820184_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental Quaff

"51114. HIP g Y.iii UDiV
0 Di13i0n Of Wat@r Resources
qk 1 j�
i'Numbrr I� I, .v!sion of Soil and Water Conservation
4 1J.:_'IE11::11- ,. . e .:
VI ti� IIII-u!�nl`'' 1 f m=�! f I �� Other Agency �..,:.....
Type of Visit: EY7Routine
fiance Inspection Q Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: 0 Complaint 0 Follow-up 0 Referral 0 Emergency Q Other O Denied Access
Date of Visit: ®n Arrival Time: ��'js 01Departure Time: V,( �3T County: Yl�,�y �j Region:1-
Farm Name: s'� r :� � y±fS jL� Owner Email: '�—
Owner Name: ttcv4L.A ti, Phone:
Mailing Address:
Physical Address:
Facility Contact: I C C•C �C �6Cytf �,/� Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator: t" Esc _
Certification Number:
Certification Number:
Longitude:
..,, �,' , . ;,6, 1 1 I {
1 Stl l ,. E gn k l III ; ,sl.i : ,r9 : 1�.., , €.ili I I l ; .ia .� I rl:,3 1::':'.Ii1 _ l il.,i y . .., ,., I'll ill .l , ,;: R F, , , ,I , I. I I, , , ; , ,. '
4i1�+.Designli.Currentl�,.��3;,1i ,;.II 1,,.lJIDesign� Current :,, ., ; i Design Current
1 I� { I 1„
3 ..II��,�I
1,,.., , a I
l i ill.:. ,Grl 9 1 1 t E �. r, I I h
I l pool Pop ;'
wineG+Is�I'I�III�'f`; Capacity, Pop :'I, �IIiII 'Wet Poultry +�'Capacity�
Cattle ' Capacity' Pap.
i i
' Wean to Finish ,. La er
I
I Wean to Feeder t Non La er
1;F Feeder to Finish I I h' I hI',I '�,'� €I€<� �� I ��' „�I ' '
i:i �llr ''' FI€ i, n �'l l I
Farrow to Wean 1 l II �' , l KI � �5. 1 j Ipf I I fi t. a
G�lllpll"�"''': �``i>�I�'il Deslgi� ]`Current
III
Farrow to Feederr; I, II1ID 1Poult 1 Ca aci� ;Po I
Farrow to Finish Lrs
gl Gilts ersBoars'HNo�nn-La
Pullets I
',a t4 i
:I
qi 11 , I� l,i V „
l l K I 11 i i i I',II '�Y' 1$ I II y ,:if y I 'E' T i
tl.j �I {! I i l`i,1 x } I I n ll Turkeys k i : ;li
I '
€ y I � ,€ ,'.
I' I
,� IR ik , . lit I i , . I I' 1 i.
Turke Poults �
=
j„n" Other Other
I -
Dairy Cow
Dairy Calf
Dairy Heifer
D Cow
Non
Beef Stacker
Beef Feeder
Beef Brood Caw
Discharges and Stream Imoncts
~❑
1. Is any discharge observed from any part of the operation?
❑ Yes
Vo
NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
[:]No
�A
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
❑ No
❑'CA
0 NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (if yes, notify DWR)
❑ Yes
❑ No
[� NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
[ 31N' o
0 NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
[] Yes
fNo
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 2/412015 Continued

Facility Number: - Date of Inspection:
Waste Collection & Treatment
4. Is storz.�e 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.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
No ❑NA ❑NE
[] No &NA ❑ NE
Structure 6
❑ Yes No ❑ NA ❑ NE
❑ Yes to ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes []'llo ❑ 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 E3 ,vo ❑ NA 0 NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [ZNo ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): t, ✓` u��Qy C>
13. Soil Type(s):
rul
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records _& Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [;3-No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [�fNo
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes Ef'No
❑ Yes
dNo
❑ NA
❑ NE
❑ Yes
0-go
❑ NA
❑ NE
❑ Yes
[]No
❑ NA
❑ NE
❑ Yes �Io ❑ NA ❑ NE
❑ Yes [a"No ❑ NA ❑ NE
❑ Yes
[ 1Vo
❑ NA
❑ NE
[,] Yes
[�Clo
❑ NA
❑ NE
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑NA ❑NE
Page 2 of 3 21412015 Continued

Facility Number: - I oF Date of Inspection: h4
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [3-9-oo
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [3'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 []- N' o
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
❑NA ❑NE
[:]Yes ❑ No ❑ NA ❑ NE
❑ Yes [ No ❑ NA ❑ NE
❑ Yes [ "No ❑ NA ❑ NE
❑ Yes 7[ f-No ❑ NA ❑ NE
❑ Yes
[;['Rfo
❑ NA
❑ NE
❑ Yes
[:rNo
❑ NA
❑ NE
❑ Yes
[�No
❑ NA
❑ NE
Comments !refer to nestI ""#':,'Exnla164h ;YES answers,,andlor`any;4dditional recont;mendations organ "otfi'e'rjcomment§
9 ,1gaa,a`i R': 61 €, yf�Vl r! r,',r,l ;r�!r €i _• -elf It iii'{.•:!I Y1 I y er
Usei'drarvingslof;focility;to betten'ex lafa sltuiitlpns" usc�addi.tional
3k ,,r,qV i }t, -eal
Reviewer/Inspector Name: " �/)k�
Reviewer/inspector Signature:1
Page 3 of 3
Phonelit7 q3 3J337.5�
Date:�u e�
21412015

ti s fl zR1Fwbt7
Division of Water Resources
Facility Number - 0 Division of Soil and Water Conservation
Q Other Agency
Type of Visit: C�ommpliance Inspection Operation Review Q Structure Evaluation Q Technical Assistance
a Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral Q Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: County: Region:
Farm Name: . 1Y� .J�� �� i �4s Owner Email:
Owner Name: �d �'I,C Phone:
Mailing Address:
Physical Address:
Facility Contact: =( & 64`7-C 4 Title:
Onsite Representative: L
Certified Operator: r(
Back-up Operator:
Location of Farm:
Design Current
Swine Capacity Pop,
Wean to Finish
Wean to Feeder
Feeder to Finish MqJ5 ' a
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Latitude:
Phone:
Integrator:
Certification Number:
Certification Number:
Design Current
Wet Poultry Capacity Pop.
Layer
[Non -Layer
Design Current
Dry Poultry Capacity ["op.
Layers
Non -Layers
Pullets
Turkeys
Turkey Poults
Other
Longitude:
Design Current
Cattle Capacity Pop.
Dairy Cow
Dai Calf
Dairy heifer
Dry Cow
.Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
Discharges and Stream fraacts r
1. Is any discharge observed from any part of the operation? ' ❑ Yes No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No [51NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR) ❑ Yes ❑ No 2rNA ❑ 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 eNA ❑ 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 6No ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 21412015 Continued

