820152_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental Qual

3' ' itivi:►ion of Water Resources
Facility Number InE Divisi-5-515A Sol! and Water Conservation
Type of Visit: $Com H nee Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: Routine O Complaint Q Follow-up O Referral O Emergency O Other O Denied Access
e^r
Date of Visit: (� Arrival Time: / Y Departure Time: Count Region:
Farm Name:�,� �� yyt 3, �"� Owner Email:
Owner Name: !� t r �� s f ; .� Phone:
Mailing Address:
Physical Address:
Facility Contact: C�dr-u— �1='�—y _ Title: /!7-�Jw yl''� Phone:
Onsite Representative: n—L� - - Integrator:
Certified Operator: '�,.�� Certification Number:/EQ Z
Back-up Operator:
Location of Farm: Latitude:
Certification Number:
Longitude:
Design Current
Swine Capacity Pap.
Wean to Finish Sim
Wet Poultry
Layer
Non -La er
Design
Capacity
Current
Pop.
Design Current
Cattle Capaci Pop.
ow
Dairy lf
Wean to Feeder
Feeder to Finish
Dairy eifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Dry, P,qultr,
La ers
Non -Layers
Pullets
Turkeys
TurkeyPoults
other
Design
Ca aci.
Current
P,o
Da'
rNn-Dai
cker
der
od Cow
Gilts
Boars
Other.
Other
Discharges and Stream Imaacts
1. Is any discharge observed from any part of the operation? [:]Yes D-ITo ❑ 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 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 �!o ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412015 Continued

Facility Number: - Date of Inspection
a Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes tJ l o ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):^
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[ -N'o
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
[31�o
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
[D] Noo
D NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[]k<o
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
[]'No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[3'N`­o'
❑ NA
' ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes []"No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): V vYl
13. Soil Type(s): /�9�rlfr�� C W .
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
LJ 1"O
❑ NA
0 NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[3' l�o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[ -N-o
❑ NA
❑ NE
Required Records & Documents
19, Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
�-�
E3�°"o
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check
❑ Yes
[] No
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑ Other:
21 _ Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes l3 '4o ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 " Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes 0N ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE
Page 2 of 3 214,12015 Continued

'L
Facility Number: - Date of inspection: 7-7
24. Did the facility fail to calibrate waste application equipment as required by the permit?y ❑ Yes ErNo ❑ NA ❑ NE
25. is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes D<o ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes to ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [3-Ko ❑ 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 ❑ Lagogn/Storage Pond ❑ Other:
�1
32. Were any additional problems noted which cause non-compliance of the permit or CAW M P?
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
to
❑ NA
❑ NE
❑ Yes
[ -No
❑ NA
❑ NE
❑ Yes
B<o
❑ NA
❑ NE
❑ Yes
ffNo
❑ NA
❑ NE
❑ Yes Er,410
❑ Yes �to
❑ Yes io
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
Comments {refer to question #) Explain any;YES answers and/or any additional recommendationsior::any other comments:
Use drawings of faeiiiiy to betteriexplam situattoas.(use additional pages:as,necessary). �,
Reviewer/Inspector Name:
i
Reviewer/Inspector Signature:
Phone:�U
Date:
2/4/2015
Page 3 of 3

(Type of Visit: iD•Co;mpha,ce Inspection 0 Operation Review Structure Evaluation Technical Assistance I
Reason for Visit: utine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit:-, Arrival Time: Departure Time: County:-- Region:
Farm Name: v���� �- �j �— 5 Owner Email:
Owner Name: L- r rD �[ i n Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: man r _ Phone:
Onsite Representative: integrator:
Certified Operator: !�'���.� Certification Number: 194—y 7
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
- De ign Currpent �y Depsign. Current Design Current
Swin11
e Ca aci •Po Wet Foul Ca acity- �P�op. Cattle Capacity Pop.
Wean to Finish
La er
Dairy Cow
Wean to Feeder
L pP
Non -La er
Dairy Calf
Dairy Heifer
Feeder to Finish
- - -=
Design ;Current
DTv Poultr. Ca aci Po
Farrow to Wean
Dry Cow
Farrow to Feeder
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turkeys
Turkey Poults
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, notifj, DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge'?
❑ Yes Quo— ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
[RNo
❑ NA
❑ NE
❑ Yes
Eq No
❑ NA
❑ NE
❑ Yes
Jallo
❑ NA
❑ NE
Page / of 3
21412015 Continued

Facili Number: Date of Inspection: L -
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
[allo
❑ NA
❑ NE
a. if yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): �=
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
�o
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
EE.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
Oe No
DNA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit'?
❑ Yes
allo
❑ 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
allo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
13 No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application'? If yes, check the appropriate box below. ❑ Yes E( No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s): T ��
v
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
L3,No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement'?
❑ Yes
ZR No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
III 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
,KNo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
E�-No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
Eq 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 KNo
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall [:]Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I " Rainfall Inspections
22, Did the facility fail to install and maintain a rain gauge? ❑ Yes [K No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment'? ❑ Yes Eallo
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑NA ❑NE
Page 2 of 3 21412015 Continued

