820194_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental W6

�T
y (3*3 IL(+ Irk 00
Division of Water Resources
s.
FAQ Number - Division of Soil and Water Conservation
ygas
®Other Agency
Type of Visit:ommpliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: Grio'utine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: //y/S County:
Farm Name: & U- MM 125-61V av,ti Owner Email:
Owner Name: e "t F f S "� Phone:
Mailing Address:
Region: Cl�
Physical Address:
Facility Contact: Cr, "'A5 &Ce -cu i`Ci -t Title: Phone:
Onsite Representative: Integrator: A q - S
Certified Operator: 6-V, 1De4c--f 0''1 Certification Number:
Back-up Operator:
Location of Farm: Latitude:
Certification Number:
Longitude:
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes ❑ o ❑ NA ❑ NE
❑ Yes [] No [B'<A ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
[:]Yes
❑ No
E21 A
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
[—]Yes
❑ No
NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
E] No
[:3 NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
E][ -No
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412015 Continued

Facili Number: - Date of Inspection: D—/.;;z—
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
allo
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3 1)
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
�o
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc_)
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
RNo
❑ 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 pari 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
RNo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
�No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application
Outside of Approved
Area
12. Crop Type(s): (] v-eo
13. Soil Type(s): 1v
14. Do the receiving crops di er from those designated in the CAWMP?
❑ Yes
® No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
KLNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
® No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
® No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
C] No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
M No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
® 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 D No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soi I Analysis ❑ Waste Transfers
❑ Rainfall ❑Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ® No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes F4__1 -No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
E] NA ❑NE
0 NA ❑ NE
Page 2 of 3 2/4/2015 Continued

Facility Number: - Date of Inspection. lj
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 [L]-iV'A ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ©1�_o ❑ NA ❑ NE
(Le., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a ❑ Yes l�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 EK0 ❑ 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 to ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes El"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 p Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): 13 c '- " cj�. S. O
13, Soil Type(s): tJA_
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes Eg-No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [3-�do ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes Eg--Ko ❑ 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 Q'l�o ❑ NA ❑ NE
❑ Yes ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
L3 "o
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[ Ko
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21 _ Does record keeping need improvement'? If yes, check the appropriate box below.
❑ Yes
[2110
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather
Code
❑ Rainfall ❑Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
[!_T'�o
❑ NA
❑ NE
23_ If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑'No
❑ NA
❑ NE
Page 2 of 3 2/4/2015 Continued

Wacfflty Number: - / Date of Inspection: j
24. Did -he facility fail to calibrate waste application equipment as required by the permit? ❑ Yes Q.Nf [] NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [] Yes E3 --NO ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes E2,M° ❑ NA ❑ NE
❑ Yes PEr I�❑ NA ❑ NE
❑ Yes ❑•?do ❑ NA ❑ NE
❑ Yes [3-1To ❑ NA ❑ NE
❑ Yes [7FIo ❑ NA ❑ NE
❑ Yes
©-lqo
❑ NA
❑ NE
❑ Yes
D-IT5
❑ NA
❑ NE
❑ Yes
[.-N'a
❑ NA
❑ NE
[] Yes
[;'3l;ro-
❑ NA
❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments.
Use drawinus of facility to better exDlain situations fuse additional nares as necessarvl.
Ca ('b,r.41 d -, �-
U — 3: q(
s
P - S. 5 3'37
Reviewer/Inspector Name:
Reviewer/Inspector Signatur
Page 3 of 3
Phone: v` q n-33�L
Date:
21412015

i
Type of Visit: 0"Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: County: ry Region:
Farm Name: �1n ��� ��� ��' Owner Email:
Owner Name: �y_ 22 �� l Yrrs [7-� Phone:
Mailing Address:
Physical Address:
Facility Contact: G �C�r/- ��/`G Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator: ^ S/7��✓ /r // _
Certification Number: /Dy
Certification Number:
Longitude:
Discharees and Stream ImDaets
1. Is any discharge observed from any part of the operation?
❑ Yes
[aNo
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
Design Correct
Design Current
a. Was the conveyance man-made?
Design Current
Swine
Capacity Pop.
Wet Poultry
Capaeity Pop.
Cattle t Capacity Pap.
Wean to Finish
❑ NA
Layer
c. What is the estimated volume that reached waters of the State (gallons)?
Dairy Cow
Wean to Feeder
Non -Layer
I
Dairy Calf
Feeder to Finish
❑ NA
❑ NE
2. is there evidence of a past discharge from any part of the operation?
Dairy Heifer
Farrow to Wean
❑ NA
❑ NE
Design Current
Dry Cow
Farrow to Feeder
❑ NA
D , P,ouht .
Ca aci P,a
Non -Dairy
Farrow to Finish
Layers
I 113eef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turke s
OthellgIUMLOW1
Turkey Poults
Other
Other
Discharees and Stream ImDaets
1. Is any discharge observed from any part of the operation?
❑ Yes
[aNo
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWR)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (if yes, notify DWR)
❑ Yes
❑ No
❑ NA
❑ NE
2. is there evidence of a past discharge from any part of the operation?
❑ Yes
[RNo
❑ NA
❑ NE
3_ Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
RNo
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 2/412015 Continued

Facili Number: V. - Date of Inspection:
❑ Yes
R No
❑ NA
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[gNo
❑ NA ❑ NE
r
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
54 No
❑ NA ❑ NE
the appropriate box(es) below.
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
[allo
List structure(s) and date of first survey indicating non-compliance:
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
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
M No
❑ NA [:]NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
R 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
[S 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
[allo
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
[] Yes
No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
RNo
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
F, 5 -No
❑ NA
❑ NE
Comments
(refer to gtiestion #f): Eplain any YES answers:andlor any additional'recommendatioos or any other comments.
Use drawings of facifity to better explain situations-, (use additional pa�Cs as'neCeSsary.
r�5� F'I'V_ -7
( C1W2__d /o-1 k- �
Reviewer/Inspector Name:
Reviewer/Inspector Signatur
Page 3 of 3
Phone:
Date: /D _/_2 4
2/4/2015

(Type of Visit: ('Compliance Inspection U Operation Review 0 Structure Evaluation Q Technical Assistance
Reason for Visit: 19<outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: -3--/ Arrival Time: Departure Time:;3 {7 County: Region:
Farm Name: P1 j:--C10-rn- Owner Email:
Owner Name: (�' ,:&, k, Zff 0-- Phone:
Mailing Address:
Physical Address:
Facility Contact: 6 z Title:
Phone:
Onsite Representative: S�� � Integrator:
Certified Operator: lam/ cylr� ��z—�� it -V Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current
esign
MISS
Current
Design Current
Swine Capacity Pop.
Wet Poultry
Capacity
Pop.
C►attle Capacity Pop.
Wean to Finish
La er
Dai Cow
Wean to Feeder Non -La er
Dai Calf
Feeder to Finish
Dai Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
Dr Poul
Ca aci
P,o
Non -Dairy
Farrow to Finish Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars Pullets
Beef Brood Cow
... L: it a ..
Turkeys
r._
he
Turke Poults
Other
Other
Discharges and Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes R No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ N E
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes [:]No
❑ Yes (R No
❑ Yes [allo
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 2/4/2025 Continued

Facili Number: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
allo
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[allo
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
Q No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
g No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[allo
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
® No
❑ 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 or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [g[ No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s);
13. Soil Type(s): a
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes t�;_No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ELNo ❑ NA 0 NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes � No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑Yes FM ❑ NA [:]NE
❑ Yes qNo [DNA ❑ NE
Re uired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes Q No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes QNo ❑ 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 [2�No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes �o
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 0 No
❑NA 0 N
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 214/2015 Continued

Facili Number: - Date of Inspection: /
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes RNo ❑ 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 provide documentation of an actively certified operator in charge? ❑ Yes �Z No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes 14 No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes 5� 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 LZ 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 MNo ❑ 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 fKj 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 Eg-No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawines of facility to better explain situations (ase additional pages as necessarv).
Reviewer/Inspector Name:
Phone: �/- , 1' 33 �c0
v /
Reviewer/Inspector Signature: Date: 3J�
Page 3 of 3 2/4/2015

_,�942r— & --:23-/L-
ion of Water Resources
Facility Number d Water Conservation
�- �" ®Other Agency
Type of Visit: Q<ompliance Inspection 0 Operation Review 0 Structure Evaluation 6 Technical Assistance
Reason for Visit: a, routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit. L L i Arrival Time: sr; c7 Departure Time: c� County: =
Farm Name: mat rm /—& Owner Email:
Owner Name: ���%�„ /C�yG�' Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: D Phone:
Region:
Onsite Representative: `^�� Integrator:
Certified Operator: Certification Number: G
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Design Current
DesigQ
Current
Design Current
Swine Capacity Pop.
Wet Poultry
Capacity
Pop.
Cattle Capacity Pap.
Wean to Finish
La er
Dai Cow
Wean to Feeder
Non -La er
Dai Calf
Feeder to Finish pOU
Dai Heifer
Farrow to Wean
Dry Cow
Farrow to Feeder
D > Paint .
Ca aci
Ro
Non -Da'
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
LEI
Boars
Pullets
Beef Brood Cow
Turkeys
0
Turkey Poults
OtherI
I 10ther
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes ❑ No ❑ NA ❑ NE
[:]Yes ❑No
[:]Yes ❑ No
❑ Yes [—]No
[] Yes ❑ No
❑ Yes ❑ No
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 21412015 Continued

Facility Number: jDate of inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? D Yes
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Z No ❑ NA ❑ NE
❑No [:INA ❑N
Structure 6
Spillway?: c�
Designed Freeboard (in): Z g' -
Observed Freeboard (in): � I r_— 3 — 3
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes M 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
R 1 No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
2[No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
® No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
allo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
[:]Yes
E!.No
❑ NA
❑ NE
maintenance or improvement?
11. is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes L?[.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): Z:22V.'& /
13. Soil Type(s):%���_��
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes Z[ 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 [0 No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes ,QNo ❑ NA ❑ NE
❑ Yes jallo ❑ NA ❑ NE
Required Records &_Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes DZNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [a No ❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists [:]Design [:]Maps ❑ Lease Agreements E] Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes IN
F-1WasteApplication ❑ 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 JaNo
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? 0 Yes O_No
o ❑ NA [:]NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑NA ❑NE
Page 2 of 3 21412015 Continued

Facifi Number: - d Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [n-No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [g-No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes allo ❑ 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?
Reviewer/Inspector Name:(rTli'j—
Reviewer/Inspector Signature:
Page 3 of 3
❑ Yes CE�No ❑ NA ❑ NE
❑ Yes ®, No ❑ NA ❑ NE
❑ Yes [a No ❑ NA ❑ NE
❑ Yes Ca No ❑ NA ❑ NE
❑ Yes ED No
❑ Yes allo
❑ Yes allo
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
Phone: 133-33 ro
Date: Z_
21412015

N
e
Date of Visit: — / S' Arrival Time: ; 3 O Departure Time: _.1,6 County: S'f�-� Region:I �-
Farm Name: &/-7" el Owner Email: �^
Owner Name: 4- k n TZ74-efS cr— Phone:
Mailing Address:
Physical Address:
Facility Contact: 'c- Title:
Phone:
Onsite Representative:
S'.y�
Integrator: ",F
Design.
Current
Design Current
Certified Operator:C1�s.7,-t
f te r-/� �f�--
Certification Number:
—zz6y
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design
Current
[ No
Design.
Current
Design Current
.Swine Capacity
Pap.
Wet Poultry
Capacity
Pop.
Cattle Capacity Pop.
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWR)
[:]Yes
❑No
Wean to Finish
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
La er
Dairy Cow
Wean to Feeder
❑ No
I
INon-Layer
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
E] No
Dairy Calf
Feeder to Finish
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
[,No
❑ NA
Dairy Heifer
Farrow to Wean
Design
Current.
Dry Cow
Farrow to Feeder
D P,oW
Ca aci
P,o
Non -Dairy
-
`
harrow to Finish
La ers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
jPullets
Beef Brood Cow
Turke s
Other •.
TurkeyPoints
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
[ No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
[]Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWR)
[:]Yes
❑No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
E] No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
[,No
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 2/4/2014 Continued

Facili Number: - Date of ins ection:
❑ Yes
allo
❑ NA
❑ NE
Waste Collection & Treatment
[:]Yes
3,No
❑ NA
❑ NE
i 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
EZYNo
❑ NA
❑ NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[ No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): I Or
Observed Freeboard (in): 11�
5. Are there any immediate threats to the integrity of any of the structures observed?
0 Yes
�!-No
0 NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
in No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
[3,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
MNo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[ft 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): /nj _Mj--'
13. Soil Type(s): !vQ
14. Do the receiving crops di er from those designated in the CAWMP? ❑ Yes ff po ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement`? ❑ Yes allo ❑ 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
allo
❑ NA
❑ NE
18. is there a lack of properly operating waste application equipment?
[:]Yes
3,No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[ No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes J�j No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking p Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑NA ❑NE
Page 2 of 3 2/4/2014 Continued

Facili Number: - Ds 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 ❑ No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31 . Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question #i): 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).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date: // 1"2—�->
2/4/2011

I
Type of Visit: 0,'Compliance Inspection U Operation Review Q Structure Evaluation U Technical Assistance
Reason for Visit: outine O Complaint O Follow-up O Referral O Emergency O Other Q Denied Access
Date of Visit: F �� Arrival Time: ;'OQ Departure Time: ? 'p County: w Region:
Farm Name: �'r �r� /� �e` `�rS 1r jC:i2 r^L Owner Email:
Owner Name: �ry /i Fz-f �/e�,�5 HT1- Phone:
Mailing Address:
Physical Address:
Facility Contact: �� y. yY./ /f��j Title: nn, Phone:
Onsite Representative: 5��� Integrator: _1�r� ,C� D w �..
T% -
Certified Operator:y r�e C6 Certification Number: / ";'/0
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design Current_
Design Current
VIEPoultry
Design Current
Swine Capacity Pop.
Capacip.
rf ty Po
Cattle. Capacity Pop.
Wean to Finish
La er
aig Cow
Wean to Feeder
Non -La er
aig Calf
eedertoFinish
- '" = ".
Dairy heifer
Farrow to Wean
m ., Design Current
Dry Cow
Farrow to Feeder
D .Poult : @a aci ,: ._P,o P.
Non -Dai
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
lBeef Brood Cow
Turk -7c
Other
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation'?
Discharge originated at; ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes �RNo ❑ NA ❑ NE
[—]Yes ❑ No
Yes [] No
❑ Yes [:]No
❑ Yes rU No
r"-❑Y4r"-
[—]Yes
es E3 -No
❑NA E] NE
❑NA ❑NE
❑NA E] NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3 2/4/2011 Continued
f ,
r

Facili Number: -22t jDate of Inspection:
❑ Yes
a No
❑ NA
❑ NE
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
53 -No
❑ NA
❑ NE
a. if yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
9. Does any part of the waste management system other than the waste structures require
❑ Yes
K[ No
Spillway?:
❑ NE
maintenance or improvement?
Designed Freeboard (in):
Waste Application
?�
Observed Freeboard (in): U fto
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
0 No
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
E"o
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
a 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
[S No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
allo
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
K[ No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
0 No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [:]Yes 2 IVo [DNA ❑ 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):�/"rn
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes ®,No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement'? ❑ Yes [R No ❑ NA ❑ NE
16_ Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes [. No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes [ZNo ❑ NA ❑ NE
❑ Yes allo ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes M.'No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check [:]Yes Callo ❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. [:]Yes Ej No
❑ Waste Application ❑ Weekly Freeboard [:]Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking 0 Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes CR No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [—]Yes C2.No
❑ NA [] NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑NA ONE
Page 2 of 3 2/4/2011 Continued

Facili Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? [:]Yes KNo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? if yes, check ❑ Yes �gNo ❑ 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 allo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [g No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes CS 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
L&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
Ig No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
3 L Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
CNo
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
Lr-2_g'fNo
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
JW No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
,&No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date: 9—
1/4/2011

Type of Visit: O Compliance Inspection O Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit: O Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Q' -/ rival Time: ' b Departure Time: p County:9tai—r—Region: r=F o
Farm Name:
L-eE l .kl „l
f
+ci.rrj,­—
Owner Email:
Design Current
Design Current
Design Current
Owner Name:
01- 1,1 h n tG
T__,_TyrS
a ^_�
Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Integrator: I/jLt/r raj
Certification Number:
Phone:
Onsite Representative: !��
Certified Operator: H A � '✓ /Y/� �-
Back-up Operator:
Certification Number:
Location of Farm: Latitude: Longitude:
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation'?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes )No ❑ NA ❑ NE
[::]Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
[:]Yes ® No
❑ Yes J2�No
❑NA ❑NE
E] NA ❑NE
❑NA ❑NE
❑NA E] NE
❑NA ❑NE
Page I of 3 2/4/2011 Continued
f
Design Current
Design Current
Design Current
Swine
Capacity Pop.
w -
Wet Poutry*pactty�Pop.
Cattle Capacity Fop.
Wean to Finish
La er
Dai Cow
Wean to Feeder
Layer
Dai Calf
eeder to Finish
t7 -�
`''
Dai Heifer
Farrow to Wean
_ Design, Current
D Cow
Farrow to Feeder
_.�
D . Poul Ca aci Y' P,a ,
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Nan -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
_
Qther
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation'?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes )No ❑ NA ❑ NE
[::]Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
[:]Yes ® No
❑ Yes J2�No
❑NA ❑NE
E] NA ❑NE
❑NA ❑NE
❑NA E] NE
❑NA ❑NE
Page I of 3 2/4/2011 Continued

Facili Number: - Date of Inspection:
❑ Yes
� No
❑ NA
Waste Collection & Treatment
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
1 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes �RNo
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes ❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5 Structure
6
❑ NE
Identifier:
❑ Yes
E�rNo
❑ NA
Spillway?:
the appropriate box.
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes [3 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 14 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 El No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes P 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
❑ NA
❑ NE
maintenance or improvement?
'52LNo
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes ,F..No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or ] 0 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): , &_ -ma/Z/0"",",
13. Soil Type(s): wllt�
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes KNo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [Q No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes RNo ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
� 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
MO.,
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 EjNo
❑ 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 Jallo
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes Z�No
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Pale 2 of 3 2/4/2011 Continued

Facility Number: - Date of Inspection: p
< 24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes " No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑ No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes ® No
27. Did the 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)
3 L 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 M.'No ❑ NA [] NE
❑ Yes allo ❑ NA ❑ NE
❑ Yes EqNo ❑ NA ❑ NE
❑ Yes fNo ❑ NA ❑ NE
❑ Yes
�jNo
❑ NA
❑ NE
0 Yes
0,No
❑ NA
❑ NE
❑ Yes
E[No
❑ NA
❑ NE
Comments (refer to question f: 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).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date: 1 _2--
2/4/2011

Itype of visa: v--ruompnance inspection V uperatton icevtew V notructure Lvamateon V i ecnntcai Assistance I
Reason for Visit: Q16-utine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: ® Arrival Time: Departure Time: p County: s Region:
Farm Name: rj �r,e° f.5 ��rt/ r✓�� _ Owner Email:
Owner Name: � ' n �` - ' 1`jr- /- j, Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative: Integrator:
Certified Operator: �Ien n /'GY/' S D -vim- Certification Number:
- -�
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Discharges and Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes LKNo ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes [:]No
❑ Yes No
[:]Yes ® No
❑NA ❑NE
❑NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 21412011 Continued
..
Design Current
'Design Current
esignII&Rnment
Swine Capacity Fop.
Wet FoultryCapactty Pop.
Cattle Capacity Fop.
Wean to Finish
La er
Dairy Cow
canto Feeder
Layer
Dairy Calf
Feeder to Finish"
"
Dairy Heifer
Farrow to Wean
Design Catt
Dry Cow
Farrow to Feeder
Ca aei Pow.
Non -Dai
Farrow to Finish
I I Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
r,
Other r
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes LKNo ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes [:]No
❑ Yes No
[:]Yes ® No
❑NA ❑NE
❑NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 21412011 Continued

Facili Number: - Date of Inspection: p -
/
❑ NA
❑ NE
❑ Yes
Waste Collection & Treatment
❑ NA
❑ NE
❑ Yes
[S No
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
[g No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
[] NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):_
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
[] Yes
[A 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
0 No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
C3 No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
F-21 No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
® No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [0 No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN 7 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop fWindow ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s)=
13. Soil Type(s): Wg
14, Do the receiving crops
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?
❑ Yes
[RNo
❑ NA
❑ NE
❑ Yes
®, No
❑ NA
❑ NE
❑ Yes
[S No
❑ NA
❑ NE
❑ Yes a No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes [5� No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check [] Yes Lg_No [] NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design p Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes �No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [25 No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [a. -No
DNA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑NA ❑NE
Page 2 of 3 214/2011 Continued

FaciliiKNumber: - Date of Inspection: p> — —
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ® No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes allo ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32_ Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
®, No
❑ NA
❑ NE
[:]Yes [�j No ❑ NA ❑ NE
❑ Yes (Z No ❑ NA ❑ NE
❑ Yes [gNo ❑ NA ❑ NE
❑ Yes 54 No
[:]Yes [�.No
[-]Yes TCii.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).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Dater - "
2/4/2011

Silks Iz-401-2-00 y
Type of Visit &-C-ommppliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit O Koutine 0 Complaint O Follow up O Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: /2 -d�`d `� Arrival Time: I %4 fR+ Departure Time: /2115 , County: Sv" Sc. i Region: o"Vd
Farm Name: &le.AvAJ /0c'A0,-_f0u �a rn.. Owner Email:
Owner Name: 61 r_'J^1 Pr_tr.ySa"J Phone:
Mailing Address:
Physical Address:
G+�e-er �oe._e-. Title: '7e6& s �c .
Facility Contact:_ F_ Phone No:
Onsite Representative: (9V_C_Z r__ Integrator: 114- sr-a"r'y
Certified Operator: l�t>L`+� S°``'� (rr /�.,in/ Operator Certification Number:
Back-up Operator:
Location of Farm:
Sack -up Certification Number:
Latitude: =0 =i Longitude: =0=1 = "
Design Current
n C►urreut
ity Population
WetPoultry Capapulation
EciffixPlo
CattleCapacity Population
E No
❑ Wean to Finish
❑ Layer I
I
❑ Dairy Cow
❑ Wean to Feeder
❑ Non -Layer
a. Was the conveyance man-made?
❑ Dairy Calf
❑ No
Feeder to Finish 2`/90 12
❑ NE
❑ Dairy Heifer
❑ Yes
❑ Farrow to Wean
Iry Poultry
El Dry Cow
c. What is the estimated volume that reached waters of the State (gallons)?
El Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
❑ Layers
❑ Beef Stocker
��J
ETNA
❑ Gilts
❑ Non -Layers
E3 Beef Feeder
BINN0
❑ Boars
El Pullets
❑ Beef Brood Co
❑ Turke s
Other
❑ TurkeyPoults
Numher of Structures:
❑ Other
❑ Other
other than from a discharge?
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
E No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
Ej NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
3<A
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
El Yes
❑ No
��J
ETNA
ElNE
2. Is there evidence of a past discharge from any part of the operation?
ElYes
BINN0
❑ NA
EINE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
ON o
❑ NA
❑ NE
other than from a discharge?
12/28/04
Continued

Facility Number: 872-7— /7iY Date of inspection tz-08 dY
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [1�To ❑ NA [INE
a. If yes, is waste level into the structural freeboard? El Yes 2No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): 19
Observed Freeboard (in): 38
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ET/No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.) ,,��,,/
6. Are there structures on-site which are not properly addressed and/or managed El Yes 1R<0 ❑ 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'? El Yes El"No ❑ NA ❑ NE
S. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ETNo [:INA ❑ 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 LJ 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? .,�
IL _ Is there evidence of incorrect application? If yes, check the appropriate box below. ClE Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) bzrwc 4td
13. Soil type(s) &Ja 8
14. Do the receiving crops differ from those designated in the CAWMP?
Cl Yes
15. Does the receiving crop and/or land application site need improvement? ❑ Yes
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination,[:] Yes
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ Yes
[YNo ❑ NA
V
" ❑ NA
No E3 NA
VoN
❑NA
❑ NA
Reviewer/Inspector Name �y{`° ��VQ( Phone: 9�a.�• 33nv
Reviewer/Inspector Signature R".1— Date: i2 -08 -O r/
❑ NE
❑ NE
❑ NE
❑ NE
❑ NE
12/28/04 Continued

a
J'2--09-09
Facility Number: !Y717 - Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes Z No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [1 No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps -
❑Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
E No
❑ NA
❑ NE
E No ❑ NA
❑ 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
LJ No ❑ NA
❑ NE
and report the mortality rates that were higher than normal?
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
Le No
❑ NA
❑ NE
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
LJ No ❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
E3/'N' o
El NA
F] NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
El Yes
lLf NN
❑ NA
El NE'
25.
Did the facility fail to conduct a sludge survey as required by the permit?
Ely es
;No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
<
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
7No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
E No ❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
LJ 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
LJ No ❑ NA
❑ NE
General Permit? (id discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
ZNol ❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
No ❑ NA
❑ NE
Comments and/or Drawings:
12128/04

Type of Visit Compliance Inspection 0 Operation Review 0 Structure Evaluation O Technical Assistance
Reason for Visit0-60--u–tine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: / Departure Time: County: V"— Region: =_0
Farm Name:p-�•�. 25� r.� � t -►i'�f Owner Email:
Owner Name: /YPhone:
Mailing Address:
Physical Address:
Facility Contact: aK rni1yt_ Title: gQW-A w% Phone No:
Onsite Representative: Integrator:IW'IdreL
Certified Operator: niWnn P� Yr Operator Certification Number: Z ZZQ f� -
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: =0
❑ ' ❑ H Longitude: = n = I ❑ u
Design Current
Design Current
Design Current
Swine C*apacity Population
Wet Pouitry Capacity Population
Cattle Capacity Population
❑ Wean to Finish
10 Layer
❑ Dairy Cow
❑ Wean to Feeder
110 Non -Layer
I
❑ Daia Calf
59 -Feeder to Finish 911V
❑ No
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Non -Dairy
❑ Farrow to Feeder
❑ Farrow to Finish
❑ La ers
❑Non -La ers
❑ Pullets
❑ Beef Stacker
❑Beef Feeder
❑ Beef Brood Cow
❑ Gilts
❑ Boars
❑ Turkeys
Other
❑ Other 1
❑ TurkeyPoults
10 Other
Number of Structures:
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
Other than from a discharge?
❑ Yes Z_No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
EINE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
[K No
❑ NA
❑ NE
❑ Yes
t No
❑ NA
❑ NE
Page l of 3 12/28/04 Continued

Facility Number —
Date of Inspection l
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:
❑ Yes R No
❑ Yes ❑ No
Structure 5
❑ NA ❑ NE
❑ NA ❑ NE
Structure 6
Spillway?:
Designed Freeboard (in): jJ
Observed Freeboard (in): 34?
5. Are there any immediate threats to the integrity of any of the structures observed? La Yes KNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed ❑ Yes 0,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? j9yes ❑ No [INA ❑NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ®.No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
4. Does any part of the waste management system other than the waste structures require ❑ Yes [aNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance aitematives that need ❑ Yes Cg.,No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes RNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc_)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s) /V
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes J;![No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes Jallo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
R No
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
JQ No
❑ NA EINE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
9LNo
❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comuments:
Use drawings of facility to better explain situations. (use additional pages as necessary):
°0-
�R�I-r Work to
Reviewer/inspector Name 1 Phone:
Reviewer/inspector Signature: Date: /a /9 2';4�a
Page 2 of 3 12/28/04 Continued

Facility Number: — Date of Inspection
Required Records & Documents
19. Did the facility fail to have 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 RNo ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists
❑ Design El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes PI.No ❑ NA EINE
❑ 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
KNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
E[Vo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
',No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
allo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
R No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification'?
❑ Yes
[RNo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[ANo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
[,No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
[0 No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
&No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
Dn-No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
P -No
❑ NA
❑ NE
Comments and/or Drawings:
Page 3 of 3 12/28/04

-09 -09 R
Girrivision of Water Quality
Facility Number 1 $2- / 9 `t O Division of Soil and Water Conservation
Q Other Agency 11
Type of Visit compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit outine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: 112 -17 -OM Arrival Time: Departure Time: County: Q an/
Farm Name: L C SL l:"j C' Owner Email:
Owner Name: GI""r"l r d..+,,V
Mailing Address:
Phone:
Region: la�ea
Physical Address: --//
Facility Contact: cre c*— ri4,04 t— _ Title: l • mac— • Phone No:
Onsite Representative: wne4, (Ant)re Integrator: A-0t�rA/
Certified Operator: Operator Certification Number:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Back-up Certification Number:
Latitude: = = = Longitude: [� o [=;
=
Design Current Design Current
Capacity:= Population Wet Poultry Capacity Population
❑ Layer
❑ Non -La et
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkc s
❑ 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?
Cattle
Design Current: :r;
Capacity Population_
❑ Dairy Cow
❑ Dai Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stockei
❑ Beef feeder
❑ Beef Brood Co
Number of Structures: E
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 ErNo ❑ NA ❑ NF
❑ Yes
❑ No
G<A
❑ NE
❑ Yes
❑ No
[31TA
❑ NF
[3'Iq'A--
ElNE
❑ Yes
El No
ElG Yes
o
❑ NA
❑ NE
❑ Yes
9 o
❑ NA
❑ NE
12/28/04 Continued

Facility Number: 72- —
Date of Inspection Z -/y- 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: /-y #I /
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): -/
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes ,�, No ❑ mNA El NE
El Yes E]0Ko ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes EP -lo ❑ NA ❑ NE
❑ Yes 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 EVN. ❑ 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 21 o ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ❑N'o"_❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes D iTo E] 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 Drib ❑ Application Outside of
Area 1
12. Crop type(s) g�ra �� f Y-4 l� t9�i��.J C Q. S• J
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes B No ❑ NA ❑ NE
15_ Does the receiving crop and/or land application site need improvement? ❑ Yes
Io
❑ NA
❑ NE
16. aid the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
Ls <o
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes
0 -go—
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes
❑-m-o❑
NA
❑ NE
Comments (refer to question {f): 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):
AL
Reviewer/inspector Name Phone: WO, rl33, 333rd
Reviewer/inspector Signature: Date: 12-17-2 !2-0- _8
12/28/04 Continued

Facility Number: SZ —/ylj! 1 Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes [9'�o ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes i No ❑ NA ❑ NE
the appropirate box.
❑ WUP El Checklists El Design [:1 Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
E3<o ❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1"
Rain Inspections ❑ Weather
Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
D<o ❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
BNo ❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
B<o ❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
91vo ❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
[3'go ❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
[3 -go ❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes 3'5'o ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
El Yes
3 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
M<o
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
❑-ilo
❑ 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
❑ NA
[:3 NE
33. Does facility require a follow-up visit by same agency?
ElE Yes
,No
o
❑ NA
❑ NE
Comments and/or Drawings:
12/28/04

Type of Visit compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit *outine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: County. �� Region:
Farm Name:
Owner Email:
Owner Name: Ca W�Sg! � Phone:
Mailing Address:
Physical Address:
Facility Contact: Q Title: Uwo
Onsite Representative:
Certified Operator:
C—Amrsa-
Back-up Operator:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: 1:1 o ` ❑ u Longitude: ❑ ° ❑
Discharges & Stream impacts
Is any discharge observed from any part of the operation'? ❑ Yes )�No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
MEDesign Current
Design Current
Design Current
Swine Capacity Population
Wet Poultry Capacity Population
Cattle CapityacPopulation
❑ Wean to Finish
❑ Layer
❑ Dai Cow
❑ Wean to Feeder
❑ Non -Layer
❑ Dai Calf
eeder to Finish
❑ Dai Heifer
El Farrow to Wean
Dry Poultry -
❑ D Cow
❑ Farrow to Feeder
No
❑ Non -Dairy
❑ Farrow to Finish
❑ Layers
❑ Beef Stocker
Gilts
❑ Non -Layers
El Beef Feeder
PE]Boars
❑ Pullets
❑ Beef Brood Cowl
❑ NA
❑ Turkeys
other than from a discharge?
Other
❑ Turke Poults
EEI
❑ Other
❑ Other
Dumber of Structures:
Discharges & Stream impacts
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
9NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
ANA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
No
NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ YesfNo
o
[:1 NA
El NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
11/28104
Continued

Facility Number: imt
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes A
No ElNA ElNE
❑Yes kNo ❑ NA EINE
Structure 5 Structure 6
❑ Yes KNo ❑ NA ❑ NE
❑ Yes *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 No [INA ❑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 ❑ YesThNo [JNA ElNE
maintenance or improvement?
Waste Aoolication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes �Vo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes kNo ❑ 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)i71u+U.. - ' �47-r1.1�/Q Jy�•t i �i�
13_ Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
N No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
NrNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ yes
R No
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
ANo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
[-]Yes
PTo
❑ NA
❑ NE
Comments (refer. to, question ft Explain any YES=answers and/or any recommendahoiis or any other comments,
Use drawingssafkfacility to better explain situations. (use additional.pages.as necessary):_ x
i
Reviewer/Inspector Name Phone: Q s 3
Reviewer/Inspector Signature: Date: N V 1=-1QQ
Page 2 of 3 12/28/04 Continued

Facility Number: —I!M Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes �bo ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 16.No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
�(No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
O NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
1�1 No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
;@ No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
7�lNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
00 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
fa 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
[INA
❑ NE
If yes, contact a regional Air Quality representative immediately
jJ��'
31 _
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
F No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
[ 1 No
❑ NA
❑ NE
Additional Comments and/or Drawings.:
0� bbay sVo�s ho�..ve_ �zt 16e d Cin 00n , �� Seen//mu
vrC1, fcP , &chat s Q u n) S _ Oc� 3
Page 3 of 3 12128104

q - I
G�
Facility No. ('�� l� Time In Time Out Date
Farm Na AZzyS IF C>, -f Integrator P xm L
Owner�k'4 _ _ _ _ _ Site Rep`i VO(
Operator No.
Back-up
COC
No.
Circle: General or NPDES
Design Current
Design Current
Wean - Feed
Farrow - Feed
Wea n_--EwAsh,
Farrow - Finish
ed = F' "
Gilts 1 Boars
Farrow -Wean
Others
FREEBOARD, Desi
r���
S1�dy-a sup
Crop Yield
Rain Gauge `�—
Soil Test
PLAT
Observed 1
Calibratio.nir:pnn 1/ i
Waste Transfers
Rain Breaker
Wettable Acres
Weekly Freeboard ---�� Daily Rainfall r 1 -in Inspections
Spray/Freeboard Drop _P H l
Weather Codes
120 min Inspections
Waste Analysis:
Date Nitrogen (N)
3— 2
Date Nitrogen (N)
1i v Lg z
o btl
Pull/Field Soil Crop Pan Window

Type of Visit A Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: I LO Arrival Time: � Departure Time:L� County. on. S+M Regi
Farm Name: �"�-"� �Q� R IIS( Owner Email:
Owner Name: V �L�lY1 P� �Y 71 _ Phone: 1 s [� O'S �J�. mA
Mailing Address: qago
Physical Address:
Facility Contact: Title: Phone No: ,J
Onsite Representative: Integrator: i V
Certified Operator: G t2 h�_ �, 2 Operator Certification Number:R]
O�
Back-up Operator:
Location of Farm:
Back-up Certification Number:
Latitude: --] o n' n" Longitude: Flo n I n
t
Design Current
Swine Capacity Population
❑ Wean to Finish
❑ Wean to Feeder i
eeder to Finish 9 O
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts '
EI -13 oars
j
Other
❑ Other – — — —
Design Current
Wet Poultry Capacity Population
❑ La er
❑ Non -Layer
Dry Poultry
❑ Layers
❑ Non -Layers i
❑ Pullets f
❑
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
❑ Dai Cow
❑ Dairy Calf
❑ Dairy Heifej
❑
Dry Cow
❑
Non -Dairy
❑ Beef Stocket
❑ Beef Feeder
❑ Beef Brood Co
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures: Ejj
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 **>ZNo ❑ NA ❑ NE
❑ Yes ❑ No
XNA
❑ NE
❑ Yes ❑ No
JtNA
❑ NE
❑ Yes allo �NA
C1 NE
❑ Yes JKNo
❑ NA
❑ NE
❑ Yes ,)qNo
❑ NA
❑ NE
12/28/04 Continued

Facility Number:— 101 Date of Inspection
❑ Yes
Zy No
Waste Collection & Treatment
15_ Does the receiving crop and/or land application site need improvement?
❑ Yes
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?esNo
❑ NA ❑ NE
ElNA [INE
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:
18. Is there a lack of property operating waste application equipment?
❑ Yes
Spillway?:
❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers andlor any recommendations or any other comments..
Designed Freeboard (in): 1Q t
Use drawings of factiity to better explain situations. (use additional pages as necessary):
►1
Observed Freeboard (in):
4-
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes No
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
//
4-oNo �.lt'DSliytin ��� �� U +��� 5 0 a✓ Tt 57�
rC
6. Are there structures on-site which are not properly addressed and/or managed
❑ Yes No
❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
.Yes QNo
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes -%Vo
❑ 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
ElYeso
❑ NA El NE
maintenance or improvement'?
350
Reviewer/Inspector Signature: Date:
Waste Application
0 p_u(p
12128104
Continued
I0. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes 14Wo
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes A 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 oi(jWind Drifl ❑ Application Outside of Area
Iii JU{o�-I,{�lr . 1
12. Crop type(s)
UeJ1r W r.�
13. Soil type(s) �p�Qr(�,J►rl
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
Zy No
❑ NA ❑ NE
15_ Does the receiving crop and/or land application site need improvement?
❑ Yes
IgNo
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination:
❑ Yes
ANo
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
%No
❑ NA ❑ NE
18. Is there a lack of property operating waste application equipment?
❑ Yes
No
❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers andlor any recommendations or any other comments..
Use drawings of factiity to better explain situations. (use additional pages as necessary):
4-
bl'1 4U/�
rt&V,*a_
//
4-oNo �.lt'DSliytin ��� �� U +��� 5 0 a✓ Tt 57�
rC
!
s-{�.nd11
. /� { r
jf�� j aGC✓t's5 SLt,/"f'0.C� �✓a��� c�,ytSLihCt rt0�.se� ..
6
!'i"!so
Reviewer/Inspector Name r ��- Phone:9 1
D _33
350
Reviewer/Inspector Signature: Date:
0 p_u(p
12128104
Continued

facility Number: ' "L— Date of Inspection (p ap
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 'VNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes (XNo ❑ NA EINE
the appropirate box.
❑ WLFP ❑Checklists El Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes NNo ❑ 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 PtNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes�No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes Vo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes Wo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CA WMP?
❑ Yes 'ItAN0
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes ANo
❑ 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 ONo
❑ 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 PONo
❑ 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 )dNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes %No
❑ NA
❑ NE
Additional Comments and/or Drawings:
UXA .
12/28/04

' I ,
Type of Visit 49 Compliance Inspection O Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit * Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: y -/_O �� Arrii-al Time: Departure Time: County: s4002sa.,_ Region: tiPo
Farm Name: C-lenn eelerjo#I FaIf0" Owner Email:
Owner Name: the r+ __ PG7'Crsar. _ Phone: 9/0 - $`4-y– 2,5_-2
Mailing Address: 17.20 EnoaA Rd CA1A /ari _ Al C p3 Ar
Physical Address:
Facilitv Contact: G/i,,, pe /e1s,.,4 Title:
Onsite Representative: Gl...,� Lod/. d^,
Certified Operator: _ Glen E. _ &LC-1am
Bach -up Operator:
Phone No:
Integrator 1_ S
Operator Certification Number: / g/yX
Back-up Certification Number:
Location of Farm: Latitude: =0
=' = Longitude: 0 0 ET = "
Design Current
Swine Capacity Population
❑ Wean to Finish
❑ Wean to Feeder
['Feeder to Finish 4 O.2 a o 0
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
'Other
❑ Other
Design Current
Wet Poultry Capacity Population
❑ Layer
❑ Nan -La ei
Dry Poultry
❑
Layers
❑
Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑Other
De§igtt Current
Cattle Capacity..Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
i
❑ Beef Stocket
I
❑ Beef Feeder
❑ Beef Brood Co
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 -trade?
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)?
Number of Structures: MJ
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?
11,
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes D-Tgo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
El<o
❑ NA
❑ NE
❑ Yes
D<o
❑ NA
❑ NE
12/28/04 Continued

Facility Number: .2 El Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier:
Spillway?: n0
Designed Freeboard (in): /9'~
Observed Freeboard (in): -0 't
❑ Yes 9 No ❑ NA ❑ NE
❑ Yes ❑ No [INA ❑NE
Structure 5 Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 2TJo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed ❑ Yes EF% ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ❑'No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
ZNo
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
Reviewer/inspector Name I /f'f k ,8i c;r Lu��•,, �a,c%r-.. Phone: yly -li I ert7,?a
—�
Reviewer/Inspector Signature: Date:
9. Does any part of the waste management system other than the waste structures require
❑ Yes
9'No
[-I NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
e No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
E]-%
❑ 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) 0S
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
Elmo
❑ 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'
E] Yes
❑ No
❑ NA [}KE
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA [3-3d£
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[2No
❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
IUse drawings of facility to better explain situations. (use additional pages as necessary}:
pltoJ[ wn►�[ sh Sai[ Rocas do 49kc9
ip �f�a`l j{ oarf ss Govir
gra �o ��t✓��.i.'
e
Reviewer/inspector Name I /f'f k ,8i c;r Lu��•,, �a,c%r-.. Phone: yly -li I ert7,?a
—�
Reviewer/Inspector Signature: Date:
12/28/04 Continued

J `,
Facility Number: 8) -/cylf I Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
❑ Yes 9�<o ❑ NA ❑ NE
20.
Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[oto
EINA
❑ NE
1i60� ��Ir Gso�e Lo�v,,, n I
the appropirate box. ❑ Ww" ❑ Che lsts ❑ Design ❑ M,4,K- ❑ owe'r
/-4,- / U J
Af•+.✓�! /,15/ottr•an c& /. .01 •
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
21.
Does record keeping need improvement? If yes, check the appropriate box below.
9-1'es
❑ No
❑ NA
❑ NE
us -Scan 1►5 P -as;
[' a pplica ' El �!(ul-Fxeboard ❑-ILI }psis 1-7
❑ �yis ElE]
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
[2 No
n
[__1 NE
❑ Psi„; 44-❑fstuckin [+ erop Yield [31-20 Minute Inspections ❑ Monthly and 1 Raii.
in.
[aWeather
Code
22.
Did the facility fail to install and maintain a rain gauge?
GKes
x.*Q
9<o
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
M V' es
❑ No
❑ NA
❑ NE
24.
1'7n. t
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
M -No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
9 No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
O -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 O No ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
D No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
1i60� ��Ir Gso�e Lo�v,,, n I
aw � /"'-4L/
/-4,- / U J
Af•+.✓�! /,15/ottr•an c& /. .01 •
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
2 No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
us -Scan 1►5 P -as;
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
[2 No
❑ NA
[__1 NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/]nspector fail to discuss review/inspection with an on-site representative?
❑ Yes
ONo
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
U No
❑ NA
❑ NE
Additional Comments and/or Drawings: ..
,9 e.w►s
,c
fo recs W®a�e .e^'&.4, eve, i ,tWe
1i60� ��Ir Gso�e Lo�v,,, n I
aw � /"'-4L/
/-4,- / U J
Af•+.✓�! /,15/ottr•an c& /. .01 •
; s J I ra /11 f O^1
us -Scan 1►5 P -as;
� r7 IC
PLAT,
12/28/04

f
Type of Visit gCompliance Inspection Q Operation Review Q Lagoon Evaluation
Reason for Visit Q Routine Q Complaint Q Follow up Q Emergency Notification Q Other ❑ Denied Access
Facility Number Date of Visit: S o Time:
Q Not Operational Q Below Threshold
Erfe'�n itted 0 Certifiied [3 Conditionally Certified [3 Registered Date Last Operated or Above Threshold:
Farm Name: AJCtn„ wt Sort Rrwn £CG 1 County
9r°sb�Owner Name: ----- .. • ........ f�e'kr5� ..... Phone No: -5.71
Mailing Address:.. g o_.�► �1.: Sri. �e '�Q ...
�... _--- „-„---.„._._._...._._._�_--______---
Facility Contact:„.„.„ Title• Phone No.
Onsite Representative: idd`G "5ati .. Integrator: jr i ............ „„.„..
Certified Operator:. 0 . Operator Certification Number:
Location of Farm:
Bswine ❑ Poultry ❑ Cattle ❑ Horse Latitude • & °4 Longitude ' ° 64
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes 2 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 [RfVo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes M No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes 2*f4o
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 5
Identifier: ......... -.1 ................... __._....................
Freeboard (inches): 39
12112103 Continued

f
Facility Number: 9A -- 19411 Date of Inspection �Sf
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes G'Po
seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a waste management or ❑ Yes YNo
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 [R(No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes [$To
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
❑ Yes
ENo
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes
21' 40
11. Is there evidence of over application? If yes, check the appropriate box below.
❑ Yes
[;r&o
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
ReviewerA spector Signature: Date:
12. Crop hype Xclw. Wj&% r&rx r„^i! 1bL 1A
13. Do the receiving crops differ wi those designated in the rtified A 'mal Waste Management Plan (CAWMP)?
❑ Yes
ONo
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
92rNo
b) Does the facility need a wettable acre determination?
❑ Yes
3WO
c) This facility is pended for a wettable acre determination?
❑ Yes
[.bio
15. Does the receiving crop need improvement?
❑ Yes
[2No
16. Is there a lack of adequate waste application equipment?
❑ Yes
B14o
Odor ].sues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
❑ Yes
Tr 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
2'No
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
El Yes
[�lo
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional
❑ Yes
[.]�No
Air Quality representative immediately.
:Comments (reler�tuuesteon #) F�[plata any�YES answers and/or ayry reco oas ar,anq�otlrer comments.
;Use drawrngs of to better exphun sttnatio s {use'additwnal pages as necessary)F ted Copy ❑ Final Notes '
Pay- b k A's.
`" �-F'.�y lu.<. bre„► �rz� �,.n b� �-4 � S�� 4�� � �a� 1� k �� a•.d rro �..�cd�
1
HW
Reviewer/Inspector Name
ReviewerA spector Signature: Date:
12112/03 Continued

i .
Facility Number: — Date of Inspection S 8
Required Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
23. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
25. Did the facility fail to have a actively certified operator in charge?
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
27. Did Reviewer/Inspector fail to discuss review/inspection with on-site representative?
28. Does facility require a follow-up visit by same agency?
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
32. Did the facility fail to install and maintain a rain gauge?
33. Did the facility fail to conduct an annual sludge survey?
❑ Yes B"NO
❑ Yes ERf4o
❑ Yes 21Qo
❑ Yes B"go
❑ Yes ❑'Flo
❑ Yes B No
❑ Yes [�To
❑ Yes Blo
❑ Yes Eg o
["Yes
❑ Yes
❑ Yes
❑ Yes
34. Did the facility fail to calibrate waste application equipment? ❑ Yes
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below. ❑ Yes
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After 1" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
❑ No
ONO
[�io
[1lo
Erfio
B No
No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
ddtttonal Costitnents attd/ar'Drawtngs _ m 7 - W x ='•:
""OC 't"�
12112103

r
�~ State of North Carolina
Department of Environment,
Health and Natural Resources •
Fayetteville Regional Office
James B. Hunt, Jr., Governor p E �--.� N R
Jonathan B. Howes, Secretary
DIVISION OF ENVIRONMENTAL MANAGEMENT
December 21, 1995
Mr. Glenn E. Peterson
RE: Peterson Farm
8360 Keener Road
Clinton, NC 28328
SUBJECT: Compliance Inspection
Sampson County
Dear Mr. Peterson:
On November 14, 1995, an inspection of your animal operation was performed by the
Fayetteville Regional Office (FRO). Please find enclosed a copy of our Compliance
Inspection Report for your information. It is the opinion of this office that this facility is
in compliance with 15A NCAC 2H, Part .0217, and that Animal Waste Management is being
properly performed.
Should you have any questions regarding this matter, feel free to contact me at (910)
486-1541.
Sincerely,
Ricky Revels
Environmental Technician IV
Enclosure
cc: Facility Compliance Group
F�w
Wachovia Building, Suite 714, FayettevilleFAX 91D -4$b-0707
Nif
Norio Carolina 28301-5043C An Equal Opportunity Affirmative Action Employer
Voice 910-486.1541 50% recycled/ `10% post -consumer paper

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Site Requires Immediate Attention: /Y
Facility No. _8 z - P-7 �4
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: //- /0 , 1995
Time: /4445
Farm NarnelOwner: f c 7cV50A/ Fit A"'" / (�' %�v.v E• Re -le ►-sa.v
Mailing Addms: S3&0 K�taNe- r Ad . Ci;NY6,j NC Z S 3 2 S
`County: So Ze sc. i
Integrator: Pja we•j 6!tgaC y _ Phone:
On Site Representative: G/ENN Pc.firsoN - Phone: e- 910 Slv
Physical Address/Location: g03 =..x0.1-4 14-/5'0A1 Ci.Af7�M %a ee&� s". s,..,I�s,. ,r v
/'741&
Type of Operation: Swine ✓ Poultry Cattle
Design Capacity: Z940 Number of Animals on Site: 2'WO
DEM Certification Number: ACE DEM Certification Number: ACNEW
Lati`ude: O *ongitude: O _
• w
Circle Yes or No
Does the Animal Waste Lagoon �yLur
fficient freeboard of 1 Foot + 25 year 24 hour storm event
{approximately 1 Foot + 7 inches) No Actual Freeboard: 3 Ft. o inches
Was any seepage observed from the la oon(s)?
Is adequate land available for spray? es r No
Crop(s) being utilized: Wily w R,,e - Colo
Yes or�Was any erosion observed? Yes ori
Is the cover crop adequate? (r or No
Does the facility meet SCS minimum setback criteria? 260 Feet from Dwellings? <YY:Oor No
100 Feet from Wells? li-oor No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes oi(93
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line: Yes or®
Is animal waste discharged into water of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes or(J9 If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? Yes
Additional Comments: T/ 1',4 / r� o6 Q„v rw a4p,"Jcd s.. gyk �I aA
TA, -.T Gi r % S r`Csi 4/
D"e,.46<-,- 31, f997
r��k" /Qz✓x.15 /�� �� _
Inspector 14aim Signature
cc: Facility Assessment Unit Use Attachments if Needed.