820097_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental Qual

li
Type or visit: W uompvance inspection v vperanon meview V structure Evatuanon tJ iecnmcat Assistance
Reason for Visit: ® Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: (1717-4 /( Arrival Time: Departure Time: , WCounty: Region: C�
Farm Name: Owner Email:
Owner Name: g4to4_5 --#-t C_e Phone:
Mailing Address:
Physical Address:
Facility Contact: /t/i�e44,c h61 Title: Phone:
u
Onsite Representative: Integrator: 5;",944W
Certified Operator: Certification Number:
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Dischar es and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes 1P No ❑ NA ❑ NE
❑ Yes [—]No
❑ Yes []No
❑ Yes ❑ No
❑ Yes No
❑ Yes No
NA ❑ NE
NA ❑ NE
NA ❑ NE
NA ❑ NE
❑NA ❑NE
Page I of 3 21412015 Continued
Design Current
=
Design
Current
Design
Current
Swine
Capacity Pop.
- Wet,Poultry
Capacity
Pop.
Cattle Capacity
Pop.
Wean to Finish
La er
Dairy Cow
Wean to Feeder
Non -Layer
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Dry Cow
Farrow to Feeder
D PouIt ,
Ca aci
P,o
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turke s
s []ther
Turkey Poults
Other
Other
Dischar es and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes 1P No ❑ NA ❑ NE
❑ Yes [—]No
❑ Yes []No
❑ Yes ❑ No
❑ Yes No
❑ Yes No
NA ❑ NE
NA ❑ NE
NA ❑ NE
NA ❑ NE
❑NA ❑NE
Page I of 3 21412015 Continued

Facility Number: Date of Inspection.
❑ Yes
No
❑ NA
❑ NE
Waste Collection & Treatment
❑ Yes
No
❑ NA
❑ NE
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
❑ 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?
❑ YesNo
1P
❑ NA
E]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
[P No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
Waste Annlication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes® No ❑ NA [—]NE
maintenance or improvement? T
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [5@ 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 [3 Application Outside of Approved Area
12. Crop Type(s): C$_1r9& I
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑Yes No ❑ NA C—]NE
15. Does the receiving crop and/or land application site need improvement? [:] Yes No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes VO No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. [] Yes l No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes No
❑NA ❑NE
0 Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑NA ❑NE
Page 2 of 3 2/4/2015 Continued

Facili Number: - 7 Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [P No
25. Is the facility out of compliance with permit conditions related to sludge? if yes, check ❑ Yes [0] No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
[] Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes CR No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes '�°] No
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
No
❑ NA
❑ NE
and report mortality rates that were higher than normal?
17,
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
[g 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
❑ YesNo
le
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
33. Did the Reviewer/inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
[P No
❑ NA
0 NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
[V No
❑ NA
❑ NE
Comments (refer to question � Eap1Mn any ,YES.answers. and/or any additional+recommendations or:any a
a .. , :. ,... ether coTmenfs:` �
Use drawmgs;of facility to_betterFexglam situations {use additional pages as_necessaryl..;.
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 9`V_7'1V_-?j2D
Date: fp12-111
2/4/2015

Type of Visit: (0 Compliance Inspection 0 Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: 46 Routine O Complaint 0 Follow-up O Referral Q Emergency O Other O Denied Access
Date of Visit:f Arrival Time: yG10 Departure Time: IXC County: Region:
Farm Name: A' A) F%W M Owner Email:
Owner Name: aj Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
/Vi
W
Title:
Phone:
Integrator• 5if f'
Certification Number: 99-07-7
Certification Number:
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'?
❑ Yes PNo ❑ NA ❑ NE
❑ Yes ❑ No r NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
Des" gnCurrent
❑ No
Design
Current
Design Current
Swine
Capacity Pop:
Wet Poultry
Capacity
Pop.
Cattle Capacity Pop.
[:]No
Wean to Finish
❑ NE
Layer
0 Yes
Epqo
❑ NA
Dai Cow
3. Were there any observable adverse impacts or potential adverse impacts to the waters
Wean to Feeder
P No
Nan -La er
❑ NE
of the State other than from a discharge?
Dai Calf
Feeder to Finish
S�
m1° 'I
�ti
Dai Heifer
" .
Farrow to Wean
M.iP
Design
Current
D Cow
Farrow to Feeder
D , l;o_nl
Ga gci
P,o
Non-DairY
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkey
�`��
Turke Poultsmay,...
_
Other
1. 1
10ther
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made'?
❑ Yes PNo ❑ NA ❑ NE
❑ Yes ❑ No r NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
❑ No
[n NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (if yes, notify DWR)
❑ Yes
[:]No
P NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
0 Yes
Epqo
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
P No
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 2/4/2015 Continued

Facili Number: IDateof Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): y
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 No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes &No [] NA ❑ NE
maintenance or improvement?
Waste ADDlieation
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ YesNo ❑ NA ❑ NE
maintenance or improvement? 1P
l t. 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 E] Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check
the appropriate box.
❑ Yes
E� No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ YesNo ❑ NA [:]NE
[:]Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑WUP C1 Checklists [:]Design [:]Maps ❑Lease Agreements E] Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes E�No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis 0 Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I " Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes P No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes C9, No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: Date or Inspection: ,
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey [] Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [:]Yes No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes No
❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
34. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes No
❑ NA
❑ NE
permit? (Le., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes ® No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes P1No
❑ NA
❑ NE
Comments (refer to°question #): Explain any YES answers and/or any additional recommendations or,, any other,comments�� '.
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: *0 "
Date: 14, �q
2/4/2011

