❑ Yes [ No ❑ NA ❑ NE
Page I of 3 21412011 Continued

Facility Number: / - Date of Inspection:
Waste Collection & Treatment o�
4" Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 2< ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No 6-4 ❑ NE
Structure i Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes M-< U 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
LvJ o
❑ 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
1EK0
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
B<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
53�'NO
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
[:]Yes
H No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [9-1q"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 Approved Area
12. Crop TYpe(s): _:) / 6��r
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20_ Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ Yes
Q No
❑ NA
❑ NE
❑ Yes
��N
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
E No
❑ NA
❑ NE
❑ Yes
21<o
❑ NA
❑ NE
❑ Yes [.� ❑ NA ❑ NE
[:]Yes ��o❑ NA ❑ NE
❑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 V Rainfall Inspections Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No PA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes [:]No ❑ NE
Page 2 of 3 21412011 Continued

[Facility Number: -I jDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit.
❑ Yes
[tq4o
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
[—]Yes
L`T o
❑ 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
E No
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
❑ No
[t-'NAB ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? if yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
[:]Yes M- o ❑ NA ❑ NE
❑ Yes LB'I"o ❑ NA ❑ NE
❑ Yes [E.18' ❑ NA ❑ NE
❑ Yes ril❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? [:]Yes
Z?-IQo
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes
[a'qo
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency? [:]Yes
U24o
❑ NA
❑ NE
Comments (refer to question #): Explain -any YES answers and/or any additional recommendatronsfor any+other, camni`en"V.
ts.
Use'drawings of facility to better explain.situations:(use additional pages as necessary)..
Reviewer/Inspector
Reviewer/Inspector
Page 3 of 3
Phone:
Date:
IV14120;1

r
Type of Visit (compliance Inspection Q Operation Review O Structure Evaluation Q Technical Assistance
Reason for Visit outine Q Complaint Q Follow up Q Referral Q Emergency Q Other ❑Denied Access
Date of Visit: ZS— /O Arrival Time: 2: 3O •ti I Departure Time: 3�L ' .� County: Region:
Farm Name: L `� ��-- T / Owner Email:
Owner Name: v L 6 Phone:
Mailing Address:
Physical Address:
Facility Contact: ei'V A'S B� , �.�r �� ,rG Title: _ e�i Phone No:
Cr
On site Representative: w(' i-j &"W'yL Integrator: 10 ` &rV_"1jV
Certified Operator:
Back-up Operator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: = n = = u Longitude: = o = 1 = u
Design Current
Design
lgesign Curreu#
Swine Capacity Population
Wet Poultry Capacity Population
Cattle Capacity Population
❑ Wean to Finish
El Dairy
Farrow to Wean
Farrow to Feeder
❑
❑ Farrow to Finish
Gilts
Continued
El Wean to Feeder
Feeder to Finish ODO
Cow
❑ La er
❑ Non -La er Dairy Calf
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation'? ❑Yes 0 No El NA El NE
Discharge originated at: El Structure El Application Field El Other
a. Was the conveyance man-made? El Yes [I No ElNo ,❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) [I Yes El No LQ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)? ,�,�
d. Does discharge bypass the waste management system? (If yes, notify DWQ) ❑Yes ❑ No L7 NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑Sk�o Yes I ❑ NA ❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State ❑Yes To ElNA ❑ NE
other than from a discharge?
12/28/04
Cow
❑ La er
❑ Non -La er Dairy Calf
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation'? ❑Yes 0 No El NA El NE
Discharge originated at: El Structure El Application Field El Other
a. Was the conveyance man-made? El Yes [I No ElNo ,❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) [I Yes El No LQ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)? ,�,�
d. Does discharge bypass the waste management system? (If yes, notify DWQ) ❑Yes ❑ No L7 NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑Sk�o Yes I ❑ NA ❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State ❑Yes To ElNA ❑ NE
other than from a discharge?
12/28/04

Facility Number: 92 — g6-
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
❑ Yes • eNo
❑ Yes No
Structure 5
❑ NA ❑ NE
❑ NA ❑ NE
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 2 'y �
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes to ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.) ,_ ,�
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes L7No ❑ 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 Eh o ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes L'1 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 E4 No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu., Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) "s4kol­61$�/yF��;,� �b •J •�
13. Soil type(s) v,
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
B Ko ❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
io ❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
E rvo ❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ NA
El NE
18. Is there a lack of properly operating waste application equipment?
ElE4 Yes
,—,[�'�fo
-Yvo ❑ NA
❑ NE
Comments (refer''to question #): Explain anv YES—ansRers andlor any recommendattonsorany other comments.
Use drawings of facility to better explain situations (adds[ anal pages as necessary).
Reviewer/inspector Name /`�� ''. y: V . Phone: 9/0, f13.3.33Oa
Reviewer/inspector Signature: 's-g'--� Date: 2 — ZS = 2-010
12128104 Continued

