820166_INSPECTIONS_20171231

NUH I H UAHULINA
Department of Environmental Qual

3 \vy —5
ILCM Division of Water Resources
Facility Namber - 0 Division of Soil and Water Conservation
� Other Agcy
Type of Visit: ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: (a'Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: S rr (&Arrival Time: ! t Departure Time: i. 3i) County:Region: f ' lZ-0-
Farm Name: m j Vt H o,A -esig �,! j a.,r,A
Owner Name: j- .Mea YRi CA d -ef A �i✓
Mailing Address:
Physical Address:
Owner Email:
Phone:
Facility Contact: Cc's-%,%+fi S Title: Phone:
Onsite Representative: �y I t
Certified Operator: Hope
Back-up Operator: _ �l� t' f e
Location of Farm:
Integrator: PrvcFC '
Certification Number: a g- D q
Certification Number: 11 &- pg 2
Latitude: Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Wet Poultry
Layer
Design
Capacity
Current
Pop.
Design Current
Cattle Capacity Pop.
Da Cow
Wean to Feeder
]Non -Layer
Dai Calf
Feeder to Finish
❑ Yes
❑ No
E3 --NA
Dai Heifer
Farrow to Wean 12-00 —
❑ Yes
Design
Current
D Cow
Farrow to Feeder
D . P,oult
Ea aci
Po
Non -Dairy
Farrow to Finish
Layers
❑ No
E51&A
Beef Stocker
Gilts
Non -Layers
[3 -No
❑ NA
Beef Feeder
Boars
Pullets
[3'No
❑ NA
Beef good Cow
of the State other than from a discharge?
Turkeys
Otherllll
Turkey Poults
01 Other
Other
Discharees and Stream Imuacts
1. is any discharge observed from any part of the operation?
❑ Yes
Q -Kc
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
E3 --NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
[] No
Q1T'A
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
❑ No
E51&A
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
[:]Yes
[3 -No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
[:]Yes
[3'No
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412015 Continued

Facility Number: - Date of Inspection: OLS' o
❑ Yes
[E'&o
❑ NA
❑ NE
Waste Collection & Treatment
❑ Yes
[E'llo
❑ NA
❑ NE
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
O-No—
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
[-]No
LO-NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
❑ NA
Identifier:
the appropriate box.
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
[:]Yes
D 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
[a<o
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify
DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
Q<
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[3'go
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
[3'5-o
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
[-]Yes
Q'No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes �Io ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > l0% 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): f M L cQ ._ S G 0 0 C
13. Soil Type(s): 4LA_ ^�
14. Do the receiving crops differ from those designated in the CAWMP? [-]Yes D -11o_ ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [g-fio ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable [:]Yes [9-<o ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[E'&o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[E'llo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
Eal<o
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[cKo
❑ NA
❑ NE
the appropriate box.
❑WUP [I Checklists ❑ Design ❑ Maps ❑ Lease Agreements []Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. [:]Yes �No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard [:]Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [3'�Io ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 2<0 ❑ NA ❑ NE
Page 2 of 3 214/1011 Continued

F'acilf Number: - Date of Inspection: p
• 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❑'i o� ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes []moo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes Q 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 ❑ 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 �o ❑ NA ❑ NE
❑ Yes [ o ❑ NA ❑ NE
❑ Yes 2'Ro ❑ NA ❑ NE
❑ Yes [Erl�o ❑ NA ❑ NE
❑ Yes []-wo-
❑ Yes [J�o
❑ Yes ❑moo
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments ,(refer to question ft Explain any YES answers and/or any additional recommendations or, any,othercosnments
..
Use drawings of facility to better ex latn sitiation5f use additional pages as necessary).- �- -
����Efi�� - �J4 C P'." -et
I .S -P
C.?,1( o.10- 3 0% , 6 Fs- S (
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
1�C''Aj*V0 Phone: /o- q 33-. 337
;J Date: 11 l
2/4/2015

I AS. 1-7 Ca I
Type of Visit: Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: (routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: Departure Time: County: Region: lit"
Farm Name: ycr'v Owner Email:
Owner Name: t k Phone:
Mailing Address:
Physical Address:
Facility Contact: ea'C. 5 ���Gcit(�tL Title: Phone:
Onsite Representative: l i Integrator: pf- C &1_0
Certified Operator: f •l 4( A C Certification Number: f 3
Back-up Operator:
Certification Number:
Location of Farm: Latitude: Longitude:
Design Current ` Designer Cprrent ' � -= '� � ;'!� : °Design Current
Swine Capacity Pop. �pouitryC
apacity Pop Cattle. Capacity Pop. =:
Wean to Finish Layer DairyCow
Wean to Feeder Non -La er
Dairy Calf
Feeder to Finish DairyHeifer
Farrow to Wean 0-00 - D Design Cre rent Dry Cow
Farrow to Feeder
Ca aci 1'o Non -Dairy
Farrow to Finish La ers Beef Stocker
Gilts Non -La ers Beef Feeder
Boars Pullets Beef Brood Cow
Turkeys "
Other
Turkey Poults -�
Other Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes tL.P" p NA ❑ NE
❑ Yes ❑ No ❑1%A ❑ 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
❑'Nio
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
�rNo
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412015 Continued

Facilitv Number: /h L Date of InspeetiOn:
Waste -Collection & Treatment
4! is storage capacity (structural plus storm storage plus heavy rainfall) less khan adequate? ❑ Yes[�' 1�❑ NA ❑ NE
1
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No �A ❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
RAI�o
❑ NA
Spillway?:
15. Does the receiving crop and/or land application site need improvement'?
❑ Yes
ErNo
❑ NA
Designed Freeboard (in): _
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
�o
❑ NA
Observed Freeboard (in):
acres determination?
❑ Other:
5_ Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
� 'Vo
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
18. Is there a lack of properly operating waste application equipment?
❑ Yes
<o
❑ NA
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
Flo
❑ NA
❑ NE
waste management or closure plan?
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
[:]Yes
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
[EJ -No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[Er"&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
❑-1Qo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
E315o
❑ NA
❑ NE
maintenance or improvement?
11, Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes E30ONo ❑ 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): f) `,rltt kA 560
0
13. Soil Type(s): AA
No
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
RAI�o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement'?
❑ Yes
ErNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
�o
❑ NA
❑ NE
acres determination?
❑ Other:
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
<o
❑ NA
❑ NE
Required Records & Documents
No
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
C!
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
❑ 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
dNo
❑ 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
�o
❑ 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 21412015 Continued