Type of Visit: 4M Compliance Inspection O Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: d Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit:
Arrival Time:
O `,
Departure Time: rg County: V�-� Regioif: "�
Current
Design Current
Swirte Capacity Pop.
Wet Poultry
Farm Name: _ , l jJ
c
Owner Name: 7 w(�rr
V^
CattleMC.apacity Pop.
_ Owner Email:
Phone:
Mailing Address: -
Physical Address:
Facility Contact: 120 { y _f _ Title: Phone:
Onsite Representative: In#egrator: �w
Certified Operator: Certification Number: 0
Back-up Operator:
Certification Number:
Location of Farm: Latitude: Longitude:
Design Current ?
-='-ME
Design
Current
Design Current
Swirte Capacity Pop.
Wet Poultry
Capacity
Pop.
CattleMC.apacity Pop.
Wean to Finish
Layer
Dairy Cow
Wean to Feeder
Non -La er
Dairy Calf
-
Feeder to Finish
Dai Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
D . P,oultr.
Ga a c i
P,o
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
I 113eef Brood Cow
Turke s
Othe&E
Turkey Poults
Other
Other
Discharges and Stream impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes 99 No ❑ NA ❑ NE
[:]Yes ❑ No
❑ Yes [—]No
KNA ❑NE
NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR) ❑ Yes [—]No P NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? [—]Yes [P No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes M No ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 21412015 Continued

Fncili ,Number: Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes PQ No ❑ NA ❑ NE
It—
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):i N
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 1W 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 P No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ YesNo [—]NA [:]NE
maintenance or improvement?
Waste AoDlication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ YesNo [:]NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ® 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
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes M No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield [:1120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [P No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [-]Yes M No
❑NA C-] NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 2/4/2015 Continued
12. Crop Type(s):
13. Soil Type(s):d-0
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
No
❑ NA
❑ NE
acres determination?
T
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
1p No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
[:]Yes
E0 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 M No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield [:1120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [P No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [-]Yes M No
❑NA C-] NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 2/4/2015 Continued

Facili � Number: jDate of Inspection.-_
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
No
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
h
[P No
❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes
T No
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
No
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes[No
❑ NA ❑ NE
and report mortality rates that were higher than normal?
TT
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
j� No
❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
i
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
[] Yes
EP No
❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
3l. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
RR No
❑ NA ❑ NE
p Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
f o No
❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
(9 No
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?❑
Yes
� No
❑ NA ❑ NE
Conamentsk(refer to gnesttan # AExplatnzany YES answers an or any.additiotial recommendations o�,�atay!ot -i�4- men_ts
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date:
2/4/2015

I ype of visit: IP Compliance Inspection V Operation Review (> Structure Evaluation V Technical Assistance
Reason for Visit: 0 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Li
L d Arrival Time: ,v? Departure Time: County:Region: Lr9z�
Farm Name: J Owner Email:
Owner Name: �' JA)A 4±ti(517,l e Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative. v u
Certified Operator:
Back-up Operator:
Location of Farm:
Title:
Latitude:
Phone:
01
Integrator: 9
Certification Number: < ��
Certification Number:
Longitude:
Discharees and Stream Impact_s
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other;
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes �D No ❑ NA ❑ NE
❑ Yes
Design Current'.
NA
Design Current_
Design Curren#
Swine
Capacity ' Pop :
Wet Poultry
CapacttyPop. .'
Cattle Capacity Pop.
❑ NA
❑ NE
Wean to Finish
Layer
Dairy Cow
Wean to Feeder
;_91
jNon-Layer__j
Da' Calf
Feeder to Finish
77 2W 5-71''
Da4y Heifer
Farrow to Wean
Design Curren
Dry Cow
Farrow to Feeder
D , P,ouI
Ca aci -Po
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
-
Turkeys
Other Turkey Poults
Other
Other
Discharees and Stream Impact_s
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other;
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes �D No ❑ NA ❑ NE
❑ Yes
❑ No
NA
❑ NE
❑ Yes
❑ No�c]
NA
E] NE
❑ Yes
❑ No
NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
Page I of 3 2/412014 Continued

Facili 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
Struc e 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Spillway?:
Designed Freeboard (in): _
Observed Freeboard (in):�
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., 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?
PNo ❑NA E] NE
T❑No P]NA E] NE
Structure 6
❑ Yes T No ❑ NA ❑ NE
❑ Yes �] No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes [� No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? [—]Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need [:]Yes ® No E] NA E] NE
maintenance or improvement? T
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes W 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 Wipdow r ❑ Fyidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ Yes
No
❑ NA
❑ NE
[] Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes [�§ No ❑ NA ❑ NE
[:]Yes �D No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [9 No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and l " Rainfall Inspections
22_ Did the facility fail to install and maintain a rain gauge? [:]Yes [�] No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 03 No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 2/4/2014 Continued

[Facility Number: jDate of inspection:VZ
24. Did the facility fail to calibrate waste application equipment as required by the permit ❑ Yes No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
. permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface file drains exist at the facility? If yes, check the appropriate box below
❑ Application field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes No
❑
Yes
No
❑ Yes No
❑ Yes No
❑ Yes P No
[] NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes ® No ❑ NA E] NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative? ❑ Yes TT No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes No ❑ NA ❑ NE
Comments (refer -to question, ft Explain any YES answers and/or any,additional recommendations or_any other commentL
Use drawings of facility to.better explain situations (use -additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: `1e-'yP—_7=
Date:
/4/2014

Type of Visit:m
on�pliance Inspection n Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: GrI outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: , c3 T Departure Time: County -e.__
Farm Name: 1 �y` -r�'e d L,44 S r -V Owner Email:
Owner Name: h Phone:
Mailing Address:
Physical Address:
L
Facility Contact: t''T v f y��► Title: Phone:
Tt-
Onsite Representative: (� Integrator: rlli G
Certified Operator: C fit, D `t. Ute- Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Region:
ine
ean to Finish
rTFeeder
Design Current
Capacity - . Pop.
Wet Poultry
La er
Design
Capacity
Current
Pop.
Design Current
Cattle Capacity Pop.
Dai Cow
ean to Feeder
Non -La er
Design
_Dai
Current
Dai Calf
Heifer
- Cow
to Finish
rrow to Wean
Farrow to Feeder
D . P,out
C$ aci
Ro .,
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
ML_jOther
_
Turkeys
Turkey Poults
Other
Discharees and Stream impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
Page I of 3
[:]Yes 0 ❑ NE
❑ Yes ❑ No U TA ❑ NE
[:]Yes ❑ No E144 -A- ❑ NE
[:]Yes ❑No
❑ Yes []176
❑ Yes [3 -No
❑ qA ❑ NE
❑ NA ❑ NE
❑ NA ONE
21412014 Continued

Facility Number: - Date of Inspection:
'Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes Q -?fa -_0 NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No 9 -NA --F] NE
Structure i Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 5-D
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
D -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
[:2 o [] NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
No ❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[� 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
[]'I'Tio` ❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes to ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes 'Co❑ NA ❑ NE
❑ Excessive Ponding [] Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > l0% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): k S L_7 V
13. Soil Type(s): '0
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [3110 ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? [-]Yes E 'moo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes FI No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes [E -No ❑ NA ❑ NE
[:]Yes [.]'Flo ❑ NA ❑ NE
Required Records & Document_s
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes [2 -No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [/rNo ❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ 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 E;3 No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes d No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑ NA ❑ NE
Page 2 of 3 2/4/2014 Continued

Facili umber: - V Date of inspection: I ErM26S
24" Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes 23-<o ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [a ❑ 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 [31o❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [31 off ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes ❑'lao ❑ 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 u Tqo ❑ 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 ❑ Yeses ❑ 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
C3'go—
❑ NA
❑ NE
. ❑ Application Field ❑ Lagoon/storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
C3'56-
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
21"go
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
No
❑ NA
0 NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other -comments,
Use drawings of facility to better explain situations (use additional pai~es as necessary).
C fcLb V--4 1,
s«des ton _
Reviewer/Inspector Name:
Reviewer/inspector Signature:
Page 3 of 3
Phone: "l t, h—
Date: Ykr NA
/4/2014
2

type w uompuance inspection V operation xevtew V structure Evaluation V l ecbnlcal Assistance I
Reason for Visit: & Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: T Departure Time: p A County: IOt� Region:
Farm Name: s_ wv�--'� Owner Email:
Owner Name: 17 r�r�" T'�•+^-�' Phone:
Mailing Address:
Physical Address:
Facility Contact: � wS 9�� Title: Phone:
Onsite Representatives CX Integrator:
Certified Operator: Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Page
umber
Longitude:.
Discharges and Stream impacts
Certification Number-
Design Currents=� =
Design
Ell
Current Design Current
Swine
Capacity F p ; .* WetPoultry"
Capacity
Pop. "Cattle Capacity Pop.
"
Turkeys
Wean to Finish
eau La er
❑ NE
-Dai Cow
Wean to Feeder
Non -Layer
® NA
Dai Calf
c. What is the estimated volume that reached waters of the State (gallons)?
Feeder to Finish
20 yy
"
yy Dai Heifer
Farrow to Wean
n= $� -} ^�
Design
Current �$` D Cow
Farrow to Feeder
$
D - 1PoW -
•
Ca aeity
l;o Non -Dairy
Farrow to Finish
1� No
❑ NA
Beef Stocker
Gilts
TT
s Beef Feeder
Boars
Beef Brood Cow
`
"
cr
Discharges and Stream impacts
Certification Number-
La ers
� No
❑ NA
❑ NE
Non -Layers
Pullets
"
Turkeys
❑ No
Turkey Poults
❑ NE
Other
1. Is any discharge observed from any part of the operation?
❑ Yes
� No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other;
a. Was the conveyance man-made?
❑ Yes
❑ No
NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
® NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
1� No
❑ NA
❑ NE
of the State other than from a discharge?
TT
Pege I of 3 2/4/2011 Continued

Fa ili 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
Struc7e 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
No ❑ NA ❑ NE
❑ No `� NA ❑ NE
Structure 6
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
Q!j 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
10 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
PoNo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
T
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
o] 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): CQV_"t W1
13. Soil Type(s): _t,L� i 1L---�p
T
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[� No
❑ NA
D NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
© No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
® No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
ft No
❑ NA
❑ NE
1$. Is there a lack of properly operating waste application equipment?
❑ Yes
0 No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
V No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement`? If yes, check the appropriate box below. ❑ Yes F 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 N
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? E:]Yes ® No
C]NA ❑ NE
❑ Weather Code
F1Sludge Survey
0
DNA ❑ NE
❑ NA ❑ NE
Page 2 of 3 2/4/2011 Continued

1-4
FaciM Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes OpNo ❑ NA
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes}.gyp No [] NA
the appropriate box(es) below. `�"'
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance.
26. Did the facility fail to provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ NE
❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes [] No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes IF No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative? ❑ Yes No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes �] No ❑ NA ❑ NE
Comments (refer to question:. Explain any YES answers and/or any additional recommendations or any other comments:_ �
Use drawmgsiofs:faciRty to•beiier explain situations (use additional Pam as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: '1tv ` 4 3 -? VD
Date: ?M H
2/4/2011

Type of Visit: 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 0 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit:Arrival Time: !L•- Departure Time: County: _ Region:
Farm Name: A'�Pjl
I;Lem Owner Email:
r
Owner Name: /yl s»CG Phone:
Mailing Address:
Physical Address:
Facility Contact: Z_ Title:
Onsite Representative: It
Certified Operator:
Back-up Operator:
Phone:
Integrator: h
Certification Number: 98807
Certification Number:
Location of Farm: Latitude: Longitude:
Design Current
� _' Capacity Pop.
Wean to Finish
- � i'EDsign
Wet 1'oultacity
La er
Current
Pop.
Design Currenwine
CattEe Capacity Pap.
Dai Cow
Wean to Feeder
Non -La er
Dai Calf
Feeder to Finish
airy Heifer
Farrow to Wean
Desiign
Current
Dry Cow
Farrow to FeederD%vPou.lt
; �_ ,Ca aciry
P.o ,
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gifts
Non -Layers
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)?
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 [P No ❑ NA ❑ NE
❑ Yes ❑ No
[:]Yes ❑No
❑ Yes [:]No
❑ Yes No
❑ Yes No
IRNA ❑ NE
51 NA ❑ NE
NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3 2/4/2011 Continued

