820088_INSPECTIONS_20171231

NORTH CAROLI NA
Department of Environmental qua]

S 1's 4vG
(Type of Visit: aComp11 ce Inspection O Operation Review O Structure Evaluation Q Technical Assistance I
Reason for Visit: outine Q Complaint Follow-up O Referral O Emergency O Other O Denied Access i{
Date of Visit: /"O
Arrival Time:
/
`�-a�
Departure Time: County: $ 6t , Q
n
Farm Name: arJ'rX
C,ti'w ��--
Owner Email:
r�
Owner Name: Phone:
Mailing Address:
Physical Address:
Region: t--Z�./
Facility Contact: �Q Title: Phone:
tt
Onsite Representative: Integrator: VAS .e, /
Certified Operator: Certification Number: Z-0 Z
Back-up Operator:
Location of Farm:
Certification Number:
Latitude: Longitude:
tgn 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
U
Dairy Heifer
Farrow to Wean
Design Current
Dry Cow
Farrow to Feeder
D , P,oul Ca acit P,o
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Beef Brood Cow
Pullets
5 M
OfyrM19'r/FI _ ther ��� ��F+rz�,r.
Turkeys
Turkey Points
Other IMLJ.Lther
e:S. e...
Discharges and Stream ImDBCtS
1. Is any discharge observed from any part of the operation? ❑ Yes ❑.A}6'— ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other.
a. Was the conveyance man-made? ❑ Yes ❑ No �TA ❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWR) ❑ Yes ❑ No EE '` A ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (if yes, notify DWR) [:]Yes ❑ No A ❑ NE
2. is there evidence of a past discharge from any part of the operation? ❑ Yes FNo
❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters [:]Yes ❑ NA ❑ NE
of the State other than from a discharge?
A
Page 1 of 3 21412015 Continued

Facility Number: jDate of inspection tK
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 'o ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No [!I' A ❑ 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
Eg lvu
❑ NA
D 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
[5-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
❑- '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 [�o� ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need [] Yes Il l " ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? if yes, check the appropriate box below. ❑ Yes [g— 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): �`J eJ'YIr{t c5 C./
13. Soil Type(s): /Y 0 6ja- _
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes �lo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [3] No ❑ 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 E No ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment?
[-]Yes
No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No
❑ NA
❑ NE
the appropriate box_
❑ WUP [:]Checklists ❑ Design [-]maps ❑ Lease Agreements
❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
to
❑ 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
VNo
❑ NA
❑ NE
Page 2 of 3
21412015 Continued

FaciliNumber: Ds ection: In
24_ Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes 0 No ❑ NA ❑ NE
4,25. is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes 0'1o� ❑ 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]-Wo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [D-M- ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes [ds ❑ 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?
If yes, contact a regional Air Quality representative immediately.
❑ Yes [ZkN6 ❑ NA ❑ NE
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
Ea N%5-
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
C�'No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[D-No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
CJ N-o
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
[�No
❑ NA
❑ NE
Comments (refer to question #) Explain any YES answers MEM any additional recommendations or any other comments.
Usedrawings of facility to better explain situations (ase additional pages as necessa
a-
09 - �sr
Reviewer/Inspector Name:
Reviewer/Inspector Signatur
Page 3 of 3
Phonel(L 61- 4 3-7 3
Date: ()
21412015

Jya.... ..au. a vuiyuuucc auayc'L..v.. v vyc.aa.va. .­ac" V ouwcau.c uV"MUM..00 v aa.c.....ca. raaawaaucc
Reason for Visit: (91foutine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: L I Is Departure Time: inn County: Region: F?-2:)
Farm Name: 0'0� x P Qr ! e ✓"� Owner Email:
Owner Name: i Phone:
Mailing Address:
Physical Address:
Facility Contact: cya 'l .�� � ^ Title:
Onsite Representative:
Certified Operator: t(
Back-up Operator:
Location of Farm: Latitude:
Phone:
Integrator: Prr-4"J'e
Certification Number: Zc�
Certification Number:
Longitude:
Design Cnrrent Design Current
u� ;.' ow
Design Current
Swine
;
Capacity Pop. 1�Vet Ponitry" Capacity Pop.
Cattle Capacity Pop.
Wean to Finish
Layer
DairyCow
Wean to Feeder
Non -La er
DairyCalf
,
Feeder to Finish
DairyHeifer
Farrow to Wean
Design Current
D Cow
Farrow to Feeder
D , Poul Ca aci Po
Non -Dairy
Farrow to Finish
G
La ers
Beef Stocker
Gilts
Non -Lavers
Beef Feeder
Boars
Beef Brood Cow
Pullets
Turke s
Otber
Turke Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
[] Yes
[t�-t�fo
[] NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
[�A
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
[] Yes
❑ No
6'1gA
❑ 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
[? NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
o
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
[] Yes
No
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412015 Continued

Factli Number: &k - Date of Ins ectioa:
.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
�o ❑ NA ❑ NE
❑ No NA ❑ NE
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): Z
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes �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
L�1 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 DWR
7. Do any of the structures need maintenance or improvement?
[3 Yes
0o
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
E]--9_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
NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[J'No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [2'Na ❑ 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-1� .�(j O
13. Soil Type(s): No %o tJq
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [e;'&o ❑ 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 [B<o ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes E� No ❑ NA ❑ NE
❑ Yes ltd""" ❑ NA ❑ NE
Rtguired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes ErNo [] NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes Flo ❑ NA ❑ NE
the appropriate box.
❑ WUP ❑Checklists [] Desigm ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below_ ❑ Yes [T N
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [E No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? El Yes �No
o ❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Faciiii Number: eL - g & I Date of Inspection:
Did the facility fail to calibrate waste application equipment as required by the permit? ❑Yes [�-No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes []-No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance;
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes [3-No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes Q1Vo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i_e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
[:]Yes C f rNo ❑ NA ❑ NE
❑ Yes Callo ❑ NA ❑ NE
❑ Yes [aNU [] NA ❑ NE
❑ Yes []-No [] NA [] NE
❑ Yes [31To
❑ Yes EEMO
❑ Yes D-No
[] NA [] NE
❑ NA ❑ NE
❑ NA ❑ NE
Reviewer/Inspector Signature: Date: k1:7
Page 3 of 3 21412015

