820142_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental Qual
II

Q rks IG�--(YL I BL)
Type of Visit: er7outine
iance Inspection O Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit; O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: ( Departure Time: County; Region
?�
Farm Name: `1412ftOwner Email:
Owner Name: �� Phone:
Mailing Address:
Physical Address:
Facility Contact: t j`GZ} Title: T Phone:
Onsite Representative: Integrator: ! i 1 15
Certified Operator:
Sack -up Operator:
Certification Number: (f 0
Certification Number:
Location of Farm: Latitude: Longitude:
Swine
,
U,Dsin CurrentDp
pacity Pop
ft
g tyC Trent
Wet Poultry <<r Ca act Fop.
ix -
Design Current
Cattle C+apacity Pop.
❑ Yes
[3<o
Wean to Finish
❑ NE
La er
Dai Cow
❑ NA
Wean to Feeder
r
Non -La er
Dai Calf
Feeder to Finish
Farrow to Wean
Farrow to Feeder
:'^ 1 = -i'
r r* Design" Current
D I;oetlt Ca acx _Po
Dai Heifer
D Cow
Non -Da'
to Finish
Layers
Beef Stocker
lts
Non -Layers
Beef Feeder
ars
Pullets
Beef Brood Cow
kFarrow
.`-
Turkeys
Turke Poultsher
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 ®"1 a�❑ NA ❑ NE
D Yes [:]No
❑ Yes ❑ No
Com'❑NE
❑ NE
❑ Yes
❑ No
Eg A
❑ NE
❑ Yes
[3<o
❑ NA
❑ NE
❑ Yes
e No
❑ NA
❑ NE
Page I of 3 214/2011 Continued

1Facili Number: - Date of Inspection:
:Waste Collection & Treatment
. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 0Wo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No L -1!d7'c- ❑ NE
Structure 1 Stricture 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?
(i.e., large trees, severe erosion, seepage, etc.)
Structure 5 Structure 6
❑ Yes E?[ -Ko ❑ NA ❑ NE
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
'l_ llo
❑ 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
®'1�Io
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
Io
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
�No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
Gil -<o
❑ NA
❑ NE
maintenance or improvement?
I. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ❑ 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): ry u"'.Ll cS (7 O
13, Soil Type(s): _ 9 _
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes EP o ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes []jw1 o ❑ NA 0 NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes L 2,Ko ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application? ❑ Yes ❑.iQo ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? [:)Yes Mo ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes [;K4o ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [21% ❑ 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 [:gKo
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? [:]Yes J�rNo
23_ If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes G2(No
❑ NA 0 NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 2/4/2011 Continued

Facili Number: Date of Ins ection:
❑ Yes [!!r No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
4. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
�o
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
[;g -Ko"'
❑ NA ❑ NE
the appropriate box(es) below.
❑ Yes [e N6 ❑ NA ❑ NE
® Application Field ❑ Lagoon/Storage Pond ❑ Other:
Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Yes �o ❑ NA ❑ NE
Non-compliant sludge levels in any lagoon
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?
List structure(s) and date of first survey indicating non-compliance:
Comments (refer.•to.•question #): Explain any YES answers and/or any additional recommendations or-anyother.•comments:
Use drawings of. facility to better explain situations (use additional pages as necessary).
26. Did the facility fail to provide documentation of an actively certified operator in charge?
❑ Yes
[ J 1"�
❑ NA [:]NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
VNo
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes [!!r 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 �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 [ o ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes [e N6 ❑ NA ❑ NE
® Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes �o ❑ 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 HYN-o ❑ NA ❑ NE
Comments (refer.•to.•question #): Explain any YES answers and/or any additional recommendations or-anyother.•comments:
Use drawings of. facility to better explain situations (use additional pages as necessary).
C44-Ut
fi CZ
4
t• 0(�7
Reviewer/Inspector Name: { � 1&0 Phdrisq1 3 31 It
c
Reviewer/Inspector Signature: Date:,
Page 3 of 3 2/412011

I
- - $ IMS 4AfI1 i i/ �
' ivision of i' .8 QResonrces
Facility Number Z - N Z 0* Division of Soi! and Water Gonservatioa
MOther Agency
Type of Visit: ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: (2M&utine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: , I #p Arrival Time: %�� Departure Time: l County: So
Farm Name: _ Ni Ie- TI li IyLLU*S ei^y Owner Email:
Owner Name: 3acrtl r S 1`644 40P e Phone:
Mailing Address:
Physical Address:
Facility Contact: ['tom J.1`S �u,Nvic.�t Title: Phone:
Onsite Representative: ' t Integrator: --5
Certified Operator: Av pt
Back-up Operator: bor.
Location of Farm:
Latitude:
Region: j' I�
Certification Number: 1 C'R"D
Certification Number: 7 C 9 04P
Longitude:
Design Current
❑ No
Design
Current
Design Gurrent
Swine C>apacity Pop..:
Wet Poultry
Capacity
Pop.
Cattle Gagacity Pog.
Wean to Finish
Layer
Dai Cow
Wean to Feeder oo
Non -La er
Dai Calf
Feeder to Finish
Dai Heifer
Farrow to Wean
Design
Current
D Cow
Farrow to Feeder
D , P,oul
Ga .aci
P,o .
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 DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes 0'�io ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes
❑ No
❑ Yes
Q o
[:]Yes
CfNo
Q -NA ❑ NE
[ A [] NE
DIN
0 N
❑ NA
❑ NE
❑ NA
❑ NE
Page I of 3 21412015 Continued

[Facility Number: Date of Inspection: A
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
ED"'NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): %-7
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[�TO
❑ 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
[2190
❑ 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
�o
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[Z"No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
[] Yes
EJ -90
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
�o
❑ 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 ED Application Outside of Approved Area
12. Crop Type(s): i Vel e& -1 G
13. Soil Type(s): 1\1 0
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [rNo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ffNo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes (5—No ❑ NA ❑ NE
acres determination?
IT Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
ReQuired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑ Yes [D No
❑ Yes [f No
❑ Yes [H f o
[-]Yes [3 No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. [:]Yes Q No ❑ NA ❑ NE
❑ Waste Application D 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 WNo [:INA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [2"No ❑ NA ❑ NE
Page 2 of 3 2/4/2011 Continued