Facili o Number: - Date of Ins ection:Xth it
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ®'o
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No
Identifier:
❑NA ❑NE
5g, A ❑ N E
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): �' C
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes E3-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<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 [?'No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes ENo ❑ 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 P�'rNo ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes 2rNo ❑ 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): CX 'lfQri? -U2
13. Soil Type(s): Cep i L
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes El"No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes dWNo
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
do
❑ NA
❑ NE
Reaulred Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[2fNo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
[:]Yes
%f No
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
appropriate box below.
21. Does record keeping need improvement? If yes, ch;?Waste
[/ryes
❑ No
❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking [] Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
2No
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
ZNo
❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facili Number; 150L Date of Inspection:
24s'Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes EEr5o ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes io ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA . ❑ NE
27, Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
❑ Yes No ❑ NA ❑ NE
❑ Yes C '-< ❑ NA ❑ NE
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
e No
❑ NA
ONE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
E! N.
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
ff/�1 o
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
ENo
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
[ZNo
❑ NA
❑ NE
Comment, (refer -to ,question #): Eaiplain any °YES' atEsw,ers and/ar,- any additional r,'e'e"'om" m''e"hdM16h's!VrAhy'�at9he' r'cotnrnents
ie Y d.,.. }am .._.,
Use drawingsaof facility to better` explain situations, (u9e additiunitl-pages as necessary} .`,
c�P�`awf.44,A
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
ke, 685(
Phone: q3310J5
Date: rl1— 1
7
21412015

iv sign of Water Resources
` Facility Number - 0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit: aCompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: (Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time:County: _ Region"
Farm Name: t'x( v^—° f►`Yyl Owner Email:
Owner Name: 51,t�-��,Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: i [
Certified Operator: `4
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
Title:
Latitude:
Phone:
Integrator: pt_4 40��
Certification Number:
Certification Number:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
Layer
Non -Layer
ury rouury
Layers
Non -Layers
Pullets
Turkeys
Turkey Poults
Other
Design Current
Longitude:
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
.Non-Dairy
Bcef Stocker
Beef Feeder
Beef Brood Cow
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
EI'No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
EfNA
❑ 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
4NA
❑ 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
C 'I&o
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412014 Continued

Facili Number: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes EK0 ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No E2 A ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ❑moo ❑ 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 CIONo ❑ 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 E No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ YesEj`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 ETNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 2�rNo ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes I Z 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): g tialy 56
i
13. Soil Type(s): D k)
IrIE_
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [ <o ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes �o ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes �o ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[21�o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[ "'N' o
❑ NA
❑ NE
Re aired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
6�'No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
E�rNo
❑ 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 [tr�10 ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections [:]Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? [:]Yes []�No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [3/No ❑ NA ❑ NE
Page 2 of 3 21412014 Continued

Facility Number: Oak- Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
U2*'�o
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
RNo
❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
❑ Yes
C No
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
[ZOONo
❑ NA ❑ NE
Other Issues
2$. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
[?No
❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
YNo
❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30, Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
[;�No
❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
TT
3 1. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
[7 No
❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
dNo
❑ 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)'":
c �4 T
�(w0,.egav-4kj' 4'6--P
PaI0 P_
Reviewer/inspector Name:
e
Reviewer/Inspector Signature:
Page 3 of 3
Phone: q3
Date: im, V X2/4 014

.. 131Ns X1ToQU rSgv
Reason for Visit: VRoutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Time: 0 Departure Time: County: 'l Region:
Farm Name: &eL C �i v�
"S141r Owner Email:
Owner Name: S 7 e f ` Pt(�L _r�4 Phone:
Mailing Address:
Physical Address:
Facility Contact: 10
Onsite Representative: e L
Certified Operator: l
Back-up Operator:
Location of Farm:
Title:
Latitude:
'Phone:
Integrator: q 1l C
Certification Number: L 8
Certification Number:
Longitude:
Design Current Design Current
Swine Capacity Pop. Wet Poultry Capacity ,op.
inish La er
Cattle
DairyCow
Design Current
Capacity Pop.
eeder
Non -La er
DairyCalf
DairyHeifer
Finish
I'l
—0—
Wean
Feeder
lFarrow
Design Current
Di, P,oult�. Ca acl P.o
D Cow
Non -Dairy
Finish
La ers
Beef Stocker
Non -La ers
Beef Feeder
Pullets
Beef Brood Caw
Other�M__
INFIr1r0ther I
Turke s
Turkey Poults
10ther
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation? [:]Yes No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes [—]No [5'14A ❑ 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
EfNA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
[:]Yes VNo
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412014 Continued

acifi Number: - Date of Ins ection: M aU /$
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ff jl A ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):�
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 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 0-lqo— ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
[�
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[DITo—
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
2<0
❑ 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
0 o
❑ 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
[�Jo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
�o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[7No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
to
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[ "No
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? if yes, check the appropriate box below. ❑ Yes fo ❑ 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 ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No [] NA ❑ NE
Page 2 of 3 21412014 Continued

F'
FacilityNumber: - Date of inspection: v
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [3W0—=NA❑ NE
�Q25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes 'NA�❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey [] Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes Q-K-o__ ❑ NA ❑ NE
27. Did the facility fail_to-secure a phosphorus loss assessments (PLAT) certification? ❑ Yes Q'110 ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes [Erl�o ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes [j No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the ❑ Yes [ /No ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
'*No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[2 o
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
2TNo
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
No
❑ NA
❑ NE
Comments (refer to question #):, Explain any YES answers and/or. any additional recommendations or any either comments P
Use drawings of facillty to better explain situations (use additional napes as necessurvl.
e,1.6�•�r- 7�2a-W
SL�sS��-3Z-
F
Reviewer/Inspector Name: 1� L) l'
Reviewer/Inspector Signature:
Page 3 of 3
. ID�_ q, 6
Phone:
Date: �.
21412014

. 1xq�15 6 `
(7Divlsion of Water Quality
Facility Number-'`T"--''-� 0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit: o lance Inspection Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Arrival Time: Departure Time:Q= County_ !?S Region:U2_�)_
CMW'oOwner Email:
Phone:
Facility Contact: _ Q� M C' Title:
Z'
Onsite Representative: t�
Certified Operator: I t
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
Latitude:
Phone:
Integrator: IVM ..{
Certification Number:
Certification Number:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
La er
Non -La er
Pullets
Poults
Design Current
Discharees and Stream Impacts
I. 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?
Longitude:
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
.Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes No ❑ NA ❑ NE
❑ Yes
❑ No
[3-lq'X
❑ NE
[:]Yes
❑ No
1A
❑ NE
[-]Yes
[:]No
alq'X
❑ NE
❑ Yes
Ej<o
Q NA
❑ NE
❑ Yes
12<0
❑ NA
❑ NE
Page I of 3 21412011 Continued

Facili Number: -in Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ❑ NA ❑ NE
a. if yes, is waste level into the structural freeboard? ❑ Yes ❑ No []'NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):�
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No ❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
[:]Yes
[3110 ❑ 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
C2011o' NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
6<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
[Va ❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[no ❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [:]Yes [no ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus [] Failure to incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): cis S' 6 0
13. Soil Type(s): (j O
L K'
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
To
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[fNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
/❑INo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
�Io
❑ 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
dNo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[21"'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
[DNA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
[ZNo
❑ NA
❑ NE
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
[:]Yes
VNo
❑ NA
❑ NE
Page 2 of 3 21412011 Continued

