820196_INSPECTIONS_20171231

NORTH CAROLINA .�
Department of Environmental Qual

M�
gLAt
"^' Division of Water Resources
Facilityy Number - 1 g =d%
ion of Soil aad Water Conservation
er Agency
Type of Visit: ® Compliance Inspection 0 Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: ® Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: } Departure Time: p County: ��t- Region:7�
Farm Name: tl� �� f OL"t' )q"t66✓v Owner Email:
Owner Name: WA � atM w i4CI-11A Phone:
Mailing Address:
Physical Address:
Facility Contact: PoLja f j I: tA'Qvt j Title: Phone:
Onsite Representative: WtgI t am Integrator:
Certified Operator: u Certification Number:
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Design Current
Swine Capacity*; _Pop m
Design Current
Wet Poultry Capacity Pop.
Design Current
Cattle Capacity Pop.
Wean to Finish
La er
IDai
Caw
Calf
Wean to Feeder
Non -La er
IDai
Feeder to Finish
Farrow to Wean
Farrow to Feeder
7
Design Current
D.. P,oul Ca aci P,o
Dai Heifer
Dry Cow
Non -Dairy
Farrow to Finish
ILavers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other.
Turkeys
Turke Poults
Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
X No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
7) 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
© No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
[3 Yes
TV No
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412015 Continued

Facili 'Number: - Date of Inspection:
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
rO 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
0] 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 Pa 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 O Yes r-_1 No ❑ NA ❑ NE
maintenance or improvement?
Waste AwAication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ® No ❑ NA ❑ NE
maintenance or improvement? TT
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes q No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
.. f
13. Soil Type(s): A*
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 [5]o No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes �j No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
iu 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
CH 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 I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes r No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes P No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑NA ❑NE
Page 2 of 3 21412015 Continued

Facil - Number: jDate of Inspection: 'Z-I
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes �E No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [�j 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 Q9 No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes F�j 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? TT
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 [!0 No ❑ NA ❑ NE
❑ Yes QO No ❑ NA ❑ NE
❑Yes WNo ❑NA ❑NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes [A No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes [A No ❑ NA ❑ NE
Reviewer/Inspector Name: Zvi 4 Phone: qC 0:Y1? -3 3 00
Reviewer/Inspector Signature: Date: 2
Page 3 of 3 21412015

r ype or visit: w trompuance inspection v uperauon xeview V structure hvatuarron V i ecnmcan 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: QZ� County: .w��Region: F�y`-f—j
Farm Name: �i + +4A,— W Owner Email:
Owner Name: ('j F VL"a" l�lJ LSD � Phone:
Mailing Address:
Physical Address:
Facility Contact: V60 g N
EA
Onsite Representative: �1
Certified Operator: , �ji +'tt `�0 Ir\
Back-up Operator:
Title:
Phone:
integrator:
Certification Number:2�3
Certification Number:
Location of Farm: Latitude: Longitude:
esign
CurrentDesign
pactyPop.
ID
_esign
Wet Poultry
Capacity
Pap.
Cattle Capacity ffient
Wean to Finish
La er
DairyCow
Wean to Feeder
Non -Layer
DairyCalf
Feeder to Finish7
7-
DairyHeifer
Farrow to Wean
, _.:
Design
Current
D Cow
Farrow to Feeder
Dr. P,oult ,
Ca aci
Pa
Non -Dairy
Farrow to Finish
Lavers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
_
Turkey Pouets
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 P NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
❑ No
[P 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
® No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
[] Yes
®T No
❑ NA
❑ NE
of the State other than from a discharge?
T�
Page 1 of 3 21412015 Continued

Facility Number: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
No
P
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
RNA
❑ NE
Struc e l Structure 2 Structure 3 Structure 4
Identifier:
Structure 5
Structure 6
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
No
❑ NA
❑ NE
waste management or closure plan?
T'
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)
T
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 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 /n❑ Evidence of Wind Drift ❑ Application Outside of Approved Area L".412. Crop Type(s): ootS7a'( "4 i7 pass )i9M L'�Y1 f i
13. Soil Type(s): O v "&-- (J
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes 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
W No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[P No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
T No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CA WMP readily available? If yes, check
[:]Yes
[P No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other.
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
[� No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 " Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
[]Yes
[P No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
® No
❑ NA
❑ NE
Page 2 of 3
21412011 Continued

r- f
Facili Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes EP No 0 NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes (P No [] NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes M No ❑ NA ❑ NE
❑ Yes �D No ❑ NA ❑ NE
❑ Yes P No ❑ NA ❑ NE
❑ Yes pa No ❑ NA ❑ NE
❑ Yes [�j No
❑ Yes No
❑ Yes No
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
i
Reviewer/Inspector Signature:'�/`� _ Date:
Page 3 of 3 21412011

(Type of Visit: i® Compliance Inspection O Operation Review p Structure Evaluation Q Technical Assistance
Reason for Visit: ® Routine O Complaint O Follow-up O Referral p Emereencv O Other O Denied Access
Date of Visit: Arrival Time: Departure Time: L)i� County: Region: r�
Farm Name: ,CtlM 500TG�%'1 Owner�Email/' ':
Owner Name: WA
r l , SO Ln Phone:
Mailing Address:
Physical Address:
Facility Contact:
✓ w
Onsite Representative!: l� {
Certified Operator:
Back-up Operator:
Location of Farm:
Title:
Latitude:
Phone:
Integrator: }mow•
id
Certification Number: 261 K3
Certification Number:
Longitude:
Design C•rrrrent
Desiga
@urrent
Design Current
Swine Capacity Pop.
Wet Poultry
Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish I
ILayer
I
Da Cow
Wean to Feeder
Non -La er
Dairy Calf
Feeder to Finish
Da� Heifer
Farrow to Wean
Dry Cow
Farrow to Feeder
D-HIRT,l
Ca aci
P,o
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
1pullets
Beef Brood Cow
Turkeys
Other
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. is any discharge observed from any part of the operation? ❑ Yes 1P 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 o Q NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes No ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412015 Continued