1~ acility Number: j9Z — Date of Inspection Z S /O
Required Records & Documents ,_,/
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes E No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ©96 ❑ NA ❑ NE
the appropriate box.
❑ WUP ❑ Checklists El Design El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [-}No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
B'Ko-
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
B,90
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
i p<
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
ElB Yes
No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
a o
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
B-5
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CA WMP?
[IE Yes
No
El-
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
B<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?
ElB yes
,—,
[vo
❑ 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
,--
E, 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
D o
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
1J90
❑ NA
❑ NE
12128104

r s /0-07--z60 9
u.
ivision of Water Quality
Facility Number K %7 0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit -Kou
Cr—Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit rJ tine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
i
Date of Visit: j - Arrival Time: 0 ,'Q0► I Departure Time: /0,30 County: ram✓ Region:
Farm Name: T L / `ty+"'� Owner Email:
Owner Name: _ D V �J 2 n1 //�% i@it4� Phone:
Of
Mailing Address:
Physical Address:
Facility Contact: ''��'S I&C V-6 3 t1. A:L ,Title:.�Da-e_ — Phone No:
Onsite Representative: Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Back-up Certification Number:
Latitude: [= o = i = {' Longitude: = o = 0
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
r I ❑ Non -Layer
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Pouets
❑ Other
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made'?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifej
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stockei
❑ Beef Feeder
❑ Beef Brood Cowl
Number of Structures: E'
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
LJ NA
❑ NE
❑ Yes
❑ No
0 9A_
❑ NE
I2 Np.
❑ NE
❑ Yes
❑ No
❑ Yes
O'No
❑ NA
❑ NE
❑ Yes
No ❑ NA
❑ NE
12128104 Continued

r
Facility Number: 2 —
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):
Observed Freeboard (in): Z �o
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 1T N'o ❑ NA ❑ NE
❑ Yes Ejl�o ❑ NA ❑ NE
Structure 5 Structure 6
El Yes No El NA ONE
❑ Yes No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmentalltthbreat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes LI No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes 0"No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes El 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?
It. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
E7 No
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes
ETNo
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
No—
El NA [I NE
17. Does the facility lack adequate acreage for land application? El Yes
,,�--,,
oo
El NA El NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes
ELT,
[] - o
❑ NA ❑ NE
nts (refer to question #): IJxplain any YES answers and/or any recommendations or any other cammeats.
Fomme—
se drawings of facility to better explain situations. {use additional pages as necessary):
Reviewer/Inspector Name Lt e_v
Reviewer/Ilnspector Signature:
Phone: 9147, . 3331v-
Date: 9—/S- Zee -
Page 2 of 3 — 12128104 [;on&nued

A .
Facility Number: 2 — Date of Inspection
ReQuired Records & Documents f
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes El No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes EfNo ❑ NA ❑ NE
the appropiate box. ❑ VVUp ❑ Checklists ❑ Design ❑ Maps ❑ Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1"
Rain Inspections El Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
El Yes
E No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
E(No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
El NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
El Yes❑
7No
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
0 No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the pernvt or CAWMP?
❑ Yes
No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
J! 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
EYNo
❑ 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
EI No
❑ NA
❑ NE
33_
Does facility require a follow-up visit by same agency?
❑ Yes
No
❑ NA
❑ NE
Comments and/or Drawings:
12128104

lob f31 �u -S 3'rzsilae -
Z H g(
Type of Visit (fcom lance 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: 8-12- 0 Arrival Time: /4: OO,Q, Departure Time: /D: 30 County: Q SeN Region:
k
Farm Name: 7� L re, 1rv►1 Owner Email:
Owner Name: J3 r• u a'_1G I'4/'i� Phone:
Mailing Address:
Physical Address:
`s Rarw r`c _ K ' Facility Contact: st Title: Phone No:
Onsite Representative: CU14 %. L�;'Xl- w; �� _ Integrator: C,01rt A-Y-' 1 C. �a i�iKs
Certified Operator:
Back-up Operator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: = o = I = W Longitude: 0 0 = I = "
Design Current
`Design Current _�_
Desigu Current
Swine t . Capacity Population
Wet Poultry Capacity Population..
Cattle Capty Population
Finish
❑ La. er
❑ Dai Cow
to Feeder
S3
❑Non -La er
❑ Dai Calf
CR r to Finish Z
.Pw
Dai Heifer
to WeanD
Cow
to Feeder
��
_w
Non -Dairy
Eto
to Finish
❑Beef Stocker
ers❑Beef
Feeder❑
Pullets
Beef Brood Co❑
Turke s❑
Turke Poults
❑ Other
Number of Structures: L
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
�,/
IJ No
❑ NA
❑ NE
Discharge originated at: [:]Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
Q NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
13 NA
❑ NE
c. What is the estimated volume that reached waters of the State (gailons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
[E NA
ElNE
2. Is there evidence of a past discharge from any part of the operation?
ElYes
Ej NoNo
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
B- 1lo
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12128104
Continued

9 ..
Facility Number:F2— 0 �p � Date of Inspection
Waste Collection & Treatment DI
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? El Yes D NNo�o El NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes B o ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): ZO
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 [3' ll�o ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ElL Yes No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ©'go_ ❑ 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 0'9o_ ❑ NA ❑ NE
maintenance or improvement?
Waste Application �,�
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes E No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ETNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) L el -x„ it eLa. e-)
13_ Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
B No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
R<o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[:] Yes
2 No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
B 1vo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
2<o
❑ NA
❑ NE
[ Comments (refer to question ft Explain any YES answers and/or any recommendations or any other comments.
IUse drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/Inspector Name • �/ is Phone: y10. , lUg.3330
Reviewer/lnspectorSignature: Date: 9 /2—ZO6$
12128104 Continued

y •
Facility Number: $2 — gSo
j Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ETNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes E No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design El Maps El Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
B<o
❑ 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
l�fo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
�[
1� No
❑ NA
❑ NE .
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
El NA
El NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
El Yes
,_�o
L( oo
ElNA
ElNE
26.
Did the facility fail to have an actively certified operator in charge?
ElYes
(3<
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
[3 o
❑ NA
❑ NE
Other lssues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
L_TNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
B 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
, ,��
L7 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
El Yes
�
D o
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
[I Yes
�.,,�
L7 1vo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
0<o
❑ NA
❑ NE
nal Comments and/or Drawings:
12178104

'6;VArcd 9 - ze-Zang R2
W Division of Water Quality
Facility Number OZ g(p Q Division of Soil and Water Conservation
e) Other Agency
Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit W Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: '2 ]-0% Arrival Time: Departure Time: $/�a-� County: SQs+t�bfo�' Region:
Farm Name: g �z Y,,/' ,, Owner Email:
Owner Name: t3Ya trA / /�l�G 34 Phone:
Mailing Address:
Physical Address:
Facility Contact: �.f( j / Q ✓W�GC Title: ��✓ll. /PJhonne No:
Onsite Representative: �(tN7 Tea ✓ w, Gt Integrator: L oLfa+ e;
Certified Operator:
Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: [= 0 0 I 0 « Longitude: = o = , = "
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
_ ❑ Layer
❑ Nan -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
Design Current
Capacity¢ ;Populat on
❑ Dairy Cow
❑ Dai Calf
❑ Daia Heifei
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stockei
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system`? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes ❑ No NA ❑ N13
❑ Yes
❑ No
`y NA
❑ NE
❑ Yes
❑ No
[ NA
❑ NE
❑ Yes
❑ No
NA
❑ NE
❑ 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
� No
ElNA ElNE
a. If yes, is waste level into the structural freeboard?
❑ Yes
9 No
❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 321
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
[XNo
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
P No
❑ NA ❑ NE
(Not applicable to -roofed pits, dry stacks and/or wet stacks)
4. Does any part of the waste management system other than the waste structures require
❑ Yes
�j 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?
1 I . Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
F 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) / e �/r1�[lJ _ C01��/V
/O. S
-
— -
13.
Soil type(s)
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement'?
❑ Yes
i] No
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre detennination?❑ Yes
No
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
] No
❑ NA
❑ NE
IComments (refer to question ft Explain any YES answers and/or any recommendations or any other comments. Use drawings of facility to better explain situations. (use additional pages as necessary): I
W 7
OF L4,511V 1. R[u S c-
Reviewer/Inspector Name S Phone: M9, V_0j 7
ReviewerAnspector Signature: Date: 9 - Z 7 - �ap�
lz✓zaiv4 Lonanueu

Facility Number: 4—&�, I Date of Inspection 9-2
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 1PNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 9No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes --EA No ❑ NA El 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
Q'No
❑ NA
❑ NE
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
P No
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
WNo
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
[A No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
§3 No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
V1 No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
P No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
PI 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
[jNo
❑ 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
No
❑ NA
❑ NE
Comments and/or
12128104

Type of Visit ®Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit ®Routine Q Complaint 0 Follow up Q Referral 0 Emergency Q Other ❑Denied Access
Date of Visit: dS-01-U(, Arrival Time: Departure Time: County: SUM o2a A/ Region -
Farm Name: _.._ h L 1"av w► _ Owner Email:
Owner Name: -S C- F0. r wt 5 Phone:
Mailing Address:
Physical Address:
Facility Contact: _g, &1 ilk L a 10 Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Phone No:
Integrator: (--r-6aLr; r- r&frU& S
Operator Certification `umber:
Back-up Certification Number:
Location of Farm: Latitude: ❑ a E-1 ' E:1 Longitude: = ° = I =
Design Current
Design Current
DesignGurreat::.:
Swine Capacity Population
Wet Poultry Capacity Population
Cattle Capacity Population;
❑ Wean to Finish
❑ La er
El Wean to Feeder
❑ Non -La et
Feeder to Finish
- - _ ..._ .;
El Farrow to Wean
Dry Poultry
1,
❑ Farrow to Feeder
El Farrow to Finish
i
❑ Gilts
El Layers
El Non -La Layers
El Pullets
❑ Turkeys
❑ Turkey Poults
❑
Disci & Stream Impacts
Disci & Stream Impacts
❑
Beef Feeder
1. Is any discharge observed from any part of the operation? ❑ Yes [Z No ❑ NA ❑ NE
Discharge originated at: El Structure El Application Field El Other
a. Was the conveyance man-made? El Yes 13 No El NA ❑ NE
b. Did the discharge reach waters of the State'? (If yes, notify DWQ) ❑ Yes 5 No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ) El yes [9 No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? El Yes `Z No ❑ NA El NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State El Yes [A No ❑ NA El NE
other than from a discharge?
12128104 Continued

s
S
Facility Number: Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes CKNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes N No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): `f
Observed Freeboard (in):[
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 0 No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes 21 No ❑ NA [:1 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 54 No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes K] 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 CgNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 2) No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes [gNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) K, v 1AA I A f4 .^_ 146 : _ ' i; t eii
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
ER 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
93 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
KNo
❑ NA
❑ NE
Reviewer/inspector Name a I L �, Phone: A9/Q �$r'o ~ / 5- f1/
Reviewer/inspector Signature: Date: OS - D/- Zoe (ri
12128104 Con#inued

Facility Number: gZ— Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ANo []NA ❑ NE
20. Does the facility fail to have all components of the CA WMP readily available? If yes, check ❑ Yes ® No ❑ NA ❑ NE
the appropirate box. ❑ WUp ❑ Checklists . ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ® 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 UR No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes CRNo ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
�9 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
KNo
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
[3No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
14 No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
[9No
❑ 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
M No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
3 L Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
[X 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
P No
❑ NA
❑ NE
�'
Addthoaal, gtnments'add/or Drawings
12128104
12128104

cps`
Type of Visit 40 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance I
Reason for Visit ® Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: � Arrival Time: Departure Time: County: So 2 Region:
Farm Name: _ G f"a�S Owner Email:
Owner Name: rJ D C 1~a' , c Phone:
Mailing Address: P D 11 ox i -'AL fr _ _(_u"r. , N C_ aQ3 3 S'
Physical Address:
Facility Contact:
Title:
Onsite Representative: �^ `�x_t o� ")'c
Certified Operator: C CL%- rr a t1
Back-up Operator:
Phone No:
Integrator: C o �N aY ,% C
Operator Certification Number: 19 3 l a
Back-up Certification Number:
Location of Farm: Latitude: a o = ❑ Longitude: = o = I = 11
t� Design Current `'' Design Current . �I
Swine1. �k_r .Capacity Po- Vet Poultry, " Ca air population , Cattle'
❑ Wean to Finish ❑ Layer i�.
r- ❑ DairyCow.
❑ Wean to Feeder ❑ Non -La et ❑ Da' Calf
'Design Current
Ca acity Population
Feeder to Finish
5( Yp�
Dry Popltry
❑ DairyHeifei
_ s T �; ❑ D Cow
t': ❑ Non -Dairy
El Stocker
❑ Beef Feeder
❑ Beef Brood Cold
a
I❑Other .Number of Structures:
❑ Farrow to Wean
❑ Farrow to Feeder
ElFarrow to Finish
❑ Layers
❑Non -La Non -Layers
El
El Gilts
ElPullets
❑ Boars
❑ Turkeys
Other
Turke Poults
FE Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
9 Yes
❑ No
❑ NA
❑ NE
Discharge originated at: X Structure ❑ Application Field ❑Other
a. Was the conveyance man-made?
❑ Yes
R3 No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
(Z Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
is d
d. Does discharge bypass the waste management system? (]fyes, notify DWQ)
Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
❑ No
P6 NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
19 No
❑ NA
❑ NE
other than from a discharge?
12128104
Continued

I
Facility Number: S,;L — fr Date of Inspection - p3
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes W 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): f �j
Observed Freeboard (in): 3 +
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
® 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
U 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
V1 No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
M No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
® No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Dri1i ❑ Application Outside of
Area
12. Crop type(s) %�� r rp Qc� 1 5 , ll q v�C Z. OS
13. Soil type(s) /Tu7�r
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[2 No
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
� No
El NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination`❑
Yes
R 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
y No
❑ NA ❑ NE
7� l�er+Lac�� /��Aaa�7 p1`n9�QfLa 1 �G Lac O-� f'hL� a1 cC. �+ j+4
wa>rC_ WG-I
/qDj�. 6c. /S�rG<<oP, Co r%rc_Xarf
Reviewer/inspector Name a�ar� �+���� Phone:
Reviewer/Inspector Signature: Date:
12128104 Continued

S'
Facility Number: Date of Inspection UL T 1-6-
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes Cfl No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes (9 No ❑ NA ❑ NE
the appropiiate box. ❑ V" ❑ 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 [2 Monthly and I" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
E7No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
(Y No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
® NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No
® NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
M No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
® NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[,No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
® No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ 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
U1 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
M No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
6 No
❑ NA
❑ NE
a
Ad'drhofla!„,Co�iments�and/or�Drawiiigs _ ` �'_` �`
0 Lk
rG ;b 4- 43. c c r? a'p Ycs . caQ
al! — i,LSG Gfjavo•Je'9_ -car YY.-] a., rLpu; ^td� is y pcMvim-1 ,
12128104

SDC Farms, LLC
P.O. Bog 128
Dunn, NC 28335
March 9, 2005
NC Division of Water Quality
Attn: Larry Baxley
225 Green Street, Suite 714 Systel Building
Fayetteville, NC 28301
SUBJECT: Violation — 3/8/2005
Dear Mr. Baxley:
The purpose of this letter is to respond to the NOV of March 8, 2005. During a
routine inspection performed by you on March 9, 2005, lagoon liquid was observed in a
storm water retainage area at my hog facility, SDC Farms, LLC, facility number 82-86.
This was our first knowledge of the waste discharge. We have determined the cause of
the discharge was a blockage in the waste discharge line from the house to the lagoon.
The discharge was contained in the storm water retainage area and was not
discharged off the farm. We immediately started cleanup of the discharge. We started
pumping the discharge back into the lagoon on March 8, 2005. Wednesday March 9,
2005 we monitored the retainage area and continued cleanup. We monitored the lagoon
side and did not see any seepage into the retainage area. You visited our farm again on
March 9, 2005 and suggested we check the flush system to make sure the spill did not
originate from the lines from the lagoon or a cracked floor in the building. You
suggested we start by checking the hog house next to the retainage area. We performed
the test and decided to flush one side of the house at the time so if it was a floor crack we
would know which side of the house the crack was on. We flushed the right side of the
house and went to the retainage area to see if any lagoon water entered the area. We
were monitoring the area and notice the lagoon discharge pipe was only flowing about
5% of what it should have been flowing. We went in the hog house and water was up to
the slats. The line from the hog house to the lagoon was blocked. We ran a 1 inch water
hose through the line and opened the line up. The water immediately discharged into the
lagoon as designed. If both flush tanks had been dumped at the same time the water
would have been 8 to 10 inches above the slats and would have run out the back of the
building because the house is sloped to the rear. If the water had run out of the back of
3/1i%as"
.4 Ca

the building it would have drained into the retainage area because the site is sloped to the
retainage area. As best we can determine that is what happen, moth tanks flushed at the
same or approximately the same time and that was the reason for the discharge.
We have removed the blockage and are confident this was the problem. We will
continue to monitor the retainage area daily for the next few weeks to ensure there is not
any seepage from the lagoon_ We will also monitor the flush lines to ensure they are
open and working properly.
If you need additional information please feel free to contact my office at
910-892-5737.
Sincerely Yours,
Stanley C oll

I , 7 r a..,�
BOTTOM ELEV. - 2
q fl-.,Ov 'foo j- to J
o f w, -A-1pri
ey rt
pa A of w4 s
I �-1130
l
7.
Hod ltowf�
--------------------------------

NCDA onai�'
Division 4300 Reedy.:Cre�k Road ;Raleigh, NC 2�._6ax=6465 -(916 -3_3-2655"
•R_eportINo:; �Vq 2 W
Grower: SDC Farms LLC
Copies To.,
_
PO Box 579
Dunn, NC 28335
Jlr �ra10
rite nalyszs effort
Farm.• SDC F
8/2T/04
Sampson County
Sample Info.
Laborat2a Results arts. per million unless otherwise noted
Sample ID:
N
P K Ca M S
Fe Mn Ln
Cu B Mo Cl C
01
TOtNI 3,10
81.3 665 132 43.9 33.5
2.38 0.54 1.19
0.27 1.29
IN-N
Waste Code:
4114
ALS
-NO3
Na ,Vi Cd Pb Al
Se Li PY
SS C:N DM% CCF% AIP X al
187
7.44
Description:
OR -A'
Swine Lagoon Lii .
Urea
Recommendations:
Nutrients -Available fer�First! Cro '
-Ibs1IOOO; allons
OtheriElements' . lbs/1000 allolrs
Application Method
h' P205 ` K20 Ca Mg. S Fe'Gl
•. ;,.;.
Na 'Ni Gd . Pb: Al Se Ll
lrrigulion
1.4 1.1 5.3 0.77 426 '0;20 . - 0A1`• 1 0.01 . "I
001 ,.
1.6. ,

1 _Th
Type of Visit (YComplianc
Reason for Visit outine
Inspection Q Operation Review O Lagoon Evaluation
O Complaint O Follow up O Emergency !Notification O Other ❑ Denied Access
Facility Number Datc of Visit: Time:
�� - - Not O erationa[ Below Threshold
®'Permitted 92'Certilfed ©Conditionally Certified Registered Date Last Operated or Above Threshold:
Farm Name: -sic_farvv%s t�.0 County:
Owner Name: Phone N(,
Mailing Address: s• d - / 'Ay AI C A?335
Facility Contact: kt' iS �n �f`�K Title: fip"�c ,_. Phone No:
OnsiteRepresentative: Integrator: 1.1 LLr'ir F4rw.S
Certified Operator: tr �G6� I� _ Operator Certification Number: 1931,2
Location of Farm:
wine ❑ Poultry ElCattle ❑ Horse Latitude �~ Longitude
Design Current
Swine Cftnacity Pnnnlatinn
❑ Wean to Feeder
ceder to Finish
�b
❑ Farrow to Wean
❑ Farrow to Feeder
Farrow to Finish
Gilts
po
Boars
Design Current Design Current
Poubry Capacity Population Cattle Ca acitV Population
❑ Laver ❑ Dairy
❑ Non -Laver t Non -Dairy
❑ Other
Total Design Capacity
Total SSLW
Number of Lagoons ❑ Subsurface Drains Present ❑ L.aeoen Area ILI 5 rav Field Area
Holding Ponds / Solid Traps _ r] No Liquid Waste Management Svstem
Dischar-es S Stream Impacts
1. Is anv discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is obsmed, was the convevance 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 eal/min?
d. Does discharge bypass a lagoon system? (If ves. notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure ;
❑ Yes D<
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes [�I No
El Yes LIt'No
❑ Yes G o
❑ Yes LKNo
Structure 6
Identifier:
Freeboard (inches):
05103107 Continued

Facility Number: g� — gG
Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(if any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
12. Crop type --coo-441
13. Do the receiving crops differ with thos designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination'?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Reuuired Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes Io
❑ Yes ED40
RY es ❑ No
❑ Yes M�Ko'
❑ Yes 021Qo
❑ Yes [g' 0
❑ Yes No
❑ Yes [�Wo
❑ Yes R'1I�o
❑ Yes 0'No
❑ Yes ,[9-Vo
El Yes Ltl`l�to
❑ Yes 2No
❑ Yes O<o
❑ Yes Gi�a
❑ Yes E�1 o
❑ Yes ❑ No
❑ Yes ❑'1qo—
(ie/ discharge, freeboard problems, over application) ❑ Yes B-Igo
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes o [ -m
24. Does facility require a follow-up visit by same agency? ElYes 03 lvo
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes ! fo
© No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
CommenisPefer to queshon #) EzplaiIany YES answers and/or any recammeadattotas or any other;
, N .:
IJse,drawings,of facility to be#ter eapiain situations. (use additional pages as necessary 1 field Copy ❑Final Notes
F4(- SCew-r- qu L[ 1.
So�C 7 q, 'gr�er rMIA-Ay Na AkSS `+arS a-nr t*�S
0-1 14 ►^ b (ShamR /
(YCdln Ge ii±l q, ��(aS, cif rj t1it;5 e�m lL�
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date:
05103101 Continued

V
Type of Visit Compliance Inspection
0 Operation Review 0 Lagoon Evaluation
Reason for Visit ® Routine 0 Complaint
0 Follow up
0 Emergency Notification 0 Other ❑ Denied Access
Date of Visit-
lime: 9 "3
Facility Number
10 Not Operational 0 Below Threshold
Permitted ® Certified O Conditionally Certified
D Registered
Date Last Operated or Above Threshold:
Farm Name: -/����/f
County:
Owner Name: 5..- /�i�i��
l �.�,C,L�7
Phone No:��
Mailing Address- G _���i
�..��.
2 �.3ZK:
_
Facility Contact: ��t.//C�
Title:
Phone No:
Onsite Representative: _l1 s
fellClC
Integrator: /�
//
03�Fk'1"
/t/
Certified Operator:
i[RG
Operator Certification Number:
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 0 6 " Longitude ' ram° 0"
Design
Current Design Current
Design Current ,'i
Swine' Capacity
Population Poultry Ca acity Po Wation Cattle
Ca aci Po elation_
❑ Wean to Feeder
11 10 Layer ❑ Dairy
Feeder to Finish Z)f
ILI Non -Layer I I Non -Dairy
❑ Farrow to Wean
,
f
❑ Farrow to Feeder
❑Other
to FinishTotal
Design Capacityzs
tElFarrow
Total Ssiiv
Number of Lagoons
❑ Subsurface Drains Present 11131,agooxiArea
JE3 Spray Field Area
Holduig Ponds I Solid Traps ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other `
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min'?
d. Does discharge bypass a lagoon system'? (If yes, notify DWQ)
2. is there evidence of past discharge from any 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?
WasteCollection 8, 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): 2 7
05103101
❑ Yes CRFNo
❑ Yes Wo
❑ Yes [ WNo
❑ Yes [RNo
❑ Yes ® No
❑ Yes [2fNo
❑ Yes `C' No
Structure 6
Continued

61 h
Facility Number: Z — NG
Date of Inspection 0
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
12. Crop type 6,,ff
❑ Yes [�FN_o
❑ Yes P No
❑ Yes ZINo
❑ Yes *IN,
❑ Yes )gNo
Cl Yes ANo
❑ Yes ❑ No
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes UNo
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
W No
b) Does the facility need a wettable acre determination?
❑ Yes
PQ No
c) This facility is pended for a wettable acre determination?
❑ Yes
P No
15. Does the receiving crop need improvement?
Lpt Yes
ElNo
16. Is there a lack of adequate waste application equipment?
❑ Yes
NTNo
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
C+lo
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP ,chec, kUsts, design, maps, etc.)
❑ Yes
KNo
✓ v
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
RN
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
KNo
21. Did the facility fail to have a actively certified operator in charge?
❑ Yes
eLgNo
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
SINo
23. Did Reviewer/inspector fail to discuss review/inspection with on -site representative?
❑ Yes
® No
24, Does facility require a follow-up visit by same agency?
❑ Yes
No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
KFNo
© No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
rM a`3 1 ,. • i 'fi r a - - ti M'A:
IRdi—iwl � s of fa� tobettere y ~mments (re`�fer to gnXesiion.#i) Explaut anytYES answex�r�Aps and/or any recommendahans or an other comments.
g T ty zplatnWituations: (use addit on0pages asinecessary) ❑Field Copy ❑Final Notes
a1� w r _
�...t� .:, .. tea.....
�,�� s ,�,.e
.cx�:j✓v �;e,�i�,s-�iE.•-� �.� s acu���cr�� �.,5� �Z�'�,�r�rt
Reviewer/Inspector Name = `
Reviewer/Inspector Signature: Date:
O5103101 Continued

Facility Number: z — Date of Inspection a
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or Iagoon fail to discharge at/or below Yes ❑ No
liquid level of lagoon or storage pond with no agitation? r�
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes No
28. is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes } No
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes NTNo
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes OfNo
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes N'No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? t![ Yes ❑ No
05103101

t
REGI STRAT:ON F ORIM FOR ANIMAL FEEDLOT OPERATIONS
Department of Environment, Health and Natural Resources
Division of Environmental Management
Water Quality Section
if the animal waste management system for your feedlot operation
is
designed to serve more than or
equal to 100 head
of cattle,
75
horses, 250 swine, 1,000 sheep, or+30,000 birds that
are served
by
a liquid waste system, then t:Iis
form must be fi'_ied
out and mailed
by December 31, 1993 pursuant _o
15A NCAC 2H.0217 (c)
in order to
be
deemed permitted by DE.M. Please
print clearly.
arm Name • S G �G'-.u,
Mail_nc Address: r- [�. tx>r 57 y
Co=_- y — ,.,o Phone No 9i0 �-x -57Y7
Owner (s) Name: s ti��� rry/,� �.��.� C.'rdr� - -
Manager (s) Name: n.; n �.�!►
Lessee Name:
Farm Location (Be as specific as possible: road names, direction,
milepost, etc.) 11 s u,o N'..-f-4 e f , .�,, ,;- K1--.e,-
Latitude/Long=rude if known:
Design capacity of animal waste management system (Number and type
c= confined an:.:na_ (s))
Average animal population on the farm (Number -and type of animal (s)
.raised)
Year Production Began: 1W ASCS Tract No.: — _2-P9_3
Type of Waste Management System Used:
Acres Available for Land Application of Waste: 'el t:zs
Owner (s) signature(s) :
/u4C u 5
.7 C2
�3 �y
,4plorek.:)- '-k,/es N` -Jf

Site Requires Immediate Attention: t4N
Facility No. �t Sa- b&
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: -1-4.0 , 1995
Time: `S . ' 8
Farm Name/Owner: 450 .C,
_-Mailing Address: t'c T3 s-1g �► *� _rJ C'
County: S wr,^ to m a
Integrator: C.0%ke.r:a Phone: 54-4 -oho$
On Site Representative: C" < . t i Phone:
Physical Address/Location: U-S, 5:e.%Pj4 - s cue^&. -
Type of Operation: Swine Poultry Cattle
Design Capacity: Lk o cc, Number of, Animals on Site: 4000
F ,,.•5�..,. _
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: " Longitude: "
Circle Yes or No
Does the Animal Waste Lagoon haye sufficient freeboard of 1 Foot + 25 year 24 hour storm event
'(approximately I Foot + 7 inches) (e or No Actual Freeboard: 3 Ft. Inches
Was any seepage observed from the la oon(s)? Yes or�as any erosion ob rued? Yes o Na
Is adequate land available for spray? Yes r No Is the cover crop adequate? or No
Crop(s) being utilized: AVT�.cRE LA-0 AGXM s
Does the facility meet SCS minimum setback criteria? 200 Feet from DwelliPes
es r No
100 Feet from Wells? r o
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? r
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line: Yes o(No)
Is animal waste discharged into water o e state by man-made ditch, flushing system, or other
similar man-made devices? Yes No If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? es or No
.Additional Comments: !� Q.'1 • s k C. rC_dk
13LDG5 % . %_Ta%G00W
�okn� t�1' .wt�- _,� CAo t�.a. «..► ;t'�, m �. 5 �S�`�-tom•
N e-t 3:,'rt. Cv."[ 'P G W N `%t°4 r' a'C' a +h
Inspector Name
Signature
cc: Facility Assessment Unit Use Attachments if Needed.

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