Facili Number: ML- Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes g -<o ❑ NA ❑ NE
21. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes CD,>a ❑ 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 [21% ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? 0 Yes E2 -No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes �o ❑ NA ❑ NE
❑ Yes [2 -No ❑ NA ❑ NE
Yes [--No ❑ NA [:]NE
❑ Yes [a -No ❑ NA ❑ NE
❑ Yes dNo
Yes [ N' o
❑ Yes [!T*No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ONE
Ue d encs (r'efe� to question #): Explatn�Any YES;answers and/or"'any iiddtttonal;recomittendatioas or.any otlte mments.
O x
_rawingsyofgfacility to better e�rplam situattotts,(use addtttonal. pages�,as neves"nary) _� � ._;
e,
Reviewer/Inspector Name:
Reviewer/Inspector Signatur
Page 3 of 3
Pbone:Y(O
Date:
2/4/20]5

Type of Visit: 1UCoompliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
. Reason for Visit: (? routine 0 Complaint 0 Follow-up O Referral 0 Emergency O Other O Denied Access
Date of Visit: Arrival Time: Departure Time: , D p County: So4)t( Region:
Farm Name: ( -L _go W Owner Email:
Owner Name: l� Phone:
Mailing Address:
Physical Address:
/� JJ r
Facility Contact: GUAM � Zir6, {,O title:
Onsite Representative: L
Certified Operator: P 1 1Y
Phone:
Integrator:
Certification Number: d
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Discharges and Stream Impacts
Design Current
Design 'urrent
Design Current
1. Is any discharge observed from any part of the operation?
Swine
Capacity Pop.
Wet Poultry'.. ' `Cap tty Fop.
Caa le Capacity Pop:
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
We to Finish
Layer
Da' Cow
a. Was the conveyance man-made?
We to Feeder
Feeder to Finish
❑No
Non -La er
Da' Calf
Da' Heifer
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
Farrow to Wean
00 —
D sign
D Cow
Farrow to Feeder
,Current
D P_oult . Ca aci Top.
Non -Dairy
[:]Yes
Farrow to Finish
16NA
I Layers
Beef Stocker
❑ Yes
Gilts
❑ NA
Non -Layers
Beef Feeder
Boars
0No
jPullets
Beef Brood Cow
of the State other than from a discharge?
F
Turkeys
- -
Other
TurkeyPoults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
�o —
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
[:]Yes
❑No
C3 NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
[:]No
�TA
❑ 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
16NA
❑ WE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
]ffNo
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
0No
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3
2/4/2011 Continued

Facili Numbar: - Date of Inspection:
❑ Yes
[3No
❑ NA
Waste Collection & Treatment
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
1� to
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
Obi� NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
[:]No [G]•Ad'A
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
❑ Yes
�_eNo
❑ NA
Spillway?:
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[:�/No
Designed Freeboard (in):
❑ NE
Required Records & Documents
Observed Freeboard (in):
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
1734 ❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
❑ Yes
[](No
❑ NA
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
[yio ❑ 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 <o ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes [Zfo ❑ 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 No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ZNo ❑ 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): 4-1tl.d�Q,
13. Soil Type(s): �..
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[3No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
1� to
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
[jrNo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
�_eNo
❑ 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
EdNo
❑ 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 ffNo ❑ 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 U**No ❑ NA ❑ NE
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [TNo [] NA ❑ NE
Page 2 of 3 2/4/2014 Continued

924 11 j
Facility Number: jDate of Ins ection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ER"No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes aKo ❑ 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 E�No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [R(No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes [y 01No❑ 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?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes E!(No ❑ NA ❑ NE
❑ Yes [200'No [DNA ❑ NE
❑ Yes dNo ❑ NA ❑ NE
Comments, (refer to question ft Explain any YES answers and/or any additional recommendations or any other comiments
rte z =r
Use drawings of facility to better explain situations (use additional pages as necessary).
cr"A'b'jfA
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
t2-3('(7
Phone: —U ]=" � ] j 1
Date: 11M,A
21411011
❑Yes
dNo ❑ NA ❑ NE
I—] Yes
gNo ❑ NA ❑ NE
❑Yes
eNo ❑ NA [:]NE
Comments, (refer to question ft Explain any YES answers and/or any additional recommendations or any other comiments
rte z =r
Use drawings of facility to better explain situations (use additional pages as necessary).
cr"A'b'jfA
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
t2-3('(7
Phone: —U ]=" � ] j 1
Date: 11M,A
21411011

Type of Visit: (LWompliance Inspection U Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: r ( Departure Time: ounty:_ Regiont
Farm Name: r G ' V-^ Owner Email:
Owner Name: -iKt N If _ Phone:
Mailing Address:
Physical Address:
Facility Contact: 004-V 13 . SIJ rA Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator:
Certification Number:
Certification Number:
Longitude:
III 11�111� 4111 Design Current
Design
Current
Design Current
Swine Capacity Pop.
Wet Poultry
Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
Layer
Dairy Cow
Wean to Feeder
Non -La er
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
D , foul
Ca aci
P,o
Non-Daixy
Farrow to Finish I
ILayers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
I Beef Brood Cow
Turkeys
Other
Turkey Poults
Other Other
Discbar es and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify 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?
Page l of 3
❑ Yes � ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes �o
❑ Yes E�rNo
[3 -MA ❑ NE
[�A ❑ NE
[]INA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
2/4/2014 Continued

Facili Number: Date of Inspection:
Waste Collection & Treatment
❑ Yes
dNo
❑ NA
❑ NE
4. is stoAe capacity (structural plus storm storage plus heavy rainfall) less than adequate?
0 Yes
gNa
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
[;]�
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
Spillway?:
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis p Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
Designed Freeboard (in):
22. Did the facility fail to install and maintain a rain gauge?
[:]Yes
U r10
❑ NA
Observed Freeboard (in):
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
F?JINo
[] NA
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
�o
0 NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
[,mss
❑ 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
Ey5o
❑ NA
❑ NE
S. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
LD Ko
❑ 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
0 Yes
Q' V�o
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
0'No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes e'<o ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. CropType(s): �,G1tµ•t �(.�
13. Soil Type(s): U_
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes ❑ No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ❑ No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes ❑ No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
dNo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
Lj4"Ko
❑ 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 p 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
U r10
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
F?JINo
[] NA
❑ NE
Page 2 of 3 2/4/2014 Continued

lFacility Number: jDate of Inspection: t.`
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes n Nom ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes '[�•i ro ❑ 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)
❑ Yes
JB -99
❑ NA
❑ NE
[:]Yes
[ o
❑ NA
❑ NE
[—]Yes [3 -go ❑ NA ❑ NE
❑ Yes CZ PO ❑ NA ❑ NE
❑ Yes [B<o ❑ NA ❑ NE
31. Do subsurface tile drains exist at the facility? if yes, check the appropriate box below. [] Yes 21qo
❑ Application Field ❑ Lagoon/storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes 931%0
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative? ❑ Yes r';Wo
34. Does the facility require a follow-up visit by the same agency? ❑ Yes ER -No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations-oraayiothe,r,-commeats�
Use drawings of facility to better explain_ situations (use additional pages as necessary).+°
C.tl'41 t
7e, q '0
'- �)
Reviewer/Inspector Name: 11 ( Phone: t3
Reviewer/Inspector Signature:Lk tl�tm
Date: f'
Page 3 of 3 214/2011

r fts 13 VA, l
Type of Visit: QR6mpl' ce Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: ou6ne 0 Complaint 0 Follow-up 0 Referral O Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: County: `-'J J-U/l Region:�-�/L.�j
r_�
Farm Name: e ` �'� 11-t� Owner Email: 1
Owner Name: z✓' Kt Phone:
Mailing Address:
Physical Address:
Facility Contact:- U Title:
Onsite Representative:-(.;w"i
Certified Operator:
Back-up Operator
Location of Farm:
Latitude:
Phone:
Integrator: ;4f R
Certification Number: rb g
Certification Number:
Longitude:
esign Current
Doa
9i
Current
Design Current
Swine Capac ty Pop.
WetPoultry '-
"D
dap ty
Pop.
Cattle Capacity Pop.
Wean to Finish
ayer
Dairy Cow
Wean to Feeder
Layer
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
-
Design
Current
Dry Cow
Farrow to Feeder
D : 1P.ou1
Ca acity
P,o
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Illoill 11-'i
Turkeys
Other
Turkey Poults
Other
Other
Discharges and Stream Imoacts
I. Is any discharge observed from any part of the operation? [—]Yes NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? [:]Yes [] No �;�A
�" ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) ❑ Yes E] No E3 NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (if yes, notify DWQ) ❑ Yes ❑ No A ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yesi/o E] NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes 121<0 ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 2/4/2011 Continued

Facility Number: - Date of Inspection:
WAste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ YesZ[M
NA ❑ NE
a. if yes, is waste level into the structural freeboard? ❑Yes NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): M
t
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ❑ 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 5o ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes [L"'o ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes [JN4r_1 ❑ 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 fo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
[] YeseeN*o_,,,D
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
Window ❑ Evidence of Wind Drill [:1 Application Outside of Approved Area
❑ Outside of Acceptable C8"ejV1tVA
12. Crop Type(s):
13. Soil Type(s): •�
14. Do the receiving crops differ om those designated in the CAWMP?
❑ Yes
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[:I<o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
Ijo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
2<0
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yesio
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yesio
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No
❑ NA
❑ WE
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 0 Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections [:]Monthly and V Rainfall Inspections Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes No ❑ NA ❑ NE
Page 2 of 3 2/4/2011 Continued

Facili • Number: Date of fns ection:
'i kiv
24!Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes M o ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes g4lo' ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes Cg4o ❑ 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 (34o" ❑ 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 ted o ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. ❑ Yes M ZNo ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ YesVNo
❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative? ❑ Yes ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes D -No ❑ NA ❑ NE
Comments (refer to question #): Explain any.YES answers and/or any additional recommendations or any other comments:`
Use drawings of facility to better explain situations (use additional pages as necessary).
k�_�
V ( d f
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
"" [ 3,
Phon o
Date: 04, Iq
2/4/2 1 11

I
iype of visit: ut�ompnance inspection to Lrperatton xevtew u structure P-vatuanon a +ecnmcat Assistance I
Reason for Visit: routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: / Arrival Time: 7'30f0n I Departure Time: !3G A County: Jq Region: f/�1`1
Farm Name: MttiCF— HA Qlr 170R
Owner Name: 'yqr�2_5 M-%_,1.Aex V1ORE
,Mailing Address:
Physical Address:
Owner Email:
Phone:
Facility Contact: ��p,, 5 �qR s ,Title: &AAXCA) `&7 C ,0&S'1- Phone:
Onsite Representative: SN,\F-
Certified Operator: �jgtv�,s M, NdQ�
Integrator: _"o§gnotra i
Certification Number: Z zo %% ,
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design' -Current
".
aDesign
Current
Design Current
Swine Capacity fop.
Wet Poultry
Capacity
Pop.
Cattle C•apaeity Pop.
Wean to Finish
La er
Dai Cow
Wean to Feeder
Non -La er
Dai Calf
Feeder to Finish
a
Dai Heifer
Farrow to Wean I 'aU
Design
Curreni
D Cow
Farrow to Feeder
Dr. P,oult f
Ca aci
Pop.
Non -Dairy
Farrow to Finish
Layers
I I
Beef Stocker
Gilts
Non -Layers
MBeef Feeder
Boars
Pullets
I
Beef Brood Cow
Turkeys
Other
Turkey Poults
L_jOther
I 10ther
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes dN o ❑ 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)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
[-]Yes [] No
❑ Yes fNo
❑ Yes E""No
�NA ❑NE
❑NA ❑NE
❑NA ❑NE
Page I of 3 2/4/2011 Continued

y
❑ Yes ["No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
Facili Number: - ` Co Date of Inspection: l ?
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
❑ NE
Waste Collection & Treatment
9. Does any part of the waste management system other than the waste structures
require ❑ Yes E3*"No
❑ NA
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
[gNo
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
E? NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [( No
Identifier: Z
[] NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground
❑ Heavy Metals (Cu, Zn, etc.)
Spillway?:
❑ 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
Designed Freeboard (in): lc
Observed Freeboard (in): w4
5. Are there any immediate threats to the integrity of any of the structures observed?
[:]Yes
[ff 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
[fNo
❑ 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 gNo
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
❑ NE
Required Records & Documents
9. Does any part of the waste management system other than the waste structures
require ❑ Yes E3*"No
❑ NA
❑ NE
maintenance or improvement?
[ o
❑ NA
❑ NE
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes [5 No
❑ NA
❑ NE
maintenance or improvement?
the appropriate box.
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):
0
13. Soil Type(s): V)LABmu:[-- '-k
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [a 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 ❑ Yes E No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
[:]Yes
[9 -No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[�fNo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
[:]Yes
[ o
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
[:]Yes
[EI'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 ff No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield C:]120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? [:]Yes dNo
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No
Page 2 of 3
[] NA ❑ NE
❑ Weather Code
[❑ Sludge Survey
❑ NA ❑ NE
U3'0N"A ❑ NE
214/7011 Continued

f �
[!Y'No
❑ NA
❑ NE
Facility Number: - Date of Inspection: J'
CErNo
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
E!fNo
❑ NA ❑ NE
25_ Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
[g'^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
[E(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
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
[!Y'No
❑ NA
❑ NE
❑ Yes
CErNo
❑ NA
❑ NE
[—]Yes [!YNo ❑ NA ❑ NE
[:]Yes & o ❑ NA ❑ NE
[:]Yes [ONO
❑ Yes [!fNo
[:]Yes [!(No
❑NA ❑N
❑NA ❑NE
❑ NA ❑ NE
Reviewer/Inspector Signature: _FAL� Date: 4J (710 -
Page 3 of 3 21412011