Facili Number: Date of inspection: 2�
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA
a. If yes, is waste level into the structural freeboard? ❑ Yes No [�d NA
Structure l Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: I
Spillway?:
Designed Freeboard (in):
(jam
Observed Freeboard (in): 2 O
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
❑ NE
❑ NE
❑ NA
❑ NE
❑ Yes
No
❑ 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 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?
El Yes
[PNo
❑ 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
�Vo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes 4 No ❑ NA
❑ Excessive Ponding 0 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 A
12. Crop Type(s):
13. Soil Type(s):
❑ NE
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
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
® No
❑ NA
❑ NE
Required Records & Documents
T'
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 ❑/,ease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 1�h No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes F
No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

I+acili Number: - Date of Inspection:
4 .
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 CJNo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [A 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 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.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the ❑ Yes [� No ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
[] Yes
[h No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CA W NCP?
❑ Yes
19No
❑ 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
© 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 pales as necessarv).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Phone: ' O- ?�
Date: �(
Page 3 of 3 1j21412015

Type of Visit: 0 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 0 Denied Access
Date of Visit: Arrival Time: t ?�,.� Departure Time: ounty: k^) Region:
Farm Name: W311, " .4!24 � �1�� Owner Email:
Owner Name: j/lf11/1(q V�_ R • b)I 15co Phone:
Mailing Address:
Physical Address:
Facility Contact: I,
Onsite Representative:
Certified Operator: lji 6llQ IM C' WJo m
Back-up Operator:
Location of Farm:
Title:
Latitude:
Phone:
Integrator: �J Q
Certification Number:
Certification Number:
Longitude:
Design Current
Design
Current
Design Current
Swine
Capacity , Pop.
Wet Poultry
Capacity
Pop.
Cattle
Capacity Pap.
Wean to Finish
La er
D Cow
Wean to Feeder
-Layer
D Calf
Feeder to Finish
a
"� `
Da Heifer
Farrow to Wean
Design:
Current
D Cow
Farrow to Feeder
D ..Pou!
Ca aci
Po
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Soars
Pullets
Beef Brood Cow
Turkeys
Uther
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 F
No ❑ NA ❑ NE
[—]Yes [:]No
❑ Yes [:]No
[:]Yes [:]No
[:]Yes ® No
[:]Yes Ig No
NA ❑ NE
NA ❑ NE
RNA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
Page I of 3 21412014 Continued

* Faci r Number: - IDate of Inspection:
Waste Collection & Treatment
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
NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Identifier:
Structure 5
Structure
7
6
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 4�
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No
❑ NA
0 NE
(i.e., large trees, severe erosion, seepage, etc.)
T
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
[DNA
❑ 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
No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus 0 Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application
Outside of Approvedau�.'
12. Crop Type(s): Q S �.
13. Soil Type(s): IVO
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
q0 No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
® No
T®
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
D Yes
No
❑ NA
❑ NE
acres determination?
T
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
1p No
❑ NA
❑ NE
Required Records_ &_Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[P 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 1P
No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis 0 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 1� No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes J0] No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑NA ❑NE
Page 2 of 3 21412014 Continued

Facili Number: 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 ❑ 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 [a No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [�jj No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
❑NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes �d No ❑ NA ❑ NE
❑ Yes No
❑ Yes [ No
❑ Yes No
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Phone:
Date:
21412014

i ype of visit: 8 t_:ompiiance inspection u uperanon meview u structure Evaluation u i ecnnicat Assistance
Reason for Visit: 0 Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Gf Arrival Time: D Departure Time: County: 5*1­�
Farm Name:_ &) Xtou"' W C ! 5e4" T _ Owner Email:
Owner Name: W j[44' U.1S0►. Phone:
Mailing Address:
Physical Address:
Facility Contact:
kS J Title:
Onsite Representative: Ur
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Region: RI-3—
Integrator: IV, --B
Certification Number: 2.52
Certification Number:
Longitude:
�i Des g Current esDgti�C-tirrent _ Design Current
Swine "paeity Pop. W P ultry Cagac�tyP,op.Cattl15
e Capacity Pap.
Wean to Finish La er DairyCow
Wean to Feeder Non -La er DairyCalf
Feeder to Finish - DairyHeifer
Farrow to Wean Desi gn Current ;... D Cow
Farrow to Feeder D . 1'oult Ca aciPo -Dairy
Farrow to Finish La ers - Beef Stocker
Gilts Non -Layers Beef Feeder
Boars Pullets Beef Brood Cow
�- Turkeys
Others TurkeyPoutts
�.
Other
�the�t„5ra.
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)?
❑ Yes P No [] NA ❑ NE
❑ Yes
[:]No
NA
❑ NE
❑ Yes
❑ No
® NA
❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) ❑ Ycs ❑ No h NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes k3 No [DNA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes M No ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

acili Number: I L Date of Inspection: Z D
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
No
NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[�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
® No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
No
❑ NA
❑ NE
S. 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)
T
9. Does any part of the waste management system other than the waste structures require
❑ Yes
eg 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 �3 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
12. Crop Type(s):
13. Soil Type(s):
❑ NE
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
rn No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
IFNo
T�
❑ 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
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 ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
[:]Rainfall ❑Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ® No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

acili Number: RU 7 Date of Ins ectioo: 75 !
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 No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes �g No ❑ NA ❑ NE
❑ Yes f�jNo ❑ NA ❑ NE
❑ Yes PNo ❑ NA ❑ NE
❑ Yes �No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes b�bNo ❑ 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 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:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: /D_ 3
Date: 1 —I
214 011

