820134_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental Out

16
Date of Visit: Z-00 gArrival Time: p Departure Time: J County:Region:��_
Farm Name: �M _ Owner Email:
Owner Name: �� [ fly - p) ��1 r•� Qw4 rp ioae:
Mailing Address:
Physical Address:
Facility Contact: _CU J I Title:
Il
Onsite Representative: jj
Certified Operator: t oA�Gvv
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator: pq as
Certification Number: (� 3 70
Certification Number:
Longitude:
'Design Current
Design
Current
Design Current
I'M III I
ine Capacity Pop.
R'et Poultry
Capacity
Pop.
Cattle Capacitq Pop.
ean to Finish
rFFF—eederto
La er
Dai Cow
ean to Feeder
Non -La er
Dai Calf
Finish Z't) 000
Dairy Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
D . Poul
Ga aci
P,o P.
Non -D
row to Finish
Layers
Beef Stocker
s
Non -Layers
Beef Feeder
rs
Pullets
Beef Brood Cow
Turkeys
JkG
Turke Poults
er
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DW R)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes [D-TTo ❑ _NA ❑ NE
[:]Yes ❑ No [3 -'NA ❑ NE
❑ Yes [:]No [] 9A ❑ NE
[:]Yes ❑No
❑ Yes []'14o
[:]Yes [24o
[3-lq-A ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 2/417015 Continued

Facility Number: -13 jDate of Inspection: ' =_)0
Waste Collection & Treatment
4. Is sto .,ge capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ivu L❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? [:]Yes ❑ No [SEC' ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): _
Observed Freeboard (in): T
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
❑ Yes [t No ❑ NA ❑ NE
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 46 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
[::I'No
❑ NA
❑ NE
8_ Do any of the structures lack adequate markers as required by the permit?
❑ Yes
I�J�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
0'K0
❑ NA
❑ NE
maintenance or improvement?
❑ Yes
❑'No
❑ NA
❑ NE
Waste Application
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
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 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): C ftp is
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes ❑C ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes Ltd'1VD ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes [ o ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
E] Yes [9-11o'—❑NA ❑NE
❑ Yes []bier ❑ NA ❑ NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
I31Vo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[ oo
❑ 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 1" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
[D<
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
FI -No
❑ NA
❑ NE
Page 2 of 3 214/2015 Continued

Facili Number: - 1 Date of Ins ection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ��1�❑ NA ❑ NE
25. Is th% facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes to o NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes Nom❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes B'No IINA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes Imo""" ❑ 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 [ l o ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
3 L Do subsurface tile drains exist at the facility? If yes, check the appropriate box below_
❑ Yes
Q'No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[ffNo
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
E?No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
E 'moo
❑ NA
❑ NE
Reviewer/Inspector Signature: Date: G Ttl't�j
Page 3 of 3 21412015

1►1�_S Q_ b 1'Vl�., n LTJ
Divisio or Water R`e'sources -
F
OR Number - ©Division of Soil and. - ater Conservation
® Other Agency
Type of Visit: 0 -compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 04outine 0 Complaint O Follow-up O Referral 0 Emergency O Other 0 Denied Access
Date of Visit: I qL's Arrival Time: -c t[ Departure Time: t D / County:
Farm Name: Owner Email:
Owner Name:�f �'t �`�-'cruet Phone:
Mailing Address:
Physical Address:
Facility Contact: r Jig Title:
Onsite Representative: t{
Certified Operator:
Back-up Operator: �0a/l� Y'1
Location of Farm:
Latitude:
Phone:
Integrator: ly ,6-- s
Certification Number:
Certification Number:
Longitude:
Region: rll2ej-
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field D 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)?
❑ Yes to ❑ NA ❑ NE
❑ Yes ❑ No C -N-A ❑ NE
❑ Yes 0 No E3'-N—A ❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWR) 0 Yes ❑ No E2<A ❑ NE
2. Is there evidence of a past discharge from any part of the operation? 0 Yes C3"No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes Q No ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 2/4/2015 Continued
Design Current
HowDesign
Current -`-
esign Current
_s Swine
Ca acct Po ��
p y p
Wet PoultD"
ry
Capactty Pop
Cattle
Capacity Pop.
Wean to Finish
La er
-
Dairy Cow
- Wean to Feeder
�s
Non -Layer
Dai Calf
Feeder to Finish
3, 7--0
Dairy Heifer
Farrow to Wean
Design Current .= ,=
Dry Cow
Farrow to Feeder
D . Po_ult .
Ca act Po
Non -Dairy
Farrow to Finish
q
Layers
gra;
Beef Stocker
Gilts
Non -Layers
T'
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
r
,Other
TurkeyPoults+
Other}
s
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field D 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)?
❑ Yes to ❑ NA ❑ NE
❑ Yes ❑ No C -N-A ❑ NE
❑ Yes 0 No E3'-N—A ❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWR) 0 Yes ❑ No E2<A ❑ NE
2. Is there evidence of a past discharge from any part of the operation? 0 Yes C3"No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes Q No ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 2/4/2015 Continued

Facility Number: . - Date of Inspection: !Z laL
❑ Yes [3'NTo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available'? If yes, check
Waste Collection & Treatment
❑ NA
❑ NE
the appropriate box.
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
L• o
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
[DIVA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Code
Identifier:
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes E No
❑ NA
Spillway?:
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes E6 No
❑ NA
❑ NE
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[B<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
['�lo
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
[]'No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[2No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
[D-T�o
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[TNo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes dNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes CyNo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [allo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes [+FNo ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Reauired Records & Documents
❑ Yes []"No ❑ NA ❑ NE
❑ Yes [3"'No ❑ NA ❑ NE
19_ Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes [3'NTo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available'? If yes, check
❑ Yes E3 -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 E240
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transf rs
❑ 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 E No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes E6 No
❑ NA
❑ NE
Page 2 of 3 2/4/2015 Continued

[Facility Number: - 173 ti jDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes 12�<o ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [E�No ❑ NA ❑ NE
the appropriate box(es) below,
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge Ievels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of fust 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
L� o
1
❑ NA
❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
[f] No
❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
[ Ko
❑ NA
0 NE
If yes, contact a regional Air Quality representative immediately.
❑ Yes
[31M
❑ NA
❑ NE
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
[D-qo
❑ 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
[]I Nb
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[3 -No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
[31M
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
[3'1 to
❑ NA
❑ NE
CCU
Reviewer/Inspector Name: j
Reviewer/Inspector Signature:
Page 3 of 3
o- s.r -7-,2-
66
PhoneqLu'
Date: ,.5 JAS 1 7
21412015

type of visit: t& [:ompliance inspection V Uperation iceview V structure Evaluation V Iecnnical Assistance I
Reason for Visit: &Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time:County: S�
Farm Name: �Fj/n� r -a/!1] Owner Email:
Owner Name: a-10AN _V-6r7f �O rn-r Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title: ©yPhone:
Onsite Representative:
Certified Operator: Mau
Back-up Operator:
Location of Farm:
Latitude:
Integrator: N- Q
Region: FC
Certification Number: QbOo
Certification Number:
Longitude:
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
[-]Yes CR No ❑ NA [] NE
❑ Yes
Design
Current ���� Design
Current
,,.
. Design Current
Swine
Capacity
Pap. Poultry- Capacity
�..
Pop.
Cattle Capacity Pop.
Wean to Finish
Layer
Dairy Cow
Wean to Feeder
Non -La er
Dairy Calf
Feeder to Finish
Q
Dairy Heifer
Farrow to Wean
.. Design
Current
Dry Cow
Farrow to Feeder
D 5, It . Ca aci
jr
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Lavers
Beef Feeder
Boars
j Pullets
Beef Brood Cow
::.-.._
Turkeys
Other
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
[-]Yes CR No ❑ NA [] NE
❑ Yes
❑ No
❑ NA
[] NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes ❑ No
❑ Yes Cg No
❑ Yes Pg No
❑ NA [] NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 21412011 Continued