5
w
VW -
Type of Visit: � Compliance Inspection U Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: &xoutine Q Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: X1 QU Departure Time: County: /
Farm Name: L! I -7L yrjyL� Owner Email:
Owner Name: e-5 LILCj-*—I Phone:
Mailing Address:
Physical Address:
Region: [J
Facility Contact: t.Ld-�-tS &1.!^(. jjjL. Title: �CX� _ L Phone:
Onsite Representative: &L W_' Integrator:
Certified Operator: 5 4 Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Discharges and Stream Imnacts
1. Is any discharge observed from any part of the operation?
Design
Current;NEW
Design
Current
Design C«urrent
Swine
Capacity
Poptpaul�try `Capacity P.op
Cattle Capacity Pap.
❑ Yes
❑ No
[tom 1A
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
CBIGA
We to Finish
c. What is the estimated volume that reached waters of the State (gallons)?
La er
Dai Cow
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
We to Feeder
❑ No
Non -La er
0 NE
2. Is there evidence of a past discharge from any part of the operation?
Dai Calf
�o
Feeder to Finish
❑ NE
�'`
,I
"'
Dai Heifer
Farrow to Wean
a.Uo
n -
_
Design
Current
D Cow
Farrow to Feeder
�� D Poul
Ca aci
Po
Non -Dairy
Farrow to Finish Layers
Gilts - Non -Layers -
Beef Stocker
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
E
Turke Poults
Other
r.
Other
Discharges and Stream Imnacts
1. Is any discharge observed from any part of the operation?
❑ Yes
[0,<o
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
[tom 1A
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
CBIGA
❑ 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
[EjX'A
0 NE
2. Is there evidence of a past discharge from any part of the operation?
[D Yes
�o
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters [] Yes 2<o ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 2/4/2011 Continued

Facili Number: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [ o ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes [] No [ A ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:'1 —
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes P110 ❑ 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 a o ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes 0'lo ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes [j],<o ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ®No ❑ NA ❑ NE
maintenance or improvement?
Waste Aoolication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes �lo ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes -leo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground p 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 p❑ Evidence of Wind Drift ❑/ Application Outside of Approved Area
12. Crop Type(s):�—
13. Soil Type(s):
14. Do the receiving crops differ loin those designated in the CAWMP?
❑ Yes
[B' 4o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
ER-f4o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
[ o
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
(D `~"
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[]I -Ko
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
2-f4o
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
Lam'""
❑ NA
❑ NE
the appropriate box.
❑ WUP El Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes([�Wo— ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers [] Weather Code
Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to ii,'stall and maintain a rain gauge? [:]Yes -go ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes ❑No g-1QA ❑ NE
Page 2 of 3 2/4/2011 Continued

Facility, Number: jDate of Inspection:
OF
z4. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ffNo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes �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
Er�o
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
❑ No
Q-N�C
❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
��
+�Ko
❑ NA
ONE
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
E3<o
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
[:]Yes
g o
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
217o�o
❑ NA
❑ NE
p Application Field p Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
g2'11;ro'
❑ NA
❑ NE
33. Did the Reviewerfinspector fail to discuss review/inspection with an on-site representative?
❑ Yes
❑<o
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
❑ NA
❑ NE
Comments ((refer to question #): Explain .any:YES: { swers and/or anyadditionaUrec mmendations or any, other cam ents.'I
pages
Use'drawin sof facili to better ea lain situations use additional as necessary)"
CJ -d- E l C -5 1;-ScQ i s ca f l y f
G�tjz4 Fcw'�
Reviewer/Inspector Name:
Reviewer/Inspector
Page 3 of 3
Phone:
Date:
2/ /2OII

itti[S 2121o/OO10 2�L
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 ❑ Denied Access
Date of Visit: Arrival Time: 9'.26,6, 1 Departure Time: County: ! Q 5;,A/ Region: /C__X0
'
Farm Name: /'� ► ike A4 e a r"" _ Owner Email:
Owner Name: & * KG Phone:
Mailing Address:
Physical Address:
Facility Contact: Iff"Ke Title: �w Phone No:
Onsite Representative: Integrator: ��'��✓ Sw�NU AM_,o'nt
Certified Operator: /W`�` lta�P- Operator Certification Number: 9g8D88
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: =0
= = Longitude: 0 ° = f 0 U
Design Current
mill
Design Current
Design Current
Swine Capacity Population
Wet Poultry
Capacity Population
Cattle Capacity Population
❑ Wean to Finish
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
iry Cow
❑ Wean to Feeder
❑Non -La er
a. Was the conveyance man-made?
ElYes
iry Calf
❑ Feeder to Finish
❑ NE
❑ Dairy Heifer
DO Farrow to Wean WO
Dry Poultry
❑ Dry Cow
Farrow to Feeder
❑ La erg
❑ Non -Dairy
El Farrow to Finish
❑ Beef Stocker
❑ Gilts
❑ Non -Layers
❑Beef Feeder
❑ Boars
El Pullets
❑ Beef Brood Ca
❑ Yes
❑ Turkeys
❑ NA
Qther
❑ Other
❑ Turkey Poults
❑ Other I
Number of Structures:
M'No
❑ NA
❑ NE
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
B No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
ElYes
❑ No
/
ETNA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
LINA
❑ 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
[j No
,.,
[NA
T
❑ NE
2. is there evidence of a past discharge from any part of the operation?
❑ Yes
0 No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
M'No
❑ NA
❑ NE
other than from a discharge?
12/28/04
Continued

Facility Number: BZ —!(p Date of Inspection
Waste Collection & Treatment ��
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? El Yes ET 'No ElNA [:1NE
a. If yes, is waste level into the structural freeboard? ElYes ON. ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): �g
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes DN"'o ❑ NA ❑ NE
(ic/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed ❑ Yes ffNo ❑ 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? [_1 Yes EKo— ❑ NA ❑ NE
8_ Do any of the stuctures lack adequate markers as required by the permit? ❑ yes to ❑ 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 L�Vo [:INA ❑ NE
maintenance or improvement?
Waste Application �,�
10. Are there any required�buffers, setbacks, or compliance alternatives that need ❑ Yes Lel No ❑ NA ❑ NE
maintenance/improvement? ��
11. Is there evidence of incorrect application? If yes, check the appropriate box below. El Yes [3/No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > i0% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) a,c�� Gam.":�5k.v wlu
OF 9
13. Soil type(s)u'y ,,��!!
14. Do the receiving crops differ from those designated in the CAWMP? [I[mak Yes o ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [R ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes 2"'No ElNA [__1NE
17. Does the facility lack adequate acreage for land application? [:]Yes ,[B o ❑ NA ❑ NE
18. is there a lack of properly operating waste application equipment? [I Yes B No ❑ NA ❑ NE
Comments refer to-questionry # E P tarn an YES answers and/or a`nv; recomm0flN ns or an other comments
() P
y y
Use drawings of facility to better ex lain situations. (use additionalAT C
pages as necessar}) ,
Reviewer/inspector Name TPhone: %O, 43313300
Reviewer/inspector Signature: Date: 2 - `Zf7/Q
12/28/04 Continued

Facility Number: 02— Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box. ❑ W ­Up ❑ Checklists
❑ Design El Maps ❑Other
❑ Yes LI No ❑ NA ❑ NE
❑ Yes 0 No ❑ NA ❑ NE
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
LT No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I"
Rain Inspections Weather Code
22. Did the facility fail to install and maintain a rain gauge?
El Yes
�❑
o
El NA
El NE
EK01 ❑ NA
❑ NE
'No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
El Yes
,L�g
EJ
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
0 No
❑ NA
❑ NE
[I Yes
Leo ❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
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
NNo
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
gl o
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[:1 NA
N
[:3E
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
El Yes
,R
L- o ❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
ElYes
EK01 ❑ 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?
[I Yes
Leo ❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
Eff< ❑ NA
❑ NE
Addttomal C minents;and/dr3Dr wrngs�'
H
12/18/04

Type of Visit Q e6mp nce Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit Routine O Complaint O Follow up O Referral Q Emergency O Other ❑ Denied Access
Date of Visit: Arrival Time: .I e� Departure Time: i� County: 8=-- Region:
4.1
Farm Name: % Owner Email:
Owner Name: A f Phone:
Mailing Address:
Physical Address: LL
Facility Contact: �%% -A ! ! Title: Phone No:
Onsite Representative: Integrator:
Certified Operator: Operator Certification Number:
Bach -up Operator:
Location of Farm:
Back-up Certification Number:
Latitude: =0 =t =" Longitude: =O=A 0
Design C►urrent
❑ No
Design Current
Design Current
Swine Capacity Population
Wet Poultry
Capacity Population
Cattle Capacity Papulation
❑ Wean to Finish
❑ La er
❑ Dairy Cow
❑ Wean to Feeder
❑ Non -Layer
❑ Yes
❑ Dairy Calf
❑ Feeder to Finish
[.No
❑ Dairy Heifer
Farrow to Wean 1A DD
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
[_1 NE
❑ Non -Dairy
❑ Farrow to Finish
❑ La ers
❑ Beef Stocker
❑ Gilts
❑ Non-Laers
❑ Beef Feeder
❑ BoarsTurke
❑ Pullets
❑ Beef Brood Co
l i❑
s
Otber
❑ Other
❑ Turkey 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 C.No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
[.No
❑ NA
❑ NE
[I Yes
(9No
El NA'
[_1 NE
12/28/04 Continued

t
Facility Number:
Date of Inspection / f�
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:
❑ Yes
Spillway?:
❑ NA
Designed Freeboard (in):
15. Does the receiving crop and/or land application site need improvement?
Observed Freeboard (in):
RNo
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
[Z No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
a No
6. Are there structures on-site which are not properly addressed and/or managed ❑ Yes
[allo ❑ NA ❑ NE
through a waste management or closure plan?
❑ Yes
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
[30 No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
ER No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
❑ NA
9. Does any part of the waste management system other than the waste structures require ❑ Yes
91 No ❑ NA ❑ NE
maintenance or improvement`?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
[SNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
allo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) �aoeku"'J'. 1 W 7 ��t-f A+r'A-Z ' J�1�la t'-� -r ✓c�-% !"-:
13. Soil type(s)
f
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
RNo
❑ NA
❑ NE
16_ Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
a No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
[N No
❑ NA
❑ NE
18_ Is there a lack of properly operating waste application equipment?
❑ Yes
(Z -No
❑ NA
❑ NE
lrTd�� F`-.
Comments (ref,q estion #): Explain any YES onsei_sandloreyrecommendations or any other commentsa,
Use di awtngs-AfactGty to better explain situations: (use=additional pages as neeessarv)
•
Reviewer/Inspector Name -_ + Phone: cyyp -ly(� 0
Reviewer/Inspector Signature: Date:
IV 12/18104 Continued

t
Facility Number:— 4,4 Date of Inspection
Re aired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? [&Yes BgNo [INA ❑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 ❑ 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 [ZNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [--]Yes [34 No ❑ NA EINE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
13 No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
ER No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
® No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
0 N
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
RNo
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
�&No
❑ NA
❑ NE
and report the mortality rates that were higher than nominal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
EM 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
N 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
[3No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
-&No
❑ NA
❑ NE
A�'ddrtional Comments and/or Drawings:
12128/04
12128/04

I
Type of Visit (a-Co-mpliance 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 ❑ Denied Access
Date of Visit: Arrival Time: , !!ice Departure Time: l/.��� County: �'"f Region: �y
Farm Name: i �L 7^�- fir ___ Owner Email:
Owner Name: /y/1 !1 t__ _ _ Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: /�� /TDA Title: Phone No:
Onsite Representative: S­� Integrator:.,4 / 1
Certified Operator:<s Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: latitude: =0
= = Longitude: = ° = ' F -1"
Swung
Desi2n. rrent'
D 'g Current _ , � ult , Ca agiu Po `�
Wet'Po
Capacity Mont tton x� p ty pulah n
Cattle
Design Current
Capacity Popuiation
❑ Wean to Finish
❑ La er
❑ Dai Cow
❑ Wean to Feeder
� ❑ Non -Layer
❑ Dai Calf
❑ Yes
❑ Feeder to Finish
' `
❑ Dai Heifer
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
Farrow to Wean
i70 Dry PouIt
❑ D Cow
❑ NE
❑ Farrow to Feeder
s `� `
❑ Layers
Non -Dairy
❑ Farrow to Finish
d. Does discharge bypass the waste management system? (If yes, notify DWQ}
❑ Beef Stocker
❑ No
El Gilts
(] Non -Layers
❑ Beef Feeder
❑ Yes
ElBoars
❑ Pullets
❑ Beef Brood Co
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
Turkeys
❑ NA
❑ NE
Other
❑Turkey Poults
❑ Other
❑ Other
Number of Structures:
Continued
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
JKNo
❑ 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
W No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
ANo
❑ NA
❑ NE
other than from a discharge?
Page .1 of 3
12/28/04
Continued

Facility Number: —/2' 6
Date of Inspection Ir -0 `
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
O.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): Z9
Observed Freeboard (in): 3 %
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
® No
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed
❑ Yes
ONo
❑ NA
❑ NE
through a waste management or closure plan?
If any of questions 46 were answered yes, and the situation poses an immediate public health or
environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
[N No
❑ NA
❑ NE
8_ Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
[& No
❑ NA
❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
0 No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[3No
❑ NA
❑ NE
maintenance/improvement?
11. is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
19 No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l 0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)u
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[RNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
ESNo
❑ 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
L -No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
S.No
❑ NA
❑ NE
Reviewer/Inspector Name . Phone:
Reviewer/Inspector Signature: Date: f
Page 2 of 3 12/28/04 Continued

4 Facility Number: — (, Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes EgNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWIvIP readily available? if yes, check ❑ Yes RNo ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ® No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
[3 No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
M No
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
B 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
4 No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
RNo
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
® No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
KNo
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
[&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
[allo
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
[$ No
❑ NA
❑ NE
Plage 3 of 3 ]2/28/04

ivision of Water Quality �+
Facility Number L Q Division of Soil and Water Conservation 0 7
Q Other Agency
Type of Visit 0<o-mpliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason far Visit &ko"Utine O Complaint O Follow up 0 Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: rrival Time: L_!._CL�SC! Departure Time: .3� County: Region:��
Farm Name: *e l/�h"- Owner Email:
Owner Name: ZnJ� f zyn `G _ Phone: 2z2-&-yO
Mailing Address:
Physical Address:
Facility Contact: &L Title: Phone No:
Onsite Representative: z��r�-� Integrator: C�
Certified Operator: �-- Operator Certification Number- ./,c��
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: E__1 e =' = u Longitude: = ° = + [� +s
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
EEL
Layer
on -La et
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑
Turkeys
❑ urkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design, Current..
Cattle Capacity Population,
❑ Dairy Cow
❑ Dairy Calf
❑
Dairy fleifei
❑Dry Cow
❑ Non -Dairy
❑ Beef Stocket
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes )4No [:INA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
E6No
❑ NA
❑ NE
❑ Yes
;�No
❑ NA
❑ NE
.12/28/04 Continued

Facility Number: Date of Inspection e7
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
RNo
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
RNo
❑ NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): D
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[ No
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed
❑ Yes
® 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
J No
[:INA
❑NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
M 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@ No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[S 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 Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)z-/�-�
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes 5 No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes fZNo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes 2 -No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application'? ❑ Yes I&No ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes Di -No ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/Inspector Name �v� dt� Phone:
Reviewer/Inspector Signature: Date: 42— / 2L2ZI27
11/28/04 Continued

�! Facility Number: Date of Inspection 7_�%
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 0 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ® No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes �W No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes �RNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes UNo ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
,RNo
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
[KNo
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
51No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
CB:1Vo
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
R No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
J -No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
O No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional off -ice of emergency situations as required by
❑ Yes
® No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
® No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
9 No
❑ NA
❑ NE
Additional Comments and/or Drawings:
1,2128104

C
Type of Visit G-C—om pliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit autine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: ® Arrival Time: 00 Departure Time: s County: Region:
Farm Name: l►Owner Email:
Owner Name: j�K rLe, `7- Phone:
Mailing Address:
Physical Address:
Facility Contact: �M )1AefTitle:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: =0 =1 Longitude: =1 ° =1' = u
Design C►urrent
Design Current
Design Current
Swine Capacity Population
Wet Poultry Capacity Population
Cattle C►apacity Population
[=Wean to Finish ID
Layer
❑ Dairy Cow
❑ Wean to Feeder 110
Non -Layer 1
❑ Dairy Calf
❑ —Feeder to Finish
4.�
� `
❑ Dairy Heifer
Farrow to Wean >❑
Dry PoaltryY>_:__>=.�:::
Dry Cow
❑ Farrow to Feeder"
"`
El Non -Dairy
El Farrow to Finish
❑ La ers
❑ Beef Stocker
Gilts
s
❑ Beef Feeder
RBoars
❑Pullets
❑ Beef Brood Cowl
❑ Turkeys
Other
❑ Other
❑ Turkey 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?
Page 1 of 3
❑ Yes [9 No ❑ NA ❑ NE
❑ Yes
®-No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
j] No
❑ NA
❑ NE
❑ Yes
g[No
❑ NA
❑ NE
12/28/04 Continued

ti Facility Number: — (� Date of Inspection .r'ZU! do
any YES; answers and/or anyyrecommendations or any other comments
(use additional pages as necessary)::: r
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
D? No ❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
LKNo ❑ 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
J3 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
[3No [INA
❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
® No ❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
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
($ No ❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
CKNo ❑ NA
❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
[--]Yes
KNo [:INA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 1 O lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside
of Area
12. Crop type(s)&f
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 [9 No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes 4 No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes 91 No ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes R No ❑ NA ❑ NE
Comments (refer to question ##): Explain
Use drawings of facility to better explaifl 'situafiok
any YES; answers and/or anyyrecommendations or any other comments
(use additional pages as necessary)::: r
Reviewer/Inspector Name
f�.-r.- Pbone
Reviewer/Inspector Signature:
Date:
Page 2 of 3 112/28/04 Continued

Facility Number: — 6 Date of Inspection 0
4. Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes �[ No ❑ NA [__1 NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes D�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 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 V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes RNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes q No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
JR No
❑ NA
❑ NE
25- Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
KNa
❑ NA
EINE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
® No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
IN No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMF?
[:]Yes
JRNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
® No
❑ NA
EINE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
M No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
C&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
[KNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
RNo
❑ NA
❑ NE
Additional Cbin' ments`and/or Drawings.-' -
Page 3 of 3 12/28/04
Page 3 of 3 12/28/04

® Division of Water Quality; F'
=�acilityum_ ber jL O Division of Soil and Water Conservation
O Other Agency
Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: Jil00 Departure Time: County: —4-ift/4! tel. Region: ,FA10
Farm Name: 4if lVe FQPrn _ Owner Email:
Owner Name: _Q___lri r �� K. Phone:��� - a
Mailing Address:
Physical Address:
Facility Contact: ��.�.1r L✓,_� +'0 1Title:
Onsite Representative:
Certified Operator: •'.1e
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
Phone No:
Integrator:f���,
Operator Certification Number:
Back-up Certification Number:
Latitude: ❑ c ❑ 1 Longitude: ❑ ° ❑ ' 0 u
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
_ ❑ Layer
T I �: ❑ Non -La et
Other
❑ Other
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turk e Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made'?
Design Current
Cattle Capacity Population
❑
Dairy Cow
❑
Dairy Calf
❑ Dairy Heifei
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stockei
❑ Beef Feeder
❑ Beef Brood Cow
Number of Structures: Z-1
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 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 91� to ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
EINE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
�o
❑ NA
❑ NE
❑ Yes
Q'l�lo
❑ NA
EINE
12/28/04 Continued

ri
[?'No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
Facility Number: g —1&0 Date of Inspection
9. Does any part of the waste management system other than the waste structures require ❑ Yes
[allo
❑ NA ❑ NE
maintenance or improvement?
Waste Collection & Treatment
Waste Application
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate'?
❑ Yes
YNo
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
[INA
❑NE
Structure I Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier:
?OS 5-v
Spillway?:
13. Soil type(s) 4,1
Designed Freeboard (in):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
D -Ko
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes
Observed Freeboard (in): 3 D a
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination'[-] Yes
❑ No
❑ NA 2 -NE
17. Does the facility lack adequate acreage for land application? ❑ Yes
❑ No
❑ NA [SNE
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
ZNo
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed
❑ Yes
2 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
[allo
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
[?'No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes
[allo
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
ONo
❑ NA ❑ NE
maintenancelimprovement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
[ <
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drifl ❑ Application Outside of Area
?OS 5-v
12. Crop type(s) any G
13. Soil type(s) 4,1
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
D -Ko
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes
2-lqO
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination'[-] Yes
❑ No
❑ NA 2 -NE
17. Does the facility lack adequate acreage for land application? ❑ Yes
❑ No
❑ NA [SNE
18. Is there a lack of properly operating waste application equipment? ❑ Yes
[allo
❑ NA ❑ NE
Commentsl(�re6
Mq hon.#) Explain anyiYESS?ail weirs and/or, any .IOcammendahous r any other comments.
Uof facility tbe . e eapiain sitn'attons "{nse addihonel pages.as,necessary)
Freelpb.y% ,', fg,, �, n CQGS%�rrpr�
Reviewer/Inspector Name IRae& , Phone: I&-Wfr
Reviewer/Inspector Signature: ,� Date:
12/28/04 Continued

/
Facility Number: SZ - Date of Inspection '`a3 -os`
Required Records & Documents
19_ Did the facility fail to have Certificate of Coverage & Permit readily available? 2Yes ❑ No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes DoKo ❑ NA ❑ NE
the appropirate box. ❑ gels ❑ Ch=iuc is ❑ Design ❑ m4nm ❑ Other
21. Does record keeping need improvement? If yes, check the ap ropriate box below. Wes ❑ No El NA El NE
// 10-/s '1.( fl-P)0/•f
2 aste Application ❑ q ^7 T'«ttfad ❑ Wnt_dt ltl!�--sis ❑ ❑ yrs ❑
// ion
ElRmtrf fl ❑fig rop Yield 20 Minute Inspections O'Monthly and t" Rain Inspections [Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes R'Ro ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No ❑ NA D -NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit'?
❑ Yes
❑ No
❑ NA
ow Q ;h -ISr F0'711qt✓1. /Ir O"fll .4 9/0-4rA-/fy1 f
25.
Did the facility fail to conduct a sludge survey as required by the permit?
El Yes
El No
❑ NA
,[:-NE
G NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
G No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification'?
❑ Yes
❑ No
❑ NA
DIN E
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
ZNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
2No
❑ 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
ZNo
❑ 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
ErNo
❑ 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
O'No
❑ NA
ElNE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
[ No
❑ NA
❑ NE
X"itional Comments and/or Drawings:
i�, P/rase Plc.Cc a eolv�, owe
,,n f Records c,^- s.•/r. 24r yow -,ir<J C.•AAe. alc i4eje 001eav:e
ow Q ;h -ISr F0'711qt✓1. /Ir O"fll .4 9/0-4rA-/fy1 f
1i P(eusc S/0 04 ✓S, -�%'�1t (r fit °ipPr'auir� .�QID! GO/n�inr� w.f�! 1.t�0•),
jDrl�'Is. /�A.St vSL C�o�p !e'E%� mY�*'►• Please I�r)r'T(w.f
Gji •tr Gly/
f TGtrn e✓rnf �hSPtG1,'arr G/7C af)�rr lh4i7fji/ ��'Onf� /7150
y�
f4
o,
RR •! Fer.� PJrasc l�, dal co1r.�.7 7'., J;« /,'-9 k 4l- tic l�o,•,,�,irle ,.7sr'r><�
the/e ..+ert. P/ease- 4-a lee wa.s>(ir S/rs
a re good fai GO Jars *,61 aff=r So..yp/c o%�r. .trr,'g 4>{:0„ ever, - rt,,
ijlC -R;rsf Pa/�df Tonwrr 'Ovt 01, -e YlpT 1love
12/18/04

of Visit WCompliance Inspection O Operation Review O lagoon Evaluation
Reason for Visit A'goutine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number
Date or visit: FA -15 -- O+ Time: �
Q Not 2Eerational Q Below Threshold
rm
Peitted Certified [3 Conditionally Certified 0 Registered Date Last Operated or Above Threshold: ..... ...— _.. .
Farm Name: ..... M i Ke ....RVe- t'!')-------------.................._........... County: -.. s ' !^ ...._. ..... W. �� _...._....
Owner Name: !mti a ['L ... Phone ��
No:
W _ __. _...__._� .__.. _._.._ _ _.__.. . _._. 9j
Mailing Address: $vN aid+nth a`�328
Facility Contact: .. .]-!+1�L..-`1-e----------------------- --------------- Title: ....9Wr►cA................................ Phone No:..
Onsite Representative:._° _ Integrator= .� �+!"iutw._S4a+c___
Certified Operator:._.. .M i K<- .�...� ....... �' _-----__ _ .... _ Operator Certification Number:
Location of Farm:
[Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • 4 44 Longitude • I «
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes 03/No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min'?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes 0640
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes [�Io
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes 53"No
Structure 3 Structure 2 Structure 3 Structure 4 Structure _i Structure 5
Identifier: - I.. W .. .......................................................
Freeboard (inches): A 'g
12112103 Continued

Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or 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 O N' o
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes [��lo
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 GKNo
Air Quality representative immediately_
%�-.F=-.'`' ...L°r. ' 3 3 e�.�EC.e..«xx.
Comm�eats (refer to giiiwbh #) Explaun any YES aaswe s and/Ora ny rem Onsor ahyLother comments. , =
Use drawtngs of 1Bctility4o better exglaue sitnatibhi4,(&se sddibonal:pages ry)c Field Copy ❑ Final Notes `
---AS
- T&rm Crops cck' -
' Facility Number: �(A — Date of Inspection ®o
5. Are there any immediate threats to the integrity of any of the structures observed? (iel trees, severe erosion,
❑ Yes
03"No
seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a waste management or
❑ Yes
vdNo
closure plan?
(If any of questions 46 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
[3No
8. Does any part of the waste management system other than waste structures require maintenancerimprovement?
❑ Yes
[+/No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
❑ Yes
93/No
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes
[3No
I I . Is there evidence of over application? If yes, check the appropriate box below.
❑ Yes
[!(No
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type !Fey-muAa. L Na f a,; k,
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWW)?
❑ Yes
[lf4o
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
13<0
b) Does the facility need a wettable acre determination?
❑ Yes
[] No
c) This facility is pended for a wettable acre determination?
❑ Yes
Bf4o
15. Does the receiving crop need improvement?
❑ Yes
ERINo
16. Is there a lack of adequate waste application equipment?
❑ Yes
ErNo
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or 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 O N' o
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes [��lo
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 GKNo
Air Quality representative immediately_
%�-.F=-.'`' ...L°r. ' 3 3 e�.�EC.e..«xx.
Comm�eats (refer to giiiwbh #) Explaun any YES aaswe s and/Ora ny rem Onsor ahyLother comments. , =
Use drawtngs of 1Bctility4o better exglaue sitnatibhi4,(&se sddibonal:pages ry)c Field Copy ❑ Final Notes `
---AS
- T&rm Crops cck' -
Reviewer/Inspector Name r
—
Reviewer/Inspector Signature: 94.1 Date: 93 f o4
I21.11103 V Continued

Facility Number: ,j Date of Inspection b
Required Records & Documents
2I . Fail to have Certificate of Coverage & General Permit or other Permit readily available?
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
23. Does record keeping need improvement? If yes, check the appropriate box below.
Waste Application [Freeboard ETWaste Analysis [Soil Sampling a-11 in �ctcc.
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
25. Did the facility fail to have a actively certified operator in charge?
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
27. Did Reviewer/Inspector fail to discuss review/inspection with on-site representative?
28. Does facility require a follow-up visit by same agency?
29. Were any additional problems noted which cause noncompliance of the Certified AWMI?
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 3I-35)
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
32. Did the facility fail to install and maintain a rain gauge?
33. Did the facility fail to conduct an annual sludge survey?
34. Did the facility fail to calibrate waste application equipment?
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After V Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
❑ Yes fidNo
❑ Yes [ErNo
❑ Yes O No
❑ Yes 2*f o
❑ Yes Q No
❑ Yes 2<o
❑ Yes dNo
❑ Yes ErNo
❑ Yes Q No
❑ Yes dNo
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑"Yes ❑ No
❑ Yes ❑ No
No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
tUo mmcnts attd/ar Drawtn _ _,
-A11 r_co4�. ;n Pfa�tr
T
12112103

State of North Carolina ' 'T
Department of Environment,
Health and Natural Resources• •
Fayetteville Regional Office A4
James B. Hunt, Jr., Governor C)C
Jonathan B. Howes, Secretary C
Andrew McCall, Regional Manager
DIVISION OF ENVIRONMENTAL MANAGEMENT
December 13, 1995
Mr. Mike Hope
826 Chancey Road
Clinton, NC 28328
SUBJECT: Compliance Inspection
Sampson County
Dear Mr. Hope:
On November 13, 1995, an inspection of your animal operation was performed by the
Fayetteville Regional Office (FRO). Please find enclosed a copy of our Compliance
Inspection Report for your information. It is the opinion of this office that this facility is
in compliance with 15A NCAC 2H, Part.0217, and that Animal Waste Management is being
properly performed.
Should you have any questions'regarding this matter, feel free to contact me at (910)
486-1541.
Sincerely,
Ricky Revels
Environmental Technician IV
Enclosure
cc: Facility Compliance Group
j -2o
Wachovia Building, Suite 714, Fayetteville, North Carolina 28301-5043 Telephone [phone] FAX [phone]
An Equal Opportunity Affirmative Action Employer 50% recycled/ 10% post -consumer paper

Farm NamdOwner:
Mailing Address:—
Integrator A4 _
On Site Representati
Physical Addms&U
Site Requires Immediate Attention: �b
Facility No. 5rz - / q- 7
DIVISION OF ENVIRONMENTAL MANAGEMENT !n 7 Tz� ri✓fi
ANIMAL FEEDLDT OPERATIONS SITE VISITATION RECORD
ee p';,fl(s /. 6.9 -
DATE: -1-13,1995 4'-' A�'4r"
Time: 113n --
Farm
/3a
3Z& CtWACeh Rd C1:ti-,�� IJC 2$
�o N
Phone: /►-
_ Phone: � Wo.)J 51 z -
laLz]oF,e -7o1 S, 74,g 53 5:212Z0
Type of Operation: Swft* PoultryCattle
Design Capacity: (Z o e. Number of Animals on Site: 19 a
DEM Certification Number: ACE DEM Certification Number. ACNEW
latitude• • , « Longitude: • ' «
Circle Yes or No
Does the Animal Waste Lagoon hpe.,sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately I Foot + 7 inches) OLisbr No Actual Freeboard:__�L_Ft. -a-Inches
Was any seepage observed from the la oon(s)? Yes ot*Was any erosion observed? Yes or 0
Is adequate land available for spray? oro Is the cov9T crop adequate? �r or No
Crop(s) being utilized: k; .s Crams coo S fro 1
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings? or No
100 Feet from Wells? d3 or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes ori
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line: Yes ot!E?
Is animal waste- discharged into water of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes or4&D 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)? r No
Additional Comments:
i G i5 t -v e -
Inspector Name Signature
cc: Facility Assessment Unit Use Attachments if Needed.