Facili Number: - Date of inspection: 7—A, —
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes MNo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes �a 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:
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 J4 No ❑ NA ❑ NE
❑ Yes E4-No ❑ NA ❑ NE
❑ Yes E!f No ❑ NA ❑ NE
❑ Yes ER No ❑ NA ❑ NE
❑ Yes [a No ❑ NA ❑ NE
❑ Yes allo ❑ NA ❑ NE
❑ Yes No
❑ Yes [lNo
❑ Yes BNo
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments.
Use drawinns of facility to better explain situations (use additional paces as necessary},
Reviewer/Inspector Name:
Phone: 2;i D--*'303 01.E
Reviewer/Inspector Signature:
Page 3 of 3
Date: ;;, —/4 -- / Z__
21412015

i�
ivision of Water Resources
facility Number ®- % O Division of Soil and Water Conservation
O Other Agency
Type of Visit: ompliauce Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: GICoutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: p County: Region:
Farm Name:j/`r�/` �1.✓ 1�_LGf��� Owner Email:
Owner Name: rr jTbk Phone:
Mailing Address:
Physical Address:
Facility Contact: L� �p �{ k, Title: l{/��./'' Phone:
Onsite Representative: S'�� Integrator: /i745
Certified Operator: Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design Current
Design
Current
Design Current
Swine Capacity Pop.
Wet Poultry
Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
La er
Dai Cow
Wean to Feeder g)
Nan -La er
Dai Calf
- Feeder to Finish
DairyHeifer
Farrow to Wean
Desigu
Current
Cow
Farrow to Feeder
D , P,oullr
@a aci
P,o
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
I
113eef Brood Cow
Turkeys
`£
Uther.
TurkeyPoults
OtherL
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes V No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
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? [D Yes M No [] NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes V] No ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412014 Continued

ti
Facility Number: jDate of Inspection:
--/
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
® No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):^
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
allo
❑ 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
U3,No
❑ NA
[] NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental
threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
®. No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[&No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ 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 IN 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):—iy
13. Soil Type(s): ATJ , 1 ` _Z���`-� _
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes ANo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? [:]Yes D�'No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes Eq No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
t8. Is there a lack of properly operating waste application equipment?
Required Records & Documents
❑ Yes �No [] NA ❑ NE
❑ Yes [R No ❑ NA ❑ NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes '2 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes Q'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 EINo [DNA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑Stocking 0 Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes qNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes W No ❑ NA ❑ NE
Page 2 of 3 21412014 Continued

Facili Number: - Ds ection: ,;z-
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes EB-No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [:]Yes JKNo
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 allo
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [:]Yes �No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail.to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑NA ❑NE
❑ Yes IQ No
❑ NA
❑ NE
❑Yes ®No
❑NA
❑NE
❑ Yes _KNo
❑ NA
❑ NE
❑ Yes O-No
❑ NA
❑ NE
[:]Yes Jallo
❑ Yes E No
[:]Yes allo
❑NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
Comments (refer. to :question ft Explain any YES,answers and/or any additional recommendations or+any other comments:,
a ges as necesia
r5Use drawin offacility to better ez lain.stiattons use additional )• .,..
Reviewer/Inspector Name: ��� - _ Phone:
Reviewer/Inspector Signature: Date:
Page 3 of 3 21412014

Type of Visit: Q`Com nce Inspection U Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: Cr Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of MI: � Arrival Time: D Departure Time: ,'3 J County:��---- Region:
r
Farm Owner Email:
Owner Name: '�, _ Phone:
Mailing Address:
Physical Address:
Facility Contact: ze r �+( % i .11 Title: gae f„ .c ./ _.
Integrator: /I V1,0F„ r�}„y✓~
Certification Number: g L 7y
Onsite Representative:
a _
Certified Operator: _--
Phone:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current
Design
Current
Design Current
Swine
Capacity Pvp.
Vet Poultry
Capacity
Pop.
@attle1111
Capacity Pvp.
Wean to FinishI
ILayer I
Dairy Cow
Wean to Feeder
f7
Non -Lager
L
I
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Desigu
Current
Dry Cow
Farrow to Feeder
Dr. P.oul
Ca aci
P,o
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turke s
Othe
ITurkey Poults
Other
Other
Dischar es and Stream Impact
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes allo ❑ NA ❑ NE
[:]Yes 0 No
[:]Yes [] No
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes
❑ No
DNA
❑ NE
❑ Yes
[a No
❑ NA
❑ NE
❑ Yes
�3 No
❑ NA
❑ NE
Page 1 of 3 21412014 Continued

`[Facility Number: jDate of Inspection:
Waste Collection & 'treatment
• 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
No
❑ NA
0 NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure
6
Identifier:
Spillway?:
Designed Freeboard (in): T
Observed Freeboard (in): j
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
Eg 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
MNo
❑ 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
Oro
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
Eg 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
C�g No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
® No
❑ NA
❑ NE
maintenance or improvement?
11. is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [�[ No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s): _ XJd 4 l :� 7— _
14. Do the receiving crops differ from those designated in the CAWNIP? ❑ Yes ® 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 [:]Yes [A No ❑ NA' ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
® No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
® No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
® No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check
[:]Yes
® No
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
[3 No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
® No
❑ NA
❑ NE
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
[]Yes
® No
❑ NA
❑ NE
Page 2 of 3
21412014 Continued

Facility Number: 42= - Date of inspection: —
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
�&No DNA ❑ NE
• 25. is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
lS No 0 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
EZ No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
] Yes
® No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
® No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
No ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
[:]Yes
ED 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 U4No ❑ 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 Vg No ❑ NA ❑ NE
(Comments (refer to question ##): Explain any YES: answers and/or.. any additional on recommendatisi'Vr4ii"*,Sir—
erif �comm—F£ �
Use drawings of facility twbetterexplain situations (use additionai;pa -es as:nece�sary).AN
Reviewer/Inspector
Name: 7—e, &,.r— 6—
Phone:
Reviewer/Inspector Signature:
Page 3 of 3
Date: —
21412014

