820206_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental Quai

M
ik
Type of Visit: Q Compliance Inspection O Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit: t�utine O Complaint 0 Follow-up O Referral 0 Emergency O Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: County: J ✓7 V " 1 Region:
Farm Name: itN+E Owner Email:
Owner Name: �0A,L� Phone:
Mailing Address:
Physical Address:
Facility Contact: CutA., t-C Title: Phone:
Onsite Representative: 1( _ _ Integrator: h��_
Certified Operator: rla, S_Gtr, (1c� _ Certification NumberRE Z 7 Z
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Design Current
' 5wirie Capacity Pop.
Design Currenrt
Wet Poultry Capacity Pop.
Design Current
Cattle Capacity Pop.
Wean to Finish
Layer
Dairy Cow
Wean to Feeder
Non -Layer
Dairy Calf
Feeder to Finish
Da' Heifer
Farrow to Wean
Farrow to Feeder
Dry Cow
Non -Dairy
D , foul Ca aci P,o
Farrow to Finish
-
La ers
Beef Stocker
Gilts LL
lNon-Layers
Beef Feeder
Beef Brood Cow
FAI
Boars I
Pullets
Other
....
Turkeys
Turkey Poults
Other I
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 To ❑ NA ❑ NE
❑ Yes
❑ No
[ '9A
❑ NE
[—]Yes
[:]No
'"� " -
❑ NE
[:]Yes [-]No
❑ Yes Q o
❑ Yes Ej"No
E!rNA
❑ NE
❑ NA
❑ NE
❑NA
❑NE
Page I of 3 21412015 Continued

Facili Number: jDate of Inspection -
Waste Collection & Treatment
4. Is ttorage capacity (structural plus storm. storage plus heavy rainfall) less than adequate? ❑ Yes M-Ne"❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No l 3'<A ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): -2,
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
[T 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
QNo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
❑Tlo
❑ 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
E�rNo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
�To
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes Ea o ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): 6, u w,GG{,& _4Z d
13. Soil Type(s): Alt
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
El"No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
EfNo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
R No
❑ NA
❑ NE
18. Is there a tack of properly operating waste application equipment?
❑ Yes
Q No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
eNo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [2'*No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and l ° Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes dt
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes Vll�o
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑NA ❑NE
Page 2 of 3 21412015 Continued

Facili Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes 0 o ❑ 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?
27. Did the facility fait to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
Reviewer/Inspector Name:
Reviewer/inspector Signature:
Page 3 of 3
lit
❑ Yes
2<o
❑ NA
❑ NE
❑ Yes
[�'�io
❑ NA
❑ NE
❑ Yes
ETNo
❑ NA
❑ NE
❑ Yes
LJ '"o
❑ NA
❑ NE
❑ Yes EfNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes [ _<0
❑ Yes �To
❑ Yes El"No
4,3
C�q q[ U - 3q-t95(
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Phone: II`Q
Date: (!
21412015

tom.
Number 2 � � Division of So 1 and Water Conserve#i, _
iail .ty � - ® -. � on
s.:®.Other Agency' _
Type of Visit: Co/mpliance Inspection Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 40Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: P, f6a County: Region:
Farm Name: LIZU414 L Owner Email:
Owner Name: G - ram{ - Phone:
Mailing Address:
Physical Address:
Facility Contact: 0.6c * (3c, t Title:
Onsite Representative: I
Certified Operator:
Back-up Operator:
Location of Farm: ' Latitude:
Phone:
Integrator: .�
Certification Number:
Certification Number:
Longitude:
Design. Current kDesigei Current Design Current
Swine Capacity Pop. Wet Poultry.C.apactty .Pop`; Cattle Capacity Pop.
Wean to Finish Layer Dairy Cow
Wean to Feeder Non -La er I Dairy Calf
Feeder to Finish p v . Dairy Heifer
Farrow to WeanDesi�gnCurrent, D Cow
Farrow to Feeder on- airy
Farrow to Finish La ers =� Beef Stocker
Gilts Non -La ers Beef Feeder
Boars Pullets Beef Brood Cow
Turkeys
Other Turkey Poults
Other Other
Discharges -and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes Eff<o ❑ NA ❑ N E
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made'? ❑ Yes ❑ No ❑'�A ❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWR) NA
❑ Yes
❑ No
[ jj
❑ 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
E7rN A
❑ NE
2. Is there evidence of a past discharge from any part of the operation'?
❑ Yes
�C o
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
En"No
❑ NA
❑ NE
of the State other than from a discharge?
Page l of 3 21412015 Confinued

Facility Number: jDate of inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate'? ❑ Yes ❑ Pier❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No f�TNA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): V
5. Are there any immediate thr ats to the integrity of any of the structures observed? ❑ Yes B oo ❑ 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
Rio
❑ 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
E310
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
LJ aoo
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
M No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[2 1f4o
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? if yes, check the appropriate box below.
❑ Yes
dNo
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application
Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s): a
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
FzP'To
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
El No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
[2"N' o
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
RfNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[D"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_
❑ W UP ❑ Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
[r]'TJo
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall [:]Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
dNo
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
dNo
❑ NA
❑ NE
Page 2 of 3 21412015 Continued

Facili Nu ber: Date of Inspection:
24. did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes LD'No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [E o
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 E�J No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [E] No
❑NA ❑NE
❑ NA ❑ NE
D NA ❑ NE
❑NA ❑NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
�o
❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
<o
❑ 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
eNNo
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
Wo
❑ NA
❑ NE
33. Did the Reviewer/lnspector fail to discuss review/inspection with an on -site representative?
❑ Yes
En No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
[2,'N-o
❑ NA
❑ NE
Comments (refer to question #): Explain any. YES;answers and/or any additional recommendations ar any other gornmem
w
Use drawines of facility to better'eanlain sitn>3tions lose' additional napes as: necessarvl
_ . `.
_
C4 Flo-
Reviewer/Inspector Name: �l L\ Phone: LOS `
Reviewer/Inspector Signature: Date: j (2
Page 3 of 3 21412015

