820105_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental Qual

B I o.s k I L hir 130
Type of Visit: Ism ance Inspection O Operation Review Q Structure Evaluation O Technical Assistance I
Reason for Visit: Routine 0 Complaint O Follow-up 0 Referral O Emergency O Other 0 Denied Access J
Date of Visit: Z f Arrival Time: 2 ti 5 Departure Time: (7 County: S Region:�`�zd
Farm Name: j L n c-e Ak ad "`r Owner Email:
Owner Name: i C L .. e- Phone:
Mailing Address:
Physical Address:
Facility Contact: O L'j, ` 1 S E 0_6AW II &i� _ Title:
Onsite Representative: 1 I Integrator:
Phone:
Off-S
Certified Operator: 1r Ti end t Certification Number: f 3 Z
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design Current
Design
Current
Design Current
Swine
Capacity Pap.
Wet Poultry
Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
Layer
Dairy Cow
Wean to Feeder
11
INon-Layer
I
Dairy Calf
Dairy Heifer
Feeder to Finish Z 3
Farrow to Wean
REFEM
e
Dry Cow
Farrow to Feeder
0 ry, P.ouIt ny
a aci
$o
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Beef Feeder
Gilts
Non -Layers
Beef Brood Cow
Boars
Pullets
Turkeys
14
ot erAMMOM
Turkey Poults
Other I
I
Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
[AI o
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
[:]No
E3-NA
❑ NE
b_ Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
❑ No
D-N—A
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
❑ No
[3'11A
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
❑moo
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
J ' o
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412015 Continued

Facili Number: jDateof Inspection: zi
Waste Collection & Treatment
4. R storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No EJ_N-k—❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
n
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
F__4—<o ❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
[ZL>,a— ❑ 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
0'o ❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
[:]Yes
P— 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
[3--M6❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
Yes
[E"9-o ❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes I g-Ko ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): 01 PE Zt
13. Soil Type(s): `,,)C- A/O -
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [2j X5 ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes L�7'' o ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes ❑fiJo ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. 1s there a lack of properly operating waste application equipment?
0 Yes ❑ NA ❑ NE
❑ Yes E_ _?" 66 ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[5'No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
E3-lqo`
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? Ifyes, check the appropriate box below.
❑ Yes
[Pi6
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather
Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I " Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ No❑
NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑i'Now
❑ NA
❑ NE
Page 2 of 3 21412015 Continued

Facility Number: Z Date of Inspection: a<
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑.Alo ❑ NA
❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
[3'igo ❑ 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
[]-"o ❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
2-go ❑ NA
❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
to
❑ 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
&],xo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately_
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
[:]
❑ 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
CTNo
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
(D <oo
❑ 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
L2'1qo
❑ 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).
c'r 44 E-y
C4 q(0- �L)5-h� SI
Reviewer/Inspector Name:
Reviewer/Inspector Signatu
Page 3 of 3
I �v� Phone: 1 `533- , 13
re: Date: I '
2141201

type of visit: U uompnance inspection v uperanon Keview V Ntructure Evaluation V tecnmcal Assistance
Reason for Visit: {Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit:.L Arrival Time:
r D
Departure Time: County:
..rJ • k
Region: P, Z4D
Farm Name: t ILe "kwtw% r
k t
Owner Email:
Owner Name: la i7s Phone:
Mailing Address:
Physical Address:
Facility Contact: �_ L5 &w4JIC4 Title:
Onsite Representative: Y
Certified Operator: W A44" L q&r!L
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator: 44
Certification Number: �&' 2—
Certification Number:
Longitude:
Design Current "'" Design Current
r
Design Current
Swine
Capacity Pop Wet PoultryCapacity Pop .
Cattle C�ctty
Pop.
Wean to Finish
- La er
Dairy Cow
Wean to Feeder
= Non -Layer
Dairy Calf
Feeder to Finish
--Z
Dairy Heifer
Farrow to Wean
= Design Current , :
Dry Cow
Farrow to Feeder
� D Poelt Ca achy P,o
SLa
Non-Dai
Farrow to Finish
ers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Bect' Brood Cow
Turke s ry
Other
Poults
Other
Other,
Dischar,aes 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 , o ❑ NA 0 NE
[:]Yes [:]No EJ—PA ❑ NE
❑ Yes ❑ No ETNNA ❑ NE
❑ Yes ❑ No E NA ON E
Yesdo ❑ NA ❑ NE
❑ Yes VNo ❑ NA ❑ NE
Page I of 3
k.dc:—
21412015 Continued

Facilit ° Number: Date of inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [3006'0 NA ❑ NE
a. if yes, is waste level into the structural freeboard? ❑Yes ] No 1A ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes Ro ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes �No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? [—]Yes ff!rNo ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes [�fNo ❑ NA ONE
(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 IQo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [3 No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? if yes, check the appropriate box below. ❑ Yes &NIO ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): e_yy1j
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes �o ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [?rgo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes �'1qo ❑ 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 eNo
❑ Yes ETNo
❑ NA ❑ NE
❑ 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 ETNo ❑ NA ❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements ❑other:
21. Does record keeping need improvement? I f yes, check the appropriate box below. ❑ Yes [j 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
❑ Weather Code
❑ Sludge Survey
❑ NA [] NE
❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facili Number: - Date of Ins ection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes 5 to ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [] Yes [21 o ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
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.
❑ Yes B, o
❑ Yes [-No
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes [INo ❑ NA ❑ NE
❑ Yes PT -No ❑ NA ❑ NE
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
[:]Yes
G30"No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
3 I. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
dNo
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other.
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[2"No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
[allo
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency'?
❑ Yes
[]'No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
CAA, bd'cc�o -1 --
Reviewer/Inspector Name:
r�2�1
�} 0 n B
-g�
a f I-ee+ 3, 6 <<
Reviewer/Inspector Signature:
Page 3 of 3
;ki
CL
ritr
31«
t
� lt,s -P—ff� 1�sS
CA �tl o
8-s r
Phone: P -13 3`,3339e�
Date: M[l
21412015