Type of Visit: ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: _// Arrival Time: D.'1) Departure Time: ,' / County:` Region: 5
Al
Farm Name: Owner Email:
Owner Name: Al ►��
Mailing Address:
Physical Address:
Phone:
Facility Contact: Z;ne j/ Title: Phone:
Onsite Representative: Integrator:
Certified Operator: —<C*�
Back-up Operator:
Certification Number:
Certification Number:
Location of Farm: Latitude: Longitude:
Current
Design Current
Design 014 ent
I N� �Dsign
Swine Elacity Pop.
Wet Poultry Capacity Pop.
Cattle Capacity Pop.
Wean to Finish
La er
DairyCow
Wean to Feeder
900
f 50
Non -La er
I
Dairy Calf
Dairy Heifer
Feeder to Finish
Farrow to Wean.
Design Current
D Cow
Farrow to Feeder
D . P,oui Ca ace P,o
-Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other11 MOM,
Turkey Poults
_
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
WL 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
R No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
jZ No
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

Facili Number: - sue- Date of Inspection: Z — /
f
Waste Collection & Treatment
• 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
JR) No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
[] NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
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
La 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
PK[ No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
LK No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes RNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): /`/yt q 1f ,V'_." Y�'d
13. Soil Type(s): Adenb4k A�Z:il!'`ws3
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
MNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
[:]Yes
jallo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
Eg[No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
0 Yes
PI.No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
J�gNo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
�No
❑ NA
[3 NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
allo
❑ 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 0,No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall 0 Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 " Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes L&No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes (g. No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

[Facility Number: - / Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [:]Yes No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes [,No
27. Did the facihty fail to secure a phosphorus loss assessments (PLAT) certification? [:]Yes Co 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 file drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes �?[ No ❑ NA ❑ NE
❑ Yes E[ No ❑ NA ❑ NE
[:]Yes CS -No ❑ NA ❑ NE
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
0 No
❑ NA
❑ NE
❑ Yes
INo
❑ NA
❑ NE
Comments (refer -"'to question #): Explain any YES answers and/or any additional recommendations or any oth'e comments *
Use drawings of facility to better explain situations (use additionaLpages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date:
21412011

(Type of Visit: 0 Compliance Inspection U Operation Review Q Structure Evaluation Q Technical Assistance I
Reason for Visit: • Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: j Z� Arrival Time: Q: 1 Departure Time: IZ-' County: s"Sol" Region:
Farm Name: `�{ f V WrR/cj y 4,5"' Owner Email:
Owner Name: _ 1. f �DS,rrj �a Phone:
Mailing Address:
Physical Address:
Facility Contact: Lee—Aouk /70 Title: Phone:
Onsite Representative: Integrator:
Certified Operator: Certification Number: �b I
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
f i @` '.''!"9� ^�.Y
. :. ,. � ?,,,-: hm. 8 *'_r u�•,.
i'� -•1- 1 1
1 t
1
.�+ .�,-.'..:
MINE
kro I I
__-..-=iP^'��:s�
�3
� .y ,� yy �.'�-,,.�M1 Sink- i
¢ +'g {'r`° ' 1 �
,`.E,,. �
1 _ }•
��
:-sin:.-
� ' 1 1 ���.��.i7s4
.„aX � ' I 1 - 1
�f .. •�Il:SMI�I'! ' 1 1
`. :.[- T"'�'l
�'
ENNINNIN
■
1 1
-_
■MINENNIN-
.
Beef Stocker NNIN
0
NNN�
NNN�
"
NEEN
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 R No ❑ NA ❑ NE
❑ Yes
❑ No
® NA
❑ NE
❑ Yes
❑ No
� NA
❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes ❑ No M NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes [5j 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 l of 3 21412011 Continued

Facility Number: L -152, jDate of Inspection: j Q
Waste Collection & Treatment
4_ Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No NA ❑ NE
Structure l Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: l{
Spillway?:
Designed Freeboard (in): _
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
❑ Yes No ❑ NA ❑ NE
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
0 No
❑ NA
❑ NE
maintenance or improvement?
Waste Aopication
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals
(Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): Cc�it r -Q5-5S 044u4�) cya-A
13. Soil Type(s): 6' /1
14. Do the receiving crops differ from those designated in e CAWMP?
❑ Yes
0 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?
T
17. Does the facility lack adequate acreage for land application?
❑ Yes
1�3 No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
(g 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
0 No
❑ NA
❑ NE
the appropriate box.
❑ W UP ❑ Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. [:]Yes 5,No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I " Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? [:]Yes ® No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
;a No
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
0 No
[] NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
❑ Yes
V2 No
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
No
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
No
❑ NA ❑ NE
and report mortality rates that were higher than normal?
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?
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
❑ Yes PQ No ❑ NA ❑ NE
❑ Yes P No ❑ NA ❑ NE
❑ Yes [J, No ❑ NA ❑ NE
❑ Yes ® No
❑ Yes No
❑ NA ❑ NE
❑ NA ❑ NE
Phone: U` ,33-33CO
Date: V1711y
21412011

Date of Visit: Arrival Time: Departure Time: M County: /J Region:
( y
Farm Name: AA_ Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: 14t A,k. Title:
Onsite Representative:
Certified Operator:
Back: -up Operator:
Phone:
Integrator: P&p 4PDR-i H
Certification Number: l yk / q__
Certification Number:
Location of Farm: Latitude: Longitude:
Design Current
Design C►urrent Design C•urrettt
Swine CapacityVet
Poultry Capacity Pop. Cattle Capacity Pop.
Wean to Finish
La er Dairy Cow
Wean to Feeder
Non -Layer
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design Current
Drv,P,oultr Ca aci l;o
DryCow
Farrow to Feeder
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Putlets
Beef Brood Cow
Boars
Turkeys
Other
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation'?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes S# No ❑ NA ❑ NE
❑Yes
No
�NA
❑NE
❑ Yes
[] No
NA
❑ NE
❑ Yes ❑ No
❑ Yes CP No
❑ Yes In No
NA ❑ NE
NA ❑ NE
❑ NA ❑ NE
Page 1 of 3 21412011 Continued