Faciii Number: - Date of Inspection:
24, Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE
25. is the facility out of compliance with permit conditions related to sludge? if yes, check ❑ Yes ✓] No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes �o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes To ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes 4;Ko ❑ NA ❑ NE
and report mortality rates that were higher than normal?
24. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes [2No ❑ NA ❑ NE
[:]Yes [j"No ❑ NA ❑ NE
❑ Yes [;KNo ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes Ca No ❑ NA ❑ NE
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative? ❑ Yes ONo ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes [;3"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 paces as:neeessarv).
CaC V41 6n
Slw�Se SaV�
Reviewer/Inspector Name:
Reviewer/inspector Signature:
Page 3 of 3
? 1-, 31 �__ I,(
Phone -
Date:
2/4/20 1
w

s a5-rv60 0 . 73- C)
ivision of Water Quality
Facility Number - O Division of Soil and Water Conservation
Y# O Other Agency
Type of Visit: VCompllance Inspection 0 Operation Review O Structure Evaluation Q Technical Assistance
Reason for Visit: reKoutine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: V1 Arrival Timer Departure Timer County�t Region
Farm Name:U dV {' Owner Email:
Owner Name: �fLA Phone:
Mailing Address:
Physical Address:
Facility Contact: I V�Q df ot ✓' Title:
Onsite Representative:
Certified Operator: 1 r
Phone:
Integrator:r
Certification Number: q?s eV
Back-up Operator: Certification Number:
Location of Farm:
Swine
can to Finish
can to Feeder
:eder to Finish
.rrow to Wean
.rrow to Feeder
.rrow to Finish
Other
Other
Latitude:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
La er
Non -La er
La
Pullets
Poults
Design Current
Discharaes 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?
Longitude:
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
.Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes L B!X ❑ NA ❑ NE
[:]Yes [:]No [D.-NA ❑ NE
[:]Yes ❑ No [a" ETA ❑ NE
[:]Yes [—]No
❑ Yes OErNo
❑ Yes 191<0
E]A
❑ NE
❑NA
❑NE
❑NA
❑NE
Page I of 3 CJ 21412011 Continued

Facili Number: - Date of Ins ection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [&Ko ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes �ia ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? [:]Yes No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes [�No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes ED No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes [glo
❑ 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 o
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes [El<o
❑ NA
❑ NE
maintenance or improvement?
1 l . Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes E2rl�0
❑ 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): 6e Y" 4a4 !!;`6 V
13. Soil Type(s): _ �cu �W S bG�r] f N- `7-Ul
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
E3No
❑ NA
[D NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[]Io
❑ 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
�To
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[PIONo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail have Certificate Coverage & Permit
to the of readily available?
❑ Yes
[2 o
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
g3 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 r7lf4o ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis [] Soil Analysis ❑ Waste Transfers [] Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections []Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? [:]Yes [yNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [2'No C] NA- ❑ NE
Page 2 of 3 21412011 Continued

Gin
Facili Number: Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [ZkKo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes 64o ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes [trNo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [D,1'4o ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes [(ZkNo
❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes [a-Ko
❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes Io
❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes 2No
❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes [B No
❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes [� No
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes []I/No
❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
s tu S 7 �.f g a7-1a
Cct(t,6'c/4 7, 13— 202—
Reviewer/Inspector Name:
ft -qB--
ReviewerArispector Signature:
Page 3 of 3
Datels 000% 1
21412011

- , 1 19Ix11Z1.
("Ivision of Water Quality
Facility Number ®- �a 0 Division of Soil and Water Conservation
0 Other Agency '
Type of Visit: Cotompliance Inspection 0 Operation Review 0 Structure Evaivation 0 Technical Assistance
Reason for Visit: "outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: � County: .SA Region: E80
Farm Name: k� A, LT kjLA4OCA( Owner Email:
Owner Name: Q hF_j% %,.)0g0 (1kVeinX � Phone:
Mailing Address:
Physical Address:
Facility Contact: oO Akktdl. Title: (h%__lkqrA Phone:
Onsite Representative: Sow% Integrator: UtZ[Z1r�.r 3acki
Certified Operator: pr ee Certification Number: 1q
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
Certification Number:
Latitude:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
Layer
Nan -La er
Dry Poultry
Layers
Non -Layers
Pullets
Turkeys
Turkey P_oults
Other
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?
Page I of 3 _.
Longitude:
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
.Non
-Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes [fNo ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes ❑ No
[:]Yes ❑ No
❑ Yes E2rNo
❑ Yes Rr"No
[v NA ❑ NE
rVNA ❑ NE
dNA
❑ NE
❑ NA
❑ NE
❑NA
❑NE
21412011 Continued

Facili Number: Vaa, - 1 WA Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
CgrYes
❑ No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
[]0NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:r
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
[�io
❑ 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
[3ySio
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[gio
❑ 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
QAo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
❑Ao
❑ NA
❑ NE
maintenance or improvement?
1 l . Is there evidence of incorrect land application? If yes, check the appropriate box below. [:]Yes Cg/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 ❑r Evidence
of Wind Drift ❑ Application Outside of Approved Area
12. Crop TYPe(s): Cog T : to kg.N,-01 C.OMiCy+\ lllp-{
13. Soil Type(s): &AA5i oeci) LQ CRp► y\ T:)kiAvk?to+0
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 [3y�4o [DNA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable [] Yes [5 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 E? No ❑ NA ❑ NE
❑ Yes [ErNo ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes D No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [gNo ❑ 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 [2No
❑ 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 [qlo
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes [:]No
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
[RfNA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: (late of Inspection: g
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes CDAo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes WN`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 (W No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No ® NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative'?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes C�rNo ❑ NA [-] NE
❑ Yes 2"No ❑ NA ❑ NE
❑ Yes [Z"No ❑ NA ❑ NE
Yes ❑ No ❑ NA ❑ NE
❑ Yes [RfNo
❑ Yes 2 No
❑ Yes [](No
❑ 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).
(M.a. WLLO Cam aol
F.c-tAM)g PA0.1_ I-rt 00.0Ee
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: q
Date:
21412011

Type of Visit: 18 Compliance Inspection Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: (DRoutine 0 Complaint Q Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: �' Departure Time: County: Region: t eL
Farm Name: LV�S �oC Owner Email:
Owner Name: }e�(}� Ai )Lci�k Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title: t1f Phone:
OnsiteRepresentative: �5� . AJILQ&
r-
Certified Operator: S
Back-up Operator:
Location of Farm:
Latitude:
Integrator:
Certification Number:
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Design Current
Wet Poultry Capacity Pop.
I Layer
Cattle
Dairy Cow
Design
Capacity
Current
Pap.
Wean to Feeder
Non -La er I I
Dairy Calf
Feeder to Finish pqqD
I
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
I
esign Current
Dr, P■r_kultr, C•_a aci_ P,o D.
Layers I
D Cow
Non-Dairy
Beef Stocker
Gilts
Non -Layer
Beef Feeder
Boars
Pullets
Beef Brood Cow
©tltcr
Other
Turkeys
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
❑ Yes q No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (if yes, notify DWQ) ❑ Yes 16o ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes H No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes � No ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 214120.11 Continued

Facili 'Number: -4W ISM Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Spillway?: _
Designed Freeboard (in): 4
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.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
�No ❑NA ❑NE
❑ No ❑ NA ❑ NE
Structure 6
❑ Yes N No ❑ NA ❑ NE
❑ Yes f.Z;�No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? [S Yes ❑ No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes jgj 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 [R No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes IR No [] NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground C] 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): L—U# Pff/hIJ Uejs
13. Soil Type(s): by
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
R No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
1�0 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
�]C No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No
❑ NA
❑ NE
the appropriate box.
❑ WUP []Checklists ❑ Design ❑ Maps ❑ Lease Agreements []Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes JR No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers [] Weather Code
❑ Rainfall ❑Stocking ❑ Crop Yield ❑ 120 Minute Inspections []Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes J�j No ❑ NA [D NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [] Yes [] No 0 NA ❑ NE
Page 2 of 3 21412011 Continued