Type of Visit: QfC�,ommpliance Inspection U Operation Review U Structure Evaluation U 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: !�`(�J Departure Time: County: Region: '-
�
Farm Name: G%t�W f-aen Owner Email:
Owner Name: av44 t" Phone:
Mailing Address:
Physical Address:
Facility Contact: Cccr ri ` ,i+W Title: Phone:
Onsite Representative: Integrator:
Certified Operator: r I. c a Certification Number: / [ [ J z-
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current Design Current
Swine Capacity Pop. Wet Poultry Capacity P.op.
Design Current
Cattle 11Capacity Pop.
Wean to Finish
La er
Dairy Cow
Wean to Feeder
Non -La er
Dairy Calf
Feeder to Finish
Farrow to Wean
Farrow to Feeder
li(O
Design'. Current
D . P,oul Ca aci P.o .
Dairy Heifer
Dry Cow
Non -Dairy
Farrow to Finish
Lavers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
jPullets Beef Brood Cow
Turkeys
Turkey Pouets
Other
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)
❑ Yes ❑O;e— ❑ NA ❑ NE
❑ Yes
❑ No
[�lA
❑ NE
❑ Yes
❑ No
<A
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR) ❑ Yes ❑ No NA ❑ NE
2. is there evidence of a past discharge from any part of the operation? [::]Yes [?-No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters [::]Yes PD-No ❑ NA ❑ NE
of the State other than from a discharge?
Page l of 3 21412014 Continued

1,
acffi Number: - O Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Identifier:
Spillway?:
Designed Freeboard (in):
R3-be— ❑ NA ❑ NE
[-]No DIIA' ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Observed Freeboard (in): 131
5. Are there any immediate threats to the integrity of any of the structures observed? ❑Yes t-0^0 ❑ NA [] NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes Q'K'0 ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes L2"No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes [2"'N'o
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures
require [-]Yes 2<o
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes [21<o
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes �o
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground
❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift
❑ Application Outside of Approved Area
12. Crop Type(s): ri3 G ( AR
13. Soil Type(s): _ AL - k
14. Do the receiving crops differ from those designated in the CAWMP? [] Yes �o ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [R'No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes C5-No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes [3h10 ❑ NA ❑ NE
❑ Yes 2�No ❑ NA ❑ NE
Re aired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
[:]Yes
0No
❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
[:]Yes
2 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
[20fFo
❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall [:]Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
Sludge Survey
21 Did the facility fail to install and maintain a rain gauge?
❑ Yes
[�FNo
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes �No ❑ NA ❑ NE
Page 2 of 3 21412014 Continued

F'acflitty umber: Date of Ins ection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes Elio ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes �o ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey [:]Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes O'No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes RNo ❑ 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 12No ❑ NA ❑ NE
❑ Yes EfNo ❑ NA ❑ NE
❑ Yes � No ❑ NA ❑ NE
❑ Yes [�fNo ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes [' No
❑ NA ❑ NE
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative?
[:]Yes E2No
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes [J'No
❑ NA ❑ NE
Comments (refer to question # ): Explain any YES answers and/or any additional recommendations or any other comments** '
Use drawinp-s of facility to better explain situations (use additional owes as necessarv).
`.
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 35:332
Date:
214,12014

91 )Nt.s 19
Type of Visit: a<ompliance Inspection U Operation Review Q 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: e r Departure Time: unty: _ Region:
Farm Name: L aw,4 �.C-C Finn Owner Email:
Owner Name: C WS Phone:
Mailing Address:
Physical Address:
n c
Facility Contact: _ C� n t C _ Title: Phone:
Onsite Representative: Integrator: P ..Pi
Certified Operator: ¢y Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design
Current
Design Current
Swine CPop.
napaifty
Wet Poultry
Capacity
Pop.
Cattle
Capacity Pop.
Wean to Finish
La er
DairyCow
Wean to Feeder
Nan -La er
DairyCalf
Feeder to Finish
Da' Heifer
Farrow to Wean
Design
Current
D Cow
Farrow to Feeder
Dr P,oul
Ca aci
Pao
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Lavers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
lr
Other
TurkeyPoults
Other
Other
Discharges and Stream Impacts
I . Is any discharge observed from any part of the operation? ❑ Yes o ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No 0 NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR) ❑ Yes ❑ No E114A ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR )
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
[-]Yes [:]No
❑ Yes EY to
[:]Yes [2,No
❑'NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
Page 1 of 3 21412014 Continued

[Facility Number:' - Date of inspection:
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure 1 Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 1
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?
qo ❑ NA [] NE
❑ No NJ'' A ❑ NE
Structure 5 Structure 6
[:]Yes U3Ao ❑ NA ❑ NE
❑ Yes [ ' o ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environment rent, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes [] No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes r No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
dNo
❑ NA
❑ NE
maintenance or improvement?
11. is there evidence of incorrect land application? If yes, check the appropriate box below.
[:]Yes
No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals
(Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ kom those designated in the CAWMP?
❑ Yes
[].1!Go
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[9Io
❑ NA
❑ NE
16_ Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
E34o
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
C!rNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
Ego<
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
E ilVo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
EX
❑ NA
❑ NE
the appropriate box.
❑VSTUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑�lvo 0 NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers 0 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 [� ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes J�No ❑ NA ❑ NE
Page 2 of 3 21412014 Continued

aati +!Number: A Z - Date of Inspection:
24_ Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes 6.P'15_ ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [j l�e1'_❑ 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 Q'v ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [D>W- ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
0-14
❑ 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
UPCO-1-1❑ 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
/
[-KO
❑ 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
ETNo
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑Yes
No
❑ NA
❑ NE .
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
R;o
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
ffN o
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations oriany other comment_'s."
Use drawings of. facility to better explain situations (use additional pages as necessary)."` ,,
o4t4 Iq
�Uru
Reviewer/inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
k3
Date:
6 -5
21412011

tkS IsAAV-14
(Type of Visit: 10 Com fiance Inspection O Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit• outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: V,�Aval Time Departure Time: County: ii Region:
Farm Name: ` thA Owner Email:
Owner Name: VIA, Phone:
Mailing Address:
Physical Address:
Facility Contact: CyV, 3,::r✓` Title: Phone:
Onsite Representative: # Integrator:
Certified Operator: '.� �`1 �C�[ '"� l _ Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design Current
Design
Cprrent
Design Current
Swine
Capacity Pop.
Wet Poultry
Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
La er
Dairy Cow
Wean to Feeder
Non -La er
Dairy Calf
Feeder to Finish
t/
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Design
D , P.o_ul Ca act
P,o
Dry Cow
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
Turkey Poults.
Other
Other
Discharees and Stream Imnacts
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 [4—J,iQo A ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) ❑ Yes [] No CTKA ❑ 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 iA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes O "' [; A ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters [-]Yes � ❑ NA ❑ NE
of the State other than from a discharge?
Page l of 3 21417011 Continued