hype of Visit: U Compliance Inspection U Vperation Review U atructure Evaluation U i ecttnical Assistance
Reason for Visit: O Routine O Complaint O Follow-up O Referral O Emergency O Other p Denied Access
Date of Visit: 110 Arrival Time: j T Departure Time: County: egion: (pCnP M_
Farm Name: Owner Email: "T
Owner Name: I DM Phone:
Mailing Address: to r l % J a yyN _ e W t' ).So ^-j
_
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative: . Integrator: '
For, rn , ji �r
Certified Operator:��+(„[1�� S�/�1+'jji�l,y Certification s\Tumber:�gl�9iJ�,3-�."
Back-up Operator:
Location of Farm:
Wean to Finish
We -an to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Latitude:
Pullets
Turkey Poults
Other
Certification Number:
Longitude:
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow _
Non -Dairy _
Beef Stocker
Beef Feeder
Beef Brood Cow
Discharges and Stream Impacts CQ ¢ WR
�L rJ
1. is any discharge observed from any part of the operation.
❑ Yes,,E3'no
❑ NA
❑ NE
Discharge originated at: ❑Structure ❑ ApplicatioiNoi1lda $ 25j4 r:
a. Was the conveyance man-made?
❑ Yes ❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the SWA�ft A
❑ Yes ❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons . nlm
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 �1 o
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes �o
❑ NA
❑ NE
of the State other than from a discharge?
/—
Page 1 of 3 21412011 Continued

Facili Number: 19 Sc- Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes J2'F4o
a. If yes, is waste level into the structural freeboard? [—]Yes D No
❑ NA ❑ NE
❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): ecr_'�_5_
5. Are there any immediate threats to the integn-ity of any of the structures observed? ❑ Yes P174o ❑ 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 Zj 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 PI -No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes J�+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 ):;�o ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ;2rNo ❑ NA ❑ NE
maintenance or improvement?
11. is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ff No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 101bs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): L
13. Soil Type(s): i
14. Do the receiving crops differ from those designated in the CAWMP?
[D Yes �E] No
❑ NA
L] NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes fl'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 2-No
TO'No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ 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 V:�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 ZNo
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Faciii Number: -
Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes PI -No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes j 40
the appropriate box(es) below. T
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ NA ❑ NE
❑ NA ❑ NE
❑ 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 ONo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes J;3No ❑ 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)
3 I. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes E No ❑ NA ❑ NE
❑ Yes L?No ❑ NA ❑ NE
❑ Yes dNo ❑ NA ❑ NE
❑ Yes la"No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWNW? ❑ Yes
?fNo
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes
Z) o
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes
Zo
❑ 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 (use additional pages as necessary).
a
W'
13 1 .aa.
41- a --1 3 :) ,;)I
la-a7-19 a.21
Reviewer/Inspector Name:
Reviewer/Inspector Signatur
Page 3 of 3
Phone: Ql q 7 9/ Y2>o
Date: M II - 0
21412011

IType of Visit: V Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: 0 Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: ►T r � Arrival Time: : / Departure Time:j, p,t County• .<jV /Region: �t7
Farm Name: t/�� r t QYv� i s 0 h FM m Owner Email:
Owner Name: W.11(OkK , l,,-91SOh - Phone:
Mailing Address:
Physical Address:
Facility Contact: l Title: Phone:
Onsite Representative: Integrator: 44Al
Certified Operator: �/I�r�f f Qw �, �Sp Certification Number: e-3
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current
Design. -urreint"
Design Current
Swine
Capacity Pop.
Wet;.Poult .
. Capacity '' p
Cattle Capacity Pop.
can to Finish
La er
Dairy Cow
can to Feeder
Non -La er
Dairy Calf
Feeder to Finish
- ,
. -_ ,. , :._
Da'y Heifer
Farrow to Wean
Design Current
Dry Cow
Farrow to Feeder
Dr. 1',o_ult ,
Ca aci Po
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
I
L
Pullets
Beef Brood Cow
Turkeys
Other
Turkey Poults
Other
Other
Discharies and Stream Imuacts
1. Is any discharge observed from any part of the operation? ❑ Yes P No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? [:]Yes ❑ No NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) ❑ Yes ❑ No NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (if yes, notify DWQ) ❑ Yes ❑ No �] NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes rpNo ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes [M No ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

' Facili T number: Date of Inspection: 171170(12
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 �9 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
1p 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
IM No ❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement'?
❑ Yes
No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the 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
P No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.}
❑ PAN [] PAN > 10% or 10 tbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into
Bare Soil
[] Outside of Acceptable Crop Window ❑ Evidence o Wind Drift ❑ Application Outside of Approved Area
i
12. Crop Type(s): nnncL �
v1
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CA WMP?
❑ Yes
[P 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
LCI No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[P 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 A No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis [] Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall inspections
22, Did the facility fail to install and maintain a rain gauge? ❑ Yes No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes Q4 No
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑NA ONE
❑NA ❑NE
Page 2 of 3 21412011 Continued

Facitii Number: - Date of Inspection: 7i
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes] No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes i( 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? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ 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?
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 ReviewerAnspector 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 [5�j No ❑ NA ❑ NE
❑ Yes P No ❑ NA ❑ NE
❑ Yes Ep No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
[] Yes No [DNA ❑ NE
❑ Yes;�No ❑ NA ❑ NE
Phone:
Date: 7
21412011

Type of Visit: 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 0 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: 19 Departure Time: b L County: egion:
Farm Dame: r f ct M 01 50n 9;7 r 47 Owner Email:
I r►
Owner Name: �i I1 I q /►�� W i ko, _ Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: ��
Certified Operator: A! f "4 M ►iV
Back-up Operator:
Location of Farm:
Title:
Latitude:
Phone:
Integrator:
Certification Number:p3
Certification Number:
Longitude:
Design Current
Swine C►apacity Pop. W,get Poultry
Design Current
Capacity Pop.
Design Current
Cattle C►apaclty op.
Wean to Finish
La er
DairyCow
Wean to Feeder
Non -Layer
DairyCalf
Feeder to Finish
Y ,:
©, P,oultr,
Design Current
Ca aci Po
DairyHeifer
Farrow to Wean
D Cow
Non -Dairy
Farrow to Feeder
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turkeys
TurkeyPoults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
❑ Yes (7l No ❑ NA ❑ NE
a. Was the conveyance man-made? ❑ Yes [:]No M NA ❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWQ) ❑ Yes ❑ No C ] NA E] NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes ❑ No NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes [ No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes EV No ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