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 R No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey [] Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
❑ No
O NA
❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
No
❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
"K No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
n No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
Yes
[3 No
❑ NA
[] NE
`"Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
12 No
❑ NA
❑ NE
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
[K No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
rXNo
❑ NA
❑ NE
Comments (refer to question ft Explain tinyVIES answers and/or'any addition'61',i cornrriendati6h' or any �t1i comments
Use drawings of facility to better explain situations (use Additional pages ass,neeesssary}:'
-71 k YV'y1 0r) brXe, s p* o, la pc — ' NrOavco- ►Ior- MP M
' ch s ^1 a Ilet I Rye i�
1st F gilds o(t i v��rboo s r n r,,;dd l e. .
lot,r
31, Dro� -� d� (�� en?x�thonii� ,
99 s b6fW
palm recodr are f� goad .sAOfP,
a
5� Sf �d � ��� 1 ' at a�l o �-r --hr► ` r�o� M11 ham. c6o,*
o f a If has 50���
w I
n0_. abR1 y\A aj Vt0jvte,C0fjj'
Reviewer/]nspector Name:
Reviewer/lnspecior Signature:
Page 3 of 3
Phone: aim ,,33M
Date:
21412011

Y'Facility No. $L—IWFarm Name
Permit ►,/, COC
Shfny,o{ Allcox M
C Date vll
Nam
k�iCJ�■ mil■
Design - • • . •Observed
freeboard
Sludge Survey Date
S, OMNI
Sludge Depth (ft)
37
be stgn Width
W-*
Soil Test Date Wettable Acres_ RAIN UGE
pH Fields �- WUP ea r incinerator
Lime Needed ��. Weekly Freeboard �/� Mortality Records
Lime Applied 1 in Inspections
Cu-I ✓ Zn-11 120 min Insp.
Needs Weather Codes
Crop Yield ✓ Transfer Sheets
• . -
El�i�l��li�1��1�1��1�C71�R.���1f��1��
...
.
��
�
� '►
1 .
r _ ►,,�•
fi�r_
!li►1����
I
!
r 3,r�
Verify PHONE NUMBERS and affiliations
Date last WUP FRO Date last WUP at farm
-�Itiatio�
FRO or Farm Records -11WD
Lagoon #
Top Dike
Stop Pump
Start Pump
Conversion- Cu-1 3000= 108 lb/ac; Zn-I 3000= 213 Iblac
App. Hardware
a) 4(b
{fa

HIGH FREEBOARD NOTIFICATION FORM
Staff please retain your original and place a copy in the High Freeboard Notification
Box located in Richard Canady's office.
Person Receiving Notification 1Z+ C_k 'Re—v e_ 1—S
Facility Number 82 - ! ate Received ?/5 2 o /o
Farm Names- E � Time /O: p Am
Cailer's.Name Ske_rwood E. A_llc.ox
Caller's Telephone Numbers
Home#
Farm #
Cell#
Pager#
For all callers PLEASE obtain a phone number where they can be reached at any time.
(Cell phone numbers, home phone numbers, farm phone numbers, pager numbers)
Tell the caller that a member of the CAFO unit or Paul Rawls will contact them as soon
as possible. Fa✓m-v rrryv�r.4d - cal/ To-i kf*'j,
® F ✓ZVM Se-vvr�e- w.pti 6cji -vvs �/R.►.IrLRfedN /e✓[Jtivybt Lsuer,lkt. M.-F.v
Freeboard (in inches) ' s s t 4P.,.
Lagoon # 1 Lagoon # 4
Lagoon # 2 Lagoon # 5.
Lagoon # 3 Lagoon # b:
Do not instruct the caller on the action they should take. That is up to the caller. Remind
them that they are to remain in compliance with their Permit and Waste Utilization
Plan.
Make the caller aware that you are assigning a tracking number to their call. Give the
caller the tracking number and tell them to use this number for.. all future contact as bout
this_ particular incident and when they call back reporting they are back into compliance.
High Freeboard Level Tracking Number is ANWIF
Thank the caller for their cooperation.
*Water Quality Staff Only*
If the caller indicates that the lagoon level is.<12 inches, contact one of the CAFO staff
AND Paul Rawls. Do not leave a note, e-mail or voicemail without contacting the
CAFO staff AND Paul Rawls. directly, on any report of <12 inches.
Treat any report of <12 inches as an emergency event.
-----------------------------------------------------------
*CAFO STAFF ONLY*
Establish a Filemaker/ BIMs Entry number for this report.
Print the Filemaker/ BIMs Entry and attach it to this form.
-2 01 Dd 6­73

9x045 g-11- 7,010
Type of Visit ompliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit outine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: 7— /3 —/Z71 Arrival Time: Departure Time: 6.� 30 County: Region:
Farm Name: S �� /`�. L,►�VC I
S �e_ Owner Email:
Owner Name: S� le vLAf ON e d�L/G Eo ' Phone:
Mailing Address:
Physical Address: 1 /�
Facility Contact: S� r vad A11G4� Title: ez&A/f;d� Phone No:
Onsite Representative: Integrator:
Certified Operator:
Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm:
Latitude: ❑ c ❑ 6 ❑ Longitude: = ° ❑ ❑
Design Current
Swine Capacity Population
Design
Wet Poultry Capacity
Current
Population
Cattle
Design
Capacity
Current
Population
❑ Wean to Finish
10 Layer I
1
❑ Dairy Cow
❑ Wean to Feeder
JE1 Non -Layer I
I
❑ Dairy Calf
eeder to Finish Z 9 0
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry
El La ers
❑ Dry Cow
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Non -Dairy
El Beef Stocker
❑ Non -Layers
❑Beef Feeder
❑ Gilts
❑ Boars
El Pullets
❑ Turke s
❑Turke Poults
❑ Other
❑ Beef Brood Cow
Number of Structures:
Other
❑ Other
Discharees & 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
oth r than from a discharge?
Page 1 of 3
❑ Yes 2<o ❑ NA ❑ NE
❑ Yes
❑ No
IENA
❑ NE
❑ Yes
❑ No
ETA
❑ NE
2-11A
❑ NE
❑ Yes
❑ No
❑ Yes
Rl�o
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
12128104 Continued

1 �
Facility Number: $Z- / g
Date of Inspection •'1 -/O
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I 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?
(iel 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 :�O00O3
NA ElNE
I -]Yes NA ❑ NE
Structure 5 . Structure 6
❑ Yes E Io ❑ NA ❑ NE
❑ Yes 9 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
tTivo
7. Do any of the structures need maintenance or improvement? ❑ Yes ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes 9No ❑ 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 Ei o ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ["1To- ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes B No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or la 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) ZCJ-4-L&L-1/y,, y �fi'ttG� �yr++.~N (D•s,
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ Yes
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
17. Does the facility lack adequate acreage for land application? ❑ yes
18. Is there a lack of properly operating waste application equipment'? ❑ Yes
I-] NA ❑NE
M No ❑ NA ❑ NE
No ❑ NA ❑ NE
No ❑ NA ❑ NE
ET'Noo ❑ NA ❑ NE
%<x,s ..., :. 3,-- --.. i,. x�YSkf,5�.,. ${a'�: &:1: � .%�&' S€y.`�'9k'.+it5� "
,Comments (refer tq question #) Ex`plain�any YGS$itnswers and/or anyYg,�recommendahons oreiiy other come ments�t rx�A
P.`?*
:Use drawmgs'of,faciliEy to better ezplam s�titat•�ons. {use additional pages; as necessary);, �Y �} �.'
i
T
Reviewer/inspector Name
GCJ- j Phone: ahP . 5.V -Jt3W O
Reviewer/Inspector Signature:
Date: 7—/._,' ^ ZD/a
12128104 Continued

