820213_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental Qual

r
ypr u, v an. v %.ompnance inspection v vperanon Keview V structure nvamanon V i ecunicai %ssistance
Reason for Visit: O Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: IN J Arrival Time: U.' Departure Time: County: s/� .410 Region:
Farm Name: /S j -a ZEA_&yl Owner Email:
Owner Name: -jez,+VL�Fy S )Cg Phone:
Mailing Address:
Physical Address:
Facility Contact:,! C-�-/e i 5: Title: �EG� ��G Phone:
Onsite Representative: Lzr Integrator: S'Lf�7'�/�jQ.,U
Certified Operator: 44 ,/-P,t Certification Number -
Back -up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Tl'"19
Design Cu�.n
a
��������`�Des
�i��
gn
Currentl}esign
^,�
E
Cnrreat
Swine
Ca aci
Pe9Poult�';Ca
?�
aci
! P h
Po p.,2
Cattle -
a
Capactty
Pop.
„aw
Wean to Finish
Layer
Dairy Cow
Wean to Feeder
Non -La er
Dairy Calf
Feeder to Finish;47
Dairy Heifer
Farrow to Wean
!MEN;
Design
Current
D Cow
Farrow to Feeder
D , P;oul,Ca
aci
Po
Non -Dairy,
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
ft_.....
Turkeys
k'
Other
l'urkey Poults
Other
I 10thcr
r
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
[A No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWR)
❑ Yes
No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
[] Yes
[�] No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
[ ] No
❑ NA
❑ NE
3_ Were there any observable adverse impacts or potential adverse impacts to the waters
[] Yes
No
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412015 Condnued

FacilityNumber. 3 _ Date of Inspection: PIA1,9� /
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): 1
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
PfNo ❑ 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
EJONo ❑ 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
t reat, 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
Flo ❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
0 o ❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
Io ❑ NA
❑ NE
maintenance or improvement?
I I . Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes 1 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): '137:RM u A+ r%l�n ii(/ S
13. Soil Type(s): Vateh72_Z_,'
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
00No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
'�o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
[] Yes
7 No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Ye\Lo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Re aired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
2<o
NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
E3<o
❑ 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 E� < ❑ 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 EXNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes F2rNo ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Faeility Number: - 'Zj Date of Inspection: 0 OV 1
24. Did the facility fail to calibrate waste application equipment as required by the permit? []Yes No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail 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
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑NA ❑NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
M No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
No ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? if yes, check the appropriate box below.
❑ Yes
No ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other.
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
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
Costion.# Ex lam an _:YES"_
rr��,, jJ �f mmeeda ,
omments refer to u' .' :s ers °o aaa�aonial reco ,. bons or any other commence
lase dirawmgst-0 ikeiuty to better explain srtuahoas,.(use:ikoft nal pages as necessary.)•,:
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Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
rc� �-•— Phone: ��(, � 3 3, � N'
Date:
21412015

I ype of visit: U Compliance Inspection U Operation Review O 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: p.' Q Departure Time: �� County: Region: �(�
Farm Name: _ f t C" ra, '. -L' Owner Email:
Owner Name: � d c,-i. 7 rraz j �r-�` Phone:
Mailing Address:
Physical Address:
Facility Contact: T r moo'--r-- Title: Phone:
Onsite Representative:
a
Certified Operator:��
Back-up Operator:
Location of Farm:
Latitude:
Integrator: ��; Y 41/
Certification Number:
Certification Number:
Longitude:
Design Current ,F Design Current*t
Design Curreut
Swine Capacity Pop. Wet Poultry Capacity Pop.
Cattle Capacity Pop.
Wean to Finish
La er
Dairy Cow
Wean to Feeder
Non -La er I
Dairy Calf
Feeder to Finish v
Design Current
Dairy Heifer
Farrow to Wean
Dry Cow
Farrow to Feeder
D , P,oul Ca aci P,o
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
113eef Feeder
Gills
Non -Lavers
Boars
Pullets
Beef Brood Cr
Turkeys
Otleer
Turkey Poults
Other
10ther
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
. of the State other than from a discharge?
❑ Yes �No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes [2�No
❑ Yes E[ No
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
Page 1 of 3 21412015 Continued

Facility Number: - J Date of lus ection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [2—No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes R(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 [K 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 M- 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
[aYes ❑ No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
[] Yes IC* No
❑ NA ❑ NE
maintenance or improvement?
I I. 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):�l-yytcc�
13. Soil Type(s): 'Ajw'�' I k— _
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes 0�No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes LqNo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes [&,"No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes qNo ❑ NA ❑ NE
❑ Yes JNo [] NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes [3,'No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes EKNo ❑ 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 RNo
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes 4 No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [Z—No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412015 Continued

IaaciG Number: I Date of Ins ection: / -- --
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes JA No ❑ NA ❑ NE
• 25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes RNo ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey [] Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes
0 No
❑ NA
❑ NE
❑ Yes
[2No
❑ NA
❑ NE
❑ Yes
RA No
❑ NA
❑ NE
❑ Yes [a No ❑ NA ❑ NE
❑ Yes ANo ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
32_ Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
q No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? [—]Yes
14 No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes
[7}No
❑ NA
❑ NE
Commenttsftefer to quest only#) 4Explain1any YES0hs*ers_andlor any,additional''recommendations'or any o#her eommeots :_!il
� ,qil i.;,
Use drawings of facilitv'to better:egula�©;srtuations (use additional nalzes as necessary] N
ajJ.,
Al parr u�
j'&
Reviewer/Inspector Name:
Phone:
Reviewer/Inspector Signature: Date:
Page 3 of 3
21412015

/.--Z-1 1 TLC
Type of Visit: QYCompliance Inspection Q Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: / Arrival Time: ' [7 Departure Time: ,'pU County:
Farm Name: ,_; S�r,­ ]warn. Owner Email:
Owner Name: _G'r,, Y,.� may; 5�`r� Phone:
Mailing Address:
Physical Address:
Facility Contact: 6 / jr, e- L Title:
Onsite Representative:
Region:
Phone:
Integrator: Sflf //I
Certified Operator: ���•.� Lam.-;�� Certification Number:
Back-up Operator:
Location of Farm:
Certification Number:
Latitude: Longitude:
Design Current
Desigu
Current
Design Current
Swine
Capacity Pop.
We Poultry
Capacity
Pap.
Cattle Capacity Pop.
Wean to Finish
La er
Dairy Cow
Wean to Feeder
Non -Layer
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
Dry P,oultr,
Ca aci
la ,
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
lBeef Brood Cow
Turkeys
Other
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man -trade?
b. Did the discharge reach waters of the State? (If yes, notify DW R)
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 E.No ❑ NA ❑ NE
❑ Yes ❑ No
[—]Yes [] No
[:]Yes
❑ No
❑ Yes
L&No
❑ Yes
Wo
❑ NA ❑ NE
❑NA ❑NE
DNA ❑NE
[] NA ❑ NE
❑ NA ❑ NE
Page 1 of 3 21412015 Continued

Facility Number: - 13
jDate of Inspection:
Waste Collection & Treatment
'r14. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes allo
a. If yes, is waste level into the structural freeboard? 0 Yes ❑ No
❑ NA ❑ NE
❑NA ❑NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): 9
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes [a No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes C�JNo ❑ 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 o ❑ NA C] NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes Eallo ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes O No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes J&No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes 12�No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload 0 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
ff Window ❑ Evidence of Wind/Drift ❑ Application Outside of Approved Area
12. Crop Type(s): _ � v�o �Ay zr1s15 -;.
e —
13. Soil Type(s): A k
14. Do the receiving crops differ from those designated in the CAWMP? [:]Yes allo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes allo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes allo ❑ 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 (r---A No ❑ NA ❑ NE
❑ Yes �o ❑ NA ❑ NE
Re uired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes E[No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes RNo ❑ NA ❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes allo
❑ 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 Q No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facifi Number: JDate of Inspection; ZI/
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes E No ❑ NA ❑ NE
Nt25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes f-81 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 fast survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
3 L Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
Le
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?
% �rx �Qs � Girt—�J �-y-1— ✓t�,��c/�C
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
❑ Yes JZ No ❑ NA [] NE
❑Yes 0No [:3 NA ❑NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes [ No ❑ NA ❑ NE
❑ Yes [g No ❑ NA ❑ NE
❑ Yes ®,No
❑ Yes ® No
❑ Yes Ea No
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
Phone: ZE:-j- 33 ! _ l
Date:
21412015

type or visit: t7 compliance Inspection V operation Review U Structure Evaluation U Technical Assistance
Reason for Visit: outine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: �L
Arrival Time: J �,
Departure Time: FFF�10_po
County: 4i�pa� Region: /3�z L).
Farm Name:
Owner Email:
Owner Name: f4q_✓_G0't-
Phone:
Mailing Address:
Physical Address:
Facility Contact: 4r=!�rz-r /%%per -r-- Title:
Onsite Representative:
—a
Certified Operator: (//
Back-up Operator:
Phone:
Integrator: 11�x
Certification Number:
Certification Number:
Location of Farm: Latitude: Longitude:
Design @urrent
Des gn Current
Design
Current
Swine
Capacity .. "Pop.-
Wet Poultry
Gapactty AY,Pop
Cattle Capacity
Pop.
Wean to Finish
Layer
Dairy Cow
Wean to Feeder
Non -La er
Daia Calf
Feeder to Finish
Dai Heifer
Design Current
Dry Cow
Farrow to Wean
Farrow to Feeder
D . P,ouI
Ca act Po
Nan -Dairy
Farrow to Finish
La ers
Non -La ers
Beef Stocker
Beef Feeder
Gilts
Boars
Pullets
Beef Brood Cow
Turkeys
IEL
Turkey Pouits
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
[—]Yes RNo ❑ NA ❑ NE
❑Yes
❑No
❑NA
❑NE
❑ Yes
[:]No
❑ NA
❑ NE
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 ® No
[:]Yes allo
DNA ❑NE
DNA ❑ NE
❑ NA ❑ NE
Page I 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 Structure 5
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
(53,No ❑ NA 0 NE
❑No ❑NA ❑NE
Structure 6
[:]Yes V,No ❑ NA ❑ NE
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes [RNo
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes 0 No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes P. No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require [:]Yes allo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 0 No
❑ NA
0 NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes FLNo
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphors ❑ 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) ��/`rYG/���r �� C�-�Y� /t�Din �W fi/S6r-�►"^s
/ r
13. Soil Type(s):nr
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?
18. Is there a lack of properly operating waste application equipment?
❑ Yes � No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes [2 No ❑ 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 No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute inspections ❑ Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes � No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [3-No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412014 Continued

• Facility Number: - Date of Ins ection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? Yes C3,No 0 NA 0 NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check 0 Yes �To 0 NA ONE
the appropriate box(es) below.
Failure to complete annual sludge survey Failure to develop a POA for sludge levels
❑ Non -compliant sludge Ievels 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
Ca No
❑ NA 0 NE
27_ Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Yes
No
[] NA ONE
Other Issues
2& Did the facility fail to properly dispose of dead animals with 24 hours and/or document
Yes
No
0 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
Co No
0 NA ONE
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
ANo
❑ NA 0 NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface file drains exist at the facility? If yes, check the appropriate box below.
0 Yes
JZ(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 0 NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
Yes
(21 No
0 NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
Yes
® No
❑ NA 0 NE
Comments (refer to question:#: Explain,aiiy YES answersiand/or any.additional recommendations o.� any a her�eomments. ` y
Use drawings of.facility�to better explainsituahons (use:-additional:oaees as necessarv).
?,?-vI rare / ,� ^ / -;7-0 /�
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:3
Date:
21412014

Iype of Visit: (49'C:ompliance Inspection V Operation Review O Structure Evaluation O'Technical Assistance
Reason for Visit: (31 tine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit:
Arrival Time: 1 ; p-::> I
Departure Time: r
County: �-
Farm Name:
Y o, yn.
Owner Email:
Owner Name:
f'* V-�e.. J`� �� j����
Phone:61
Mailing Address:
Physical Address:
Facility Contact: ��n;•Yy_ NNW lr_ Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone:
Integrator:
Certification Number:
Certification Number:
Latitude: Longitude:
Discharges and Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
Region: em
❑ Yes ® No ❑ NA ❑ NE
[—]Yes ❑ No
[:)Yes ❑ No
[:]Yes [—]No
[:]Yes ® No
[—]Yes [j.No
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
[] NA ❑ NE
❑ NA ❑ NE
Page I of 3 21412011 Continued

FaciliNumber: 8' - ! Date of Inspection: D
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes gNo ❑ 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): _:57
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes [4No
❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes 0 No
❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes La 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 CgNo
❑ NA ❑ N E
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 ❑ Eviddence of Wind Drift ❑ Application
Outside of Approved Area
12. Crop TYPe(s): ur!'Srra / C_19 i r AzAl 4,7L
13. Soil Type(s): X)9)/-AIlr-
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [9 No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes 0 No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes [a No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[R No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[a No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
Z No
❑ NA
0 NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
ELNo
❑ 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
1K 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
E[ No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[&No
❑ NA
❑ NE
Page 2 of 3
21412014 Continued

Facility Number: jDate of Ins ection: 19 /L
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [g-No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [-]Yes 0 No ❑ NA 0 NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey [] Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes allo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes S No ❑ NA ❑ NE
Other issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
Z 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
allo
❑ 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
[S No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
3 1. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
PINo
❑ NA
❑ NE
❑ AppIication Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[a No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
[RNo
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
JQ No
❑ NA
❑ NE
Usemenu'drawings (refer
fao q estlon # Ez lain an YES answers .and/or an �additionalirecommendahons er an oth`er�camments: # Comments efer to tyyto tietter_explain situations (use.additional.pages;as
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date: IQ �"3 OVA
21412014

Division of Water Quality
Facility Number ®- 13 Division of Soil and Water Conservation 1� !-
� Other Age, ncy
Type of visit: ��ompGance Inspection Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: (2e utine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: �;-�p —j- Arrival Time: 1 '• pc7 Departure Time: �', p� County: xy — Region:
Farm Name: R r,/- lc:_afervo%� Owner Email:
Owner Name: r Phone:
Mailing Address:
Physical Address:
Facility Contact: /��/` 0e7__ Title:
Onsite Representative: 5rrr
Certified Operator: .r L e-
0�
Back-up Operator:
Location of Farm:
Latitude:
19�_. Phone:
Integrator: 111 u,,z4 Z
`T
Certification Number:
Certification Number:
Longitude:
Design Current Design Current Design Current
Swine Capacity Pap. Wet Poultry Capacity Pop. Cattle' Capacity Pop.
Wean to Finish
Layer
Dairy Cow
iry Calf
Wean to Feeder
Non -Layer
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design Current
Dry Cow
Farrow to Feeder
DryFoul
Ca aei Po ,
Non -Da'
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Broad Cow
, b=
Turkeys:;
Other
Turkey Poults
Other
Other"
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes Dq No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No [DNA []NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) ❑ Yes ❑ No ❑ NA D 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)
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 (a No
❑ Yes FM No
kmk
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
Page I of 3 21412011 Continued

Facility Number: % Date of Inspection: -i ---
Waste Collection & Treatment
ti 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
CR.No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Arc there any immediate threats to the integrity of any of the structures observed?
E] 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
[A No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental
threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
0 No
❑ NA
❑ NE
$. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[Z No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
® No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
R No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ® 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): rr� frh,}ve'!a r24 14,D rPL IW4-t 451lo-, 4
13. Soil Type(s): l)l7'0
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes U�J_No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes M No [DNA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable [-]Yes [:RNo ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
9No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
allo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
KNo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
[:]Yes
RNo
❑ NA
❑ NE
the appropriate box.
❑WUP [-]Checklists ❑Design [:]Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes � No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall [:]Stocking ❑ Crop Yield ❑ 120 Minute inspections ❑ Monthly and I" Rainfall Inspections
22_ Did the facility fail to install and maintain a rain gauge? ❑ Yes R No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ® 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? ❑ Yes jg.No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes Q 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
[DNA ❑ NE
❑ Yes � No ❑ NA ❑ NE
❑ Yes 54 No ❑ NA ❑ NE
❑ Yes V' No ❑ NA ❑ NE
❑ Yes Q No ❑ NA ❑ NE
❑ Yes gj No
❑ Yes � No
❑ Yes ERL No
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
Comments
❑drawm(refer.
r fer.toqUe ti better explain any YES answers and/or any additional recommendations or any other cominenWF
fi
,:r ,
gs.. facility plan situations (use additional pages as necessary)..-
r
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: C/v -a- yj aD
Date: Q—/— `e9y-3
21412011

Type of Visit: Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: / D.' a Departure Time: // ' O P-71 County: Region:
Farm Name: Owner Email:
Owner Name: �r Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: ,'; ,G. Phone:
Onsite Representative: Integrator:
Certified Operator:
Back-up Operator:
Certification Number: / 7 SW
Certification Number:
Location of Farm: Latitude: Longitude:
esign Current Design Current
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
- Dairy Heifer
Farrow to Wean
Design `Current D Cow
Farrow to Feeder
D ; P,oul Ca city P,o Non -Dairy
Farrow to Finish
Layers Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets Beef Brood Cow
Turke s
t]ther
Turkey Poults
Other
Other
Discharges and Stream Impacts
l . 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 O No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes ❑ No
[:]Yes allo
[:]Yes ER -No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page l of 3 21412011 Continued

Facili Number: - Date of Ins ection:
Waste Collection & Treatment
ti
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): .2a2:
Observed Freeboard (in): —
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes [S No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes ® No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ® No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit? [:]Yes 2,No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ® No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ® No
❑ NA
❑ NE
maintenance or improvement'?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes P-No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu,Ln, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):z.� rnudl i1 j
13. Soil Type(s):
l
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [A No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes FNo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes ELNo [] NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
04No
❑ NA
0 NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
,�j No
7�
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
RNo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
�Z No
❑ NA
❑ NE
the appropriate box.
❑ WUP [—]Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other;
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes R No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ® No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 5jNo
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
DNA ❑ NE
[] NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: - �- 1 Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes 5a No
' 25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ® No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey [:]Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? [-]Yes ® No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ® No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface file 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 `K No ❑ NA ❑ NE
❑ Yes q No ❑ NA ❑ NE
0 Yes ® No ❑ NA ❑ NE
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes ® No
❑ Yes CZ No
❑ Yes [&No
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
Comments (refer .to question #: Explain:.any YEStanswers and/or any additional recommeadahans or any other commentsz
Use drawings. of -facility to better explain situations (use additional pap -es as necessary)...:::"-
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 9 D/-'q -'_-070p
Date: // —_
21412011

i v isn: tJ l:ompuance inspecuon %_1 Lpperarton xeview v nrrucrure r-vatuanon V i eennical Assistance
Reason for Visit: O Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: ,' D Departure Time: !D, County: Region:
Farm Name:��7-Y�Q rr►ti Owner Email:
Owner Name:r,,t :9`S �C� Phone:
Mailing Address:
Physical Address:
Facility Contact: re'-1- Ixomn Title: Phone:
Onsite Representative: Integrator:
Certified Operator: j�%-r Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
1.
Design Current
a Design Current Design Current
wineCapacity
1?
iVet Poultry Capacity Popes Cattle Capacity Poinish
La er g Dai Cow
Nan -La er Dai Calf
Dai Heifer
eeder
Finish
rFFF
pU
Wean
Design Current" D Cow
l
try sCa actPa Non-DairyFinish
Feeder
Seef Stocker
ers Beef Feeder
Beef Brood Cow
7EN-pLa
Boars
>^
heri`'
ME
Poults
Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes [ricn
j No E] NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
[-]Yes ❑ No
❑ Yes CK No
[:]Yes ® No
❑ NA ❑ NE
❑NA ❑NE
❑NA ❑NE
Page I of 3 21412011 Continued

Facility Number: - ,(j Date of Ins ection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? [:]Yes [M No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): '3.2
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ro No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes ®, No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement? 5..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 [2!�No
❑ NA
❑ NE
maintenance or improvement?
_Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [5� No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ® No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): le_pe�L S
i
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes ® No ❑ NA ❑ NE
[]Yes )[.No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes &[ No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes Eq 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 LS No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes 54 No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facie Number. - Date of Ins ection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? Yes No NA NE
■ 25. Is the facility out of compliance with permit conditions related to sludge? If yes, check Yes 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 Ievels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? Yes No NA NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No NA NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
[] Yes CK No [:] NA NE
Yes ® No NA NE
Yes W) No ❑ NA NE
Yes CB�No NA ❑ NE
Yes �K No
El Yes [CI No
❑ Yes ® No
NA NE
�NA NE
NA [] NE
Comment&(refer,to question #): Explain any.YES answers and/or., any additional recommendatrans or=any other coinimen�ts.
Use.drawin�s of facility:to better explain situations (use; additional vanes as necessary). ' _ '," '
Reviewer/Inspector Name:
Reviewer/inspector Signature:
Page 3 of 3
Phone: gypC33 :33� a
Date:
21412011

'•t
Type of Visit (D<o-mpliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit ( Koutine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: j ti !_ Departure Time: County: Region: ���
jor
Farm Name: Ze?1 Fa e-m— Owner Email:
Owner Name: G1 a yr rt y j 5��r� Phone:
Mailing Address:
Physical Address:
Facility Contact: C'-r"�Y' - 7Zra- 2 v-"_ Title: O w h y,-1 . Phone No:
Onsite Representative: t3 �'r'z� /9'1 by rcIntegrator: _ 1
tl
Certified Operator:. Certification Number:Elf-
Operator�, ,.
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: 1710 ❑ 1 ❑ ,1 Longitude: ❑ ° ❑ I ❑ N
Design Current
Design Current
Design Current
Swine Capacity Population
Wet Poultry Capacity Population
Cattle Capacity Population
❑ Wean to Finish
❑ La er
❑ Dairy Cow
❑ Wean to Feeder
❑Non -La er
❑ Dairy Calf
® Feeder to Finish
❑ Dairy Heifer
❑ Farrow to Wean
❑ Farrow to Feeder
El Farrow to Finish
❑ Gilts
❑ Boars
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑Beef Feeder
❑ Beef Brood Co
Other
❑ Turkey Pouets
❑ Other
❑ Other
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c, What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system'? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes RNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
[--]Yes
;KNo
❑ NA
❑ NE
❑ Yes
[&No
❑ NA
❑ NE
Page 1 of 3 12128104 Continued

Facility Number: — r3 Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
❑ Yes CKNo ❑ NA ❑ NE
❑ Yes §.No ❑ NA ❑ NE
Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): _A;t-
Observed Freeboard (in): _ 32-
a —
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
WNo
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
RNo
❑ 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
[A No
❑ NA ❑ NE
maintenance/improvement?
]I. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
[RNO
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)--
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
NNo
❑ 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
JKNo
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
,®,No
❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facilit}° to better explain situations. (use additional pages as necessary):
s
Revi ewer/] nspector Name 7 ; _ r Phone: glp `y3l 3� pa
Reviewer/inspector Signature: Date: AP
Page 2 of 3 I2125 N Lonanuea

Facility Number: Date of Inspection v—ID
1
Re aired Records &Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes O,No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes RNo ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes VNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [,No - ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ® No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
2RNo
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
DNo
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
RNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
UNo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
E� No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
®,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
ANo
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/inspector fait to discuss review/inspection with an on -site representative?
❑ Yes
q No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
ZNo
❑ NA
❑ NE
Additional.Commen't"sandlor DrawingsON a
Page 3 of 3 12128104

1�Lm5 i z- o 9- Z 00 9 R. k{,�
Type of Visit &Compliance Inspection 0 Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit & Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: !a.-b8't)9 Arrival Time: : /S Departure Time: - �3 �., County: Ste" y' Sry Region:
Farm Name: _ sc r t r Owner Email:
4
Owner Name- Car- I+drJ i is : 5'iGr` Phnni •
Mailing Address:
Physical Address:
r/�
Facility Contact: C "-c.r iW a 0 i S— Title: ,., i ��� �� %=x= Phone No:
Onsite Representative: tW ec-e-V­ A"Or c-- Integrator: /M - 8�'z"/"
Certified Operator: JrfAyr j+a..1 ke_�' 5 44e-I; Operator Certification Number: I.M9.5 —
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = = f =66 Longitude: = ° 0 ,
Design Current
Design Current
Design
Cntrent
Swine Capacity Population
V4'et Poultry Capacity Population
Cattle Capacity
Population
❑ Wean to Finish
❑ Layer
❑ Dairy Cow
❑ Wean to Feeder
❑ Non -Layer
❑ Dairy Calf
Feeder to Finish IZE80
2-Sex)
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
❑ Non -Dairy
Farrow to Finish
El Farrow
Layers
El Beef Stocker
❑ Gilts
❑ Non -Layers
❑ Beef Feeder
❑ Boars
❑ Pullets
El Beef Brood Co
_ -
❑ 'Furke s
Other
❑ Turkey Poults
❑ Other
❑ Other
Number of Structures:
Discharges & Stream Impacts
�
1. Is any discharge observed from any part of the operation?
El Yes
2 No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
BIN. A
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
[R<A
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
Yes
ElL7
El No
�/
NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
'
NNoo
El NA
El NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
,.',
BIN' o
❑ NA
❑ NE
other than from a discharge?
12128104
Continued

Facility Number: 2 —21,3 Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes /No ElNA ElNE
a. If yes, is waste level into the structural freeboard? ElYes L+1 No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: Laq 1
Spi Ilway?:
Designed Freeboard (in): Yr.22,00
X
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
L 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? El Yes
BNNo
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
3/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
,�_..,,//
IJ No
❑ NA [I NE
maintenance or improvement?
Waste Application
W. Are there any required buffers, setbacks, or compliance alternatives that need El Yes
,,�
L'J No
❑ NA ❑ NE
maintenance/improvement?
] 1. Is there evidence of incorrect application? if yes, check the appropriate box below. ❑ Yes
Eg No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or ] 0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) B@. ✓M M d., C/*y f- e±7 r ti � c.� . S�•f1� �.��.'�r IQ ,S.� Cr�FnJ - W �tt_.�.f - ��e:.us - —
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
NNo
ElNA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
ElYes
,ET
No
L��No
❑ NA
El NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
Z"N'
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
7 No
❑ NA
❑ NE
Comments (refer to gu6stion #): Explain ahy YES answ._ers an any`recommendatious or any other comments.
Usedrawings offacility to better explain situations( su a addrhona! pages as necessary)
Reviewer/inspector Name F,/ e t!e/,$ r> x . ; Phone: 0,433-334d
Reviewer/lnspector Signature: '.cis Rs's.�p �Date: /Z _ p f?Zy0
12128104 Continued

/z -0 0 -O i
Facility Number: 92 2 /3 Date of Inspection -Q f5-3
Required Records & Ducuments
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes O�/�No [I NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check El Yes LTNo ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 21 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 ErNe ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes (FN. ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
Additional Comments and/or
❑ Yes 27
ElNA ElNE
❑ Yes No ❑ NA ❑ NE
❑ Yes Q No ❑ NA ❑ NE
❑ Yes + No ❑ NA ❑ NE
❑ Yes L7No ❑ NA ❑ NE
❑ Yes LRNo ❑ NA ❑ NE
❑ Yes ONo ❑ NA - ❑ NE
❑ Yes IYJ No ❑ NA ❑ NE
❑ Yes L►7 No ❑ NA ❑ NE
❑ Yes ��No ❑ NA ❑ NE
12128104

.. ✓ - &N-S ix -
Type of Visit OMompliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
I ,�..�
Reason for Visit v Koutine 0 Complaint 0 Follow up 0 Referral 0 Emergency Q Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: I7: Yt7 County: aw/ Region: ��
Farm Name: 51`�e.� �°-✓+�--- Owner Email:
Owner Name: Come- I41 )Z e s �t�y Phone:
40.'
Mailing Address:
Physical Address:
Facility Contact: Title: _r51 . _ siP� _ Phone No:
Onsite Representative: - ���-t �� �+ YL Integrator: W^1
Certified Operator: Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm:
Latitude: [=] 0 =' = Longitude: = ° ='
0
Design Current Design `Current -, Design Current
Swine
Capacity Population "W.et Poultry Capac- ity l'opulahori �Catle Capacity Population
❑ Wean to Finish
❑ Layer ❑ Dairy Cow
❑ Wean to Feeder
❑ Non -Layer
I
❑ Dairy Calf
❑ Feeder to Finish
2 � � a vx'. El Dairy Heifer
I?ry Poultry �� s : , El Dry Cow
b ' `'"` ❑Non-Dai
❑ Lavers ;; ❑ Beef Stocker
❑ Non -La ers [] Beef Feeder
El Pullets.
Cow
❑ Farrow to Wean
❑ Farrow to Feeder
El Farrow to Finish
❑ Gilts
r
:i
❑ Boars
010 Beef Brood
❑ Turkeys
'1
Other
;. x
❑Turkey Pouets �.
❑ Other u �Nurnber of Structures:
�
El Other §
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
El Yes
��
o
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
El No
�,/
L� NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
['�]A
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
lA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
2'�7o
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
No
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12128104
Continued

Facility Number: 2 -2/
Date of Inspection
Waste Collection & Treatment ,,��//
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? El Yes 2No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes Imo ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: 0! t
Spillway?: NO
Designed Freeboard (in):
r
Observed Freeboard (in): Z9
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes gfgo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes ETNo ❑ 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 ETNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? [I Yes No ❑ NA [I 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 B 5o ❑ NA ❑ NE
maintenance or improvement?
Waste Application �
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ �
Yes l� 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 101bs ❑ 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) _ �i �. t` Gr, e, SGGw//6^;nJeO,S.J C-0KAf, kJX16. 74- AleAs —
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes I��- <oo ❑ NA El NE
15. Does the receiving crop and/or land application site need improvement? ElL1 Yes nio ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[:] Yes B +�Io ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes [Tgo- ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes L#o ❑ NA ❑ NE
Reviewer/Inspector Name ...� �; ; 015 Phone: 214. 33, 3330
Reviewer/Inspector Signature: Date: /2 -/4 -Zoo
Page 2 of 3 12128104 Continued

Facility Number: L — 249 Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes [B<o ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [3 lvo ❑ NA ❑ NE
the approprrate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other �
21. Does record keeping need improvement? If yes, check the appropriate box below. [I Yes B ivo ❑ 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
2*<o
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
ElYes
El NA
El NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
,0'-Noo
[I NA
[I NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
,L—d,,"N�o
!� �o
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
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
❑Tqo—
❑ 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
13<0
❑ 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
�
B
NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
El Yes
_Now❑
L�'No ❑ NA
❑ NE
Additional Commds n end/or Drawings: `-� ' t )h Y `
AL
Page 3 of 3 12128104

3s�lS lz/19/0a o 7
0 Division of Water Quality
Facility Number �Z L/,3 0 Division of Soil and Water Conservation
- - 0 Other Agency 11
Type of Visit ® Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit O Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of visit: rz -/l D y Arrival Time: /�: ff' Departure Time: /Z: 3d County: Sau-pr—
— Region:
T
Farm Name: Fa v w" Owner Email:
nwnPr Nnmw Cat-1-6"1 L . R--C"5kr Phnnr-
Mailing Address:
Physical Address:
Facility Contact: C9 C,.L Y oZP-<— Title: feeW• ge— c Phone No:
Onsite Representative: Integrator: _ /1 .��
Certified Operator: C6tj-b6,y L . LLi _s w Operator Certification Number: /7S9S
Back-up Operator:
Location of Farm:
Back-up Certification Number:
Latitude: [=o [=r Longitude: =e ❑, =
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population
❑ Wean to Finish
[:]Wean to Feeder
Feeder to Finish Zj?So Z880
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
F
La er
Nan -La et
Dry Poultry
Layers
Non -Layers
Pullets
Turkeys
Turkey Poults
Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Covd
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes [ffNo ❑ NA ❑ NE
[--]Yes
JA No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑NA
❑NE
❑Yes
F41No
❑ Yes
[M No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
12128104 Continued

Facility Number: 82 —213
Date of Inspection /Z-//-6
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
Identifier:
❑ Yes ® No ❑ NA ❑ NE
❑ Yes B No ❑ NA ❑ NE
Structure 5 Structure 6
Spillway?:
Designed Freeboard (in): /9• S
Observed Freeboard (in): Z
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes )] No ❑ NA ❑ NE
(iel large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes M 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 [gNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ® No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes [6No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ElNo ❑ 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 ] 0 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) l3ea•.K (-k,t= A54,, M4 �vv:pr�J purtScCd✓ (-e/N 4dcc, O lUtc.s
13. Soil type(s) /tloA
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes 3No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes
[NNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
'N 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
m No
❑ NA
❑ NE
I Comments (refer to question ft Explain any YES answers and/or any recommendations or any other comments.
fUse drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/Inspector Name �;L ��vL�S Phone: VO, 933. 33'"
Reviewer/Inspector Signature: q,..�,�� Date: / Z - // " zoo 7
12128104 Continued

-71
Facility Number: 82 -Z13 Date of Inspection iZ-/l-Q
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 [ANo ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 10 No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yicld ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
® No
❑ NA
❑ NE
23.
if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
�R No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
RNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
[0 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
14 No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
EM 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
[A 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
V1 No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
® No
❑ NA
❑ NE
nal Comments and/or Drawings:
12128104

rr
Type of Visit 49 Compliance Inspection O Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit 0 Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: Arrival Time: 00!5ram 1 Departure Time: 1 eq:56-CU-1111 County: SOI.1 Region: PAO^
Farm Name: 15-ctr Owner Email:
Owner Name: O' mgerx is Phone:
Mailing Address: 1 � 40 W t 1111l r V\S0 ^ FAY d , C ! i n4y rti /f C _;-93 ai3
Physical Address: t,, '
Facility Contact: itDh I"a'11ST[�' Title:
Onsite Representative: "^" �h t 54e _
Certified Operator: Garr +()V, �r
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
,��y
Phone No:
Integrator. __ MW-a 6,
Operator Certification Number: 17 s-IJn
Back-up Certification Number:
Latitude: = e = , Longitude: = o E_-1 , =
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ -aver
❑Non -La et -
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
l . Is any discharge observed from any part of the operation'?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State`? (If yes, notify DWQ)
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifej
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stoekei
❑ Beef Feeder
❑ Beef Brood Cowl
I
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures:
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes [5�No ❑ NA ❑ NE
❑ Yes
❑ No
[�[NA
❑ NE
❑ Yes
❑ No
EPNA
❑ NE
❑ Yes
❑ No
[ji NA
❑ NE
❑ Yes
FP1 No
❑ NA
❑ NE
❑ Yes
0No
❑ NA
❑ NE
12128104 Continued

Facility Number: Date of Inspection o o O
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 5allo ❑ 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):
N
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
W 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
EANo
❑ NA ❑ NE
8_ Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
W 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
59 No
❑ NA ❑ NE
maintenance or improvement?
Waste ARplication
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
k§ No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
fA No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals
(Cu, Zn, etc.)
[]PAN ❑ PAN > 10% or l0 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of A/c`c.,eptta�bl_e Windows ❑l Evidence of WindDrillDrri_ll ❑ Application Outside of Area
12. Crop type(s) �`_
(Crop
&J-MUL
l�l l CoiS-6I i�f M-15 A (P0.5`�'CJ
f
, SVk4N
�+ _
Grtzt',
lJll�✓50Zd
13. Soil type(s) oA
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
fig 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
W No
❑ NA ❑ NE
Comments (refer to question #): Explain --any YI:S 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 1 ` t I ' I Phone: NO -.3.�
Reviewer/Inspector Signature: Date: /0 06
12128104 Continued

Facility Number: �',L Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ® No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 4�No ❑ NA ❑ NE
the approprrate box.
❑ WUP ❑Checklists ❑Design El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ® No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crap Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
® No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
® NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
U1 No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
Q9 No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
[P No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
E,No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
ZI No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
®No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
® No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
W 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
fKNo
❑ NA
❑ NE
A`dill>ih©nal,Comntenits and/or Drawings:
12128104

*'Division of Water Quality u�
Facllity Number �� 13 Q Division of Soil and Water -Conservation
—�
Other Agency
Type of Visit 49 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit- /y`as✓ Arrival Time: i0: Departure Time: County: s_ sa.� _ Region: r na _
Farm Name: �P�r:ittG� Fay,.: - Owner Email:
Owner Name: 41.e� ,..._ _> •'� Phone: 9eu ' S 9 m
Mailing Address:—/—OqoL.
_ _1,C.1�o�,a��ear.� 61,:,/_01 Al
Physical Address:
Facility Contact: - !!_ s ..,_�;P Title:
Onsite Representative: C n2Vr_ , Req %,S/er _
Certified Operator: a •;s>{rr
Back-up Operator:
Location of Farm:
Phone No:
Integrator:
Operator Certification Number: _fRe
5'
Back-up Certification Number:
Latitude: ❑ o =' ❑ Longitude: [� ° ❑ ,
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population Cattle
❑ Wean to Finish -L
❑ Wean to Feeder
0<eederto Finish �8Q
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other _
❑ Layer
❑ Non -Layer
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Pouits
❑ Other
Discharges & Stream Impacts
1. is any discharge observed from any part of -the operation?
Discharge ori-inated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Capacity Population
I
❑
Dairy Cow
❑
Dairy Call'
❑
Dairy Heifei
❑
Dry Cow
❑
Non -Dairy
❑
Beef Stocker
❑
Beef Feeder
❑
Beef Brood Coy+
b. Did the discharge reach waters of the State'? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures:
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 E to ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑Yes
❑No
❑NA
❑NE
❑ NA
❑ NE
❑ Yes
❑ No
❑Yes
R o
❑NA
❑NE
❑ Yes
90
❑ NA
❑ NE
12128104 Continued

Faculty Number: ,9_? —� Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
M, o
❑ 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): .7.,
Observed Freeboard (in):
S. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
210
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
D-<o
❑ 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
9-&o
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
91�o
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
❑ No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
g 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 Drifl ❑ Application Outside
of Area
1, Z ) 30 3.Sb �s8.7s s e
s`d
12_ Crop type(s) w
13. Soil type(s) o
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
u lVo
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
allo
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination: ❑ Yes
❑ No
❑ NA �E
17. Does the facility lack adequate acreage for land application'?
❑ Yes
No
El NA 21 E
18. is there a lack of properly operating waste application equipment?
El Yes
E❑
654 o
❑ NA ❑ NE
Reviewer/Inspector Name �/11 Phone: lig- y& cave.
Reviewer/Inspector Signature: Date: re -L's- arm
12128104 Continued

Facility Number:,*2 —21_1-1Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes QIlro__ ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes �o ❑ NA ❑ NE
the approprrate box. ❑ " Tom ❑Check ❑ Din ❑❑ Nos'O
21. Does record keeping need improvement? If yes, check the appropriate box below. 0'rs El No ❑ NA ❑ NE
4-11f
-� s y s--�� 3,
to a n ❑.Veekly Freeboard El❑ Sv*Amaiysis ❑ haste-T-ranFi€eaps ❑ a
P-gainfall ❑s�g ❑ ccog iel� ❑ �� tylin�rt lncnPrtinug -;-Monthly and V Rain Inspections ❑�eathe�e-
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes
Q'l�o
❑ NA
❑ NE
'es
❑ No
❑ NA
❑ NE
❑ Yes
Q-<
❑ NA
❑ NE
❑ Yes
9<
❑ NA
❑ NE
❑ Yes
[D-Wo
❑ NA
❑ NE
❑ Yes
M-x-o
❑ NA
❑ NE
❑ Yes QNo ❑ NA ❑ NE
❑ Yes ❑K-o ❑ NA ❑ NE
❑ Yes ❑-<o ❑ NA ❑ NE
❑ Yes e<o ❑ NA ❑ NE
❑ Yes
ETNO o
❑ NA
❑ NE
❑ Yes
EJ No
❑ NA
❑ NE
A�d�d�tJr galrComments and/or`-DraRuigs r
" Z g
Please
ke-e /iO
'f«r4o. j r Geur�J a+1�
��//'+ / /
/'Ge.'y�T4/� /'Geor�S ems+ �+/��oM✓r�
/e..e
ri71*7 4�d r�,�C,at -?Oar
r
h
/ / /
4 e p�tfej afar '
ink
Lt P Gvas><e e:
/O 'CAI
12128104

Type of Visit ® Compliance Inspection O Operation Review O Lagoon Evaluation I
Reason for Visit & Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access I
ri ir_ruri.�rrr ri .rwtr r��i irr.�r�
Facility Number
Date of Visit: —�U 'isme:
2 �
O Not Operational O Below Threshold
i
UPermitted Certified [] Conditionally Certified [3Registered Date Last Operated or Above Threshold: ....... _. -__..
Farm Name: .............joee ,1.Pn......... e n�..........._...... .. County:........
Owner Name: ,0
.........rr., �_ ..._...... „t..� L S .: _ ._._._....__ ........ Phone No: _1. �?.`1�:...�J 2.
N4ailing Address:
Facility Contact. ........ ...... Title: .. . ...... . ........ . ........ . . .... Phone No:
Onsite Representative: 1.......Q
Integrator•. /l7 vt^
_._. �.....I...._.--•............................ _..._ _. ..
Certified Operator: ............ c1l�nrs._ L ...._R' t?�e� ........-----..._--• Operator Certification
Location of Farm:
wine ❑ Poultry ❑ Cattle ❑ Horse Latitude u• 4 C4 Longitude • 4 �C.1
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes [two
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes o lco
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑1[o
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 O-No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes 0`No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes Rio
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes eiq—o
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: .............. I................... ................
Freehoard (inches):
12112103 Continued

Facility Number: ._,� Date of Inspection 7 0
Required Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes [-Ne"_
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(iel WU11, eci 'sts, AmAOmapg,-etc.) ❑ Yes Q-No
23. Does record keeping need improvement? If yes, check the appropriate box below. ❑Yes C3-No
❑ DPP n ❑TTUeb=d- ❑- C-f�t� lysis ❑ Soil tpling--
--`i 7 0?- 7 //- /p —2 _). -2-
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes ON
25. Did the facility fail to have a actively certified operator in charge? ❑ Yes [-iota`
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes 194w--
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes P� [1'
28. Does facility require a follow-up visit by same agency? ❑ Yes 0-Ma
29. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes 9446'
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35) es ❑ No
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? es ❑ No
32. Did the facility fail to install and maintain a rain gauge? ❑ Yes e-NS
33. Did the facility fail to conduct an annual sludge survey? ❑ Yes 9-No
34. Did the facility fail to calibrate waste application equipment? ❑ Yes 0-Nb
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below. ❑ Yes &W
❑ Steel g Fert ❑ e ❑ Rztrnfa}}— ❑ Iff
❑ 120 Minute Inspections ❑ —
© No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
ddtttonal Commcnts a—n'c ov Drawingsu
.�. r�:,s 3,✓'r".,x�" ->c �s:u_E°::::.-.i`-a^.....;.:. ., ....----z._�.^-- �. ...--
/O/e e
gasp
�.id6le
aKa%.f!f .�.�
`'al4/
ITr. RFyiJe,,
Au,
s,'I -ie
pYlSPh�
�ii/` l�nG
R�/
Lt/Rs�[
al'Vbea h0%i
!°Vee, �s !
12112103

Facility Number: fj — Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, [j Yes L No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑ Yes
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes la' o
8. Does any part of the waste management system other than waste structures require maintenancelimprovement? ❑ Yes E?1oo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes [moo
elevation markings?
Waste Application
10. Are there any buffers that need maintenancefimprovement? ❑ Yes 0-Ko
I I . Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes OXo
❑ Excessive P��JJonding ❑% PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑]Copper and/or Zinc
12. Crop type E�77r /h✓cI7�3 •, _ .`/G•t] 1 �C�/� /� r1„2 r!��(�
- ^
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes Dwo
14. a) Does the facility lack adequate acreage for land application? ❑ Yes ©-No
b) Does the facility need a wettable acre determination? ❑ Yes ❑-No
c) This facility is pended for a wettable acre determination? ❑ Yes 92-Na
15. Does the receiving crop need improvement? ❑ Yes [- - o
16. Is there a lack of adequate waste application equipment? ❑ Yes ELNO-
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 [}No
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes GNO
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 O-No
Air Quality representative immediately.
Comments (refer to gnestzdn) Explarn any YFS answers andlor any. recommendatir3ns arany other commeuts: -
Dse drawuzgs of facility to better exp�arn sitnabo s. {nse addtttona! pages ass necessary) [IReld Copy ❑ Final Notes
k x s
/,G/]S 7to _Vro / ! Or Lvee4lj as CC �rP✓� ?r+'�2 �/�ICGf['�C �
T
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date: ,20 G
12112103 Continued

Site Requires Immediate Attention: NZ)
Facility No.
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: , 1995
Time:
Farm Name/Owner: C M d Etl LF E. fZ F G 19-
Mailing Address: RL a , i Rex _3 3 A �_S.L,,.rj-r QA PLC_ - ? RA 2_$
Courity: — - s --- P C^ _ -
Integrator: _ RR, Qhj'c 121- o,A R o L l &A Phone: a
On Site Representative: SQ d %/ 9 ni A g ck i s; k 2 Phone:
Physical Address/Location: o
3:1o1J Or- _crt 11 941 ALE ak _j atu.o2A grzr.o
R
Type of Operation: Swine X Poultry Cattle
Design Capacity: Number of Animals on Site: P.XR 6 EIVEl rt�cn1G
DEIM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: Longitude: "
Circle Yes or No
Does the Animal Waste Lagoon have sufficient fieeboard of I Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches) es r No Actual Freeboard: ? S Ft. Inches
Was any seepage observed from the lagoon(s)? Yes or(F Was any erosion observed? Yes o>(1
Is adequate land available for spray? (9 or No Is the cover crop adequate? (S)or No
Crop(s) being utilized:
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings . es r No
100 Feet from Wells? es r No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes o 1Qo
Is animal waste land applied or spray irrigated within 25 Feet of a TJSGS Map Blue Line? Yes "`s)
Is animal waste discharged into waters of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes o No If Yes, Please Explain.
Doesthe facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop) . Yes r No
Additional Comments:. 4 E,1_,S,Sr_s T-+-io LN,&�j, g_
AECrtSTE2 G1)
f v 9A CE197
L Fry
Inspector Name
K 4 13s Signaturell
cc: Facility Assessment Unit Use Attachments if Needed.

BROWN'S
OF CAROLINA
f!
L�AVF:N RErISTER - a
(4) 720 FAG N a3mTy
s ■'{Df+iifi•.ms FMM/• ' MUM E[IGEWAY 24 ToTUMMY'
! ' '+; ]•1 •. • �' i 1 1 �•
■ 1'1�•i •. t FROM CLINTCN TAKE HIGEWAY # 403• f■ 1 BE CH L:I
RIGHT JUST PAST '!'
fY i • NC.28328 ter. s. q ■ . . malff
I •• /:' 2832