820095_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental Quai

-_,,
FrOMPIMIM411M
l ype of visit: k:fcompliance inspection V Operation Review V Structure Evaluation U 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: & a0 County:_
Farm Name: 1l1q_v,s;__V (Ja _.,J e "l . SA ✓—n Owner Email:
Owner Name: W i V I --t `+t W 4-v" L- "1 Phone:
Mailing Address:
Physical Address:
Region:{
Facility Contact: (_) 1 `� I�� ,.ti.� [Aj A,/ /--r-1 Title: Phone:
Onsite Representative: ( Integratorin a
Certified Operator: t ( Certification Number: /00'3�
Back-up Operator:
Location of Farm:
Certification Number:
Latitude: Longitude:
1
urrent
Design- C11
Design
Current
Design GIN eat
Swine
Capacity Pomp.
Wet Poultry
Capacity
Pop.
Catfle Capacity Pop.
Wean to Finish
Layer
Dairy Cow
Wean to Feeder
JA Z S
Non -Layer
I
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
D , P,o
Ca aci
Ro
Non-DaiTy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
I 113eef Brood Cow
Turkeys
Qther
Turkey Poults
OtherOther
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 [3 -No- ❑ NA ❑ NE
❑ Yes [::]No
[-]Yes ❑No
❑ Yes ❑ No
[:]Yes [ o
❑ Yes ENo
[]"RA ❑ NE
[r lA ❑ NE
EJ -KA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
Page I of 3 2/4/2011 Continued

Facili Number: 2 - -F-75= jDate of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes r_7VN`6❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No [3 -NX` ❑ NE
Stricture 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 [�'l�lo ❑ 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
DN
❑ 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]I�o
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[2'1�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
dNo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
❑'N- o
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes �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): 0
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? [:]Yes [DXo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes M N -o ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes U -N0 ❑ 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 B'go ❑ NA ❑ NE
❑ Yes [D -N -o ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes Q-Noo- ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check [] Yes Ca No ❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design [:]Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. [] Yesv
❑ Waste Application [] Weekly Freeboard ❑ Waste Analysis []Soil Analysis ❑ Waste Transfers
❑ RainfalI ❑ Stocking ❑ Crop Yield [:]120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [3 -No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [r No
❑NA [3 NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑ NA ❑ NE
Page 2 of 3 11412011 Continued

Facili ' Number: R 2 - Date of Inspection: a( ate., �
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ff:fNo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑'*-No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29_ At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, cbeck the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes [3"*'No
[:]Yes ffNo
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes dNo ❑ NA ❑ NE
❑ Yes El No ❑ NA ❑ NE
❑ Yes [7] -No ❑ NA ❑ NE
❑ Yes Ej No ❑ NA ❑ NE
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 allo ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? [:]Yes dNo ❑ NA ❑ NE
Use drawings facih, ' to better explain situations use additional a es as necessa any other comments:-
Comments (refer to question Explain an YES answers and/or an additional recommendations o T �r
g •t5' P ( P 9 ry)• s
cat l/1 �] U
l l7
qj -7v
C'cd_ ell— ra-
Reviewed] nspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
5
3S- 33
Phone: �10_' V _L Q.5 I
Date:
214/2011

Type of Visit: 45 -Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: (;)r�outin-e7 O Complaint O Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit:
CA, (Arrival Time: ;,� Departure Time: i County:
Farm Name: ,,� Owner Email:
Owner Name: kJQ eve - Phone:
Mailing Address:
Physical Address:
S Region:/i ZL
Facility Contact: w t 6 ( t 1M!!!a & ,�Z,l� t: �-, _ Title: Phone:
(S
Onsite Representative: Integrator: /��-�
C
Certified Operator: Certification Number: /! 73-;j
Back-up Operator: Certification Number:
Location of Farm:
Latitude: Longitude:
,Design Current
Swine Cam
pacify Pap.
Wean to Finish
Wet Poultry
No
Layer
Design
Capacity
Current
Pop.
Design Carrent
Cattle Capacity Pop.
Dai Cow
Wean to Feeder i D ,� -t
Non -La er
Dai Calf
Feeder to Finish
- "q'" I'' i ih
Dai Heifer
Farrow to Wean
Design
Current
D Cow
Farrow to Feeder
D . ,P,oul
Ca aci
I:o .
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
�k fir. _
O ther "" �-
Turke s
Turkey Poults
Other
I 10ther
Discharges and Stream lmnacts
1. Is any discharge observed from any pan of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
❑ Yes ❑moo ❑ NA ❑ NE
a. Was the conveyance man-made? ❑ Yes ❑ No [fl—NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR) ❑ Yes ❑ No Q 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 ❑,1A ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes allo ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes [ rNo ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 2/4/2015 Continued

Facitily Number: a - Date of Ins ection: Xg JZ.
Waste Collection & Treatment
4�ls storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes []-l46 ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No [3'9A ❑ 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 [3'lqo- ❑ 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
[3'1 o
❑ NA
❑ NE
waste management or closure plan?
❑ Yes
ONo
❑ NA
❑ NE
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
[� "'o
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
❑ NE
the appropriate box.
9. Does any part of the waste management system other than the waste structures require
❑ Yes
[ffNo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance altematives 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 EEJ �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): 1 ��c.r✓urc�if s' (U Q
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? [:]Yes 0 o ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? [:]Yes [ca']`lo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes ❑llqo ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
dNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
ONo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
[:]Yes
Q"No
❑ NA
0 NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
D—No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design [:]Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. [:]Yes [�No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste 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 EjNo
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [-]Yes dNo
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 214/2015 Continued

li acili Number: 1' Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes Q,MY ❑ NA ❑ NE
2S. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [(�]�o ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes &No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes CD -Na ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
ED -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
E51�o
❑ NA
❑ NE
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
❑ Yes
�o
❑ 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
❑-N6-
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
E3 -No
❑ 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
[E1
❑ NA
❑ NE
Comments (refer t�qtjffi : ETD)M in any YES answers andlar any additional recommendations or any other commenUse drawings of faer ezplain sitnations (use addonal pages as necessary,),
ccj
5
(U - 6sly
Reviewer/Inspector Name: (_� t\\ '
c
Reviewer/Inspector Signature:
Page 3 of 3
Phone:[phone]
Date:
2/4/201

-mss _ , 16 5 eU 4O~ M - -
Di"vi"sion of Water Resources
Facility Number � - � � Division of Soil and Water Conservation
Q Other Agency
Type of Visit: Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: QCRoutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time:11)9/t � 4-
ounty: �, Region:
Farm Name: U Owner Email:
Owner Name: S Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: t `
Certified Operator:
Back-up Operator:
Phone:
Integrator:
Certification Number: 757
Certification Number:
Location of Farm: Latitude: Longitude:
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
Design Current
❑ NA
Design
Current
Design Current
Swine
Capacity Pop.
Wet Poultry
Capacity
Pop.
Castle Capacity Pop.
❑ NE
Wean to Finish
Wean to Feeder
p 0
Layer
Non -La er
EA
❑ NE
Dai Cow
Dai Calf F�
Feeder to Finish
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
[:]Yes
❑ No
Dai Heifer
❑ NE
Farrow to Wean
❑ Yes
E No
Design
Current
D Cow
❑ Yes
Farrow to Feeder
Farrow to Finish
❑ NA
.
D Noult ,
Layers
Ga aci
P,o
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Turkeys
Beef Brood Cow
Other
Turke Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
Q N
❑ 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
EA
❑ 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
dNA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
E No
❑ NA
0 NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
ETNo
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 2/4/2015 Continued

Facili Number: Date of Inspection:
❑ Yes [2No
❑ NA
❑ NE
maintenance or improvement?
Waste Collection & Treatment
11. is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ YesJ�No
❑ NA
4. -Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
[ I]� ❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
[:]No
CaITA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
14. Do the receiving crops differ from those designated in the CAWMP?
Designed Freeboard (in):
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
D Yes dNo
Observed Freeboard (in): S/ —
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes eNo
❑ NA
❑ NE
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
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
[2*lQo
❑ 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
PlrNo
❑ NA
❑ NE
maintenance or improvement?
Waste ADDlication
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes [2No
❑ NA
❑ NE
maintenance or improvement?
11. is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ YesJ�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
R❑
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes J�J`No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
D Yes dNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes eNo
❑ 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?
Re uired _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.
❑ WUP []Checklists [—]Design ❑ Maps ❑ Lease Agreements
❑ Yes 21"No ❑ NA ❑ NE
[:]Yes Flo ❑ NA ❑ NE
❑ Yes 91Bio ❑ NA ❑ NE
[:]Yes d ❑ NA ❑ NE
❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below_ ❑ Yes El 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?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑Yes '8
NA E:] NE
[:]Yes No ❑ NA ❑ NE
Page 2 of 3 2/4/2015 Continued

Facili Number: Date of inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
�' o
❑ NA
❑ NE
A Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
U�'Ro
❑ 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
ElNo
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
ZrNo
❑ NA
❑ NE
Other Issues
28. Did the facility fail to property dispose of dead animals with 24 hours and/or document
❑ Yes
Z_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
[rNo
❑ 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
OTfo
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
❑'No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[J -No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
E!rNo
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
❑ No
❑ NA
❑ NE
Comments (refer to question: Eplsin any YES answers and/or aay additional recommendations or any a#her comments.
Use drawings of facility to better explain sitnatii T5s (pse additions! pages as necessary,).
(5- [
lD
` 3
Reviewer/Inspector Name: (�
Phone:
,�J
Reviewer/Inspector Signature:
fir
Date: '
Page 3 of 3
2/4/2015

Type of Visit: &Cmpliance Inspection 0 Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: Gr9outine O Complaint O Follow-up Q Referral O Emergency Q Other O Denied Access
Date of Visit: Arrival Time:Departure Time: . County: S Region: rl'C
Farm Name: MDcam. oz Owner Email:
Owner Name: Phone: S174472—
Mailing
17_ 472—
Mailing Address: 1.J LLt,--+- 9E5 —((S? f _
Physical Address:
Facility Contact:p C .tv ✓ Title: Phone:
Onsite Representative: Integrator: WA
Certified Operator: t ( Certification Number: 7,
Back-up Operator:
Certification Number:
Location of Farm: Latitude: Longitude:
Discharges and Stream Impacts
I . Is any discharge observed from any part of the operation? ❑ Yes ®-go— ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance Fran -made? ❑ Yes [—]No DNA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR) ❑ Yes [:]No Ej 'NA ❑ NE
c. ' What is the estimated volume that reached waters of the State (gallons)? j
d. Does the discharge bypass the waste management system? (If yes, notify DWR) [:]Yes ❑ No dNA. ❑ NE
2. Is there evidence of a past discharge from any part of the operation? [:]Yes [3jNo ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters [—]Yes F ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 2/412014 Continued
Design Current
Design
Current
Design Current
Swine
Capacity Pop.
Wet Pouttry
Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
La er
Dai Cow
Wean to Feeder
Q b
Nan -La er
Dai Calf
Feeder to Finish
Dai Heifer
Farrow to Wean
Desi
Current
Cow
Farrow to Feeder
D -71 PoutCa
sc'
P,o
Non-DaiTy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turke s
Other
Turkey Poults
Other
Other
Discharges and Stream Impacts
I . Is any discharge observed from any part of the operation? ❑ Yes ®-go— ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance Fran -made? ❑ Yes [—]No DNA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR) ❑ Yes [:]No Ej 'NA ❑ NE
c. ' What is the estimated volume that reached waters of the State (gallons)? j
d. Does the discharge bypass the waste management system? (If yes, notify DWR) [:]Yes ❑ No dNA. ❑ NE
2. Is there evidence of a past discharge from any part of the operation? [:]Yes [3jNo ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters [—]Yes F ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 2/412014 Continued

[FaMity Number: - Date of Inspection;
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Spillway?:
Designed Freeboard (in):
to ❑ NA ❑ NE
❑ No B<A ❑ NE
Structure 6
Observed Freeboard (in):
5. Are there any inunediate threats to the integrity of any of the structures observed? ❑ Yes lJ 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 fo ❑ 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? ❑ Yeso C] NA C] NE
8. Do any of the structures lack adequate markers as required by the permit? [] YesgNo ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes To ❑ NA ❑ NE
maintenance or improvement? `
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes E3No [DNA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes arNo ❑ 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 l � -' _ LA7. E &a,,j
13. Soil Type(s): V0 6o Wk
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes EIKo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? [:)Yes EKo ❑ 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 No ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? [:]Yes To ❑ 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 ❑ YesNo ❑ 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 E]Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑7 e U N ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:)Yes U No ❑ NA ❑ NE
Page 2 of 3 2/4/2014 Cont7nued

Facili Number: Rj -
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [ZKo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes []'Ivo ❑ 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 ED -?Mo ❑ NA ❑ NE
27_ Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes Q�Ko' ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes io ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes No ❑ NA 0 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)
3 L Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
D 11 0
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
C�NNo
❑ 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
6<o
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facilitv to better explain situations (use additional pages as necessary).
I
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date-.
2/4/2014

Type of Visit: (5 Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance I
Reason for Visit: (3 Routine 0 Complaint 0 Follow-up () Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: 'L9� Departure Time: County: _ Regionr)F"
Farm Name: 9,4, I„'tt/✓trt. �"Zr/vt.� Owner Email:
Owner Name: Kwil-L 9 QP ✓✓`e-1\ Phone:
Mailing Address:
Physical Address:
Facility Contact: _&L� 04 vr� Title:
Onsite Representative: i l Integrator:
Certified Operator: 4
Phone:
�� tJ
Certification Number:
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 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 ❑t .N6— ❑ NA ❑ NE
[:]Yes ❑No -EJ-NA ❑ NE
[:]Yes ❑No [][-5A ❑ NE
❑ Yes ❑ No E j A ❑ NE
❑ Yes �Io ❑ NA ❑ NE
❑ Yes F3No ❑ NA ❑ NE
Page 1 of 3 2/412011 Continued
Design Current 111"Design Current
Design Current
Swine Capacity Pop. Wet Poultryti .; Capacity ' ` Pop.
Cattle Capacity Pop.
Wean to Finish La er
airy Cow
Wean to Feeder
Non -Layer
airy Calf
Feeder to Finish
Design Current
airy Heifer
Farrow to Wean
D Cow
Farrow to Feeder
Dr Poul : gCa ci ty 'o
Non -Dai
Farrow to Finish
La ers
Beef Stocker
Beef Feeder
Beef Brood Cow
Gilts
Non -La ers
Boars
Pullets
Turkeys
Other
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
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 ❑t .N6— ❑ NA ❑ NE
[:]Yes ❑No -EJ-NA ❑ NE
[:]Yes ❑No [][-5A ❑ NE
❑ Yes ❑ No E j A ❑ NE
❑ Yes �Io ❑ NA ❑ NE
❑ Yes F3No ❑ NA ❑ NE
Page 1 of 3 2/412011 Continued

Facili Number: - Date of inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No [DAKA ❑ NE
Structure i Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): �C
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ®-1q_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 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
�f o
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
01<o
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
❑ NE
acres determination?
9. Does any part of the waste management system other than the waste structures require
❑ Yes
[�No
❑ NA
❑ NE
maintenance or improvement?
❑ Yes
`Co
❑ NA
❑ NE
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
Egr<o
❑ NA
❑ NE
maintenance or improvement?
�o
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes L;r"'o ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 tbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift E]Application Outside of Approved Area
12. Crop Type(s): C'V C S
13. Soil Type(s): d(/,-. 4-: Aff
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes E] No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes �ao
DNA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes & No
[] NA
❑ NE
acres determination?
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
17. Does the facility lack adequate acreage for land application?
❑ Yes [dNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes Q 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
C3"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
`Co
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield [3 120 Minute Inspections [:]Monthly and I" Rainfall Inspections E] Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
[:]Yes
�o
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
E�rNo
❑ NA
❑ NE
Page 2 of 3 2/4/2011 Continued

92
[:]Yes
Facili Number: - Date of Ins action:
❑ NA
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes ®'leo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
[:]Yes tI "" ❑ 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
❑ NA
List structure(s) and date of first survey indicating non-compliance:
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
26. Did the facility fail to provide documentation of an actively certified operator in charge?
❑ Yes [:fN—o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes ffNo ❑ NA ❑ NE
Other Issues
❑ Yes
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
[:]Yes EJ'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 [3 ' -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 C! No ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31 _ Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
[:]Yes
[] No
❑ NA
❑ NE
❑ Application Field p Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
2rNo
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
[3No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
EjXo'
❑ NA
❑ NE
Comments, (refer to question #): Explainany YES: answers and/or any additional recommendations or, any other comments:
Use:.drawings ,of FaciltY to better eiPT.ani'siWatins 'sa}use additiouaa es as nec
scr� P r -to �) zC" 3( g, 0 1 f
Reviewer/Inspector Name: `!
Reviewer/Inspector Signature:
Page 3 of 3
Phone# f�a
Date: � { o 6
2/412014

a Eti�s L4D�`�`�� i.3 a t7
(Type of Visit: (WCoaOliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance I
Reason for Visit: QVRoutine 0 Complaint 0 Fol1Qw-up 0 Referral 0 Emereenev 0 Other 0 Denied Access
Date of Visit:
�
Arrival Time:
Departure Time: /[/C/ ] County�
Regio-1
Farm Name:
Aa54-�Owner
Ej No
Email:
Capacity Pop.
Wea
Swin"Finish
FFeeder
Wet Poultry Capacity
Layer
_Pop.
Cattle Capacity Pop.
Dai Cow
Owner Name:
<[n
{/�`'�'
Phone:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
Mailing Address:
Physical Address:
Facility Contact: �� Title:
Onsite Representative: L
Certified Operator: 1Jr_(rAYA,
Phone:
Integrator: K 9
Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Discharges and Stream Impacts
Design Current
Design
Current
Design
Gnrren#
Ej No
❑ NA
Capacity Pop.
Wea
Swin"Finish
FFeeder
Wet Poultry Capacity
Layer
_Pop.
Cattle Capacity Pop.
Dai Cow
❑ Yes
❑ NoA
Wea
Non-La er
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
E]Yes
Dai Calf
WN A
❑ NE
to '"
Dai Heifer
Farrow to Wean
Design;
Current
Dry Cow
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
Farrow to Feeder
❑ No
ap i
Pio .
Non -Dairy
FeYes
❑ No
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars Pullets
- Turke s
F.Beef Brood Cow
Other
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
Ej No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ NoA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
E]Yes
E]No
WN 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 DWQ) ❑ Yes
❑ No
K�NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
Mies
❑ No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
FeYes
❑ No
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 114/2011 Continued

C164 ez
Facili Number: Date of Ins ection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3 r
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ONo ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a ❑ Yes No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do 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 I4""'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 10 ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need [-]Yes f h C ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [&Ko ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus p Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift D Application Outside of Approved Area
12. Crop Type(s): 0 d
13. Soil Type(s): L
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
[] Yes
hio
r] NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
hio
NA
❑ NE
acres determination?
[:]Yes No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
17. Does the facility lack adequate acreage for land application?
❑ Yes
[" No
❑ NA
❑ NE
l8. 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 rN
❑ NA
❑ NE
the appropriate box.
I
❑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
dge Survey
❑ Rainfall ❑ Stocking ❑ Crop Yield [:]120 Minute Inspections ❑ Monthly and V Rainfall InspectiWN)❑�3NA
22. Did the facility fail to install and maintain a rain gauge?
[:]Yes
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
[:]Yes
❑ NA
❑ NE
Page 2 of 3 214/2011 Continued

a. -
Facility Number: Date of Ins ection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes �'1<lo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [:]Yes Io ❑ 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 U24!o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAN') certification? ❑ Yes �KN ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes [2 f%Fo ❑ 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 En 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
gNo
❑ 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
E5/No
❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or GAWMP?
❑ Yes
eNo
❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
E(N o
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
[2]"'No
❑ NA ❑ NE
Comments (refer to question ff): Explain jaby YES answers and/or any additional recommendations or any other conminti.'
Use p drawings'of facility to better exlain'situations (6se`additional pages as necessary).
S 6
i
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
V
Date:
2/4/2011