Facility 1Samber: - ai Date oInspection: 6
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
Identifier:
Spillway?:
Structure 3 Structure 4 Structure 5
No ❑ NA ❑ NE
No NA ❑ NE
StrucPre6
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 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 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) 1P
9. Does any part of the waste management system other than the waste structures require ❑ Yes EP No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [P No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [PNo ❑ 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 Frop Window ❑] Evidence of,Wind
� Drift ❑Appliccaaltion ,Outside of Approved ea
ads 12. Crop Type(s): 1 /V[.t L7+ Z SS q'�.�7
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'?
❑ Yes
N No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
M. No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes MNo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
[] Yes CS No
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes [*No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather
Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes I No
❑ NA
❑ NE
Page 2 of 3 21412011 Continued

Faaili Number: - Date of Inspection: ,6 IL/
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 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 T® No ❑ NA ❑ NE
Other Issues TT
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?
24. 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
[!R>No
❑ NA
❑ NE
❑ Yes
� No
❑ NA
❑ NE
❑ Yes
P9 No
❑ NA
❑ NE
[] Yes
1 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 E�j 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 aay, other comments:' '�
Use drawings of facility to better explain:situations.(use adc[thonal'pa es as necessary)..r4,
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: r
Date: /
2/ /2011

I;,..
Type of Visit 10 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: f Zd 10 Arrival Time: Departure Time: /1 County: s A_AAr S6Pj Region: Fle-0
Farm Name: �"r NIxlW31 15 Owner Email:
Owner Name• a Phone:
Mailing Address:
Physical Address: y�
Facility Contact: �'e� Ait {� Title: Phone No:
tr
Onsite Representative: Integrator: Ile It l _
Certified Operator: Operator Certification Number:
_UE��
Back-up Operator:
Location of Farm:
Back-up Certification Number:
Latitude: = o = Longitude: = ° = 4
Design Current
ii�i��j
Design Current Design Current
Swine
Capacity Population
We# Poultry
Capacity Population Cattle Eapacity Population
❑ Wean to Finish
ID Layer
❑ Dairy Cow
Wean to Feeder
1 7100 1 t -W
ID Non -Layer I
❑ Dairy Calf
Dairy Heifer
❑ Dry Caw
El Feeder to Finish
I Dry Poultry
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Non -Dairy
El Farrow to Finish
❑ Layers
❑ Beef Stocker
❑ Gilts
❑ Non -Layers
❑Beef Feeder
❑ Boars
❑ Pullets
❑ Beef Brood Co
❑ Turke s
Other
❑ Turkey Poults
❑ Other
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?
Page 1 of 3
❑ Yes ® No ❑ NA ❑ NE
❑ Yes
❑ No
ja NA
❑ NE
❑ Yes
❑ No
'] NA
❑ NE
[ftNA
❑ NE
❑ Yes
❑ No
❑ Yes
tp No
❑ NA
❑ NE
❑ Yes
�d No
❑ NA
❑ NE
12128104 Continued

Facility Number: —
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier: I
Spillway?:
Designed Freeboard (in):
r
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes ®No ❑ NA ❑ NE
❑ Yes ❑ No NA ❑ NE
Structure 5 Structure 6
❑ Yes )n No ❑ NA ❑ NE
❑ Yes In No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes A No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes liq No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes W No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? if yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptablef Crop Window
f❑ Evid&4_')
nce of Wind Drift ❑ Applicati_on,�Ou-tsi/de of Area
12. Crop h Pe(s) Se Z Sr-` ' C'�" ax_tli!
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 acre determination ?
❑ Yes
W No
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
5�No
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
Wo
❑ NA
❑ NE
Comments {refer to question #): Explain any YES answers and/or any recommendations or any other comments
Use drawings of facili to better explain situations use a¢drtional pages as necessa
g ty. xP ( P g ry):
Reviewer/inspector Name �` 171,
Phone 9/0 3
--33W
Reviewer/Inspector Signature: Date: I
/a
Page 2 Of 12128104 Continued

+ Facility Number: 2- Date of Inspection io
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 1� No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 5JNo [DNA ❑ NE
the appropriate box. ❑ WUp ❑ Checklists ❑ Desig
n ❑ Maps
p ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 6 No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
15JNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
O No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
19 No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
CRNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
WNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
'QNo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
[ No
❑ NA
❑ 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
Io
ElNA
ElNE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
�6No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
[PNo
❑ NA
❑ NE
Additional Comments and/or Drawings:
Page 3 of 3 12128104

IType of Visit a Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance I
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: 1 Z Arrival Time: r Q Departure Time: County: Region: 'y y
Farm Name: [ 3 Owner Entail:
Owner Name: Phone:
t7_
Mailing Address:
Physical Address:
Facility Contact: t'"— /.-6 DSilr Title: Phone No:
N -✓
Onsite Representative: Integrator: AM&
_ Vo
N
Certified Operator: Operator Certification Number:
Back-up Operator:
Location of Farm:
Back-up Certification Number:
Latitude: = o = { = a Longitude: = o ❑ 6 =
is
Design
Current Design C►urren# Design Current
Swine Capacity
Population Wet Poultry Capacity Population Cattle Capacity Population
❑ Wean to Finish
❑ Layer
❑ Daia Cow
Wean to Feeder
-5-D
JE1 Non -Layer
I I
❑ Dairy Calf
Feeder to Finish
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry
E]Dry Cow
❑ Non -Dairy
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Layers
❑ Beef Stacker
❑ Gilts
❑ Non -Layers
El Beef Feeder
❑ Boars
❑ Pullets
❑ Beef Brood Co
❑ Turke s
Other
❑ Other
❑Turke Poults
❑ Other
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation'?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes FNo ❑ NA ❑ NE/
❑ Yes
❑ No
IM
e NA
❑ NE
❑ Yes
❑ No
1PNA
❑ NE
❑ Yes
❑ No
QTNA
❑ NE
❑ Yes
tRNo
❑ NA
❑ NE
❑ Yes
EP No
❑ NA
❑ NE
12128104 Continued

J '`.
Facility Number: Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
EANo
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
1�NA
❑ NE
S cture 11 Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier: r
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 2`7
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[P 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
[PNo
❑ 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
PNo
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
[�No
❑ NA
❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
4. Does any part of the waste management system other than the waste structures require
❑ Yes
QPNo
❑ NA
❑ NE
maintenance or imnrovement?
Waste Aaalication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes IV No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes [DNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or ] 0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window []Evidence da,
of Wind Drift ❑ Application Outside of Area'
12. Crop type(sCXV6M �" 6' 54 , fa ), give, On'vt
13. Soil type(s)
of
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
CP No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
1� No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
19 No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
�j No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
M No
❑ NA
❑ NE
z M s. ,;: a... ,
Comments (refer question #!)' Explain any YES answers and lorf any r."ecommendations or any othe comments �
Use.:dra«ings;o faeili[y to b'etteruexplain situations. (useadditional'pages as necessary)
Reviewer/Inspector Name ` a Phone:
Reviewer/Inspector Signature: Date:l—,"ll-dog
I
Continued

[•
t
Facility Number: Date of Inspection `7 0
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes JANo ❑ 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 ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis 0 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
W No
❑ NA
❑ NE
23, if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
No
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[�No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
99 No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
P No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
® 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
TNo
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
EpNo
❑ NA
❑ NE
12128104

Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit • Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: ( Q� a - Departure Time: (I ; „r County: .�/v Region:
7S
Farm Name: s i' Owner Email:
t
Owner Name: j 9Phone:
Mailing Address:
Physical Address:
Facility Contact: oL.'4' +dos k"', Title:
r�
Onsite Representative.
Certified Operator: t�
Back-up Operator:
Phone No: f
Integrator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: = e = = " Longitude: ❑ ° ❑ g ❑ «
fA
Design Current
Desigu Current
Design Cnrrent
wine Capacity Population
Wet Poultry Capacity Population
Cattle
Capacity Population
f
❑ Wean!tto Finish
❑ Layer
❑ DairyCow
Wean o Feeder
❑ Non -Layer
❑ DairyCalf
Feeder to Finish
Dry Poultry
❑ DairyHeifer
❑ D Cow
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
❑ La ers
sElPullets
❑ Beef Stocker
ElBeef Feeder
❑ Beef Brood Co
EllGilts
Boars
❑ Turkeys
Other
❑ Other
❑ Turkey Pouits
❑ Other
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
1P No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
T NA
❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
❑ Yes
❑ No
T NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
[:]No
*NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
I] No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
TNo
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12128104
Continued

Date of Inspection �a
Facility Number: Sri %
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
EoNo
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
J& NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):% N
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
Q9 No
❑ NA
❑ NE
(ic/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
No
❑ NA
❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat, notify DWQ
7_ Do any of the structures need maintenance or improvement?
❑ Yes
EtNo
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes W 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 JP 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 �3 No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN [:IPAN > 10% or ] 0 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) LDkc& l Ei!'f'l14" t9 MSS W4, . iQS` A---_b 5M
13. Soil type(s) L ox Vi(�P ra
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
50 No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
W No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
6 No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[Q No
❑ NA
❑ NE
C � GCOV l V)1L" 5`
Reviewer/Inspector Name ` - Phone: 3
Reviewer/Inspector Signature: Date: �� 8 Cg
Page 2 of 3 12128104 Continued

Facility Number: Date of Inspection
Re uired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes `IKI
No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 'M No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design
g El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes F No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
No
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
[&No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
® No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
51 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
[P No
❑ NA
❑ NE
General Permit`? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
ESNo
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
1�9No
❑ NA
❑ NE
-,.,� , , �, g x r c wa .A i�:'%e. F: d T'i r ' "" 4` a i--'r ° #t
Acldtiona! Comments and/or Drawut s �t-;s :r rYH,
Page 3 of 3 12128104

Facility Number r,sa
0 Division of Water Quality
0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit . Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: 1 !f Arrival Time: � Departure Time: /O,'L�gp County: 5hil— s wi
Farm Name: &96ttc �fl, Owner Email:
Owner Name: WAS na Phone:
Mailing Address:
Physical Address:
Region:
a
Facility Contact: LkO$ YIA Title: Phone No:
Onsite Representative: fl Integrator:
Certified Operator: 4 Operator Certification Number:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Back-up Certification Number:
Latitude: = c [=] ' [::] N Longitude: 0 ° [=] ' 0
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
I (! i GaLfO 1 JONon-Layer
r
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 Ficld ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes.. notify DWQ)
Design Current
Cattle Capacity Population
❑
Daia Cow
❑
Daty Calf
❑
Daia Heifer
❑
Da Cow
❑
Non -Dairy
❑
Beef Stocker
❑
Beef Feeder
❑
Beef Brood Cowl
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures: ET-1
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 E ,No ❑ NA ❑ NE
❑ Yes
❑ No
E�I NA
❑ NE
❑ Yes
❑ No
4 NA
❑ NE
❑ Yes
❑ No
§�NA
❑ NE
❑ Yes
IF No
❑ NA
❑ NE
❑ Yes
1' No
❑ NA
❑ NE
12128104 Continued

l
Facility Number: _ p-- ��`d- Date of Inspection / 0
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 5�No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No BA 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 C& No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Arc 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 1P No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes [V No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes EP No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes N No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 1p 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 ❑yvidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s) IlI&Y--F,o f /__
14_ Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
M No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
E.No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
[D 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
M No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
i
Reviewerlinspector Name Phone: 1' Zq1 300
Reviewer/Inspector Signature: Date:
12128104 Continued

Facility Number: — a Date of Inspection ii D7
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ERNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes El No ❑ NA ❑ NE
the appropirate box. ❑ WUp ❑ Checklists ❑ Desig
n ❑ Maps
p El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes E,No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
ERNo
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[P No
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
EANo
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
W No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
1�3 No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
14 No
❑ NA
❑ NE
Otherlssues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
EP No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
5 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
[fNo
❑ 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
EPNo
❑ 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
qNo
❑ NA
❑ NE
E
I2128104

r
Type of Visit erc'ompiiance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit autine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: 3" " Arrival Time: Departure Time: County _T_ ` tcgion:
Farm Name: ram ,i,� ✓' ��c?.s+z- J7_L! Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: f Integrator:
Certified Operator:-�a`'+'�- Operator Certification Number:
Back-up Operator:
Location of Farm:
Back-up Certification Number:
Latitude: = o = ` = " Longitude: 0 ° ❑ ` = "
Design tNurrentl
Design Currentf '{ ' Design Current
Swne
Capacity Population Wet Poultry
Capa®itty Population AC Ie' C-apacity Population
❑ Wean to Finish
❑ La er
ei
❑ Wean to Feeder
JCV c>D
❑ Non -La ei
❑ Feeder to Finish
}
❑ Farrow to Wean
"❑
Farrow to Feeder❑
Farrow to FinishGilts
Boarser
Other
'Number of Structures:
PPE
rs
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
❑ Dairy Cow
❑ Dairy Calf
❑ Dai Heifer
❑ D Cow
❑ Non -Dar
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
1. Is any discharge observed from any part of the operation?
Discharges & Stream Impacts
❑ Dairy Cow
❑ Dairy Calf
❑ Dai Heifer
❑ D Cow
❑ Non -Dar
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
1. Is any discharge observed from any part of the operation?
1. Is any discharge observed from any part of the operation?
❑ Yes
� No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does 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
f-No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
NJNo
❑ NA
❑ NE
other than from a discharge?
12128104
Continued

Facility Number: — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. if yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes 9No ❑ NA ❑ NE
❑ Yes ®,No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes J21No ❑ NA ❑ NE
❑ Yes �Q No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? M.Yes ❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes 0 No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes V[No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes X-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 l0 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
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 acre determination'
❑ Yes
❑ No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
❑ NA
❑ NE
Reviewer/Inspector Name l� �APAQOM Phone: y ISM%
Reviewer/Inspector Signature: Date: 3 ID —A_�_
!L/La/V$ t,onnnuea

Facility Number: Date of Inspection6
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available'? ❑ Yes 24No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ yes JKNo ❑ NA ❑ NE
the appropirate box, ❑ W­UP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑Yes [�No El 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
[YNo
❑ NA
El
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
,
INNo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
0No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
ENo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
124 No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
9No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
RINo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
gNo
❑ 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
F91 No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
3 l .
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
X[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
gNo
❑ NA
❑ NE
33,
Does facility require a follow-up visit by same agency?
❑ Yes
04-No
❑ NA
❑ NE
A�diithoi sl CommenisIndlor, `Drawings
12128104
12128104

It
Type of Visit • Compliance Inspection O Operation Review O Lagoon Evaluation A
Reason for Visit • Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number S Date of Visit: 8 '�� Time: % r
Nat erational O Below Threshold
[Permitted O'/Certified D Conditionally Certified 13 Registered Date Last Operated or Above Threshold: .-------..--------
Farm Name: ....txKGC . ,D�is�2.�,1- �tnr�... ...... County: ......C���yPSr.
Owner Name: _ Cg _..._ A--._.---- �.��'a� Phone No:
Mailing Address:..... . .........de /1 c._js.Ae I[%C ._ .. �� .� 3�.�
Facility Contact: Title:..
Onsite Representative: '
Certified Operator:, 4 ipe'
Location of Farm:
Phone No:
Integrator: ... m&!P_....F....amJ!'.!...Fgi1�J
Operator Certification Number:.---_.._.__-_
[iawine ❑ Poultry ❑ Cattle ❑ Horse Latitude 0 ` " Longitude 0 ` "
Discharges & Stream Imp Cts
1. Is any discharge observed from any part of the operation? ❑ yes 011Qo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes 01 o
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) El Yes 10
c. If discharge is observed, what is the estimated flow in gal/nvn'?
d. Does discharge bypass a lagoon system? (If ycs, notify DWQ) ❑ Yes [No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes [314o
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes Ej No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ❑ No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ...... - - - - - .. --- ... _ _............_...
Freeboard (inches):
12112103 Continued

{
Facility Number: - — Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑ Yes 01 o
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 maintenancerimprovement? ❑ Yes [flo
8. Does any part of the waste management system other than waste structures require maintenance./improvement? ❑ Yes ONo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes ElKo
elevation markings?
Waste Application
10. Are there any buffers that need maintenancelimprovement? ❑ Yes B No
11. Is there evidence of over application? If yes, check the appropriate boa below. ❑ Yes ❑ No
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type Brrmvda , .511 G ra:, — H0
I3. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAW")? ❑ Yes G3Xo
14. a) Does the facility lack adequate acreage for land application? ❑ Yes ado
b) Does the facility need a wettable acre determination? ❑ Yes GWo
c) This facility is pended for a wettable acre determination? ❑ Yes MWo
15. Does the receiving crop need improvement? ❑ Yes allo
16. Is there a lack of adequate waste application equipment? ❑ Yes 9 No
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge attor below ❑ Yes ❑ NO
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes ®-No
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes D No
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional ❑ Yes Rio
Air Quality representative immediately.
- :.Usetd--'r-i ai w-�-uag.�3's',� 'o� x"f ' l�-.m'- tyS�to - b"�eamt-t•'e4�r�"e.-x.:�.p`..lam-�1rsxi�.tcu�-Ea#�oa�sT�.�-{-.u�-sre.—a—dsdT,z- L�� oaZ.�a, i pages aemss. nfe--c-eee-s.rs""a�sri,y!Yo-)^� .� ld-t''m.�❑�m.. r e.F.�(reer`to queston ) zI a any�Eanswersnor any mtinsor-anyoheroon-ar.-
Co:nmeus
Al.
If105l,'n9 Js 4yt75 {� VV al/ �'e%rS �.r �os7vrc
Has `l�Gnf -�`0 6� jioq aro�H� �asoas, fo Co.,irc/ drit�r �.,ol art S/roj5 4�cod
r
$pp�.e,f Fd Conira! �Vem.
. T
Reviewer/Inspector Name _4
err 1' kk
ReviewedInspector Signature: Date: 8 - /U • J 7
121.12103 Continued

l
Facility Number: Date of Inspection
Reuuired Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
9-No
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
Gel I
WJP,mists, design, aaaps, etc.}
El Yes
ONo
23. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
Q-No
❑ Ww te-,4 ca4Qs— ❑ Freebeard ❑ WssieAftelysis ❑ l
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
O-No
25. Did the facility fail to have a actively certified operator in charge?
❑ Yes
0 M
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
moo_
27. Did Reviewer/Inspector fail to discuss review/mspection with on -site representative?
❑ Yes
[3-11�6
28. Does facility require a follow-up visit by same agency?
❑ Yes
MNO
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
a No
N'PDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
❑ Yes
[}No
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
32_ Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ No
33_ Did the facility fail to conduct an annual sludge survey?
❑ Yes
❑ No
34. Did the facility fail to calibrate waste application equipment?
❑ Yes
❑ No
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below.
❑ Yes
❑ No
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After V Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
12112103

Type of Visit ® Compliance Inspection Q Operation Review 0 Lagoon Evaluation
Reason for Visit ®Routine O Complaint O Follow up O Emergency Notification Q Other ❑ Denied Access
Facilin• Number Date of Visit: Time: ' i �
Not O erational Q Below Threshold
® Permitted ® Certified 0 Conditionally Certified 0 Registered Date Last Operated or Above Threshold-
Farm Name: dea.ycx j)ts,, .. W3. �L , f- Jr Count•:
Owner Name: Le'e_ Phone No: _11'`J
0Mailing Address: L..r 2.0.jg � �� At-C.
facility Contact: LaG Title: Phone No:
Onsite Representative: Lee- toCbnti Integrator: k
Certified Operator: L Cr__ i]L Operator Certification Dumber: q 4'
Location of Farm:
M Swine ❑ Poultry ❑ Cattle ❑ horse Latitude ' 4 « Longitude ' �• �"
Design Current
Swine ronarity Pnnnlatinn
® Wean to Feeder
a
v-ti
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Number of Lagoons
Holding Ponds / Solid Traps
Design Current Design Current
Poultry Ca acity Population Cattle Ca neity Po ulatlon
❑ Laver I ❑ Dairy
❑ Non -Laver I I ❑ Non -Dairy
❑ Other
Total Design Capacity
Total SSLW
1Ll Subsurface Drains Present ]ILJ Lagoon Area lU Spray Field Area
❑ No Liquid Waste Management System - _
Discharges & Stream Impacts
1. Is anv discharge observed from any part of the operation?
❑ Yes [RNo
Dischar,c originated at: ❑ Lagoon ❑ Sprav Field ❑ Other
a. If discharge is observed, was the conveyance man-made? El Yes ❑ No
b. if discharge is observed, did it reach Water of the State? (If ves, notify DWQ) ❑ yes ❑ No
c. If discharge is observed• what is the estimated flow in eal/min?
d. Does discharge bypass a lagoon system? (If yes, notiN, DWQ) ❑ Yes ❑ No
2. is there evidence of past discharge from any part of the operation? El Yes JNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes R No
Waste Collection 8- Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes � No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard (inches): 1� �-
05/03/01 Continued

Facility Number: — I Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ic/ trees, severe erosion, ❑ Yes (� No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? El Yes (� No
(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 maintenance/improvement? ❑ Yes Q No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes ® No
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes No
11.
Is there evidence of over application? ❑ Excessive Pondmg ❑ PAN ❑ Hydraulic Overload
❑ Yes
®.No
12.
Crop type ii cryyi '
13.
Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
PQ No
14.
a) Does the facility lack adequate acreage for land application?
❑ Yes
Q No
b) Does the facility need a wettable acre determination?
❑ Yes
❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes
❑ No
15.
Does the receiving crop need improvement?
❑ Yes
4Q No
16,
Is there a lack of adequate waste application equipment?
❑ Yes
El No
Reauired Records & Document!
17.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
ff No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
® No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
❑ No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
PNo
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
P No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes §3 No
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative'? ❑ Yes fo No
24. Does facility require a follow-up visit by same agency? ❑ Yes CR No
25. Were any additional problems noted which cause noncompliance of the Certified A WMP? ❑ Yes JTTo
© No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit
p. y� answers ..
A ran recommendahons;or any other comments `.:
Gomme�ts refer to' ueshon # Er taut any"YES answers an y � ,_„
4
tter eaptamNsituaaons(use,autunonat,pages FF�ps necessary)❑Field Copy El Final Notes
`mot c V11) �� re6 + t e_p'n�' k. 0 k c A verj ? bco
Reviewer/Inspector Name f
Reviewer/Inspector Signature:
Date:
05103101
Continued

Facility Number: — Date of Inspvctinn
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge atfor below
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours?
28. 1s there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt.
roads. building structure. and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon?
30. Were any major maintenance problems with the ventilation fan(s) noted? (Le, broken fan belts, missing; or
or broken fan blade(s), inoperable shutters. etc.)
31. Do the animals feed storage bins fail to have appropriate cover?
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
AdditionaUCottiiiients.and/or Drawidgs .
05103101
❑ Yes ❑ No
❑ Yes IR No
❑ Yes ED No
❑ Yes ®No
❑ Yes bg No
❑ Yes ® \o
❑ Yes ❑ No

a
Site Requires Immediate Attention:
Facility No. _ 45:Z=
j DMSION OF ENVIRONMENTAL MANAGEMENT
f ANUAAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: J M 0 1995
Time:
Farm Name/Owner: __ C _ 14— C FG /-0-7
Mailing Address: 0 , Oo x C 1• -I "tc)•-I �✓ ,c , _ a j- ? a d� --
County: _ :5 6,
Integrator: Phone: 9 /t _A &F- 3 Q d'
On Site Representative:_ ,.z r h' % v'3 r , ,, ; A Phone:
Physical Address/Location: S P to zo G
Y
Type of Operation: Swine ✓ PouItry Cattle
Design Capacity: 3,d gnrzt2 Number of Animals on Site:..,,..Ks...
DEM Certification Number: ACE_ DEM Certification Number: ACNEW
Latitude: « Longitude: «
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately I Foot + 7 inches) 0e. or No Actual Freeboard:_ L—Ft. � � Inches
Was any seepage observed from the ]a oon(s)? Yes or l&o Was any erosion observed? Yes orCo
Is adequate land available for spray. e or No Is the cover cro adequate? Uesor No
Crop(s) being utilized: 0 a - 1
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings? a or No
100 Feet from Wells? ZDe or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or&
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line: Yes or—C
Is animal waste discharged into water of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes or No 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:
1_4 �� J�� - �� -
Inspector ame Signature
cc: Facility Assessment Unit Use Attachments if Needed.

'k, .
► r a ��,„
Site Requires Immediate Attention:
Facility No.
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: 24 , 1995
Time:
Farm Name/Owner: _ C+
Mailing Address:
County:
Integrator: _^ . _ _ _ Phone:
On Site Representative: _ _ Phone:
Physical Address/Location:
Type of Operation: Swine -age'o" Poultry - Cattle
Design Capacity: 1 __ Number of Animals on Site: -(aid
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: Longitude: "
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches)
Was any seepage observed from the
Is adequate land available for spray"
Crop(s) being utilized:
No Actual Freeboard:_ a Ft. _Inches
Is)? Yes or�&Was any erosion observed? Yes or o,
r No Is the cover crop adequate? Yes or No
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellin . e or No
100 Feet from Wells? Ye or No
Is the animal waste stockpiled within 100 Feet of USGS Blue -Line Stream? Yes onNN
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue-3ne: Yes oQ
Is animal waste discharged into water of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes or CO)If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? Yes or No
Additional Comments:
Inspector Name
Signature
cc: Facility Assessment Unit Use Attachments if Needed.

REGISTRATION FORM FOR P.NIMAL F= = DLOT OPERATIONS
Department of Environment, Health and Natural Resources
Division of Environmental Management
Water Quality Section
If the animal waste management system for your feedlot operation is
designed to serve more than or equal to 100 head of cattle, 75
horses, 250 swine, 1,000-sheen, or 30,000 birds that are served by
a liquid waste system, then this form must be filled out and mailed
by December 31, 1993 pursuant _o 15A NCAC 2 .0217 (c) in order to be
deemed permitted by DEM. Please print clearly.
Farm Name: C & C FARMS
Mailing Address: PO Box 86
Clinton, NC ZIP Z8726
County: Sampson Phone No. -
Owner (s) Name: W. F. Carr
Manager (s) Name: W. F. Carr
Lessee Name: P3 A
=arm Location (Be as specific as possible: road names, direction,
milepost, etc.)
From Clinton take 24 W. pass Roseboro about 4 miles turn �rccltie.
L. on SR'r 1255. Farm is about 4 miles on the L.
Lat_tLde/Long i-!_ude if )mown:
Design capacity of animal waste management system (Number and type
c= confined an_mal(s)): 3315 Feeder to toopina
Average animal population on the farm (Number and type of animal (s)
-raised) 3315__,Zgppina Farm „
Year Production Began:1991 ASCS Tract No.: 1584
Type of Waste Management System Used: Laaoon/irrigation
Acres Available for Land Application of Waste:
Owner (s) Signature (s) :
28
DATE:

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