1'acili Number: Date of Inspection - it
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes rV1 No ❑ NA ❑ NE
a_ If yes, is waste level into the structural freeboard? ❑ Yes n No �] NA ❑ NE
Structure i Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
❑ NE
Identifier:
® No
❑ NA
❑ NE
❑ Yes
Spillway?:
❑ NA
❑ NE
Designed Freeboard (in):
Observed Freeboard (in): y
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
W 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
No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
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):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ Yes
No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
[P No
❑ NA
❑ NE
❑ Yes 10 No ❑ NA ❑ NI-
❑ Yes 1171 No ❑ NA ❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements F] Other:
2l. 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 Q No
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes Qq No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑NA ❑NE
Page 2 of 3 2/4/2011 Con inued

aciG `Number. - Date of Inspection: 11141111
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33_ Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
16NA ❑NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes P No ❑ NA ❑ NE
❑ Yes 1P No ❑ NA ❑ NE
❑ Yes �§ No
❑ Yes No
❑ Yes No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to yueshon #} Explain any YES. answers and/or any add ittottalTrecommendations or any other comments.
Use drawings of facility to bettertexplatn'situations (use additions! pales. as necessary) .
SCS U -_o 201Y
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Pare 3 of 3
Phone: 0:9 ;3300
Date: i &H
21412011

<N
13D

Type of Visit 4P Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: i D Arrival Time: p Departure Time: / •�/ !� County: Region: fO
Farm Name: Al M Owner Email:
�,} c W
Owner Name: 1J 9 /iLq �ais ��C r Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: j� k
Certified Operator:
Back-up Operator:
Phone No:
"�✓tIntegrator: t. -j ^
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: =' =' ="
Longitude: = ° =I =
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Cit urrent
Dpignty urrent Design Carrent
Swine
Ca acs Po Mahon Wet Poul
b=P �y
Ca aci Pq I Cattle Capacity Population
❑ Wean to Finish
❑ Layer
..Mahon
❑ Dai Cow
❑ Wean to Feeder
❑ Non -Layer
❑ Dai Calf
Feeder to Finish
P NA
r ❑ Dai Heifer
El Farrow to Wean
"
Dry Poultry
❑ D Cow
❑ Lrrow to Feeder
❑ rrow to Finish
;� � O'Non-Dairy
❑ Layers
ers ❑ Beef Stocker
❑ Gilts
❑Non -Layers
❑ Beef Feeder
Boars
❑ s
ElPullets
❑ Beef Brood Co
- -
= El Turke s
' VTNA
Other
❑ Turkey Pointsaim
❑ Yes
❑ Other
❑ Other
Number of Structures:
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
ONo
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
IFNo
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
P NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
(73 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
' VTNA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
to No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
ONo
❑ NA
❑ NE
other than from a discharge?
Page I of 3
71/28/04
Continued

Facility Number: —
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
❑ Yes 0TNo
❑ Yes ❑ No
[:1 NA [:1 NE
RNA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): I
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes�No [INA El NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed ❑ Yes [allo [INA ❑NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
W No
[INA ❑NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
PNo
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
q9No
❑ NA EINE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window [:]Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) Clo-rn ,4 1 gem-, S
13. Soil type(s) A)9 -r V__
_
14_ Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
P No
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
M No
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[:]
Yes
�bVo
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
P No
❑ NA ❑ NE
18. Is there a lack of property operating waste application equipment?
❑ Yes
1h No
❑ NA ❑ NE
r.�#` do i_ � - Y a- o ' ii5'a� n
Comments (refer to question #}Ezpiattt aay YES<answersand/or any recommendations aranyotiser camnsents.
se drawut s of factlt_ to betterex Earn sttuativns. use�addttionai a es as neeessa
Reviewer/Inspector Name Phone: 9/'P -S�3 3��cr
Reviewer/Inspector Signature: Date:'7&7
Paige 2 of 3 12/28/04 Continued

Facility Number: — Date of Inspection I W21110
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropirate box.
❑ WUP El Checklists El Design El Maps El Other
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
[:INA
❑ NE
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes � No ❑ NA [:1 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?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
2T Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes
�INo
❑ NA
❑ NE
❑ Yes
[PNo
❑ NA
❑ NE
❑ Yes
ONo
❑ NA
❑ NE
❑ Yes
[)YNo
❑ NA
❑ NE
❑ Yes
[Po
❑ NA
❑ NE
❑ Yes
PNo
❑ NA
❑ NE
❑ Yes [A No ❑ NA ❑ NE
❑ Yes KNo [INA ❑ NE
❑ Yes allo ❑ NA ❑ NE
❑ Yes
N No
❑ NA
❑ NE
❑ Yes
ENo
/O
[INA
ElNE
❑ Yes
No
❑ NA
❑ NE
Additional;Comments and/or Drawings: + y
L
Page 3 of 3 12128/04

r�
Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance I
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: 11 J Oq Arrival Time: Departure Time: di ��� County:
Farm Name: 2 W Fae-m Owner Email:
Owner Name: l6 s + Phone:
Mailing Address:
Physical Address:
Region: Pqy
Facility Contact: _90141-1 L / Title: Phone No:
Onsite Representative: 11 integrator: /"1(1�'�j��` LLC
Certified Operator:` Operator Certification Number: 9Bg7
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: =0
=4
= Longitude: =0[=,
oa, 0
Discharees & Stream Impacts
1 _ Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes P No ❑ NA ❑ NE
El Yes
Design Current
Design Current
Design Current
Swine
Capacity no
Wet Poultry Capacity Population
Cattle Capacity Population
❑ Wean to Finish
❑ No
La er
❑ Dai Cow
❑Yes
TNo
FNon -La er
❑ Dai Calf
❑ Yes
155
❑ NA
❑ Dai Heifer
12/28/04
Continued
Dry Pouttry
❑ D Cow
rWean
❑Non -Dai
❑ La ers
❑ Beef Stocker
❑ Non -La ers
❑ Beef Feeder
I
❑ Pullets
❑Beef Brood Co wi
❑ Turkeys
Other
❑ Other
❑ Turke Poults
❑ Other
Dumber of Structures:
Discharees & Stream Impacts
1 _ Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes P No ❑ NA ❑ NE
El Yes
El No
0 N
Feeder
❑ Yes
Finish ,ZQ
CP NA
Wean
Feeder
Finish
❑ No
EFNA
Discharees & Stream Impacts
1 _ Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes P No ❑ NA ❑ NE
El Yes
El No
0 N
❑NE
❑ Yes
❑ No
CP NA
❑ NE
❑ Yes
❑ No
EFNA
❑ NE
❑Yes
TNo
El NA
EINE
❑ Yes
1� No
❑ NA
❑ NE
12/28/04
Continued

Facility Number: Date of Inspection 11
Do any of the structures need maintenance or improvement?
❑ Yes
No
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes 'b No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes ❑ No
Aj NA
❑ NE
Strufture 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure ti
Identifier:
❑ Yes
(D No
❑ NA ❑ NE
Spillway?:
maintenance or improvement?
Designed Freeboard (in):
Waste Application
Observed Freeboard (in): �2
10_
Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
5. Are there any immediat t i gn o any of the structures observed?
❑ Yes kTNo
❑ NA
❑ NE
(ic/ large trees, severe rosi , seepa , etc.)
IL _
6. Are there structures on- ' c are not properly addressed and/or managed
El Yes No
❑ NA
❑ NE
through a waste management or closure plan?
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
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
Wo
❑ 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
(D No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10_
Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
EpNo
❑ NA ❑ NE
maintenance/improvement?
IL _
Is there evidence of incorrect application? If yes, check the appropriate box below.
[--]Yes
MNo
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 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) Co" 1'+lam, 5Lh, bQQ�IQ _
13.
Soil type(s)
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
rNo
❑ 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
P No
❑ NA ❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
f3No
❑ NA ❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
On No
❑ NA ❑ NE
Use rawin s of facili to better ex lain sitnahons. use a .,
ents (refer to grestton #): Explain any YES answers andlor,any, recommendations or anyother comments. I
g t} P ( dditro alipage"s as necessary]
Reviewer/Inspector flame � � ft- � Phone: D
Reviewer/Inspector Signature: Date: �r
12/28/04 Continued

+ Facility Number: — Date of Inspection l� 1
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box.
❑ WUP El Checklists El Design El maps El Other
21. Does record keeping need improvement? if yes, check the appropriate box below. ❑ Yes �bNo [__1NA ❑ NE
Waste Application ❑ Weekly Freeboard ElWaste Analysis ElSoil Analysis ElWaste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
1�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
P No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
JP No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
M 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
[P 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
ERNo
❑ 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
VkNo
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
0 No
❑ NA
❑ NE
A�ddhonalCommenis and/orDrawrngs „
IZ/M8/04
IZ/M8/04

A
Type of Visit 40 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 40 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
?%aN Region;
Date of Visit: /� ( �g Arrival Time: Departure Time: t�%. County:
Farm Name: ._ s k1 I—cZZM __ Owner Email:
Owner Name: HM s C' Phone:
Mailing Address:
Physical Address:
Facility Contact: o Title:
Onsite Representative: L
Certified Operator: e_ • &:- Cvo±
Back-up Operator:
Phone No:
Integrator:
Operator Certification Number: 077
Back-up Certification Number:
Location of Farm: Latitude: r] 0 =4
= s, Longitude: = e = I =
11
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Design Current. _
Design Current. Design Eurrent
SwineCapacity
Pop la�tion Wet Poultry
L...
Capacity ln,, Cattle .. Capacity Papulation
Popctaho
_F
❑ Wean to Finish
❑
❑ Layer ❑DaiCow
Wean to Feeder
❑ Non -Layer I
❑ Dairy Calf
Feeder to Finish
_ ,
Dairy Heifer
0Frrow to Wean
;Dry PoulEry�
E]Dry Cow
❑ Farrow to Feeder
❑ Farrow Finish
❑ Layers
# ❑ Non -Dairy
❑ Stocker
to
Gilts
❑ Non -Layers
Beef
❑ Beef Feeder
PoBoars
❑ Pullets
❑ Beef Brood Co
❑ Yes
❑ Turkeys
-
-I
Otber
❑ Other
❑ Turkey Poults
ANUMber of Structures:
0 No
❑ NA
❑ NE
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
NNo
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
R-3 NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DW Q)
❑ Yes
❑ No
[PNA
❑ 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
15 NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
0 No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
PDNo
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
12128104
Continued
i

Facility Number: —
Date of inspection /1 D
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: 1
Spillway?:
Designed Freeboard (in):
r
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 &PNo ❑ NA ❑ NE
❑ Yes ❑ No 0 NA ❑ NE
Structure 5 Structure 6
❑ Yes W No ❑ NA ❑ NE
❑ Yes .Q No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes IM 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 IgNo ❑ NA ❑ NE
maintenance or improvement?
Waste Anolication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes )a No ❑ NA ❑ NE
mai ntenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ® No ❑ NA CINE
❑ 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 ElApplication Outside of Area
12. Croptype(s) �om,41h�t -�p,i Ln"c
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes QNo ❑ NA EINE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes
[M No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment? []Yes
•M No
❑ NA
❑ NE
Couxments (irefer to question # 1 E plain any YE5 answers andlor any recommendatioi sko any othAP er comments.
piise dt swings:oftfactiiity to betterer explatn sifuahons= (nse addttiona[ pages as necess ry 5.
Reviewer/Inspector Name e Phone: /O -y33 `33c�
Reviewer/Inspector Signature: Date: // "
Page 2 of 3 12/28/04 Continued