InA fill
Facility Number: - jDate of Ins ection: - ai
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes EJ-Nb ❑ 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): 6�
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes L7 11 ❑ 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 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 ©.W ❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes [;>a ❑ 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 [r�<o❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes [!TNo ❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
[:]Yes !dam'`"' ❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[�
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
L ' o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
®.Ko—
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[5No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[T N
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
EB<o
❑ 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
O 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
o
No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
Q
❑ NA
❑ NE
Page 2 of 3 21412011 Continued

a 17 _
�acili Number: Date of Inspection:14
24. Did the facility fail to calibrate waste application equipment as required by the permit? f ❑ Yes [g No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes � ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes ER -No
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [—]Yes Q-3Q0 ❑ NA ❑ NE
Other Issues
2& Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
E:fNo
❑ 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
[5rhfo
❑ 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
F7144o
❑ 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.
0 Yes
[3-No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[Q-I] o
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
❑ No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
[:]No
❑ NA
❑ NE
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3

ivision of Water Quality � �-�
Facility Number - ® ® Division of Soil and Water Conservation
® Other Agency �! !3
Type of Visit: Oleompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: 3D" Arrival Time: 8' ` Ot7 Departure Time: County: spa•-- Region: Z5�!D
'OF
FarmName: �! �r- ��t�w _ Owner Email: `-
Owner Name: �/ltyr' �arn; Gp,yG Phone:
Mailing Address:
Physical Address:
Facility Contact: [�iC I� Title: Phone:
Onsite Representative: S' - - Integrator•
Certified Operator: �3.r�._ Certification Number:�3�
Back-up Operator:
Certification Number:
Location of Farm: Latitude: Longitude:
Design Current
4l)esign Current
Design Current
Swine 1111 1 Capacity Pop.
Wet Poultry
Capacity Pop.
Cattle Capacity Pap.
Wean to Finish
La er
Dairy Cow
Wean to Feeder
Non -La er
Dairy Calf
Feeder to Finish
O
Da' Heifer
Farrow to Wean
Design Current
Dry Cow
Farrow to Feeder
D . P■oul
Ca aci
Pop.
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turke s
Other
Turkey Poults
Other
Other
Discharses 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 Wo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
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 J4 No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes JR No ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

Facility Number: - 6 Date of Inspection: 5--- So-,OADC
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes allo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): j
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 [0 No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes Q 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 Z No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [R No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes J�g_No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):/'yl1i�
13. Soil Type(s): t�—Ld;
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes ZI 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
RMuired 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 ❑ Stacking ❑ 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 ® No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 21 No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facili Number: f- -6 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 R No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey [] Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes .No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No
Other issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit'? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes g No ❑ NA ❑ NE
❑ Yes ®,No ❑ NA ❑ NE
[]Yes [SNo ❑ NA ❑ NE
❑ Yes [@ No ❑ NA ❑ NE
❑ Yes ® No
❑ Yes No
❑ Yes C3-No
[DNA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other coQuments
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewcr/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: �O�j-33D'Z3
Date: 3 o j Jj� K
21412011

k,
N b,D iJ U-P s o fa-Tc- .19
4.
Type of Visit: (DrComphance inspection O Operation Review 0 Structure Evaluation O Technical Assistance
Reason for Visit: 016utine 0 Complaint 0 Follow-up 0 Referral 0 Emereency 0 Other 0 Denied Access
Date of Visit: Arrival Time: 1 3r,, p0 Departure Time: QQ County:Region: Egg?
Farm Name: Laurel 0"oew — Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: ' Title: eL 11' /
Onsite Representative: Integrator:
Phone:
,
Certified Operator: S'�,�` Certification Number: 7k:273,-
Back-up Operator:
Certification Number:
Location of Farm: Latitude: Longitude:
Design Current
Swine Capacity "Pop.
Design Current
Wet-Poult Capacity Pop,
Layer
Design Current
Galtle Capacity Pap.
Dai Cow
Wean to Finish
Wean to Feeder
Feeder to Finish jJ
Farrow to Wean
Farrow to Feeder
Farrow to Finish
/
I INon-Layer
IDai
Calf
D , P,oul Ca aci P,o
JLayers
Dai Heifer
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Beef Brood Cow
Boars
Other
Pullets
Turkeys
Turkey Poults
Other
Other
Discharges and Stream Imycts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
[—]Yes ® No ❑ NA ❑ NE
[:]Yes [—]No
[:]Yes [:]No
❑ Yes [:]No
❑ Yes [ No
[:]Yes No
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3 21412011 Continued

Facili Number: - P-0 to Date of inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
�No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure
6
Identifier:
Spillway?:
Designed Freeboard (in): i 9
Observed Freeboard (in): 151
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
0 No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify 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
0 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
[DNA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
'o No
0 NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [D 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): �rA AW/� = � ��v _�L Si�7af� ly�"p:. � ��Y'�1Kit__ 11941�rr,5 ��
13. Soil Type(s): _d
14. Do the receiving crops differ from those designated in the CAWMP? [] Yes Q 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
Q No
❑ NA
❑ NE
Required Records & Documents
l9. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
® No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
[] Yes
® No
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ®- No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 " Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? [:]Yes ® No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ® No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑NA ❑NE
Page 2 of 3 21412011 Continued

Facility Number: - Date of inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? [a Yes ❑ No ❑ NA ❑ NE
' 25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [Z 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
rV1 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?
❑ 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
[DNA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
® No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
No
❑ NA
❑ NE
Comments (refer to question-f: Explain any -YES_answers and/or any additional recommendations`or any other coiaments
Use drawings of facility to better explain situations (case additional pages as necessary),
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: }le— 3�33-33a o
Date:
21412011

Type of Visit: ompliance 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: t v ice_ ri J Arrival Time: / D Departure Time: ; D County: Region: 21)
Or
Farm Name: 2—u /- % A& Owner Email:
Owner Name: �QrisT; rt� ('� _�/�G, Phone:
Mailing Address:
Physical Address:
Facility Contact: /`.` Title: G�� Phone:
Onsite Representative: S Integrator: �iY-spa
Certified Operator: �� ®-�.�^ Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design Current Design Current
Design Current
SwineJill CapacityPoultry Capaciiy Pop. Cattle
Capacity Pop.
Finish La er Dai Cow
Feeder
Non -La er
Dai Calf
o Finish
Sri
Dai Heifer
UFarrowo Wean
Design }Cu`r ent, :
, k
D . Po"ult Ca aciPo
D Cow
o Feeder
Non -Dairy
o Finish
Beef Stocker
La ers
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other'{
Turkey Poults
Ocher
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made'?
b. Did the discharge reach waters of the State'? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes ® No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
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 [a No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters []Yes ® No ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

= Facility Number: � - O IDate of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
[?�-No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure i Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): Al
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
§kNo
❑ 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
Pq No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[KNo
❑ 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 ❑ Failure to Incorporate
Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside ofApproved Area
12. Crop Type(s): /`l�ilu /dv�-rr5r —� leoI-N. Lk/,ie-/fBf.Frew.
13. Soil Type(s): Z&&y1;11 Q IAa 11
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
Reuuire_d 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
0 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 IS 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 JS No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

[Facility Number: - OG Date of inspection: / --
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes allo
• 25. Is the facility out of compliance with permii conditions related to sludge? If yes, check ❑ Yes B_No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? [:]Yes ® No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [:]Yes No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
0 Yes [Z No ❑ NA ❑ NE
❑ Yes � No ❑ NA ❑ NE
❑ Yes [0 No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes [Z No
❑ Yes ® No
❑ Yes ® No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to: question f : Explain any YES answers and/or any additional recommendations or any other comments � _t.?
Use drawings of facty to=better explain situations (use additional vases as necessary). „
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:a
Date:
21412011

' ivisian of Water Quality
iFacility Number ` 0 DMIS] Q of Soil and Water Conservation
�OIfftk—er-
11 Agency
Type of Visit (9-C—ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit outine O Complaint O Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: ' r�
Arrival Time: . � (� Departure Time: � t fl (� County: 1"""�� Region:
.01
Farm Name: 1-a y�r { L+a-��Pf'�f Owner Email:
Owner Name: G%Ns r"rl' 9 i r'� C� I n �- Phone:
Mailing Address:
Physical Address:
Facility Contact: �� Title: Phone
No:
Onsite Representative: 9ate— Integrator:
Certified Operator:"~ Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = 0 ='
= •, Longitude: = ° = ,
Design
Current
Design Current
Design current
Sv►ine Capacity
Population
Wet Poulte:y Capacity Populatinn
Cattle Capacity Population
❑ Wean to Finish
❑ La er
I
Dairy Cow
❑ Wean to Feeder
❑ Non -Layer
❑ Dairy.Calf
eeder to Finish
t7
❑ Dairy Heifer
❑ Farrow to Wean
pry Poultry
❑ Dry Cow
❑ Farrow to Feeder
❑ La ers
❑ Non -Dairy
❑ Farrow to Finish
11E]
❑ Non-crs
❑ Beef Stocker
❑ Gilts
❑ Pulletsts
❑ Turke s
❑Beef Feeder
❑ Beef Brood Co
Boars
Other
ElTurkey Poults
❑ Other
❑ Other
Number of Structures:
Discharmes & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes JaNO ❑ NA ❑ NE
[--]Yes
[]No
❑ NA
❑ NE
❑ Yes
[--]No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
RNo
❑ NA
❑ NE
❑ Yes
®-No
❑ NA
❑ NE
Page 1 of 3 12128104 Continued

Facility Number: — Date of Inspection 3 a
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes allo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): /
Observed Freeboard (in): y�
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ZNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes RNo ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? [--]Yes K[No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes P.No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
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 13 No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes allo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s) ¢f�,-rr/ tl i
14. Do the receiving crops di&r from those designated in the CAWMP?
❑ Yes
U.No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[ IVo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
9 No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
RNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
ZNO
❑ NA
❑ NE
IReviewer/Inspector Name �►J d.a ,- „ �� Phone: g-/p l 55_33
Reviewer/inspector Signature: Date:
Page 2 of 3

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 CA WMP readily available? If yes, check ❑ Yes [9 No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Desig
n El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes f 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
JO No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
ERNo
❑ 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
® No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
�&No
❑ NA
❑ NE
Other lssues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
J,No
❑ NA
❑ NE
29.
Did the facility fail to property 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
® 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
allo
❑ 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
U4 No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
[X No
❑ NA
❑ NE
Page 3 of 3 12128104

Type of Visit ITompliance Inspection U Operation Review U 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, Departure Time: i D County: Region:
Jr
Farm Name: Laensl Az A c _ 60y�n— Owner Email:
Owner Name: %l 40-tn ' rt CD • it_ C. Phone:
dr
Mailing Address:
Physical Address: l Facility Contact: G,w.. �� _ 61k 10�j _ Title: _ 111r Phone No:
Onsite Representative: _i,a46a _ _ Integrator:
Certified Operator: 1 .0z+_
Back-up Operator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: ❑ n = f = I1 Longitude: ❑ o ❑ I = "
Design Current
Design
Current
Design current
Swine Capacity Population
Wet Poultry Capacity
Population
Cattle Capacity Population
❑ can to Finish
10 Layer
❑ Dairy Cow
❑ Wean to Feeder
IEJ Non -Layer
I
I
❑ Dairy Calf
[� Feeder to Finish bEJ
❑ Dairy Heifer
❑ Farrow to Wean
❑ Farrow to Feeder
El Farrow to Finish
❑ Gilts
❑ Boars
Dry Poultry
❑ Layers
❑ Non -La ers
❑ Pullets
❑ Turkeys
❑ Dry Cow
❑ Non
-Dairy
❑ Beef Stocker
❑Beef Feeder -
❑ Beef Brood Co
Other
❑ Turkey Poults
Number of Structures:
❑ Other ❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
[9 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
[6 No
❑ NA
❑ NE
other than from a discharge?
12128104
Continued

Facility Number: T Date of Inspection
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes. is waste level into the structural freeboard?
Stnicture I Stnicture 2 Structure 3 Stnicturc 4
Identifier:
Spillway?:
Desiened Freeboard (in):
Observed Freeboard [in);
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes ANo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure � Structure 6
❑ Yes I.No ❑ NA ❑ NE
❑ Yes iR 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 M No ❑ NA ❑ NE
S. Do any of the stuctures lack adequate markers as required by the permit? ❑ yes
X 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
maintem ee./improvemenV
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 CropWindow❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) nr�
13. Soil type(s) r
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
CgNo
❑ 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
KNo
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes
&dNo
❑ NA ❑ NE
,Comments (refer to question ft Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/Inspector Name Phone: }/O �133 33aD
Reviewer/Impector Signature: Date: kk�I-W i3 O
1207 04 Continued

FV
Facility Number: — pate of Inspection w 7
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ;�SNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes KNo ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [JcNo ❑ 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
Eallo
❑ 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
1SNo
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
® No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
® No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
�4 No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
® No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
[] Yes
E8 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
[X No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
0 No
❑ NA
❑ NE
General Permit? (id discharge, freeboard problems, over application)
32. Did Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
CgNo
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
KNo
❑ NA
❑ NE
Additional Comments and/or Drawings:
12128104

Division of Water Quality
Facility Number 0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit
omplia a Inspection
0 Operation Review 0 Structure Evaluation
0 Technical Assistance
Reason for Visit
outine 0 Complaint
0 Follow up 0 Referral 0 Emergency
0 Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: � O County• Region:
Farm Name: _ l �(i icp� 'd�'" Owner Email:
Owner Name: C 6a ews t Phone:
Mailing Address:
Physical Address:
Facility Contact: �i�L�-s/ 31 f - Title: Phone No:
Onsite Representative: Integrator:.anc�
Certified Operator: 4S�t _ Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = o = f = 4{ Longitude: 0 0 = 1 = "
Swine
❑ Wean to Finish
❑ Wean to Feeder
Feeder to FinishbUZ)
1,3-26-5
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Design i Current Design Current
Capacity: Population Wet Poultry Capacity Population
❑ La er
❑ Non -La et
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
ElTurkey Pouits
❑ Other
Discharges & Stream impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Curr6n ',`
Cattle Capacity P,..opulation<
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocket
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures:
C.
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes [? No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
E4 No
❑ NA
❑ NE
❑ Yes
®,No
❑ NA
❑ NE
12128104 Continued

Facility Number: —
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
BNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): / 2t
Observed Freeboard (in): Y6
5. Are there any immediate threats to the integrity of any of the structures observed'?
❑ Yes
K 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
[SNo ❑ NA ❑ N£
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
Uff No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit'?
❑ Yes
9No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
RNO ❑ 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
&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) t41�yV; )l z.-- L_ 2021
14. Do the receiving crops differ from those designated in the CAWMP?
❑Yes
XNo
El NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑Yes
RNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
KNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
L&No
❑ NA
❑ NE
Comments (refer to question'#): Explain any YES answers and/or any recommendations orany other comments. ,
Use drawings of facility to better explain situations. (use additional pages as necessary)• "mot x�
i
T
Reviewer/inspector Larne
!-'^ � ': „
Phone: C h) ;d/3 ,330Q
ReviewerAnspector Signature:
Date:
Page 2 of 3 12128104 Continued

t
Facility Number: Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available:? ❑ Yes 0 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 El Maps El 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 V Rain inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes �5No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [3 No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[9 No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
RNo
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
19 No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
[A No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAW MP?
❑ Yes
No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
CANo
❑ 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
R 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
CKNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
5kNo
❑ NA
❑ NE
Additional Corn menanrlloD�awings:
Page 3 of 3 12128104

Type of Visit QMompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: 3 ``� Arrival Time: 1 i ID I Departure Time: I i 3 County • Region: t
Farm Name: �a l j i P_ / La-k r, ra rw%-, Owner Email:
Owner Name: G- Y11.5 ram i $72� e o. Phone:
Mailing Address:
Physical Address: /1 f
Facility Contact: [ �� STrf ��%hd Title: Phone No:
Onsite Representative: Integrator: ��/�
IV
Certified Operator: Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: E__1 o = I = " Longitude: 0 ° = I = "
Swine
❑ Wean to Finish
ceder
Design Current
Capacity Population
Design Current
Wet Poultry @apacity Population
❑ Layer
❑ Non -Layer
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ DairyCalf
Feeder to Finish
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2_ Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes �ELNo ❑ NA ❑ NE
❑Yes
El No
El NA
El NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
2!�No
❑ NA
❑ NE
❑ Yes
DtNo
❑ NA
❑ NE
12128104 Continued

r Facility Number: — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ZI No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [�INo ❑ NA ❑ NE
the appropiate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes p.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 Cade
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
2S 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
99 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
ER No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
CKNo
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[A No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
4No
❑ 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
D4 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
D4 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
E9 No
❑ NA
❑ NE
Comments and/or Drawings:
12128104

Facility Number: (o Date of Inspection
f
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? [I Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3100
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
[9 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
[0 No
❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes
,4 No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
� No
El NA El 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
(4 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
❑ 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 Drifl ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
C,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
[.No
❑ NA
❑ NE
j Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
I Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/lnspectarName Phone: /33 spa
Reviewer/Inspector Signature: Date:

Type of Visit <�rt ompliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit Routine O Complaint Q Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: Arrival Time: t/i oci Departure Time- County:
Farm Name: Owner Email:
Owner Name: �„��ar� �iGl�Lari� Phone:
Mailing Address:
Physical Address: /�??
Facility Contact: C I_ee i Title: Phone No:
Onsite Representative: Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Region:
Location of Farm: Latitude: = o= I 0 0 Longitude: = e 0 i = µ
Design
Current Design C►urrent Design Curren#
Swine Capacity
Popnlation Wet Poultry Capacity Population Cattle Capacity Populatiao
❑ Wean to Finish
I ❑ La er
❑ Dairy Cow
❑ Wean to Feeder
I
111E] Non -Layer
I I ❑ Dairy Calf . I
DI Feeder to Finish P91qo
lr
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultn}. ❑ Dry Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ La ers ❑ Beef Stocker
❑ Farrow to Finish
❑ Gilts
❑ No ❑ ets ers Puliets ❑Beef Feeder
❑ Beef Brood Cowl
❑ Turkeys -
❑ Boars
Other
❑ Turkey Points
❑Other Number ofKStructures:
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
J] No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
XNo
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
,K 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
1KNo
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
0 No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
QNo
❑ NA
❑ NE
other than from a discharge?
Page I 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?
❑ Yes
[9No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
P.No
❑ NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): 4
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
4 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
JKNo
❑ 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 [9No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes KNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes (3 No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ® No ❑ NA ❑ NE
❑ Excessive Ponding ❑ hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[]PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
EtNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
1rV8.Y.es
❑ 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
PR No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
1Z No
❑ NA
❑ NE
Reviewer/inspector Name ✓ o 'y ' Phone:
Reviewer/inspector Signature: Date: wQ'-tea
IW8104 Continued

# Facility Number — 0� Date of Inspection Vo
i Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ,K No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes -allo ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 29 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
CKNo
❑ 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
JS No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
JO No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
®,No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
®.No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes RNo ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
®No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
® No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
®,No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
J4 No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
RNo
❑ NA
❑ NE
12128104

i ® Division of Water Quality
Facility Number a� aD O Division of Soil and Water Conservation F
�.
F O Other Agency,
j Type of Visit 41 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
IReason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: S llj f oS Arrival Time: Departure Time: County: 5-m j2scl Region: F)z'Qh
Farm Name: K.-" �k. a�w.o� F4 rw Owner Email:
Owner Name: kc.++re I S r : �i��o..•oR _ Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: �S�'e�-� S� �`' d �4
Certified Operator: -<.av _S'�' ✓' + LAC l aQ
Back-up Operator:
Location of Farm:
Swine
❑ Wean to Finish
❑ Wean to Feeder
® Feeder to Finish
a qo
.Fqx
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Phone No:
Integrator:_ _p �4 9 t_
Operator Certification Number:
Back-up Certification Number:
Latitude: 0 e 0 ' = Longitude: 0 ° =
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Laver
❑ Non -Layer
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkev Poults
❑ Other
Discharges & Stream Impacts
I _ Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Daia Cow
❑ Dairy Calf
❑ Dairy Heifej
❑ Dry Cow
❑ Non-Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Col
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'? (Ifyes, 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 W No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
[M No
❑ NA
❑ NE
❑ Yes
R] No
❑ NA
❑ NE
12128104 Continued

r VA
Facility Number:
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
® No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 1: Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3 '
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
® No
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
® No
❑ NA
❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat, notify
DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
® No
❑ NA
❑ NE
8.
Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
QV 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
(A No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10.
Are there any required buffers, setbacks, or compliance alternatives that need [I Yes
[ No
El NA El 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 i0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window El Evidence of Wind Drifl El Application Outside of Area
12.
Crop typeo3s) -c A ^-I at X", f.t 7 /0S jC o,�.v . t✓�i e a '� Ca n r a f -4
r art
13.
Soil type(s) A4 , Z__
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
I &
Is there a lack of properly operating waste application equipment? ❑ Yes
W No
❑ NA ❑ NE
Reviewer/Inspector Name phone:
Reviewer/Inspector Signature: Date: 45-
12/2&04 Continued

Facility Number: Date of Inspection /A /
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes [)I No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ® No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ® Yes ❑ No ❑ NA ❑ NE
❑ Waste Application Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
El"Rainfali ❑ Stacking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes lM No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [A No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[A 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
M No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
(9 No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
® No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
M No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
® No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
® No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
® No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
X No
❑ NA
❑ NE
Addtaonal Comnlentslaud/nrDrawings
1' ' 7 C c& rocs a--,—
6 t: -%-
k c-r+ 6 k't
a r ipr o <_ak cLAr t
Ar to�,-I&I
"-aC-"2.
P1aa-b c toc,g►+�
4U �s� •c prercr
12/28104

(Type of Visit 0 Compliance Inspection O Operation Review O Lagoon Evaluation j
Reason for Visit • Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Date of Visit: FT G `0 Tune:
Facility Number
�,, / Q Not O erational C Below Threshold
El#ermitted [3 Certiified 0 Conditionally Certified © Registered Date Last Operated or Above Threshold: --..... _. ».
FarmName: ..... County:.... 12 a.........
» .........».».»..... »....».
Owner Name:.----»..... I �.�L/�». .....Z ! �,�G h 1-..W».. Phone No:
Mailing Address:..». G Z......FGi!_.I MF ....»S................2L,..nr.4t2._.... NL.....»»------
Cc !I
Facility Contact: _- a tf-ie /1 S 1r, ck/u11 » »Title:.._ ............. Phone No:ya 7 �
Onsite Representative:.... �[G I�alr' S rriG �C�G Integrator:
Certified Operator:..».»..,.»`G}! e �� S l�' �'cla �� Operator Certification Number:
Location of Farm:
Egl�wine ❑ Poultry ❑ Cattle ❑ Horse Latitude • ` " Longitude • ` "
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes RNo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes Er&o
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes E31To
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes G o
2. Is there evidence of past discharge from any part of the operation? ❑ Yes [J No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes 0310
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes [31�o
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier i
Freeboard (inches): yG "
12112103 Continued

r
' Bacilit3' Number: 2 d G
Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severs erosion, ❑ Yes ❑'No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑ Yes [ i-o
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 allo
8. Does any part of the waste management system other than waste structures require maintenance/improvement? [:]Yes 0-N-0-
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes Q,906
elevation markings?
Waste Aaolication
10. Are there any buffers that need maintenance/improvement? ❑ Yes E No
11. Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes Ergo-
0 Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type 13trryuJu SM.11 Gru,'., , 6,-,1 , l,✓A,u/' -Se",Lr.I., c
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes BNO
14. a) Does the facility lack adequate acreage for land application? [:]Yes el o
b) Does the facility need a wettable acre determination? ❑ Yes ONO
c) This facility is pended for a wettable acre determination? ❑ Yes [3 No
15. Does the receiving crop need improvement? ❑ Yes [ 1' 0
16. Is there a lack of adequate waste application equipment? ❑ Yes ONO
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes 2No
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes ERNo
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 040
Air Quality representative immediately.
;Comwreaxs (ieef'er to gaestian#)_ 'Explain atiy YES�aip�veis"`and/or airy recamnnc�edatfons ar a�ay atliir rontmeats: � � _._, �.�
-I3se drawings of facility to'beite� expla srtons (use ddtfzanal pages as 7'}eld Copy �❑ Final Notes
F,, �s c..e, kepi.
�CCOrr.%S u/C will I�G/��
r►
Reviewer/Inspector NameAT
Reviewer/Inspector Signature: ` Date: if - - 0
I2112103 Continued

Facility Number: ga __20G Date of Inspection
Required Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
23. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Waste Application[] Freeboard' ❑ Waste Analysis ❑ Soil Sampling---
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
25. Did the facility fail to have a actively certified operator in charge?
26, Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
27. Did Reviewer/Inspector fail to discuss review/mspection with on -site representative?
28. Does facility require a follow-up visit by same agency?
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
NPDES Permitted Facilities
30. Is the facility coveted under a NPDES Permit? (If no, skip questions 31-35)
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
32. Did the facility fail to install and maintain a rain gauge?
33. Did the facility fail to conduct an annual sludge survey?
34. Did the facility fail to calibrate waste application equipment?
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below
❑ Stocking Forte ❑ Crop Yield Form ❑ Rainfall'❑ Inspection After 1" Rain
❑ 120 Minute Inspections'[] Annual Certification Form
❑ Yes EINo
❑ Yes Gll�o
❑ Yes 040
❑ Yes 01v0
❑ Yes E'lo
❑ Yes Eg No
❑ Yes QS No
❑ Yes Q No
❑ Yes 0-90
des ❑ No
❑ Yes. BIZ,
❑ Yes EJNo
❑ Yes L10
❑ Yes [3 No
❑ Yes 0-90,
12112103

Site Requires Immediate Attention:
Facility No. T 7- — les 6
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: ,l V1 y / , 1995
Time:
Farm Name/Owner: �� 5 F/-" c k /
Mailing Address: L ogyRh L LN65' Qo &- ?
County:. 5,TSrur
Integrator:
On Site Representative: A ow
Physical Address/Location: _ t / yr)
t hgLe-Z L- f f_ ®2 .tom _l am ff. 7& Fila1.
:Z - 7/ 5^/ Y/a
Phone:
Phone: `-
vc N i I ,, /if%_ �ivn/.P.wLfT. �a
'j- A# ; /.e aw 4, 4:A
Type of Operation: Swine v Poultry Cattle
Design Capacity: Number of Animals on Site: �?`fU F�%+-•S _
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: ° u d ' �-V" Longitude: ° ;Ll' 0 "
Circle Yes or No
Does the Animal Waste Lagoon hav sufficient freeboard of 1 Foot + 25 year 24 , hour storm event
(approximately 1 Foot + 7 inches) l`__e or No As4W Freeboard: Ft. a Inches
Was any seepage observed from the lag n(s)? Yes orWas any erosion observed? Yes or N@
Is adequate land available for spray? 0or No Is the cover crop adequate? je or No
Crop(s) being utilized: (/ 5 i#-/ ci* u DID'
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellin or No
100 Feet from Wells?s or o
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line: Yes o0o
Is animal waste discharged into water of Ael state by man-made ditch, flushing system, or other
similar man-made devices? Yes or No If Yes, Please Explain.
Does the facility maintain adequate waste management reco (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? Ye or No
Additional Comments:
Inspector Name
cc: Facility Assessment Unit
Signature
Use Attachments if Needed.
fi

. it
J
RMTH CAROLINA DEPARTNMRT OF HEALTH b NATURAL RESOM:U S
DIVISION OF ENMONPMTAL KAHAGEKMT
Fayetteville Regional office
Animal Operation Compliance Inspection Fo=
�..
r. - �'.. :.� �'°«Yr-�+'+'�3J%i�-.acr
3N.SFHGTZON ATE
o-"�'"".z,."w�-�• fir':.^,r`"...<
:gpgl4 :>
,
LaKe Form Kd Deli co Stirfc (a
�
H .. M]1Ii.II+�G. fi1DDR85.x „y',�x4
e
,EMACxLiTY-.`�TONii :�4I]7�ffii ��'
�GtUf�� Co-Ke d. [embu 2�
(C()v a-7 lb
All questions answered negatively Will be discussed in sufficient detail in
the -Comments section to enable the deemed Permittee to perform the appropriate
corrections:
sEMON r
Animal 92eratio_n_ Type: T n l S )
Horses, cattl swin , poultry, or sheep
SE 10M IT
1. Does the number and type of animal meet or exceed
the (.0217) criteria? [Cattle (100 head),
horses (75), swine (250), sheep (1,000),.and
poultry (30,000 birds with liquid waste
system)) - .
2. Does this facility meet criteria for
Animal Operation REGIST"TI_OW.
3. Are animals confined fed or maintained
in this facility for a 12-month period? -
4. Does this facility have a c�RTTfl=.
WASMANAGENEW P%AW.
5. Does this facility maintain waste management
records (volumes of manure, land applied,
spray irrigated on specific acreage with
specific cover crop)?
6. Does this facility meet the 5CS minimum
setback criteria for neighboring houses,
wells, etc?
EMS ra

saC ION 1XI
F' gld Site Management
1. Is animal waste stockpiled or lagoon
construction within 100 ft. of a USGS
Map Blue Line Stream?
2. Is animal waste land applied or spray
irrigated within 25 1t. of a USGS Map
Blue Line Stream?
3. Does this facility have adequate acreage
on which to apply the waste?
4. Does the land application'site have a
cover crop in accordance'with the
CERTIFICATION PLAN?
5. Is animal waste discharged into waters of
the state by man-made ditch, flushing system,
or other similar man-made devices?
6. Does the animal waste management at this
farm adhere to Best Management Practices
(BMP) of the approved CERTTFICATIflP?
7. Does animal waste lagoon have sufficient
freeboard? How much? {Approximately __ )
8. Is the general condition of this CAFO facility,
including management and operation,
satisfactory?
SECTION IV
COMMents
Innal Ins
11
■

ANZM L WAS13 XAbMG `EMZ T PLAN CSR' =71CATMON FOR HMV OR =2AHMED PEEDIATS
please retu�-= the cryplated fort to the Division of Mmv _onma-tal Haaagemeat at
the add_-aaa on the ravarn4 aide of tsia foes.
Name of =arm (Please print) : �;. S�2rG1�L_AY0
Ad,-4-ess: '
Phone No. . -
Count:, : SA m o rn
=a--m location: Latitude and Longitude. 4r go' za" /78&2T'Sb"(required) . Also,
Please attach a copy of a county road map with location identified.
'Z,rpe of operation (swine, layer, dairy, etc.): Sumo
Design capacity (number or animals) : Z9¢�" F��o- F�r�•5H
Average size of operation (12 month population avg.)
Average acreage needed for land application of waste (acres): 44-
aaaaaaaaaaaaaaasaaasasaaaaa3aaaaasassaaayye a�aa�aaaaaa3assaaaaa3aasaaassssaaaaaaaa
Technical speciallst car-Ilication
As a technical specialist designated by the North Carolina Soil and Water
Conservation Commission pursuant to 15A NCAC 6F .0005, I certify that the new or
expanded animal waste management system as installed for the farm named above
has an animal wastes management plan that meets the design, construction,
operation and maintenance standards and specifications of tze Division of
=nvironmental Management and the USDA -Soil Conservation Service and/or the North
Carolina Soil and Wacer Conservation Commission pursuant to 15A NCAC 2H.0217 and
15A NCAC 6F .0001-.0005. The following elements and their corresponding minimum
criteria-ha:ve-been verified by me or other designated technical specialists and
are i_cluded in the plan as applicable: minimum separations (buffers); liners or
equivalent for lagoons or waste storage ponds; waste storage capacity; adequate
quantity and amount of land for waste utilization (or use of third party) ; access
or ownership of proper waste application equipment; schedule for timing of
applications; application rates; loading rates; and the control of the discharge
of pollutants from stormwater runoff events less severe than the 25-year, 24-hour
storm.
Name of Technical specialist (Please Print) : G G[Fnn Ci. iz:an
Af=' liation- Pecs-rAae FAitrAs Tnt.
Address (Agency) : P.Q. Ao x 4 SA Ctrn mn n c Z832B_ Phone No. $22 -_5 7-7 +
Signature: A ddL--- CL [ Cr*- Date: =V1-A195
a a a a a a a s a s a s s s a s a a s a a a s s a a a s a s a s a e e a a a a s a a a a a s a a a a a s a a= a a a s a s s a a a a a a s e
owner/Haaager Agreement
(we) understand the operation and maintenance procedures established in the
approved animal waste management plan for the farm named above and will implement
these procedures. I (we) know. that any additional expansion to the existing
design capacity of the waste treatment and storage system or construction of new
facilities will require a new certification to be submitted to the Division of
environmental Management before the new animals are stocked_ I (we) also
understand that there must be no discharge of animal waste from this system to
surface waters of the state either through a man-made conveyance or through
runoff from a storm event less severe than the 25-year, 24-hour storm. The
approved plan will be 'filed at the farm and at the office of the local Soil and
Water Conservation District.
Name of Land owner ( Please Print) : ' 51?z 7UL } A,
Signature: Bate: Z�2f9�
Name of HaaaQer, if different from owner (Please print):
Signature: Date:_
*late: A change in land ownership requires notification or a
(if the approved plan is changed) to he submitted to
Environmental Management within 60 days of a title transfer.
OEM USE ONLY : AG'dF�v
new certification
the Division of

DIVISION OF ENVIRONMENTAL MANAGEMENT
1
SUBJECT: Compliance Inspection
County ���� 5G �
Dear ("'
On , an inspection of your animal operation was performed by the
Fayetteville Regional Office (FRO). Please find enclosed a copy of our
Compliance Inspection Report for your information. It is the opinion of this
office that this facility is in compliance with ISA NCAC 2H, Part .0217, and
that Animal Waste Management is being properly performed.
Should you have any questions regarding this matter, feel free to contact
me at [phone].
Sincerely,
Grad)( Do son
Envir ental Engineer
GD/
Enclosure
cc: Facility Compliance Group

Site Requires Immediate Attention:
Facility No. _ 7
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: 7 — ! Y , 1995
Time: J
Farm Name/Owner: �°� 2E� S�2`` /INN" 1"%A
Mailing Address: a u vim' Si: /VC _`43 2-9
County:— SI"P 150"V
Integrator:_ I t e, 4. E- rm:ej h _ Phone:
Ah On Site Representative: R � K` Phone:
Physical Address/Location: /3
Type of Operation: Swine !L Poultry Cattle
Design Capacity: Number of Animals on Site: C1/0
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: Longitude: "
Circle Yes or No
Does the Animal Waste Lagoon hater sufficien
(approximately 1 Foot + 7 inches) (
Was any seepage observed from the
Is adequate land available for spray?
Crop(s) being utilized:— r
or No
t
freeboard of 1 Foot + 25 year 24 hour storm event
A,cfual Freeboard: 3Ft. Inches
)? Yes or(Ta Was any erosion obs� ' ed? Yes o No
No Is the cover cropadequate. YeVor No
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings? lrg� or No
100 Feet from Wells? (Yi or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Streams Yes or No
No Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line: Yes o
Is animal waste discharged into water of the state by man-made ditch, flushing system, or other
o similar man-made devices? Yes or If Yes, Please Explain.
Does the facility maintain adequate was management record (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? or No
Additional Comments:
Inspector Name
cc: Facility Assessment Unit
is '�•�
Signature
Use Attachments if Needed.

SORTH CAROLMM DRPARTKMgT OF EwnwImcmT, WKALTS A HATCAiAL RESOM=
Fayetteville Regional Office
Animal Operation Compliance Inspection Fora
v
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All questions answered negatively will be discussed in sufficient detail in
the -Comments section to enable the deemed Permittee to perform the appropriate
corrections:
MION I
Animal operation Type: Ti n1s )
Horses, cattle, swine, poultry, or sheep
SECTION II
1. Does the number and type of animal meet or exceed
the (.0277) criteria? (Cattle (100 head),
horses (75), swine (250), sheep (1,000),.and
poultry (30,000 birds with liquid waste
system)) _ '
2. Does this facility meet criteria for
Animal operation REGISTRATION?
3. Are animals confined fed or maintained
in this facility for a 12-month period? -
4. Does this facility have a CERTIYM ANIrAL
WASTE NLL GMC T PLAW
5. Does this facility maintain waste management
records (volumes of manure, land applied,
spray irrigated on specific acreage kith
specific cover crop)?
5. Does this facility meet the SCS minimum
set -back criteria for neighboring houses,
wells, etc?
nn
0 � CA
OEM
INESEN

8=7g Q ZII
kield Si an
1. to animal va&La sLuckpilgd or logoou
construction within 100 ft. of a USCS
flap Slue Line Stream?
Z. Is animal waste land applied or spray
irrigatad w;*M n 25 St. of a UGGO Map
Blue Line Stream?
3. Does this facility have adequate acreage
on which to apply the waste?
4. Does the land application -site have a
cover crop in accordance with the
C1MTIFIGTIo" PLM?
5. Is animal waste discharged into waters of
the state by man-made ditch, flushing system,
or other similar man-made devices?
6. Does the animal waste management at this
farm adhere to Best Management Practices
(SHP) of the approved CZ TMCATxOI?
7. Does animal Waste lagoon have sufficient
freeboard? How much? (Apprpximately )
B. Is the general condition of this CAFO facility,
including management and operation,
satisfactory?
SEC.7'ION IV
r=Ments

N
REGISTR_17I0N FORM FOR ANIMAL FI&CLOT npEp TiONS
Department of Environment, Health and Natural Resources
Division of Environmental. Management
Water Quality Section
If the animal waste management system
for your feedlot operation
is
designed to serve more than or
equal to 100 head
of cattle,
75
horses, 250 swine, 1,000 sheep, or 30,000 birds that
are served
by
a liquid waste system, then this
form must be filled
out and mailed
by December 31, _ 993 pursuant _..
15A NCAC 2 .02,7 (c)
in order to
be
deemed permitted by OEM. Please
-print clearly.
Farm Name: A, WiRte AX: A
Mailing Address C0?oi'1� --
County _S�?f?����- _ Phone No. 7I$S
Owner (s) Name: r' /
Manager (s) Name:
Lessee Name:
Farm Location (Be as specific as possible: road names, direction,
milepost, epc,.) mi.ti T
Latitude/Longitulle it known:
Design capacity of animal waste mana ement system (Number and type
c: confined animal (s)0
Average ani al poculat' on' yon the farm (Number and type of animal(s)
-raised)S
Year
Production Began:l�Z ASCS Tract
No.:
0 63 S
Type
of Waste Management System Used:
-
r. - ,` l
Acres Available for Land Application of Waste • y•S We fiedr S T 33.(o
�� MoRE
Owner (s) Signatars (s) DATE: 3$ 3
DATE•