Facilit 'Number: - Date of lns ection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure 1
Identifier:
Spillway?:
Structure 2 Structure 3 Structure 4 Structure 5
Designed Freeboard (in): I
Observed Freeboard (in): aby
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
No ❑ NA ❑ NE
❑No 99NA ❑NE
Structure 6
❑ Yes
No
❑ 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 T 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 IF
❑ NA ❑ NE
maintenance or improvement'? I
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes O No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes P 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): (A&I )t 5�,44,
13.Soil T es:
P
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
fo 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
D 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
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
4
[DNA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
INo
❑ 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 21412011 Continued

Facili umber: Date of Ins ection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes 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:
14
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [] No 1 NA ❑ NE
Other issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
[:]Yes
M 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
1� No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
No
❑ NA
❑ NE
permit? (i.e., discharge.. freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
® No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
TT
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 reviewlinspection with an on -site representative?
❑ Yes
No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
W No
❑ NA
❑ NE
Commeits (refeto question # Explatn a�v.YESnswers and/or any ad+iitttongTrecommendatsvns or any other comments.
11sedrawt�t s of facilt 10 Netter ex lain=sttui li: i use additional a es aspnecessary,):
Reviewer/Inspector Name:
Phone:
Reviewer/Inspector Signature:
Date:
Page 3 of 3
21412011

Type of Visit 49 Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit 40 Routine O Complaint 0 Follow up 0 Referral O Emergency O Other ❑ Denied Access
Date o1 Visit: 0 ArrivalTime: ; qy—� x' Departure Time: 0 County: sOK Region:
Farm Name: ILIA& w� Cson l'l.�M Owner Email:
Owner Name: ' ` �1 ct Phone:
Mailing Address:
Physical Address:
Facility Contact: 2OLVA ^'I i?✓k0 A Title:
Onsite Representative:
Certified Operator: �' r
Back-up Operator:
Phone No:
Integrator: W
Operator Certification Number: 2!5--2
Back-up Certification Number:
Location of Farm: Latitude: = e = f El " Longitude: = o = 6
Design Current Design Current Design Courfen
Swine
❑❑ Farrow to Finish Capacity Population Wet Poultry Capacity Population C►attte Capacity Population
Wean to Finish ❑ Layer ❑Dai Cow
El Wean to Feeder ❑ Non -Layer ❑Dai Calf
Feeder to Finish � 2€ <� , ❑Dai Heifer
D �oul
El Farrow to Feeder t s - '
ry. _' ry ❑ D Cow
P
M ...
Non -Dairy
r ❑ La ers ElBeef Stocker
❑ Gilts
' ElNon-Layers
El Pullets El Beef Feeder
r
T❑ Beef Brood Cowl
❑ urke s
Other ❑ Turkey Poults
❑ Other [] Other Dumber of Structures:
Farrow to Wean
❑ Boars
Discharges & Stream Impacts
. Is any discharge observed from any part of the operation?
Discharges & Stream Impacts
. Is any discharge observed from any part of the operation?
El Yes
.�No
ff __
❑ NA
❑ NE
Discharge originated at: ❑Structure El Application Field ❑Other
a. Was the conveyance man-made?
El Yes
❑ No
� NA
❑ NE
b. Did the discharge reach waters of the State? (]Eyes, notify DWQ)
El Yes
❑ No
� NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
[I Yes
❑ No
�NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
El Yes
F No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑Yes
Q9 No
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
12/28/04
Continued

Facility Number: — Date of Inspection I 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: I
Spillway?:
Designed Freeboard (in):
4
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 ❑ NA ❑ NE
❑ Yes ❑ No NNA ❑ NE
Structure 5 Structure 6
❑ Yes �allo ❑ NA ❑ NE
❑ Yes ;9 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 ?jNo ❑ NA ❑ NE
S. Do any of the stuctures lack adequate markers as required by the permit? []Yes IgNo [:]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 C] Yes ® No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes §No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes I] No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[]PAN ❑ PAN > 10% or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift
�❑ Application Outside of Area �� ,„ Lu,
12. Crop types) edQ,SN44 Czz� 5(/ ), 5 - W U--�. V i L r �l.V'uv f 1
� r
13. Soil type(s)
-
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
,� 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
19 No
❑ NA
❑ NE
1 S. Is there a lack of properly operating waste application equipment?
❑ Yes
i} No
❑ NA
❑ NE
Comments (refer to question #) Explain any YES answers and/or any recommendations or any other omm nts"
Use drawings ofEfacility to bettervxplain situations. (use additional pages as necessary):-
Reviewer/Inspector Name ��--.' — - — Phone: l? —'13'3300
Reviewer/Inspector Signature:1A Date:
Page 2 of 3 12128104 Continued

i
a.
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 03 No El NA ❑ NE
the appropriate box. ElWUP El Checklists ❑ Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes �9 No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
® No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
® 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
0 No
❑ NA
❑ NE
2T
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
S No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[jPNo
❑ 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
to 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
CA No
❑ NA
❑ NE
Comments and/or Drawings:
Page 3 of 3 12128.104

1
Type of Visit &'Compliance Inspection Q Operation Review U Structure Evaluation U Technical Assistance
Reason for Visit outine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: %/ f —O Arrival '! ime: ' C7 Departure Time: f �� [i(� County: �� Region:
Farm Name: _ Lu i + 1 ��� a.rv� 1 D Owner Email:
Owner Name: _ I�/' I , - % %S a- Phone:
Mailing Address:
Physical Address: I _
Facility Contact: ui" 1 ff Uj i Title: [fit A t., r Phone No:
Onsite Representative: Ji 9 L. a:= �; C_ rrrny,.Integrator:
Certified Operator: Al" VJ �� s'��--- Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: 0 e = I = Longitude: 0 ° = I = f.
Design Current Design Current Design Current
Swine Capacity Popula#ion Vet Poultry Capacity Popula#ion Cattle Capacity Population
❑ an to Finish
❑ Layer
❑ DairyCow
❑ an to Feeder
❑ Non -Layer
❑ Dairy Calf
Feeder to Finish D Q ❑ DairyHeifer
❑ Farrow to Wean Dry Poultry. ❑ D Cow
❑ Farrow to Feeder ❑ Non -Dairy
❑ Layers
❑ Farrow to Finish ❑ Beef Stocker
❑ Non-terg
❑ Gilts El Beef Feeder
❑ Pullets
❑ El Beef Brood Co
❑Boars
Turkeys
Qther ❑ Turkey Poults
❑ Other ❑ Other Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
[2jNo
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b_ Did the discharge reach waters of the State? (if yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
(LNo
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
g[No
❑ NA
❑ NE
other than from a discharge?
12128104
Continued

