820150_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental Qual

(� � � t �- - - . - - .. — _.__ ---.� _...-..----•� - ..-.:......--vim.-..-- -._-.. , - � � -- ^--�-�- --� -�. - . . � ._� _ -.---...--......-_....r- _. �,
Type of Visit: ® Compliance Inspection 0 Operation Review O Structure Evaluation 0 Technical Assistance
Reason for Visit: O Routine O Complaint 0 Follow-up C) Referral 0 Emergency O Other O Denied Access
Date of Visit: Arrival Time: Q r Departure Time: County: Region: V_
Farm Name. P`5 Owner Email:
Owner Name: rtyAw piolo- _ Phone:
Mailing Address:
Physical Address:
Facility Contact: l'S Title: Phone:
tr
Onsite Representative:
Certified Operator: RAI ai 5 �
Back-up Operator:
Location of Farm: Latitude:
Integrator: P
Certification Number:
Certification Number:
Longitude:
Current
Design
CurSwine
15n
pacity
k' Pop..
=e1:.Poultry
"Capacity
lienCapacity Pop,
can to Finish
[Layer
E
IDairvCow
Wean to Feeder
Non -La er
I
Dairy Calf
Feeder to Finish
' '!'
Dairy Heifer
Farrow to Wean
-Design `
Current
Dry Cow
Farrow to Feeder
a sei
Po .
Non -Daily
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?
❑ Yes [Po ❑ NA ❑ NE
❑ Yes ❑ No JPNA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes ❑ No
NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes ❑ No
NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes No
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412015 Continued

4
Facili Number: Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. Ifyes, is waste level into the structural freeboard? ❑ Yes
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier: +j
No ❑ NA ❑ NE
❑ No tu NA ❑ NE
Structure 6
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 1-4 4
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[gNo
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
® No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy
Metals (Cu, Zn, etc.
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
A(pRlication Outside of Approved Area
❑ Outside of Acceptable Crop Window Evidence of Z��
12. Crop Type(s): coeS561J- -
kD
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
P9 No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
53 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
No
❑ NA
[] NE
18. is there a lack of properly operating waste application equipment?
❑ Yes
EO No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
® No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes
M 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 [�3 No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑NA ❑NE
Page 2 of 3 21412015 Continued

I
Faeili Number: jDate of Inspection: '2
24. Did the facility fail to calibrate waste application equipment as required by the permit? [—]Yes No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the 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?
Reviewer/Inspector Name:
Reviewer/Inspector Sipatur
Page 3 of 3
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
C] NA ❑ NE
❑Yes
�No
❑NA
❑NE
❑ Yes
[ No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes N No ❑ NA ❑ NE
[] Yes ® No
❑ Yes No
❑ NA ❑ NE
❑ NA ❑ NE
Phone: 91D
Date: qlu 4 7
i/4/2015

type or visit: `p t-ompuance tnspecnon v operation mevtew v Ntructure tvatuatnon V t ecnmcai Assistance
Reason for Visit: ® Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: 'Qr0 Departure Time: County�SRegion:
Farm Name: Owner Email:
Owner Name: Pre Phone:
Mailing Address:
Physical Address:
Facility Contact: VR^"'QS Title:
Onsite Representative:
Certified Operator: 15
Phone:
Integrator: ki
Certification Number•.
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current Design Current
5wute 4 Capacity Pop. Wet�l'oult_ry Capacity Pop.
Wean to Finish La er
Design Curren#
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Wean to Feeder
Layer
Feeder to Finish
_'
D : tPouIt .
= `
Design Current
Ca aci P,o .
Dairy Heifer
Farrow to Wean
Farrow to Feeder
'L
Dry Cow
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
r
Other'
Turkeys
Turkey Poults
Other
Other
Discharizes and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
P No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made'?
❑ Yes
❑ No
�3 NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
[P NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
�a NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
T No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
� No
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

Facili Number: - Date of Inspection: Z$
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
No
P
❑ 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: 1
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
toNo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
[] Yes
No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[y No
`
[DNA
[3 NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
F 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 Acce table op Window Ev' ence 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]
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?
0 Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
Yes
No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes]
No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes P No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No
❑ NA ❑ NE
❑ Weather Code
[:]Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 2/4/2011 Continued

Iracili Number: Date of Inspection: d
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE
25. is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ( No
Other Issues
28, Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30, Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes No
[:)Yes No
❑ Yes No
❑ Yes No
❑ Yes 1P No
❑ Yes 1 No
[—]Yes No
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
[DNA ONE
❑ NA ❑ NE
Comments (refertoquestion #): Explain any YES answers,and/or any additional. recommendations or:any other comnieiuts:"
Use drawings of facility to better explain situations :(use _additional pages as necessarv). _ _ , _ s
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date:
21412011

IType of Visit: ® Compliance Inspection U Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit: ® Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: f Arrival Time: � Departure Time: O,'AP4 County: , ;4" Region: 1511719
Farm Name: f `" __y Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: ��� Title:
Onsite Representative:
Certified Operator: l2lS ><n
Phone:
Phone:
Integrator: &160,
Certification Number: 1'9rnxs'�
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design. CHE ci I ign Current
Swine Capacity Pop. Wet Poultry Capity acPop.
Design Current
Cattle Cagacity Pop.
Wean to Finish
Layer
IDai
Cow
Wean to Feeder
I InalLayer
IDai
Calf
Feeder to Finish
D , P,ouita Ca aci P,o
Layers
DairyHeifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars Pullets
Turke s
Other Turkey Poults
Other Other
Beef Brood Cow
Discharges and Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
[] Yes [N No ❑ NA ❑ NE
❑ Yes ❑ No [)j NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
❑ No
QI NA
❑ NE
e. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
[:]Yes
❑ No
JNNA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
[:]Yes
Q§ No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
W No
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412014 Continued