Type of Visit: (D Compliance Inspection O Operation Review p Structure Evaluation p Technical Assistance
Reason for Visit: (!TVoutine O Complaint O Follow-up O Referral O Emergency Q Other O Denied Access
Date of Visit: ArrivalTimed POO Departure Time: County: Region:
Farm Name: Owner Email:
Owner Name:Phone:
Mailing Address: s ZS ��.�7
Physical Address:
Facility Contact: tx_) ' { �
1, i
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
V(
Title: Phone:
Latitude:
Integrator: P r -e
Certification Number: 7ZV Z, b�7
Certification Number:
Longitude:
— Design C►urrent Design Current
Swine Capacity Pop. Wet Ppultry Capacity Pop.
Cable
Dairy Cow
Dairy Calf
Dairy Heifer
Design Current
Eapaclty Ppp.
Wean to Finish
Wean to Feeder
Layer
I INon-Layer
I
Feeder to Finish
IMP
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
D , P,oult Ca aci Plo
Dry Cow
Non -Dairy
Layers
Beef Stocker
Non -Layers
Beef Feeder
Boars
Pullets
Turkeys
Beef Brood Cow
z'
Other n
Turkey Poults
Other
I 10ther
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
Lo►No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
[]Yes
❑ No
�NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
❑ No
LI.DlA
❑ 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
[;J'I�o
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
ZNo
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412015 Continued

Facility Number: Date of Ins action:
Waste C,gllection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [DlRo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No Ij"^ ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3_
5. Are there any immediate threats to the integrity of any of the structures observed? [] Yes [+r No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
E;�No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
E�,No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
jfNo
❑ 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
ZNo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
[] Yes
La -`No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes dNo ❑ 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): C8 & 0
13. Soil Type(s): &D ^ ji cc,
14. Do the receiving crops differ from those designated in the CAWMP? [—]Yes E5-No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [2'No DNA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes [!!rNo ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application? ❑ Yes [ZNo ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes dNo ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes [i3 No
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [2rNo
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. [] Yes �No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis 0 Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [2rNo
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes allo
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑
NA
Page

Facility Number: - Date of Ins ection:
23. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [3No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes eNo
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 fast survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes EjNo
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes M"No
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
[] NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
[] Yes
[3No
❑ 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
CfNo
❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
[*No
❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility9 if yes, check the appropriate box below.
❑ Yes
❑ No
❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
E�No
❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
[ffNo
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
[:]Yes
[fNo
❑ 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).
/0- 16.1 �
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date:
21412015

i YM 11 � Z� - rs 4
Type of Visit: (D.empliance 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 0 Denied Access
Date of Visit: Arrival Time: Departure Time: 0 County: c5 M
Farm Name: 7 Qv. kc.. F" Owner Email:
Owner Name: V w l - Phone:
Mailing Address:
Physical Address:
Facility Contact: Wq, �a �.. Title:
Onsite Representative:
Certified Operator:
t(
Region: Rzo
Phone:
Integrator: Pi'C3 •�
Certification Number: d 2
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current Design Cnrreat Design
Swine - Capacity Pop. Wet Poultry Capacity Pop. Cattle Capacity
Current
Pop.
Wean to Finish
La er
Dai Cow
Wean to Feeder
Nan -La er
Dairy Calf
Feeder to Finish
Farrow to Wean
airy Heifer
Design Current Dry Cow
D . P■oeiltr. Ca aci P,o Non -Dairy
Layers Beef Stocker
Non -Layers Beef Feeder
Pullets Beef Brood Cow
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Turkeys
Turke Poults
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?
❑ Yes ❑'N-o ❑ NA ❑ NE
❑ Yes ❑ No NA ❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWR)
❑ Yes
❑ No
[ffA
❑ 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
[5"NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
[ff'No
DNA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
[�fNo
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412014 Continued

Fact i Number: - Date of Inspection: o ,
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [B-NorD NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No E�- A ❑ 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 E&Nb ❑ 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 [919'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 DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes �. o ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? [] Yes �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 io ❑ NA [] NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes [] No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [ No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground
❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure
to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift
❑ Application Outside of Approved Area
12. Crop Type(s): $(' o
13. Soil Type(s): ��2 p _ 044,
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 No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes E3*<o
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
[:]Yes
[ro
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
jErNo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit
❑ Yes
❑ NA
❑ NE
readily available?
[a*'No
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check
[:]Yes
[/] No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes dNo
❑ Waste Application [:]Weekly Freeboard []Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes � o
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes YNo
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑ NA ❑ NE
Page 2 of 3 21412014 Continued

Facili Number: - Date of Ins ection.
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [41-ka ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [94i_ ❑ 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 CjXo ❑ NA ❑ NE
2T Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes �o ❑ NA ❑ NE
Other lssues
28_ Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
[ja4lro—
❑ 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
01'9-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
C]-TSo
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[J�o
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
�o
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
[3'lq-o
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings oftfacihittojetter explain situations (use additional pages as necessary).
&1'.' t
e- 6c4-� `7 LN 0 -(,cJ c9 3, v
o
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: l33 83 3
Date: b La i
21412014

Type of Visit: Inspection O Operation Review Q Structure Evaluation p Technical Assistance
Reason for Visit: (Ds£outine O Complaint O Follow-up O Referral O Emergency O Other Q Denied Access
Date of Visit: 0 Arrival Time: Departure Time: County: & Region:
Farm Name: Owner Email:
Owner Name: Q vA4 f 1, )a Phone:
Mailing Address: as'' L't
Physical Address:
Facility Contact:
Onsite Representative:
2J
pQ jar^ Title: Phone:
1(
Certified Operator: V
Integrator: ^ ?
Certification Number: �—V z 6
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Discharges and Stream impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DW R)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes Qj>cr ❑ NA ❑ NE
❑ Yes
❑ No
[31A
❑ NE
[:]Yes
[—]No
[]'M
❑ NE
❑ Yes [:]No I__I 1 A ❑ NE
❑ Yes [allo ❑ NA ❑ NE
❑ Yes L2-No ❑ NA ❑ NE
Page I of 3 21417014 Continued

L
+
Facility Number: jDate of Ins ection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
M.Nkf ❑ NA
❑ NI -
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
E3-11'
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Sp,311�4ay?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
[—]Yes
Q o
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
Ug-lllo­
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
[]No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
E]r V�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 Q-No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes Rr<o ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? if yes, check the appropriate box below. ❑ Yes No [ D,-K� ❑ 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): Zev
13. Soil Types): N 4J'
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes - 0,1�4;e ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [A-M ❑ NA ❑ NE
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 0"Kb ❑ NA ❑ NE
[:]Yes
dNo
❑ NA
❑ NE
[:]Yes
ffl'-No
❑ NA
❑ NE
[] Yes
[P o
❑ NA
❑ NE
❑ Yes
[]kNa-
❑ NA
❑ NE
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ff No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers [] Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes Q,lo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 621<o ❑ NA ❑ NE
Page 2 of 3 21412014 Continued

L
Facility Number: Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes Eno ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [al 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 to provide documentation of an actively certified operator in charge? [—]Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [—]Yes [:fNo ❑ 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
M-No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
[:5"No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
[JNo
❑ NA
❑ NE
El Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[3�No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
[ 'No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
[%rNo
❑ NA
❑ NE
Reviewer/Inspector Name:
Phone: ` 0 3 —3 J
Reviewer/Inspector Signature:
Paige 3 of 3
21412014

D MS JVJ 043,10013
Type of Visit: Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 4�0 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: ' Q},q F ( Departure Time: County.J�
Farm Name: W!I= 4& FQ/21 Owner Email: �-
Owner Name: GQ•y Wr PQfk& Phone:
Mailing Address:
Physical Address:
s�
Region: FAD
Facility Contact: Title: }y Phone:
Onsite Representative: Y VOT( �0411 _ Integrator: %todQq 0
Certified Operator: &ry b Certification Number: QQa0
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Des' n Current Design Current ' Design Curren#
Swine Ca act Pop Wet Poultry Capacity Pop. Cattle Capacity Pop.
P t}
Finish
La er
DairyCow
Feeder
Non -La er
DairyCalf
o Finish
q5'Q
Design Current
Dr. P,oul o Ca aci Fo
La ers
Dai Heifer
[I
to Wean
D Cow
Po
to Feeder
Finish
Non-Daito
Beef Stocker
Non -La ers
Beef Feeder
Pullets
Turkeys
TurkeyPoults
Beef Brood Cow
„........
Other
m..
.
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 ® No ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes ❑ No
[] Yes ❑ No
[—]Yes ® No
[:]Yes ® No
❑ NA ❑ NE
❑NA ❑NE
[] NA ❑ NE
❑ NA ❑ NE
[] NA ❑ NE
Page 1 of 3 21412011 Continued

Facility Number: g - 987 Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes Ej 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: 1 �1
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):_
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes Ej 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 E3'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 E No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes N 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 wasie structures require
❑ Yes N No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes allo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
[] Yes Cg No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable CropWindow ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): C&1� I kMU111Q aly. &+wi'l10101l OV-61-P4
— —
—
13. Soil Type(s): kck1 k A r,l�%'A- ' w9la2i 8
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes R No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? [:]Yes [:]No ❑ NA CE'NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes 0 No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
CR No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
tQ No
0 NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
0 No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
® No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ® Yes [] 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 ER No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes ❑ No RNA ❑ NE
Page 2 of 3 21412011 Continued

Eacili Number: - 9F I Date of Inspection ; q I & I L-3_
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes RNo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑ No ❑ NA ® NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes gNo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No [RNA ❑ 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 21 No ❑ NA ❑ NE
❑ Yes fo No ❑ NA ❑ NE
❑ Yes [R No ❑ NA ❑ NE
❑ Yes ffNo ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
[�j No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes
f@ No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes
tD No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
at, Pi ,� o aola � d a01-3, h �I���
� n
S� a0�� sfvd9�r�y� ShokleL lam-, o4of ciPf«a�re_'GbfP cyp. Gcr ���► ySr�e
chd -eualtaie_ comp l`ai(.ew Pass bee- Nice o: WoKat, .
li
n rvt e%
)013-#�-� 71, irfati
�,�� - �� s POA ,
N00 �a �d ion s t s ys ri��
`� cola �17o�-f9a. i � `.
900, I 1 S 5tII 00 ` of al 1104(f
Reviewer/Inspector Name: cj t7n� . ^� n� Phone: la-'�3,_
,1;(0
ReviewerAnspector Signature: q Cry,, ' Date: SML(p a01 13
Page 3 of 3 21412011

Facility No.t>-&$ Farm Name wk _pAf ,r� Date _oa WDOf3
Permit COC �IC� NPDES (Rainbreaker PLAT Annual Cert Daily pipe )
a� b � IT, tl1lti 3�3_
Lagoon Name, S forspillway
1
2
3
4
5
6
7
Design Freeboard I Last Recorded in
Observed freeboard
Sludge Survey Date
Sludge Depth ft
"
Liquid Trt. Zone (ft)3
.
Ratio Sludge to Treatment Volume if> 0.45
r
Date out of compliance/ POA?
Date
-Calibration
Ring Size (in)
Der -
-------
Soil Test Dater
pH Fields
Lime Needed
Lime Applied
Cu-I Zn-I
Needs S (S-I <25)
Naardc P
Crop Yield 4�
Wettable Acres ✓
WUP
Weekly Freeboard 1e-,-
1 in Inspections ✓
120 min Insp. T—
Waathar (nriPc
Transfer Sheets
RAIN GAUGE
Dead box or cinerat
Mortality Records ✓
Check Lists
Storm Water
Pull/Field
Soil
Crop
Acres
PAN
Window
Max Rate
Max Amt
I
S!a,
�r
QQ
rp
50 va LO-1
VerifyPTHONE NUMB RS and affiliations
Date last WUP FRO 1130 (4 FRO or Farm Records
Date last WUP at farm Lagoon # Ifa vi l '
App. Hardware Top Dike 4Q.s
Stop Pump 453
Start Pump 470'
1,47 Oft,--a4
Conversion- Cu-I 3000= 108 Iblac; Zn-I 3000= 213 Iblac
,01 +` A fAt5 0,f11.3
'fiNirL►
J-, ft-&ohs= 111),' 1111S D13