Facility Number: — Date of Inspection I
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): f 2
Observed Freeboard (in): Al2__
5_ Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes allo ❑ NA ❑ NE
(ic/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed []Yes XNo ❑ 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 rONo ❑ NA ❑ NE
S. Do any of the stuctures lack adequate markers as required by the permit? to 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 CR No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes (ANo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13.
Soil type(s) _A JQe7,:0' /k
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
PNo
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre detennination ? ❑ Yes
rQI No
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application!
❑ Yes
(K No
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
[9-No
❑ NA
❑ NE
Comments fer touesdon #): Explain any ITS answers andlor an recommendationson r aother com
Use driiMn(res of facilito better explain -situations. use additional a es as�net!essa y meats
e {�au�- IY2µ.'p 3f�wrt S-'-ji'_oX iv�-Uj men✓h.-�`-Dy` rn
su�,r (/p �" /01ao-A-1
a f. _zn ,tvD-.A - [),ti ['Kjffl� P%_
Reviewer/inspector Name
Phone:.
Reviewer/Inspector Signature:
Date: IgI--
61 12128104 Continued

r•
Facility Number: — Date of Inspection L!
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes [3No ❑ 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 ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. Yes RK ❑ 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?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes
[XNo
❑ NA
❑ NE
❑ Yes
`d No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
E,No
❑ NA
❑ NE
❑ Yes
[KNo
❑ NA
❑ NE
❑ Yes
KAL
El NA
[I NE
❑ Yes (, No ❑ NA ❑ NE
[]Yes [SNo ❑ NA ❑ NE
❑ Yes RNo ❑ NA ❑ NE
❑ Yes EK No ❑ NA ❑ NE
❑ Yes [3 No ❑ NA ❑ NE
❑ Yes PdNo ❑ NA ❑ NE
A,�dd>itio aI Comments an,�d3/oi�D�r mugs:
12128104
12128104

Type of Visit q).Co-impliance Inspection Q Operation Review Q Structure Evaluation U Technical Assistance
Reason for Visit outine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: Arrival Time: fl Departure Time: [� County:, Region:
Farm Name: _ Wlaep%- i&) . I .Sne- ra/y l._ � '1� OTwner Email:
Owner Name:. 1jJ"W_ e"&^^ w i I S 9 Phone:
Mailing Address:
Physical Address:
Facility Contact: j j ! I S -1 022- Uy 1 1.50'" t Title: Phone No:
Onsite Representative: �50-{ — ZnQg% N I eMDo' A. Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = o = f =16 Longitude: = o = 1 = u
g: � �
Dent n Current"
g � Design Current
p ty
acn P p laton
Wet Poultry
C p cityl?op"t'on Cattle Capacity Population
h
❑ La er
❑ Dai Cow
rowDe
r
❑Non -La er
❑Dai Calf
sh
29
a ❑Dai Heifer
n Dry Poultry, : ❑ Dry Cow
❑ Farrow to Feeder �x
y El Non -Dairy
❑ La ers
El Farrow to Finish
❑ Beef Stocker
❑ Gilts
❑Non -La ers
❑Beef Feeder
❑ Boars
• ❑Pullets
ElBeef Brood Cowl I
Other
;_
El Turke s
❑ Other
.
❑ Turkey Poults=T
❑ Other�?Numl,er
....
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? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
[&No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
L&No
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
12128104
Continued

Facility Number: Date of Inspection
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 1 Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in): 19
Observed Freeboard (in):
2--
[]Yes K No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ® No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes QNo ❑ 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 10 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 9 No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes {XNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes � No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[]PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)rrJ/�
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
®.No
❑ NA
❑ NE
15_ Does the receiving crop and/or land application site need improvement?
❑ Yes
® No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
®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
BNo
❑ NA
❑ NE
ReviewerllnspectorName jo,�e: - ;s Phone: / — 3-33cJ�
Reviewer/inspector Signature: Date: 4L (I �9 '
rage 1. Uj .7 •4/L01VY

i Facility Number: — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 5d No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes CKNo ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ® No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge'?
❑ Yes
[KNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
RNo
❑ 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
9No
❑ 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
14 No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
Z No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
® 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
(S 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
ONo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
®,No
❑ NA
❑ NE
... - RF -.., - ?6- '� is
Additional Comments and/or Drayrmgs: _ �* � ,. ,
i
Page 3 of 3 12128104

I
sion of Water Quality
Facility Number �— �(� 0 Division of Soil and Water Conservation [�
O Other Agency
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: fit] Departure Time: County: Region:
Farm Name: , lI .err► _ sp Owner Email:
Owner Name -1,.,( w r LS a Phone:
Mailing Address:
Physical Address:
Facility Contact: W ' 4x'" �' S �Title: /
Onsite Representative:
Certified Operator:
Phone No:
Integrator: L_
Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Boars
Other
❑ Other
�o �1 0` Longitude: ❑u
Latitude: on itude: =00c
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
L___�' ❑ Layer
❑ Non -La et
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream imoacts
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"`�
Capacity.: Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ 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 Q�No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
0,No
❑ NA
❑ NE
❑ Yes
14 No
❑ NA
❑ NE
12128104 Continued