Facili Number: Date of Inspection: 1
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes �g No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? 0 Yes ❑ No NP NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: �^
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? [:]Yes PNo D NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.) ��""
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes P No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes tA No ❑ NA ❑ NE
8_ Do any of the structures lack adequate markers as required by the permit? ❑ Yes Pq 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? T
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No [DNA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes P 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 Wi dd Drift ❑ Application Outside of Approved Area
12. Crop Type(s): �-C)QS A404i-t4 CVS5
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
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.
[:]Yes
No
❑ NA
❑ NE
❑ Yes
[ No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes [� No ❑ NA ❑ NE
❑ Yes P No [] NA ❑ NE
❑ Yes $ No ❑ NA ❑ NE
❑ Yes 0 No ❑ NA ❑ NE
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes `i~ No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis [] Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 " Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? [—]Yes P No
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [$ No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412014 Continued

Facility Number: Date of Inspection: j
24. Did the facility fail to calibrate waste application equipment as required by the permit. [] Yes No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes ® No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes M No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes [?_3 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 W 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 J�j No ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
�] No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/Pnspection with an on -site representative?
❑ Yes
No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
No
❑ NA
❑ NE
(Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comme b' ..I
Use drawings of facility to better explain situations (use additional pages as necessary)..
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:"���!
Date: V// �L
21412014

Type of Visit: ® Compliance Inspection 0 Operation Review O Structure Evaluation Q Technical Assistance
Reason for Visit: • Routine O Complaint O Follow-up Q Referral O Emergency Q Other O Denied Access
Date of Visit: 2./ G Arrival Time: :00q.� Departure Time: O County: SAry- SOd
Farm Name: `- �O Owner Email:
Owner Name: Cris s Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Region: F-PD
Phone:
Integrator:`mot,( 40_
Certification Number: g e g,
Certification Number:
Longitude:
111111
Design Current
Design
Current
Design Current
Swine
Capacity Pop.
Wet Poultry
Capacity
Pop.Ed
Cattle Capacity Pop.
Wean to Finish
Layer
Da'x Cow
Wean to Feeder
I
jNon-Layer
I
Da'y Calf
Feeder to Finish
Daig Heifer
Farrow to Wean
Dry Cow
Farrow to Feeder
D , Paul
Ca aci
P,o
Non -Dairy
Farrow to Finish
ILayers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
jPullets
Beef Brood Cow
Turkeys
Other
Turkey Poults
Other
Other
Discharges and Stream Imnacts
1. Is any discharge observed from any part of the operation?
❑ Yes
C5 No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
EJ�NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
❑ No
(RNA
❑ 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
B NA
[] NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
Ej No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
® No
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412014 Continued

Facili Number: jDate of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? [:]Yes E) No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes 0 No EYNA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: �^
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3 �f
5. Are there any immediate threats to the integrity of any of the structures observed?
[:]Yes
® No
❑ NA
[] NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
g) No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
PNo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
® No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
® No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
[—]Yes
5@ No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals
(Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate
Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ of WindDrift[ ❑ Application Outside of Approved Area
jEvidence
12. Crop Type(s)
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
rP No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
O No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
allo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
C] Yes
[) No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
[] Yes
P No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
Vallo
❑ 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 ❑ Design [—]Maps [:]Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall [:]Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" RainfaIl Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
E3 No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[gNo
❑ NA
❑ NE
Page 2 of 3 21412014 Continued

r ,
Facility Number: QL- Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
No
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
[:]Yes
No
❑ NA [] NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey 0 Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
❑ Yes
W3 No
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
B No
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
® No
❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes 0 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 CoNo ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
® No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
[—]Yes
® No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
0 No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
[:]Yes
® No
❑ NA
❑ NE
(Comments (refer to question ft Explain any YES answers and/or any additional.recommendations or_anyiother-comments"`
Use drawings of facility_ to better explau�.situations (use additional pages as necessarv): �:
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date: i
21412014

Divvisiou of Water Quality
Facili0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit: S Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 0 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: I '2.a Arrival Time: OZ i Departure Time:, County: ' N
Farm Name: � � Owner Email:
Owner Name: VW" Phone:
Mailing Address:
Physical Address:
Facility Contact:
-J L_n•e,S Lo_" Title:
�i
Onsite Representative:
Certified Operator:
Back-up Operator:
Region:
Phone:
Integrator:
Certification Number:
Certification Number:
Location of Farm: Latitude: Longitude:
Design Current
Swine Capacity Pop.
s
WetfPoultry
Y-
Design
Capacity
Current
Pop
Y
Design Current
Cattle Capacity Pop.
inish
Layer
Dai Cow
eeder
Non -La er
-
- - D : tPouI
La ers
Non -Layers
Pullets
Turkeys
Turkey Poults
Other
Design
Ca aei'
Current
P,o .
-
Da' Calf
Da' Heifer
D Cow
Non-DaiTy
Beef Stocker
Beef Feeder
Beef Brood Cow
inish
'j ;Z
j
WFarrowto
Wean
Feeder
Finish
Boars
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes ; No ❑ NA ❑ NE
[:]Yes [:]No
❑ Yes ❑ No
[0] NA ❑ NE
[� NA ❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes ❑ No NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes ® No ❑ NA ❑ NE
of the State other than from a discharge? T
Page 1 of 3 21412011 Continued

Facility Number: jDate of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier: 1
Spillway?:
Designed Freeboard (in): _
/f
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.)
PNo ❑NA ONE
❑ No P NA ❑ NE
Structure 6
❑ Yes PD No ❑ NA ❑ NE
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
[A No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
® No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[4 No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes Z No ❑ NA
❑ 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 r❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
?
12. Crop Type(s): ` as'Q [7 �p_,,wjct c.,4 ' CRi4-_re), Sm. _C &
13. Soil Type(s):
0
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ NE
❑ Yes
MU No
ro
❑ NA
❑ NE
❑ Yes
JR] No
❑ NA
❑ NE
❑ Yes
r) No
❑ NA
❑ NE
❑ Yes 4 No ❑ NA ❑ NE
❑ Yes Qg No ❑ NA ❑ NE
❑ Yes [23 No ❑ NA ❑ NE
❑ Yes E] No ❑ NA ❑ NE
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ® No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Ifacility Number jDate of Inspection: if ]o
24. Did the facility fail to calibrate waste application equipment as required by the permit? [] Yes C� No
25. Is the facility out of compliance with permit conditions related to sludge? if yes, check ❑ Yes 0 No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of fast survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
M 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
[P 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
No
❑ NA
❑ NE
rm peit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
[] Yes
0) No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
�O No
❑ NA
❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any, other cointhents � :
Use drawings of facility to better explain,sitaations (use additional pages as necessary).
Reviewer/Inspector Name:
Reviewed]nspector Signature:
Page 3 of 3
Phone:
Date: ?o
21412011

Type of visit: compliance inspection U operation Review U Structure Evaluation U'Technical Assistance
Reason for Visit: O Routine O Complaint O Follow-up Q Referral O Emergency 0 Other Q Denied Access
Date of Visit: L? 2 Arrival Time: !pD Departure Time: d/;u0 County: .s Region: r-i2r%
Farm Name: Owner Email:
Owner Name: Tj`Qs`{�e_-I ems✓ ; Phone:
Mailing Address:
Physical Address:
Facility Contact: 12an4�j B0.re_4,c+ Title: Phone:
Onsite Representative: Integrator: aQ_44 le
Certified Operator: _RjA n l's f-+r r Certification Number: 9 01:834 /S_
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
' I
Swiffe
A„�
Design Current
l;apacfty P p'et
yF
Design Current
Poultry Capacity Pap.
Design Curren#
Cattle Capacity Pop.
Wean to Finish
a er
DairyCow
Wean to Feeder
[INon-Layer
Dairy Calf
Feeder to Finish
Design @urrent
D „ P,ouitry Ca aci 1'0
Da Heifer
Farrow to Wean
Farrow to Feeder
$Z
Dry Cow
Non -Dairy
Farrow to Finish
ILayers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
• .
Other
Other
Pullets
Turkeys
Turkey Poults
Other
Beef Brood Cow
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
P No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
No
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

Facility Number: - Date of Inspection: q L7 12
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes Vg No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ® NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: I
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):_
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes P0 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 W No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
® No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[P No
❑ NA
0 NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
TT
9. Does any part of the waste management system other than the waste structures require
❑ Yes
® No
❑ NA
❑ NE
maintenance or improvement?
T
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 F 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): Qoo6 &," &Ls5 CR644'r j S
13. Soil Type(s): i3Q 5, F-A ,
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes IM No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
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 El Checklists ❑ Design ❑ Maps ❑ Lease Agreements
[:]Yes No
❑ Yes Gj] No
❑ Yes No
❑ Yes No
❑ Other:
❑ NA ❑ NE
[DNA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
21 _ Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes � No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers [] Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes P No ❑ NA 0 NE
❑ Yes ® No 0 NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: - /_5V Date of Inspection: 4_'7y
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes W No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes EK No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes [P No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes °Fa' No ❑ 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?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes Dg No ❑ NA ❑ NE
❑ Yes ICI No ❑ NA ❑ NE
❑ Yes �M No ❑ NA ❑ NE
❑ Yes
1p No
❑ NA
❑ NE
❑ Yes
fo No
❑ NA
❑ NE
❑ Yes
til No
❑ NA
❑ NE
IComments. (refer to question #): Explain any YES answers and/or any additional recommendations or any other commen0-1 +
Use drawings of facility to better explain situations (usemdditional pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 9/0-4.3'-:i�bO _
Date: 9 Z1 Z
21412011

Type of Visit: 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 0 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: oS� ,. County: Region:
Farm Name: ', Owner Email:
Owner Name: !'�ir�4 _ Phone:
Mailing Address:
Physical Address:
Facility Contact:' r4w' i l Title: Phone:
Onsite Representative: Gl�ac t¢fo4b Integrator:
Certified Operator: —a~ I Certification Number: 1 l�
y
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Swine
Design
Capacity
..
Current "'
Pop. Wel sultry
Design
CapaciLI
Current
Pop.
Design C•urreut
Cattle Capacity Pop.
Wean #o Finish
Layer
Dairy Cow
Wean to Feeder
I INon-Layer
I
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Dry Cow
Farrow to Feeder
DP,oul
Ca aei
Po
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
.:._.
Turke s
Other
Turkey Poults
Other
Other
Discharges and Stream Impacts
1, is any discharge observed from any part of the operation?
❑ Yes
�No
[] NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
�jNA
❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
❑ Yes
❑ No
CP 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
EP NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
[P No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
[B No
❑ NA
❑ NE
of the State other than from a discharge?
Page l of 3 21412011 Continued

Facility Number: Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes Wo ❑ 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 Strucy 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes -Q No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes E@ No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes No ❑ NA
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, et .)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of A,
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ NE
[:]Yes
[� No
❑ NA
❑ NE
❑ Yes
[ No
[DNA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes �p No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes JA No ❑ NA ❑ NE
❑ Yes [P No ❑ NA ❑ NE
❑ WUP []Checklists [:]Design [:]Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 1� No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall []Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 " Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? [:]Yes No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ® No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
[DNA ❑NE
Page 2 of 3 21412011 Continued

Facili Number: Date of Ins ection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes E;� No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes 53 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?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes
)] No
❑ NA
❑ NE
❑ Yes
[:]No
® NA
❑ NE
❑ Yes
g No
❑ NA
❑ NE
❑ Yes 7p No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes �g No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes ® No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes ® No ❑ NA ❑ NE
Comments (refer to question ff): Explain any YES answers and/or any additional recommendations or anyTother comments. `
Use drawings of facility to better. explain situations (use additional pages`as necessary). m. '
5WC VttS 1- Co
97q l�.
Revi ewer/] nspector Name:
Phone: 910A33 -3300
Reviewer/Inspector Signature: _ \ LTI&M Date: 9"1q-11
Page 3 of 3 21412011