LX'
�N f ZF
.it 2-,a I&
l'ype of visit: UC:ompliance Inspection U operation Review U Structure Evaluation U Technical Assistance
Reason for Visit: lErRoutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency O Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time:` •LI�J County: r�![
Farm Name: �4 l i[1CC KCJ! Owner Email:
Owner Name: m xf k erlr y` C'vy Phone:
Mailing Address:
Physical Address:
Region:
Facility Contact: `-'"--f—LS &.!' 10 E Ut Title: Phone:
Onsite Representative: i t Integrator: .90
Certified Operator: Ot tdA, ..J LKGJ`�'` Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
ta_c�. 4
jat6 -PC- OILS'
Longitude:
Design Curr nu Design Current
Swine CapacityPopr _ Wet Poultry Capacity' Pop.
Wean to Finish La er
Wean to Feeder Non -Layer
Design Current
Cattle Capacity Pop.
airy Cow
airy Calf
Da' Heifer
Feeder to Finish
D . P.oul "
Design
Ca aci
.` - "
Current'
7913.
Farrow to Wean
Dry Cow
Farrow to Feeder
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Boars
Non -Layers
Pullets
Beef Feeder
Beef Brood Cow
Other -_ *
Turke
Turkey Poults
Other
Other
_Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes Q'11o'' ❑ NA ❑ NE
❑ Yes ❑ No �A ❑ NE
❑ Yes ❑ No []�`NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR) [:]Yes [] No [ KA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? [:]Yes ff No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes fNo ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412014 Continued

Facili Number: jDate of Inspection: to
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes g4iu- ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes D No LJ_NA ❑ NE
Structure' 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
E<o
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
BrI 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
L'-'"o
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
io
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
rl; '<o
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
C] Yes
�o
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [:]Yes F-.I- o [DNA ❑ 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 ofWindDrift ❑ Application Outside of Approved Area
12. Crop Type(s): (3�� �, & ] 6, D _
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
eNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
1,01No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
C3"'No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[:Ko
D NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
�o
D NA
❑ NE
Reauired 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
Aio
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
[] Weather
Code
❑ Rainfall [:]Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
[a Yes
o
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
0N10
❑ NA
❑ NE
Page 2 of 3 21412014 Continued

Facili Number: - Date of lns ection:-
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes GDAW6 ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [3'N10 ❑ 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 [].N66 ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [:]Yes Cg- o ❑ NA ❑ NE
Outer Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
[:]Yes
[Z]_b�
❑ 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
C3-3do
❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
U 1Vo
❑ 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
Q�<o
❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
Yes
Cjf4
❑ NA ❑ NE
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
❑moo
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
P "'o
❑ NA ❑ NE
Comments (refer to question_#) Explain any YES answers and/or any additional -recommendations or any�othergcomments .
Use drawings of facility to- better,, explain situations (use additional pages as necessary).
Reviewer/Inspector Name: l `I, Phone:
Reviewer/Inspector Signature: Date: ?24,it.. p
Page 3 of 3 21412014

� i Ms 2 S r�..6 2-0(` Q�
Structure Evaluation inspection
Facility Number: rZ - Date: d-3&6 1� -
t�
Time in: -8; /V t' _ Time out:
Name: Mi t 41�::q"LI Farm 911 address
Owner Name: -A(�K Phone
Facility Contact: C11-44 r
Onsite Representative:
i�
Integrator: W&
Certified Operator: r✓11t Cert. Number
Is storage capacity less than adequate? Yes No vo
If yes is waste level into the structural freeboard? Yes No &,-'
Was non -compliant level reported to DWR el _ POA received
Structure: 1 2 3 4 5 6
Identifier:
Spillway?
Designed Freeboard (in.):
Observed Freeboard (in.): t
Are there any immediate threats t he integrity of any of the structures
observed? Yes No
Do any structures lack adequate markers as required by the permit? Yes — No a�
Does any part of the waste management system need repair Yes No .�
Condition of field's Q 00. A�4 C.,;p
Condition of receiving crop
Comments:

' v�s`ion pf Water Quality
Facility Number I - /�� Division of Soil and Water Conservation
'7`�`^� QQ other Agency
Type of Visit: 92YZompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: / Departure Time: County:
Farm Name: ��e��/ �c+� �� f Owner Email:
Owner Name: Yk I CA&4 L , ti. stet Phone:
Mailing Address:
Region:r` V'*-
Physical Address:
r r
Facility Contact: �µ � 1 &IYA_) C[ Title: Phone:
C
Onsite Representative: Integrator:
1 Q,
I
Certified Operator:
( � � ✓'C Certification Number: Z
Back-up Operator: V Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current =
Design
Current
Design Current
Swine
Capacity Pop.. Wet Poultry.;;
Capacity
Pop. r-
CattleCapacity Pap.
;
Wean to Finish
Layer
`' Dairy Cow
Wean to Feeder
Feeder to Finish
Non -La er
I
Dairy Calf
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Di: Poultr.
Design
Ca acity
Current
P,p
- Dry Cow
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
:.::...:..:.
Turkeys
Other
Turkey Puuets
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
[ fo ~❑ 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
Ea 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
[j"NA
❑ NE
2. is there evidence of a past discharge from any part of the operation?
❑ Yes
{7]'Rlo
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
[D,<o
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

Faciti 1Vumber: U Date of Inspection v
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? [:]Yes [B-No—E] NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes [:]No C3-347- ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ®No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
[—]Yes
[�'No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
[:]Yes
C3ri-Vo_
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[],N6
❑ 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
alll V
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
ffNo
❑ NA
❑ NE
maintenance or improvement?
I. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes PN ❑ NA ❑ NE
D Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window .❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop TYpe(s): 1?�s`�t' `•c r[�t�i ��& ----C
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
�No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
E31No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[/o
❑ NA
❑ NE
18. is there a lack of properly operating waste application equipment?
❑ Yes
[] o
❑ 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 ErNo
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists El Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes Ea o
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste -Transfers
❑ Weather
Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes [ �I 6
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes L? No
❑ NA
❑ NE
Page 2 of 3 21412011 Continued

lFacility Number: V - Date of Inspection:
or
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [2-N'o ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [3-Mo— ❑ 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 [:6^ ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes C J N6 ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes D.Nar ❑ NA ❑ NE
❑ Yes [3~1q`o­ ❑ NA ❑ NE
❑ Yes [3'lgo ❑ NA ❑ NE
❑ Yes ETNo ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAW MP? ❑ Yes E]-?,4o ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? [:]Yes I__T 11° ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? [:]Yes [JNo ❑ NA ❑ NE
Comments (refer to question'#)Explain any YES'answersland/or any additional recommendations or any other�comments:;
Use drawings of facility to better explain situations (use additional pales as necessary):
C'CJCIG4_0_4�
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
M
.e
-0 - �2` 1
r�_s S
Phone:- &A
Date:
2/4/Z 14

type of visit: QMompliance Inspection U Operation Review O Structure Evaluation U Technical Assistance
Reason for Visit: tine O Complaint 0 Follow-up 0 Referral Q Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: County: 574_� Regio7l
Farm Name: e, rl,/ ( / ✓L� Owner Email:
Owner Name: /��C t/./t Phone:
Mailing Address: 67
Physical Address:
Facility Contact: ., 'r Gr �LV tz Title: �t® Phone:
Onsite Representative: t( Integrator: K�L
Certified Operator: cc t Me Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
-
...
Design Current 1Jesegurrrut
Design Current
Swine
Capacity Pop. "� etultry C pitV r Pop.
Cattle Capacity Pop.
M
Wean to Finish
Layer
Dairy Cow
Wean to Feeder
Non -La er
Dairy Calf
Feeder to Finish
1 .:.W _
Dairy Heifer
Farrow to Wean
.r Design ;Current
Dry Cow
Farrow to Feeder
IN ,
iPP
Non -Da*
Farrow to Finish
h Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
k"
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:
[]Yes [a1q'o ❑ NA ❑ NE
a. Was the conveyance man-made? ❑ Yes ❑ No [q-N7C_ -❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) ❑ Yes ❑ No [j-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 A ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes l Ef' o ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes E2 l"o ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

Facility Humber: jDate of Inspection:
Waste Collection &Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
'❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑"140C- ❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):'
5. Are there any immediate threats to the integrity of any of the structures observed?
[:]Yes
E'Ifo
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
[:]Yes
l- Ko
❑ 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
[R o
❑ 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
EIVo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
❑'1G'o
❑ NA
[] NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
[c to
❑ 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): 133 "Ci-O'k- ' �g� &U-C, 'Z-C.s
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
Inc
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
[—]Yes
[J,>e
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
[]IXr
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
Q- o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[,_J,1 o
❑ NA
❑ NE
Re uired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
2 o
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
[] Yes
[-'No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
EK90
❑ NA
[] NE
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
Ld' o
❑ NA
❑ NE
Page 2 of 3
21412011 Continued

Facili Number: jDate of ins ection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes
25. Is the facility out of compliance with permit conditions related to sludge? if yes, check ❑ Yes
■ 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:
G0.Mo'❑ NA ❑ NE
g4ro ❑ NA ❑ NE
❑ Yes
Ra o
❑ NA
❑ NE
❑ Yes
[ ► o
❑ NA
❑ NE
❑ Yes [C:,. o ❑ NA ❑ NE
[:]Yes No ❑ NA ❑ NE
❑ Yes [%jNo ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes ❑ 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 [10 ❑ NA ❑ NE
Comments (refer to question # ): Explain any YES answers and/or any additional recommendations or any other c6i iaients.
Use drawings of facility to better explain situations (use additional pages as necessarv).
k, 0 P - -31 b
S-0,4Lkt
Reviewer/Inspector Name-
Reviewer/Inspector Signature:
Page 3 of 3
Date:

t ype of v isn: t4^ompuanee inspecnon v operation Keview tJ -)trucrure r vaivarion v iecnnicai assistance
Reason for Visit: G/Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Arrival Time: Departure Time: a!/ County �A n
Farm Name: 5. Owner Email:
Owner Name: fps \ H Phone:
Mailing Address:
Physical Address:
Facility Contact: Z Title:
Phone:
Region: rM
Onsite Representative: aNAM Integrator: Mugo,A l{otjf�
�T
Certified Operator: Mat, h At L. L, Certification Number:
Back-up Operator:
Certification Number:
Location of Farm: Latitude: Longitude:
estgn Current Design Current Design C►urrent
Swine C•apaeity Pop. Wet Poultry Capacity I'op.. Cattle Capacity Pop.
Wean to Finish Layer Dairy Cow
Wean to Feeder
Non -Layer
Dairy Calf
Feeder to Finish
Design ;Current
Dry P,oult, Capa Po ,
Layers
Dairy 1-Leifer
Farrow to Wean
Farrow to Feeder
Dry Cow
Non -Dairy
Farrow to Finish
Beef Stocker
Gilts
Non -Layers
Pullets
Turke s
Turkey Poults
Beef Feeder
Boars
Beef Brood Cow
Other
Lec
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?
❑ Yes [g'NIo ❑ NA ❑ NE
❑ Yes ❑ No 2NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) NA
[] Yes
❑ No
Q
❑ 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
B3�No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
[:]Yes
F7(No
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

r +
Facili Number: $a - / Date of Inspection: ry
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
[:]Yes
WNo
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
[91NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):_
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
[-]Yes
EdNo
❑ 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
g 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
allo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[v7 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
["J No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[v/No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below_
[-]Yes
[2"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): Qum V D R / "A-r 2 yai� & . U . D
..
13. Soil Type(s): n} URIVUIV. -0-3 _ War, 0- U
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [�lo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [f 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?
18. Is there a lack of properly operating waste application equipment?
❑ Yes
&No
❑ NA
❑ NE
[:]Yes
[ "No
❑ NA
❑ NE
Re uired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? [:]Yes [gNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [O No ❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? 1f yes, check the appropriate box below. ❑ Yes [ 'No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ RainfalI ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? [-]Yes eNo
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes [::]No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
E(NA ❑ NE
Page 2 of 3 21412011 Continued

t
[Facility Number: VA - Date of Inspection: VL4
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes []gNo ❑ NA ❑ NE
25. is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes F9440 ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No ❑ NA [R/NE
Otherlssues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes [�Vo ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes Q""No ❑ NA ❑ NE
❑ Yes dNo
❑ Yes [�No
❑ NA ❑ NE
❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes dNo ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative'? [—]Yes dN ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes V [DNA ❑ NE
Reviewer/Inspector Signature:
• -1- _% tV
r-
Date: S t" 7-
2/4/2011

type of visit: Q�Momphance Inspection U Operation Review U Ntructure Evaluation U 'Technical Assistance
Reason for Visit: tine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: 17/ Arrival Time: Departure Time: County: i'') Region:.1 / 4W j1
Farm Name: Owner Email:
Owner Name: ktLS .,ej Phone:
Mailing Address:
Physical Address:
Facility Contact: 5 t Ll, Title: Phone:
Onsite Representative: Integrator:
Certified Operator: Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current y Des gn Current
Swine Capacity Pop. VVet PoultryCapacttv�Pop.
12X:
Wean to Finish La er
Design Current
Cattle ity CapacPop.
iry Cow
Wean to Feeder
Layer
Dairy Calf
Feeder to Finish#
Farrow to Wean
Farrow to Feeder
" zDes�gn�Current
D . 1'oiri `Ca j ci Pao .
Dairy Heifer
Cow
Non-Doiry
Farrow to Finish
La ers
Non -La ers
Beef Stocker
Beef Feeder
Gilts
Boars
Other
Of Other
Pullets
Turkeys
Beef Brood Cow
Turkey Pouets
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
[:]Yes
10
[] NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
A
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑4A'
❑ 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
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
VN
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

FaCili Number: - Date of Inspection:
Waste Collection & Treatment
4.`is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
2<o
❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
uke❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
�o
0 NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes &o
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes [g-Ko
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit? [:]Yes l_''T'"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 [ZJ,XIT�
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need [] Yes E�.M
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below_ ❑ Yes ILd'"'o
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of W' d Drift ❑ Application Outside of Approved Area
/
12. Crop Types) eL_ C .Lit
13. Soil Type(s): &. `' 0
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes 2<o ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes E;�Ko ❑ NA ONE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes [Dollo" ❑ 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 [5"No [DNA ❑ NE
❑ Yes To ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
2'Vo NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑Yes
o
❑] NA ❑ NE
the appropriate box.
❑WUP ❑Checklists [—]Design ❑Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
o
❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
[:]Waste Transfers
❑ Weather Code
[:]Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I " Rainfall Inspections Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
/❑
Eq- o
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
NE
Page 2 of 3 21412011 Continued

Facility Number: jDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑Yes L No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes Vfi"'
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 o
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
❑ NA Q�?e
[:]Yes 6 to ❑ NA ❑ NE
❑ Yes [&? o ❑ NA ❑ NE
❑ Yes I'� "No ❑ NA ❑ NE
[:]Yes io ❑ NA ❑ NE
❑ Yes
[�Ko
❑ NA
❑ NE
❑ Yes
2No
❑ NA
❑ NE
❑ Yes
[gTo
❑ 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).
Rea_<41
4K.-e (f,51- 4r�
0_opco�
Pam- CLa I L'0, a, ,.4«" � 5e1L or .
Reviewer/]nspector N
Reviewer/Inspector
Page 3 of 3
Phone: 47,,
Date:
2/4/20l

.5_XWS 2-0el-zo/o
Type of Visit e-Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit outine O Complaint O Follow up Q Referral O Emergency O Other ❑ Denied Access
Date of Visit: 2-Oi'/0 Arrival Time: 1 9. 45 Departure Time: County: $�R /� s° Region: G/W
Farm Name: 1'l �, K� ,der ` Owner Email:
Owner Name- + ��yrt� N� Phone:
Mailing Address:
Physical Address: Facility Contact: ti� /�
U K-h-S G Title: % G S�� �-�. _ Phone No:
Onsite Representative: Integrator: (fz 4'r. K 4..- r `~ S
Certified Operator:
Back-up Operator:
Location of Farm:
Operator Certification Number:
Back-up Certification Number:
Latitude: E__1 o =1' 0 Longitude: = ° = 4
Sv►ineWervacit,-jRUv—_ulation
Design Current
Design
Design Current 111111
Wet Poultry Capacity Population Cattle C•apaeity
Current
Population
❑ Wean to Finish
❑ Layer
❑ Dairy Cow
❑ Wean to Feeder
❑ Non -La er
❑ Daia Calf
Feeder to Finish
6 % L 126 p
❑ Da Heifer
Dry Poultry ❑ Dry Cow
ElNon-Dairy
El Layers El Beef Stocker
El Non -Lay era
El Pullets El Beef Feeder
❑ Turkeys Beef Brood Co
❑
❑ Turke Poults
❑ Other Number of Structures:
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
Gilts
❑ Boars
Other
❑ Other
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
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 ff10No ❑ NA ❑ NE
❑ Yes
❑ No
[ NA
❑ NE
❑ Yes
❑ No
IT Na
❑ NE
fT NP►
❑ NE
❑ Yes
❑ No
❑ Yes
D-N'o-
❑ NA
❑ NE
❑ Yes ffCEI NA ❑ NE
12128104 Continued
1. ..<< ,,;,

Facility Number:
8z 0 Date of Inspection®—!
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ETNo ❑ 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): Z
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes CTNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes 2 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 El Yes B No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance/improvement?
1 I . Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes E o ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) fie r.4( u C)C-_ rc'0 3 e. J �� (� rn Inl CO, S • ! -
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
L�J NNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
L�NNo
El NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
2"No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
[FNNo
❑ NA
❑ NE
18. is there a lack of properly operating waste application equipment?
❑ Yes
L7 No
❑ NA
❑ NE
Comments (refer to question.#) Ekplain and YES answers and/or any recommendations or any other comments.
tfse drahmgs of facility to better explain situations. (use. additional pages as necessary): A
z
AL
Reviewer/Inspector Name ie�� f{ eVe�S Phone: 9/O• K.2' 3380
Reviewer/Inspector Signature: Date: 2--0/-20/1)
12128104 Continued

Facility Number: 02 —/OS Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes B<o ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes L<o ❑ NA ❑ NE
the appropriate box. ❑ WUp ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes E3 o ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ t20 Minute Inspections [:]Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
<o
El NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
Yes
ElI
,L7
4o
❑ NA
El NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
--�,
B �o
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
2<o
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
B<o
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
L7 No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
ET/No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
0 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
ElL(
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
Q"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
ER<o
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
Ej< ❑ NA
❑ NE
12128104

Facility Number
ivision of Water Quality
O Division of Soil and Water Conservation
O Other Agency
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: Arrival Time: : LtU Departure Time: 333, e� County: s'f's° Region: f' 0
Farm Name: �J'lf II#CA-ri'�9 Owner Email:
Owner Name: M i k-c. K�, tit Al ti Phone:
Mailing Address:
Physical Address: —�^
Facility Contact: CK�j &t"r-Jr Lk- Title: / �'`'�• S��`= = Phone No:
Onsite Representative: Integrator: C6 in t-f
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Other
I,[:]. -Other
Operator Certification Number:
Back-up Certification Number:
Latitude: 0 e❑ A 0« Longitude: = o❑ 1❑
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
_ ❑ Layer
❑ Nan -La er
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Pouets
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑
Dairy Cow
❑
Dairy Calf
❑
Dairy Heifei
❑
Dry Cow
❑
Non -Dairy
❑
Beef Stocker
❑
Beef Feeder
❑
Beef Brood Co
Number of Structures:.
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes B o ❑ NA ❑ NE
❑ Yes
❑ No
E31GA
❑ NE
❑ Yes
❑ No
[2-11A
❑ NE
�
❑ NE
❑ Yes
❑ Now
❑ Yes
Blgo
❑ NA
ElNE
❑ Yes
915o
❑ NA
❑ NE
12128104 Continued

Facility Number: g Z-- / Date of Inspection �3'c
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes CrNo ❑ NA ❑ NE
a_ If yes, is waste level into the structural freeboard? ❑ Yes 1TNo ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes [T N ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes CrNo ❑ 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 CTh�No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes 0<0 ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks) ,�,
9. Does any part of the waste management system other than the waste structures require El Yes L'�'IVo El NA ❑ NE
maintenance or improvement?
Waste Application 10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 04o ❑ NA ❑ NE
maintenance/improvement?
] I. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ffNo ❑ 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) evm tcdl�l r )(s,`0 Ste (1 G�-��; N D. S. �
13. Soil type(s) LJ&E / Y t3 /4
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ Yes
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
17. Does the facility lack adequate acreage for land application? ❑ Yes
18. Is there a lack of properly operating waste application equipment`?
❑ Yes
3'No ❑ NA
❑ NE
ETONoo ❑ NA
❑ NE
No ❑ NA
❑ NE
BKo ❑ NA
❑ NE
0416 ❑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 /�i t`t K 1K �/ a.�S Phone: 41167, V33,. 33W
Reviewer/[nspector Signature: Date: 9 -Z3 - Z 009
g
12128104 Continued

Facility Number: 82 — Date of Inspection
Re uired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? [] Yes [BIo [ 1 NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check 0 Yes 01105"113 NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other ��
21. Does record keeping need improvement? If yes, check the appropriate box below. ElLT Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
EjlZo ❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑,,-No El NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
,'tv
LBo ❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
9416❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
B'No ❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
[moo ❑ NA
❑ NE
Other issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
//
B o ❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
0 Yes
El ❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
El Yes
�, ,/
L7No ❑ 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
91Qo ❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
ElYes
atgo ❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
[EKoo ❑ NA
❑ NE
12128104

Type of Visit (YCompliance Inspection O Operation Review 0 Structure Evaluation O Technical Assistance
Reason for Visit outine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: 17 G ff I Arrival Time: Departure Time: ?' k+ County: n�m Region:
Farm Name: r'�r�� r�"/'��! Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Cur-rS ,+rc tr[,� Title: Phone No:
Onsite Representative: Cu r��s 1 i'c�i`GK integrator: 4a Yf e- r' �s
Certified Operator:
Back-up Operator:
Operator Certification Number:
Back-up Certification Number:
:rI(/
Location of Farm: Latitude: = o ❑ I 0 Longitude: ❑ Q ❑ { ❑ A,
D Ki
1Destgn. Gurrent Design Current
Swine Ca
ultryCapacity Population Cattle Capacity Population
_
❑ Wean to Finish
❑ La er
❑ Dairy Cow
❑ Wean to Feeder
❑Non -La er
❑ Dairy Calf
❑ Dairy Heifer
"'' ❑ Dry Cow
ErFeeder to Finish
Z
1 3
D Poul}.�
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Non -Dairy
❑ La ers
❑ Farrow to Finish
❑ Beef Stocker
❑❑ Beef Feeder
Beef Brood Co
❑ Gilts
❑ Non -Layers
❑ Boars ❑ Pallets
- ❑ Turkeys
Other ❑ Turke Poults
❑ Other 10 Other
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 I of 3
❑ Yes lJ No ❑ NA ❑ NE
❑ Yes []No E NA
❑ NE
❑ Yes ❑ No ['VA
❑ NE
❑ Yes ❑ No NA
❑ NE
❑ Yes 2<o ❑ NA
❑ NE
❑ Yes No ❑ NA
❑ NE
12/28/04 Continued

Facility Number: gZ—/Qjr Date of Inspection
Waste Collection & Treatment
�
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes L'J 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): 2
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes No
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
r-,,�
❑ Yes I� lvo
❑ 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 B<o ❑ NA ❑ NE
S. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes R 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 3 No ❑ NA ❑ NE
maintenance or improvement?
Waste Application �,/
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes L�'J No ❑ NA ❑ NE
maintenance/improvement?
I. is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes allo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Croptype(s) &P-Atitd,,,, r(T, clD.S,
13. Soil type(s) tya,,8 , )Vp /¢
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
ONo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
0 NNo
❑ NA
❑ NE
16_ Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
L'��7,, N"�o
El NA
El NE
17. Does the facility lack adequate acreage for land application?
El Yes
LTNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[ "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 RCJC ReV�e_IS Phone:
Reviewer/Inspector Signature: Date:
12128104 Continued

Facility Number: 72- —jp,, Date of Inspection
Required Records & Documents 19. Did the facility fail to have Certificate of Coverage & Permit readily available? ElE Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes E No ❑ NA ❑ NE
the appropirate box.
❑ WLJP ❑Checklists El Design El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes B<o ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
B11-o
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
2<6
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
Bigo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
0-1q_o
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
D<o
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
[Tigo-
❑ NA
❑ NE
Outer Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
BImo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
[4'izo-
❑ 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
ElE
,—,.�
3 o
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
9<
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
�/
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
El Yes
E,N"o
El NA
El NE
33.
Does facility require a follow-up visit by same agency?
El Yes
0110
❑ NA
❑ NE
Page 3 of 3 12128104

Division of Water Quality /
Facility Number SZ / O S O Division of Soil and Water Conservation ✓
0 Other Agency
Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit ® Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: j0'03-Oy Arrival Time: j;/S Departure Time: County: Q"'+ Son/ Region: F�
Farm Name: &t Sixr... _ Owner Email:
Owner Name: IAt K 4xki t Phone:
Mailing Address:
Physical Address:
Facility Contact: + 1� �[-/r►'i nos Title: Phone No:
Onsite Representative: CLL Btw:,�Integrator: rl- LekMiit-
Certified
Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boats
Other
❑ Other
Operator Certification Number:
Back-up Certification Number:
Latitude: = o ❑ c 0 Longitude: 0 ° 0 ' ❑
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
��� ❑ Non -La et
Dry Poultry
Layers __-
Non -Layers
Pullets;
Turkeys_
Turkey Poults
Other
Discharges & Stream Impacts
I . is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifei
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
�i
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?
a
❑ Yes Q? No ❑ NA ❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
% No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
[RNo
❑ Yes
[� No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
12128104 Continued

Facility Number: SZ- f Qs
Date of Inspection /0-4>3-07
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3 2-
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes DI No ❑ NA ❑ NE
❑ Yes fW 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 in No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes EyNo ❑ 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 [9 No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 0 No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ® No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) �Gi�w1t^ (G ra SA44J/ Orv, V (10.5. -
13. Soil type(s) Oa $DA
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 [YNo ❑ 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
J� No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes
® 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 R>46 P—" -5 Phone: 910 , 330 0
ReviewerfInspector Signature: Date: p - ZOO %
lai.c61v4 uonrinuea

Facility Number: gZ —#L751 Date of Inspection /O-D3-07
Reauired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes [yNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ® No ❑ NA ❑ NE
the appropiiate box. ❑ WUp ❑ Checklists Design ❑ Maps
❑ Desi p El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes V No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
�0 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
EM No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
(4 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
R No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
,P No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
09 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
M 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
(A 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
rMl No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
rg No
❑ NA
❑ NE
Comments and/or Drawings:
12128104

Type of Visit ® Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit ® Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other [:1 Denied Access
Date of Visit: 5-OZ-0(o 1 Arrival Time: Z'�D � 1 Departure Time: County: �"'� Region: F20
Farm Name: M "Ke- Owner Email:
Owner Name: +fie— e-V- P i 14a _ Phone:
Mailing Address:
Physical Address:
Facility Contact: /Ul/A Me-&-r'm4 Title:
Onsite Representative: Cat5_4Yt` k
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feedej
Farrow to Finish
Boars
Other
❑ Other - T
Phone No:
Integrator: C4, Aa r* <_
Operator Certification Number:
Back-up Certification Number:
Latitude: = o =' = Longitude: [� o E::] ' 0
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
_ ❑ Layer
I❑ Non, -La er
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Cattle
Design Current
Capacity Population
I
❑
Dairy Cow
❑
Dairy Calf
❑
Dairy Heifer
❑
Dry Cow
❑
Non -Dairy
❑
Beef Stocker
❑
Beef Feeder
❑
Beef Brood Co
Number of Structures:
El!
h. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system'? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes ® No ❑ NA ❑ NE
❑ Yes
M No
❑ NA
❑ NE
❑Yes
IDNo
El NA
El NE
❑ NA
❑ NE
❑ Yes
® No
❑ Yes
0 No
❑ NA
❑ NE
❑ Yes
[° No
❑ NA
❑ NE
12178104 Continued

Facility Number Z —�
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
_- Structure 1 Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in): _-/ 9 a
Observed Freeboard (in): / Sp
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 [59 No ❑ NA ❑ NE
❑ Yes D9 No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes [P 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 DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes [54 No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes [0 No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require El Yes � No ❑ NA El NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes M No El 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 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window [:]Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) Z?er.,u tl d L — G ra L .Silt r. G P-" i iv - ct! �V S c` r4
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes N 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?
18. Is there a lack of properly operating waste application equipment?
❑ Yes 14 No
❑ Yes (0 No
El NA ❑NE
❑ NA ❑ NE
Reviewer/Inspector Name
Phone:
Reviewer/Inspector Signature: p r..e i2� Date: s- 00 - ?D0IP
12128104 Continued

Facility Number: -1—/OS Date of Inspection 3-e2-0&
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes M No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [A No ❑ NA ❑ NE
the approprrate box. ❑ yip ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [�No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes (%No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes M 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
0 No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
N No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
® No
❑ NA
❑ NE
Other issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
t] 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
DO 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
JK1 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
I@ No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
[2 No
❑ NA
❑ NE
Addition ahCommeatsiand/or:Drawings: p i AW `
12/28/04

® Division of Water Quality
acility Number ga ® Ds T Division of Soil and Water Conservation
0 O#her Agency hip
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
6?
Date of Visit: Arrival Time: Departure Time: County: Region: V�:7r— �
Farm Name: m � /�G Jac rr: n `�, t �.-. Owner Emad:
Owner Name: i'%7. /�C e r r`.1 �l Phone:
Mailing Address: _ 7S� T v , ,`��. 5 ���' /i.vTl►�y, /VC
Physical Address: cce—
Facility Contact:
Title:
Onsite Representative: Z Wt " , u--
Certified Operator: 1T'7e t r
Back-up Operator:
Location of Farm:
Phone No:
Integrator: C¢ A - 0 Cn.,
Operator Certification Number: ���-2
Back-up Certification Number:
Latitude: = 0 0 I = Longitude: = ° ❑ 4
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population
❑ Wean to Finish
❑ Wean to Feeder
® Feeder to Finish C, 7Yk 2 os
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other _
❑ La er
❑ Non -Layer
Dry Poultry
❑ Lavers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
I
I 7-7d
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-inade?
Design Current
Cattle Capacity Population
❑
Dairy Cow
❑
Dairy Calf
❑
Dairy Heifer
❑
Dry Cow
❑
Non -Dairy_
❑
Beef Stocker
❑
Beef Feeder
❑
Beef Brood Cowl
Number of Structures:
b. Did the discharge reach waters of the State? (if yes. notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system`? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes ® No - ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
R1 No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
12128104 Continued

1~ acility Number: *2 — /o -r- Date of Inspection 3//4-inn
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ® No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): /. 9,, .2 "' S /!.z /o
Observed Freeboard (in): � 3 `'
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 56 No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes ® No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ® No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ yes ® No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ® No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes CKI 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 I0 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) Z?e
13. Soil type(s) /Vo A7 , (,vim
14. Do the receiving crops differ from those designated in the CAWMP?
ElYes
[50 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
® No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
ReviewerAnspector Name ® Phone: mot' �o `f i✓! , �S�
Reviewer/Inspector Signature: Date: 3 / /[
JV2&04 Continued

i
Facility Number: Date of inspection 3 J/c /ate
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ® No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design
. gn ❑ Maps p ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. Yes ❑ No ❑ NA ❑ NE
Waste Application ❑ Weekly Freeboard �] Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
[� No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
® 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
M No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
09 No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
[19 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
06 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
0 No
❑ NA
❑ NE
Additional Comments and/or_ Drawings ' S
n pp l ; c� I pNs YVI c CP i U Jq o V V%I% a
-e D �{ rc ►-+- a dZer �,�, : �'�.0, � �4-
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P-r+o pv-d s ,.
l GK
es yp&e ��✓� 1J��ive !.�l���G Say -plc ih �r��
rr to
12/2&/04

Information contained in this database is from non agency sources and is considered unconfirmed.
Farm Emergency Call Form
DWQ Facility Number
82 — 105
Date
3-21-2003
Farm Name
Mike Herring Farm
Time
11:30
Owner First Name
Mike
Control Number
2104
Owner Last Name
Herring
O Reporting 0 Complaint
Source
Plan Due Date
Date Plan Date Freeboard
Inches (? equals blank)
Received Level OK
Breached
Depopulated
Overflowed
LQ Issue
PermissionToPump
Inundated
Flooded
Pumping Equipment
Comments
10 Yes 0 No
10 Yes No
Yes 0 No
0 Yes 0 No
O Yes No
O Yes 0 No
O Yes O No
10 Yes O No
Freeboard Lagoonl 18 3/23/2003 11 113-28-2003
Freeboard Lagoon2 7
Freeboard Lagoon3 ?
Freeboard Lagoon4
Freeboard Lagoons 7
Freeboard Lagoon6 7
22" O.K.
...........................................................................................................................................................................
...................................................................................................................................................................................................................................
................................................ ................................................. ......................................................... I................
...........................................................................................................................................................................
-----------------------------------------------------------------------------------------------------------------

[Type of Visit 6 Compliance Inspection Q Operation Review O Lagoon Evaluation
Reason for Visit Q' ioutine Q Complaint Q Follow up 0 Emergency Notification Q Other ❑ Denied Access I
Date or visit: 5�� a Time: it � 1S
Facility Number o
Q Not Operational Q Below Threshold
p'Permitted E ertified [3Conditionally Certified [3Registered Date Last Operated or Above Threshold.: ... ._. - .
�
Farm Name: .....Xk� .__.....___! .. ............ County:
Owner Name: __ A i ki' Phone No: �l
4
......................_, �.� ...._ _
-MadmgAddress: �51e ar'^ ^m IQcI ��`ivt`io� 14e--
Facility Contact: .._.ice... !`€ _Title: OwreaQ
Onsite Representative:..... .C_.__....w`K- -- �._...... ...... .......
Certified Operator:...._.. -�.... -...........
_ ..........�
Location of Farm:._..
Phone No:
Integrator: ,_ f q. eia..........__..... �.
Operator Certification Number:._...._.J'VW'Z
2twine ❑ Poultry ❑ Cattle ❑ Horse Latitude • 4 " Longitude • 4 "
Discbarges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes B'Ro
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) [I Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/rain?
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 B'Ro
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes (RNo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes Efilo
Structure I Structure 2 Structure ; Structure 4 Structure 5 Structure 6
Identifier: 1.... _�._ - ,.. _ ..... _ _...............
Freeboard (inches): PIA
12112103 Continued

Facility Number: $2 - OS
Date of Inspection S 9n 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 maintenancerimprovement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
`Waste Application
10. Are there any buffers that need maintenance/improvement?
I I _ 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
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours?
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
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
Air Quality representative immediately.
❑ Yes [+rNo
❑ Yes []'No
❑ Yes ff No
❑ Yes E No
❑ Yes B140
❑ Yes UrNo
❑ Yes ErNo
❑ Yes ErNo
❑ Yes [ENO
❑ Yes [91q0
❑ Yes [kfVo
❑ Yes 3 No
❑ Yes [3No
❑ Yes [ErNo
❑ Yes [ No
❑ Yes 2 No
❑ Yes G�&o

Facility Number: — OS Date of inspection F Tw.?o 0
Required Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
3<0
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
2No
23. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
allo
❑ 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?
❑ Yes
[3No
25. Did the facility fail to have a actively certified operator in charge?
❑ Yes
QNo
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
&I discharge, freeboard problems, over application)
❑ Yes
2Vo
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
[fNo
28. Does facility require a follow-up visit by same agency?
❑ Yes
E64o
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
Elf4o
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
[Yes
❑ No
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
00%
32. Did the facility fail to install and maintain a rain gauge?
❑ Yes
ErNo
33. Did the facility fail to conduct an annual sludge survey?
❑ Yes
214o
34. Did the facility fail to calibrate waste application equipment? ❑ Yes Rfio
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below. ❑ Yes [9No
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After 1" Rain
❑ 120 Minute inspections ❑ Annual Certification Form
lEr No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
12112103

Site Requires Immediate Attention:
Facility No. Q
DIVISION OF ENVIRONMENTAL MANAGEMENT
/ ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
I DATE: 2.0 , 1995
Time: 1 I
Farm Name/owner: Ai k C'
Mailing Address: 1 (o ? a
County:
Integrator: Phone:
On Site Representative: ►l c, Phone:
Physical Address/Location: -- 4 P_-f - M- '11"q _
Type of Operation: Swine v Poultry Cattle
Design Capacity:. ?2 c, c s Number of Animals on Site: .16, 72
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: Longitude: _'_-
Circle Yes or No
Does the Animal Waste
Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches) U or No
Was any seepage observed from the lFe,
(s)?
Is adequate land available_ for spray9or No
Crop(s) being utilized: �—
Actual Freeboard: g -Ft. 0 Inches
Yes or 1�o Was any erosion observed? Yes or lO
Is the cover crop adequate? Yes or No
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellin sCes or No
100 Feet from Wells? Ye or o
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or l$o
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line: Yes or IDo
Is animal waste discharged into water of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes or & If Yes, Please Explain.
Does the facility maintain adequate waste management reco (volumes of manure, Iand applied,
spray irrigated on specific acreage with cover crop)? r No
Additional Comments:
4,za,
Inspector N
Signature
cc: Facility Assessment Unit Use Attachments if Needed.

_ Site Requires Immediate Attention:
�Z Facility No.
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: , 1995
Time: #1
Farm Name/Owner:
336V Z WA"' -Cna
Mailing Address:— -- C1
County:
Integrator: Phone: — — - On Site Representative: Phone:
Physical Address/Location: -
Type of Operation: Swine _-tZ' Poultry Cattle
Design Capacity: _ !��,, Number of Animals on Site:
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: Longitude: °
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 inches) `Dor No Actual Freeboard: 2 Ft. -f.2— Inches
Was any seepage observed from the la oon(s)? Yes or(@ Was any erosion observed? Yes o No
Is adequate land available for spray? 9r± Is the cov crop adequate? Yes or No
Crop(s) being utilized:
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings? eslr No
100 Feet from Wells? e orf o
Is the animal waste stockpiled within 100 Feet of USGS Blue -Line Stream? Yes or o
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line: Yes or No
Is animal waste discharged into water of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes or 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)? (fe )or No
Additional Comments:
Inspector Name
Signature
cc: Facility Assessment Unit Use Attachments if Needed.

:le, 75
awed
and
:) in
WATER QUMTY PLAwNG Fax:[phone] Iul 19 0.CIO P. E11.f Q
` �7716
4' NOV 1993
MI STFATIONEPRK FOR
Depart Ent of -Environment, Health and patural Resa e
division" of Environmental Management .-�' �YAT%QUAUTY
Water Quality Sectiori' 9 Nanni:ir, gfARc
`
If the animal
is designed to seer°
horses, 250 swi �e,
by a liquid waste r ,
mailed by December
order to be deemed
Farm Name: Mike Hu. -
PW.-lt"' br8rid'8x tf8nsr► i t ) 1Ti8tm
p
Kong IVreli
I„
:sr s i
Route i tiox lb'!t
Clinton, NC 28328
Sampson ,County
Owners) Name:
Manager(s) Name
Lessee Name:
i
919-554=6943
t!r �
Farm Location (Be as,specific as possible;
direction. mile6ost-.:etc.1 : SV Tile.
road names.
Latitude/Longitude if known: QBSP # 15-134-24716
i
Design capacity'of-animal waste management !system (Number a d
type of confined animaal(s): I l-,L-"'t ;Y,� a_
Average animal population on the farm (Number and type of
animal (s) raised).: ?L 7,a- :.- ' 'E ... . _ _.
Year Productionisegan: ✓
Type of Waste Management system used:
ASCSITract No.:
i
Acres Available' for Land Application of Waste' Sid ✓
i
Owner (a) Signature (s) : Atyz,,ld Date: Z:gr--Af1
' Date:
(Fulton Peterson. Servicwma )
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