Facility Number: Sa Date of Inspection
Re uired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes rNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes tgNo ❑ NA ❑ NE
the appropirate box. ❑ WUp ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes � No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield [:1120 Minute Inspections ❑ Monthly and 1" Rain inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
IPNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
09 No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
10 No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
09 No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
[1] No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
ER No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
;N No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ YesNo
01
[INA
ElNE
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
[3 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
q No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
0 No
❑ NA
❑ NE
Page 3 of 3 12/28/04

1 Division of Water Quality
Facility Number ME O Division of Soil and Water Conservation
O Other Agency
Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: % bi,� Arrival Time: �% t Departure Time: (� �� County- �a Region:
It
Farm Name: 14-; w r Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: U4 tAz4vto not Title:
Onsite Representative: U
Certified Operator: tL'j Nk'
Back-up Operator:
Location of Farm:
Phone No:
Integrator:
Operator Certification Number: 47800 7 ?
Back-up Certification Number:
Latitude: = o ❑ ' ❑ Longitude: ❑ 0 0 t
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population Cattle
❑ Wean to Finish
❑ Wean to Feeder
%F Finish q'AO
Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
❑ La er
❑ Non -Layer
Dry Poultry
N
U urkey 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?
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Designtorrent
Capacity ;Population
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?
iI
❑ Yes t?�No ❑ NA ❑ NE
❑ Yes ❑ No NA
❑ NE
❑ Yes ❑ No NA
❑ NE
❑ Yes ❑ No [r NA
❑ NE
❑ Yes C�No ❑ NA
❑ NE
❑ Yes IRNo ❑ NA
❑ NE
12/28/04 Continued

Facility Number: 9 Date of inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No [INA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No �9 NA ❑ NE
Structure I. Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 31
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
R 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
Wo
❑ 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
[9 No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
IS No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
® No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
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 El Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) 0-r rX ISS
13. Soil type(s) a
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
43 No
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
® No
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
®No
❑ NA ❑ NE
IT Does the facility lack adequate acreage for land application?
❑ Yes
161 No
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
10 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):
Reviewer/Inspector Name Phone(—%/p yf_`'
Reviewer/lnspectorSignature:Zk�LbLDate: / a%
12/28/04
vO
Continued.

Facility Number: Date of Inspection
Re uired 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. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [)FhTo ❑ 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
nj No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
(V No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
Q9 No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
19 No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
IN No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
PNo
❑ 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
El NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
P No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
F1No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
JANo
❑ NA
❑ NE
Comments and/or Drawings:
12/28/04

Type of Visit ® Compliance inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit *Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit:
QQ Arrrrival Time: Departure Time: A County: 5AYwkPS01J
Farm Name: Owner Email
Owner Name:t? r�,'_lfiP Phone:
Mailing Address:
Region: r-90
Physical Address: ,, !
Facility Contact: "1`�`' /J Title: Phone No:
J j
Onsite Representative: d0kc!3- /V4 i%ot,d_ „ Integrator: ���'►I►tvv� s7 'glD+'t'%f
Certified Operator:
Back-up Operator:
Location of Farm:
Operator Certification Number:
Back-up Certification Number:
Latitude: =0 ❑ , = Longitude: = ° = 1
❑ an to Finish
Design Current
ty Popuatoneoultry
❑ La er
tyPopalation
99,5001
1
Cattle Capacity Population
❑ Dairy Cow
❑ No
❑ an to Feeder
❑ NE
❑ Non -Layer
I
❑ Dairy Calf
Feeder to Finish
3'1;LC
�`
❑ Yes
❑ Dairy Heifer
❑ Farrow to Wean
P No
D , Poult .
;`� ' t '-
❑ Dry Cow
❑ Farrow to Feeder'
0 N
[I NE
❑ Non -Dairy
❑ Farrow to Finish
❑ Layers
❑ Beef Stocker
❑ Gilts
LINon-Layers
❑ Beef Feeder
❑ Boars
❑ Pullets
❑ Beef Brood Co
❑Turke s
❑ Turkey Poults
❑ Other
I
ILI Other
I
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at_ ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d- Does discharge bypass the waste management system'? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page 1 of 3
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes
❑ No
Q9 NA
❑ NE
❑ Yes
❑ No
14NA
❑ NE
PNA
❑ NE
❑ Yes
❑ No
❑ Yes
P No
❑ NA
❑ NE
El Yes
V9No
0 N
[I NE
12/28/04 Continued

Facility Number: S Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
❑ Yes MNo. ❑ NA ❑ NE
❑ Yes ❑ No P NA ❑ NE
Structure 5 Structure 6
Identifier:
Spillway?:
Reviewer/Inspector Name
Designed Freeboard (in):
Reviewer/Inspector Signature:
Date: Q
Observed Freeboard (in): 3
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[PNo
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed
❑ Yes
;3 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
[9 No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
55 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
EP No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10_ Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
&9 No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
&9 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 Evidence of Wind Drift [:]Application Outside of
Area
jWindow , r❑
12. Crop
type(s) lit 4k,n�^WYi
13. Soil type(s) /Ve
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
® No
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
® No
❑ NA EINE
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
W No
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[j9 No
❑ NA ❑ NE
Comments (refer to question #): Explain .anyYES answers andlor any,:recommendations or any other comments -
Use'drawmgs:of facility to better explain situations: (use addtion al pages as necessary):
:F...
Reviewer/Inspector Name
Phone: t7 33 3
Reviewer/Inspector Signature:
Date: Q
Page 2 of f 12/28/04 Continued

Facility Number: 17 Date of Inspection 0 0
Reuuired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes T No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes V3 No ❑ NA ❑ NE
the appropriate box. ❑ WUp ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes Oj 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?
❑ YesNo
❑ NA
[--]NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
ElYes
No
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
In 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
5q No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
E� No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
&U 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
h No
❑ NA
❑ NE
Additional Comments and/or Drawmgs 44
Page 3 of 3 12/28/04
r-