-UVj 6114S Walb"
Type of Visit: I9Compliance Inspection 0 Operation Review O Structure Evaluation Q Technical Assistance
Reason for Visit: 0 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency O Other O Denied Access
Date of Visit: i is++n+ICJ Arrival Time: BAH Departure Time: County: S/ar
Farm Name: WArCL F101/`, Owner Email:
Owner Name: �ay ��r k�r Phone:
Mailing Address:
Region: FP
Physical Address: 53� T FG1SOf) -C$wy l�
^ r
Facility Contact: �(�r� Title: Awl _ Phone:
Onsite Representative: Y�/ 6KL I)YAo� Integrator: W e t q
Certified Operator: 6Qr CN ker Certification Number: pn` (
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current
�� Design
.Current
Design Current
Swiae
Capacity Pop.
Wet Poultry
,,
Capacity
Pap.
Cattle
Capacity Pop.
Wean to Finish
Layer
Dai Cow
Wean to Feeder Non -Layer
Dai Calf
Feeder to Finish
25 qjQHeifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
D , ,P,oul
Ca aei
P,o
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non-1- ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turke s
Other
Turkey Poults
Other
Other
Discharges and Stream Imoacts
1. Is any discharge observed from any part of the operation?
❑ Yes
ER No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
'K No
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

Facili Number: `6 jDate 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
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier: I a
Spillway?:
Designed Freeboard (in)- q �_
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., IArge trees, severe erosion, seepage, etc.)
No ❑ NA ❑ NE
❑ No ❑ NA ❑ NE
Structure 6
[] Yes 5 'No ❑ NA ❑ NE
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes 1,;,� No
[D NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No
❑ NA
[] NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes [W No
❑ NA
❑ NE
maintenance or improvement?
Application
_Waste
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ® No
❑ NA
❑ NE
maintenance or improvement?
I 1 _ Is there evidence of incorrect land application? if yes, check the appropriate box below. ❑ Yes f�jNo
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu., Zn, etc.)
❑ PAN [] PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): LQ R -
} '
13. Soil Type(s): l��! r' n1 (} i4 ' yV 0''M'
--
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
® No
❑ NA
❑ NE
IS. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
O No
❑ NA
[] NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
CR No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
f5kNo
❑ NA
C] NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
10 No
❑ NA
❑ NE
the appropriate box.
❑WUP El Checklists ❑ Design [:]Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes g No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall [] Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes ❑ No
[DNA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
NA ❑ NE
Page 2 of 3 21412011 Continued

Facili Number: jDate of Ins ection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [5j-No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check 0—Yes ❑ No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey fKFailure to develop a POA for sludge levels
❑ NA ❑ NE
❑ NA ❑ NE
- Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:—IT�R r
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [] No CR NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes to No ❑ NA ❑ NE
[-]Yes ® No ❑ NA ❑ NE
❑ Yes tRI No ❑ NA ❑ NE
❑ Yes DR -No ❑ NA ❑ NE
❑ Yes G 'No
❑ Yes K] No
[:]Yes ® No
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional vases as necessarv).
as, i ao4a s(ud, svveyy haj- not- 0 b�, dale- j;in#Wr �-o be eof f 1eW .by
I�3144,. /tI`II y L /a's
is �1 lea ao a oc� r
boa, be �[,eo�t�. �, y
Pros� l e l j3, 41- � a,) e- PY o7 -� �a fetwa4 U �' r:, -}o pa lei A,
15, `fn wUt QppjIRd �iIS yPa'.
God r,?1f eg)q re(&-dy ,
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: q3
Date: BBC M 5 DO I a
21412011

Facility No. TkU Farm Name
Permit COC
DR0
Of fl-INP-4-2
l Yod Date tQ)h3 1 -�—
OIC� NPDES (Rain breaker PLAT Annual Cert Daily Pipe )
Lagoon Name, S forspillway
1
2
3
4
5
6
7
Design Freeboard / Last Recorded in
Observed freeboard
-7
Slud a Survey Date
-
Sludge Depth (ft)
A - -I
Liquid Trt. Zone ft
Ratio Sludge to Treatment Volume ifs 0.45
,
Date out of compliance/ POA?
■ - ..
�I►Y��-------
Design Uiai;--
Soil Test Date 92)A1.4
Crop Yield
Transfer Sheets OAL—
pH Fields
Wettable Acres T
RAIN GAUGE
Lime Needed
WUP ✓
Dead box or incinerator
Lime Applied
Weekly Freeboard
Mortality Records
Cu-1 ✓ Zn-1
1 in Inspections --'"
Check Lists i✓
Needs S (S-1<25)
120 min Insp.
Storm Water
Needs P - t j ri k 19
Weather Codes -�
R.
..
WE MMI
Verify PHONE NUMBERS and affiliations
Date last WUP FRO FRO or Farm Records
Date last WUP at farm 7 Lagoon #
App. Hardware 0306a Top Dike
Stop Pump
Start Pump
Conversion- Cu-I 3000= 108 Ib/ac; Zn-I 3000= 213 Ib/ac

I ypr of V 151t: %F I-ompna"ce lu'spucuun Ll vperatluu neV1Cw LJ Ml UUMIC r ValuatlUU LJ 1 CCnmCal AS (Stance
Reason for Visit: 0 Routine O Complaint O Follow-up O Referral Q Emergency O Other O Denied Access
Date of Visit: 1-1-a-laa Arrival Time: ra Departure Time: County: �gT Region:
Farm Name L.r 3 A p, pj N (LI�4£R 'FAPf --' Owner Email:
Owner Name: �5 p�� itR i- P RIC f-1 Phone:
Mailing Address:
Physical Address:
Facility Contact: Upao P wzy _E Title: Q w rnEz Phone: 590 -c'j 1 al
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Integrator: &eaInj f
Certification Number:
Certification Number:
Longitude:
-
Design q Current
Design Current
Swine-
;++
Capacity E Pop
Wet�P,o_ultry
,� ,
Capacity Pop..
Cattle Capacity Pop.
Wean to FinishF`.
La er IDai
Cow
Wean to Feeder
I
jNon-Layer
I
lf
Feeder to Finishsoapb
Dairy Heifer
Farrow to Wean
-
"'
Design 'Current
Dry Cow
Farrow to Feeder;
,DrPoul�try Ca aci ,- Po P.
Non -Dairy
Farrow to Finish
°»
La ers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
A
Pullets
Beef Brood Cow
Turkeys
Other
Turkey Pouets
Other
ISM
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 [% No ❑ NA ❑ NE
[] Yes
[-]No
(] NA
❑ NE
❑ Yes
❑ No
ENNA
❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes ❑ No [ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? [:]Yes C� No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes M No ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