Facili Number: Lj= jDate of Inspection: &LS flon I &'
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes E3No
25. � the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes 01140
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 fust survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes ❑'iso
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes 0 o
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, aver -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?
Cul ; 6'w+1 o� — (�_ � I — i b
91,41,e_�vufy l7--)-1- r7
e�e.q a[0 - 3t,&- G bis I
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
❑ NA ❑ NE
DNA ❑NE
❑ NA ❑ NE
❑NA ❑NE
❑ Yes [T No ❑ NA ❑ NE
❑ Yes E N_o ❑ NA ❑ NE
❑ Yes Cj- o ❑ NA ❑ NE
❑ Yes Vo ❑ NA ❑ NE
❑ Yes
❑moo
❑ NA
❑ NE
❑ Yes
[]'No
❑ NA
❑ NE
❑ Yes
[31No
❑ NA
❑ NE
Phone:333�_
}&O
Date: 9-S Jl
21412015

ivisio' of ate Resources
Division of soil and Water Conservation
� Other Agency - _
Type of Visit: Compliance Inspection 0 Operation Review O Structure Evaluation Q Technical Assistance
Reason for Visit: Q'Routine Q Complaint Q Follow-up 0 Referral O Emergency O Other O Denied Access
Date of Visit: / Arrival Time:
�_- t7 '
bl
Departure Time: County:
�'' I AFDesign Current
Cattle = Capacity Pop.
airy Cow
Farm Name: j{ Hp'ac Ajptlm
goo /1D
Owner Email:
airy Calf
Owner Name: Ob c, P"e
Phone:
Dai Heifer
Mailing Address:
Physical Address:
Facility Contact: Title: Phone:
6 Onsite Representative: it -Integrator: 1 �fjr
Certified Operator: CIA r ffdoc Certification Number:
41
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Region-2rzo
Swine
Wean to Finish
Design Current
Capacity Pop.
NJ
D>nCui=renk
Wet PoultryCap.acity Pop.
Layer
�'' I AFDesign Current
Cattle = Capacity Pop.
airy Cow
Wean to Feeder
goo /1D
I JNon-Layer
airy Calf
Feeder to Finish
���"'.
Dai Heifer
Farrow to WeanDesign�C-trent
D Cow
Farrow to Feeder
Dry P,ouIt Ca act . Pa
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turke s...
Other
Turke Poults
r,
Other
Other
t
Discharmes and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge? -
❑ Yes �)o ❑ NA ❑ NE
❑ Yes [-]No �A ❑ NE
❑ Yes ❑ No [11 -NA ❑ NE
❑ Yes ❑ No
❑ Yes ff No
❑ Yes E!(No
dNA
❑ NE
❑NA
❑NE
❑ NA
❑ NE
Page 1 of 3 2/4/2015 Continued

Facili Number; jDate of Inspection: En
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
Structure 1 Structure 2 Structure 3
LJ 1"° ❑ NA ❑ NE
[:]No Cg -*A ❑ NE
Structure 4 Structure 5 Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed?
(i -e., large trees, severe erosion, seepage, etc.)
❑ Yes [ r No ❑ NA ❑ NE
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
[;?<o
0 NA
❑ NE
waste management or closure plan?
❑ Yes
['Flo
❑ NA
❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
C!fNo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[[!fNo
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
9. Does any part of the waste management system other than the waste structures require
❑ Yes
VrNo
❑ NA
❑ NE
maintenance or improvement?
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
E5No
❑ NA
❑ NE
maintenance or improvement?
❑ NA
❑ NE
the appropriate box.
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). N
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
Vno
❑ NA
❑ NE
I5. Does the receiving crop and/or land application site need improvement?
❑ Yes
['Flo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
L to
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[; 3 o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
2<o
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
ER -<o
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[;;.No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps p Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. [] Yes [TNo
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes o
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No
E] NA []NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 2/4/2015 Continued

Facility Number: jDateof Inspection: a IV
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes B - 5o ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ® Yes I�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 Eq�<o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [; 'l o ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes E7rNo ❑ 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 IJ °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 []'Ivo
❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes [ "No
❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes [TN
❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes dNo
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes LJ No
❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
Cot, (A 40--, r— I- I- C 6
5?r- - 6 -p - `� � o
- -
t asr
Reviewer/Inspector Name: ` 1AA
-
Phone: Ova
Ir
I
Reviewer/Inspector Signature:
Date:
kA( l
Page 3 of 3
2/4/2015

Type of Visit: (OrCompliance Inspection O Operation Review 0 Structure Evaluation 0 Technical Assistance I
Reason for Visit: Qdoutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: tr ad Departure Time: % County: sy Region: f�m
Farm Name: i L Owner Email:
Owner Name: �'Qw� �S•` ua�C Phone:
Mailing Address:
Physical Address:
Facility Contact: S T4Z a .. t�, Title:
Onsite Representative:
Certified Operator: f k.&
Back-up Operator:
Phone:
Integrator:
Certification Number:
Certification Number:
Location of Farm: Latitude: Longitude:
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes lo_ ❑ NA ❑ NE
[:]Yes ❑No e"NA ❑ NE
[:]Yes ❑No [] NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes ❑ No [30"NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? [:]Yes [2'3Vo ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters [:]Yes ZNo ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 214/2011 Continued
Cu rent
Design Current
Design C�ffi_re.nt
Capacity Pop.y
Wet Poultry
Capacity
Pap.
Cattle Capacity
7FEedDesign
inish
Layer
Dai Cow
eeder
�j
Non -La er
Dai Calf
erFinish
" -
Dairy Heifer
w to Wean
Design
Cure_ nt
- ' Cow
w to Feeder
D . P,oult .
Ca achy
Rap.
Non -Dairy
w to Finish
Layers
Beef Stocker
Non -Layers
Beef Feeder
!Boars
Pullets
Turke s
Beef Brood Cow
Turke Poults
Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes lo_ ❑ NA ❑ NE
[:]Yes ❑No e"NA ❑ NE
[:]Yes ❑No [] NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes ❑ No [30"NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? [:]Yes [2'3Vo ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters [:]Yes ZNo ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 214/2011 Continued