R
- - a Ilivision of Water Quality � � y
[=;i=F=.aTR1it0yNumber l 0 Division of Soil and Water Conservation '
� Other Agency
Type of Visit • Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time- County: �-�_ Region: FPO
Farm Name: B oma �✓ Far n, _ Owner Email:
Owner Name: Te_ Bbr[ �- Phone: 5--f =da 9 y
Mailing Address: _ [GO_S' (rrrs�t� - 64mu/4 �/toorl F.'I'_ __ NC ,9 z yI
Physical Address:
Facility Contact: Title: Phone No: r1/v -_-i� 2 - oma
Onsite Representative: C'pA.3s S��..,�^Qgyjq Integrator: eren %&- .SA:ma/ryrat/
Certified Operator: C'r.,rf.'s A!6, e e Jn Operator Certification Number: _._2ke' ftiO
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: ❑O ❑ f ❑ Longitude: ❑ ° =I
= N
De7P0paanP
ptk'!-C. arrenf �� Desi Current current
gn Design C
Swine Capn W�e`oultry Capacety Population' Cattie, _ Capacity Population
❑ Layer ❑ Dai Cow 1 71
❑ Non-Layet ❑ Dai Calf
❑ Dai Heifei
^.I?ry F-ooultry ❑ D Cow
❑ Non -Dai
= ❑ Layers F . El Beef Stocker
i r ❑ Non -Layers
❑ Pullets F ❑ Beef Feeder
❑ Beef Brood Cowl
is ❑Turke s
k x- ❑ -.-w
OtherFoults
❑ Other `` ❑ Other Number of .5 ctures:
f :4 max. - - - .•.c
❑ Wean to Finish
❑ Wean to Feeder
��eeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
El Farrow to Finish
FE]
Discharttes & Stream Impacts
1. is any discharge observed from any part of the operation?
❑ Yes
9-1�o
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
GiltsBoars
a. Was the conveyance man-made?
Discharttes & Stream Impacts
1. is any discharge observed from any part of the operation?
❑ Yes
9-1�o
❑ 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
e. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
[I Yes
E]No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
Noo
El NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
Yes
ElP
,B
-No
❑ NA
❑ NE
other than from a discharge?
12/28/04
Continued

I
Facility Number: — Date of Inspection
Required Records & Documents
14. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes D -5o' ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 911;ro ❑ NA ❑ NE
the appropirate box. El JXf ❑ Che ists ❑stn❑ s❑ O�
,—1
21. Does record keeping need improvement? If yes, check the appropriate box below. El -fes ❑ No ❑ NA ❑ NE
Ela ton ElWecklpFFeebea&d 6 *Aiw�� ❑.&4Aft*ysm ❑ ❑
❑Ampfiidl ❑ eel rg915ropYield E]4-- [;�onthly and 1" Rain Inspections ❑ Weat#er£ode
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27_ Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
24. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32_ Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
33. Does facility require a follow-up visit by same agency?
Dies
❑ No
❑ NA
❑ NE
❑ Yes
90No
❑ NA
❑ NE
❑ Yes
EKo
❑ NA
❑ NE
❑ Yes
21Qo
❑ NA
❑ NE
❑ Yes
[-No
❑ NA
❑ NE
❑ Yes O -No ❑ NA ❑ NE
❑ Yes [314o ❑ NA ❑ NE
❑ Yes 9 No ❑ NA ❑ NE
❑ Yes OXo ❑ NA ❑ NE
❑ Yes 254o ❑ NA ❑ NE
❑ Yes
[1lo
❑ NA
❑ NE
❑ Yes
E No
❑ NA
❑ NE
Ai#�nal CommentsiandJoiiDrswings: '; + 1 µ �; .
P1A*Se_ v�
�io�s Kelel
Fd��tS,
rlBw.s� fir, Nom/ rei ®.,fry y d.,�l / �• rG/?
lRfLkc�n73.
M,. Warm
3"e
w,d 4e ki. �leost r'ep/ C
ru,i� y��9t
Soon,
%„-c
lea sfrr +vw/�
14[
12128/04

Facility Number: X.1 —elt7 Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [Vivo ❑ 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?: r70
Designed Freeboard (in): 2 y "
Observed Freeboard (in): ;tS "
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes o ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.) ,�
6. Are there structures on-site which are not properly addressed and/or managed El Yes Ir No ❑ NA Cl 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 allo ❑ NA ❑ NE
8- Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
9 No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
❑''Flo
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[2Tlo
❑ NA ❑ NE
maintenancelimprovement?
H. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
EMo
❑ 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
/13 y
12. Crop type(s)
— � �/Jrtat
13. Soil type(s) A/6,¢
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
ErNo
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
DIN
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination:❑
Yes
❑ No
❑ NA [4�GE
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA O -NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
0'No
❑ NA ❑ NE
Review 'Oe -6,5,44 FreeZ d A M,,
Reviewer/Inspector Name WAMMeAF* ems_ Phone:
Reviewer/Inspector Signature: 7 Date: 3 - o�
12/28/04 Continued

Facility Number Date of Visit: / Mme: `f• /�
O Not Operational O Below Threshold
QA ertztitted CJ, errdfied 13 Conditionally Certified 13 Registered Date Last Operated or Above Threshold: ... — ..
D 4. W -- ftp c�� /r�.�.�. County: �w►pSar+
Farm Name: _ ----------------- ................................... ty: _._....._ _..................... ..._.._........
Owner Name:... �!tils Phone No: g a G
Mading Address:
Facility Contact-. .._ .li u,r +i 5 Warman
-.-Title:
Phone No: ............ . .... . ...... . ....... . . . ...........
._ _ ... _ ... ....................._. - - — _......_.._..
Onsite Representative: ......_.-......._---- Integrator:+^ ��
_W
Certified Operator%._....... u�5 LJccrrr�n Operator Certification Number:._ .............. _. _.. .
Location of Farm:
wine ❑ Poultry ❑ Cattle ❑ Horse Latitude • 1 66 Longitude • 9 46
Discharzes & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes 3'10
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
h. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) [] yes ❑ No
c. If discharge is observed, what is the estimated flow in gallmin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes Ej1q06
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes Q'Ko'
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Identifier:
Freeboard (inches):
12112103
Structure l Structure 2 Structure 3 Structure 4 Structure 5
3a
❑ Yes ❑ No
Structure b
Continued