Facility Number: a - V6 JDate of Inspection. ja a a
Waste Collection & Treatment
4. Is storage capacity (structural plus stone storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
identifier:
Spillway?:
Designed Freeboard (in): I
Observed Freeboard (in): �;' a 9
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
14 No ❑ NA ❑ NE
[� No [] NA ❑ NE
Structure 6
[:]Yes [@ No ❑ NA ❑ NE
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
[A No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
® No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
(A No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes g 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): DERMU pA l bU r—RSFEP
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [Z No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [A No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable [:]Yes [N No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[M No
❑ NA
❑ NE
18. is there a lack of properly operating waste application equipment?
[:]Yes
m No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
® No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
W No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? if yes, check the appropriate box below. [] Yes [S� No ❑ 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 M No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [] Yes [A No ❑ NA ❑ NE
Page 2 of 3 21412011 Condmued

Facili Number: - '6 Date of Inspection: 9230 t
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [A No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes 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 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.
34. 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 file 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?
0 Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes [N No ❑ NA ❑ NE
❑ Yes [j No ❑ NA ❑ NE
❑ Yes ®No ❑ NA ❑ NE
❑ Yes
[]g No
❑ NA
❑ NE
❑ Yes
[Z No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
[@ No
❑ NA
❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
Rt_CGRD5 ird SoaC, 56&pf ,
SQ[�a-� �'szRsS���o t` �xr�tD6 LoatleU SooD-
Reviewer/Inspector Name: f`"
cl:l� -Flo-ta3T-7&U11
Phone: [phone].�
Reviewer/Inspector Signature:
Page 3 of 3
Date: 1"A IQ a lit? 1
21412011

0
Type of Visit
Inspection
O Operation Review O Structure Evaluation
O Technical Assistance
Reason for Visit
�,00mmpliance
V Routine 0 Complaint
0 Follow up 0 Referral 0 Emergency
0 Other ❑ Denied Access
Date of Visit: PL( Arrival Time- O t'7 Departure'fime: County: Region:
Farm Name: ��N?71 �Lt fly rr' Fit t rv-- Owner Email:
Owner Name: �Gii /� r� —Phone:
Mailing Address:
Physical Address: Facility Contact: viaedF l�L
e— Title: �t,(J�'1 -r` Phone No:
OnsiteRepresentative: 604,Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = e 0 g ❑ {! Longitude: = o = g = if
Design Current Design
Current
Design Current
Swine Capacity Population Wet Poultpa
ry Cacity
Population
CattleI I I 10 U.6a PA c- 11 YJ Population
❑ Wean to Finish
L
Layer
❑Dairy Cow
❑ Wean to Feeder
I
Non -Layer
❑Dairy Calf
® Feeder to Finish
Dairy Heifer
❑ Farrow to Wean pry poultry
❑ Dry Cow
❑ Farrow to Feeder —
ElNon-Dairy
El Farrow to Finish ❑ Layers
❑ Beef Stocker
❑ Gilts ❑ Non -Layers
❑ Beef Feeder
❑ Boars ❑ Pullets
❑ Beef Brood Co
❑ Turke s
Other ❑ Turkey Poults
Number of Structures:
❑ Other ❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes 19 No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
Page f of 3 12128104 Continued

Facility Number: Date of Inspection i�V
Waste Collection & Treatment
4_ Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes J@ No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? El Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): s}
Observed Freeboard (in): 3 3 f
5. Are there any immediate threats to the integrity of any of the structures observed'? ❑ Yes KNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes LZ 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 KNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes J4 No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require [] Yes [0 No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes J4 No ❑ NA ❑ NE
maintenance/improvement?
11, Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ,9LNo ❑ 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
KNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[&No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
14 No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
P�No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
RNo
❑ NA
❑ NE
Comments (referto question #): explain any YES answers and/or any recommendations'or:any other comments
Use draw rags Afaciiity.to better explain situations. (use addtteonal pages as. necessary.):
Reviewer/Inspector Name I Phone: o— t .� o0
Reviewer/Inspector Signature: Date: /,2—�2=A!�Q j-O
1 Z/.,VU4 [,onttnuea

Facility Number: — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box.
❑ WUP ❑Checklists El Design El Maps [I Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ' ❑ Yes $,No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes � No [I NA El NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
4 No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
R No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
ja No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
9[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
[8 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
RNo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
® 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
4 No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
a No
❑ NA
❑ NE
12128104

I
Type of Visit
Compliance Inspection
O Operation Review O Structure Evaluation
O Technical Assistance
Reason for Visit
Routine O Complaint
O Follow up Q Referral 0 Emergency
O Other ❑ Denied Access
Date of Visit:. IDS Arrival Time: Departure Time: t7 County' Region:
Farm Name: _ ZP6tr4 �'jr P�' e *t Owner Email,
Owner Name: ` !` CP'— Phone:
Mailing Address:
Physical Address:
Facility Contact: WaCOL F&rhr/-- Title: Phone No:
Onsite Representative: _,�� — Integrator: 7z .-
tl
Certified Operator: Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: E__1 o = ' 0 " Longitude: =° = I = u
mmN
esign Current
wine pacity Population
❑ Wean to Finish
❑ Wean to Feeder
Feeder to Finish I !
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Discharges & Stream Impacts
Design Current
Wet Poultry Capacity Popul�at
❑ Layer
❑ Non -Layer
Dry Poultry �'
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
Uiurkey Poults
❑ Other
Design Current
Cattle Capacity Popu�
❑ Dairy Cow
❑ Dairy Calf J
❑ Dairy Heifer
❑ Da Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
Number of Structures:
1. Is any discharge observed from any part of the operation?
❑ Yes
C&No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
19 No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
KNo
❑ NA
❑ NE
other than from a discharge?
12128104
Continued