Facility Number: — 8 Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box. ❑ WUP ❑ Checklists. ❑ Design El Mans ❑Other
ElYes No ❑ NA ❑ NE
❑ Yes B o ❑ NA ❑ NE
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
L`Mo ❑ 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 El Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
E No ❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
NA
N�0[01
❑ NE
24.
Did the facilityfail to calibrate waste application equipment as re required b the pen -nit?
ppq Y p
❑ Yes
NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
O NA
El NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
:_0
❑ 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
B<O ❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30,
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
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
nNo ❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
'
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
ElB Yes
o ❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
to ❑ NA
❑ NE
Addition alGomments and/or Drawings:U.
Page 3 of 3 12128104
Page 3 of 3 12128104

B. ►41j 11-04-2-009
Type of Visit ()t3mpliance Inspection O Operation Review O Structure Evaluation O Technical Assistance I
Reason for Visit outine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: O~2S-d% Arrival Time: ! SO Departure Time: 3
Farm Name: S• �. A • 1_o' ✓GS1.rGX-
Owner Name: 514c-t—Wood A f1 c-o x
Mailing Address:
/ S County: sa"'f!� 5� Region: /f"2d
Owner Email:
Physical Address: _
Facility Contact: 5t ar'a0� i�l><COtr Title: DLJNey
Onsite Representative: :51'' Gyyjcoc • Ali' eox
Certified Operator:
Back-up Operator:
Location of Farm:
Phone:
Phone No:
Integrator _%y%�ry dulN
Operator Certification Number:
Back-up Certification Number:
Latitude: = e ❑ 1 = Longitude: = o = g =
Dctsign en.. Design Current
Swine Capacity Population Wet Poultry Capacity Population
Design Current
Cattle Capacity PapulaHon
❑ Wean to Finish
1 JEI Layer
❑ Dairy Cow
❑ Wean to Feeder
I JEJ Non -Layer
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
Feeder to Finish 129
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
Dry Poultry
❑ Layers
❑ Non -Dairy
❑ Beef Stocker
❑ Gilts ❑ Non -Layers
❑ Pullets
El Boars Boars
❑ Turkeys
Other ❑ Turkey Pou Its
❑ Other
❑Beef Feeder
❑ Beef Brood Cow
IIIIIIIIIIIIIIIIIINJUMMber of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes C No ❑ NA ❑ NE
❑ Yes
❑ No
[] NA
❑ NE
❑ Yes
❑ No
EKA
❑ NE
L'NA
❑ NE
❑ Yes
❑, NNoo
❑ Yes
L� <0
[I NA
[INE
ElYes
2-No ❑ NA
❑ NE
12128104 Continued

i - -. .
Facility Number: L3 2 i8
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
Identifier:
Spillway?:
Designed Freeboard (in);
Observed Freeboard (in): 'T
Structure 2 Structure 3 Structure 4
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 [�], N' ❑ NA ❑ NE
ET
❑ Yes o ❑ NA ❑ NE
Structure 5 Structure 6
El Yes 211o'❑NA ❑NE
❑ Yes 01 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? El Yes L7No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes 211'o ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application ,.,�
10. Are there any required buffers, setbacks, or compliance alternatives that need El Yes l_TNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes El' o ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)ea'�u`�sd �t. C
13. Soil type(s) eso/d,�ic�ya fefkyia,,,r ,S�i�,�,,L�, ar
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes 2N"o ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes Ej o ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes 2 No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes LRNo ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes No ❑ NA ❑ NE
Comments (refer to .question: #): Explain any 1'ES answers andloranylreco med aor any other eamments. i1,s
Use drawings of facility to better explain situations. (use additional pages.,assnecessary;) °,
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Phone:
Date:
12128104 Continued

N �r
Facility Number: Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ 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 LJ1Vo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes E ❑ NA ❑ NE
❑ Yes M<o' ❑ NA ❑ NE
❑ Yes 0< ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[ oo
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
3,
El NA
El NE
26. Did the facility fail to have an actively certified operator in charge?
Yes
[I1�1
,L�'110
"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
[;R o
❑ 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?
Yes
Ell5
,�
'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
�
EK
❑ NA
❑ NE
General Permit? (ic/ discharge, freeboard problems, over application)
��,��
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
El Yes
12 ElNA
ElNE
33.
Does facility require a follow-up visit by same agency?
ElYes
LrTNo
❑ NA
❑ NE
12128104

Facility .Number
-Division of Water Quality
O Division of Soil and Water Conservation
O Other Agency
Type of Visit Ncompliance
Inspection
0 Operation Review 0 Structure Evaluation
0 Technical Assistance
Reason for Visit
WRoutine 0 Complaint
0 Follow up 0 Referral 0 Emergency
0 Other ❑ Denied Access
Date of Visit: `� 0� Arrival Time: Q�3Q 1t} Departure Time: County:'SyM Region: 'p_
Farm Name: S UVIVAQ& /�I Owner Email:
Owner Name: SSftwO A I COX Phone: q10-4_7"
Mailing Address: ass- Ftrk LAe_ Dr f L,,o— _(;,.�% Mak
Physical Address: /�
Facility Contact: S &woo C _ Al 1 e-&o Title: —_0,n r- Phone No:
Onsite Representative: Integrator: M`
/^�
Certified Operator: Shff 1`tI I CA)C Operator Certification Number: 1�I Q%
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: e ❑ I = 1
1 Longitude: 0 °
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
�j I ❑ Layer
❑ Non -Layer
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
I . 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:
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 29 No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
DfNo
❑ NA
❑ NE
❑ Yes
KNo
❑ NA
❑ NE
Page 1 of 3 12128104 Continued

f
Facility Number: —IF Date of Inspection I1�1
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in): 1
Observed Freeboard (in):
❑ Yes CRNo ❑ 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
C 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
WNo
❑ 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?
DRYes
❑ No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
�ffNo
❑ 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
9No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
C&No
❑ NA ❑ NE
maintenance/improvement?
1 l . Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
J�rNo
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window ❑{Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) wog
�erthV
13. Soil type(s) R l&Jna ', roO«i b&o ',
Kag ro�rt
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
93 No
❑ NA ❑ NE
15, Does the receiving crop and/or land application site need improvement?
❑ Yes
QTNo
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑
Yes
CT No
❑ NA ❑ NE
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
�ZNo
❑ NA ❑ NE
" ,n�'.,S,'`;.
.,�, �,3 rk, ���z "`a""": ,. fix40
'Cammnta„(refeitqu stiuit';#}f�plaln,sn�YSnnswesandlar anyrecommen�datipns�,or anyiother comments.
�U s drawing of facility to hettertexplaln `situations%useadditlonal pages as necessary �y NK
a
Reviewer/Inspector Name 1__�._ . sf_!v Phone; 10 . —,3� 33,33
Reviewerllnspector Signature: Date:
Page 2 of 3 12128/04' Uontinued

r
Facility Number: I — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? [--]Yes tSNo ❑ NA ❑ NE
20, Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes (Z No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps El 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 fXNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No [XNA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
D9 No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
JRNo
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
MNo
❑ NA
❑ NE
27,
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
ERNA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
RrNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
XNo
❑ 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
ZNo
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32,
Did ReviewerAnspector fail to discuss review/inspection with an on -site representative?
❑ Yes
DffNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
jRrNo
❑ NA
❑ NE
Additional Comments, and/orDrawings: ,
a y. Co I, b -akih nP
wake bcr� s �}-s on )nude j om wa lls; Exr � qW
� q dirn& � aid, smal r 1W s .sue -ho
� hea FN, � i
Vy 7
*aoea_ -FA'M 4- r-eCordS,
Page 3 of 3 12128104

i
Facility No. io1�j8 `� Farm Name SFr4 I!AeJ42CJ Date
Permit `--'COC OIC_ �a,NPDES (Rainbreaker
,5*T= 54,VQ -
Cl1eckS�tlti —f
,Slop--S� r /
Cats 66e,n ar I S` .
PLAT Annual Cert )
Freeboard
---���—
MAW V!TALWW;r �ThLf1
7�calibri6o­n Date17�
Soil Test Date 3ag lot
pH Fields. — 3
Lime Nee ed ?AEQ l�
Cu Zn ✓
Need P
I�( too
Crop Yield Obor
Wettable'Acres
WUP
Rain Gauge'
Weekly Freeboard
Rainfall >1"
1 in Inspections
120 min Inspections
Weather Codes
Transfer Sheets
Waste Analysis Date
'l; VJ
Soil Test Date 3ag lot
pH Fields. — 3
Lime Nee ed ?AEQ l�
Cu Zn ✓
Need P
I�( too
Crop Yield Obor
Wettable'Acres
WUP
Rain Gauge'
Weekly Freeboard
Rainfall >1"
1 in Inspections
120 min Inspections
Weather Codes
Transfer Sheets
Waste Analysis Date
'l; VJ
'l; VJ

Type of Visit J&qompliance inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit V Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Rate of Visit: S 41 Arrival Time: ((� Departure Time: County'
Farm Name: `�I Owner Email:
Owner Name: c '_t'r_ _ WC�CL L Phone:
Mailing Address:
Phvsical Addrecc:
Regiorr�
Facility Contact: r, q �. Title: �1�C�Q-Y Phone No:
Onsite Representative: '+_ `t V UbX1 _ Integrator: �?M-m 54
Certified Operator: ""' ' ��_. l�- Operator Certification Number: r
Back-up Operator:
Location of Farm:
Back-up Certification Number:
Latitude: = c = I = Longitude: ❑ ° = 1
Design Current Design C►urrent Design Current
Swine C►apacity Population Wet Poultry Capacity Population Cattle Capacity Population
❑ Wean to Finish
10 Layer
❑ DaiEX Cow
❑ Wean to Feeder
I ILI Non -Layer I
I
❑ Dairy Calf
eder to Finish D
1 b
1
❑ Dairy Heifer
Farrow to Wean Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
❑ Non -Dairy
ow to Finish
❑ Beef Stocker
Non -La ers
r
❑ Beef Feeder
s Pullets
Beef Brood Cow
❑ Turkeys
40
Other ❑ Turkey Poults
umber of Structures:
❑ Other IE1 Other
I
Discharses & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes) Vo ❑ NA ❑ NE
❑ Yes ❑ No �UA
❑ NE
❑ Yes ❑ No NA
❑ NE
❑ Yes ❑ No NA
❑ NE
❑ Yes RNo ElNA
ElNE
❑ Yes RNo ❑ NA
❑ NE
12128104 Continued

Facility, Number: 'Z-- Date of Inspection t~17
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?
❑NA ❑NE
El NA El NE
Structure i Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?: l
Designed Freeboard (in): I t
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yeso ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes o ❑ NA ❑ NE
through a waste management or closure plan? rrrr
❑ Yes )6o
❑ Yes � No
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes o ❑ NA ❑ NE
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
maintenance/improvement?
❑ Yes N No ❑ NA ❑ NE
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes N No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
�jNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
�3 No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
0 No
❑ NA
❑ NE
17, Does the facility lack adequate acreage for land application?
❑ Yes
N No
❑ NA
❑ NE
18. is there a lack of properly operating waste application equipment?
❑ Yes
50 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):
Y
g tY P P g rl')�
Reviewer/Inspector Name Al I Phone:�5 d5o)
Reviewer/Inspector Signature: Date:
Page 2 of 3 12128104 Continued

Facility Number: — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ YeSN No [3NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ElYes KNo ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design g ❑ Maps [IOther
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes �$ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and l " Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes 9No ❑ 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
WO
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
ONA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permor CAWMP?
El Yes
,,.am�,�qq
+lNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
91 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
XNo
❑ 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 discuss review/inspection with an on -site representative?
❑ Yes
Xio
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
IXNo
❑ NA
❑ NE
Additional Comments and/or Drawings:
I OL✓ JYt te
A.
Y
Page 3 of 3 12128104

F.acility NoV { Time In. Time
Farm Names U V L
Owner
Operator Sa(1L=d
tut Date
Integrator
Site Rep
No. A:1
Back-up No. -
COC Circle: General or NPDES
Design
Current
Design
Current
Wean —'Feed
Farrow — Feed
Wean — F'
Farrow — Finish
Finish
Z
Gilts / Boars
— can
Others
FREEBOARD: Design
0iiiuyo .SiUiJey
Crop Yield
Rain Gauge
Soil Test PLAT
Weekly Freeboard ✓
Spray/Freeboard ❑rope
Weather Codes
Waste Analysis:
Daily Rainfall
120 min Inspections
Date Nitrogen (N)
Z Z.
Observed , /
Calibration!GPAA 3 b/ ✓ �`'s
Waste Transfers —�--�
Rain Break6iA­
Wettable Acres iz
1-in Inspectionst�
Date Nitrogen (N)

j Type of Vlsit compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit ARoutine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: L 1 pb Arrival Time: Z S Departure Time: County'Region: 1:7 t-0
Farm Name: 5���,•- L; Ujt_4act� . r Owner Email:
SICE Owner Name: w� d A r � C� Phone:
Mailing Address: kSS F-ofA. LakL D _cjf �U3
Physical Address: 5 3 VZ, Oaf r o Us iq,,,j iqd
Facility Contact: � J Title: Phone No:
Onsite Representative: ' luf L-�& A I I Onc Integrator: Fe -, ;Wm - S&n&LrC
Certified Operator: Si il'�1 1���- A r ! Ca K Operator Certification Number: / I � l I
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
'Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Back-up Certification Number:
Latitude: = o ❑ I ❑ Longitude: ❑ ° ❑ 6 ❑
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -La et
Dry Poultry
❑ Layers
❑ Non -Layers
❑ 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?
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: �I
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 I No ❑ NA ❑ NE
❑ Yes �rNo ❑ NA ❑ NE
❑ Yes 11lpvo ❑ NA ❑ NE
❑ Yes )UNo ❑ NA ❑ NE
❑ Yes �Vo ❑ NA ❑ NE
❑ Yes *o ❑ NA ❑ NE
12128104 Continued

r
Facility Number: g Z— Date of inspection Q
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):
9 Ir
si
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 A Vo
❑ Yes [� No
Structure 5
[I NA [:1 NE
El NA El NE
Structure 6
❑ Yes ;d No ❑ NA ❑ NE
❑ Yes 0 No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes Wo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes _�M No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement? 10
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes k No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes�No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window /Evidence of Wind Drift El Application Outside of jArea
12. Crop type(s) rn � gn0 SS `1'4� V . � ljl QCl d,t�t� o U'Q�1.1.►
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes qkNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes XNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes X No
❑ NA
❑ NE
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 XNo
❑ 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): t =...
LReviewer/inspector
iewer/Inspector Name 1 C4 j MG- �� IV _-- I Phone: ► l0 113 3 33�
Signature: Date: 7UNEZ (r
Page 2 of 3 12128104 Continued

Facility Number: "Z— Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes V No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes �<No ❑ NA ❑ NE
the approprrate box, ❑ WCp ❑ Checklists ❑ Design ❑Maps [I Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 'XNo ❑ 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 P No
❑ NA
❑ NE
23.
if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes ❑ No
❑ NA
VNE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes XNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes "KNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes /, No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes )ONo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes ;QNo
❑ 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 nonnal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes It No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes io No
❑ NA
❑ NE
General Permit? (ic/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes O No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes VNo
❑ NA
❑ NE
Additiunal.Comrnents.andlot Drawings:
12128104

Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: a? o a Arrival Time: Departure Time: County: Saa—,-.J Region: Frz<:)
Farm Name: 5 % e t S re/��- `_ Owner Email:
Owner Name:
S�, 1 Cox Phone: r910 S9a - 3G38
�. r w b n �,,,;,,,, ,-,
Mailing Address: _ o� s,� ra r K e ke
Physical Address:._ rrwx _ Calr •- �G �•o� .
Facility Contact:
Title:
Phone No:
Onsite Representative: Integrator: Pre- »,.& = .
Certified Operator: ��+�� d2 �� e�x
p _ c� h � Operator Certification Number: .66 / 7 % 2/
Back-up Operator:
Location of Farm:
Swine
Back-up Certification Number:
Latitude: = 0 0 d = 6, Longitude: = ° = 4 = 1I
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
I
❑ Non -Layer
❑ Wean to Finish
❑ Wean to Feeder
® Feeder to Finish
Z) 4(D
o0
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Dry Poultry
❑ La ers
❑ Non -Layers
❑ 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?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifei
❑ DEZ 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:
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
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
0 No
❑ NA
❑ NE
❑ Yes ® No ❑ NA ❑ NE
12128104 Continued

i •
Facility Number: — } g Date of Inspection !p ds
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [2 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): 3110
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
X 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?
5� 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?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
Q No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[]PAN ❑ PAN > 10% or I O lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into
Bare Soil
❑ Outside of Acceptable Crop Window,1 ❑ Evidence of Wind Drill ❑ Application Outside of
Area
12. Crop type(s)
13. Soil type(s) !S q % ('] o /L , "_9
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
® No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
® Yes
❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination,[]
Yes
[0 No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
[j� No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
® No
❑ NA
❑ NE
Cammee (refer to question #,) Explain any YES enswtirs'.anator,•an re allons or apy other comments.
Use drawmgsoftfacility to hetter'ezplain sltuatlons (use addition>tlkpages;asnecessary):w,
�2M�-.i�"#n .+{ � •i � -,: `�e 3 .:rc �.t�� er[s i-"7'�B �f L•".'i��i°:"".�
(�� fQ�..k/.1f.
IS'-) WO r !t Of cLE v� a�On C ,S lW)!' �'�h nih� #-i� C.� .� -l'r C .. i� rQ�. I ►ti i- +� e— io�C /
n 1-0V l ✓,, � �I.l. �' (.JGL7Gr � +, itr G/tGG Dr /O Lhs o s�.,$ O�-�`i,vr. C,
Reviewer/Ins ector Name ,La r� /
p r t�. Phone: 110 JUI - is-V
Reviewer/Inspector Signature: Date: cql/a �aS
12128104 Continued

i
Facility Number: r,7 - %Fy Date of inspection a I« a
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design El maps [I Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ® No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
N No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
A NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
Dd 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?
El Yes
rP
LCt 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
Q0 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
E� No
❑ NA
❑ NE
General Permit? (iel discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
[4 No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
W No
❑ NA
❑ NE
Additf&naF.Cornmetts and/ or. .Drawings �d�" '`10 r'Sm.V.'
:�., {r ^�$��rriw!T �x:i 'rta
D3- Mr, �/Y41\co>L is a�wa�b o,- Si+ oQv.'`�•� aP�ol�j;c-dk�o��-
rvl r, 1'S���C71L �.G�. a— e,j( Gv pkr;,v— bra hex �j1L4d�s� Si�r�i �� I._i1-+ 1
a 007•
SOLI �a��
12128104

n
(Type of Visit ® Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit O Routine O Complaint O Follow up Q Emergency Notification O Other ❑ Denied Access
Facility Number $a1 "ate of Visit: T/a P/�1 Time: ��
Q Not Operational Q Below Threshold
W Permitted ® Certified © Conditionally Certified © Registered Date Last Operated or Above Threshold: .........................
Farm Name: ..........5.... �.... .:........ }.� e s # o k .... County:......—�? .r. .� pct.............................. F ............
G
Owner Name: ...».....»f '. w.t rQ...........r..... ...... Phone No: „ l o� . s9a - 3C. 3 .............
Sti.p.L!cax..................................................................... ....
Mailing Address....... fsE..... Et7 h......L icr:..-...xtx.4................................ .....(.jintyN...,,......C.................................°?�... �g.....
Facility Contact: ................ ...... r ....... ti a ..... �.�.u'a.... Title: ........ C ,w»K c r.............................. Phone Na:...................................................
Onsite Representative:..... .�`. w.�f:. ............. j kll '.O................................ Integrator: ...... Px.5 w= �....... ;-� .� .............
Certified Operator: .... Skcrvjov.Q.. r: tic01..................................... Operator Certification Number:...�..�.7'� ....1.........
Location of Farm:
EWSwine []Poultry ❑ Cattle ❑ Horse Latitude • 4 " Longitude Imo• ' «
Discharees A Stream impaCts
1. Is any discharge observed from any part of the operation? ❑ Yes ❑ No
Discharge originated at; ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made'? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min'?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes X No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes JZ No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes j6 No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ............. .................................................................................................................................................................................................
Ir
Frechoard (inches): (90?
12112103 Continued

Facility Number: VA -I 91f ^ Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes [P No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑ Yes] No
closure plan?
(If any of questions 4.6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes No
8. Does any part of the waste management system other than waste structures require maintenancelimprovement? ❑ Yes No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes W No
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes g No
11. is there evidence of over application? If yes, check the appropriate box below. ❑ Yes] No
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type C(3 C�. A :.1 r rrn % (� S �r-t c
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAW T)? ❑ Yes No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes No
b) Does the facility need a wettable acre determination? ❑ Yes ® No
c) This facility is pended for a wettable acre determination? ❑ Yes (,$� No
15. Does the receiving crop need improvement? ❑ Yes ® No
16. Is there a lack of adequate waste application equipment? ❑ Yes W No
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes q No
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes M No
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional ❑ Yes R] No
Air Quality representative immediately.
Field Copy ❑ Final Notes
LGrI r_- W e--* C,r ed- o s'�-G \'"l W �T4r -0-_<
Mc.rallen"c '% s Lorlc'i..nl -kA,:LS
V-e +o W U r V_ Oh l •i b o o, -4 a h L 6 a r L _r p, k s.
Reviewer/Inspector Name 1`
Reviewer/Inspector Signature:
Date: 5//.2 9 /d
12112103
Continued

FacUity Number: g,2 — Date of Inspection
Required Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes [j No
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ic/ WUP, checklists, design, maps, etc.) ❑ Yes No
23. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
24.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
No
25.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
No
26.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
j No
27.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
1p No
28.
Does facility require a follow-up visit by same agency?
❑ Yes
91 No
29.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
M No
NPDES Permitted: Facilities
30.
Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
[% Yes
❑ No
31.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
IN Yes
❑ No
32.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
® No
33.
-Did the facility fail to conduct an annual sludge survey?
❑ Yes
50 No
34.
Did the facility fail to calibrate waste application equipment?
❑ Yes
Jj No
35.
Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below.
❑ Yes
;0 No
❑ Stocking Form ❑ Crop Yield Form [:]Rainfall ❑ Inspection After 1" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
12112103

Site Requires Immediate Attention:
Facility No. CZ
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: 3_1&tn 119 , 1995
Time:
Farm Name/Owner: S.E.N. Liye.s4o c!< / S keYw o o ci A t 1 c-o K
Mailing Address: _ P,+ Z 5&K S85 . CI:N:A2U JVC 28328 - ---
County: Sa.Kpsoi%l
On Site Representative:' a sg S � �,•-�,r p` � Phone: �9/OJ .5 9 2~ - S 7 7/
s do d ,., ,
teox Phone: t 9/D) 51?2 3 / 4� !
Physical Address/Location:
1
Type of Operation: Swine _L/ Poultry Cattle
Design Capacity: 2-1?*0 Gi-d-F,'ni Number of Animals on Site:
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: Longitude• "
Circle Yes or No
Does the Animal Waste Lagoon have sufficie
(approximately 1 Foot + 7 inches) es or No
Was any seepage observed from the lagwn(s)?
Is adequate land available for spray? Ye or No
Crop(s) being utilized: tru ria _ G►-o,i
nt freeboard of 1 Foot + 25 year 24 hour storm event
ctual Freeboard:-3Ft. 0 Inches
Yes o>D Was any erosion ob rved? Yes o No
Is the cover crop adequate? Ye or No
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings? Ye or No
100 Feet from Wells? Yes r No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes 00Z)
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line: Yes o Na
Is animal waste discharged into water of he state by man-made ditch, flushing system, or other
similar man-made devices? Yes o Na 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)? es or No
Additional Comments:
R; c.ky R "e-Ls
Inspector Name
.IRA R4
Signature
-cc: Facility Assessment Unit Use Attachments if Needed.

16
NORTH CAROLM DSPARTIMT OF EbTP MONMENT, HSALTl3 b NATURAL RESOURCES
DMSION OF MMONHENTAL NAHRGMCM
Fayetteville Regional Office
Animal Operation Compliance inspection Form
p1 v yy
'i+"'PT MMTF %r k .. �..... •.�y...n pklf' -. y, y i P f
T, t ,+ . • w '" r• .� S S Slil��i'/Y
YAM: l�U►?f8f
,� T .M�4.' n,; vtiv:'R;.Yw'+!1`Ao- rLSy.. '. ..
- V�+ xnC T
EARN ,k�
„..... . T...: ...w':'„. . t�.:�� r �
'�..,? ia�a7rF..�ION;,D83'$ ', � .. r. .H�
S��.A• L�,�es� 5%erwaaci l-N1ct3X.
.
F:^A' ., -..YI, ... !�:'. iM.N11 OBI YIvi"y.
' s �y� -�a� �����y u'`"•"."'M �xr b•M•P��iM-�:
...• � •y[Yik li � 1'. �. r � " ', % nM<.r -
a
iiG� ''�d /� yy.�}y�� T�/�/ e��1� y�y�y�p� -
,...2:r in Nx', JVf�,.nfJii�n?�7 '1jts:a��.�t'. �'R'h'a�NoY..
.rnaf 3��Is.�l�iL,i;i;n��U[7ls ';s7 Y+'+aAlill
t dux 585 •n 2632-8
CID Z- 314 I
All questions answered negatively will be discussed in -sufficient detail in
the -Comments Section to enable the deemed Permittee to perform the appropriate
corrections:
SWTIM _ I
Ani.mAl oi2aration Tyme: finish
Horses, cattle, wine, poultry, or sheep
ON I
1. Does the number and type of animal meet or exceed
the'(.0217) criteria? [Cattle (100 head),
horses (75), swine (250), sheep (1,000),.and
poult (30,000 birds with liquid waste
systom�j
2. Does this facility meet criteria for
Animal Operation R=XSTPATLW.
3. Are animals confined fed or maintained
in this facility for a 12-month period? -
4. Does this facility have a CERTIF= -_AMM
WASIX MMQ2= P3.711W?
5. Does this facility maintain waste management
records (Volumes of manure, land applied,
spray irrigated on specig is acreage with
specific cover crop)?
b. noes this facility tweet the SCS minimum
setback criteria for neighboring houses,
wells, etc?
Y I H I CON ENTS

kield Site-lana_amMt
I. to animal vabLw sLuckpilsa ar lagoon
construction within 100 ft. of a USCS
Map glue Line Stream?
Z. Is animal waste land applied or spray
irrigatod wif-hin 25 Its of a U000 Map
Blue Line Stream?
3. Does this facility have adequate acreage
on which to apply the waste?
4. Does the land application'site have a
cover crop in accordance with the
QR=FIQZI-yvr.w
5. Is animal waste discharged into waters of
the state by man-made ditch, flushing system,
or other similar manmade devices?
6. Does the animal waste management at this
farm adhere to Best Management Practices
MY) of the approved CSR MCAT3QW t
7. noes animal, waste lagoon have sufficient„�i�
freeboard? How much? (Approximately
B. Is the general condition of this CAFE facility,
including management and operation,
satisfactory?
R=193 .Y
QLaments

r
!
v�
x
�6
`
v
he
14)
�
ick
is
A
f
toy
gs
Ill
JBY
\\\S
J
1
D U
P L
r y
{
Sampson [
North Carolina's largest
square miles. Sampson C
founded in 17S4. Its county si
at Clinton. The county w,-

RE,GIST'RAT:CN FORM FOR A►�1IwAL FEEDLOT O?rRATIONS
Department of Environment, Health and Natural Resources
Division of Environmental Management
Water quality Section
If the animal waste management system for your feedlot operation is
designed to serge more than or equal to 100 head of cattle, 75
horses, 250 swine, 1,000 sheep, or 30,000 birds that are served by
a liquid waste system, then t_:is fcrm must be filled out and mailed
by December 31, 1993 pursuant ,c 15'A NCAC 2H.0217 (c) in order to be
deemed permitted by OEM. please print clearly.
arm Name: fit, A.
Mailing Address: P4
County:
Phone No. 5QA- ;iU1
Owner (s) Name: t1_�_r L.CyCC1 _CC1r I Allr e\,z-
Manacer(s) Name:
Lessee Name:
Farm Location (Be as specific as possible: road names, direction
milepost, etc.) : Tir'1�lJ't��1 t1 3L1] 'i�1CrG 5h?. tI ��-i ��.151�or �fZ�
Latitude/Longitude if known: 4 -,�U -03
Design capacity of animal waste managqement system (Number and type
cf con finea animal (s)) : �q� 0 �eeriPv - 7 ni Sl
Average animal population on the farm (Number and type of animal (s)
-raised) : t�i ram_ r�R mhry
Year Production Began:-3 ASCS Tract No.:
Type of Waste Management System. Used: ,rn�;����f Y-)
Acres Available for Land Applicationof Waste:T
Owner (s) Signature (s) :CDATE g,3
DATE: