820175_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental Qual

G �Ii�IIII!� i�ii�.tiill, lY�ri�rF_ �l Itt4; y�"nIl1,t�]'l N'IIltgu .IrAIiu'�Ei�JIl+imndiiNkf:�`ibII °II"IR!I cI�l •prh lIllY Il�lI'III' Ii�I�if4II ®. I".GY :I! IL IY�i¢!i'�d� „i� �1 �l� i 13�al !iltiEtij �n�l,, €�I��[ii
ii° ,Li`•Y. „�"�,,� �.i I�!,Y !�iI I��'I,,�I I�_..{.!i' ' �I Iii i�E,l:ll'I',•�Q� Drylia�ss'�ll'oi'nnI ''of
f :SWol�I i tear dRE i, W�.oiuterIcI eC,s^ �o• nser-.. v!'
,aII!tio' ..n
QOtaer AgeCy. iiF. tr ,:� �.� I .. ,.• i YI11
Type of Visit: O'C__omp��O
tdliance Inspection O Operation Review O Structure Evaluation Technical Assistance I
Reason for Visit: 'ffoutine O Complaint Q Follow-up Q Referral 0 Emergency O Other 0 Denied Access
Date of visit: — f-1 Arrival Time: ; Departure Time: County: I�D
Farm Name: E st/ 'Su U; 1/aP-- 7 of Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: �fy . <, "—a i/a.^_ Title: L-9L4U &,I- Phone:
Onsite Representative: 1 Integrator:
Certified Operator: Certification Number:
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Region;5
44 4-
I!!tI�I�E' il�i ill�kl!i "�t�iil�:l�t. ltlil���l Ilii�l:�l'lli�r�IID3 Sli fi CCeI ' eSi n� rent i'
D "g C.ur Y,.l. Design :Current
I1 Il�IySwine�1�1�yhf'', ill' ;: Capaclity . ,Pop ! Wet,Ppultry ':Cuppci#y,,''Pop Cattle Capacity' E'op.
II
Wean to Finish
La er
Wean to Feeder
10 y a
_3
Non -Laver
Feeder to Finish
, �i Dry . Poult Caoaci Po
Farrow to Wean
Farrow to Feeder
Farrow to Finish
t. I
Layers
Gilts'
ISI $F(E E,FI Ili;"6YI a I I"f a
, w' II :s i I: t ' tY
k`1E,,till,sl, ►
1V:i�ldllllfE+i „', ,.::Y§€,:,.°it l iyy
Non -Layers
j
,•I'..
b
y
Boars
Puilets
lil'i 11! 'I I'I � Ill It lit l` Y
i�i6 !l I I �II � 10
,t,l,i llis!�l kIdk l 1,I �illl,jil!
{)ther,�l,�ltEtlN�Y�li I�EEci6�`,Eik��Yr a
Turke s
TurkeyPouits
Other
10ther
I
It,E{
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?
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
;�J ,r
IPgj?.. pi yiie
[—]Yes 2'i'Io ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
[:]Yes
❑ No
[_]NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
0 Yes
[ o
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412015 Continued

I
1Racili Number: - Date of Inspection: /—
Waste Collection & Treatment
`4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ❑ No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes [3'No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):�
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes [�o ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes [D'<o
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes E0<o
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes D'' 4o
❑ NA
D. 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'+�lo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need [] Yes []'l�o
❑ 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 > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidenceof Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes �lo ❑ 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 �o ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes Ea o ❑ NA ❑ NE
❑ Yes EJ No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes [] No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes allo ❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes �o
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall [:]Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I " Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes 2�&o
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [3"No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑NA ❑NE
Page 2 of 3 21412015 Continued

aelli Number: Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
jj�-No
❑ 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
to
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
[] Yes
[2No
❑ 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?
6
❑ Yes I_J 5o ❑ NA ❑ NE
❑ Yes [j'go ❑ NA ❑ NE
❑ Yes hTo ❑ NA ❑ NE
❑ Yes F;r90 ❑ NA ❑ NE
❑ Yes
io
❑ Yes
[ o
❑ Yes
F—_KNo
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
Reviewer/Inspector Name: f j�c�_ L�—s�,e%�.-•�_ Phone: `�/10
Reviewer/Inspector Signature:
Date: 6 v2/ 'a✓lf �11
Page 3 of 3 21412015

G/s1
("Ivision of Water Resources
Facility Number ®- 4 Division of Soil and Water Conservation
Q Other Agency
Type of Visit: ompliance Inspection 0 Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: &I routine O Complaint O Follow-up O Referral Q Emergency Q Other O Denied Access
Date of Visit:? Arrival Time: flC� Departure Time: County: � Region: /c:?ZD
Farm Name: �y f1c �'jVa Owner Email:
Owner Name: a--t y Ity ,j le ci Phone:
Mailing Address:
Physical Address:
Facility Contact: ��Gti! �� %��y a Title: �lCJ h y r
Onsite Representative: �'a,..,�.� Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Boars
Other
Other
Latitude:
Phone:
Certification Number:
Certification Number:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
HL
ayer
194 b G
rou
Pullets
Poults
Design Current
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
Longitude:
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
.Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes [SNo ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes [:]No
❑ Yes ❑ No
❑ Yes LR No
❑ Yes �No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3 21412015 Continued

Facility Number: jDate of inspection: r
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes RLNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No 0 NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 7 1 .
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ,® No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes [E�No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes allo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes ® No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes 2 No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need [:]Yes [allo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land 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 Approved Area
12. Crop Type(s): eo d n_ /GV !.
13. Soil Type(s): p ,r �
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 �2. No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes EjNo ❑ 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 5�_No ❑ NA ❑ NE
❑ Yes ER -No ❑ NA ❑ NE
Re uired Records _& Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes EE-No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes allo ❑ NA ❑ NE
the appropriate box.
❑ WUP ❑Checklists [:]Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. [:]Yes ®-No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall [:]Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes .] No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes Q5-No
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑NA ONE
Page 2 of 3 21412015 Continued

jo. IFacility Number: Date of Inspection: --J
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes JZ[ No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes �No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes [a No
27, Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes allo
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility9 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/]nspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes ®No ❑ NA ❑ NE
❑ Yes 2§—No ❑ NA ❑ NE
❑ Yes 5INo ❑ NA ❑ NE
❑ Yes 5—No ❑ NA ❑ NE
❑ Yes EINo
[:]Yes ®,No
❑ Yes �No
❑ NA ❑ NE
❑NA ❑NE
❑NA ❑NE
JComwjits#efer to :questlon:#) Explain any YES answers,and/or,any additionalpikiimmendations or�'any other.coinments
Usedrawin�s, of facility fo �betferexplain slt`uatiani;i{use adlitianal''pa�es�asneccssurv) ;` � � `+ � ` � ,� z „ ` , .. ,' .. , >.� � t , ;" "l
Reviewer/inspector Name:
Phone:
Reviewer/Inspector Signature: Date:�j=,j/�
Page 3 of 3 21412015

i
_6 _;;�11p
iviiion of Water Resources
li acility Number ®- / S O Division of Sol! rand Water Conservation
Q Other Agency
type of Visit: ommpiiance Inspection Operation Review Structure Evaluation Technical Assistance
a Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: OD Departure Time: /,p' c7 County: Region: 2RO
Farm Name: , L F—a Owner Email:
Owner Name: / A, V In Phone:
Mailing Address:
Physical Address:
Facility Contact:y kt, S ��� l/c�-.-.� Title: a W n rT Phone: mm
Onsite Representative: 7os..c� Integrator: — � Trz37,-_ � -_
Certified Operator: Certification Number: A
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
.Design .Current
Design
Current
Design Current
Swine Capacity Pop.
Wet Poultry
Capacity
Pop,
Cattle Capacity Pop.
Wean to Finish
Layer
DairyCow
Wean to Feeder
3
Non -La er
EH]
DairyCalf
Feeder to Finish
DairyHeifer
Farrow to Wean
Design
Current
D Cow
Farrow to Feeder
Rr, Poultt,
Ca aci
l:a
Non -Doi ry
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
Xon=Turke
Poults
Other
Other
NJ
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)? _
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
[—]Yes jNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
[:]Yes [:)No
❑ Yes E&No
❑ Yes [Z No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
a
Page 1 of 3 21412015 Continued

Facllity Number: Date of Inspection: [�
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
E&No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
[S No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
allo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
[:]Yes
allo
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
M No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
® No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes a No ❑ NA ❑ NE
❑ Excessive Pending ❑ 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
�j 12. Crop Type(s): 4ru / wxi-ot'/ AVr,s,,•t
13. Soil Type(s): 6r-6 % J
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 [VNo ❑ 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 Let No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes ®, No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes Callo ❑ 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
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? [:]Yes �No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes ®, No
[:].NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑ NA Q NE
❑NA ❑NE
Page 2 of 3 21412014 Continued

Facility Number: - / S Date of Inspection: /
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes allo ❑ 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?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
P9 No
❑ NA
❑ NE
❑ Yes lam. No ❑ NA ❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
[,� No
❑ NA
❑ NE
[—]Yes ® No
❑ Yes ® No
❑ Yes ELNo
[DNA ❑NE
❑NA ❑NE
❑NA ❑NE
Comments (refer to question ft Explain any.Y.ES answers and/or any additional;.recommendations of any. other'comments.:,
Use drawings of facility to better explain situations (use additional pages as necessa )
r/
PL
Reviewer/Inspector Name:
Phone:
Reviewer/Inspector Signature:
Page 3 of 3
Date: 6 ,ob /�7��•-
2/4/2014

type of visit: kd uompllance Inspection U Operation Keview V Structure Evaluation V 'l echnlcal Assistance
Reason for Visit: 04' 0utine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time:'t):61 Departure Time: ` o County: Region: l]
Farm Name: �ay r'"-- Owner Email:
Owner Name: Jje. dePhone:
Mailing Address:
Physical Address:
Facility Contact: (7oec4, 5 ,��`�/p-�-- _Title: Phone:
Phone:
Onsite Representative: Integrator:
Certified Operator: Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current Design Current
Swine Capacity Pop. Wet Poultry Capacity Pop.
Wean to Finish Layer
Design Current
Cattle Capacity Pop.
DairyCow
Wean to Feeder o Non -La er
DairyCalf
Feeder to Finish
DairyHeifer
Farrow to Wean Design CEEJ
urrent
Farrow to Feeder FDtr,� Ca acit P,o
Farrow to Finish Layers
D Cow
Non -Dairy
Beef Stocker
Gilts
ers
Beef Feeder
Boars
Beef Brood Cow
Other
Other NJ
Turke s
Turke Pouets
10ther
Disebarees 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)
Z. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
[—]Yes ®.No ❑ NA ❑ NE
[:]Yes ❑ No ❑ NA ❑ NE
[:]Yes ❑ No ❑ NA ❑ NE
❑ Yes [:]No
[:]Yes allo
[:]Yes allo
❑ NA ❑ NE
[DNA ❑NE
❑ NA ❑ NE
Page 1 of 3 21412014 Continued

Facili Number: - Date of Ins eetion:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
['q No ❑ NA ❑ NE
No ❑NA ❑NE
Structure 6
❑ Yes CS No ❑ NA ❑ NE
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
allo
❑ 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
2,No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[LNo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [] Yes M No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN> 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window 1 ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): - �,�rvU 1,.,-4 rs�' % :or B;-liS> 6
13. Soil Type(s): _ �l D'A l r
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [N 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 ❑ Yes 0 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 [allo ❑ NA ❑ NE
❑ Yes allo ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes E No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check [:]Yes [VINo ❑ 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 Ca No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall [:]Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? [:]Yes � No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [allo
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: Date of Inspection: /
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ;K�No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [ No
the appropriate box(cs) 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?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑NA ❑NE
❑ NA ❑ NE
❑ Yes
M.
❑ NA
❑ NE
❑ Yes
IM No
❑ NA
❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes P No ❑ NA ❑ NE
❑ Yes 5§ No ❑ NA ❑ NE
❑ Yes S No ❑ NA ❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
®-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." necessary).
Reviewer/Inspector Name:
Phone: gj�—�333
Reviewer/Inspector Signature:
Page 3 of 3
Date:
21412011

CAJ'iiivlsion of Water Quality
Facility Number F r;9 - / 7 0 Division of Soil and Water Conservation
ti. 0 Other Agency
Type of Visit: Z5rompliance Inspection Z5 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: '3 D Departure Time: ; d0 County
Farm Name: !�Ll f ya', Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Region: F'R 0
Facility Contact: �,� ; Q Title: � Phone:
Onsite Representative: Integrator:y-G_
Certified Operator: —1 Certification Number:
Back-up Operator:
Location of Farm:
Swine
Certification Number:
Latitude:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
La er
O p fl HNon-La er
Wean to Finish
Wean to Feeder
13
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
t'oul
Pullets
Pouets
Design Current
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: El Structure El Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
Longitude:
Design Current
Cattle Capacity Pop.
DairyCow
Dai Calf
DairyHeifer
D Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes ja No ❑ NA ❑ NE
[:]Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
[:]Yes [:]No
❑ Yes Z No
[:]Yes ®.No
❑NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
Page I of 3 21412011 Continued

Facility Number: - = jDate of Inspection: r
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes gL No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):�
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes � No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the pen -nit? ❑ Yes 21 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 f;a No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ®. No
❑ NA
❑ NE
maintenance or improvement?
1 I . Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes 2!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): dorm W _
13. Soil Type(s): _,A11? ZE2 PS - --- _ - -- _
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes 0 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 [S No ❑ NA ❑ NE
[:]Yes C&No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes M No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes M No ❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists []Design ❑ Maps ❑ Lease Agreements []Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [ZNo
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes LZ No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes V.No
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑NA ❑NE
Page 2 of 3 21412011 Continued

Facility Number. - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes J&No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes allo
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes &No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes C& No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non=compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ Yes g No ❑ NA ❑ NE
❑ Yes RNo ❑ NA ❑ NE
❑ Yes [a No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes
JR No
❑ NA
❑ NE
❑ Yes
Z No
❑ NA
❑ NE
❑ Yes
4Mf f No
❑ NA
❑ NE
Comments'(refer:to question #): Explain any YES answers and/or any additionalrecommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: gLi/ t>o
Date:
21412011

` ` 70 311 I3 1P�f
Facility Number ®-
Chl Division of Water Quality
0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit: eFCompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: gRoutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: �i� Arrival Time: DepartureTime: ;n� County:Region: Ego
Farm Name: �Q,t Svc iyQ, FGrLy
Owner Name:Qu
Mailing Address:
Physical Address:
K 0
Owner Email:
Phone:
Facility Contact: 5441 1 rvL Title: Nor Phone:
Onsit�ef?Representative: 7Iy Sal j Ld3 Integrator: P/'PV1W
�cE'er ifind r ,h Operator; -Q t� . ! V Certification Number: i ��]
operator; r �Q��A
�(�. S�1 I Certification Number:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Latitude:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
Layer
Non -La er
Pullets
Other
Poults
Design Current
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
Longitude:
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
.Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes 1>_� No ❑ NA ❑ NE
a. Was the conveyance man-made? ❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) ❑ Yes ❑ No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (if yes, notify DWQ) ❑ Yes ❑ No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes CR No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes O No ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

Facility Number: Date of Inspection; 3
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?. ❑ Yes IU-No ❑ NA ❑ NE
a. if yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):_
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
[:]Yes
MNo
❑ 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
tR-No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
CR No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
® No
❑ NA
❑ NE
maintenance or improvement?
11, is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes to No ❑ NA [3 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 y_,,❑ Evidence of Wind Drift [3 Application Outside of Approved Area
}
12. Crop Type(s): QN/1 .* � �IJIF5o m r
13. Soil Type(s): f\kMIt( ,q, tt 13
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes 2 No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ® No ❑ NA [3 NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes N] No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
U No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
lU No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
® No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
f5a No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design []Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [>_� No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [-No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No ff NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: - Date of Ins ectiom s-
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ® No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ® No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
No
❑ NA
❑ NE
❑ Yes
❑ No
MNA
❑ NE
❑ Yes
CR No
❑ NA
❑ NE
❑ Yes CRNo ❑ NA ❑ NE
❑ Yes [S[No ❑ NA ❑ NE
[:]Yes CffNo ❑ NA ❑ NE
❑ Yes CR No
❑ Yes Ej No
❑ Yes allo
❑NA ❑NE
❑ NA ❑ NE
❑ 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).,
ivMd6N `(4- co.-n S' 7 Htt� 1
Reviewer/Inspector Name: _�(�� ���`,hP�y Phone:
Reviewer/Inspector Signature: Date:
Page 3 of 3 21412011

Fa
FB
i� Date2-U
': NPDES (Rainbreaker.-,-,��PLAT. Annual Cert:;[ Pipe )i6�
Lagd6ri Nam
f6.646111"
WO
- V1;
2
3,
.4
5
Desidn'-frdeb
id'.IT
'a
Mkor`ded
in
d idn,
ff
777-
ObseN.bd'l rj e
6
Stud rve'.'.j
Ua
77777
Sludq6-Dep'th
Liquid .1 Ft; 4o()W(tt
`W1
Ratio S I ud g"6
o TiQ
t Mi
611
1FW.1 d
m 6'� I ftt. 0A 5
Date 'b tut,b
Zen. H
e Dot ' 160, ij j::I:�-!� i Crop Yield M CA
Soi'7s I Transfer Sheets
pH Fi ds
!,Wettable Acres RAIN GAUGE
Ulme� WUP Dead bok or incinerator'';
e6�
N de
'lied :f Weekly Freeboard Mortality. Record Lime Applied If 1�: s
Cu-I Zr 1 1 in Inspections Check Lists
Needs S'(j-1 25) 120 min Insp. Storm Water
Needi V., ijki 7*j ;Ml 1 :11 1:1. lli:', -,Weather Codes
V1,
e Dot ' 160, ij j::I:�-!� i Crop Yield M CA
Soi'7s I Transfer Sheets
pH Fi ds
!,Wettable Acres RAIN GAUGE
Ulme� WUP Dead bok or incinerator'';
e6�
N de
'lied :f Weekly Freeboard Mortality. Record Lime Applied If 1�: s
Cu-I Zr 1 1 in Inspections Check Lists
Needs S'(j-1 25) 120 min Insp. Storm Water
Needi V., ijki 7*j ;Ml 1 :11 1:1. lli:', -,Weather Codes
V1,
E M-1
131,1111FEAR-49
"0,
12�1
M
M�Mnwmliqlv�
7141�2
151
MORMI
IRS
�,
p*,
Verify P aff lliations
"A j;!11
Date last-W F !!','FRO or Farm Records
Date 1"� WO 'i Lagoon # Wor&- i
J
Top Dike
Stop Pump q3, 4
UM
Start Pump�L,,�,,
Conversion
ui P1 C.�1 lac„ Zn-1 3000= 213 lb/ac ersion-A ;-

DIM.D5 31301i-1
Type of Visit: -P Compliance Inspection Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 19) Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: �L1 .] Arrival Time: Departure Time: p. T County: SDi Region: D2Q
Farm Name: F m
Owner Name: $ all 1('00
Mailing Address:
Owner Email:
Phone:
Physical Address:
r
Facility Contact: ., s..l j vOn Title: Phone:
Onsite Representative: Qlr ,S ✓ �lQIntegrator: iIPfQ�_
Certified Operator: Tay VLn Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Resign Current
Design
Current
Design Current
Swine
Capacity Pop.
Wet Poultry
CapacityCattle
C►apucity Pop.
Wean to Finish
Layer
Dai Cow
_
Wean to Feeder
p
Non -La er
DairyCalf
Feeder to Finish
Dai Heifer
Farrow to Wean
Design
Current
D Cow
Farrow to Feeder
I)r� P,oultr,
C•_a aci.
P,o
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
Turkey Poults
Other
Other
Discharees and Stream Impacts
I. is any discharge observed from any part of the operation'?
❑ Yes
ER No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
[RNo
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 21412011 Continuer)

Facilit' Number: - Date of Inspection: a�
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 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in);
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 1' 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 �3 No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ER No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit? [] Yes �R No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes �_gj No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need [:]Yes ® No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes D3 No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload [] Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
fg No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
�g No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
[RNo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[RNo
❑ 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
5R No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
TR 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 JR No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking [:]Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
Page 2 of 3
❑ Yes No
❑ Yes ❑ No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
NA ❑ NE
21412011 Continued

FaciWy Number: jDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? [:]Yes P No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [] Yes CRNo
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility'? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
❑ No
NA
❑ NE
❑ Yes
C�No
❑ NA
❑ NE
❑ Yes MNo ❑ NA ❑ NE
❑ Yes
D'No
❑ NA
❑ NE
❑ Yes
allo
❑ NA
❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes No
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative'? ❑ Yes No
34. Does the facility require a follow-up visit by the same agency? ❑ Yes No
❑ NA ❑ NE
CD NA ❑NE
❑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 wees as necessurv).
a�,1�} II n caP��rafibt � Pd of yeas,
L uo 1v&si®e Way' sr� % Ka�� bA w A9- far b6, &/ -0)" SPI-e-a i ypw,
Nell ajd` oo� records,
No Spra 1�9 dOie s;�ce 1 ar_ Vlgfl.
p s2no4 Schnwi�- -- _,......,.. : q/t�g__ Oj �l°
Reviewer/ins ector Name: Phone Q�
Reviewer/Inspector Signature: Date: H&rA aa. aola,
Page 3 of 3 2/4/20H

7W
?a
,4z
Facility No.Farm Name J 6r S1,() W� Date J� 1
Permit ---'COC OIC_ k NPDES (Rainbreaker PLAT Annual Cart)
FB
ro s
Lagoon
1
2
3
4
5
6
7
S illwa
Design freeboard
zq
Observed freeboard in
Sludge Survey Date
Sludge Depth ft
Liquid Trt. Zone ft
Ratio Sludge to Treatment Volume
... .. -
Erj]a
,6
Q�� 1►i�©�©���Design
Width
Soil Test Date lad 1
far 1
pH Fields
Lime Needed x03
Lime Applied
Cu-1 ✓Zn-T-,�.,
Needs Pyo
Yiew
- 60
+ 60
N Ar
p_
Wi,fi -30e, -
Wettable Acres ✓IOo,S�
WUP T
Weekly Freeboard
1 in Inspections
120 min Insp.
Weather Code
RAIN GAUGE
Dead box or incinerator
Mortality Records
A
-_
Verify PHONE NUMBERS and affiliations
Date last WUP FRO '3 11716)9 Date last WUP at farm
FRO or Farm Records
Lagoon #
Top Dike
Stop Pump
Start Pump
Conversion- Cu-I 3000= 108 Iblac; Zn-I 3000= 213 Iblac
App. Hardware

b
WDivision of Water Quality
+ Faeidly Number ®- 0 Division of Soil and Water Conservation
0 Other Agency
rype of Visit: 9 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
teason for Visit: [Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: 161141 [F] Arrival Time: Departure Time:""""""'T County:`
Farm Name: 70v S✓jt��!(� �arn� Ownneerr Email:
Owner Name: ✓ Phone:
Mailing Address:
Physical Address:
Facility Contact: -O'a r VOA Title: 1' Phone:
Onsite Representative:�Taif'svll&lmIntegrator: PrP j �aq
Certified Operator; Sv , v Certification Number: (0
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Boars
Other
Other
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
=Non-Layer
Pul
Other
Poults
Design Current
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other: _
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
Region: _PQ
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
,Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
[]Yes RNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑Yes
❑No
❑NA
❑NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
W No
❑ NA
❑ NE
❑ Yes
KNo
❑ NA
❑ NE
Page 1 of 3 21412011 Continued

Facili Number: - — Date of Ins ection:
1
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 'FCKNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats two the integrity of any of the structures observed? ❑ Yes CR 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 tR No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement? E3 Yes ❑ No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes Fh[ No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes n No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes S[ No
0 NA
❑ NE
maintenance or improvement?
H. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes Ca No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN [] PAN > 1011/. 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): CACn_ , PMPA Say bMr f
J �1
13. Soil Type(s): Q� $ Iv
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes N No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes 0 No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes � No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
t@ No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
� No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
&I No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
ek�7] No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists [:]Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
❑ No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather
Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
J;a No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
Q NA
❑ NE
Page 2 of 3
21412011 Continued

'REVISC-D
Facility Number: - Date of Ins ection:
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 E' 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 fait provide documentation of an actively certified operator in charge? ❑ Yes [ No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No CR NA ❑ NE
Other Issues
28. Did the facility fail to property 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)
3 I. 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 jg No ❑ NA ❑ NE
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes 53� No ❑ NA ❑ NE
❑ Yes ff No
❑ Yes Cff No
[-]Yes P No
❑NA ❑NE
❑ NA ❑ NE
❑ NA [] NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments = "Kr
Use drawings of facility to better explain situations (use additional pages as necessary).
�HajOr bare s ©+ bo&� 1de C F- f a o� . urm� pf als -�o s� or s'o,
A1sp n� Cu+Drs �7 bvAes [qj�o,
Wei
I maila4 A(m eaer� a m*cC pbo'lP, 600r r"d-1,
W hea{ VV0J- ,/A CV" 1 a,+- Week, a
®INS
VUM" - tevi'sek pa e 3 Q� f oca►-fj dpdje (s)rve ex� "cam u ex� Sl ��l e.
SV(v ` 0 be ,�,,,,d,Cn!15)1o[ C�!
of i�imQ� A* h6-G, reVtj-" , , CAftt P'0&'Lt4- _ V I.PY_A1 OAd >9rt01', Htre&t+
feqVP4f-he_ mail bufli of VP a coy 6"?e eKihs/0
Reviewer/Inspector Name: Z3-0n eltr Phone. 916-111-Qf ii _
Reviewer/Inspector Signature: Date: Tw_ i q ,aoij
Page 3 of 3 RSV 2/4/20'111 (0115-1

` Facility No. 'fit _Far Name L4/ t4 ) Date
Permit COC OIC NPOES (Rainbreaker PLAT Annual Cert j
FB
Drpps
lop —
Lagoon
1
2
3
4
5
6
7
Spillway
Design freeboard
3
Observed freeboard in
Sludge Survey Date
1 ttalam
Sludge Depth (ft)�.
Liquid Trt. Zone ft
S-
Ratio Sludge to Treatment Volume
MIMJ7002-CM V%/ -M
Soil Test Date a Wettable Acres RAIN GAUGE
pH Fields WUP Dead box or incinerator
Lime Needed Weekly Freeboard _ Mortality Records
Lime Applied 1 in Inspections
Cu-1 V Zn-I �� 120 min Insp.
Needs P Weather Code4,2
Cron Yield -v Transfer Sheets1.
.WNW,
wwrtlli
IBM
Verify PHONE NUMBERS and affiliations
Date last WUP FRO Date last WUP at farm App. Hardware
FRO or Farm Records
Lagoon #
Top Dike
Stop Pump
Start Pump
Conversion- Cu-1 3000= 108 Iblac; Zn-I 3000= 213 Iblac
7

P I MS 7yf WIMP
P
a
43CDivision of Water Quality
Facility Number E
J�O Division of Soil and Water Conservation
-- O Other Agency
Type of Visit i07'Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit ® Routine 0 Complaint 0 Fallow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: ® Arrival Time: Departure Time: p County: Sor
Farm Name: 7nq V r r al F(! f Owner Email:
Owner Name: I H Su f j V,9.1 Phone:
Mailing Address:
Region:
Physical Address:
Facility Contact: s� r + Title: Phone No: �1Qq`1Sa�7
Onsite Representative: ✓)f il1Q'r� Integrator: it?}�04
Certified Operator: Sy-U 7-- - -- - - Operator Certification Number: 16-7 YA
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Other
❑ Other
Back-up Certification Number:
Latitude: ❑ e 0 I❑ Longitude: 0 0❑
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑
❑ Non -Layer er
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turke s
❑ Turkey Poults
❑ Other
Discharges & Stream Facts
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)
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures: [l
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 qNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes tgNo ❑ NA ❑ NE
❑ Yes RNo ❑ NA ❑ NE
12128104 Continued

Faci#ity Number:'35' —
Date of Inspection L�iJ
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
12 No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Alved Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
tZ 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
RNo ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
JR Yes
❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
birNo ❑ 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
f.RNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
allo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
5rYes
❑ No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
�KNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
J,;jNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
. �No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Comments (refer to question #): Explain.any YES.answers and/or any reccominendatlpns or any othericomme s
Use drawings of facility to better explain situ ations.jusc additional pages -as necessary) , �� _ � r � a ':
aX, �. . a. a4 �..3b ��
Reviewer/Inspector Name
-- Ct "; t<.' Phone:'
Reviewer/inspector Signature:
Date: Nfu
Page 2 of 3 (J 12128104' Continued

Facility Number., —t Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes J>_jNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [,9-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 5�-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?
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
2$. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than nonnal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewerd n spector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
Additional C,,omments,.itndlor Drawings , ,;,'tk ,.n. fiftiG ,_=f
❑ Yes
C3 No
❑ NA
❑ NE
❑ Yes
❑ No,
- t'NA
❑ NE
❑ Yes
RNo
❑ NA
❑ NE
❑ Yes
WNo
❑ NA
❑ NE
❑ Yes
CjNo
❑ NA
❑ NE
❑ Yes
❑ No
C�-NA
❑ NE
❑ Yes C'No ❑ NA ❑ NE
❑ Yes IRNo ❑ NA ❑ NE
❑ Yes JYNo ❑ NA ❑ NE
❑ Yes 'RrNo ❑ NA ❑ NE
❑ Yes EfNo ❑ NA ❑ NE
❑ Yes [kNo ❑ NA ❑ NE
7 plv) e wor k`-.On be S�Qt n n l a�oa, bac��fo� ,
I Coen wol'- To rn rniplen� IsF w-�efo� e� v h� So ga is of haP,
L9�. S � y,�a
i
0hP ear na4eo�. abao�. w �1 I �e -.qyj, , q jo� �'ecarc�s
I !'
12128104

'3�.
7(:33
763.3
'03),
Fi ciiity No. Farm Name
Permit ✓ COC
Pop,
Type
Design
Current
9-
770 `f 0
OIC_
Date 1036,0
NPDES (Rainbreaker
PLAT Annual Cert )
freeboard
Observed freeboard (in)
Sludge Survey Date
V1 us"I
SludgeDesign
Depth (ft)
Ratio Sludge to Treatment Volume
WARM
Sfu �I�. I � 1 r(
• r ■ . -
law
be -sign Width
Actual Width
Soil Test Date QDM,30i0! CrOve, rO Wettable Acres -� RAIN GAUGE
pH Fields WUP Dead box or incinerator
Lime Needed �i4c. Weekly Freeboard Mortality Records
Lime Applied 1 in inspections
Cu-I ✓ Zn-I ✓ 120 min Insp.
Needs P Weather Codes
Crop Yield -_-__ Transfer Sheets
1
wrey (A6
:.
.'
..
..
1M
CROP
VNI, ►�
•
Con w'nd10,v - Yj�� "� FebVerify PHONE NUMBERS and affiliations
Date last WUP FRO Date last WUP at farm
FRO or Farm Records
Lagoon #
Top Dike
Stop Pump
Start Pump
Conversion- Cu-I 3000= 108 lblac; Zn-I 3000= 213 Iblac
App. Hardware

a
1:.rk s /0 - o.s- z 0-6 9
Type of Visit &C-ompliance Inspection O Operation Review 0 Structure Evaluation O Technical Assistance
Reason for Visit (31fo—utine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival'Time: i+.��0 Departure Time: County: Region: FiQa
Farm Name: act nr ^4 Owner Email:
Owner Name: J aN 5 lli Va�•I Phone:
Mailing Address:
Physical Address: //��
Facility Contact: �--U 1141 s Lr w+�C-Title: �Y--Sao
Phone No:
Onsite Representative: C+�r"�+3 �'+'�"J��u� Integrator:
Certified Operator:
Sack -up Operator:
Location of Farm;
Operator Certification Number:
Back-up Certification Number:
Latitude: ❑ 0 0' =" Longitude: ❑ ° 0 6 =
Ld
Design Current
Swine Capac i t —yj Population
Design Current
Wet Poultry Capacity Population
Design Current
Cattle Capacity Population
❑ an to Finish
JE1 Layer
❑ Dairy Cow
Wean to Feeder 13,040 11
❑ Non -Layer
I
I
❑ Dairy Calf
❑ Feeder to Finish
❑ Dairy Heifer
❑ Farrow to Wean
❑ Farrow to Feeder
El Farrow to Finish
❑ Gilts
❑ Soars
Dry Pociltry
❑ Layers
Non -Layers ers
❑ Pullets
❑ Turkeys
❑ Dry Cow
❑ Non -Dairy
El Beef Stacker
❑Beef Feeder
❑ Beef Brood Cowl
I
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?
❑ Yes BNo ❑ NA ❑ NE
❑ Yes
❑ No
DOKA
❑ NE
❑ Yes
❑ No
EKA
❑ NE
3<
❑ NE
❑ Yes
❑ No
❑ Yes
B<o
❑ NA
❑ NE
❑ Yes
❑<oo
❑ NA
❑ NE
12128104 Continued

Facility Number: 9 2 -/7,5
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure l Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes �o
❑ Yes E No
Structure 5
❑ NA ❑ NE
❑NA ❑NE
Structure 6
❑ Yes CTNo ❑ NA ❑ NE
❑ Yes E o ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes 2 o ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes D 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 L"fNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application ,.,,�
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes L3No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. [:]Yes Q'10 ❑ 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 types)
13. Soil type(s) NO NO a
14. Do the receiving crops differ from those designated in the CAWMP?
ElE Yes
,�_,//
No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination? El Yes
,_.�Io
2 o
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
Ko
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
210
❑ NA
❑ NE
Reviewer/Inspector Name 1 f L l A IS ; : y Phone: 910, *33 , 333 V
Reviewer/Inspector Signature: Date: 9 —17— 2009
Page 2 of 3 12128104 Continued

Facility Number: $ 4, �- / 7,5 Date of Inspection `l 7— 0 9
Re uired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes[T No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [3 No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design El Maps [I Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
[I Yes
J] o
❑ 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
N�o
El NA
El NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
[I Yes
,['.�,
[3 No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
9'�ri
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
RNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
EiNo
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ❑ Yes No ❑ NA ❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes D<o ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
[I Yes
[Z 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
ETINo
❑ 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
i-_f 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?
El Yes
L7 No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
ErNoo
❑ NA
❑ NE
1212&04

0' lvision of Water Quality
Facility Number O Division of Soil and Water Conservation
O Other Agency
Type of Visit et—ompliance
Inspection
Q Operation Review O Structure Evaluation
0 Technical Assistance
Reason far Visit
34outlne O Complaint
O Follow up O Referral O Emergency
0 Other ❑ Denied Access
Date of Visit: 6-13-0$ 1 Arrival Time: Departure Time: 2'. Z$ County: S�te&oU Region: �2l�
Farm Name: Jay _.. SLl�� �� rH^ Owner Email:
Owner Name �R �. Sufi i Vsn/ Phone:
Mailing Address:
Physical Address;
Facility Contact: k"r4i_ S aa.lrw 1 L Y. Title: _Tc-e4 - F4ec r Phone No:
Onsite Representative: Cur{i s �w i k. Integrator:
� �;,IiiJctnr
Certified Operator: Y _ _ Operator Certification Number:
Back-up Operator:
Location of Farm:
Swine
Back-up Certification Number:
Latitude: = e = 6 = Longitude: ❑ ° = 6 ❑
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
[ILayer 3t� �55� ❑ Non -Layer
❑ Wean to Finish
19 Wean to Feeder
El Feeder to Finish
El Farrow to Wean
El Farrow to Feeder
El Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Dry Poultry
ElLayers
ElNon- Layers
El Pullets
ElTurkeys
El Turkey Poults
El Other
Discharges & p Stream Imacts
l . Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field El Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
El Dairy Cow
❑ Dai Calf
❑ Dai Heifer
❑ D Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
El Beef Brood Cow
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 O No ❑ NA ❑ NE
❑ Yes
2�jo
❑ NA
❑ NE
❑ Yes
❑ No
B A
❑ NE
E NA
❑ NE
❑ Yes
❑ No
❑ Yes
B rvo
❑ NA
❑ NE
❑ Yes
2<o'
❑ NA
❑ NE
Page I of 3 12128104 Continued

A e
Facility Number: $Z —% '79
Date of Inspection - 13,08
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1
Identifier:
Structure 2 Structure 3 Structure 4
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 63 it
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes ,.' NNo
'
E
❑ Yes No
Structure 5
El NA ❑NE
❑ NA ❑ NE
Structure 6
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes 2<o ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes B<o ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes Bfo ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes 3-5o'- ❑ NA ❑ NE
maintenance or improvement?
Waste Application ,_,,�
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ YesLI No ❑ NA ❑ NE
maintenance/improvement?
11.
Is there evidence of incorrect application? If yes, check the appropriate box below. []Yes
Dtvo
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[:]PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12.
Crop type(s) t-oi-n! , k/1t erc 7F 5, y 46� "VS
��
13.
Soil type(s) /vOli /I�o$
14.
Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
O No
❑ NA ❑ NE
15.
Does the receiving crop and/or land application site need improvement? ❑ Yes
Lt No
❑ NA ❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[:] Yes
�o
❑ NA ❑ NE
17.
Does the facility lack adequate acreage for land application? ❑ Yes
0<o
❑ NA ❑ NE
18.
Is there a lack of properly operating waste application equipment? ❑ Yes
LSNo
❑ NA ❑ NE
Comments (r�cfer to,gWestivri #) yTxplain ttriy�YES, nswer,`,sland/many recamrriendatians ar any other comments.
F•A•a� ebk aT�. �3v �„as
U e drawings of�facility to Netteraexplawsi,ivations (usetailditional�pages-as ces�sa�r�y,)„1
Reviewer/Inspector Name icrPhone: Y33. 3330
Reviewer/Inspector Signature: P 4". Date: —13 --Zoo 8
Page 2 of 3 1 Z128104 Continued

a �
Facility Number: $2 — % 751 Date or Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ErNo ❑ NA ❑ NE
20, Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 20�o ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes B' o ❑ 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
Bogo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
G o
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
9'lqo
❑ NA
❑ NE
25,
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
21o
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
9 i�o
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
01�o
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
2-go
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
❑<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?
ElE Yes
wo
❑ 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
D<o
❑ 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
J/
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
El Yes
,L1N*oo
I _1 No
❑ NA
❑ NE
Additlonsl:Comments and/or. DraWin s Aa
U
Page 3 of 3 12128104

® Division.of Water Quality
Facility Number 0 Division of Soil and Water. Conservation
0 Other Agency
r�
Type of Visit ® Compliance Inspection O Operation Review O Structure Evaluation Q Technical Assistance
Reason for Visit ® Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: /O-D$- 07 Arrival Time: /: 30 M Departure Time: 7'. 30 m County: Scl j! � &IJ Region: F�
Farm Name: 1i Vd N FwrvH Owner Email:
Owner Name: 7'Xk_ Phone:
Mailing Address:
Physical Address:
Facility Contact:
Wr i s
V-W i
Title: ENy. Mar.
Phone No:
Onsite Representative:
C�.k k .s
BAy %'Ji C_y_.
OF
Integrator:
Co` \ yl f_ F4lrvvt S
Certified Operator:
Back-up Operator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: = e ❑ i = Longitude: = 0 0 d = fl
Swine
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer 3o O
Z 738 ❑ Non-Layet
❑
Wean to Finish
Wean to Feeder
El
Feeder to Finish
El
Farrow to Wean
El
Farrow to Feeder
ElFarrow
to Finish
❑
Gilts
❑
Boars
Other
❑ Other
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turke s
El Turkey Poults
El Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field El Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Populati1.on=
❑ DairyCow
❑ DairyCalf
El Dairy Heifei
El Dry Cow
ElNon-Dairy
El Beef Stocker
El Beef Feeder
El Beef Brood Cow
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 ® No ❑ NA ❑ NE
❑ Yes
[2 No
❑ NA
❑ NE
❑ Yes
[9 No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
[A No
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
14 No
❑ NA
❑ NE
12128104 Continued

• Is
Facility Number: O 2 - j ]$ Date of Inspection /O -48-07
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
N No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
® No
❑ NA
❑ NE
Structure l Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 32.
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
[N No
❑ NA
❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
(A No
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
® No
❑ NA
❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
® No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
CA No
❑ NA
❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes [)i No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10%or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12, Croptype(s) C01rN WhC.A-k- _ Se►, Ioo_0.NS
13. Soil type(s)aA N 0h
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes N 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 [A No ❑ NA ❑ NE
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 ONE
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):
w
Reviewer/[ nspector Name R _ e-v eA s Phone: 9 0. 433 , 330 0
Reviewer/Inspector Signature: Date: / 0 - D S - 2.00 7
12128104 Continued

Facility Number: S2 -nus I Date of Inspection la—o8—d7
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes N No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 0 No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design El Maps [I Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [A 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 ® No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [,2 No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
® No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
Q9 No
❑ NA
.❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
® No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
[ No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ 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
(0 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
W No
❑ NA
❑ NE
nal Comments and/or Drawings:
12128104

•Fheility Number
Division of Water Quality
Division of Soil and Water Conservation
0 Other Agency
Type of Visit 0 Compliance Inspection 0 Operation Review Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine O Complaint O Follow up 0 Referral O Emergency A Other ❑ Denied Access
Date of Visit: 1
Farm Name: _
Owner Name:,
Mailing Address:
Physical Address:
Arrival Time: Departure Time: I 9 County:
Z-5 �I d0.hyoYyy"', Owner Email:
Facility Contact: Title:
S�Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Phone:
Region:` 'L_
nyPhone No.
Integrator:ZJ
Operator Certification Number:
Back-up Certification Number:
Latitude: = o = = Longitude: = o [=,
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Laver
.! ❑ Nan -La et
Dry Poultry
❑ Layers
❑ Non -La ers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharzes & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ElStructure ElApplication Field ElOther
a. Was the conveyance man-made'?
Design Current
Cattle Capacity Population
❑
Dairy Cow
❑
Dairy Calf
El
Dairy Heifei
El
Dry Cow
❑
Non -Dairy
❑
Beef Stocket
❑
Beef Feeder
Beef Brood Cow l
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 )� No ❑ NA ❑ NE
❑ Yes ❑ No (0 NA ❑ NE
❑ Yes ❑ No NA ❑ NE
❑ Yes J$No ,� A ❑ NE
❑ YQ. No )DNA [:1 NE
[:1 Yes ❑�1N/o �PNA ❑ NE
12128104 Continued

Facility Numbe - — t Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes %No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes PNo ❑ NA ❑ NE
Stru ure l Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
L-
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes._,� No
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes ❑ No
❑ NA 'NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ❑ No
❑ NA KNE
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 ❑ No
❑ NA NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ❑ No
❑ NA NE
0
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ❑ No
❑ NA NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ No
❑ NA
I�NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ No
❑ NA
NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
❑ No
❑ NA
NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA
NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
❑ NA
NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
a
k�kz. 6,td ckeAL.
Reviewer/Inspector Name Phone:
Reviewer/Inspector Signature: Date:r 1
12128104 Continued

Facikty Number: — r7 Date of Inspection
Re wired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ❑ No ❑ NA [� NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ❑ No ❑ NA PNE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA r NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ No
❑ NA FNE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
❑ NA J' NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
❑ NA ONE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No
❑ NA V NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
❑ No
❑ NA -471 NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ NA VNE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
❑ No
❑ NA 9) NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
❑ No
❑ NA )UNE
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
3 I.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
❑ No
❑ NA NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
❑ No
❑ NA ONE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
❑ No
❑ NA UNE
Additional Comments and/or Drawings:
12128104

x�
L
f Vlsit 0 Compliance Inspection Operation Review O Structure Evaluation Technical Assistance
n for Visit O Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Accjesss
Date of Visit: Arrival Time: a O Departure Time: County: �2V Region:'
Farm Name �.Sl+� f F Jan ��Y1Yj '--< <" LiPsQi Owner Email:
Owner Name: S tkrf 1•U� Phone:
Mailing Address: - _ - �' _G+'C" ' e1iy, 11t Fs-Q '.70 /U /I C-- 02 d 3 T7'
Physical Address:
Facility Contact: Title.
Onsite Representative: �' s IW "�G SO I t ve,
Certified Operator: 3 of�
Back-up Operator:
Phone No:
Integrator:
Operator Certification Number: Jwv`
Back-up Certification Number:
Location of Farm: Latitude: = = ❑ ,1 Longitude: = o ❑ 1 ❑
Swine
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
+ ❑ La er
O 331 ❑Non -La er - --'
❑ Wean to Finish
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
El Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Dry Poultry
❑ Layers
❑ Non -Layers
El Pullets
❑ Turkeys
El Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure El Application Field El Other
- a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
Design Current
Cattle Capacity Population
❑ DairyCow
❑ Dai Calf
El Dairy Heifei
❑ D Cow
ElNon-Dairy
El Beef Stocker
El Beef Feeder
El Beef Brood Caw
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures: �'
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 V No ❑ NA ❑ NE
❑ Yes
XNo
❑ NA
❑ NE
❑ Yes 14 No
❑ NA
❑ NE
❑ Yes
ONo
❑ NA
❑ NE
❑ Yes
0 No
❑ NA
❑ NE
❑ Yes
E0 No
❑ NA
❑ NE
12128104 Continued

Facility Number: —f 75' Date of Inspection 0(0
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes �IfNo ❑ 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 St cture 6
Identifier:
Spillway?:
Designed Freeboard (in):
rr
Observed Freeboard (in): a c7
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 No
❑ NA ❑ NE
S. 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 No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes dfNo
❑ NA [INE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes �4No
❑ 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
Corp, Spy-6. W
12. Crop type(s) P , gq eon
13. Soil type(s)
L0 ,10
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes 'M No
❑ NA
❑ NE
t5. Does the receiving crop and/or land application site need improvement?
❑ Yes
® No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination,[:]
Yes
❑ No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
"S] No
El NA
El NE
18, Is there a lack of properly operating waste application equipment?
❑ Yes
JRJ No
❑ NA
❑ NE
Reviewer/inspector Name ' ` ` " Phone: —
Reviewer/Inspector Signature: Date: n .26d
12128/0 Continued

Facility Number: — Date of Inspection S p Q{O
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? Cl Yes &No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes t3l 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 VNo
❑ 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 )9 No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes "KNo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes ❑ No
NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
[:]Yes ❑ No
NUNA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes 9No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? Cl Yes ❑ No ,M NA ❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes XNo ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
Wo
❑ 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
17No
❑ 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
A No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to diseuss review/inspection with an on -site representative?
❑ Yes
NbNo
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
QNo
❑ NA
❑ NE
12128104

Type of Visit 0 Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason far Visit @ Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: c Arrival Time: Departure Time: County: __- s Soti1 Region: F Klu
.3IIr% �
Farm Name: 1j a to N U.rOwner Email:
Owner Name: li:ti v _ a Phone:
Mailing Address: `f [S �%� i��, N �_ er,v_�_}i� a��ser. Cr a83�
Physical Address:
Facility Contact: 1 Title:
Onsite Representative: _Cur-6A 13a, ie , c- ( r A ��y-s
Certified Operator: _., �tA- !1 Q_+-,_
Back-up Operator:
Location of Farm:
Phone No:
Integrator, C a .-\ .r
Operator Certification Number:
Back-up Certification Number:
Latitude: 0 e = g =td Longitude: = ° 0 d =
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population Cattle
❑ Wean to Finish
❑ Wean to Feeder of 0
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
I
❑ Boars
Other
❑ Other
❑ Layer
❑ Non -La er
Dry Poultry
❑ Layers
❑ Non -La ers
❑ Pullets
❑ Turkeys
❑ Turkey 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
Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy hleifei
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
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 [N No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
PD No
❑ NA
❑ NE
12128104 Continued

Facility Number: �,2 — .5" Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
Al 1,
❑ Yes ® No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ® No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes © No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ® No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ® No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ® No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance/improvement?
It. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ®No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13.
Soil type(s) _�i_Qr_'�_.
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
[�d No
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determinations[:]
Yes
P No
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
[51 No
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
P No
❑ NA
❑ NE
Reviewer/Inspector Name Phone: -0
Reviewer/Inspector Signature: Date: 3 / /5 / 03r
12128104 Contdnued

r
Facility Number: $.% 7S Date of Inspection
Reguired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes Q] No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes N No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes N 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
® No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
® NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
❑ NA
® NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No
❑ NA
R] NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
® No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ NA
® NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
® No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
® No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ 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
No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
No
❑ NA
❑ NE
Additional'Comments and/or'Drawin s ,.rox �a"ram
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12128104

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Division of $ail and' Water Conservation, ` t t•
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Type of Visit ompiiance Inspe Q Operation Review Q Lagoon Evaluation
Reason for Visit e Q Complaint Q Follow up Q Emergency Notification Q Other ❑Denied Access
Facilit_t' Number
Date of ViAt: 75725W iTimc: C O
_rO Not Operational 0 Below Threshold
� ermitted 0'C.e t fled [3 Conditionally Ce '(fr'ed 0 Registered Date Last Operated Above Threshold:
Farm Name: 44 ; Vkr 0 County: 50k
Owner lame: rrs //�� �j !! Phone No: ��//
Mailing Address: _ s"f'1/ �S l!'d i!� &I /� , _
Facilitv Contact: Title: P one No:
OnsiteRepresentative: h�II1vA i. r�-+.Entegrator: •
Certified Operator: Operator Certification Number:
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 0 ° 0" Longitude
Design Current
Swine Capacity . Population
can to Feeder
eeder to Finish
❑ Farrow to Wean
Farrow to Feeder
❑ Farrow to Finish
❑ oilts
❑ Boars
Design Current Design Current
Poultry Ca aelty Population Cattle, Capacity Po ulation
❑ Laver I I Dairy
❑ Non -Laver I I Non -Dairy
❑ Other
Total Design Capacity
Total SSLW
Number of Lagoons
Holding Ponds / S6Ud Traps'
L�
Discharbes 8 Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Svrav Field ❑ Other
a. if discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
❑ Yes
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑�, No
El Yes
EIN
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collecfiog & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure t Structure 2 Structure 3 Structure 4
Identifier: rr''
Freeboard (inches):
Structure 5
❑ Yes
❑ Yes nN6
Structure 6
05103101
Continued

Facility Number: f'7 S I Date of Inspection
aQA
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
Immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
} aStLanglication
10, Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
12. Crop type
13. Do the receiving crops differ witVthose designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20, Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes No
❑ Yes No
❑ Yes L .1 No
❑ __�
Yes L
❑ Y c s No
Cl Yes
NNoo
❑ Yes
,_..,
a
❑ Yes
l,,
El Yes
,l---Ko
Imo
❑ Yes
[<o
❑ Yes
E31Vo
❑ Yes
OX-m-
❑ Yes
[4+fr'
❑ Yes &KQ
❑ Yes 9.NT,
❑ Yes l3416
❑ Yes EH16~
❑ Yes �
❑ Yes
❑ Yes L'Fo
❑ Yes 0'l o'
❑ Yes
No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
f ,<��ieF 9.d� .•,e 1LY�U+�tA°!'r''�l 4".., .. _ �"'.. r.
Cohimenni'SOfeferito'qucstinn #) Cxplain,any YES enswets'and/or any recommendations 16r any o t sqpwacnte'
y-..,..
Use�drawin s of facility to better explain situations:: {use addition6[t Oa ear
g afrtnecessary) eld Copy ❑ Final Notes
P"a �C0d..ecov-js� d czfl�.
Reviewer/Inspector Name F i 41
Reviewer/]nspector Signature: ' Date:
05103101 Continued

Facility Number: — / Date of Inspection dig? Q
018.2
266.. Doeestthe discharge pipe from the confinement building to the storage pond or lagoon fail to discharge atlor below ❑ Yes Deo
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes No
28. Is there any evidence of wind drift during land application? (i.e, residue on neighboring vegetation, asphalt, ElYes o
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes 2<0
1
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes o
31. Do the animals feed storage bins fail to have appropriate cover? El �, o
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes Ld�IQ0
Additional Cominents,`Ohd/.orjpt0 -s, r, r .,_`�.'v,..
05103101

Site Requires Immediate Attentio :
Facility No.
DIvsioN OF ENVIRONNIENTAL MANAGEMENT
ANDAAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE.• _'B— L A __, 1995
Time. A0 -' 't3
Farm Name/Owner, O M 1 O 13G,y S u 11ICcr1
Mailing Address: _ `�(Q15 G'�Sv \11e. C; b -a F3 -6H I
County:., J ••�+ ^ �m o --
Integrator. Phone-, ;91 01-1 -4 - 0.-415
On Site Representative: D� oT i cw,,o vv & Phone: l D- -D
Physical Address/Location: , _ ;S, Ri- 172-q„^ 9!ivSV
Type of Operation: Swine flat. .poultry _ &ttic �
Design Capacity. 30�0 lv�� Number of Animals on Site: Ss•�.e
DEM Certification Number: ACE,. DEM Certification Number, ACNEW,---._
Latitude:' Langitude:wT?_' tO
Circle Yes or No
r.
Does the A'mal Waste Lagoon have sufficient freeboard of 1 Foot +-15 year 24 hour stone event
(approximately i Foot + 7 inches) Yes or No #ewal Frxboard:._Ft, & Inches
Was any seepage observed from the 1 oon(s)? Yes No Was any erasion observed? Yes No
Is adequate land available for spray. Y or No Is the cover crop adequateZsrNo
Crop(s) being utilized: Co s- .� w►�=-t' _
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings Yes r No
100 Feet from Wells Yes r No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes o No
Is animal waste land applied or spray 'irrigated within 25 Feat of a USGS Map Blue Line? Yes No
Is animal waste discharged into waters of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes � If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? Yes or No
Additional Comments: -2- 13�r-n
Inspector Name
Signature
cc: Facility Assessment Unit
Use Attachments if Needed.

}
r
r ANnEAL WASTE MANAGENENi` PLAN CSRTXPXCATIgN FOR N1;W OR EXPANDED PEBDLOTS
Please ret%=n the completed fozss to the Division of Enviro=aatal HAMA9ema,at at
the addzes■ an the reverse aide of this fax=.
Name of farm (Please print) : •5� V X "1 V.�
Address: R t I Q .201
F,;Isuy, C., QU4 V Phone No.: 41L) jZ t1- /3a7
County: o
Farm location: Latitude and Longitude:,: %,L' a3�N./ !}._. LW (required) . Also,
please attach a copy of a county road map with 1 cation identified.
'Type of operation (swine, layer, dairy, etc.) 2 r-t
Demk7n capacity (number of animals) : .704C bA "., - ew
Average size of operation'(12 month population avg.):
Average acreage needed for land application of waste (acres): ,,j6-n _ CarM
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Technical Specialist Cartification
As a technical specialist designated by the North Carolina Soil and Water
Conservation Commission pursuant to�15A NCAC 6F .0005, I certify that the -new or
expanded animal waste management system as installed for the farts named above
has an animal waste management plan that meets the design, construction,
operation and maintenance standards and specifications of. the Division of
Environmental Management and the USDA -Soil Conservation Service and/or the North
Carolina Soil and Water Conservation Commission pursuant to ISA NCAC 2H.0217 and
i5A NCAC 6F .0001-.0005. The following elements and their corresponding minimum
criter ia-haze_been verified by me or other designated technical, specialists and
are included in the plan as applicable: minimum separations (buffers); liners or
equivalent for lagoons or waste storage ponds; waste storage capacity; adequate
quantity and amount of land for waste. utilization (or use of third party); access
or ownership of proper waste application equipment; schedule for timing of
applications; application rates; loading rates; and the control of the discharge
of pollutants from stormwater runoff events less severe than the 25-year, 24-hour
storm.
Name of Technical specialist (P
Affiliation:_ 4gIL
Address (Agency):
Phone No
Signature Date:����
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Owner/Has er Ag--eement
I (we) un erstand the operation and maintenance procedures established in the
approved animal waste management plan for the farm named above and will implement
these procedures. .I (we)- know that any additional expansion to the existing
design capacity of the waste treatment and storage system or construction of new
facilities will require a new certification to be submitted to the Division of
Environmental Management before the new animals are stocked. I (we) also
understand that. there must be no discharge of animal waste from this system to
surface waters of the state either through a man-made conveyance or through
runoff from a storm event less severe than the 25-year, 24-hour storm. The
approved plan will be tiled at the farts and at the office of the local Soil and
Water Conservation District.
Name of Land Owner (Please Print) ; JGtV ---.1 U + V Erh - -
Signature: U- . /-14 1 Date: 9
Name of Haaaaer, if different from owner (Please print):
Signature: • Data:
Notes: A change in land ownership requires notification or a new certification
(if the approved plan is changed) to be submitted to the Division of
Environmental Management within 60 days of a title transfer.
DFM USE ONLY:ACNEW#