)Facility Number: -j,3 jDate of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes tj� 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
❑ Yes
Identifier:
❑ NA
Spillway?:
18. Is there a lack of properly operating waste application equipment'?
Designed Freeboard (in): 19
PUNo
Observed Freeboard (in):
❑ NE
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ER No ❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a ❑ Yes 2 No ❑ NA
❑ NE
waste management or closure plan?
❑ No
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes 0 No ❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit! ❑ Yes [j No ❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
❑ NE
9. Does any part of the waste management system other than the waste structures require ❑ Yes CaNo ❑ NA
❑ NE
maintenance or improvement?
Waste Ap_j ication
❑ WUP ❑Checklists [:]Design ❑Maps [:]Lease Agreements
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes W No ❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes M -No ❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ NA
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Waste Application ❑ Weekly Freeboard tg Waste Analysis ZSoil Analysis
❑ Outside of Acceptable Crop Window [:]Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop TYpe(s): CDf
❑ Rainfall ❑ Stocking [:]Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
13. Soil Type(s): _
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes �2 No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes 1>—? No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable [:]Yes P No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
1p No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment'?
❑ Yes
PUNo
❑ 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
E -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.
aYes
❑ No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard tg Waste Analysis ZSoil 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
(21 No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
� NA
❑ NE
Page 2 of 3
2/4/2011 Continued

Facili Number: 60a, jDate of Inspection: 3
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26_ Did the facility fail to provide documentation of an actively certified operator in charge? Yes ❑ No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No WA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes J -No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes n No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the ❑ Yes G3 No ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
❑ No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond S Other: NJ% -S !fie
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
❑ No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
CR No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
JaNo
❑ NA
0 NE
a 4 Pa e-w0r k �s rn ��m ������ , i o►,re�� did ji t fW . t% soi
� a1� s 0M � Ur2. 9 0� v� a- h))su1 (a0 da say, !�1 0 lif -be-
P
gnnVaCI sa saM p1r° gar yak reCl9�1`�f rL+ � -)lot back
NOD°r`�p�� l SSU -ed, �f ill � a, j- o�n`�- a y
II � �
C # I ce,Se nay D(;` u !al +n� , Q , Prod User js si Aek u �� 6e n exp teit' Mai
9 �
irj Qrei yok shops a)j_ liw-,) caves i's,
ar�C.
9
- vAen noionfrodut'WX
OV- x0134C- O Q_) 3
Reviewer/Inspector Name:
Reviewer/]nspector Signature:
Page 3 of 3
Phone: 110- 931a'U A[n4f�.J
Date: rib a$ mu
3
214/2011

Facility No.$a �3 - Farm Name
0011AoDate
a 1 a6 1 E3
i
Permit COC
OIC^
NPDES (Rainbreaker PLAT
Annual Cert Daily Pipe)
Lagoon Name, S forspillway 1 2 3 4 5 6 7
Design Freeboard 1 Last Recorded in
Observed freeboard
Sludge Survey Date
Sludge Depth ft
Liquid Trt. Zone ft
Ratio Sludge to€Treatment Volume if> 0.45 ,a
Date out of compliance/ POA?
Calibration Date
Soil Test Date �5� Crop Yield Transfer Sheets_
pH Fields Wettable Acres ✓ RAIN GAUGE
Lime Needed WUP . ✓ Dead box or incinerator
Lime Applied Weekly Freeboard Mortality Records t�
Cu -I Zn -1 1 in Inspections Check Lists
Needs !;-(—S--1 <25) 120 min Insp. Storm Water
Needs P WPathwr r'nriPc
URI W-411ne
N (lb/1 000 GOT
Pull/Field Soil Crop Acres PAN Window Max Rate Max Amt
3
Verify PHONE NUMBERS and affiliations
Date last WUP FRO FRO or Farm Records
Date last WUP at farm Lagoon #
App. Hardware: Top Dike
i Stop Pump
Start Pump
Conversion- Cu -1 3000= 108 lb/ac; Zn -I 3000= 213 lb/ac

type of Visit: &Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
teason for Visit: 0 Routine 0 Complaint Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: j Departure Time: County:Region: 505
Farm Name: ��#P� e— 11_14 1d:afl t Owner Email:
Owner Name: -Jerq Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title: 0"6-- 6 Phone:
I 11BOnsite Representative: �� � integrator:
Certified Operator: Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify D WQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
Page I of 3
❑ Yes allo [DNA ❑ NE
❑ Yes [] No
❑ Yes ❑ No
[] NA ONE
[] NA ❑ NE
❑ Yes
Design :Curt nt
❑ NA
Design
CurrenOR
t
Design Current
Swine
Capacity .e..,l'opi.
Wet Poultry
Capacity
.Pop. -
Cattle Capacity Pop.
x` Layer
-
Dai Cow
Wean to Finish
Wean to Feeder
Non -Layer
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Fes'
Design
Current -
Dry Cow
Farrow to Feeder
1]r, P,au1. ,
C+_a .aeity
P.o P.
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
tithe
i Turkey Poults
Other
JEJ
10ther
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify D WQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
Page I of 3
❑ Yes allo [DNA ❑ NE
❑ Yes [] No
❑ Yes ❑ No
[] NA ONE
[] NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑Yes
[� No
❑ NA
[] NE
❑ Yes
M -No
❑ NA
❑ NE
2/4/2011 Continujer `
AA

Facili Number: -j Date of Inspection: I TF1
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
R 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):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
RNo
❑ 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
�To
❑ NA
❑ NE
waste management or closure plan?
77��
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
[RNo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
U No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
[:]Yes
®" No
D NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[5kNo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes �No ❑ NA ❑ NE
❑ Excessive Ponding ❑Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): CA/) • h,
13. Soil Type(s):�
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes rg**No ❑ NA ❑ NE
15_ Does the receiving crop and/or land application site need improvement? ❑ Yes N^o ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes Nk-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 CR'No ❑ NA ❑ NE
❑ Yes C'No ❑ NA ❑ NE
_Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes E -No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes MNo ❑ 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. U Yes ❑ No
❑ Waste Application 0 Weekly Freeboard EKWaste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall [:]Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I " Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes CR 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 2/4/2011 Continued

Facili Number: - 3
Date of Inspection: JA VM 111 1
24, Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes k7grNo
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes f,;;j No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance: .
26. Did the facility fail provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ NA ❑ NE
❑ NA ❑ NE
ErYes
0 No
❑ NA
❑ NE
❑ Yes
❑ No
5] NA
❑ NE
❑ Yes tR No ❑ NA ❑ NE
❑ Yes N No ❑ NA ❑ NE
❑ Yes C' No ❑ NA ❑ NE
❑ Yes Q3�No ❑ NA ❑ NE
❑ Yes
[3 No
❑ NA
❑ NE
❑ Yes
[a No
❑ NA
❑ NE
❑ Yes
�g No
❑ NA
❑ NE
Comments (refer to question ff): Explain any YES answers'_ and/or,, any'additional recommendations or any other cominents. i
ti. f .
Use drawings of facility to better explain situations (use additional pages as necessary). r;
D4, Uack aa -61 ca, mom, od r LAVs)
alPr e i1 cc[ti°or, rte, o vfi t I 4(67'4ra+rr��
<< wooie s�ie �Pj
yy Pjr,,Pd0iq 7r1who-4 a- aweit
rPe�r lnab(e� Al MMS we -e'
aS� C'00 j Ob 0) sl udje -w rr
ort t�l (/\ (00 tyLj' `1/�l ru'A&I (� e,103JVS 101 4 b� e- k/ n 1/M h� ��O( w4rJ
not- cll)e_heti Ojed Ll
.9 f�
01
NOV Lir �[p�,� o � k �4bo -a., In ch of mill) -0eh I cy�;,
way,
I Co C" i8'a far Q✓Pr&Q f �/ 1 11!
� f '�' j �n r� t4'ti, (' I la �
Sir bead c , ., h0rvaW l
.�r�, PAu � bl� k Cro �� mai l�
CZDWI
so; l t 6' i cC.
[ nolo 6f, n�_ Chfod utyr CO
(t3,
(rJ,
Reviewer/Inspector Name: %flrx .. *1
Reviewer/Inspector Signature; U `1 1)Q/) V, SV] Iw'
Page 3 oj'3
Phone:
Date: la lag I It
2/41201;

Facility No.ql:� ,Farm Name Datelcl
Permit COC `� OIC_ NPDES (Rainbreaker PLAT Annual Cert Daily Pipe }
FB Dro s
Lagoon Name, S forspillway 1 2 3 4 5 6 7
Design Freeboard 1 Last Recorded in
Observed freeboard
Sludge Survey Date3)(011
Sludge Depth ft
Liquid Tit. Zone ft
Ratio Sludge to Treatment Volume if> 0.45
Date out of compliance/ POA?
Calibration Date
Ring Size (in)
-RM MGM
------
Actual Flow
Design Diam. (ft
Verity PHUNL NUMULFtS and affiliations �r
Date last WUP FRO FRO or Farm Records � ,(0 f s4 I .Sd1? l,,
Date last WUP at farm Lagoon #
App. Hardware Top Dike
Stop Pump
Start Pump
Conversion- Cu -I 3000= 108 lb/ac; Zn -I 3000= 213 lb/ac
Soil Test Date c) W
Crop Yield ��
Transfer Sheets
pH Fields So•&Otf
Wettable Acres
RAIN GAUGE
Lime Needed0�3 soe+ie-
WUP
Dead box or incinerator
Lime Applied
Weekly Freeboard
Mortality Records
Cu -I %,,, Zn -I ✓
1 in Inspections
Check Lists
Needs S (S-125)
120 min Insp.
Storm Water
Needs P
Weather Codes
Verity PHUNL NUMULFtS and affiliations �r
Date last WUP FRO FRO or Farm Records � ,(0 f s4 I .Sd1? l,,
Date last WUP at farm Lagoon #
App. Hardware Top Dike
Stop Pump
Start Pump
Conversion- Cu -I 3000= 108 lb/ac; Zn -I 3000= 213 lb/ac

r-
1
. F4S lalal
F
'Division of Water Q ality
Facility 1\'umber ®- ® Division of soil and Water Conservation
® Other Agecy
Type of Visit: (3F Compliance Inspection 0 Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: & Routine O Complaint ()Follow-up 0 Referral O Emergency Q Other Q Denied Access
Date of Visit: Arrival Time: '(apQ Departure Time: ;als i`'t County: SLrrnbf%Y)
Farm Name:C,01[P_ Ka Jfl/j 1Y1 Owner Email:
Owner Name: 3e r%y &Mel Phone:
Mailing Address:
Physical Address:
Region:
Facility Contact: M/71pf Title: ej Wr}*)l' _ Phone: W0--7 j j,)(S j
Onsite Representative: Integrator:"��
Certified Operator: �j�l'el Certification Number: a10Q30
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made'?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
e. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3_ Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes ® No ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes CZ No
❑ Yes ErNo
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
Page I of 3 2/4/2011 Continued
19506urrent ^" �
Design
Current ...
Design Current
Swinc
CapaPop. Wet Poultry
Capacity
Pop.
Cattle. ,. Capacity Pop.
Wean to Finish
I a er
Dai Cow
Wean to Feeder
Non -La er
Dai Calf
Feeder to Finish
Dai Heifer
Farrow to Wean
..
Design
Current
D Cow
Farrow to Feeder
De, , I',oult
Ca aei
Pio
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made'?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
e. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3_ Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes ® No ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes CZ No
❑ Yes ErNo
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
Page I of 3 2/4/2011 Continued

Facili Number: 5- - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
Q No
0 NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
[] No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):—
Observed Freeboard (in):�
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
® No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
[2 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
g] No
❑ NA
❑ NE
R. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
Callo
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
g] No
❑ NA
❑ NE
maintenance or improvement'?
_Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
[] Yes
® No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? if yes, check the appropriate box below.
❑ Yes
❑ No
❑ NA
®'NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): D)rtt _ heal
13. Soil Type(s):�}� / 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 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?
Rem[ uired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ Yes ® No
❑ Yes [] No
❑ Yes [] No
❑ Yes ❑ No
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement'? if yes, check the appropriate box below. ❑ Yes ❑ No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis [:]Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No
❑NA []NE
❑ NA NE
❑ NA 2] NE
❑ NA CS NE
❑ NA E2 -NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
El NA ❑ NE
Page 2 of 3 2/4/2011 Continued

Facility Number: Q -
Date of Inspection: a
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ❑ No ❑ NA ® NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑ No ❑ NA P 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 J@ NE
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:
❑ Yes ❑ No [RNA ❑ NE
❑ Yes N No ❑ NA ❑ NE
❑ Yes r5j No ❑ NA ❑ NE
❑ Yes 152 No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA [RNE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
No
❑ NA
❑ NE
33. Did the Reviewer/inspector fail to discuss review/inspection with an on-site representative? Yes
❑ No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency? ® Yes
❑ No
❑ NA
❑ NE
Use drawings of facility to better explain situations use additional pages as necessary) Y N
Comments (refer to question' # Explain. an YES answers and/or any addrttonal recommendations or..an other commen
4-e-10 o- comnmfca-h'p�s -��Ive `lie 0"e- ivaf nod- peri+ ai did trot cht� ani
farwo'k, I Jed+anode r, iS hide -4p f(a,e w(l we -(
7160ML la , cove. Pie&e- fwr►pd©wn /0 001 ire w,'iCl<
I r 0 �r0
01 Vra S- ft cvl � e.y4t�dF
h Side- of-(�eld_ h r hle__j 1, 'I'd4o Sma I yrain� fol log l� coin. Th e e�� sides
Sorbea s ham nyef - 6e., harvej�e4.
1 a� ostaak 06od b°ev M
eeyea_1�oarher a,� dln abae
m'
�Eo0k �fce rArva�r;�CsPme�,�,T s- ul?a bie 01 Flow(
1&�Sg(h�q waste-,
Amu' fr�shwa � leapt �n -vfcyl r � - ►� ho je rs h�i�i reporr��'� `a ca�rar� �a1
Qn s +e. (zvs)
l� r, b&nfj Ca Nd- back md- we. Ywc:W,Ied_ a '00/- bec a i',
�J�n • co
lnsae�a�r-e�.+� 1a�os�1�
Reviewer/inspector Name: JDQ']Sehl��� Phone:
Reviewer/Inspector Signature: Date: DeC_ -7,3011
Page 3 of 3 2/4/2017

i
Type of Visit aCompliance Inspection Q Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit 0,Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: a a Arrival Time: Departure Time: County: Sa.T S Region:
Farm Name: ` >_ i 2 Owner Email:
Owner Name: :fi��ty �4�/I�f Phone:
Mailing Address:
Physical Address:
Facility Contact: T Qi Title: d � Phone No: QQo-7
Onsite Representative:_*4-" Integrator: M -Q
Certified Operator: ff i Bt'Im Operator Certification Number: '-Y0p30 lTnVO
Backup Operator:
Back-up Certification Number:
Location of Farm: Latitude: [=O
= =" Longitude: = o = f
esignCntn
AM
m0moultir,
F-1 NE
Swis a Ca acs Pa ulatton
_pty p
❑ No
'Capacity Populahou @attle @apaty Population
❑ Wean to Finish
❑ Layer
❑ Dai Cow
❑ NA
❑ Wean to Feeder
❑ Yes
❑ Non -La er
❑ Yes
❑ Dai Calf
❑ NA
Feeder to Finish Sc
3
&No
=�„ :. x' ❑ Dai Heifer
❑ Farrow to Wean
Dry Poultry
`❑ D Cow
❑ Farrow to Feeder
_ " "'�" El Non -Dairy
❑ Farrow to Finish
❑ Layers
El Beef Stocker
Gilts
ElNon-La ers
❑ Beef Feeder
PE] Boars
El Pullets
El
ID Beef Brood Co
a
Other❑
Turkeys
Turkey Poults
❑Other
❑ 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 1 of 3
❑ Yes N No ❑ NA ❑ NE
[I Yes
El No
I--] NA
F-1 NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
N No
❑ NA
❑ NE
❑ Yes
&No
❑ NA
❑ NE
1228/04 Continued

' Facility Number: yj�— �3 Date of Inspection
❑ Yes
JRNo
❑ NA
Waste Collection & Treatment
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
JRNo
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
tS�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:
IZiNo
❑ NA
❑ NE
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?❑
Yes
MNo
❑ 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
�a No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
[:]Yes
JgNo
❑ 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
ERNo
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
I'No
❑ NA ❑ NE
maintenance/improvement?
l . is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
C'No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[:]PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window [:]Evidence of Wind Drift ❑ Application Outside
of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
JRNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
JRNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[—] Yes
EjjNo
❑ 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
IZiNo
❑ NA
❑ NE
Reviewer/Inspector Name Q s Phone: RID) 433--3 VO 333 1
ReviewertInspector Signature: %P,11. Date: 30 10
Pavo 7 of 72/2RI#4 Continued

Facility Number: a. — 3 Date of inspection Enmo
Ryauired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes U -No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CA WMP readily available? If yes, check ❑ Yes UNo ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists
❑ Design ❑Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard 19 Waste Analysis tRSoil 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 ip•No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No ESINA ❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
Plo
❑ NA
EINE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
allo
❑ NA
EINE
26.
Did the facility fail to have an actively certified operator in charge?
'Yes
❑ No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
tRNA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
152 -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
ERNo
❑ 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
UNo
❑ 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
E❑
NA
El
33.
Does facility require a follow-up visit by same agency?
❑ Yes
[�iNo
❑ NA
❑ NE
Additional: Comments and/or Drawings: T
Qv� SOmr FPM;D'1 IL 1,111 MW
P1
fJ,tei 4{0 t
CL
-eL'i� �,f+ yy,� , w; rev; �►., `-fie record; c�1a� m�4� s��-F=,e.
g�p�� efs Q coo
g, ��
L/ d 0 01
1PIe�� d� rirn�e-a,aLsorl 4�a1 Imo' a� � s�' w�S ��°l J' Q'r
��,t to
�
S �i f0)$". PPPe v1� 4 �,PC hiPf� 4
la 0 m Jnr Ins ecfijp�
� 6rc��► h0, M% LA 130
y� s p� los G�Q� a ChGr� =
�r UIQ ? �.t�J �II y!nn '.lV py �nLV� $/�'+�.1 oi �� � 0
-Ihi's I�CXI to ✓ y � lir
UVJ t Cer�lr�o* o, ro, o ct r� b� �! d ue.40 19-7.
� � ✓
„r L� a��e
r� a�r� �s�- i � N1 a� h�
I correL- os addW0767 I 17 d6 jlol tr
� ow S res aisi1l�P, ro�ac�'1' Jv,
age down V0,/
�' FvPe �'�e'
3 '� i I
: r �t
Page 3 of 3 - 1
12128104

_ �-I
Facility No. ¢'D'13i Farm Name Ce [�l Date �a{a31r�
Permit COC % OIC NPDES (Rain breaker PLAT Annual Cert)
Pop. I Design Current FB
Type Drops
Lagoon 1 2 3 4 5 6 7
Spillway
Design freeboard
Observed freeboard in
Sludge Survey Date }
Sludge Depth ft
Liquid Trt. Zone ft U,
Ratio Sludge to Treatment Volume
cabrati—on- Date
Design Flow
Actual Flow
Design Width
Soil Test Date 3.►�C�
pH Fields
Lime Needed
Lime Applied
Cu -1 Zn -I
Needs P
_.I --
Wettable Acres
WUP
Weekly Freeboard
1 in inspections
120 min Insp.
Weather Codes
Crop Yield Transfer Sheets .
Waste Analysis Date
- 60 Da
+ 60 Da
N Amt Ib/1000 Gal
H
RAIN GAUGE
Dead box or incinerator
Mortality Records
Pull/Field
Soil Crop Acres PAN Window Max Rate Max Amt
Ma, -N 0, Yr /,0
13
53 `
Verify PHONE NUMBERS and affiliations
Date last WUP FROi�fb.jQ1 Date last WUP at farm
1440�
FRO or Farm Recardsv�R�IK�
Lagoon #
Top Dike
Stop Pump
Start Pump
Conversion- Cu -1 3000= 108 Ib/ac; Zn -I 3000= 213 Ib/ac
App. Hardware
�b��i-a. � h , It70- ��Ok-•�i�

,aa
Type of Visit Gr -Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit WRoutine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: II
Arrival Time: r3 Departure Time: [400PU County:'S? , Region: FU
Farm Name: C 01 �,,_ Owner Email:
Owner Name: ��f(U T($'� _ 1 Phone:
Mailing Address:
Physical Address: q 1-T1 h&,
Facility Contact: T-er(q tote,fL Title: w Phone No:
Onsite Representative: Integrator: Ry(Vl'_Yj/0wn
Certified Operator: _j err T Operator Certification Number: A" a (o 030
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: =0 =g =46 Longitude: =o=& =
46
Design Current
Design Current
Design Current
Swine Capacity Population
Wet Poultry C+apacity Population
Cattle Capacity opulation
❑Wean to Finish
❑ La er
❑ Dairy Cow
❑ Wean to Feeder
on -Layer
❑ NA
❑ Dairy Calf
l�Feeder to Finish 5_QQ 330
❑ No
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
N:4qo
❑ Non -Dairy
❑ Farrow to Finish
❑ La ers
❑ Beef Stocker
Gilts
❑Non -La ers
❑ Beef Feeder
PE-11Boars
Pullets
❑ Pullets
El Brood Co
-
❑ Turkeys
Other
❑ TurkeyPoults
Number of Structures:
❑ Other
❑ Other
Discharp,es & 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?
0
❑ Yes 9No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
�WNo
❑ NA
❑ NE
❑ Yes
N:4qo
❑ NA
❑ NE
4
12/28/04 Continued..

-[Facility Number: a-134 Date of Inspection �[
Waste Collection & Treatment
4_ Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes t"No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes P1 No ❑ NA ❑ NE
❑ Yes f;'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 :ETNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes qNo ❑ 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
El Yes IRNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. 10 Yes ❑ No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
N1 PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside ofAcceptable
l Crop Window ❑ Evidence of Wind Drift [I Application Outside of Area
12. Crop type(s) Call , r hga 's (9 y �l S.
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
5 'No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
1No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
R No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
JKNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
E�<No
❑ NA
❑ NE
Comments�(ref
Use dr a��m Sar to yuesfion #} Explain any YES answers and/or any recommendatiods or any other comments
. S ..
g f facility to` better explain situations. (use additional pages as necessary):
ReNiewer/Inspector Nance S Phone: 80141 x 3
Reviewer/inspector Signature: Date:
12128104 Continued

Facility Number: ; a -13V Date of Inspection
Reguired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes UTNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes tj�No ❑ NA ❑ NE
the appropriate box. ❑ WUP - ❑ Checklists ❑ Design ❑ Maps ❑ Other as
21. Does record keeping need improvement? If yes, check the appropriate box below. IYes IN 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?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes
®"No
❑ NA
❑ NE
❑ Yes
❑ No
aNA
❑ NE
❑ Yes
Wo
❑ NA
❑ NE
9Yes
❑ No
❑ NA
❑ NE
❑ Yes
®No
❑ NA
❑ NE
❑ Yes Wo 95NA ❑ NE
❑ Yes RNo ❑ NA ❑ NE
❑ Yes RNo ❑ NA ❑ NE
❑ Yes t'No ❑ NA ❑ NE
❑ Yes UNo ❑ NA ❑ NE
❑ Yes
O'NO
❑ NA
❑ NE
❑ Yes
19—No
❑ NA
❑ NE
Additional Comments andlor Drawings:
11, s fy pu�rr�� �1(0� on an Cno 064-3 Jb1/acre a, &,e- al Cf L.I-e 4 m�
errorr ,
I, hip, Sar,j analy� 4� �� rProtd-s, New vi�f wrN be cvl
w
��s0
Cn A[so wa4e_s`c� /°j a -.e oVel-, r'_
h[ 0.,or 1Qble 01llhzo,
��
J �2� r
5[tdX,s;ve -%be doge- l w �vo�Jt tA: Lo, ore d ie (a 16 rod ,
S(�d—e : r�� -�rtd, fi
5 0
So ybe&,f-Fo 6e hjr"-Pj n�W-*4vr
wAe me Ch w o
L4 In D s h a r
sly a p� , ,
{p rhOW a bore -�atM nVl�vebs,'W
Add i�G+a�,1� S,nth PY1� ��od cPr `� Gu ifrc�l'�o-, I� Ikr Yrol led4 �odt .o- LT013,SO1I -A�I'§1jr i9ole In c3D0af �
Cl60A_4' S, Grov v, �ndols Jlj�ilew Cati1� *etho -
.
1 MV04

-'Facility No.$a�LFarm Name l Date
Permit ✓ COC =� OI � NPDES (Rainbreaker PLAT Annual Cert)
Pop. Design Current
Type
Lagoon 1 2 3
4 5 6 7
Spillway
Design freeboard
Observed freeboard in
ppb
Slud a Survey Date
Zn -I A
1�i11C„
Sludge Depth ft
Liquid Trt. Zone ft
Ratio Sludge to Treatment Volume
Calibration Date 1 2 3 4 5 6 7 8
Design Flow
Actual Flow
Design Width
Actual Width
Wettable Acres
WUP
Weekly Freeboard
1 in Inspections
120 min Insp.
Weather Codes
Crop Yields 1��—N/ Transfer Sheets --Vi--7+-
Waste
t
Waste Analysis Date
- 60 Da
+ 60 Da
N Amt(Ib/1000 Gal S
H
RAIN GAUGE
Dead box or incinerator
Mortality Records
•
Pull/Field Soil Crop Acres PAN Window Max Rate Max Amt
n , 3 fit n- 635-- I
Yah -, so04 v
SD
WW
Verify PHONE NUMBER and ffil�ations
Date last WUP FRO h+b 'r 1 �3�oy Date last WUP at farm
Pew -1laa loc 1 ,004 WQMw� Arry
FRO or Farm Records
Lagoon #
Top Dike
Stop Pump
Start Pump
Conversion- Cu -I 3000= 108 lb/ac; Zn -I 3000= 213 lb/ac
App. Hardware
ve.- we+ �Oumb�r�
4[i imW�'s
Soil Test Date
pH Fields
Lime Needed
Lime Applied
ppb
Cu -I
Needs P
Zn -I A
1�i11C„
Wettable Acres
WUP
Weekly Freeboard
1 in Inspections
120 min Insp.
Weather Codes
Crop Yields 1��—N/ Transfer Sheets --Vi--7+-
Waste
t
Waste Analysis Date
- 60 Da
+ 60 Da
N Amt(Ib/1000 Gal S
H
RAIN GAUGE
Dead box or incinerator
Mortality Records
•
Pull/Field Soil Crop Acres PAN Window Max Rate Max Amt
n , 3 fit n- 635-- I
Yah -, so04 v
SD
WW
Verify PHONE NUMBER and ffil�ations
Date last WUP FRO h+b 'r 1 �3�oy Date last WUP at farm
Pew -1laa loc 1 ,004 WQMw� Arry
FRO or Farm Records
Lagoon #
Top Dike
Stop Pump
Start Pump
Conversion- Cu -I 3000= 108 lb/ac; Zn -I 3000= 213 lb/ac
App. Hardware
ve.- we+ �Oumb�r�
4[i imW�'s

i
D IRs 1aI010S - -
Type of Visit Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
.\ Reason for Visit G Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: Arrival Time: �3 !p Departure Time: 3.38 County: Sola Region: FP -0
Farm Name: CQ1[Pt,f- I —6/M Owner Email:
4g - f
Owner Name: err' r?1 lxltt�el Phone: _ . �!
Mailing Address:
Physical Address:
Facility Contact: aerry karnpTitle: Phone No:
Onsite Representative:r Integrator: Mur,�hr Plop t'i
Certified Operator: [ {I kin -P,( Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: = o ❑ I ="
Longitude: = ° = I ❑
��-
Dest n Current
I
g urrent
Design Current
Swine
�" s
Capacity�Populahon
oulul, ion
Wet PI try Capac ty, '0
N
Cattle Capacity Population
to Finish
❑ La er
❑ Dai Cow
to Feeder
❑Non -La er
❑ Dai Calf
r to Finish
a 3�5=��
El Dairy Heifer
w to Wean
�.;'
❑ D Cow
w to Feeder
`-
❑ Non -Dairy
FFarrow
to Finish
a ers
❑ Beef Stocker
on -La ersPullets❑
Beef Feeder
❑ Beef Brood Co.,,4ti
❑Turke s�❑ Turke Poults
❑ Other
-M e s:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes RNo ❑ NA CINE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made? ❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWQ) ❑ Yes ❑ No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes ❑ No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes ®'No ❑ NA ❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State ❑ Yes CTNo ❑ NA ❑ NE
other than from a discharge?
Page 1 of 3 12/28104 Continued

I Facility Number: a—_ 13' 1 Date of Inspection 11,11, 109 1
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ErNo ❑ 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): let
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes tR 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 allo ❑ 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 CR" No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? []Yes
[9No
❑ 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
t'No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10_ Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
I'No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
U 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 El Application Outside of Area
12. Crop type(s) n l ��II$� . Sp TPM
LUr
---
13. Soil type(s) V-0
--
14,
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
O No
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes
CgNo
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
CR No
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes
29 No
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes
® No
❑ NA ❑ NE
Reviewer/Inspector Name I PhoneJO
Reviewer/Inspector Signature: Date: G (Q
Page 2 of 3 12128104 Continued

Facility Number: ga — 133 Date of Inspection
Reauired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes WNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 92 No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists
❑ Design El maps El Other
21. Does,Mrecord ke 'pg eed�provement? If yes, check the appropriate box below. U Yes El No El NA [:1 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
[S'No
❑ NA
EINE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
W NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
W No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
RNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
U No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
aNA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CA WMP?
❑ Yes
C'No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
C0 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
O 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
BNo
❑ 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
N No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
9No
❑ NA
❑ NE
Additional Comments and/or Drawings: _ `` ,. t
Lala wev"ele h CMq ySefj W Fh Sl°v&aIsr/�
CJ�o e' vet 3 ~ y m Wjf hs . 600d `� G 0 d a C_
IP yi[�, D� y
fi n
7. Gam (a y � � ��'JWf rIck4 a wAeksa
c6 .
I7a,
hr
ea�io be
Page 3 of 3 12/28/04

Facitity N
AWH-91 Farm N me "Ikle "� Date �o1 ��a (000
Permit r —� COC ✓ OIC NPDES (Rainbreaker PLAT Annual Cert )
-Lagoon 1 2 3 4 5 6 7
Spillway
Design freeboard
Observed freeboard in
Sludge Survey Date
Sludge Depth ft & %
Liquid Trt. Zone ft ,
tl-'11h
Calibration Date
pH Fields
Design Flow
Lime Needed
Lime Applied
Actual Flow
Cu ✓
Design . �'-------j
Needs P
Soil Test Date$
pH Fields
Max Rate Max Amt
Lime Needed
Lime Applied
Cu ✓
Zn
Needs P
: Waste Analysis Date MU
0i� —
Crop Yield
Wettable Acres
WUP
Weekly Freeboard
Rainfall >1" ✓
1 in Inspections ✓
120 min Inspections
Weather Codes
Transfer Sheets
RAIN GAUGE
Pull/Field Soil Crop
RYE PAN Window
Max Rate Max Amt
.3Y 't�4
h F� fatS
--.fit- �-
noSv
�e
Verify PHONE NUMBERS and affiliations
Date last WUP FRO Date last WUP at farm
I -CH
FRO or Farm Records
Lagoon #
Top Dike
Stop Pump
Start Pump
App. Hardware

F MT rj)n!0,)` rVj
j `V Division of Water Quality
,[Facility Number 3 y Q Division of Soil and Water Conservation
.. O Other Agency
Type of Visit Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit, Routine Q Complaint Q Follow up Q Referral Q Emergency Other ❑ Denied Access
Date of Visit: I � r _I C I Arrival Time: QIIJ Departure Time: 7V� Coun Region: � T -f-'
Farm Name: V7L Owner Email:
U z
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Phone:
Onsite Representative:
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
❑ Other
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: =' =' = Longitude: =0=' =
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
II ❑ Non -La e.
Dry Poultry
❑
Layers
❑
Non -Layers
❑ Pullets
❑
Turkeys
❑
Turkey Poults
❑ Other
Design Current
Cattle Capacity Popt Cation'
❑
Dairy Cow
❑
Dairy Calf `._.
❑ Dairy Heifer
❑ Dry Cow
❑ Non-Dairyi
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures:
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?
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 RNo ❑ NA ❑ NE
❑ Yes
❑ NoA
[INE
ElYes
ElNo ItA
❑ NE
❑ No JiNA
❑ NE
❑ Yes
❑ Yes
&o ❑ NA
❑ NE
❑ Yes
❑ No 19 NA
❑ NE
12/28/04 Continued

Faulity dumber: ;)_-0+3Date of inspection i 4
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes q, No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes 6 +No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): -}
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed ❑ Yes 9No ❑ 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? ❑ Yeso ElNA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ElYes No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ❑ No ❑ NA NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ❑ No ❑ NANE
maintenance/improvement?
IN
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NANE
El Excessive Ponding El Hydraulic Overload El Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.) �`
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ No
❑ NA
J[NC�JE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
'kNo
❑ No
❑ NA
_ iE
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
❑ NA
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):
�oo cove.,,' anr�,�r,.�.lc�
Reviewer/Inspector Name (L IVj k /ON Phone: I //I
ReviewerAnspector Signature: Date: in
12/18/04
Continued

Facility Number: —0: Date of inspection
Re uired Records & Documents 1�,,
19. Did the facility fail to have Certificate of Coverage & Permit readily available? El Yes El No [3 NA JAI NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ❑ No ❑ NAE
the appropriate box. � `"'
E3WUP El Checklists El Design El Maps ❑Other ,],.,
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No C3 NA �tE
❑ 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
ZNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
❑ NA'
N -E
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
[:1 Yes
[I No
El NA
� `AVE
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?
[j Yes
[:1 No
El�1NA
�TiE1
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ NA
NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
❑ No
❑ NA
Q NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
❑ No
❑ NA_
1�3 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
ANo
❑ 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
❑ NAE
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
RNE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
❑ No
❑ NALiE
Additional Comments and/or Drawings: f:
Page 3 of 3 12128104

Type of Visit frCo liance 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:j� `_ 1p Arrival Time: ; Ip m y
Departure Time: Count
Farm Name: lou I:bx m Owner Email:
Owner Name: C��j ,Phone:
Mailing Address: i_ l J �t1 � l `�SOOCiy
Physical Address:
Facility Contact: RTitle:
Onsite Representative:
Certified Operator:
Back-up Operator:
Phone No: l
Integrator: _Pr em !-1T a
Operator Certification Number:
Back-up Certification Number:
Region:
Location of Farm: Latitude: =0
='
061 Longitude: ° Q =
SV_ M'0 Eaj�* 66
❑
cj
I
❑ NE
Y "Desigurrent Desigp Current Design Current
Swine
Capacty�Popu tmnT
Wet Poultry
C*ap�acity Popu non Cattle Capacity Population
❑ Wean to FinishEl
Wean to Feeder
❑ NE
❑ Layer
Non -Layer
[] Dai Cow
Dairy
Feeder to Finish
0
d
El Dairy Heifer
El Farrow to Wean
Dry Poultryh
M ElD Cow
El Farrow to Feeder
,�:.:=
;_ Non -Dairy
❑ Layers
❑ Farrow to Finish
El Beef Stocker
❑ Gilts
ElNon-Layers
El Beef Feeder
❑ Boars
❑ Pullets
E] Beef Brood Co wl I
_ r� �x �, d•
El Turkeys
�:�
❑Other
❑ Turke Poults
❑ Other
Number of Structures:
❑
cj
❑ No OTA
❑ NE
Calf
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: [j Structure El Application Field El Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
e. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page 1 of 3
❑ Yes )ifj4o ❑ NA ❑ NE
❑ Yes
❑ No OTA
❑ NE
❑ Yes
❑ No 'JI�NA
❑ NE
❑ No JNJ NA
❑ NE
❑ Yes
❑ Yes
11�'No ❑ NA
❑ NE
❑ Yes
WNo ❑ NA
❑ NE
12/28104 Continued

Fpcitity Number: % Date of inspection t 1
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes RNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No SNA ❑ 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 VNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed ❑ Yes Wo ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes Wo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes 9 eNo ❑ 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 Vo ❑ 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?
]L . Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 1,0o ❑ 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) C:pr n -
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
t%No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
IgNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
V No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
PkNo
❑ NA
EINE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
KNo
❑ NA
❑ NE
,
Comments (refer toFquestion #): Explain any YESj'answers and/or any recommendations or any�other comments.
Use drawings of facil#y:'to better explain situations. {use aiEdthona! pages as.necessary): ,
AL
Reviewer/Inspector Name t !
�N'tV
] Phone: IO 3 33,00
Reviewer/Inspector Signature:
Date: Nth ✓ 02
Page 2 of j
IZ/2&V4 Con#nuea

Facility Number: — i3 Date of Inspection I llld►f�g�
Required _Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes XNo ❑ 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 El Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [P(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 KNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes Wo ❑ NA ❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes ❑ No
❑ NA 'KNE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes 'KNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes ❑ No
❑ NA
�9NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes )UNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes . MVo
❑ 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 �ONo
❑ 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 JdNo
❑ 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 UNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes 5jNo
❑ NA
❑ NE
Additional Comments and/or Drawings:
co
AID
IkQQVS n� moeo c4
Qvcr 'e fe.amtl <;� mi,`��
Page 3 of 3 12128/04

"Fatility-'No. &� ^ 1 3 Time In I .1( Time Out Date
Farm Namecioltotm1:U,VJ �rm Integrator
Owner 7a YtlitgJ� - d. Site Rep
rro�
Operator �' No. O 3o
Back-up
COC
Circle: General
or
No.
PDE
Design Current
Design Current
Wean — Feed
Farrow — Feed
Wean — Finish
Farrow — Finish
Feed — Finish
Gilts I Boars
Farrow — Wean
Others
FREEBOARD:., Design ` I Observed 3 -
Sludge Surveyv i a,Calibratio
nlGPM
Crop Yield
Rain Gauge
Soil Test
Weekly Freeboard
Spray/Freeboard Drop
Weather Codes
Waste Transfers
Rain Breaker
PLAT �� ?? Wettable Acres
Daily Rainfall 1 -in Inspections
120 min InspeNons
Waste Analysis:
Date Nitrogen (N)
Date Nitrogen (N)
Pull/Field Soil Crop Pan Window
Vk
v V�

- 10 Division of Water Quality
FactLty'Namber $a I /,3 O Division of Soil and Water Conservation
tom, �tt J O Other Agency tS
Type of Visit * Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: S '8 O Arrival Time: ,3 ;Os �., Departure Time: County: Region:
Farm Name: //e aP F!/no/ firrrn Owner Email:
Owner Name: Teri A.r Phone: /0- -
Mailing Address: 4/S 40 %�,�� 1/6,
Physical Address:
Facility Contact: 1r��., Qar_�rs_.,. Title: Phone No: tell/)-
Onsite Representative: leret, Ale, 4 ej Integrator:
Certified Operator: aCjC,;g 46 ar Operator Certification Number:
Back-up Operator:
Back-up Certification lumber:
Location of Farm: Latitude: [=O ='
= Longitude: =0=g
0=g = f4
Design Current Design Current
Swine Capacity Population Wet Poultry. Capacity Population Cattle
❑ Wean to Finish
❑ Wean to Feeder
['Feeder to Finish 3 -12 o f 020
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
❑ Laver
❑ Non -La et
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ElStructure ElApplication Field ElOther
a. Was the conveyance man-made?
❑ Dairy Cow
❑ Dairy Calf
❑ Daia Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
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)?
Design Current
Capacity Population
Number of Structures: E'
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 NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
El -Ko
❑ NA
❑ NE
❑ Yes
El- o
❑ NA
❑ NE
12/28/04 Continued

Facility Number: t3 13 Lt Date of Inspection ®o
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes M -<o ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No Cl NA ❑ NE
Structure 1', Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
9. Does any part of the waste management system other than the waste structures require ❑ Yes
Spillway?: 170
❑ NA ❑ NE
maintenance or improvement?
Designed Freeboard (in): �I
Waste Application
Observed Freeboard (in):
�o
❑ NA ❑ NE
maintenance/improvement?
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes 04qo
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
❑ PAN ❑ PAN > 10% or l 0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
6. Are there structures on-site which are not properly addressed and/or managed
❑ Yes e'17b
❑ NA
❑ NE
through a waste management or closure plan?
/
12. Crop type(s)
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 91Qo
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
[a -go
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes
21 leo
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
�o
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
E No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l 0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
j/'7 yo / k 4/2
/
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
M -No
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes
Q<o
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination: ❑ Yes
❑ No
❑ NA C E
17. Does the facility lack adequate acreage for land application? ❑ Yes
❑ No
❑ NA DII E
18. Is there a lack of properly operating waste application equipment? ❑ Yes
❑'go
❑ NA ❑ NE
A4B613e mde -swe 4/1 ��� &.v,41,e cvv«�� I7 G�!r/ e" 7' u.4
g % ct sle ��ra/yss
Reviewer/Inspector Name IM ( 1 M Q I Phone: CPO- Yom-/S*1 eo' 7 -?o
Reviewer/Inspector Signature: Date: „L'T-OL
12/28/04 Continued

Facility Number: > — /3y Date of Inspection S 9 0
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes P'Ko ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check esK o
the appropirate box. T -1 ❑ NA ❑ NE
❑ %}cel' ❑ Chec ,ts ❑ ❑ O�
21. Does record keeping need improvement? If yes, check the appropriate box below. R- es ❑ No ❑ NA ❑ NE
-3it—Iv —)
❑ Elelel - erl d El❑ SoilIcmlysis ❑ Wa t 4ers 91Gnual Certification
❑ Wil}- ❑-Shing [-mop Yield ❑ i s ❑ ❑ We Aiei E✓ode-
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Otherissues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern'?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge. Freeboard problems. over application)
32. Did Reviewer/inspector fail to discuss review/inspection with an on-site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes
D o
❑ NA
❑ NE
❑ Yes
❑�o
❑ NA
❑ NE
❑ Yes
[;�do
❑ NA
❑ NE
❑ Yes
El-Cfo
❑ NA
❑ NE
❑ Yes
�o
❑ NA
❑ NE
❑ Yes ❑ No ❑ NA D<E
❑ Yes M -No ❑ NA ❑ NE
❑ Yes ❑•N'o ❑ NA ❑ NE
❑ Yes D-lgo ❑ NA ❑ NE
❑ Yes [1lo ❑ NA ❑ NE
❑ Yes Pio ❑ NA ❑ NE
❑ Yes Q -K ❑ NA ❑ NE
Additi6nal Comments and/or Drawings:
a5�
G n c
Ord.,
•
w5E rho, a Ca��.
Go
/1na q
l Pl e° ds e
C o,►,� le �e
Gn /�nn v,ce l C e � �; �'
Iwo
fir
CL
S��7T
.ZAs�ec co//
P Inas a
vse n
e-1 anr./ .PAR_ -
l�or� s,
Please
kee a
crop y,' 1d S rrn
12/28/04

Type of Visit Q Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit O Routine Q Complaint Q Follow up O Emergency Notification Q Other ❑ Denied Amess
Facility Number
.gam Irate of Visit: Time: 7.S
rO Not Operational 0 Below Threshold
UPerrnitted ©'Certified © Conditionally Certified 0 Registered Date Last Operated or Above Threshold: ..... __..
Farm Name: Lv l�P� �" �� County:
Owner Name: TCr ! .y.......... �4 nn..g s..... - Phone No: - 1.1�...:�.. tG.�..-... ' ....._ ......... .
Vlsililtlg Address:..__ y�......... Hr.. t�.&4!3� .......... !?,i ��.! . .. 8 ... _...._...
Facility Contact:... . 3!! s..._....?!�!2<�.. Title. -- Phone No:
Onsite Representative: r �� �.�
p ................_.�._ � ......_... � ��---------._........._.... Integrator•. , Pi"t!r? ,, v"'! _...:?�f1.4//...
Certified Operator:. _J C/'/' - -- — c� ! rr a Operator Certification Number:
Location of Farm:
I tK► ne ❑ Poultry ❑ Cattle ❑ horse Latitude Longitude �• �� ���
=Design r=Current =Design
Swine Ca as .Po' rilahon ,Poultry=Cavaeity
Wean to Feeder
ID,F&eAer to Finish 3S;z© s �o
El Farrow to Wean
Farrow to Feeder
El Farrow to Finish
Gilts
Boars
Ions ,
Dischames & Stream Impacts
1. Is any discharge observed from any part of the operation?
Curr=i
3 Cattle = Capaaty_-Popiul- tioa:-'.
1 11 l7airy
❑ Non -Dairy
C E-
aln
.- r
Total:Design'. CaSCr
]ty r
Total SSL - -
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. if discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gallrnin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
❑ Yes L4Wo
❑ Yes G14o
❑ Yes Q -Ko
❑ Yes EIM
2- Is there evidence of past discharge from any part of the operation? ❑ Yes ®moo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes E; PXo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Identifier:
Freeboard (incites)
12112103
Structure 1 Structure 2 Structure ; Structure 4 Structure 5
1 to
❑ Yes 2'No
Structure 6
......... ... .......................................•-.._...............-----......................................-----............... _..................... ..... ...............................
Continued

Facility Number: �,j —1311
Date of inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes jests
seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a waste management or ❑ Yes E44Go
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenancelimprovement? ❑ Yes 9 -Na
8. Does any part of the waste management system other than waste structures require maintenanceTmprovement? ❑ Yes E1140
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes [}•iso
elevation markings?
Waste AoDlication
10. Are there any buffers that need maintenance/unprovement? ❑ YesED-No
11. Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes &do
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type Gore tvAeW Sa .. b
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWIvIP)? ❑ Yes P40
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 [-No
❑ Yes [gNb
❑ Yes 19 -No
❑ Yes [}No
❑ Yes EI•No
f r/111�
❑ Yes [9-N-0
❑ Yes GKO
❑ Yes E.No
:Commestts'(referto - _ w
gnrsbon #)Explain any�YFS'answers and/or any recommeadatio� or any other canuacafs.: ;
xUse drawuigs oi'r�ty tu;�better,ezplasn sttnattons {� sdthaanal pages as aecessaryi Q.l~ieid Copy ❑ F nal Nates � � �;-
x
Reviewer/Inspector Name__r
Reviewer/Inspector Signature: %I1�,i( 6 •. - Date: (o —2;?
12/12103 Continued

Facility Number: 1�1 —13 1/ Date of Inspection
Required Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/,WUP, is , jesign,XLaps, etc.)
23. Does record keeping need improvement? I�yes, check the appropriate box below.
❑ W mr�atien ['Freeboard © Waste Analysis ❑ Sog-Stunplisg-
G> Li 4-, 3 0 1, g
24. Is aczlity not in compliance with any applicable setback criteria in effect at the time of design?
25. Did the facility fail to have a actively certified operator in charge?
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/�ischarge, , p*u-appHcZon)
27. Did Reviewer/Inspector fail to discuss review/inspection with on-site representative?
28. Does facility require a follow-up visit by same agency?
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
32. Did the facility fail to install and maintain a rain gauge?
33. Did the facility fail to conduct an annual sludge survey?
34. Did the facility fail to calibrate waste application equipment?
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below
A
❑Zte� 0 Crop Yield Form ❑4hffiAe4 [.Inspection After V Rain
[j3/120 Minute Inspections ❑
e/013
110,
L es UNo
❑ Yes 9 -No
aY'es ❑ No
❑ Yes OJ No
❑ Yes [a -N -o"
❑ Yes sl o
❑ Yes llWo
❑ Yes E o
❑ Yes 9 -Ko
(9 -fes ❑ No
❑ Yes To
❑ Yes BITo
❑ Yes U"40
❑ Yes 9'Tqo_
04e's ❑ No
113 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
ddivonal Catiitnents wor DImes:
Aev;ec.,[d PDE -5 aiaroveCcm Fo, cdr crtc4,o*,W�
a
/%�Cr9r[I �C[P "'� • Re„'ew ea( bv"6a I�✓cEsTG gau/yS+S S G,„P%!
eVa��,
60 da/3 Je(-Ure ecnF/es- wase �Pi 4'" -a,�. Please he sa.,P/rs
mere o Rm
3� RCvrislve Groro `f'�`Glar r1�►sai
1 >�n nvfe
J Geral � �O
eu� I')OfG 12 C7/ r f
M'kM0TG /1 171
-+qLr 211
Please keep wasle G%00.1itu CL"rO'A
P prl 0111u rtn Pecdr�s�
12112103

Site Requires Immediate Attention:
Facility No. -R; - t
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: 1945
Time: la.: 1-7
Farm Name/Owner: rrA ---to
=Mailing Address:_ a` o q 1rc� ^t�tC
'County: 60 r" Ink"LhOr,
Integrator: Phone:
`On Site Representative: kk,..w A "06sef a -'ON Fm,tai, Phon
Physical Address/Location:_R ! _ l.Sr'.;Les F=" 1
Type of Operation: Swine X Poultry Cattle
Design Capacity: Number of Animals on Site: 35ap
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: _° ' Com" Longitude: , 4
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) YA�Qpr No Actual Freeboard:_? Ft. Inches
Was any seepage observed from the lagoon(s)? Yes or ii�Was any erosion observed? Yes oras
Is adequate land available for spray? Yes or No Is the cover crop adequate? Yes or No k4l-%
Crop(s) being utilized:
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings? YkPor No
100 Feet from Wells? �i 9 or No
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 was ro� `
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)? Yes or No t­� s we l t -&-1., Q,, %, \,,- ,,-
Additional Comments:
r. si'er_%A09.i
T:s wnbC�%_ _ "Asp="2z. mai\t koe mt-c t ftE8
.. /'Na
" Le'ron)
C,,,s fir\
'L' I p" ..Jtt'env. '
Inspector Name -DE^� t;_j4k�►•Ik i?q�m mnl o 0_%c Signature
So, i c_ 114 wncl.av:a 1310.
["-a_Y eLte,,: if a NC 28301
cc: Facility Assessment Unit Use Attachments if Needed.
04