Type of Visit: 40 Compliance Inspection O Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 0 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: County:'5AmMA
Farm Name_ pug 50N M Owner Email:
Owner Name: nos -run Phone:
Mailing Address:
Physical Address:
Facility Contact: �-k C,u'o -�C, n WARPF to Title:
Integrator: 1AV 9 U h �l s 1KaL'rj
Certification Number: 114:153
Onsite Representative: :�k tkr\_ ?_
Certified Operator: a
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Region: rqo
Certification Number:
Longitude:
Swine
Wean to Finish
Wean to Feeder
Design Current:
Capacity .Pop.
yd
�Gaa,
Wetity
ILayer
Non -La er
gn
IDairy
I
Current
Pop.
Design Current
Cattle Capacity Pop.
Cow
Dairy Calf
["NA
❑ NE
Feeder to Finish
Farrow to Wean
Ur.. P,oulttCa
Design
aci
P,o
Dairy Heifer
I Dry Cow
Non -Dairy
Farrow to Feeder
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Turkeys
Turke Poults
Beef Brood Cow
Other
Other
Other
E E
..... __
Discharges and Stream Impact
1. Is any discharge observed from any part of the operation?
Discharge originated at: p 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 RNo ❑ NA ❑ NE
❑ Yes
[:]No
[v'NA
❑ NE
❑ Yes
❑ No
["NA
❑ NE
d. Does the discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes ❑ No
❑ Yes ff No
❑ Yes ffN0
dNA
❑ NE
❑ NA
❑ NE
❑ NA
❑ NE
Page 1 of 3 2/4/2011 Continued

FaciliNumber: Z a _RS I Date of Ins ection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [�'No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? [] Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
❑ NA
Identifier:
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
QIo
❑ NA
Spillway?.
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
[D,110
❑ NA
Designed Freeboard (in):
acres determination?
Observed Freeboard (in):
17. Does the facility lack adequate acreage for land application?
❑ Yes
[Erf4o
❑ NA
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[.'*No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
["No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
[I'(lo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
Q 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
E<o
❑ NA
❑ NE
maintenance or improvement?
Waste Application
No
10. Are there any required buffers, setbacks, or compliance alternatives that need
[—]Yes
C9
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [j?l�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. CropTYpe(s): Coltt4.1�hea�.Sft�j6e_Q'M' I Q
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[�No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
QIo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
[D,110
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[Erf4o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[L]' o
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? [:]Yes [: r1Qo ❑ 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 [3No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis 0 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 rNo
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [—]Yes ❑ NA ❑ NE
Page 2 of 3 2/412011 Continued

rr
Facility Number: $ a - q SI Ds ection:
24. Did.the facility fail to calibrate waste application equipment as required by the permit? [—]Yes [3'No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [�io
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 Ea"No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes E?<o
0 N E] 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
�o
❑ 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
Q'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
r;34o
❑ 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
[glf4o
0 NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
G�No
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
[1 io
❑ NA ❑ NE
omments (refer to question #): Explain any YES answers andlor_any,additional recommendations or any_otherocommilits.
Use drawings of facility to better explain situations (use additional:pages as necessary).
Aaa� v�q?4ch. n E. c%fN w tzz ter,_\9,o.N quo brxco�_
1R9'0UirO V_rn-VRz LaSacr�
Q?P V'A MN%3z wA-MaN �� L�+as htaV a< SC�oO 9
Reviewer/Inspector Name:
Reviewer/inspector Signature:
Page 3 of 3
k
Phone: QIO 3ez8' R� J _
Date:
21412011

Date of Visit: Arrival Time: O,' D Departure Time: lll, 3J County: Region
Farm Name: .L— 9&4zt-e1= Owner Email:
Owner Name: OlLr Phone:
Mailing Address:
Physical Address:
Facility Contact: '6�p&ezF, Title: Phone:
Onsite Representative: ����, Integrator: (C
Certified Operator: Certification Number: /(07`E7
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 DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes CgNo ❑ NA ❑ NE
❑ Yes
Design Current'
❑ NA
Destgn`Curren
Design Current
Swine
-.
Capacity Popes=
Wet Poultry
.:.
Capacity „ Eop �# .
Cattle Capacity Pop.
Wean to Finish
La er
Dai Cow
Wean to Feeder
e"Yo
Non -La er
Dai Calf
Feeder to Finish
_
Dai Heifer
Farrow to Wean
Design iCirrent
D Cow
Farrow to Feeder
x
D , P.oul
Ca°acii :Po d `l
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
a
Beef Feeder
Boars
Pullets
Beef Brood Cow
r-
Turkeys
=
Other
�;'
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes CgNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ 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 ® No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes [g No ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 2/4/2011 Continued

Facili Number: - Date of Inspection.
❑ Yes
n No
❑ NA
❑ NE
Waste Collection & Treatment
❑ Yes
[�3-No
❑ NA
❑ NE
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
r
❑ Yes
5No
0 NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
❑ NA
Identifier.
the appropriate box.
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
® No
0 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
[3 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
E3No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[Z No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
g( No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
0 Yes
Callo
❑ NA
❑ NE
maintenance or improvement?
11. is there evidence of incorrect land application? If yes, check the appropriate box below. �R Yes 0 No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
C& 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): Q&.`"
�
13. Soil Type(s): J� a�-
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes MNo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes 5D No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable [—]Yes R3 No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
n No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[�3-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
allo
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement'? If yes, check the appropriate box below. ❑ Yes R No
❑ 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 ® No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? 0 Yes ® No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑NA E] NE
❑ NA ❑ NE
Page 2 of 3 214/2011 Continued

Facility Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes �SNo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes El No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey 01 Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
p Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CA WMI'?
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 jjg No ❑ NA 0 NE
❑ Yes [,No ❑ NA 0 NE
❑ Yes Eg No ❑ NA ❑ NE
❑ Yes MNo [:]NA ❑ NE
❑ Yes n No ❑ NA ❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
R] No
❑ NA
❑ NE
❑ Yes
[Z No
❑ NA
❑ NE
Comments refer to question . Explain an YES answers and/or an . additional recommendations organ Bother comments: `�
{ q IP y y _ ?;
Use drawings of Tam ty.to,hetterexplain situations (use additional paees`as necessary).
/Z 4'50Z�Iis-
Ato,�f_!i !.7Xll �®x S��o7i 31
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: .tom
Date: --
2/4/201I

P
Type of visit GTompliance Inspection Q Operation Review Q Structure Evaluation U Technical Assistance
Reason for Visit !B'Routine O Complaint O Follow up O Referral Q Emergency O Other ❑ Denied Access
Date of Visit: Arrival Time: Q� (7� Departure Time: r 177i County: Region:�l/•
Farm Name: � �Alaa n— l/�'� Owner Email:
Owner Name: _/�--� Wa/�`�/'t Phone:
Mailing Address:
Physical Address:
Facility Contact: Z262K S��L- WaIYe 't– Title: g2jZlnPhone No:
Onsite Representative: �•!'� �^ Integrator:
Certified Operator: -"` Operator Certifiation Number: &7S�
Back-up Operator:
Location of Farm:
=Latitude:
Back-up Certification Number:
Longitude: =°=d
Design Current
Swine Capacity Population
Design Current
Wet Poultry Capacity Population
Design Ogrent
Cattle Capacity Population
❑ Wean to Finish I 1
1111 Layer
I
airy Cow
M -Wean to Feeder O O
I I[] Non -Layer
I
airy Calf
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
Dry Poultry
E] Layers
❑Non -La Non -Layers
❑ Pullets
❑Turke s
❑ Turkey Poults
❑ Other
❑ Dairy Heifer
❑ Dry Cow
ElNon-Dairy
El Beef Stocker
E] Beef Feeder
❑ Beef Brood Cowl
Number of Structures:
❑ Farrow to Finish
El Gilts
❑ Boars
jRtNo
Other
❑ Other
❑ Yes
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? ([f 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 XNo [INA ❑NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
EINE
❑ Yes
❑ No
❑ Yes
jRtNo
❑ NA
❑ NE
❑ Yes
59 No
❑ NA
❑ NE
Page 1 of 3 11/18104 Continued

fi
ocaU
Facility Number: Date of Inspection Fz
1.
• Waste Collection & Treatment
Phone: 9%0 'V} 3 �
Reviewer/Inspector Signature:
Date: /,-_111Z3 G; / 0
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
[&No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure l 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
[5No
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed
❑ Yes
BNo
❑ 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
0 No
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
C.No
❑ NA
❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
Q -No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
C3 -No
[INA
❑NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes KNo [INA ❑NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN [:IPAN > 10% or ] 0 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) '4. ©yrtq/
13. Soil type(s) Jlleft
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes MNo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? 29 -yes JR No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes a No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes ®.No ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes ONo ❑ 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):
ocaU
Reviewerllnspector Name _ `
Phone: 9%0 'V} 3 �
Reviewer/Inspector Signature:
Date: /,-_111Z3 G; / 0
Page 2 of 3 12/28/04 Continued

Facility Number: — Date of Inspection —1
s
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes [SNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [Q No ❑ NA ❑ NE
the appropriate box. ❑ WDP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ,Yes ❑ No ❑ NA ❑ NE
®-Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
® No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
E No
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
B�No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
ERNo
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
C&No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
Ej No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
ENo
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
RNo
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30_ At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
EINo
❑ 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
0,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
RNo
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
M -No
❑ NA
❑ NE
Additional'Commen# _
ry s and1Draw'tngs
f
Page 3 of 3 12/28/04

I
Type of Visit O'Compliance Inspection O 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: l Arrival Time: �� Departure Time: �� ' C71� County: _ �`�' Region: J`�
Farm Name: 4 n.- a /+TL. Owner Email:
Owner Name:_,462 t(5 WQ rfe Phone:
Mailing Address:
Physical Address:
Facility Contact: IuJ B''L Walo;'t'l- Title: Phone No:
Onsite Representative: :L c- _ Integrator:'w4w44
Certified Operator: -fes— Operator Certiti tion Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: =' =' =" Longitude: = ° =' a
Swine
Design Current
Wet Poultry
Design Current Design courrent
`` Cattle
❑ NE
Ca aci Po ula ion_
p tY P*..3
Capacity P.opulatron Capacity Population
❑ Wean to Finish
❑ Layer
❑ Dairy Cow
® Wean to Feeder
D t,
❑ Non -La er
❑ Dairy Calf
❑ Feeder to Finish
❑ Yes
❑ No
, ❑ Dairy Heifer
❑ Farrow to Wean
c. What is the estimated volume that reached waters of the State (gallons)?
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
`' ❑ Non -Dairy
❑ Farrow to Finish
❑ NA
❑ La ers
❑ Beef Stocker
❑ Gilts
EA No
❑ Non -Layers
❑Beef Feeder
❑ Boars
❑ Yes
u
❑Pullets
❑ Beef Brood Co
❑ NE
;.:
❑ Turkeys
Other
❑ Other
❑ Turkey Poults
❑ Other
Number of Structures: a
Continued
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
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
EA No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
ff No
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12/28/04
Continued

i Facility Number: 0_—,El Date of Inspection S
Waste Collection & Treatment
��
❑
❑
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
El Yes
L9'l�o
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
EgNo
❑ 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
0 N
[INA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
®,No
❑ NA
EINE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
E No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑Yes
23,IVD
❑ NA
❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application'? If yes, check the appropriate box below. ❑ Yes C�LNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) �r� �pi/e�4�t•� - –
13. Soil type(s)�}-
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [HNo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes (RNo '[:INA ❑ 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?
18. Is there a lack of properly operating waste application equipment?
❑ Yes [I No ❑ NA EINE
❑ Yes [ANo ❑ NA ❑ NE
Comments Use dra win(s'of facility to better explain situations. (use additional a es as necessa any oth r omments.
q 3 P y - LORSo[a
gy
efer to uestion Ez EatR an YES.answ�ers and/or anv recommendatt
IReviewerllnspector Name �'� '� Phone: gfQ-33 -33Q0 I
Reviewer/Inspector Signature: Date: //— S` 09
12/28/04 Continued

Facility Number: — Date of Inspection �}
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ISNo [--INA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check ❑ Yes Wo ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [.No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 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
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
R No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
DINo
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
EgNo
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
®,No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
&No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
&No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
[�-No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
KNo
❑ 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
KNo
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
"KNo
❑ NA
❑ NE
W
Additsonal,Comments�and/or�Drawings '�M �- �� ��' $
ki
12128104

Type of Visit O-Cbmpliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit outine O Complaint O Follow up O Referral 0 Emergency O Other ❑ Denied Access
Date of Visit: tL.�iJ Arrival Time: :f7v Departure Time: / fPO County: Region:
Farm Name: jir_ery, Owner Email:
Owner Name: _ a u 4e—,,,, _ _ /,t l�z.l/�/L Phone:
Mailing Address:
Physical Address:
FacilityContact: Tt '�G_ S t t- lVaL elt Title: Phone No:
Onsite Representative: ,�Z � Integrator: / 7%..W
Certified Operator: S�� Operator Certification Number -
Back -up Operator:
Back-up Certification Number:
Location of Farm: Latitude: [= o El
ET
Longitude: 0 0 0 t =46
Design Current Design Eurrent�= t�DesignT.
Current
Swine Gapalty Population Wet Poultry pacity Population=ttle$Capacity Population
Ca
❑ Wean to Finish ❑ La er ❑ Dairy Cow
Wean to Feeder D O ❑Non -La er ❑ Dairy Calf
❑ Feeder to Finish El Dairy Heifer
❑ Farrow to Wean I) 1'oult v ❑ D Cow
❑ Farrow to Feeder �` ❑ Non -Dairy
❑ Farrow to Finish ❑ ayes.
❑Beef Stocker
❑ Gilts Non -Layers
❑ Pullets ❑Beef Feeder
❑ Boars ❑ Beef Brood Co
❑ Turkeys
Other ❑ Turkev Poults
❑ Other ❑Other Mu_mber oftSfructures:
Discharges & Stream Impacts
1. 1s any discharge observed from any part of the operation'?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes [5d No ❑ NA ❑ NE
❑Yes
El No
El NA
El NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
[K No
❑ NA
❑ NE
Page 1 of 3 12128/04 Continued

Facility Number: — j Date of Inspection 7
Waste Collection & Treatment
13.
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
C9 No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure
5 Structure 6
Identifier:
❑ NE
15.
Spillway?:
❑ Yes
[.No
Designed Freeboard (in): Z
❑ NE
16.
Observed Freeboard (in): _315-
1j5.
S No
❑ NA
❑ NE
17.
5.Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
Cj No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
❑ NE
18.
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?
❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
[K No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
E&No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
® No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
® No ❑ NA ❑ NE
mai ntenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
[0 No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or I O 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. Croptype(s) 25jk,,r-wturia f Bt/�f`5�_ _/ GDr`� 1U+c..7—--
13.
Soil type(s)p
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
5 No
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement'?
❑ Yes
[.No
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
S No
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
3.No
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
5kNo
❑ NA
❑ NE
Reviewer/Inspector Name Phone:
Reviewer/InspectorSignature: Date: /p G2T2;A�_jq-,
Page 2 of 3 12/28/04 Continued

Facility Number: — Date of Inspection —
lk
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes P&No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check ❑ Yes R No ❑ NA ❑ NE
the approprrate box. ❑ WUp ❑ Checklists ❑ Design g [:1 Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ® No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ® No ❑ NA ❑ NE
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [&No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
No
❑ NA
❑ 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
® No
❑ NA
❑ NE
24. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
® No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
® No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
® No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
® No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
® No
❑ NA
❑ NE
Page 3 of 3 12128/04

0
s�
Division of Water Quality 102-0-a7
Facility Number j" 0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit &C—ompllance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit O outine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: d; O Departure Time: County: Region:
Farm Name: r- /" ii'L Owner Email:
Owner Name: _ guar re!5i2 Phone:
Mailing Address:
Physical Address:
Facility Contact: �/Ji(h ��ui"f �'� t Title: Phone No:
Onsite Representative: Integrator:
Certified Operator: _ S'�— Operator Certification Number: 16' 75�
Back-up Operator:
Location of Farm:
Swine
Back-up Certification Number:
Latitude: = 0 =' = Longitude: = ° =' 0
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Wean to Finish ❑ La er
01 Wean to Feeder O I " G 110 Non -La et
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑
Dairy Heifer
❑
Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
2- Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes ® No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
allo
❑ NA
❑ NE
❑ Yes
[5No
❑ NA
❑ NE
12/28/04 Continued

Facility Number: ff -9- j Date of Inspection —`/—
i1
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
[I Yes ®No [I NA [__1 NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
Identifier:
® No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes
Spillway?:
❑ NA
❑ NE
18. Is there a Iack of properly operating waste application equipment? ❑ Yes
[Z No
Designed Freeboard (in): 1 9k
❑ NE
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
0 No
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed
❑ Yes
® 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?
[9 Yes
❑ No
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
0 No
❑ NA
❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
UNo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
[]Yes
[SNo
[INA
❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ®,No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop/Window ❑ Evidence of Wind Drifl ElApplication Outside of Area
12. Crop type /
s) /hap � Ij ! d iit / 5 / CDr+1L-
13. Soil type(s)e?
1'74 L k
14. Do the receiving crops differ from those designated in the CAWMP? RYes 10Wo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement'?
❑ Yes [4 No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
® No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes
® No
❑ NA
❑ NE
18. Is there a Iack of properly operating waste application equipment? ❑ Yes
[Z No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
ALI
�G"�"�!t•! /"1 �l� �-.Prl P ✓+lY �t v 1•� tSc�i3c�,
doe
Reviewer/Inspector Name / - rt!- Phone: %�0~y3 3 33dc�
Reviewer/Inspector Signature: ��`' .-R, !a Date:
' 12128/04 Continued

Facility Number:_ jj Date of Inspection —G—�
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 appropirate box. F-1 WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement`? If yes, check the appropriate box below. ® Yes ❑ No ❑ NA ❑ NE
21 Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 124 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
EjNo
❑ 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
EL 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
[ZNo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
Q No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
® No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
[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
59 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
[R] No
❑ NA
❑ NE
Additional Comments and/or Drawings:
m-
007�
Way d"5
%j't ��e NO!/��pr • u�c►i r �h � trrm�*da � Qr/t/,�r��d-��1�'L
H
12/28/04

Type of Visit 49 Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit O Routine O Complaint 4D Follow up Q Referral O Emergency O Other ❑ Denied Access
Date of Visit: 0(, Arrival Time: ►-e: �� Departure Time: r�� County: son Region: _ RD
Farm Name: ,4{ usign `arrt'� 6~ Owner Email:
Owner Name: tCOL{,S4ki WQr#,s'.r\ Phone: yn -5-67—A/1--k
Mailing Address:
Physical Address: II
Facility Contact: t4oaST'o " yarrEY1 Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
if
Phone No:
Integrator: Imo.-Dk!4
Operator Certification Number: /675-7
Back-up Certification Number:
Location of Farm: Latitude: =0
=, 0 Longitude: 0 0 = d = «
Discharzes & 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 -trade?
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?
Page I of 3
❑ Yes ® No ❑ NA ❑ NE
C1 Yes
0 N
El NA
El NE
Design Current Design Current
Design Current
Swine
Capacity Population Wet Poultry Capacity Population
Cattle Capacity Population
❑ Wean to Finish
❑ Layer
❑ Dairy Cow
❑ Wean to Feeder
❑ Non -Layer
❑ Dairy Calf
❑ Feeder to Finish
❑ Yes
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ Da Cow
❑ Farrow to Feeder
"
ElLa ers
❑ Non -Dairy
❑ Farrow to Finish
❑Beef Stocker
❑ Gilts
❑ Non -Layers
❑ Beef Feeder
❑ Boars
❑ Pullets
El Beef Brood Co
- - ❑ Turkeys
❑ Other
❑ Turkey Poults
Other
Number of Structures:
Discharzes & 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 -trade?
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?
Page I of 3
❑ Yes ® No ❑ NA ❑ NE
C1 Yes
0 N
El NA
El NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
X] NE
❑ Yes
❑ No
❑ NA
ONE
12/28/04 Continued

Facility Number: e6'2: -9,5 -Date of Inspection aIG Q6
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a_ If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
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 p51 NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes ❑ No ❑ NA [ONE
❑ Yes ❑ No ❑ NA 0 NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? Yes ❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ❑ No ❑ NA NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ❑ No ❑ NA NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ❑ No ❑ NANE
mai ntenance/improvement?
11. Is there evidence of incorrect application? if yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA f NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14, Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ No
❑ NA
[6 NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ No
❑ NA
Q�NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination`
❑ Yes
❑ No
❑ NA
W NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA
In NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
[-INA
O NE
I Ptvtc�_ &C- �aSWN $ 64 l C.l PUw ed . A�o 1�& S a t^Q wr f -`•-�
'qO ` 2 -- C4, Lagooi, W -co, S CQ14e4
:,Q 4 -o A� ,
Reviewer/Inspector Name `o �� �{ Phone.
`Il0 45
Reviewer/Inspector Signature: Date: Oda 1L
12/28/04 Continued

Facility Number: g ;)L-- 95— Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ❑ No ❑ NA E4 NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ❑ No ❑ NA P NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA 91 NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ No ❑ NA 4 NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No ❑ NA P NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
❑ NA
0 NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No
❑ NA
[SJ 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
0 NE
Other Issues
28.
Were any additional problems noted which cause non-comp]iance of the permit or CAW MP?
❑ Yes
❑ No
❑ NA
RNE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
❑ No
❑ NA
[�j NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
❑ No
❑ NA
[$LNE
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
�5 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
[X NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
❑ No
❑ NA
CRNE
�di�� tion 1 Comments�and/or Drawrn � ° x rc' �` " t `
4(ZIS Y;e1c(. -et4 iqwfw
12/28/04

Type of Visit @�.C'Ompliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit O Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit. Arrival Time: !D`O Departure Time: ; f. County: �'� Region:
Farm Name: 14oLisSTz)vt. Dl/p r rP-, Fftt vi,%- Owner Email:
Owner Name: Holt Sl -d'-- W 92Y r z- P- f P1hone":� , !
Mailing Address: _� % ?0 5�i%`a tdJ Ora ft �Uot. I l b6� � Or N�
Physical Address:
Facility Contact: /fDc� �-�—yr. (.C)ccr/- r v-- Title:
Onsite Representative:
Certified Operator: Sd—,c
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
'(Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Phone No:
Integrator: u
Operator Certification Number:
Back-up Certification Number:
Latitude: =' =' F__] Longitude: = e ='
= u
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
j ❑ La _er
310 �', ❑ Non -La et
Dry Poultry
❑ Layers
❑ Non -La ers
❑ Pullets
❑
Turkeys
❑ Turkey Pou Its
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population:'
❑ Dai Cow
❑ Dairy Calf
❑ Dairy Heifei
❑ Dry Cow
is
❑ Non -Dairy
❑ Beef Stocker h
❑ Beef Feeder
❑ Beef Brood Cow
l I 1:a
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes 19 No ❑ NA ❑ NE
❑ Yes
[29 No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
KNo
❑ NA
❑ NE
❑ Yes
7A No
❑ NA
❑ NE
12/2$/04 Continued

Facility Number: —
Date of Inspection cl�
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes VNo ❑ NA EINE
a. If yes, is waste level into the structural freeboard? ❑ Yes RNo ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): �3 l
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
� No
El NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed
❑ Yes
ZNo
❑ 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?
[4 Yes
❑ No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
jl� 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
XNo
❑ NA El NE
mai ntenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
RNo
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu,
Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside/of Area
12. Crop type(s) ,�j V-nj U cc �a 4e / D f/Y�'
13. Soil type(s) AJ p
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
Q No
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
D6Yes
�1'�0
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination%❑
Yes
�KNo
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
RNo
❑ NA ❑ NE
18. is there a lack of properly operating waste application equipment?
❑ Yes
19No
❑ NA ❑ NE
C L ea -I— -T q G k _S -'-d e 0'r-- �a� v� �- Z . Sinal/
��eSrg-vt'Or��;� ��r �I`rGt p •�t� � a� t�D n� b a� fc ,
7�._4J u71 �`�l %S w : �� fir. �� y d /-
T�
10 ' /� �a ll - �-�� Ju.� lst-
Reviewer/Inspector Name
Reviewer/luspector Signature:
Phone:
Date: '7'1—,;;? p -,,;'-D Q
12/28104 Continued

Facility Number: ff - Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 56No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes E4 No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ®-Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stacking JOCrop Yield ❑ 120 Minute Inspections ® Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes P9 No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No KNA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
® No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
ERNA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
EQ No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
ORNo
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
® No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
CK 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
XNo
❑ NA
❑ NE
A`ddtiiopal CeimmentsandlocDrawings
Km c p CY' Npyr
12128104

Type of Visit 4B Compliance Inspection C) Operation Review O Lagoon Evaluation
Reason for Visit a Routine 0 Complaint O Fallow up O Emergency Notification O Other ❑ Denied Access
Facility Number
Date of Visit; Time: �� p
iro
lot Operational 0 Below Threshold
Permitted Utertified [3 Conditionally Certified ❑ Registered Date Last Operated or Above Threshold:
Farm Name: jA✓ F, County: _ .SCY._.srn„
Owner Name: �OVStort 1 War Phone No:
NJ ailing Address: _1970 STraal Pd ie AIL 2.9 3 9�
Facility Contact: _ 1/"40r1 lniaer e4 _ Title: Phone No:
Onsite Representative: He vdorn In%urrnn Integrator: (f rr /
Certified Operator: !`/�,r. �en �i� ��r.., Operator Certification Number: ILI
Location of Farm:
D'Sewine ❑ Poultry ❑ Cattle ❑ Horse Latitude Longitude �' �• u '`
Design Current Design Current Design Current
Swine Ca acitV Population Poultry- Capacity Population Cattle Capacity Population
BI-Vean to Feeder 1 10 Laver I ❑ Dairy
❑ Feeder to Finis 10 Non -Laver I I ❑ Non -Dairy
❑ Farro-w to N;*ean
❑ Farrow to Feeder 10 other
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ Bow Total SSLW
Number of Lagoons — J JU Subsurface Drains Present Jw Lagoon Area JU Spray Field_ Area
Holding Ponds / Solid Traps ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Irkj
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
❑ Yes
[;Ko
b. If discharge is obsen•ed, did it reach Nater of the State? (If yes, notify DWQ)
❑ Yes
[til
c. If discharge is obsened, what is the estimated flow in eal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
❑ Yes
Q -Ko
2. Is there evidence of past discharge from any part of the operation?
❑Yes
E140
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
❑ Yes
0,1' 0
Wa a CollLetion & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
❑ Yes
0 -Ko
Structure 1 Structure 2 Structure 3 Structure 4 Structure ;
Structure 6
Identifier:
r�
Freeboard (inches): �S
05IV3/0I
Continued

Facility Number: 012 —
Date of Inspection G
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes I_`7 No
❑ Yes 2 o-
❑ Yes 3 -go
❑ Yes 3 No
❑ Yes 13'No
VVaste Anniication
}110114. Are there any buffers that need maintenance/improvement? ❑ Yes Q-11-0-
11.
1. Is there evidencesof over application? F]Excessive Ponding ElPAN E3Hydraulic Overload ElYes [Q-90-
12. Crop type Bef mulla- ,
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes
14. a) Does the facility lack adequate acreage for land application? ❑ Yes E3'go-
b) Does the facility need a wettable acre determination? ❑ Yes Q3do
c) This facility is pended for a wettable acre determination? ❑ Yes Eav-0
15. Does the receiving crop need improvement? ❑ Yes �To
16.
Is there a lack of adequate waste application equipment?
❑ Yes
[]
Reogired
Records & Documents
PIetSC .►,o„*or tw/e,, �rc,1A 4 .ks;4 Crr %agaves, Moir 07.0ead
17.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
EX0,
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ A�fi , chgcllrsts. d etc.)
❑ Yes
9<0
19-
Does record keeping need improvement? (ie/ is�atiotf,&eeis�ar3. wAmmmmfnsis & sail-smttpie-reports)
❑ Yes
['-Flo
20.
I -S facility no iri compliancF li anyapplicable setback criteria m effect 1atthe time of design?
❑yes
Do
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
0 -Ko_
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑Yes Q>No
23. Did Reviewer/Inspector fail to discuss review/inspection with on-site representative? ❑ Yes [I N6
24. Does facility require a follow-up visit by same agency? ❑ Yes D -ti -0
25. Were any additional problems noted which cause noncompliance of the Certified AVVMP? ❑ Yes 91 -No
0 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
nv recommends oas or any o_tirer enis. 2 '-
Commeats;(refer to':question #) Ep lata ati YES answers and/or amm
Y
l ise drawings of faciltts to'better ezplaui sitttateos. (nse adclitton$I pages as necessary) = e1d Con v ❑Final Notes _
/'t�1✓arrin 4s e r. PcJ is' aPPl'eel acgloro;,p9 �0 �49e Soil' FeSA "/0er'1;
PIetSC .►,o„*or tw/e,, �rc,1A 4 .ks;4 Crr %agaves, Moir 07.0ead
nlot/nfld o9 't” C.U4 ��i�. Sc►�o �A/J �L Q4ihr
I 1W1
Reviewer/Inspector Name r
Reviewer/Inspector Signature: Date: - d
05103/01
Contnued

Site Requires Immediate Attention: 5,u-90hS
Facility No. � 7,- a I i l st s
�J DMSION OF ENV]RONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: _q ni b L , 1995
'iirnc: 1 z -
Farm Namelowncr. W-wt'w, waa4" (1AA0W
Mailing Address: 'T�,T t JBIX 3 SA 30 �"Z b o w C
County:- 5AMRS QK)
Phone: _ R to Z112
On Site
Physical
Type of Operation: 5wme Poultry CSttte
Design Capacity: 3'W -+D Number of Animals on Site: 3VID
DEM Certification Number: ACE_______ DEM Certification Number: ACNEW
latitude: 990Longitude• '
Circle Yes or No
Does the Animal Waste Lagoon ve sufficient freeboard of I Foot + 25 year 24 hour storm event
(approximately I Foot + 7 inches) � or No tu.al Freeboard: Ft. -L—Inches
Was any seepage observed from the I n(s)? Yes orN6 Was any erosioned? YesJ
Is adequate land available for spray? or No Is the cover crop adequate? 06k or No
Crop(s) being utilized:
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings? or No
100 Feet from Wells? (r or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or �§
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line: Yes or
Is animal waste discharged into water of state by man-made ditch, flushing system;_ or other
similar man-made devices? Yes oro 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)? Yeso `
Additional Comments: Lbn&
W?
tIonkc4 _ , kD� p oe A _ c,
-Inspector Signature -
cc: Facility Assessment Unit Use Attachments if Needed.

1: zo
State of North Carolina
Department of Environment,
Health and Natural Resources 715VA •
Fayetteville Regional Office
James B. Hunt, Jr., Governor E5F—=Jonathaan B. Howes, Secretary
Andrew McCall, Regional Manager
DIVISION OF ENVIRONMENTAL MANAGEMENT
December 13, 1995
Mr. William Warren
Mr. Houston Warren
1770 Straw Pond School Road
Roseboro, NC 28382
SUBJECT: Compliance Inspection
Sampson County
Gentlemen:
On November 13, 1995, an inspection of your animal operation was performed by the
Fayetteville Regional Office (FRO). Please find enclosed a copy of our Compliance
Inspection Report for your information. It is the opinion of this office that this facility is
in compliance with 15A NCAC 2H, Part.0217, and that Animal Waste Management is being
properly performed.
Should you have any questions regarding this matter, feel free to contact me at (910)
486-1541.
Sincerely,
k4" zee"�
Ricky Revels
Environmental Technician IV
Enclosure
cc: Facility Compliance Group
Wachovia Building, Suite 714, Fayetteville, North Carolina 28301-SO43 Telephone [phone] FAX 910-4&5-0707
An Equal Opportunity Affirmative Action Employer 5096 recycled/ 10% post -consumer paper

Site Requires Immediate Attention: 410
Facility No. 172 - 9S
DIVISION OF ENVIRONMENTAL MANAGF.NIFI+TI' 8 i- 3 7/ i s
ANIMAL FEEDL oT OPERATIONS SITE VISTfATmON RECORD I"e-P r' "+'
DATE: /f / 3 , 1995
Tom: 0 S 3 O
Farm Name/Owner:_ AI �` �,.�_ Lada. Y re -vi / /761,--s 74- N 1J-cj-
Mailing Address: 7 O S4 -mw oar d SC40 r ]fid . ►!o S C_{ae ro 1, NC 2 S 3 gZ--
County: Sd .,..�, sem.✓ - - -
-integrator:- Carrol l s Food mac- Phone:
On Site Representative: _ s s6w t,..10 � � phone: (410) 54 7 - Z ! 7
Fhvsical Address/Location: _. __F v#-, enrh-pw.e_c i oea4c ri va S2 15-77 a+
91d )
Type of Operation: Swine ✓ultry Cattle
i ----
Design Capacity: '9Yo Number of Animals on Site: 3qo o
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: Longitude. •
Circle Yea or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately I Foot + 7 inches) Yes or No Actual Freeboard: 3 Ft. O Inches
Was any seepage observed from theoon(s)? Yes o�Was any erosion observed? Yes oz�
Is adequate land available for spray?r No Is the cover crop adequate? ®or No
Crop(s) being utilized: Coos w; w4,- 4--IRtg.
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings? ®or No
300 Feet from Wells? � or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or®
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line: Yes oil
Is animal waste discharged into water of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes onAR If Yes, Please Explain.
Docs the facility maintain adequate waste management rxors (volumes of manure. land applied,
spray irrigated on specific acreage with cover crop)? or No
Additional Comments: %mss 7 7 6 a 3,94o
�' R, & /ez.' - Ar_-�
Inspector Name Signaturti
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