Eacili Number: - Date of Inspection': ,pto 2�fi
Waste Collection & Treatment
4, Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes t9-VV ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? [:]Yes ❑ No ErA ❑ 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
[jj4o
❑ 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
[�34o
❑ 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
EgKo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
ERI<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
ga'No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
EffoRo
❑ 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): S6-0
13. Soil Type(s): 0
14. Do the receiving crops differ from those designated in the CAWMP? D Yes dNo ❑ 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? ❑ Yes Eff"No ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? [:]Yes dNo ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes [�No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [?No ❑ NA ❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes dNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? [—]Yes ZNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes UfNo ❑ NA ❑ NE
Page 2 of 3 214/1014 Continued

Faiili Number: &jj - Ig jDate of Inspection: ('
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [ZL>Ta ❑ NA ❑ NE
25. is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [Z�M�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 Ievels 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 L244o ❑ NA FINE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes L�r&o ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern? [:]Yes LNo ❑ 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 ffNo ❑ 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 [�f'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 leNo ❑ 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 [XNo ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comment
Use drawings of facility to better explain situations (use: additional pages as necessary)- -
C-� j J, f ,�.� - a_ ! f-
0
Reviewer/Inspector Name:
Reviewer/Inspector Signature: IG
Page 3 of 3
Phone: • 3
Y309 -
Date:
2/4/201

N YA5 � �- k4'_ 15 e
Date of Visit: 1120c Arrival Time: 5 Departure Time: County:
Farm Name: �( t dV(Pvrnl Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: CL4. �j f 6t4l-W GXTitle:
Onsite Representative:
Certified Operator: t R L , _
Back-up Operator:
Location of Farm:
Phone:
Region:FR-�)
Integrator:
Certification Number: 9�p
Certification Number:
Latitude: Longitude:
aDesign Current
Swine Capacity Pop.
Wean to Finish
Wet Ponl#ry-
a er
Design
.Capacity
CurrentDesign
Pop.
Current
Cattle Capacity Pop.
Dairy Cow
Wean to Feeder
Non -La er
D . P,oul
I
�. "'
=Design
Ca aci
Current
P,o ,
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Layers
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
I jBeef Stocker
Gilts
Non -Layers.
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
Beef Feeder
Boars
Pullets
d. Does the discharge bypass the waste management system? (if yes, notify DWR)
Beef Brood Cow
rte`
Other ".,
Other
Turkeys
Turke Poults
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
_
Other
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
Q No
❑ NA
❑ NE
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
�10
E]NA
E]NE
Discharge originated at: ElStructure ElApplication Field ❑Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
E'PA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
❑ No
[3-TrA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (if yes, notify DWR)
❑ Yes
[] No
NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
D 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 2/4/2014 Continued

Facility Number: jDate of Inspection:
-51
[�o
❑ NA
❑ NE
Waste Collection & Treatment
❑ Yes
[q No
❑ NA
❑ NE
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
B -N -o
❑ NA
❑ NE
r a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
[3 -N -A-
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
❑ NA
Identifier:
the appropriate box.
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[E 'No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
[3'1\lo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[;]-No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
[T No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
31 _o
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [3"No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes E3 -M ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [-1 o ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable [] Yes [g'IQb ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[�o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[q No
❑ NA
❑ NE
Required Records & Documents
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
❑ Sludge Survey
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
®-11-o
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
O�No
❑ NA
[] NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
[:]Yes
[]'�lo
❑ 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
./ No
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
[]Yes
E3"No
❑ NA ❑ NE
Page 2 of 3 2/4/2014 Continued

Facility Number: Date of Inspection:
24. Did tho facility fail to calibrate waste application equipment as required by the permit? ❑ Yeses ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yest❑-hl0 ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey [:]Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes �o ❑ NA 0 NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes Quo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes E3roNo ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative? ❑ Yes C3114o ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes [3"No ❑ NA ❑ NE
Commentsfrefer to
Use drawings of facility toon #): Explain any YESanswers and/or any aditional better explain situations (use additional pages as necessary). recommendations or any other!.'"
❑ Yes �lo^ ❑ NA 0 NE
❑ Yes [3<o ❑ NA ❑ NE
❑ Yes [3<6 ❑ NA ❑ NE
[:]Yes [ErRo ❑ NA ❑ NE
CAkk f'a 4"'- 1 �
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Page 3 of 3
0-4"T P-318
q d ?o
Phone: LA
_ 3 _�J
Date:
21412011

Date of Visit:—/LL� / Arrival Time: Departure Time:' ; vc`� County Region:
Farm Name: llllr­. Owner Email:
Owner Name: /VD)i Phone:
Mailing Address:
Physical Address:
Facility Contact:s _�d�rv; Title:
Phone:
Onsite Representative: j'M .y Integrator: ✓ ttllL�
Certified Operator: ZgLeL /1'e- Certification Number: l
Back-up Operator:
Location of Farm:
Certification Number:
Latitude: Longitude:
Destgn
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 R_No ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes [:]No
[] Yes Fal
[:]Yes Da_No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
�] NA ❑ NE
[DNA ❑ NE
Page 1 of 3 214/2011 Continued
lit V74 rretit. Design Current
Swine Ca" aci Po Wet Poult act CasPo Cattle Capacity Pop.
Pah' P•
Wean to Finish La er Dairy Cow
Wean to Feeder, Non -Layer Dairy Calf
Feeder to Finish vg „: Dairy Heifer
Farrow to Wean Design Current D Cow
Farrow to Feeder Dr. Poult , Ga act 1'a Non -Dairy
Farrow to Finish Layers Beef Stocker
Gilts Non -Layers Beef Feeder
Boars Pullets Beef Brood Cow
- Turkeys
Other Turkey Poults
OtherI 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 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 R_No ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes [:]No
[] Yes Fal
[:]Yes Da_No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
�] NA ❑ NE
[DNA ❑ NE
Page 1 of 3 214/2011 Continued

FaciliNumber: 4f - /< Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ® No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): 10,
Observed Freeboard (in): 31-
❑ Yes
Co No
❑ NA
❑ NE
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[5allo
❑ 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
ZjNo
❑ NA
❑ NE
waste management or closure plan?
❑ Yes
EA 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
ELNo
0 NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
R No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
® No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
® No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [:]Yes S_No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): &,"
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? [:]Yes ®No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes IM No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes ® No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
Co No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
Mf No
❑ NA
0 NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
N No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check
❑ Yes
EA 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 Eg 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 rainbrcakers on irrigation equipment? ❑ Yes No
0 N ❑NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑NA ❑NE
Page 2 of 3 2/4/2011 Continued

Facili Number: - t Date of Inspection: — /
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes LK No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes MA 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 fust survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes ® No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [,No
Other Issues
2$. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes LQ No ❑ NA ❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ YesVIL
No
❑ NA
❑ NE
❑ Yes
RLNo
❑ NA
❑ NE
Reviewer/lnspectorName: Phone: z1D-3-3
Reviewer/Inspector Signature: Date: —/ 7—
Page 3 of 3 2/4/2011

M11[;m-1
(Type of Visit: IofCompliance Inspection O Operation Review Q Structure Evaluation O Technical Assistance j
Reason for Visit: Q4(butine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access 11
Date of Visit: 1 la Arrival Time: Departure Time: Id )Op 4^County:
Farm Name: HOLIf �gFtrr_j Owner Email:
Owner Name:Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: o�A�
Certified Operator: _e<40rr'Ej M, 1�E
Back-up Operator:
Phone:
Region: F"
Integrator: Jp,0 eAo rL,?
Certification Number: Q $&O RCS
Certification Number:
Location of Farm: Latitude: Longitude:
h
Design Current
Design Current. .`''
Design Current
Swine
Capacity Pop. -.:--
Wet Poultry Capacity Pop
Cattle Capacity Pop.
Wean to Finish Layer
Dairy Cow
Wean to Feeder
WOO 11coo
Non-Laye
Dairy Calf
Feeder to Finish
a_ Was the conveyance man-made?
[]Yes
Dairy Heifer
Farrow to Wean
❑ NE
F Design ICwent r
D Cow
Farrow to Feeder
[3"NA
D , Pa It . Ca city_ Po
Nan -Dai
' Farrow to Finish
Layers
Beef Stocker
Gilts
❑ Yes
Non -Layers
Beef Feeder
Boars
2. Is there evidence of a past discharge from any part of the operation?
Pullets
Beef Brood Cow
❑ NA
-" - -
Turkeys
❑ Yes
Qther
❑ NA
Turkey Poults
of the State other than from a discharge?
Other
jorlOther
Discharges and Stream Impacts
I . Is any discharge observed from any part of the operation?
[:]Yes
E(No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a_ Was the conveyance man-made?
[]Yes
❑ No
ffVA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
[]Yes
❑No
[3"NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d_ Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
E]rNo
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
EfNo
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 1/4/1011 Continued

[Facility Number: - of IDate of Inspection: j.
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure l Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Spillway?:
Designed Freeboard (in): /^
Observed Freeboard (in): 03,57
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
E�f No ❑ NA ❑ NE
❑ No Ef NA ❑ NE
Structure 6
❑ Yes [;Y&o ❑ NA ❑ NE
6. Are there structures on-site which are not properly addressed and/or managed through a ❑ Yes dNo ❑ 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 [S2rNo ❑ NA ❑ NE
& Do any of the structures lack adequate markers as required by the permit? [:]Yes Q 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 [5No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [Z No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes g No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence
of Wind Drift E]Application Outside of Approved Area
12. Crop Type(s),-T_�FIRMyOA 1 1 AZIj2E) 1 j� _G_ G •
13. Soil Type(s): _ JN 005& ky'-
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes 43 -No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ❑ No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable 0 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?
❑ Yes dNo
❑ Yes EfNo
❑ NA ❑ NE
❑NA ❑NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes dNo ❑ 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. ❑ Yes C5 No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
p 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 ElNo ❑ 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 21412011 Continued

[UseComments drawingselit
oifft Explain any YES answers of facity tobetter explain situations (use additional p gesmilitional endations or
as necessary). 'any othe omments.
Reviewer/Inspector Name: t
Reviewer/Inspector Signature:
Page 3 of 3
Phone: QtU 3d8 to �S I
Date: %n
2/4/2011
Facility Number: -sft Date of Inspection: Mora
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes Co No
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes 0 No
❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes K!rNo
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes ❑ No
eNA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
[] Yes UNo
❑ 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 E] 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 [allo
❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below.
❑ Yes E 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 [2f No
❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes 0 No
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes Ej No
❑ NA ❑ NE
[UseComments drawingselit
oifft Explain any YES answers of facity tobetter explain situations (use additional p gesmilitional endations or
as necessary). 'any othe omments.
Reviewer/Inspector Name: t
Reviewer/Inspector Signature:
Page 3 of 3
Phone: QtU 3d8 to �S I
Date: %n
2/4/2011

i ype of visa: q_-,Tuompttance inspection V Uperanon xeview V Structure Evaluation V iecnmcal Assistance
Reason for Visit: outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency Q Other 0 Denied Access
Date of Visit: Arrival Time: i Departure Time: County
Farm Name: mil a.�p�5 Owner Email:
Owner Name: t Phone:
Mailing Address:
Physical Address:
Facility Contact: _ 0Ltf—& XL Title: Phone:
Onsite Representative:
Certified Operator:
Region: ff= j
Integrator:
Certification Number: �®
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Dischar es and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify 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?
Page 1 of 3
❑ Yes 00'110 ❑ NA ❑ NE
❑ Yes ❑ No [V]'NA ❑ NE
[:]Yes ❑No U.I'd'1 ❑ NE
❑ Yes
Dp tg Cur nth ' -
Design
Current
Design Current
[vio
Swine
INC.a
aci Po WetfPoltw,#
Ty
;Capacity
Pop.
Cattle. Capacity Pop.
NE
t oury _
Wean to Finish
Layer
Dairy Cow
Wean to Feeder
Q Non -La er I
Dairy Calf
Feeder to Finish
�AN`
s Design
. ' FCa aci
Current.
P,o
Dairy Heifer
Da Cow
-Dairy
Farrow to Wean
Farrow to FeederDPoul
Farrow to Finish
Layers
Non -La ers
Beef Stocker
Beef Feeder
Gilts
Boars
Pullets
Beef Brood Caw
Turkeys
Other
Turkey Poults
Other
Other
Dischar es and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify 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?
Page 1 of 3
❑ Yes 00'110 ❑ NA ❑ NE
❑ Yes ❑ No [V]'NA ❑ NE
[:]Yes ❑No U.I'd'1 ❑ NE
❑ Yes
❑ No
M-NA'0
❑ NE
[:]Yes
[vio
❑ NA
❑ NE
❑ Yes
�'No
❑ NA
NE
1/412011 Continued

IFaeiHty dumber: - Date of Inspection:
'Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes B<o ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No Ea "^ ❑ 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 0 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 Eg< ❑ 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
L'Si"°
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
kg -<o
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
9. Does any part of the waste management system other than the waste structures require
❑ Yes
[�Ko
❑ NA
❑ NE
maintenance or improvement?
❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield [:1120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
[:]Yes
Waste Application
10. Are there any required buffers, setbacks, or compliance a]tematives 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
g2l o
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): r ,
13. Soil Type(s): �,( _�-
14. Do the receiving crops differ from those designated in the A WMP?
[:]Yes
[tjoo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
D -Ko
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
�o
0 NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[j -<oo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
D-1 �0❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
[—]Yes
2 qo- ❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
Lal l"o ❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
F]Yes
DJ-4Co ❑ NA
E] NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield [:1120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
[:]Yes
�❑
Kr o ❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No Z ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: - / Date of Inspection:
24' Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes 20 ❑ NA 0 NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [] Yes [] No [j3 -NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge Ievels 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 [RNo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes :jPB-ITX ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes [4]'1Vo ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes [a. -I o ❑ NA ❑ NE
❑ Yes E 1"0 ❑ NA ❑ NE
[:)Yes 10 ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes GD -No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative? ❑ Yes❑..Pd'D ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes LI -1W ❑ NA ❑ NE
Comments (refer to question:#): Explain any YES answers and/or any additional recommendations or any�o'tlier'-comments. ' �f
use drawings of facility to better explain situations (use additional pages as necessary).
74:4ettse' Cad [ � k4� ct_6 I �j S tc, 4—W 6 ot ts f-G-
Reviewer/Inspector Name:
Reviewer/Inspector S
Page 3 of 3
Phone:
Date: l
214 1

87/9 _S 2 / 2 /, /z rslo Rk9-
Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: �%: �-sl�s� County: Region: �D
Farm Name: AtKe- Owner Email:
Owner Name: /uflr4� G Phone:
Mailing Address:
Physical Address:
Facility Contact: _. 'K t- I�oD Title: i�'wNw Phone No:
Onsite Representative:
Certified Operator: N1 A�c. hke'p—
Back-up Operator:
Location of Farm:
Integrator: p
Operator Certification Number: 98�C10
Back-up Certification Number:
Latitude: =0 1=11 = " Longitude: Q ° = = u
Design C+urrent
Swine Capacity Population
Design Current
Vet Poultry Capacity Population
Design Current
Cattle Capacity Population
❑ Wean to Finish
10
❑ La er
ElYes BNNo ❑ NA
El Dai Cow
® Wean to Feeder
Non -Layer
I I
Dairy Calf
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
Dry Poultry
❑ Layers
❑Non -La ers
El Farrow to Finish
❑ Gilts
❑Beef Stocker
ElBeef Feeder
❑Pullets
❑ Boars
❑ Beef Brood CoAi
Other
❑ Other
❑ Turkeys
❑Turke Poults
❑ Other
Number of Structures:
Discharees & Stream Impacts
I. Is any discharge observed from any pan 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 31No ❑ NA ❑ NE
❑ Yes ❑ No
N//A
El NE
,'ham'
El Yes El No BN'A
❑ NE
❑ Yes ❑ No LANA
ElNE
ElYes BNNo ❑ NA
❑ NE
❑ Yes O No ❑ NA
❑ NE
12/28/04 Continued

r 4
Facility Number: S2 — l4L
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?: a
Designed Freeboard (in): f
Observed Freeboard (in): 3zZ
5. Are there any immediate threats to the integrity of any of the structures observed?
(ic/ 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 9NNo El NA El NE
El Yes 2< ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes D<o ❑ NA ❑ NE
❑ Yes D< ❑ 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? El Yes ,L��//vo [:1 NA El NE
8. Do any of the stuctures lack adequate markers as required by the permit? El Yes �No
(Not applicable to roofed pits, dry stacks and/or wet stacks) ErNo El NA El NE
9. Does any part of the waste management system other than the waste structures require ❑ Yes 2 ❑ NA ❑ NE
maintenance or improvement?
Waste ADDlication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes B o ❑ NA ❑ NE
mai ntenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes [?No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > I0% or 10 Ibs ❑ Total Phosphorus [:]Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) i3//et.��w (r%,a`G, Sill Gn�r,✓ �O S
a
13.
Soil type(s) 1V,7 i-
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
El NA
El NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
,Mi�l'o
El NA
El NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
El Yes
,l�No
fes' No
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
El NA
[:1 NE
18.
Is there a lack of properly operating waste application equipment?
[:1 Yes
��No
L''J No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES ansKers�ndlor any 'recommendatrons or any other colnments..
ilit} to explain situations ons( nse,additioaP ges anecessary drawings of fac)
a
Reviewer/Inspector Name Phone: 9/�. i�33 , 3300
Reviewer/Inspector Signature: �� Date: �2
12128104 Continued
z// g/aoo /o

Facility Number:--� Z Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box. ❑ V*1Up ❑ Checklists ❑ Design ❑ Maps ❑ Other
❑ Yes
O No
❑ NA
❑ NE
❑ Yes
[Ko
❑ NA
❑ NE
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
No ❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ NA
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute' Inspections ❑ Monthly and 1 "
Rain Inspections El Weather Code
30. At the time of the inspection did the facility pose an odor or air quality concern?
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
ET< ❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
El NA
El NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
,L�y,No
L3/N'o El NA
[INE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
es 1voo[-INA
[__1NE
26.
Did the facility fail to have an actively certified operator in charge?
ElYes
[__1 NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
[:1 Yes
�2
CL No ❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
LAB," oo
❑ NA
E] NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
{] Yes
B No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
(__1 Yes
,��
LTNo
❑ 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
,�,�
L2 No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
BNo
❑ NA
❑ NE
Additional Comments andlor Dra>Nngs d
12/28/04
12/28/04

Y
Type of Visit Q'C��ompliance Inspection O Operation Review 0 Structure Evaluation O Technical Assistance
Reason for Visit l7Hmp�outine O Complaint O Fallow up Q Referral O Emergency O Other ❑ Denied Access
Date of Visit: — �[D Arrival Time: .'D Departure Time: ; _v County Region: F Z)
110,
Farm Name:�� /�yX� %l� Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: ID Title: 438x-" _ Phone No:
Onsite Representative: Tom, �e Integrator:
Certified Operator: _ - 3_-�
Back-up Operator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: = o [--] ' [::] « Longitude: =0=, =
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
allo
❑ NA
❑ NE
Design Current
Design Current
Design Current
Swine Capacity Population
Wet Poultry Capacity Population
Cattle Capacity Population
❑ Yes
❑ Wean to Finish
❑ Layer
❑ Non -Layer
❑ Dai Cow
❑ Dai Calf
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
Wean to Feeder 1 c7 / "DZi
❑ Feeder to Finish
❑ NA
❑ Dai Heifer
❑ Farrow to Wean
Dry Poultry
❑ D Cow
❑ Farrow to Feeder
❑Non -Dai
❑ Farrow to Finish
❑ Layers
❑ Beef Stocker
❑Gilts
❑ Non -Layers
❑ Beef Feeder
❑ Boars
❑ Pullets
❑ Beef Brood Co
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Turkeys
C&No
Other
❑ Other
❑ Turke Poults
❑ Other
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
allo
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
UNo
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
C&No
❑ NA
❑ NE
other than from a discharge?
12/28/04
Continued

1 Facility Number: — / Date of Inspection Ili
cl
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes MNo ❑ 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): 1�
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
Cl Yes
Callo ❑ NA ❑ NE
(ic/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed
❑ Yes
RNo ❑ 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
RNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
[&No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
[R.NO ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
gNo [INA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
RNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Window El Evidence of Wind Drift El Application Outside of Area
/Crop
12_ Crop type(s) �/ ri Ll_jprz �_r2
13. Soil type(s) nk
14. Do the receiving crops differ from those designated in the CA WMP?
❑ Yes
PS No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
®,No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
[ No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
® No ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[ ,No ❑ NA ❑ NE
Comments (refer to question #}: Explain any YES answers and/or�any.rec mendations or any other comments. _
Use. drawings of facility to' better explain situations..(use additional p g s sanecessary)
Reviewer/inspector Name Phone: g/8��.3J~33[]a
Reviewer/inspector Signature: Date:
12/28/04 Continued

j Facility Number: Date of Inspection
Required Records & Documents ,
19. Did the facility fail to have Certificate of Coverage & Permit readily available? Yes 1�.No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 0 No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes RNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes M(No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes E&No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
C&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
El -No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
RNo
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
allo
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
JRt 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
allo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
E,No
❑ NA
❑ NE
General Permit? (ic/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
(a No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
® No
❑ NA
❑ NE
12/28/04

type of visit (.Mompliance Inspection U Operation Review U Structure Evaluation U Technical Assistance
Reason for Visit me 0 Compfaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: ��."t7D County,' Region:��
Farm Name:_�%�t� �e—! Owner Email
Owner Name: %—I7��r� _ Phone:
Mailing Address:
Physical Address:
Facility Contact: &&Al+ Title:
Onsite Representative:
Certified Operator: S
Back-up Operator:
Location of Farm:
Phone No:
Integrator: /h'kr C
Operator Certification Number:
Back-up Certification Number:
Latitude: =c EDI =.1 Longitude: =0[=i
o[=i =16
ta'Design
Currents `-
- : - Design Current
►
' '.: Design Current
Swine _ Capacity
Population "�"Wet Poultry Capacity Population
Cattle - - Capacity Population
to Finish
❑ Layer
❑ Dai Cow
to Feeder ! 00
❑ Non -Layer
❑ Dai Calf
r to Finish""
❑ NE
❑ Dai Heifer
w to Wean
�?`
ouw
❑ D Cow
to Feeder
❑ NE
❑ Non-Dairyw
to Finish
FFd
❑ La ers
❑ Beef Stocker
❑Non -La ers❑Pullets❑Beef
Feeder
❑ Beef Brood CoTurke
s
Turke Poults
❑ Other
Numberpo# Structures:LLJ
p
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 (g.No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
f.No
❑ NA
❑ NE
❑ Yes
KNo
❑ NA
❑ NE
12128/04 Continued

i Facility Number: — Date of Inspection �1
}+ Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes CHNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes ,Q No ❑ NA ❑ NE
❑ Yes JR 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
[0 No
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
®,No
❑ NA
❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
W_No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
9. Does any part of the waste management system other than the waste structures require
❑ Yes
® No
❑ NA
❑ NE
maintenance or improvement?
RNo
❑ NA
❑ NE
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
® No
❑ NA
EINE
maintenance/improvement?
11. 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) Ct.—--
13. Soil type(s) AJD /J2
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
54 No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
j4No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
W_No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
RNo
❑ NA
EINE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
RNo
❑ NA
❑ NE
�v 6P y
b F recommendattons ar�anyother comments.
mmentQrefer to ueshon E lam an i'ESlanswers andlor any 4 ` .. {I
f � F
1 s draw gs af� aciltty'to Vetter p�tgatio (u�addittonai pages as;aecessary)
.:
":>
L
7
Reviewer/Inspector Name Phone: 91j j2
Reviewer/Inspector Signature: Date:
Page 2 of 3 - ' 12/78/04 Continued

Facility Number: — / Date of Inspection D
Required_ Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes L8 -No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ,M No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists
❑ Design El Maps [I Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes RNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
®No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
ZNo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[RNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
® No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
allo
❑ NA
❑ NE
2T
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
E,No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CA WMP?
❑ Yes
Q.No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
ERNo
❑ 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
E,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
[XNo
❑ 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
ZINo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
R No
❑ NA
❑ NE
Additioaal'Comments ai 'cf/or Drawings
a
rA
Page 3 of 3 12/28/04

ivision of Water Quality S t7
Facility Number:D�._V�J 0 Division of Soil and Water Conservation `;2
0 Other Agency
Type of Visit Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit outine 0 Complaint O Follow up O Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: Q - Departure Time: [7 County: Region:
Farm Name: Owner Email:
Owner Name: —' r� �� Phone: �� —5
Mailing Address:
Physical Address:
Facility Contact: /�� �`/` Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone No: '1%D—Jd ` / 3 D
Integrator: -
Operator Certification Number: ; �
Back-up Certification Number:
Latitude: F --Io = 0 Longitude: =o =, =
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population
❑ Wean to Finish ❑ Layer
Wean to Feeder 3 O D ❑ Non -La et
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Dry Poultry
Non -L
Pullets
Other
Discharges !& Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑
DaiKy Heifej
❑
Dry Cow
❑ Non -Dairy
❑ Beef Stocket
❑ Beef Feeder
❑ Beef Brood Cowl
Number of Structures: ©'
b. Did the discharge reach waters of the State'? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes ONo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Ycs
[&No
❑ NA
❑ NE
❑ Yes
JXNo
❑ NA
❑ NE
12/28/04 Continued

Facility Number&'P__/Vi Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
❑ Yes CKNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
Identifier:
a
Spillway?:
Reviewer/Inspector Name Phone:
Reviewerllnspector Signature: Date:
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
D&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
M,No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
$4 No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
4. Does any part of the waste management system other than the waste structures require
❑ Yes
FXJ No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
® No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
CR No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or ] O lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop types) Z`/�7�--
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
R1 No
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[3 No
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
®. No
❑ NA ❑ NE
IT Does the facility lack adequate acreage for land application?
❑ Yes
E,No
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
'M No
❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
a
Reviewer/Inspector Name Phone:
Reviewerllnspector Signature: Date:
12/28/04 Continued

Facility Number: — Date of Inspection: 7
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 RNo ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement'? if yes, check the appropriate box below. ❑ Yes E,No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes RNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
g No
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
JqNo
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
,q No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge? ❑ Yes KNo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ❑ Yes P4No ❑ NA EINE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes RNo ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
KNo
❑ 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
JX 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
[RNo
❑ 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
9 No
❑ NA ❑ NE
12/28/04

i
Type of Visit 'Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit outine O Complaint O Follow up O Referral Q Emergency O Other ❑ Denied Access
Date of Visit: Arrival Time: 0 Departure Time: j County: Region: �.
Farm Name: ,�f f _ oe'!&1J �. r _ Owner Email:
Owner Name:��� /���+C Phone:
Mailing Address:
Physical Address:
Facility Contact: ,f21f, �9a! Title:
Onsite Representative:
Certified Operator: �—
Back-up Operator:
Phone No:
Integrator:7rm%"�*�- �T
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: E-1 o EJ ="
Longitude: 1 --lo=, ="
DesignCurrent
D sign
Current
Design Current
Swine Capacity Population
Wet Poultry Capaty
Population
Cattle C*specify Population
❑ Wean to Finish
❑ La er
Dai Cow
Fo
❑ NA
❑ NE
WeantoFeeder /aD O
❑Non -La er
❑ Yes
Dairy Calf
❑ NA
❑ NE
❑ Feeder to Finish
a ;:
❑ NA
❑ Dairy Heifer
❑ Farrow to WeanDry
Cow
❑ Farrow to Feeder
ElNon-Dairy
❑ Farrow to Finish
El Layers
❑Beef Stocker
❑ Gilts
❑Non -La Non -Layers
❑ Beef Feeder
A
❑ Boars
❑ Pullets
❑Beef Brood Cow
-
❑ Turkeys
Ot e
❑ Other 1
10 Turkey Poults
10 Other
NumbeGof 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
f...�A..-
❑ Yes ZINo ❑ NA EINE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
ANO
❑ NA
❑ NE
❑ Yes
gNo
❑ NA
❑ NE
12128/04 Continued
�..A

Facility Number: —/ Date of Inspection ILC1
A Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes BNo ❑ NA EINE
a. If yes, is waste level into the structural freeboard? []Yes J3No ❑ NA FINE
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 [INA ❑NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed ❑ Yes IN No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ® No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
Q�No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
[] Yes
[& No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
® No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
❑,No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Window El Evidence of Wind Drift ❑ Application Outside of Area
//Crop
12. Crop type(s) ��i X,2L
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
EN No
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
® No
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
E) No
❑ NA ❑ NE
IT Does the facility lack adequate acreage for land application?
❑ Yes
FXINo
❑ NA ❑ NE
18. is there a lack of properly operating waste application equipment?
❑ Yes
Pg -No
❑ NA ❑ NE
:Comments (refer to question ft. Explain any YES answers and/or any recommendations or any other comments....
Use drawings of facility to better explain situations. use additional a esi`as necessa
Reviewer/Inspector Name --- - ��� _(� v--�. Phone:
ReviewerAnspector Signature: Date: C> _"'10 C> 6
ruge c uj j !G/G6/v4 V.unainuru

0
Facility Number: Date of Inspection 17/
Required Records &_Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 19 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ❑'No ❑ NA ❑ NE
the appropriate box.
❑ WUP El Checklists El Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below_ ❑ Yes Wo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
9 No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
91 No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
gNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
® No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
® No
❑ NA
❑ NE
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?
❑ YesNo
ElNA
❑ 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
Z No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ YesNo
UN
ElNA
ElNE
Additional Comments and/or Drawings:
Page 3 of 3 12./28/04
Page 3 of 3 12./28/04

Type of Visit 'UC_ommpliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit utine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
F_
Facility Number r�� Date of Visit: sZ 3 O Time:.
Q Not Operational Q Below Threshold
[Permitted eCertified © Conditionally Certified © Registered Date Last Operated or Above Threshold:
Farm Name:.... NA_" County: .. . .
Owner Name: jq_� 50[c) --)q 30
� ._........� ....___.�....�.......__�.._............_................ Phone No: _............._......_._ ----............__............_.........WW....
...,_...... VNa.ttng Address.1� ro
.......... - Y� -
a..... -......................... --........ ��a8
. 1
Facility Contact. �siLG C _ . _.. Title:.. �!L a .. . _ .. Phone No: ,,. SIC) .?2 "p
Onsite Representative: _._ Integrator:.....acrtrt
Certified Operator: ...........
m - Operator Certification Number: ..........
Location of Farm:
U/Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 0 " Longitude • 6 "
Discharges S Stream Impacts
I. Is any discharge observed from any part of the operation?
❑Yes o
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
El Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d_ Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes Q1go
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes [9,50
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes M-90
structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ......... .............. ......... ...........
Freeboard (inches): 3
12112103 Continued

t Facility Number: 3a —
1
Date of Inspection p
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenancerimprovement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
H. . Is there evidence of over application? If yes, check the appropriate box below.
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type k^ ? u�t7� 7x� + 9Y. (1 jr4✓� t e�) !i r-
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours?
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional
Air Quality representative immediately.
❑ Yes ["No
❑ Yes M No
❑ Yes [dNo
❑ Yes [dNo
❑ Yes YNo
❑ Yes dNo
❑ Yes G?f4o
❑ Yes S"No
❑ Yes [�10
❑ Yes GrNo
❑ Yes [a'iQo
❑ Yes &'N' o
❑ Yes 2/No
❑ Yes OKo
❑ Yes [9<o
❑ Yes dNo
❑ Yes dNo
Commits (re%r�to questeon}�Expla many YES answersand/or any recoum�enaa�ons or _ ether comments.::
:Used awtng� iif facility to hatter e�cplam situations. (use sddl�t�onal es as Asa ) � __.:... _ .., _ ...� �a.�._ �, _ .
Pte_ Fte ❑ Final N
PY
AL
Reviewer/Inspector Name t7�v►aa
M :`�P... _ -
Reviewer/Inspector Signature: nAAM Date: O
12112103 Continued

Facility Number: ;, — J11g Date of Inspection a
Required Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes [ErNo
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.) ❑ Yes QrNo
23. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 63"No
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
RfNo
25. Did the facility fail to have a actively certified operator in charge?
❑ Yes
040
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
RrNo
27. Did Reviewer/Inspector fail to discuss reviewlinspection with on-site representative?
❑ Yes
[CrNo
28. Does facility require a follow-up visit by same agency?
❑ Yes
[rio
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
[g<o
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
❑ Yes
[ 4o
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
32. Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ No
33. Did the facility fail to conduct an annual sludge survey?
❑ Yes
❑ No
34. Did the facility fail to calibrate waste application equipment?
❑ Yes
❑ No
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below.
❑ Yes
❑ No
❑ Stocking Form ❑ Crap Yield Form ❑ Rainfall ❑ Inspection After V Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
119 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
ddttianal Comments aitdWDrawtngs
.._-car: _.�..[� .� - ^�• �::-
AqL&5 'Fl �-c Atco r -As &,,E a 1 j t.wr�er ao d ) on K �� d
� WP-9tc Sv-fk-, A le,, &4 yj IeA5
12112103

�! r20
------State-0f North Carolina
Department of Environment, kvFqA1
Health and Natural Resources A
• A
Fayetteville Regional Office .N
James B. Hunt, Jr., Governor [DC
Jonathan B. Howes, Secretary G
Andrew McCall, Regional Manager
DIVISION OF ENVIRONMENTAL MANAGEMENT
December 13, 1995
Mr. Bobby Hope
6975 Garland Hwy,
Clinton, NC 28328
SUBJECT: Compliance Inspection
Sampson County
Dear Mr. Hope:
On November 13, 1995, an inspection of your animal operation was performed by the
Fayetteville Regional Office (FRO). Please find enclosed a copy of our Compliance
Inspection Report for your information. It is the opinion of this office that this facility is
in compliance with 15A NCAC 2H, Part.0217, and that Animal Waste Management is being
properly performed.
Should you have any questions regarding this matter, feel free to contact me at (910)
486-1541.
Sincerely,
Ricky Revels
Environmental Technician IV
Enclosure
cc: Facility Compliance Group
Wachovia Building, Suite 714, Fayette Ane. North Carolina 28301-5043 Telephone [phone] FAX [phone]
An Equal Opportunity Affirmative Action Employer 50% recycled/ 10% post -consumer paper

Site Req uires Immediate A NO
, . ttention:
�- �— Facility No. 9Z - Iq r -
DIVISION OF F.NYIRONNU L MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISTTATION RECORD
DA'Z'E: / /- /3 , 1995
Time: 0 9ss
Farm Name/Owoer:_ f4Ee NC1V5e..+'-
Mailing Address: _ &1-15 Cay -14 J `' 6624 C l: M 7e. N 4C
Cmimty: SR..-. so ^j -
Integrator:- Mc & L (�7-rQ . Phone:
On Site Representative: B�{c�lo:, kl-pe,Phone: to 5790 -
Physical Addras/Irocadon: i & VT_ 20 -'r a Lrx .
�'uYNOW4 gz-c c(. Sly �L a � / �,, rN tf 41 o a ,B"IV3mu
Type of Operation: Swine ✓ Poultry Cattle
Design Capacity: 3400 Number of Animals on Site: -Z'100
;� !
DEM Certification Number: ACE DEM Certification Number. ACNEW .y,,4r
Latitude: ° Longitude. 0 1 _« jr;SFT
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of I Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches) Yes No Actual Freeboard: Ft. Inches
Was any seepage observed from thelagoon(s)? Yes or(S? Was any erosion observed? Yes ori
Is adequate land available for spra ? or No Is the cover crop adequate? �or No
Crop(s) being utilized: Com. ovcur se ' -di '3 );�C_ /o
Does the facility meet SCS minimum setback 'teria? 200 Feet from Dwellin s? No
100 Feet from Wells? No
Is the animal waste stockpiled within 100 Feet of USGS Blue Lane Stream? Yes ort
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Lane: Yes or5i;'-)
Is animal waste discharged into water of the state by man-made ditch, flushing system, or other
similar marc -made devices? Yes or4j;P . 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
Additional Comments: a671a%.J 4.4/ 4',0/Jr'crt,01 Wok C.rr�i a�%Al
/fir /7 e ire /-S
Inspector Name
Signature
cc: Facility Assessment Unit Use Attachments if Needed.