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: ! f't Departure Time: � /4 County:
Farm Name: Owner Email:
Owner Name: VrK40 Q_ Phone:
s -
Mailing Address:
Physical Address:
Facility Contact: r J O� Title:
Onsite Representative: vRme wiA^"10
Certified Operator: h t� , `0 rh
VDn
Region: r'r`w
Phone No:
Integrator• Tr—e_4g6W_
Operator Certification Number:
9eo
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: [� o [� 4 F--I « Longitude: [� o [� g
Design Current
Swine Capacity Population
Design Current
Wet Poultry Capacity Population
❑ Layer
❑ Non -Layer
Design
Cattle Capacity
❑ DairyCow
❑ DairyCalf
Current
Population
❑ Wean to Finish
❑ Wean to Feeder
❑ Feeder to Finish
Farrow to Wean 7 ZIA
Dry poultry
❑ DairyHeifer
❑ Cow
❑ Non
❑ Farrow to Feeder
❑ La ers
-Dairy
❑ Beef Stocker
❑ Farrow to Finish
❑ Non-ts ers
ElBeef Feeder
❑ Gilts
❑ Pullets
El Turke s
❑ Turkey Poults
❑ Boars
Other
❑ Other
❑ Beef Brood Co
Number of Structures:
❑ 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?
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 [ZPNo ❑ NA ❑ NE
❑ Yes
❑ No
PNA
❑ NE
❑ Yes
❑ No
NA
P
❑ NE
❑ Yes
❑ No
D9 NA
❑ NE
❑ Yes
�'No
❑ NA
❑ NE
❑ Yes
TO No
❑ NA
❑ NE
Page 1 of 3 12128104 Continued

•
Facility Number: Date of Inspection O O
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
FNo
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
�INA
❑ NE
Struc ure 1 Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier: I
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3f
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ yes
VNo
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
�No
El 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
f '
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 [ul No El NA El 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
maintenance or improvement? El Yes IP No El NA ❑ NE
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
maintenance/improvement?
❑ Yes 10 No ❑ NA ❑ NE
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes �9 No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptabjle/Crop
, Window j ElEvidence of Wind DDrift❑Application Outside of Area,
12. Crop type(s) ;1'� f 'e'^'�-�lct �t S l f R s4 -Y"e ,J ?
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? [:1 Yes t No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
16_ Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
17. Does the facility lack adequate acreage for land application? ❑ Yes
18. Is there a Iack of properly operating waste application equipment? ❑ Yes
P] No ❑ NA ❑ NE
No ❑ NA ❑ NE
7 No ❑ NA ❑ NE
P No ❑ NA ❑ NE
:Comments (refer to question #) .Explain any YES'answers and/or any recommendations or any othericomments "I
:: .s
Use drawtn s�of facili to:better�ex lam situations use additional a es as ne -� �
g ty p ( p g ., ,ces ary) w
Ak
IF
Reviewer/Inspector Name �- "; go r .: Phone:
ReviewerAnspector Signature: Date: /0 00
Page 2 of 3 12128104 Continued

� r
Facility ]`'umber: Date of Inspection
Required Records & Documents i I
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ?No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [ No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ 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
P No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
DI NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
Q9 No
❑ NA
❑ NE
25,
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
�B No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
In No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
IN No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
F No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
�] No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30,
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31,
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
kN No
❑ NA
❑ NE
General Permit? (iel discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
0 No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
EM No
❑ NA
❑ NE
Additional Commeats and/o�Drawigs n..:y
H
Page 3 of 3 12128104

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: O Departure Time: County: .9Aly\ f - _
r
Farm Name: Owner Email:
r _ �I�G
Owner Name: �'CQA� ��'�-i�� Phone:
Mailing Address:
Physical Address:
Region: FIZ0
Facility Contact: Title: Phone No:
Onsite Representative: Integrator: T�5- A Cre—
Certified Operator: Devi n t n Operator Certification Number:
Back-up Operator -
B
ack -up Certification Number:
Location of Farm: Latitude: [= n = [ =it Longitude: = o =1 = "
Design
Current Design
Cnrrent Design Current
Capacty
Wet Poultry Capacity
❑ La er
❑ Nor er
Population Cattle Capacity Populationn
❑ Dai Cow
❑ Da Calf
❑ Da Heifer
❑ D Cow
❑ Non -Dairy
to Finish
rOW
n to Feeder
Feeder to Finish
Dry Poultry
❑ La ers
Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Beef Stocker
Gilts
Non -La ers
❑ Pullets
❑ Turkeys
Beef FeederBoars
El Beef Brood Cowl
FO
-
Other,
❑ Other
❑ Turkey Poults
Number of Structures: j
❑ Other
Discharges & Stream Impacts
1. is any discharge observed from any part of the operation?
❑ Yes 'Q1 No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes ❑ No
�ZNA
ll
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
El 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
0NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes qPNo
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes !No
❑ NA
[INE
other than from a discharge?
ll
12128104
Continued

Facility Number: 0
'A'aste Collection & Treatment
Date of Inspection
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes MVo El NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes No 1A ❑ NE
Stricture l Structure 2 Structure 3 Structure 4 Structure � uucturc G
Identifier: j
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 31 If
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
❑ NA ElNE
(ie/ large trees, severe erosion, seepage, etc.)�No
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes
No
❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes
� No
❑ NA ❑ NE
S. Do any of the stuctures lack adequate markers as required by the permit? ❑Yes
El NA [I NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
V-
9. Does any part of the waste management system other than the waste structures require ❑ Yes
5 No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
Li o
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
LKNo
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drill ❑ Application Outside of Area
12. Crop type(s)S$
13. Soil type(s)1hLt�L9
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
,��
I3�'No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
Po
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination'
❑ Yes
WNo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
FNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
ElYes
ao
❑ NA
❑ NE
Comments (refer to question # ): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/inspector Name Phone:%Q±L3-3-33C0
Reviewer/Inspector Signature: AWAQ Oe Date:
12128104 Continued

Facility Number: Date of Inspection RHO
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes E o ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes e o ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Desig
n ❑Maps [I Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes gKo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ No ❑ NA 51'<E
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes El No O NA El NE
24. Did the facility fail to calibrate waste application equipment as required by the permit? El Yes o ❑ NA ❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
,EKo
lld'No
0NA
ElNE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
ElYes
ElNo
UHIA'
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
,��,�
1; o
ElNA
ElNE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
M o
❑ 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
2<o
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
�o
❑ NA
❑ NE
General Permit? (iel discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
,�,/
ICJ No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
2 o
❑ NA
❑ NE
Additional Ci mments aadlor Dr cgs:
12129104
12129104

(Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance r
Reason for Visit S Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access I
Date of Visit
Farm Name: r
Owner Name:
Mailing Address:
Physical Address:
'Arrival Time: Departure Time: h County: Regio-4C
Owner Email:
Phone:
Facility Contact: Title: Phone No:
Onsite Representative: —a rN'S Integrator: "S5.9—
_
Certified Operator:
Back-up Operator:
Location of Farm:
Operator Certification Number:
Back-up Certification Number:
Latitude: E__1 o =] I = µ Longitude: = ° = =
Design Current
Design Current
Design Current
Swine Capacity Population
Wet Poultry
Ce sty Population
Cattle Capacity Population
❑ Wean to Finish
❑ La er
I
Cow
❑ Wean to Feeder
❑ Non -Layer
❑Dai Calf
❑ Feeder to Finish
❑ Dairy Heifer
Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
ElNon-Dairy
El Farrow to Finish
❑ Layers
❑ Beef Stocker
❑ Gilts
❑ Non -Layers
❑ Pullets
❑Beef Feeder
❑ Beef Brood Co
❑ Boars
❑ Turke s
Other
❑ Other
❑ Turkey Poults
❑ Other
Number of Structures: ED
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
'jNo
rf
El NA
❑ NE
Discharge originated at: El 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
1t
❑ 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
FINA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
F No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
'W No
❑ NA
❑ NE
other than from a discharge?
Page I of 3
I2,128104
Continued

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?
Facility Number:
El NA El NE
P NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
❑ Yes F No
❑ Yes ❑ No
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes Wo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes WNo El NA [—INE
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 ONo ❑ NA ❑ NE
S. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes tPNo ❑ 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 Anolication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes � No ❑ NA El NE
maintenance/improvement?
11. is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes P No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[]PAN ❑ PAN > 10% or ] 0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Eviden f Wind Drift ❑ Application Outside of Area
12. Crop type(s) GX 426�
4 SM L9 "
13. Soil type(s) V"n- B r Piceu +"I (f TA A)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes 19 No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ yes
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ Yes
®No
El NA
El NE
09No
❑NA
El NE
f0No
El NA
El NE
PNo
❑NA
El NE
yComm=Midi
e051
nts {refer toestton#) iEptnanyYES?and/or an recommendaboos orany other commenpages asnc sawUse drav►m s.of to.onal Rages t
a
Reviewer/Inspector Name �Q- Phone: acb
Reviewer/Inspector Signature: Date:
Page 2 of 3 12128104 Continued

Facility Number: a— Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes %No ❑ NA ❑ NE
the appropiate box. ❑ wup ❑ Checklists ❑ Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes PNo ❑ 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
W No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
JANo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
-NO No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
O No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
91 No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
�ONo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
F No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
® No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
�9 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
W 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
DS No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
JANo
❑ NA
❑ NE
Additionai Comments and/or Drawings:
12128104

W \.5`S
Division of Water Quality
Facility Number -v, ether Agency 1 and Water Conservation l
SU v Z
Type of Visit 'I Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit AZRRouutine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: l 1j1 Arrival Time: ® Departure Time: County. �`� Region:
Farm Name: P—IZZ> Owner Email:
Owner Name: Pi f�&M 1:ckl 1?' L Phone:
Nailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative.
Integrator:
Phone No:
Certified Operator: Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm:
Swine
❑ Wean to Finish
❑ Wean to Feeder
❑ Feeder to Finish
rrow to Wean
❑ Farrow to Feede:
❑ Farrow to Finish
Boars
Other
❑ Other
Latitude: = [= , 0 Longitude: 0 ° 0 , ❑
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -Layer
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
urkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design :fCurrent
Cattle Capacity I'opulat>iou
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
Humber of Structures: ETll
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes RNo ❑ NA ❑ NE
❑ Yes
❑ No
RNA
❑ NE
❑ Yes
❑ No
�!PNA
❑ NE
❑ No ANA
❑ NE
❑ Yes
❑ Yesc]
No
❑ NA
❑ NE
❑ Yes
[ No
❑ NA
❑ NE
12128104 Continued

01
Facility Number: a— J Date of Inspection o
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
❑ Yes to ❑ NA ❑ NE
❑ Yes N No ❑ NA ❑ NE
Structure S 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
ElNA ElNE
(ie/ large trees, severe erosion, seepage, etc.)
VVVVVV�No
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
[�bNo
❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
RNo
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
1a 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
N No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
o
W
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
it 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) C-1 t/ 6 I
13. Soil type(s) _
14. Do the receiving crops differ from those designated in the CA W M P?
❑ Yes
P No
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[A No
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination'?❑ Yes
N No
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
N No
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[)4No
❑ 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 pages as necessary):
i
Reviewer/inspector Name el,7l AZoA j(F Phone: 3 3
Reviewer/Inspector Signature: Date:
It 12128104' Continued

Facility Number: — Date of Inspection
Required Records &_Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes %V No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes �O No ❑ NA ❑ NE
the appropirate box.
❑ WUP ❑Checklists El Design [I Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ® No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
Aa No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
'MA
❑ 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
E�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
FNA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
QNo
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
"11 No
YV
❑ 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
X 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
P9 No
❑ NA
❑ NE
General Permit? (iel discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
�allo
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
1 No
❑ NA
❑ NE
Additional Comments and/or Drawings:
12128104

Type of Visit I♦ Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Routine 0 Complaint 0 Follow up 0 Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: r�, Departure Time:
Farm Name: —15-0
County: Region: RZO
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: L Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude: = o = d
Phone No:
Integrator: Pr'f.S
Operator Certification Number:
Back-up Certification Number:
O = + = N
Longitude:
Design Current
Design Current
Design Current
Swine Capacity Population
We# Poultry Capacity Population
Cattle Capacity Population
to Finish
❑ La er
❑ DairyCow
to Feeder
❑Non -La er
❑ DairyCalf
r to Finish
❑ DairyHeifer
VI w to Wean 9 S7- `� i
Dry Poultry
❑ Cow
w to Feeder
❑ Non-DAIry
w to Finish
FEBoars
❑ Layers
❑ Beef Stocker
❑ Non -Layers
❑Beef Feeder
❑ Pullets
❑Beef Brood Co❑
Turke s
❑ Turke PoueEl Other
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
[ No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
Pd NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
11GNA
❑ 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
2�lo .
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
a No
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12128104
Continued

Facility Number: —15V I Date of Inspection
Waste ColleZtion & Treatment
4, is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
,�--,,�
Yes
❑ L94o
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes ❑ No
E1 A
❑ 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 ENo
❑ NA
❑ NE
(iel large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes �o
❑ 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 En�No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? El Yes [Z'No ❑ NA El NE
(Not applicable to roofed pits, dry stacks and/or wet stacks) Z�/
9. Does any part of the waste management system other than the waste structures require El Yes E2' o ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes W No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 0 No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 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)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CA WMP? ❑ Yes [?)No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ® No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable 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 E3 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
a`
Reviewer/InspectorName Phone:-7733�
ReviewerA nspector Signature: Date:
Page 2 of 3 1l 8104 Continued

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

Type of Visit ® Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit ® Routine O Complaint O Follow up Q Referral O Emergency O Other ❑ Denied Access
Date of Visit: �077� Arrival Time: Departure Time: County:
Farm Name: Es Owner Email:
Owner Name: + Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: 12a. QRJ4 I& O Le xr—s -t-
Certified Operator: �S p _ _ 12 : � ., �s W .
Back-up Operator:
Location of Farm:
Phone No:
Region: _ F12c:j,
Integrator: Pry, N i a
Operator Certification Number: .2a aG_
Back-up Certification Number:
Latitude: = 0 0 1 Longitude: 0°== u
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population Cattle
❑ Wean to Finish
❑ Wean to Feeder
❑ Feeder to Finish
® Farrow to Wean I 56L Q
❑ Farrow to Feeder
❑ Farrow to Finish i
❑ Gilts
❑ Boars
Other
❑ Other
❑ La er
-❑ Non -Layer IA
Dry Poultry
❑ La ers
ElNon-Layers
ElPuliets
❑ Turkeys
❑ TurkeyPoults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure El Application Field El Other
a. Was the conveyance man-made?
Design: Curren.t',
Capacity Population'
❑
DairyCow
El
Dairy Calf
❑
DairyHeifer
El
Dry Cow
❑
Non -Dairy
—
Beef Stocker
❑
Beef Feeder
❑
fC
Be
ef Broodo
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 [9 No ❑ NA ❑ NE
El Yes
El No
❑NA
❑NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
[i0No
❑ NA
El NE
Yes
El2
9 No
❑ NA
❑ NE
,ip
12/2&104 Continued

Facility Number: — /Sb Date of Inspection 11427ARri
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?
Structure1 Structure 2 Structure 3 Structure 4
Identifier: �
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
❑ Yes ® No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
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
[P 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
R No
❑ NA ❑ NE
8. Do any of the stuctures 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
V No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
�] No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or i0 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift El Application Outside of Area
12. Crop type(s) e C r r—Qra � / %( 1 s
13.
Soil type(s) o �f� is
14,
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
09 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
[0 No
❑ NA
❑ NE
@ommerit �(r tro question #} Y I( p1[manY�YES answers and/orrany recommendations or any other Comm
Use.drawings ofjfac�ltty to betterle)nkttng4o6s.:(use additignaipagss neeccessary,)=
Reviewer/Inspector Name
Reviewer/Inspector Signature:
7 7Phone:
Date:
J ' / 12128104 Continued

Facility Number: ,2 — Ir- Date of Inspection 57 6ur
ReguAd'Recdrds & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 0 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ® No ❑ NA ❑ NE
the appropirate box.
❑ WIJP El Checklists El Design El maps El Other
21. Does record keeping need improvement? If yes, check the apppropriate box below. El Yes ® No El NA ❑ NE
I•S
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
® No
❑ NA
❑ NE
23_
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
[I Yes
®No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
® No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
® No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
❑k 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
m No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
CANo
❑ 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
[0 No
El NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
[' No
❑ NA
❑ NE
Additional. Comments andlor Drawings: a, a'r� rti : . , .. �`..y iv.ftmi
12/2&04

[Type of Visit. 0 Compliance Inspection O Operation Review O Lagoon Evaluation {
Reason for Visit 0 Routine 0 Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Date of visit: 3 - 9.0 Tune: : D O
10 Not Operational O Below Threshold
permitted �rtified Q Conditionally Certified 13 Registered Date Last Operated or Above Threshold:
Farm Name: p g _ County:....: 19.,77094................. FIFO
Owner Name: �1.�� �..... ....' YC=..f ..... _. _ Phone No: _._....... s9 S "Z
%Mailing Address:.. ��. d . '� `� 3 .. _. ��, �p�1.....�--?
Facility Contact: .._...(! anC_A ........ �C�t,' d 4 .... Title: Phone No:
Onsite Representative:....- 44I'd,, .. �1..��.� _ .. Integrator:..._ p! ��?� �_.._. !. �l T. �........... ----
Certified Operator:._... _ _w . !l Operator Certification Number: a
Location of Farm: 015 4 r
045_W�Ine ❑ Poultry ❑ Cattle ❑ Horse Latitude • < " Longitude • 44
Discharges & Stream Impacts
I _ Is any discharge observed from any part of the operation? ❑ Yes [ -Ko-
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made'? ❑ Yes [4-Mo
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes BIQo
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 PWo
2. Is there evidence of past discharge from any part of the operation? ❑ Yes S-Mo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes GWo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure 1 Structure 2 Structure 3 Structure 4
Identiticr: ............ I--_---_----
Freeboard (inches): y f
12112103
❑ Yes Q-wo
Structure 5 Structure 5
Continued

Facility Number: k_7 — / 57-0 Date of Inspection 3 —O
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes 21 o
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑ Yes [-110
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? ❑ Yes [�No
8. Does any part of the waste management system other than waste structures require maintenancelimprovement? ❑ Yes ❑-No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes M-No
elevation markings?
Waste ADnlication
10. Are there any buffers that need maintenance/improvement? ❑ Yes [-Nb
11. Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes Eg-No
❑ Excessive Ponding❑r PAN [IHydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12- Crop type Co&oa! Srna
13- Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes aM
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?
IS. 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 B-No
❑ Yes [9-No
❑ Yes ❑-No
❑ Yes B11 o
❑ Yes ETNO
❑ Yes UNO
❑ Yes [}hlo
❑ Yes 3-No
❑ Yes �o .
Elfrield Copy ❑ Final Notes
ReviewedlnspectorName
.. -
Reviewer/Inspector Signature: Date: 3 9oy
12112103 Continued

Facility Number: $..? —� Date of Inspection oy
Required Records & Document~
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes [moo
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
Oel W TP, checklists, design, maps, etc.) ❑ Yes ❑'flo
23. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes NTo
❑ 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
[�No
25. Did the facility fail to have a actively certified operator in charge?
❑ Yes
B_1�0
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes
(ie/ discharge, freeboard problems, over application)
El-&o
27. Did Reviewer/Inspector fail to discuss reviewrmspection with on -site representative?
❑ Yes
[�10
28. Does facility require a follow-up visit by same agency?
❑ Yes
9 No
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
EYNo
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
❑ fes
�To
3I. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[DNo
32. Did the facility fail to install and maintain a rain gauge?
❑ Yes
O No
33. Did the facility fail to conduct an annual sludge survey?
D'Yes
914o
34. Did the facility fail to calibrate waste application equipment?
❑-Tes
[allo
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below.
❑ Yes
RING
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After 1" Rain
12112103

NCDENR
North Carolina Department of Environment and Natural Resources
Michael F. Easley, Governor
April 2, 2004
Prestage Farms
Attn: Randy Barefoot
P.O. Box 438
Clinton, NC 28329
Mr. Randy Barefoot
William G. Ross Jr., Secretary
Alan W. Klimek, P.E., Director
Coleen H. Sullins, Deputy Director
Division of Water Quality
During a routine quality assurance and quality control check of our records, it was noted that on the P-58
inspection form (inspection performed on 3-9-04) that a yes and a no box was checked for number 30.
The question is -is the facility covered under a NPDES Permit? Only the yes box should have been
checked. Our records have been corrected and we ask that you please attach this letter to the P-58
inspection form to show the correction.
If you have any questions please contact Mark Brantley at the Fayetteville Regional Office at (910) 486-
1541 ext. 730.
Thank you
y&t4Z d AIZI;4-1-
Mark Brantley
Environmental Specialist
225 Green Street — Suite 714, Fayetteville, North Carolina 28301-5043
Phone: [phone] FAX: [phone]Internet: ww.enr.state.nc.us/ENR/
An Equal Opportunity / Affirmative Action Employer — 50 ° o Recycled 1 10 % Post Consumer Paper
NorthCarolina
Naturally

Site Requires Immediate Attention: Ale)
Facility No.
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: , 1995
Time:
Farm Name/Owner: b ty'10 Nil - a e .an kr, ri dine --
Mailing Address:_ � Z zi
County:
Integrator: .�Q f - _ Phone:
On Site Representative: Zctce Phone:
Physical Address/Location:_T -=c-11SI tea
Type of Operation: Swine _,� Poultry Cattle
Design Capacity: 2•S� Number of Animals on Site: _ 62y_
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: Longitude: "
Circle Yes or No
Does the Animal Waste Lagoon hav sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches) Ye or No
Was any seepage observed from the la oon(s)?
Is adequate land available for spray? • Ve'MA,
or No
Crop(s) being utilized:
Actual Freeboard: ,,:_Ft. _,(_Inches
Yes oral Was any erosion observed? Yes or No
1s the cover crop adequate? Yes or No
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings? We or No
100 Feet from Wells? ($9 or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or(TQ
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line: -Yes or UO
Is animal waste discharged into water of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes or 0 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)? <&or No
Additional Comments: Il)Q r�l .-P,DJ-r1a..�rx,�.��, 1 ­=<.4— A I —A -
Signature
cc: Facility Assessment Unit Use Attachments if Needed.

r
" %_ BSCxYoN IIi
Field Site Management
1. Is animal waste stockpiled or lagoon
construction within 100 It. of a USGS
Map Blue Line Stream?
Z. Is animal waste land applied or spray
irrigated within 25 ft. of a USGS leap
Blue Lice Stream?
3. Does this facility have adequate acreage
on which to apply the waste?
Q. Does the land application'site have a
cover crop in accordance'with the
CERTIFICATIgE PLAN?
5. Is animal waste discharged into waters of
the state by marl -made ditch, flushing system,
or other similar man-made devices?
G. Does the animal waste management at this
farm adhere to Best Management Practices
(BMP) of the approved G'FRTIFICAT oN?
7_ Does animal waste lagoon have sufficient
freeboard? How much? (Approximately )
a. Is the general condition of this CAFO facility,
including management and operation,
satisfactory?
SECTION iv
Comments

:CRM F,.-,.R ANIM—A-L ='zINLO'r' OPERA71 NS
Depaz=enz of nvironment, Health and Natura-I Resources
Division of Enviranmental Management
Water Quality Section
if t::e animal waste management system for your feedlot cne_aticn
is
designed to serve more than o=
equal to 100 read
of cat --le,
75
horses, 250 swine, 1,000 sheen, or 30,000 birds t`at
are sewed
by
a licuid waste system, then t ;s
farm must be filled
cut and mailed
by December 31, 1993 pursuant _o
_5A NCAC 2 .02_7 (c)
in orde_ to
be
deemed permitted by DE_.M. °lease
print clearly.
= arm Name :_ C R QA�1u1� ? � ObiACK•
Mai ?ync Address:
Ccurty:
Owner (s) Name: .. C ����ANSE K O -bi ICI. _
Manace_(s) Name
Lessee Name:
ar-m Location (Be as specific as possible: read names, direction,
milepost, etc. ) :NlFil1 ry-i5K�
t--Oo -iC !Fozk r t-r r, i r vt )RC -NA oN t� try C S
Lat'_ _ude/Long -4zude -if known:
Desicn capacity of animal waste management system (Number and type
of con=;ned animal (s)) .('AL•i
Averace animal copulation on the farm (Number and type of animal(s)
:raised) : — A E
"ear production Began: �9' ASCS Tract No.: 10ap-6
Type of Waste Management System Used: L12V 1 h��� "i L
Acres Available for Land Application of Waste: 2-3
Owner (s) Signature (s) .
y
tgg3

,.
` 2 Y Site Requires Immediate Attention: N0
Facility No.
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: 1� 1995
Time:
2 2-
FarrnName/Owner:
Mailing Address:
County:
Integrator: Phone:
On Site Representative:. _ 24c k- MI- C u Il a �?_ Phone:
Physical Address/Location:
Type of Operation: Swine Poultry Cattle
Design Capacity: _ Z . � ��_ Number of Animals on Site: _ (2 Y_ l' ,—j 7�>
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: Longitude: 0• "
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches) Ye r No
Was any seepage observed from the lagoon(s)?
Is adequate land available for spry . � or No
Crop(s) being utilized:_ C'5n V. -`_ _
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings?4YR or No
100 Feet from Wells? Nisor No
Is the animal waste stockpiled within 100 Feet of USGS Blue. Line Stream? Yes or ®o
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line: Yes or(0
Is animal waste discharged into water of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes orlFa> If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover �ro`p)? . es r No
Additional Comments: w e /i /"a•�nc,� /� w c ro i ��.
rA0 r5
Inspector Name
Actual Freeboard: 3� Ft. 6 Inches
Yes or43Was any erosion observed? Yes okR
Is the cover crop adequate? for No
/��irgreLr_k'4 A0_11�
Signature
cc: Facility Assessment Unit
Use Attachments if Needed.

'1%`' 6Z9 sow �h, J
NORTH CAROLna DEPARTMENT OF ENV7=MCEBiT, HKALTEr & NATUML RSSo1Ai =
DIVISION OF ENVIRONMT 4L i�ANAGE[+�T
Fayetteville Regional Office
Animal Operation Compliance Inspection Form
Z 2837
All questions answered negatively will be discussed in sufficient detail in
the - Comments Section to enable the deemed Permittee to perform the: appropriate
corrections:
SECTION I
Animal Ooeration. : raYrl1w
Horses, cattle, wine poultry, or sheep
SECTION II
Y i N
1. Does the number and type of animal meet or exceed
the (.0217) criteria? [Cattle (100 head),
horses (75), swine (250), sheep (1,000),.and
poultry (30,000 birds with liquid waste
system))
2. Does this facility meet criteria for
Animal Operation IiE 10"I TION?
3. Are animals confined fed or maintained
in this facility for a 12-month period? -
4. Does this facility have a CERTIT ED ANIPML
WASTE NAPACE� PTAIV
S. Does this facility maintain waste management
records (Volumes of manure, land applied,
spray irrigated on specific acreage With
specific cover crop)?
6. Does this facility meet the SCS minim —
setback criteria for neighboring houses,
wells, etc?

State of North Carolina
Department of Environment,
Health and Natural Resources
Fayetteville Regional Office
James B. Hunt, Jr., Governor ID E H N R
Jonathan B. Howes, Secretary
Andrew McCall, Regional Manager
DIVISION OF ENVIRONMENTAL MANAGEMENT
November 21, 1994
Mr. Graham Ruddock
Route 2, Box 163
Clinton, NC 28328
SUBJECT: Compliance Inspection
Sampson County
Dear Mr. Ruddock:
On November 17, 1994, 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 [phone].
Sincerely,
Grady Dobson
Environmental Engineer
Enclosure
cc: Facility Compliance Group
Glenn Clifton
Wachovia Building, Suite 714. Fayetteville, North Carolina 28W1-5043 Telephone [phone] FAX [phone]
An Equal Opportunity Affirmative Action Employer 50% recycled/ 10% post -consumer paper

NORTH CAROLINA DEPARTKMT OF mmiammT, HEALTH & NATURAL RESOURCES
Fayetteville Regional Office
Animal Operation Compliance Inspection Form
Graham Ruddock Lowland Farm I 11/17/94 1 E 3600
Route 2, Box 163
Clinton, NC 28328
All questions answered negatively will be discussed in sufficient detail in
the Comments Section to enable the deemed Permittee to perform the appropriate
corrections:
SECTION I
Animal Operation Type:
Horses, cattle, 3 en , poultry, or sheep
SECTION II
1. Does the number and type of animal meet or exceed
the (.0217) criteria? [Cattle (100 head),
horses (75), swine (250), sheep (1,000), and
poultry (30,000 birds with liquid waste
system))
2. Does this facility meet criteria for
Animal Operation REGISTRATION?
3. Are animals confined fed or maintained
in this facility for a 12-month period?
4. Does this facility have a CStTIFIF.D
MASTS MANAGEMEM PLAN?
5. Does this facility maintain waste management
records (Volumes of manure, land applied,
spray irrigated on specific acreage with
specific cover crop)?
6. Does this facility meet the SCS minimum
setback criteria for neighboring houses,
wells, etc?
iloom,
e■�
e
Not yet
NNW
Jim=

SECTION III
Field Site Management
1. Is animal waste stockpiled or lagoon
construction within 100 ft. of a USGS
Map Blue Line Stream?
2. Is animal waste land applied or spray
irrigated within 25 ft. of a USGS Map
Blue Line Stream?
3. Does this facility have adequate acreage
on which to apply the waste?
4. Does the land application site have a
cover crop in accordance with the
CERTIFICATION PLAN?
5. Is animal waste discharged into waters of
the state by man-made ditch, flushing system,
or -other similar man-made devices?
6. Does the animal waste management at this
farm adhere to Best Management Practices
(EMP) of the approved CERTIFICATION?
7. Does animal waste lagoon have sufficient
freeboard? How much? (Approximately 7_ft. }
S. Is the general condition of this CAFO facility,
including management and operation,
satisfactory?
SECTION N
Comments
Inn
-
;INN
REM
mom
al=i
Section III (Nos. 4 and 6): A certified plan is not required until the end of
1993, but a cover crop is already established and is well managed.
This farm's appearance could be a showcase project for the swine industry.