Facility Number: Wq— `7
Date of Inspection i o
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 maintenancelmprovement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Aanlication
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? If yes, check the appropriate box below.
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type jeA4_ sow" 11tii —f� btn
❑ Yes 2!i o
❑ Yes 9" 0
❑ Yes El"No
❑ Yes [9/No
❑ Yes [31No
❑ Yes Bl o
❑ Yes R-60
13. Do the receiving crops differ+with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes M_<0
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
&<O
b) Does the facility need a wettable acre determination?
❑ Yes
G No
c) This facility is pended for a wettable acre determination?
❑ Yes
[A No
15. Does the receiving crop need improvement?
❑ Yes
+d No
16. Is there a lack of adequate waste application equipment?
❑ Yes
9No
Odor Issues
Reviewer/Inspector Signature:
Date: 1 D
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge attor below
❑ Yes
Ef No
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours?
❑ Yes
[7fNo
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
2l0
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional
❑ Yes
[�No
Air Quality representative immediately.
Comments {refer to ques6oa iiE) F.a�plam any FYES�aas and/or axYy recommeudaaons or as other cbmmeats. ;
Use drawtags ol'iacsliiy to better cxgla�a setoatzflns. (nse additions! pages as aecessary}. field Copy ❑ Final Notes
—(!UrUhh 5 oy awt- 04 Tl< ! Itreje) erPas +r
I
0� 1 S�5 � t,.1aS�FC �� Ic��Z. t�evr � �t� e•�B 6n /V
iH wal5`Ii' ��S
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Date: 1 D
12112103 e�/ Continued

is Facility Number: V,2_ Date of Inspection / a
Required Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
23. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
25. Did the facility fail to have a actively certified operator in charge?
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
27. Did Reviewer/Inspector fail to discuss review/inspection with on-site representative?
28. Does facility require a follow -up -visit by same agency?
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
!NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
32. Did the facility fail to install and maintain a rain gauge?
33. Did the facility fail to conduct an annual sludge survey?
34. Did the facility fail to calibrate waste application equipment?
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After I" Rain
f ❑ 120 Minute Inspections ❑ Annual Certification Form
❑ Yes YNo
❑ Yes ER/No
[j Yes [(No
❑ Yes R(No
❑ Yes E No
❑ Yes 03"No
❑ Yes Q No
❑ Yes Gy N'10
❑ Yes �INo
[3/Yes ❑ No
❑ Yes []'No
❑ Yes &+Io
Yes ❑ No
Q/Yes ❑ No
❑ Yes Q No
No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
"SCJ e,;
siw� s Q Q�i;�Ot^G�3-;ar, �av� � Sci�d�jcc� `�f-v �c (�e
A.
1
H
12/12/03

Site Requires Immediate Attention:
Facility No. - 1;2 741
DIviSION OF ENVIRONNENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: 1 , 1995
Time: I= o r'
Farm Name/Owner: 7 D M t a.) I_aLv r iaay' Joe +
Mailing Address: .1 tOO 5 GOS\n2n ChuY�h '(fid r\qw on Groyc, CSG 5 33bb
County: 5aMQQQn
Integrator. D c.r Phone:
On Site Representative: o +n Phone: 1101 -4SL Oa15
Physical Address/Location: ,,;its cL Gfi'Jdey.LL,1•
Type of Operation: Swine 'F - n Poultry _ Cattle
Design Capacity: 3`120 r -J. /E, Number of Animals on Site:
DE2%4 Certification Number: ACE_ DEM Certification Number. ACNEW.
Latitudel ' __CJL_' .X&" Longitude: ZL—' Jam' .113"
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of I Foot + 25 year 24 hour storm event
(approximately I Foot + 7 inche , Y s or No Actual Freeboard: _: Ft o Inches
Was any seepage observed from the n(s)? Yes or to Was any erosion observed'' es4:)No
Is adequate land available for spray Yes)6r No Is the cover crop adequate? Yes o(No
Crop(s) being utilized: o s b t 5 ,� t
Does the facility msec SCS minimunx setback criteria? 200 Feet from Dwellin7 or No
100 Feet from Wells? a or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes o6)
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yesor o�
Is animal waste discharged into waters a state by man-made ditch, flushing system, or other
similar man-made devices? Yes "N 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)? Ye -i or No
Additional Comments:
r
C'_ \.k c..�7� f,
Inspector Name Signature
cc: Facility Assessment Unit
Use Attachments if N

�REGISTPATION FORM FOR ANIMAL FEEDLOT OPERATIONS
Department of Environment, Health and Natural Resources
Division of Environmental Management
Water Quality Section
If the animal waste management system for your feedlot operation is
designed to serge more than or equal to 100 head of cattle, 75
horses, 250 swine, 1,000 sheep, or 30,000 birds that are served by
a liquid waste system, then this form must be filled out and mailed
by December 31, 11,193 pursuant to 15A NCAC 2:1.0217 (c) in order to be
deemed permitted by DEM. Please print clearly.
Farm Name=�
Mailing Address:
County
Owner (s) Name: Lc,rry Uc m �Oot
Manager (s) Name: _ ^
Lessee Name:
ZIP
Phone No. Fj 5-:M'Y-OQ4y
Farm Location (Be as specific as possible: road names, direction,
milepost, etc.) : Q )fie
Latitude/Longitude if known:J,57-130—O -D
Design capacity of animal waste management s stem (Number and type
of confined animal (s) } : 3 S
Average animal population on the farm (Number and type of animal (s)
raised)
Year Production Began: ASCS Tract No .: $ D
Type of waste Management System Used: l}
Acres Available for Land Application,,Of Waste:
Owner (s) Signature (s) „% �l T DATE: I+
DATE: