820195_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental Qual

Divi'sioa of Water Resources
Facility Number - 0 Division of SOit and Water Conservation
�• Other Agency
Type of Visit: # Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: • Routine 0 Complaint 0 Follow-up 0 Referral 0 Ememencv 0 Other 0 Denied Access
Date of
Farm Name:
al Time: Departure Time:County: `_� " f Region: /�✓lt�j
iH S f�b Owner Email:
Owner Name:At;'AQ Phone:
Mailing Address:
Physical Address:
Facility Contact: j'I i"Cl Title: Phone:
Onsite Representative: Uf Integrator: —P
Certified Operator: B Certification Number: 17 79 6
Back-up Operator:
Certification Number:
Location of Farm: Latitude: Longitude:
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Boars I I IMI (Pullets
Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify 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?
Cow
ow
Cy alf
Hy eifer
Cow
Stocker
Feeder
Brood Cow
❑ Yes 7 N ❑ NA ❑ NE
❑ Yes ❑ No
[:]Yes Q No
❑ Yes ❑ No
❑ Yes No
[:]Yes No
1?PNA ❑ NE
NA ❑ NE
�NA
0 N
❑ NA
❑ NE
❑ NA
❑ NE
Page 1 of 3 21412015 Continued

Facility Number: Date of Inspection:
Waste Collection & Treatment a/z. /�
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes P No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No �A ❑ NE
Structure 1 Structure 2/ Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): �= -
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ YesNo ❑ 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? F
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 (VI No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Aaalication
10. Are there any required buffers, setbacks, or compliance alternatives that need [:]Yes No E]NA ❑ NE
maintenance or improvement? T'
11. is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes 1;@ No 0 NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable ro Window &,vidernof Wind Drift ApplicationOutside of Approved Area
12.Cro T e s: nr iL)' /�P Yp () l � I �t'Ii. ��w-RL?S � l ] U�LhP.�/�
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ Yes
r� No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
� No
❑ NA
❑ NE
❑ Yes
Ep No
❑ NA
❑ NE
❑ Yes
�j No
❑ NA
❑ NE
❑ Yes
C� No
❑ NA
❑ NE
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ® No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑Yes No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑NA ONE
❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facili Number: jDate of Inspection
24. Did the facility fail to calibrate waste application equipment as required by the per ZZ l`/] 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. T
❑ 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:
❑ Yes o
❑ Yes 4NO
❑ NA ❑ NE
❑ NA ❑ NE
❑Yes ®No ❑NA ❑NE
❑ Yes
No
❑ NA
❑ NE
❑Yes
No
❑NA
E] NE
❑ Yes
ONo
❑ NA
❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes [ No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative? ❑ Yes No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes E� No ❑ NA ❑ NE
Comments (refer to question ft 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: l� -
Date:
21412015
°/ Z-7 i _r

hype of visit: 0 Compliance inspection V operation Review V structure Evaluation V i eennical Assistance
Reason for Visit: lb Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: WNArrival Time:® Departure Time: County: C!' �� Region: fW
Farm Name: - r"'1s /—'/ Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: �14 Title: Phone:
Onsite Representative: Integrator: Vrp- S&
Certified Operator: Certification Number:
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Discharges and Stream 1mnaCts
1. Is any discharge observed from any part of the operation?
OW
Designp;�Curren#_ �''-
I Design'UCurrent
Design Current
Swine
Gapsic►ty, Pop y WetiI'oultry
Capacity i'oID --
Cattle= Capacity P.
a. Was the conveyance man-made?
❑ Yes
❑ No
We to Finish
La er
❑ Yes
Dai Cow
Wean to Feeder
Non -La er
c. What is the estimated volume that reached waters of the State (gallons)?
Dai Calf
eeder to Finish
Dai Heifer
Farrow to Wean
5
Design SCurrent
D Cow
Farrow to Feeder
DPoul
Ca aetty �'Pa .,
Non -Dai �.
Farrow to Finish
Layers
[] Yes
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
I L Pullets
Beef Brood Cow
4t Turkeys
R Turkey Poults
Other
Other
Discharges and Stream 1mnaCts
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��� ❑ NFA'
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
0 NA
❑ Ni%-
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
[:]No
[�?NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
'�j No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
[] Yes
IM No
❑ NA
❑ NE
of the State other than from a discharge? .
Page 1 of 3 2/412011 Continued

Facili Number: Date of Inspection:
❑ NE
E] NA
❑NE
[] NA
Waste Collection & Treatment
❑ NA
❑ NE
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
M No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
�g NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: �^
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): �� Y5 17
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
["jNo
E] NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
�`
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
0 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
[P No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
r No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
[M No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ YesNo
'P
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
Pp No
❑ NA
❑ NE
❑ Excessive Ponding E] Hydraulic Overload [:]Frozen Ground E] 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 ❑ Evide a of Wind Drift ❑ Application Outside of Approved
Area
j�aj12. Crop Type(s):�/C `►� , 1�'
13. Soil Type(s): & 1
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes P9 No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes � No E] NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes Q] 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?
Reauired Records & Documents
[:)Yes No
[:]Yes [ No
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes No
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No
the appropriate box.
❑ WUP ❑Checklists [:]Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. [—]Yes [g 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?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
Page 2 of 3
❑ Yes ® No
❑ Yes TO No
❑ NA
❑ NE
E] NA
❑NE
[] NA
❑ NE
❑ NA
❑ NE
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA r] NE
2/4/2015 Continued

Facili Number: jDate of Inspection:
,
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
No
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? if yes, check
❑ Yes
No
❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge
levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes
j� No
T�
❑ NA] NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
No
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
[ No
❑ NA ❑ NE
and report mortality rates that were higher than normal?
T—
29. At the time ofthe inspection did the facility pose an odor or air quality concern?
❑ Yes
f
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(J0
No
❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
T0
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:
3•
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
1
No
❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
T No
[:]NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
P No
❑ NA ❑ NE
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Imp
Phone: CT 1 O-� 33-37aa
Date:
2/4/2015

(Type of Visit: ®-Compliance Inspection U Operation Review O Structure Evaluation Q Technical Assistance I
Reason for Visit: ® Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: J / Arrival Time: p/'% Departure Time: County: -9~SOAI Region:
/
Farm Name: +7 /Q., �—�6 Owner Email:
Owner Name: L°o Phone:
Mailing Address:
Physical Address:
"'AFacility Contact: 4Title: Phone:
It
Onsite Representative: Integrator: pud�x
94
Certified Operator: Certification Number: 17,74716
Back-up Operator:
Location of Farm:
Certification Number:
Latitude: Longitude:
Design Current
❑No
Design
Current
Design @urrent
Swine Capacity Pop.
Wet,Po50
ultry
Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
Layer
Dairy Cow
Wean to Feeder
I Non -La er
I
Dairy Calf
Feeder to Finish
` -
Dairy Heifer
Farrow to Wean
Dry Cow
Farrow to Feeder
D.ry P,oultr
Ca acit
P10
Non-DairV
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
.._....
Turkeys
Other
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation? 0 Yes 1� No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? [:]Yes ❑No N NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR) ❑ Yes [:]No F 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)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
[:]Yes
❑No
❑ Yes
Q tNo
❑ Yes
No
29 NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 2/4/2014 Continued

ity Number: jDate of Inspection:
Faci@
❑ Yes
P No
❑ NA
❑ NE
Waste Collection & Treatment
❑ Yes
No
❑ NA
❑ NE
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
[�bNo
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
RA NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: L� S—
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3511
Z
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[ONo
❑ 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
0 NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes 0 No ❑ NA ❑ NE
maintenance or improvement?
Waste Ani lication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ® No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. E] Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window Q Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s): BOB _
14_ Do the receiving crops differ from those designated in the CAWMP? ❑ Yes No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
P No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check
❑ Yes
No
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑ Other:
21. Does record keeping need improvement? if yes, check the appropriate box below. ❑ Yes No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 " Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 11412014 Continued

FaciliNumber: Date of Ins action:
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? ❑ Yes 0 No E] NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes TP 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?
to
of
to
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
any YES answers and/or any
as
❑ 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 ❑ NA ❑ NE
ons or any other comments.
Phone:l0-i/3�3�pn
Date:
V4/2014

hype of Visit: fp Compliance inspection U Operation Review U structure Evaluation U Technical Assistance
Reason for Visit: *Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: yL Arrival Time: ! Departure Time: County:,
Farm Name: -'� v�-� 5 {� Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
� y
Onsite Representative:
u
Certified Operator:
Title:
Phone:
Region:
Integrator: 2PS4ge_
Certification Number:
�T
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Desigo.._Cunent
[] No
Design
Curren#
Design Carrent
Swine .. Capacty..._v_.Pop.
Wet Poultry
Capacity
Pop.
Cable C*apacity Pap.
Wean to Finish
Layer
Dairy Cow
Wean to Feeder
Non -La er
D ' Calf
)Feeder to Finish
Heifer
Farrow to Wean
Design
Current
—Dairy
Dry Cow
Farrow to Feeder
D , P,oal
Ca aci
It;o
Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
-
Turkeys
Other
TurkeyPoults
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 No ❑ NA ❑ NE
❑ Yes ❑ No �RNA ❑ NE
❑ Yes ❑ No A�j NA ❑ NE
❑ Yes
[] No
,� NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
Page I of 3 2/412014 Continued

Facility Number: - Date of Inspection: I I
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes EP No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes [:]No [!R2NA ❑ NE
Structure i Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: j 51—(1. -
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3 6 y I y
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes P 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 DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ® No ❑ NA ❑ NE
maintenance or improvement? T
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes( No [DNA [—]NE
maintenance or improvement? Yes[No
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ YesNo C]NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload [jFrozen Ground E]Heavy Metals (Cu, Zn, etc.
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
p Outside of Acceptable Crop Window ❑ Evidn2t-or
of Win Drift �❑ Application Outside of Approved Area
12. Crop Type(s): C o � /mac . 6'"
13. Soil Type(s): 120P
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [P No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [�j 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?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ Yes No
❑ Yes No
❑ Yes [P No
❑ Yes T No
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? if yes, check the appropriate box below. ❑ YesNo
F1Waste Application p Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste TrErs
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA 0 NE
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 2/4/2014 Continued

Facili Number: qt Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ?No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ YesNo
the appropriate box(es) below. T
❑ 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
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
" No ❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
[;B 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
V2] No ❑ NA
[] NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility9 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 CAWIvIP?
❑ Yes
No ❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
s
No 0 NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
No ❑ NA
❑ NE
Comments refer to uestron Ex lain an YES. answers and/or an additional recommendations or. an other co
Y - mments4�
Used rawings`of facih to be[ter'expiain situations use additional ayes as necessary
tY p pages Ey)•
`}+
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: '1 l a�c�33- 33t0
Date: 2 y altl_
21412014

a
Type of Visit: 4P Compliance Inspection O Operation Review O Structure Evaluation 0 Technical Assistance
Reason for Visit: 0 Routine 0 Complaint 0 Fallow -up 0 Referral 0 Emergency 0 Other 0 Denied Access IJ
Date of Visit: jijjjj;zq2__j Arrival Time: 00 Departure Time: pp County: SA1t"f2SaA1 Region: r -)Q0
Farm Name: 3 trwn1S /4 Owner Email:
r4i"�'
Mailing Address:
Physical Address:
Facility Contact: ��ap Title: Phone:
Onsite Representative: - H Integrator: T�e.Sjqcw_
L4
Certified Operator:
Certification Number:
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 reacbed 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 rg No ❑ NA ❑ NE
❑ Yes ❑ No Pfl NA ❑ NE
❑ Yes ❑ No DC NA ❑ NE
[—]Yes ❑No
❑ Yes P No
❑ Yes $j No
IM NA
Designy� Cur ent
x Design C�urrent
Design Current
Swine " ` Capactt} =Pop;
Vet Poultry
Caiiacity -Pop.
Cattle Capacity Pop.
r"
Wean to Finish
La er
Dairy Cow
Wean to Feeder
Non -La er
Dairy Calf
Feeder to Finish
Q x
: "
Dairy Heifer
Farrow to Wean
Design, Current
Cow
Farrow to Feeder
D , Poaltry
Ca ci P.
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
-
Turke s
Other
-
Turkey Poults
Other
I
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 DWQ)
c. What is the estimated volume that reacbed 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 rg No ❑ NA ❑ NE
❑ Yes ❑ No Pfl NA ❑ NE
❑ Yes ❑ No DC NA ❑ NE
[—]Yes ❑No
❑ Yes P No
❑ Yes $j No
IM NA
❑ NE
❑ NA
❑ NE
❑ NA
❑ NE
Page 1 of 3 2/4/2011 Continned

+I
® No
❑ NA
❑ NE
❑ Yes
Facili_ Number: - Date of inspection: [ 20
[DNA
❑ NE
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
1"Zn No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
[] Yes
❑ No
NA
❑ NE
Structure l Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: b
Spillway?:
Designed Freeboard (in):
_
Observed Freeboard (in): 3
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
IM 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
[nNo
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
,[] No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
® No
❑ NA
❑ NE
maintenance or improvement?
T
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ® No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window El Evidence of Wind Driftc
❑A_pplication`Outside of Approved Area
12. Crop Type(s): �� Glc Ir /Yl i[j4 C-,- ,S5 &-k4V)l �J• �I'�
d-3 10
13. Soil Type(s): GO9
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes P No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes T No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes ® No [:]NA ❑ NE
acres determination? T
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
® No
[DNA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes [N No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes �D 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 y
No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield. ❑ 120 Minute Inspections D 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 3 214/2011 Continued

li
Facili Number: jDate of Inspection: 11/7/r jz_ _
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_
❑ Yes
T No
❑ NA
❑ NE
❑ Yes
❑ No
91 NA
❑ NE
❑ Yes
[4 No
❑ NA
❑ NE
[:]Yes
[ No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes EpNo ❑ 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 ® 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 necessarv).
Reviewer/Inspector Name: R 64 Vktk(e Phone:
Reviewer/Inspector Signature: Date:—
Page 3 of 3 2/4/2011

type of visit: w q-ompnance inspection v vperanon KMew tJ structure Evaivatnon v tecnntcai Assistance
Reason for Visit: *Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: Departure Time: County: _C_01j Region:
Farm Name: 5 S GinnLA —d Owner Email:
Owner Name: _ t -U Phone:
Mailing Address:
Physical Address:
Facility Contact: �J'►Git,tQ�op� Title:
Onsite Representative: N
Certified Operator: 4
Back-up Operator:
Location of Farm:
Phone:
Integrator: I- res
Certification Number: 17,796
Certification Number:
Latitude: Longitude:
r
❑No
NA
❑ N E
❑ Yes
❑ No
NA
Design Current
❑ Yes
Design
Current
Design Current
Swipe Cci Po
Wet Poult ,
Ca aci
Po
Cattle Ca ari Po
Wean to Finish
Layer
Uai Cow
Wean to Feeder
Non -Layer
Dai Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
Dr, P.oultr,
[Ca aci
P,o .
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
Turkey Poults
OtherL10ther
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
NA
❑ N E
❑ Yes
❑ No
NA
❑ NE
❑ Yes
❑ No
NA
❑ NE
❑ Yes
V hNo
Ir
❑ NA
❑ NE
❑ Yes
S[�] No
❑ NA
❑ NE
Page 1 of 3 2/4/2011 Continued

Facili 'umber: -1!i37DDate of Inspection: !o Zfl N
Waste Collection & Treatment
❑ Yes
JMNo
❑ NA
❑ NE
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
No
❑ NA
[] NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
No
P NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
17. Does the facility lack adequate acreage for land application?
❑ Yes
allo
❑ NA
Spillway?:
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[�jNo
❑ NA
Designed Freeboard (in):
Require_ d Records & Documents
p
Observed Freeboard (in): Z7�
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
ff] No
❑ NA
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
0 No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
the appropriate box.
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
[P No
D NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public bealth or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
1p No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[ No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? if yes, check the appropriate box below. [:]Yes [h No ❑ NA
❑ 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 fir❑ Application Outside of Approved Area
12. Crop Type(s): �- aQ �1-� 3 �gSf7" r Sint. (1✓1�. (J el%
❑ NE
13. Soil Type(s): 909
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
JMNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
allo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[�jNo
❑ NA
❑ NE
Require_ d Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
ff] 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 appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes M No
❑ Waste Application ❑ Weekly Freeboard p Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
E] NA ❑NE
Page 2 of 3 2/4/2011 Continued

Facili Number: Date of Inspection: to Zo
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes n"j 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-cornpliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes PM No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes fo 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:
Reviewer/Inspector Signature:
Page 3 of 3
❑ Yes jo No ❑ NA ❑ NE
❑ Yes FO No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes P] No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes ONo [DNA ❑ NE
Phone: //O—
Date: D ZV It
2;41201'1

/"t
Type of Visit • Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 4PRoutine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: jO Arrival Time: Departure Time: .`LID County: Region:
� T
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: 1 Integrator:
Certified Operator: t Operator Certification Number:
r7rl!2
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = =4
= Longitude: = o =, = «
Design Current
Design Current
T NA
Design Current
Swine C•apaciry Population
V4'et Poultry Capacity Population
Cattle Capacity Population
❑ Wean to Finish
La er
❑Dai Cow
to Feeder
ENon -La er
❑ NE
❑Dai Calf
6Wean
Feeder to Finish 1Aq 4W I b
❑ Yes
V No
❑ NA
Dairy Heifer
El Farrow to Wean
JpNo
Dry
Poultry
❑ Dry Cow
❑ Farrow to Feeder
❑ Non -Dai
El Farrow to Finish
❑ Layers
❑ Beef Stocker
❑ Gilts
❑ Non -La ers
El Beef Feeder
❑ Boars
❑ Pullets
❑ Beef Brood Co
❑ Turkeys
Other
ElTuArkey Poults
Number of 5truetures:
❑ Other
❑ Other
Discharges & Stream Impacts
1. is any discharge observed from any part of the operation'?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes ?)No ❑ NA ❑ NE
❑ Yes
❑ No
T NA
❑ NE
❑ Yes
❑ No
C?NA
❑ NE
09NA
❑ NE
❑ Yes
❑ No
❑ Yes
V No
❑ NA
❑ NE
❑ Yes
JpNo
❑ NA
❑ NE,
Page I of 3 12/28/04 Continued

r
Facility Number: —
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes P No ❑ NA EINE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No i"' NA ❑ NE
Struct re 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): {
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No
❑ NA
EINE
(ie/ large trees, severe erosion, seepage, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
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?
Crop type(s) Ca*jC�",AjQ
Y
13"
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
® No
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
No
❑ NA
❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
P1 No ❑ NA
❑ NE
9. Does any part of the waste management system other than the waste structures require
❑ Yes
E�No
❑ NA
❑ NE
maintenance or improvement?
[)�No ❑ NA
❑ NE
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ YesNo
ElNA
[:1NE
mai ntenance/improvement?
11.
Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
to 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 El Evidence of Wind Drift ❑`Application Outside of Area
12.
Crop type(s) Ca*jC�",AjQ
13"
Soil type(s) R�yj
C l
14.
Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
Wo ❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement? ❑ Yes
DoNo ❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
P1 No ❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application? ❑ Yes
1P No ❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment? ❑ Yes
[)�No ❑ NA
❑ NE
Comments (refer to questionif Explain any YES answers and/or any recommeadatiaas or any other comments.
Use drawings of facilitytp better explain situations. use additional pages as necessary):
AL
Reviewer/Inspector Name"'�"M, IN Phone:
Reviewer/Inspector Signature: Date: O
P 2 2 12128/0 Continued
age of

i
Facility Number: 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 [gNo ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ONo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [� No ❑ NA EINE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No R NA EINE
24_
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
No
❑ NA
E3NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
ElYes
LgNo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
P No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
P No
(__1 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
F) No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
3 1 .
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
P No
❑ NA
❑ NE
General Permit? (ie/ discharge, Freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
�No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
[ANo
❑ NA
❑ NE
Page 3 of 3 12/28/04

Type of Visit 0 Compliance Inspection O Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit 40 Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: `�-1--=-�-' Arrival Time: 1) ` Departure Time: ti County:
Farm Name: s �a'(r�►s Owner Email:
Owner Name: ndai ( i�� _ Phone:
Mailing Address:
rev Region: Lx
Physical Address: -
Facility Contact: P�YV101M� Title: Phone No:
Onsite Representative: 1 Integrator:m�`
Certified Operator: r� Operator Certification Number: 177%
b
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: =' =' =" Longitude: = e [� ' = "
Design C►urren#
Swine Capacity Population
❑ an to Finish
❑ an to Feeder
Design Current
j'i'et Poultry C•apac'tty Population
10 Layer
❑ Non -La er
Design C•nrrent
Cattle Capacity Population
❑ Daia Cow
❑ Dairy Calf
Feeder to Finish
❑ NE
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ D Cow
❑ Farrow to Feeder
a. Was the conveyance man-made?
❑ Non -Dairy
❑ Farrow to Finish
❑ Layers
❑ Beef Stocker
❑ Gilts
❑ Non -Layers
El Beef Feeder
❑ Boars
El Pullets
❑ Beef Brood Co
❑Turke s
Other
❑ Other
[Ell urkey Poults
❑ Other
Number of Structures:
❑ No
[RNA
❑ NE
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
�&o
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
lifl NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
[4NA
❑ 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
[RNA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
4No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
$ No
❑ NA
❑ NE
other than from a discharge?
12128/04
Continued

Facility Number:
Date of Inspection I I
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 Stnicture 2 Structure ? Structure 4
Identifier: _ L q a_ b
❑ Yes j� No ❑ NA [INE
El Yes (❑_ No P�FNA ❑ NE
Structure 5 Structure 6
Spillway?:
Designed Freeboard (in):
u �
Observed Freeboard (in): _$
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes [jNo El NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.) //
6. Are there structures on-site which are not properly addressed and/or managed ❑ Yes No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes QPNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes [p 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 Leto F1 NA El NE
maintenance or improvement? Lt
Waste Aunlication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes I�No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 1�bNo ❑ 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 ofA``c��ce��ptta��blleff CroopWindow ElEvidence of Wind Drift ElApplication Outside of Area
12. Crop type(s) L���� sk( 1' _ �✓T�►e L Si'^ l}riz
13. Soil type(s) Bean f\ — &B
X OQfLn�d,rlC•*�j ��P tPPI,S Q ✓0 (q ' ,^�
14. Do the receiving crops differ from those designated in the CA WMP?
❑ Yes
*No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[V No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination,❑
Yes
[�No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
�@ No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
1P No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
X OQfLn�d,rlC•*�j ��P tPPI,S Q ✓0 (q ' ,^�
Reviewer/inspector Name V
ftV Phone:
Reviewer/Inspector Signature: Date:
/2/28/04 Continued

Facility Number: — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes] No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes Y No ❑ NA ❑ NE
the appropirate box.
❑ WUP El Checklists ❑Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes T No [INA ❑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?
El Yes
No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
10 No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
No
r
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
T No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
[P No
❑ NA
❑ NE
Other issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[P No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
0 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
[3 No
❑ NA
[I 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
[:1NA
C] NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
P No
❑ NA
❑ NE
Page 3 of 3 12/28/04

IType of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance I
Reason for Visit e Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time:`tl '� "IYI�I I Departure Time: ✓r60 /"+ County: —S41V'1PS0/✓ Region: /--ieO
Farm Name: I`� S _Fewf%4 _ Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address: /r
Facility Contact: Title:
tl
Onsite Representative:
Certified Operator:
Back-up Operator:
p Phone No:
Integrator: f r'&_
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: [= o [=, = Longitude: [� 0 0 4 =u
J
Design Current
Swine Capacity Population
is 1 Current
Wet PoyltryC�apacity Population
4
Design Current
Cattle CapacityPopulation
to Finish
❑ La er
❑Dai Cow
HWean
Wean to Feeder
❑Non -La er
❑Dai Calf
Feeder to Finish
Dai Heifer
El Farrow to Wean
Dry Poultry
❑ D Cow
❑ Farrow to Feeder
❑Non -Dai
❑ Farrow to Finish
❑ Layers
❑ Beef Stocker
Non -La ers
1❑ Beef Feeder
PGilts
Boars
❑ Pullets
❑ Beef Brood Co
-
❑ Turkeys
Other
❑Turke Points
❑ Other
❑ Other
Number of Structures:
Discharges & 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 DWQ) ❑ Yes ❑ No NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (Ifyes, notify DWQ) ❑Yes ❑ No NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ YesNo NA ElNE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State ❑ Yes No ❑ NA ❑ NE
other than from a discharge?
Page 1 of 3 12/28/04 Continued

Facility Number:
Date of Inspection 9 3 O
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
No
'NA
EINE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier:
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
i�No
❑ NA
❑ NE
Spillway?:
❑ Yes
PNo
❑ NA
❑ NE
Designed Freeboard (in):
❑ Yes
1(5No
❑ NA
EINE
Observed Freeboard (in): 3_0
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed
❑ Yes
No
[:INA
❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
[6 -No
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes tp4IVo ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9_ Does any part of the waste management system other than the waste structures require ❑ Yes '�)No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance/improvement?
r
11, Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes FhNo ❑ NA EINE
❑ 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 types) Y -)p
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yeso
[:1NA
ElNE
15. Does the receiving crop and/or land application site need improvement?
ElYes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
i�No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
PNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
1(5No
❑ NA
EINE
Reviewerlinspector Name
Reviewer/Inspector Signature:
Page 2 of 3
Phone: U/
Date: 9
12/28/04 Continued

Facility Number: Date of inspection MUOT1
/
_Required Records & documents �%
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes PIN. ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes VNo ❑ NA ❑ NE
the appropirate box. ElWUP ❑ Checklists El Design ❑ Maps ❑ Other JJ
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 0 No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ 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
IrNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
�TNo
❑ 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
V] No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
12No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
6No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
V No
❑ NA
❑ NE
Additional Comments and/or Drawings:
12/28/04

V Division of Water Quality k
11 1 Facility Number Z O Division of Soil and Water Conservation®� Z 01.
O Other Agency (f3'_
Type of Visit )Q Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Q p�
Date of Visit: Di Arrival Time: Departure Time: County. Region:
Farm Name: Owner Email:
Owner Name: '�•[ti.'�� \ Phone:
Mailing Address:
Physical Address: //���
Facilitv Contact: Title: �S�`(Y� (
Onsite Representative: ft } 1 Integrator:
Al
Phone No:
If - e -IA n
Certified Operator: Operator Certification
Back-up Operator:
Location of Farm:
Swine
Back-up Certification Number:
Latitude: =0 =S
[= Longitude: ❑ o = I=] N
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Wean to Finish 10 Laver
❑ Wean to Feeder 1 10 Non -La et
Feeder to Finish I L14HO
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Dry Poultry
Cl Layers
❑
Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Cattle
DesignCurTeut
Capacity. Population
❑ Dairy Cow
❑ Dairy Calf
❑ Daia Heifei
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes 1� No ❑ NA ❑ NE
❑ Yes
❑ No
Qfl NA
❑ NE
El Yes
El No
[ NA
[:1 NE
91 NA
❑ NE
❑ Yes
❑ No
❑ Yes
fiQ No
❑ NA
❑ NE
❑ Yes
ZNo
❑ NA
❑ NE
12/28/04 Continued

Facility Number -'U: — f Date of Inspection �? O
AL
Waste Collection &Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
No
❑ NA El NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
tZNo
❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier: 9
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):�j C7
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
NNo
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed
❑ Yes
gNo
❑ 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
IM No
❑ NA ❑ NE
S. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
14 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
to No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
a9 No
❑ NA ❑ NE
mai ntenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
XNo
❑ 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) &X M V�-& — C f Q
13. Soil type(s) E]0
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
�fNo
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
&No
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
No
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
�jNo
❑ NA ❑ NE
Comments (refer to question ft 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 C-41 Q_,NG &ANTp M Phone:O `t ��
Reviewer/Inspector Signature: "I Date: 3oZ
�(,
12/28/04'' Continued

Facility Number: Z—FW Date of Inspection Z di
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available'? ❑ Yes *o ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWW readily available? If yes, check ❑ Yes V No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists
❑ Design [:1 Maps El Other
21. Does record keeping need improvement? if yes, check the appropriate box below. ❑ Yes KNo ❑ 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
b4No
❑ NA
❑ NE
23.
if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
b? NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
MNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
9No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
$4No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
JkNA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
RNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
P_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
5,No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
� No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
�No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
SqNo
❑ NA
❑ NE
Additional Comments and/or Drawings:
I I
N'!D Cuv cr on t n g; de U �11L`�c +-1 (7�1i`Y7y • A� 1&54 Flace
j) r r� Cave l g 1' �a all i -c ii 41 (XAvyLa n m cove f c"
w
12/28/04

.. .} `� �I
Facility No'�%. L � J Time In Time Out Date
Farm Name F4JA_� _ Integrator S
Owner Site Rep
Operator No.
Back-upNo. -
,
COC V/ Circle: CGeneXr or NPDES
Design urrent Design Current
Wean – Feed Farrow – Feed
Wgaa_–_F41i5b Farrow -- Finish
Gilts 1 Boars
Farrow --We—an Others
FREEBOARD: Design
Sludge Survey
Crop Yield _
Rain Gauge
Soil Test Wettable Acres
Weekly Freeboard Daily Rainfall
Spray/Freeboard Drop
Weather Codes 120 min Inspections
Waste Analysis:
Date Nitrogen (N)
Observed
Calibration/GPM 1 ��
Waste Transfers
Rain Breaker—
PLAT �1
1 -in Inspections
Date Nitrogen (N)
Pull/Field Soil Crop Pan Window
rv, {` - 0
L - 0,

Type of Visit OTompliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit "utine Q Complaint 0 Follow up Q Referral 0 Emergency Q Other ❑ Denied Access
Date of Visit: Arrival Time: OQ Departure Time: 1.�'!.3V 1 County: Region: ITo
Farm Name:P/G�Z,1 Me-- tiv F7,1 ✓ m.S / Owner Email:
Owner Name: t' 7 rel ►' Y ��P/! Crt-5 Phone:
Mailing Address:
Physical Address:
Facility Contact: G/'t-gr Lppll ��s Title: Phone No:
Onsite Representative: �S-� Integrator: as-� e�
Certified Operator: s��'^-�� Operator Certification Number: Z7 C;?-//
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = o ❑ I E__1 11
Longitude: =0=4
o=4 =
is
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Design Gurrentx 1 r::.W w� 4Pill
Design Current
Design Current
Swine
Capacity Population Wet Potitry
Capacity Population
Cattle Capacity Population
❑ Wean to Finish
❑ Layer
a. Was the conveyance man-made?
❑ Da Cow
❑ Wean to Feeder
❑ Non -Layer
❑ NE
❑Dai Calf
19 Feeder to Finish
/0 �`t r ��'" " ..
❑ NA
❑ Da Heifer
❑ Farrow to Wean
, D Poulf
�"
- y
❑ D Cow
❑ Farrow to Feeder
d. Does discharge bypass the waste management system'? (If yes, notify DWQ)
ie-`
❑ Non -Dairy
❑ Farrow to Finish
6 ❑ Layers
2. Is there evidence of a past discharge from any part of the operation?
m, ❑ Beef Stocker
❑ Gilts
,; ❑ Non -Layers
❑ NE
❑Beef Feeder
❑ BoarsElPullets
a='
❑ NA
❑Beef Brood Cowl
other than from a discharge?
- _ ❑ Turke s
-
Uther
❑
-. ::�.: TurkeyPoults
1 []
12/28/04
s.
of Structures:
Other
Other
.IVumber
_
3 _
.—
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
IQ No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
EqNo
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
❑ Yes
RNo
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system'? (If yes, notify DWQ)
❑ Yes
[M No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
(9 No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
KNo
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12/28/04
Continued

Facility Number: Date of Inspection
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural Freeboard?
Structure I Structure 2 Structure 3
Identifier: /
Spillway?:
Designed Freeboard (in): %91
Observed Freeboard (in): 411 31D
Structure 4
❑ Yes ['No
❑ Yes ;KNo
Structure 5
❑ NA ❑ NE
❑ NA ❑ NE
Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
M No
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
Reviewer/Inspector Signature: Date: 7 —Z/ v-7D�6
6. Are there structures on-site which are not properly addressed and/or managed
❑ Yes
V.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
E No
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
4 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
[&No
❑ NA
❑ NE
mai ntenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ®-No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ElEvidence of Wind Drift ElApplication Outside of Area
12. Crop type(s) P,—,-,-7 ka//p G ✓a, D/' fQlir/` SY�i�I.
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes allo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes QkNo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes ® No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes 4 No
❑ Yes 21 No
❑ NA ❑ NE
❑NA [:1 NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
T
Reviewer/inspector Name -- ej-- y � � Phone:
Reviewer/Inspector Signature: Date: 7 —Z/ v-7D�6
Page 2 of 3 12/28/04 Continued

Facitity Number: — Date of Inspection (p
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes LKNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes WNo ❑ NA ❑ NE
the appropriate box.
❑ WUP El Checklists El Design El Maps [:1 Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ER Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis J4 Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
® No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[allo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
JR No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
C4 No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
0 No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
04 No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
14 No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
K 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
[4 No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
XLNo
❑ NA
❑ NE
Additional Comments and/or Drawings:" -
Page 3 of 3 12128104
Page 3 of 3 12128104

Type of Visit S Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit i Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility- Number
Dale of Visit: �1 -' Time:
� S
• Not O erational 0 Below Threshold
Mfermitted �Certifiiedc� © Conditionally Certified [3 Re^istered Date Last Operated or Above Threshold
Farm Name: — m .�SIO Fig/ n, s _.. County: o00A �Ro
Owner Name: G/ a or Ie Phone No: 5/0- 5_90 " 3e P 7
Mailing Address: 30 Grove 54, C1;11-',, AIL d2 �
Facility Contact: Gre j&Cy V&pAe,75 Title: Phone No: yl0 � 3 gsloG�''
Onsite Representative: Gr or JlegAen j Integrator: Pry
e -S
Certified Operator:xj�5e' XS{e;gAe Operator Certification Number: ^% r14/
Location of Farm:
wine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' ` " Longitude ' • .4
Design Current
Swine C anarity Pnnnlatinn
❑ Wean to Feeder
fi: I :eller to Finish I y
❑ Farrow to %Vean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Design Current Design: Current
Poultry Ca ackv Population Cattle Ca achy Population
❑ Laver E
Dai
❑ Non -Laver Non -Dain,
_j
❑ Other
Total Design Capacity
Total SSLW
I Number of Lagoons ILJ Subsurface Drains Present Lj Lagoon Area ' L S ray Field Area
Holding Ponds / Solid Traps ❑ No Liquid Waste Management System
Dees & Stream Impacts
1. is any discharge observed from any part of the operation? ❑ yes ❑moo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ YesE3r<o
b. if discharbe is observed. did it reach Water of the State? (If ves, notify DWQ) ❑ yes Q1Co
c. If discharge is observed. what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If vest notify DWQ) ❑ Yes EEMo
2. Is there evidence of past discharge from any part of the operation? ❑ Yes 9' leo
3. Were there anv adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes D Flo
Waste Collection & Treatment
4. Is storage capacity (fieeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes a�o
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: 1
Freeboard (incbes): y 3 33
03103101 Continued

,Facility Number.8 ;; — /q ,-
Date of Inspection I Y %-4- o
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4.6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenancelimprovement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? If yes, check the appropriate box below.
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground [] Copper and/or Zinc
12. Crop type ge,mwJG ! doA rrl. Aro ze
❑ Yes B-&
❑ Yes EI -Wo
❑ Yes C3'1lo
❑ Yes ET&o
❑ Yes QW66
❑ Yes 0-wo
❑ Yes MNo
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAVVMP)? ❑ Yes U -Ko
14_ a) Does the facility lack adequate acreage for land application? ❑ Yes 0 -Mo
b) Does the facility need a wettable acre determination? ❑ Yes B -No
c) This facility is pended for a wettable acre determination? [:]Yes �
15. Does the receiving crop need improvement? ❑ Yes BNo
16. Is there a lack of adequate waste application equipment? ❑ Yes QW -0
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes 0'K05
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes �
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 EI -Wo
Air Quality representative immediately.
Caninkm (reZer to_q� ds�hon'#} Eelam any YES a w s and/or arty reeummrnda ons orJaay Otte r oommeat
;Use drawuegs of factLty to better expiam sYtinaLaas. {oVse additional pages aspec�saiy} -_ [�fe1d Copy ❑ F-tnal Notes .--
�
Reviewerlinspector Namela
Reviewer/Inspector Signature: ell
&A %� Date: y -1 9 - O
12112103 Continued

Facility Number: 8,;R — Date of Inspection
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)
3I. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
32. Did the facility fail to install and maintain a rain gauge?
33. Did the facility fail to conduct an annual sludge survey?
34. Did the facility fail to calibrate waste application equipment?
35. Does record ke✓eping for NPDES required rms need improvement? If yes, check the appropriate box below
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After V Rain
❑ 120 Minute Inspections ❑ Annual Certification Form,
❑ Yes E#o
❑ Yes g. -No
❑ Yes Q�Ko
❑ Yes ❑.Ain
❑ Yes 9 -No
❑ Yes 8• -No
❑ Yes S -No
❑ Yes ❑'W
❑ Yes QNo
['Yes ❑ No
❑ Yes S -No
❑ Yes [ o
❑ Yes am
❑ Yes &No
❑ Yes allo
113 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Additidi:ihUC6mments artd/or Drawrngs' — r= �- <�Mu
/71. S1ep4t,?s z1.1eJ A die so,l S4.*�,/�y *,,e � f�4
c4, 6y e »,�� '✓4 e
1I73.
4"4 GOw-f do 'e
aFFe. ;l,e so,I sa,-�P/rs l
7q- 3� Ipe v,'twcr/ -hc vle
12/12103

Facility Number: $.1
Division of Environmental Management
Animal Feedlot Operations Site Visitation Record
Date:
Time: t 22o
General Information:
Farm Name:o County: �vnMOsayL
Owner Name: GM,2 Sie-eine. n S_ _ _ _ Phone No: z 0 - 36�-7
7
On Site Representative: U�-..._ Integrator:_-��` _
Mailing Address: 30:x_y t,Nre- S -
u �� o�► .7 rj C, a12�2�$
Physical Address/Location:'�V- 1 2,I z;l
Latitude: I I Longitude: I 1
Operation Description_ (based on design characteristics)
Type of Swine No. of AnimaLs Type of Poultry No. of Animals Type of Cattle No. of Animals
0 Sow 0 Layer ❑ Dairy
0 Nursery 0 Non -Layer 0 Beef
Weeder I'D—
OtherType of Livestock Number of Animals:
Number of Lagoons (include in the Drawings and Observations the freeboard of each lagoon)
Facility Inspection:
No 13
Yes ❑
Lagoon
Yes U
No
Is lagoon(s) freeboard less than Ifoot + 25 year 24 hour storm storage?:
Yes ❑
No
Is seepage observed from the. lagoon?:
Yes ❑
No Ik
Is erosion observed?:
Yesq
No ❑
Is any discharge observed?
Yes 0
No IA
❑ Man-made Q Not Man-made
Cover Crop
Does the facility need more acreage for spraying?:
Yes a
No IR
Does the cover crop need improvement?:
Yes JR
No 0
list the crops which need improvement}
Crop type:_r,3n s Acreage:
Setback Criteria
Is a dwelling located within 200 feet of waste application?
Is a well located within 100 feet of waste application? -
Is animal waste stockpiled within 100 feet of USGS Blue Line Stream?
Is animal waste land applied or spray irrigated within 25 feet of Blue Line Stream?
AOI – January 17,2996
Yes d
No 13
Yes ❑
-,No ;g
Yes U
No
Yes 0
No Ca

Maintenance
Does the facility maintenance need improvement? Yes ❑ No 0
Is there evidence of past discharge from any part of the operation? Yes ❑ No 0
Does record keeping need improvement? Yes a No la
Did the facility fail to have a copy of the Animal Waste Management Plan on site? Yes ❑ No a
Explain any Yes
'Soro6p Civ- --..
Signature: Date: 2-h3)16
cc Facility Assessment Unit Use Auachments if Needed
Drawings or Observations:
L -k �rtar,rtd
nfz - 7n T 't#!'u X14 f'f1'.t�r•7!"h..•.+s�nj -- -'-- ..r.-rv'.s»_4..-. .-. -
i..f ..'
AOI — January 17,1996

State of North Carolina
Department of Environment,
Health and Natural Resources
Fayetteville Regional Office
James B. Hunt, Jr -Governor
Jonathan B. Howes, Secretary
Andrew McCall, Regional Manager
A74
IDEHNR
DIVISION OF ENVIRONMENTAL MANAGEMENT
November 21, 1994
Mr. Greg Stephens, Farm Owner
Prestage Farms, Inc.
P.O. Box 438
Clinton, NC 28328
SUBJECT: Compliance Inspection
Sampson County
Dear Mr. Stephens: T __
On November 17, 1994, 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 [phone].
Sincerely,
G yDtP
Environmental Engineer
Enclosure
cc: Facility Compliance Group
Glenn Clifton
Wachovia Building, Suite 714, Fayetteville. North Carolina 28301-5043 Telephone [phone] FAX [phone]
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J
NORTH CAROLINA DEPARTMENT OF , HEALTH & NATURAL RESOURCES
DIVISION OF AL lsAi+1AG`H4ENT
Fayetteville Regional office
Animal Operation Compliance Inspection Form
All questions answered negatively will be discussed in sufficient detail in
the Comments Section to enable the deemed Permittee to perform the appropriate
corrections:
SSCTIONI
Animal Operation Type:
Horses, cattle, n , poultry, or sheep
SECTION 11
1. Does the number and type of animal meet or exceed
the (.0217) criteria? [Cattle (100 head),
horses (75), swine (250), sheep (1,000), and
poultry (30,000 birds with liquid waste
system)]
2. Does this facility meet criteria for
Animal Operation REGISTRATION?
3. Are animals confined fed or maintained
in this facility for a 12 -month period?
4. Does this facility have a CERTIFIED AN�Ai.
WASTE MANAGEMENT PLAN?
5. Does this facility maintain waste management
records (Volumes of manure, land applied,
spray irrigated on specific acreage with
specific cover crop)?
b. Does this facility meet the SCS minimum
setback criteria for neighboring houses,
wells, etc?
En© «.
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M=XON III
Field Site Management
1. Is animal waste stockpiled or lagoon
construction within 100 ft. of a OSGS
Map Blue Line Stream?
2. Is animal waste land applied or spray
irrigated within 25 ft. of a USGS Map
Blue Line Stream?
3. Does this facility have adequate acreage
on which to apply the waste?
4. Does the land application site have a
cover crop in accordance with the
TIFICATION PLAN?
5. Is animal waste discharged into waters of
the state by man-made ditch, flushing system,
or -other similar man-made devices?
6. Does the animal waste management at this
farm adhere to Best Management Practices
(BMP) of the approved CERTIFICATION?
7. Does animal waste lagoon have sufficient
freeboard? How much? (Approximately _9 ft._)
B. Is the general condition of this CAFO facility,
including management and operation,
satisfactory?
RMON IV
Comments
Section III (5): This facility has a certified waste management plan. The
spray area is currently being cleared and the cover crop will be sprigged in
the spring of 1995. This is in the certified plan. This facility is
relatively new and is well managed and maintained.