Facility Number: —
ot
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): q12
Observed Freeboard (in):„L
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 ® No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes 14 No ❑ NA ❑ NE
❑ Yes 10 No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? CAYes ❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes CK No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ®.No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ® No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes C9 No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window El Evidence of Wind Drift ElApplication Outside of Area
12. Crop type(s) ZT'( r. SD2,
'X,' I '9-,ra 9 h-. _--
13. Soil type(s) M n + 1 Gzei± Z 14 J aZ
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes PQ No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? JaYes ❑ No ❑ 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?
18. Is there a lack of properly operating waste application equipment?
❑ Yes O No []NA ❑ NE
❑ Yes Ej�No ❑ NA ❑ NE
'.F d:�-�'
Comments (refer. to question%#) l;xplam any YES` ( savers and/or P greeamr�enda s orYany other comme T
Use drawhigs-of facility to better.explain situations: use.additional a s s n essa.}
ram/ � ('' ba � Gk f 2� cz.s 0-•-ti.
`, ate}
p 0'� 1..�•�J
�
A
RO 1u ,
Reviewer/Inspector Name 77
Phone:
^1p�I.133 3300
Reviewer/Inspector Signature:
Date: /, D
' " 12128104 Continued

t Facility Number: — Date of Inspection. S
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes V9 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ® No ❑ NA ❑ NE
the appropriate box. ❑ WUP [] Checklists ❑ Desig
n ❑Maps El other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 0 No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
IN No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
C3 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
EgNo
❑ 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
CONo
❑ 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
JgNo
❑ 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
allo
❑ 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
J4No
❑ 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
5INo
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
JgNo
❑ NA
❑ NE
1228104

type of visit (042 l' nce Inspection U Operation Review U Structure Evaluation U Technical Assistance
Reason for Visit outine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: `. ! Arrival Time: /n' a Departure Time: County: Region: l
Farm Name: -09,6KaC YI1- Owner Email:
Owner Name: (n'-dt/` 11 UJ CL"A pO e Phone:
If
Mailing Address:
Physical Address:
Facility Contact: Watd FadIII Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: = = 6 =" Longitude: = o = I = "
;IjI ,Itx Design
Current `Design
Current Design Current
Capaactcty
Population Wet IIit�Capcity
sean
PaNZ
to Finish
rl
❑ La er
❑Dai Cow
❑Dai Calf
ean to Feeder
❑Non -La er
eder to Finish
R* 5,
Dai Heifer
rrow to Wean
+r
Dry Poultry • .
❑ D Cow
❑ Farrow to Feeder
r--_
ElNon-Dairy
El Farrow to Finish
El La ers
ElBeef Stacker
El Gilts
Non -Layers
❑Beef Feeder
❑hB�ars
❑ Pullets
El
❑Beef Brood Co
�fJ J;
k 'M ❑ Turkeys
:� 4.
❑ Other
fir-� . ❑ Turkey Poults
= ❑ Other
Number of'Structures:
Discharges & Stream Impacts
I. Is any discharge observed from any part of the operation?
❑ Yes
allo
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
Z. is there evidence of a past discharge from any part of the operation?
❑ Yes
[9 No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
allo
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
12128104
Continued

`t
1 Facility Number: — Date of Inspection .S
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes U No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
CRNo
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
® No
❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
Yes
❑ No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ yes
[NNo
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
W No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
MNo
❑ 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 El Evidence of Wind Drift ElApplication Outside of Area
12. Crop type(s) &�;r'yY1 j I nCVeC'5e-'_j
13. Soil type(s) d - n /& DA 11,)Q B
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
R%No
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
ta No
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[-] Yes
0 No
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
91 No
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[4 No
❑ NA ❑ NE
YDur9 s 70
,� LU Y �u.rt �vr n ors
�, _ _
Reviewer inspector Name-� �� , ; Phone: 9 /o~ 33 33 c�
Reviewer/Inspector Signature: Date:
Iu51 J

lk
{ Facility Number: — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes [`No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [RNo ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. 9Yes ❑ No ❑ NA ❑ NE
X 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 VffNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes W No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
RNo
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
® No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
29 No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
CRNo
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[9No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
� No
El NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
allo
❑ 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
KNo
❑ NA
❑ NE
General Permit? (iel discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative'?
❑ Yes
(&No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
ZINo
❑ NA
❑ NE
Additional Comments and/�or;Drawings:,;_
H
Page 3 of 3 I2128104

ivision of Water Quality
Facili Number/ Q Division of Soil and Water Conservation
tY a Q Other Agency 10-17 ` 0 7 ..
Type of Visit
ompliance Inspection
0 Operation Review 0 Structure Evaluation
0 Technical Assistance
Reason for Visit
outine 0 Complaint
0 Follow up 0 Referral 0 Emergency
0 Other ❑ Denied Access
Date of Visit: Arrival Time: a Departure Time: , 3 D I County: Region:
Farm Name: ard • , ,Ql e r Owner Email:
Owner Name: 4a4 r y W a %o( Par- P I"-' Phone:
Mailing Address:
Physical Address:
Facility Contact: I,cl s J Tar er Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Design Current
Swine Capacity Population
I❑ Wean to Finish
❑ Wean to Feeder
Feeder to Finish fl
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
Other
❑ Other
Phone No:
Integrator: 14 �
Operator Certification Number:
Back-up Certification Number -
Latitude:
Latitude: =1
Design . .'Current
Wet Poultry Capacity Population
❑ Layer
❑ Non -La e[
Dry Poultry
❑ Layers
❑ Non -Lavers
❑ Pullcts
❑ Turkeys
❑ urkey Poults
❑ Other
Discharges & Stream Impacts
l . Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
« ❑�` u
Longitude: O
Design°Current
Cattle
Capacity Populatio'n
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifei
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
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)?
Number of Structures:
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes KNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑NA
❑NE
El Yes
mNo
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
12128104 Continued

Facility Number: —
1
Date of Inspection 7
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): 19 12
Observed Freeboard (in): .39 at'
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 [0 No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes XNo ❑ NA ❑ NE
[--]Yes [No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? Da Yes ❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ZNo ❑ 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 El Evidence of Wind Drift El Application Outside of Area
12. Crop type(s) !J 011^e ts.c.� A /0I.1 rr/'5 tlorj
13. Soil type(s) M / G ©h l wa 15 .
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes 54 No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes 3 No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes Pq No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
19. Is there a lack of properly operating waste application equipment?
❑ Yes ER No
❑ Yes �&No
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
�i x
Reviewer/Inspector Name Phone:/D'33a�
Reviewer/Inspector Signature: Date: a
12128104 Continued

{ Facility Number: — Date of Inspection I ZQ�za7
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ® No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ® No ❑ NA ❑ NE
the appropiate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes Dd No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes 0 No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes PQ No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
0 No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
0 No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
[Z 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
J4 No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
J4 No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
N No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31 _
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
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
(K No
❑ NA
❑ NE
Comments and/or Drawings:
12128104

d
r
Type of Visit Co<ompll a Inspection O Operation Review Q Structure Evaluation O Technical Assistance
Reason for VisitRoutine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of visit: Arrival Time: , Z7a Departure Time: County: 4 Region:
Farm Name: wo 0,0L �" x' a✓ Owner Email: 1000,
Owner Name: Wa eo( YFa e Phone:
Mailing Address: r},C5-D tere rt
Physical Address:
Facility Contact: W a(d 7�at kelr Title: Phone No:
Onsite Representative: --e_ Integrator: 1 er s / ;_ �
Certified Operator: -5��� Operator Certification Number: �a
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = o = = Longitude: = ° = I 0 u
M-W-.A
urrent Design CurreSwine Capaity Population Wet Poultry 4�Capacity Population Catkle Eapacity Population
❑ Wean to Finish ❑ La er �❑ Dairy Cow
❑ Wean to Feeder ❑Non -La er = ❑ Dairy Calf
Feeder to Finish D ❑ Dairy Heifer
❑ Farrow to Wean D Poulf
E]Dry Cow
❑ Farrow to Feeder -A ElNon-Dairy
El Farrow to Finish ❑ La ers
❑ Beef Stocker
Gilts ❑ Non -Layers
� El Beef Feeder
El Pullets POBoars ❑ Beef Brood Cowl I
❑ Turkeys
Other ❑ Turkey Poults
❑ Other ; Other Number of SEructures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
Vq No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
WNo
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
allo
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d_ Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation'?
❑ Yes
No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
XNo
❑ NA
❑ NE
other than from a discharge?
Page I of
12128104
Continued

Facility Number: —
Date of Inspection 4 (0
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
allo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
®,No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5 Structure 6
Identifier: �- 3
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3.71
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
ANo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
KNo ❑ 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
T Do any of the structures need maintenance or improvement?
❑ Yes
14 No ❑ NA ❑ NE
8. Do any of the stuctures 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
[:3 Yes
JQ No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
14 No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
;K 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
No
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement'?
JKYes
❑ No
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
No
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
[ZNo
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
® No
❑ NA
❑ NE
,Comments (refer to question#f) Explain any YES answers and/or any recommendations or any�other,comments ,
Use drawings of facility to better explain situations. (ase;additional pages as necessary):'
QJL
are Wr�
fZ
454Dt'i� nJ �xf` S� �1 n� .
Y
Reviewer/inspector Name r� �, � Phone: _I/0 Y33— 3
Reviewer/Inspector Signature: Date:
rage a uJ -1 [Li[aivlf q-Uri1[Raea

Facility Number: Date of Inspection — -- b
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 00 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CA WMP readily available? If yes, check [--]Yes [ allo ❑ NA ❑ NE
the appropriate box. 0 WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. 9 Yes No ❑ NA ❑ NE
U 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
[2jNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[K No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
KNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
[.No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
G& No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
XNo
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
A No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
allo
❑ 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
AdditionaFCoaiments and/or Drawtu s
Ak
Page 3 of 3 12128104

d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
of Visit ® Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit • Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number
Date of Visit: S 7 O Tune: 1: 05 P
QrZ
Q Not O rational Q Below Threshold
[I-P-eirmitted [3Certified 13 Conditionally Certified © Registered Date Last Operated or Above Threshold: ........._ ... .
Farm Name: ..W_rd. ._Z0 I e.,...... ....._..._ ...�.c .... ................... ..... -............... ...... County:....:S�W :�..�R.r.» ...W....... /--%�6...
Ce // ?19-
Owner Name. (il� ..,� r_ tc.... ....... _........ Phone No: ... „, 7
MaRing Address:... -.5�,'....... ----------.tea 2.'.I.L... a ................
Facilih Contact.Title: .............. ............... _... _.. Phone No:
Onsite Representative:.._....Integrator: , P�.�SI,F� �.-----.
Certified O tutor•/�. _ _�'�� /( c.— ........... Operator Certification Number:
Location of Farm:
040vine ❑ Poultry ❑ Cattle ❑ Horse Latitude • 4 " Longitude ' 4 44
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes awo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes [moo
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑yes M-No
c. If discharge is observed, what is the estimated flow in gaUrnin?
❑ Yes U�No
❑ Yes E3Xo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes Q No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes O.Alo
( 0A^sckV1Structure l Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ....... Lp :aI2............................................... .
Freeboard (inches): 5 �r
12112103 Continued

a
1 Facility Number: y� -- Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes Q No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑yes [040
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 maintenancelimprovement? ❑ Yes M-40
8. Does any part of the waste management system other than waste structures require maintenancelimprovement? ❑ Yes 1944o
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes [9-14o
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes [qq�o
11. Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes 0,1 o
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
I2. Crap type _ Prrnvr1li,,_L.neAll .Crru n
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes MWO
14. a) Does the facility lack adequate acreage for land application? ❑ Yes 0-No
b) Does the facility need a wettable acre determination? ❑ Yes O Iqo
c) This facility is pended for a wettable acre determination? ❑ Yes avo
15. Does the receiving crop need improvement? ❑ Yes ❑ No
16. Is there a lack of adequate waste application equipment? ❑ Yes QNo
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge atlor below ❑ Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes EjkN0
19. Is there any evidence of wind drift daring land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes [3-No
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional ❑ Yes �i Aio
Air Quality representative immediately.
use drawings oiF taczltIIy xa better explaia situsgons. {ase €honall page4 as wry)MYield Co Final Notes T/1P�G G/e Gl FP[v WoJG'y ScY�tll�fgs Glorte� r^� /SC/C/C O!` /f1P IL�OOij 7l,o.T' I1pP� / J 6 "Xe 0 1- r�C
fi 1
C0apye ko b,,,
5• 7 e 14gec'k '.7ee_T//
s ko %e
fnaeJ us ncP�Ppi dare e- r 5
C" el e ICT �ri ViIdP/ 9 lC�ci /i r�
CaGs/'li/ i„ ��GT �i/PC1 Io PS�a��fh
/ /'r.9P.7 r 11 vn e a f- A, Is
/"f" , ^. "O"A r, /,.s
9 a 0 d Cave/',
S�raJ.
Reviewer/Inspector Name AGr%l i��:►.'. Zl ----
%ax
Reviewer/Inspector Signature: ? Date:
12112103 Continued

t Facility Number: . _ Date of Inspection �p o
Required Records & Document.~
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
Q`Yes
❑ No
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WFUR,ists; ticsige,�teps, exc,)
❑ Yes
®'No
23. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
❑ No
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
-l3 7 3•U 1-/'1 -,-) l.7 10•/7 7 i,2 'T 3>l,(0 /-ll>>/,If
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
❑No
25. Did the facility fail to have a actively certified operator in charge?
❑ Yes
❑ No
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
Yes
(ie/ discharge, freeboard problems, over application)
❑
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
EjWo
28. Does facility require a follow-up visit by same agency?
❑ Yes
❑ No
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
O-No
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
['Yes
❑ No
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
32. Did the facility fail to install and maintain a rain gauge?
❑ Yes
O-W
33. Did the facility fail to conduct an annual sludge survey?
❑ Yes
EJX6
34. Did the facility fail to calibrate waste application equipment? ❑ Yes BlGo
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No
❑ ❑ Crop Yield Form ❑ Rai f jo In ain
❑-I ❑
[] No violations or deficiencies were noted during this visit You will receive no further correspondence about this visit.
12112103

Site Requires Immediate Attention:
Facility No. �
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: -7 118 , 1995
Time:
Farm Name/Owner: Pr e 5�f a ,, y/ 10a, k e y At r m S
Mailing Address:, Z& . Box -i
County:_ -
Integrator: Phone:
On Site Representative: zorY-2���1a_ Phone:
Physical Address/L.ocaton:_ S
Type of Operation: Swine Poultry Cattle
Design Capacity: z1 Number of Animals on Site: b -7 3�
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: 0 Longitude: "
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately I Foot + 7 inches) lit or No Actual Freeboard: Li Ft. - Inches z) 3 fib ,w
Was any seepage observed from the lagoon(s)? Yes oro Was any erosion observed? Yes oz
Is adequate land available for spray? (I De or No Is the cover crop adequate? n or No
Crop(s) being utilized: r'o-� v-4-L I ber 1-i - - - - — -- -
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellin s? �e or No
100 Feet from Wells? or No
Is the animal waste stockpiled within 100 Feet of USGS Blue.Line Stream? Yes or ga�
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line: Yes orv&
Is animal waste discharged into water of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes or La 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)? (Y4br No
Additional Comments: w e ! 1 ". A;. e)
t I 't S / 1_u r-A_ck--L
Inspector Name Signature
cc: Facility Assessment Unit Use Attachments if Needed.

NORTE CAROLIM DEPARTMW OF F1WI iOMCENr, BRALTH b NATWAL RZSGMLMS
DIVISION OF F.MMONMENTAL
Fayetteville Regional Office
Animal Operation Compliance Inspection Form
33�ISirrt
5 / V V f7=.:..i
El
tai�C+ia3CJatJ 77NXJ7`3M:.3
B�3 - E_CIIQLt2 Z832-E,
M 10
All questions answered negatively will be discussed in sufficient detail in
the -Comments Section to enable the deemed Permittee to perform the appropriate
corrections:
SEMCK I
Animas Op4ration : T�nishin9
horses, catty, swine poultry, or sheep
SECTION , II
T I N I COMMENTS
1. Does the number and type of animal meet or exceed
the (.0217) criteria? [Cattle (100 head),
horses (75), swine (250), sheep (1,000),.and
poultry (30,000 birds with ligt:id waste
system)3 _
2. Does this facility meet criteria for
Animal Operation REGISTRATION?
3. Are animals confined fed or maintained
in this facility for a 12-month period? -
4. noes this facility have a CER iw
WASTE MAKAGEMEW PLAW.
5. Does this facility maintain waste management
records (Volumes of manure, land applied,
spray irrigated on specific acreage with
specific cover crop)?
6. Does this facility meet the SCS minimum
setback criteria for neighboring houses,
wells, etc?

-1
�BG*rIQfi7 iiI
kie1.d Site XanactMent
1. yn animal wai*Lw e3WeVilM Or iago=
construction within 100 ft. of a USGS
Map Blue Line Stream?
2. Is animal waste land applied or spray
irrigataA Wi tl,sn 26 It. of a UOGO Dap
Blue Line Stream?
3. Does this facility have adequate acreage
on which to apply the waste?
4. Does the land application"site have a
cover crop in accordance with the
CZRTIFIGTIoi+1 DiAW
S_ Is animal waste discharged into waters of
the state by man-made ditch, flushing system,
or other similar man-made devices?
6_ Does the animal waste management at this
farm adhere to Best Management Practices
(MO) of the approved CpTIPICAT2M
7_ Does animal waste lagoon have sufficient
freeboard? How much? (Approximately _)
B. Is the general condition of this GAFF facility,
including management and operation,
satisfactory?
LEGION Ty
dents

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