Facility Number: —121,Date of Inspection L 7
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ® No ❑ NA ❑ NE
a. if yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure i Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?: Q
Designed Freeboard (in): /
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ® No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes 14 No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ® No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ® Yes
❑ No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes
01 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/improvement'?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
P9 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 Cr/op Window ❑ Evidence of Wind Drift ❑ Application Outsideof Area
12. Crop type(s) , �P�i�l�r.�d . / �U elis c���
13. Soil type(s) Nit'/iJLI
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
PNo
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes
M-No
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
allo
❑ NA ❑ NE
IT Does the facility lack adequate acreage for land application? ❑ Yes
29-No
❑ NA ❑ NE
18. 1s there a lack of properly operating waste application equipment? ❑ Yes
M-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):
ly
DL' 'S i vp
Reviewerllnspector Name �s�[ '��� Phone:
Reviewerllnspector Signature: Date: /1;Z -2:p
I2/28/U4 C.onnnuea

Facility Number: — f 9 U Date of Inspection `—'-,
Required Records & Documents
ti.
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes [3No ❑ 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 s g ❑ Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes LKNo ❑ 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
(4 No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
UNo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
® No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
29 No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
0No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
9jNo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[0 No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
DO 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
14 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
D� 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
R[No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
5fNo
❑ NA
❑ NE
Additional Comments and/or Drawings:
Page 3 of 3 12128104

-... •r; r .Iy,ry-r-;^ram.,; .�.-r�P+'2E'in�--S.r.G;C:Ia:.�}"�'•9!
Type of Visit *Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit ® Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: lv'Z7� OG Arrival Time: /x
ADO Departure Time: Q County: Gov ew! Region:
Farm Name: _ W 11;4 au. %�Seit/ / GyX4 �/� 7_ Owner Email:
Owner Name: �-• G�i 1So-✓ _ Phone:
r
Mailing Address:
Physical Address:
x
Facility Contact: -Title: Phone No: s.
OnsiteRepresentative: Integrator: AcAni.,w S4.1ekr11 .Iv�,S
Certified Operator: Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: E—] o E:] ' E�] u Longitude: = o W
T
DesM
Capcity
CurrentM
Population
DesignCurrent
Wepacify Population
Design Cwine
Cattle Capacity Population
❑ Wean to Finish
❑ La er
❑ Dairy Cow
❑ Wean to Feeder
❑Non -La er
❑ Daia Calf
Feeder to Finish
Z
�.„
Dairy Heifer
Farrow to.Wean
x
"'.Dry Poultry. ,�. �.5'�""' `'
❑ D Cow
❑ Farrow to Feeder
"'" � -
❑Non-Dai
❑ Farrow to Finish
❑ Layers
❑ Beef Stocker
❑ Gilts
❑ Non -Layers
❑ Beef Feeder
❑ Boars
❑ Pullets
❑ Beef Broad Cowl
Other
_ �.--_z.:._. ,.
a=
❑ Turkeys
❑ Turkey Poults
❑ Other
[] Other
Number of Structures:
Discharges & Stream impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page 1 of 3
❑ Yes QfNo ❑ NA ❑ NE
❑ Yes
(7 No
❑ NA
❑ NE
❑ Yes
[SPNo
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
51 No
❑ Yes
�RNo
❑ NA
❑ NE
❑ Yes
E�)No
❑ NA
❑ NE
12128104 Continued

Facility Number: FZ —/ (p Date of Inspection
Reuuired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box. ❑ WUP ❑ Checklists ❑ Desig
n ❑ Maps
p ❑Other
❑ Yes [7No ❑ NA ❑ NE
❑ Yes If No ❑ NA ❑ NE
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
T. No
T.
El NA
❑ NE
El Waste Application ❑ Weekly Freeboard El Waste Analysis El Soil Analysis El 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
LP No
ElNA
ElNE "
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
5 No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
EXNo
❑ NA
❑ NE
❑ Yes
JM 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?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did ReviewerAnspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes JFNo ❑ NA ❑ NE
❑ Yes g No ❑ NA ❑ NE
❑ Yes o No ❑ NA ❑ NE
❑ Yes
LoNo
❑ NA
❑ NE
❑ Yes
*No
❑ NA
❑ NE
❑ Yes
LeNo
❑ NA
❑ NE
Additional Comments and/or Drawings i P
x;
Page 3 of 3 12128104

Facility Number: gZ— / 9(d Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
t a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
❑ Yes [)j No ❑ NA ❑INE
i
❑ Yes 91 No ❑ NA ❑ NE
Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): 9
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 06 No ❑ NA ❑ NE
(ie/ large trees, severe er6sion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes P3 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 91 No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes [A 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 VNo ❑ NA ❑ NE
maintenance or improvement?
Waste Aaolication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ® No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes T No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) ►a.�u also C�f�� r�vrni.y_�/s�^sit �� �nr.✓.
/ c _'DNS
l 13. Soil type(s) No A
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
XNo
❑ 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
JA No
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
P No
❑ NA ❑ NE
Comments.(refer to question #): Explain any YES answers and/or any recommendations or any othcr�comments. ,
Use drawmgs'of facility to better explain situations. (use.addittonai pages as necessary) F yr
Reviewer/Inspector Name vGhS
Phone:
Reviewer/Inspector Signature:
Date: G—Z7—,Z62�
Page 2 of 12128104 Continued

8.2
Type of Visit 40 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ denied Access
Date of visit: 3 ' 3a•Of Arrival Time: /O;/D Departure Time: County: �nsv., Region: 1c00
Farm Name: 4Z;1L'gt as w•1ina _ Fa-c.y TO A- tt '7 Owner Email:
Owner Name: Li/. ___ </•�soa Phone: 91t7- s9y` �l�li
Mailing Address: -233 5Acee 7e
Physical Address:
Facility Contact: 40�q �/;..., �' Title:
Onsite Representative: &" N ���/,(, ^ !.� �_' A -,a
Certified Operator: 6✓.A
Back-up Operator:
Location of Farm:
Swine
Phone No:
Integrator: .S&c "/..s!
Operator Certification Number: 7 C o 2 3
Back-up Certification Number:
Latitude: = o = =" Longitude: = ° = = u
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -La et
❑ Wean to Finish
❑ Wean to Feeder
Feeder to Finish
�2 62 p
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Dry Poultry
❑ Layers
ElNon-Layers
El Pullets
ElTurkeys
❑ Turke Pou Its
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure El Application Field El Other
a. Was the conveyance man-made?
Cattle
Design Current .
Capacity Population
El
Dairy Cow
El
Dairy Calf
❑
DairyHeife3
El
Dry Cow
El
Non-Dairy
El
Beef Stocker
El
Beef Feeder
El
Beef Brood Cowl
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 3'1�o ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
ER No
❑ NA
❑ NE
❑ Yes
EiNo
❑ NA
❑ NE
12128104 Continued

Facility Number: 8.,2 Date of Inspection p-of
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
["Io
❑ 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?: !10
Designed Freeboard (in): -
Observed Freeboard (in): .2bo
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[1lo
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
allo
❑ NA
❑ NE
through a waste management or closure plan?
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
O 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
9-11 o
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
2*No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
ErNO
❑ 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
SO 3dt 13of fY !ate
12. Crop type(s) S / �rrorh . 8[%orscc . —'orw. 44e&
13. Soil type(s) ,21A
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
PNO
❑ 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 acre determination;❑
Yes
❑ No
❑ NA 2lqE
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA 2NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
9-No
❑ NA ❑ NE
Q v� t w�p► �es.°1 �c� 7 P�B�y�+rK = f 'f _-2 if
Reviewer/Inspector Name ate;/[ M. Phone:
Reviewer/Inspector Signature: Date: 3- 3v-o5-
17"R/All

Facility Number: gj,2 —II& Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 93"No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes R<o ❑ NA ❑ NE
the appropirate box. E_1yW ❑ Ch lists ❑ 135�OK ❑ ❑ OoOr ,,��`
21. Does record keeping need improvement? If yes, check the45 riate box below. Ld'Yes El No ❑ NA ❑ NE
El Vfastekpplieetien ❑ - /o� 7,6 El waste ❑ Su t*nalysis ❑ ors ❑
❑ ❑&teskiug ❑ Gsop-Yield ❑ ❑-Monthly and 1 " Rain 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?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
3 I. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes
3No
❑ NA
❑ NE
❑ Yes
allo
❑ NA
❑ NE
❑ Yes
ErNo
❑ NA
❑ NE
❑Yes
ONo
❑NA
❑NE
❑ Yes
[3'1 To
❑ NA
❑ NE
❑ Yes
D<o
❑ NA
❑ NE
❑ Yes 2No ❑ NA ❑ NE
❑ Yes [ o ❑ NA ❑ NE
❑ Yes [3io ❑ NA ❑ NE
❑ Yes 2No ❑ NA ❑ NE
❑ Yes
2No
❑ NA
❑ NE
El Yes
2( o
❑NA
El NE
Addliional Comments andtor Drawin
I �11 PI�,� •I f' o T ,/
[ �'l r a/ b'" .rroa�� L/nnI / � /[ ar„ �V �lt�e�^•�,�.r y!
r / Gi•n Aeo'kti, L�rwC�rlT if 6fpJ(s�
12128104

of Visit ('Compfonce Inspection O Operation Review O Lagoon Evaluation
for Visit 041outine O Complaint O Follow up Q Emergency Notification O Other ❑ Denied Access
Facility Number a Date of Visit: Tune: Ov
Q Not O erational Q Below Threshold
Eff'Permitted Certified E3 Conditionally Certified 0 Registered Date Last Operated or Above Threshold: .._ ._..............
Farm Name: W r ��i u ►►'t W Sarrr Coup
Owner Name: I►J i �iuw� W �,Spy� Phone No: S9µ - lI �7
........ .-.... ........ ..._ _ --- . W.........
��. .--....--- ..........----_..... _..... �_............
Facility Contact: ..... W i I.;[�», L"'.S°L' ........Title: ........ . ...... Phone No: _..------ .....
-Do ��...� W; I y
Onsite Representative:...... N - ... _ ��_� k/'�� [�gvt __ _ Integrator: nGw• tu--. �1a+�
Certified Operator..W `r!�?! 1�.4w1 . (/!?! ot^,,.............._... Operator Certification Number: .,........
_...
Location of Farm:
wine ❑ Poultry ❑ Cattle ❑ Horse Latitude • 4 44 Longitude ' 6 1.9
I3esrgp: Current Design ;Cnr�ent`
Swine.:_ . Caaacifv Povi Eahon Toiiitry ,-Cafrad" ;Povtdatian :C
W�2 to Feeder
B'Feeder to Finish
9 1J
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Number )f:I.agaOaS
Dischanges , Stream Impacts
l . Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min'?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
Design _ '-: Current
-ci Po-uiat,an
Ago '51
❑ Yes i <O
❑ Yes ❑ No
❑ Yes ❑ No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure l Structure 2 Structure 3 Structure 4 Structure 5
[:]Yes ❑ No
❑ Yes l<o
❑ Yes 21 o
❑ Yes lt—o
Structure 6
Idendfier:................................... -- -.. .._� w_ .._.__,_....
Freeboard (inches): 3-
12/12103
Continued

Facility Number: — 1 Date of Inspection I o
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes ZNo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑ Yes two
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? ❑ Yes ❑INN
8. Does any part of the waste management system other than waste structures require maintenancelimprovement? ❑ Yes RNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes Go
elevation markings?
Waste Application ,�,�
10. Are there any buffers that need maintenance/improvement? ❑ Yes L9 rlo
11. Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes B'Ao
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12_ Crop type 'Srr..,,A&, c*VWjj &-,;
13. Do the receiving crops differ witAose designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes ff Ro
14. a) Does the facility lack adequate acreage for land application? ❑ Yes RNo
b) Does the facility need a wettable acre determination? ❑ Yes Mfio
c) This facility is pended for a wettable acre determination? ❑ Yes [(No
15. Does the receiving crop need improvement? ❑ Yes G31No
16. Is there a lack of adequate waste application equipment? ❑ Yes [�No
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge attor below ❑ Yes ETNo
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes EfNo
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, El Yes [�No
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional ❑ Yes EfNo
Air Quality representative immediately.
Reviewer/Inspector Named
Reviewer/Inspector Signature- _c.�1 Date:
12112103 ✓ Continued

Facility Number: Date of Inspection ! 0
Reauired Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
["No
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
[!(No
23. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
ErNo
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
[(No
25. Did the facility fail to have a actively certified operator in charge?
❑ Yes
ErNo
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
Yes
dNo
(ie/ discharge, freeboard problems, over application)
❑
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
G(No
28. Does facility require a follow-up visit by same agency?
❑ Yes
MANO
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
G No
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35) [Yes ❑ No
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes J�No
32. Did the facility fail to install and maintain a rain gauge? ❑ Yes [jfNo
33. Did the facility fail to conduct an annual sludge survey? [►Yes ❑ No
34. Did the facility fail to calibrate waste application equipment? [(Yes ❑ No
35. Does record keeping for NPDES required fotans need improvement? If yes, check the appropriate box below. ❑ Yes 9?fgo
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After 1" Rain
12112103

Facility Number. RJ-- -_Lq (a
. Division of Environmental Management
Animal Feedlot Operations Site Visitation Record
Time: 101'a
General Information;
Farm Name: Ib PA I County: a,w,
Owner Name:._ W,'I i0-'js o _,Phone No: C i 0,52V o Z i 9
On Site Representative: Integrator._
Matf'ng Address: ,233 M i a 2&t( S+-
- 1Jg j� C2 ��� r l C- Z83(a( -..
Physical Address/Location: S R q b 4 o 6-tug— ff�* 701 -0— , § / +: a Ye
Latitude: 35/-r 1 33 Longitude: -79
QlDeration-Description; (based on design characteristic)
Type djE3SRR> No. of Animals . Type of Pou&ry No. of Animals Type of Ca uk No. of Animals
a sow o Layer o Dairy
o Nas=y O Non -Layer O Beef
a Feeder
OtherType of Livestock Number of Animals: 2�&-t `t O
Ntimber of Lagoons:— _ _ L _ (include in the Drawings and Observations the freeboard of each lagoon)
Facility Inspection:
Lagoon
Is lagoon(s) freeboard less than 1-foot + 25 year 24 hour storm storage?: Yes ❑
Is seepage observed from the lagoon?:
Is erosion observed?:
Is any discharge observed?
Q Man-made ❑ Not Man-made
Cover Crop
Does the facility need more acreage for spraying?:
Does the cover crop need improvement?:
( list the traps which need hVn vemertt)
Crop type: W.,� i.a r,ti Acreage: r
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 - Jimum y 174M
Yes Cl
Yes ❑
Yes ❑
Yea Q
Yes ❑
s'■
No ❑
NoM
Yes D
N
Yes D '-,Now+
Yes 0
NQA5�
Yes C7
Nobr

-' Maintenance
Does the facility maintenance need improvement? Yes ❑ NoAYC
Is there evidence of past discharge from any part of the operation? Yes 0 NQW
Does record keeping need improvement? Yes ❑ No Q
Did the facility fail to have a copy of the Animal Waste Management Plan on site? Yes ❑ No ❑
Explain any Yes answers- 1� e a� sire_ lr�••-�_ - �'
Signattuz: Date: _ p`�z 3z
cc Faany Assessment Unit Use Attachments jfNeeded
Drawings or -Observations:
OczrL — C1
1.��Zn•.w.�•-7�.4•�^'-
AOi - jimuary 17JM

Site Requires Immediate Attention:
Facility No.
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
Farm Name/Owner: 7 17 M 7
DATE: , 1995
Time:
Wi1kOLM Wttibon
Mailing Address: a+3 3 zze 11 S� ►'l e G +-ove-. nc, a 8 3b 1p
County:
Integrator. _-r D rL 4 ws _ _ Phone: v - S —OA
On Site Representative: Wi ; e-1U; sn-. _ Phone: 510 - — 14 7
Physical Address/Location: 5.RAEv O1 t- w
Type of Operation: Swine F's-, Poultry Cattle
Design Capacity: �344o i 1. Fed 1=,K Number of Animals on Site: -&. ,e —
DEM Certification Number: ACE DEM Certification Number. ACNEW____r�,�
Latitude:! 3l ' _, .S " Longitude: im 29 �_' 7
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches) Yes or No Actual Freeboard: —!—Ft. G inches
Was any seepage observed from the 1 n(s)? Yes or No Was any erosion observed? Yes or No
is adequate land avai 1 able for spray? Ye "No Is the cover crop adequate . Yes r No
Crop(s) being utilized:
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwelling? Ycdor No
lOQ Feet from Wells? Yes r No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes a No
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes a oNo
Is animal waste discharged into waters of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes No If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? Yes or No
Additional Comments:
e n5k[-r-
Inspector Name Signature
cc: Facility Assessment Unit Use Attachments if Needed.

REGISTRATION FOF.M FOR ANIMAL FEEDLOT OPERATIONS
Department of Environment, Health and Natural Resources
Division of Environmental Manacement
Water Quality Section
rf the animal waste management s_ stem fer vcur ifeedlot operation is
desicned to serve more than cr equal to 100 head of cattle, 75
horses, 250 swine, 1,000 sheep, e_ 30,000 birds that are served by
a Z;cuid ;paste system, then th;s crm must be ;il1ed our- and mailed
by [)member 31, 1493 oursuant to 1 5A NCAC 2H.021, 7 (c) in order to be
deemed permitted by DEM. Please print clearly.
c a r .t Name LJ F L G Q_... ;r-v?
mailing Addres ..
County:
Owner (s) Name:
Manager (s) Name:
Lessee Name:
Farm Location (Be s s pr'i is as possible: road names, direction,
mi�e.iost, etc. ) ; i-
r
LaeitudelLongitude if known %Z g 2l6 D
Design capacity of animal waste ma age ent ys em umber d type
OF confined animal (s) } 1944n ,.
Averace animal population an rAne fi umb2r and type of animal (s)
Year Production Began: ASCS iracr. No.:
':ype of waste Manacement System Used:
Acres Available for Land Application of Waste:
Owner (s) Signature (s) :
DATE: