820317_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental Qual

(Type of Visit: k�Comp lance Inspection U Operation Review O Structure Evaluation p Technical Assistance
!!Reason for Visit: vutine O Complaint O Follow-up O Referral O Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Fdp Departure Time: c - County:
Farm Name: iA )�/tc Ct,-.-ek Owner Email:
Owner Name: %z- %rL' -A A, I R pD r z- Phone:
Mailing Address:
Physical Address:
Region:
Facility Contact: r r�r �� _ Title: I t' �C _ Phone:
Onsite Representative: -;x pr7� C Integrator:
Certified Operator: % ��% z-j f IYl Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design
Current
Design
:Curren#
Design Cnrre it
Swrne
Capacity
Pop.:
Wet Poultry
Capacity
., Pop
!'
Cattle Capacity Pop.
Wean to Finish
La er
Dairy Cow
Wean to Feeder
Dairy Calf
Feeder to Finish
6 L`
J o O
°
Dairy Heifer
Farrow to Wean
Design
Curren#
Cow
Farrow to Feeder
D : Ponl
Ca aci
i P:o
Non-Dai
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
I
jBeef Feeder
Boars
Pullets
Beef Brood Cow
j.'
Turkeys
Other
T urkey Poults
Other
Other
Discharees and Stream Impacts
I. Is any discharge observed from any part of the operation? ❑ Yes [J No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? [:]Yes [-]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)
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
E3<o
❑ NA
❑ NE
❑ Yes
D-lgo
❑ NA
❑ NE
Page 1 of 3 21412015 Continued

fF—acilityNumber: 4p, - 3f7-1 Date of Inspection -
Waste Collection & Treatment
44. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes to ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): &
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[] 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
E]<o
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat, notify DWR
7. Do any of the structures need maintenance or improvement?
Yes
No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[a -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 U 14o ❑ NA D NE
maintenance or improvement?
Waste -Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ONo ❑ NA ❑ NE
maintenance or improvement?
l 1- Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes EjNo ❑ 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 Driift�❑ Application Outside of Approved Area
12. Crop Type(s): — e!�70�%
13. Soil TYpe(s)
14. Do the receiving crops differ from those designated in the CAWMI'?
❑ Yes
[i] 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
E]-go-
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[nNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[] No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
Q o
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[3] No
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑Stocking [:]Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
[:]Yes
[fNo
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[]/No
❑ NA
❑ NE
Page 2 of 3
21412015 Continued

Facility Number: I Date of Inspection:
/
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
ETNo
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
E] N
❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge
levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes
[3 o
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
[:JNo
O NA ONE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
El -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
J 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
0fo
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below.
[j 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
[Dl�o
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
[]'—No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
0' io
0 NA
❑ NE
B--Z_' ,w 3^4,
� ' �+L ""I --y b '�- �j o w-
Reviewer/Inspector Name:
Reviewer/Inspector Signatut
iddithiiial rec©n
/—/`1 - I Y
Phone: o3fl3 also
Date: j
21412015
Page 3 of 3

Type of Visit: [Compliance Inspection V Operation Review U Structure Evaluation V Technical Assistance
Reason for Visit: C2r1fo_utine O Complaint O Follow-up O Referral O Emergency O Other 0 Denied Access
Date of Visit: %- Arrival Time: D Departure Time: ,' County: Region:
Farm Name: Owner Email:
Owner Name: j'(crtn z. ��� 1 %�Dt9/-c Phone:
Mailing Address:
Physical Address:
Facility Contact: �� �� ,r /` m� cY`L _ Title:-;
Onsite Representative: 6 i0-r 1�/*z-__
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator:
Certification Number: o�
Certification Number:
Longitude:
Design Current a Design Current
Swine`' @a aci Po Wet Poult . @a aci Pot.
I? h' p• �7' p tY P
Design Current
Cattle Po aci Ca
p h" p•
Wean to Finish
iry Cow
Wean to Feeder
iry Calf
Feeder to Finish
Farrow to Wean
D
(rU
I?esign `Current
D . I'-,oul .F Ca' aci Po P.
Dairy Heifer
Dry Cow
Farrow to Feeder
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Turke s
Turkey Poults
Other
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 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 PS.No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
0 Yes ❑ No ❑ NA ❑ NE
❑ Yes
❑ No
[:]Yes
RNo
❑ Yes
PNo
❑ NA
❑ NE
❑ NA
❑ NE
❑ NA
❑ NE
Page 1 of 3 21412015 Continued

FaciliNumber: IL :3) Date of Inspection:
Waste Collection & Treatment
�i 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
PS 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): L 9-
Observed Freeboard (in): JID
5_ Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
M No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
fe;2t1i 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
jo No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
,ENo
❑ 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 ELNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes E4,No ❑ NA ❑ NE
maintenance or improvement?
11. is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [K.No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
Jallo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
ZLNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[LNo
❑ NA
❑ NE
IS. is there a lack of properly operating waste application equipment?
❑ Yes
['No
❑ NA
❑ NE
_Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
® No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
[] Yes
No
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other.
21. Does record keeping need improvement? if yes, check the appropriate box below.
❑ Yes
[ No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
[ ] No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[Z No
❑ NA
❑ NE
Page 2 of 3
2/4/2015 Continued

Facility Number: f 7 1 Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ® No 0 NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [—]Yes Z[No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail 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 the drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes ® No ❑ NA ❑ NE
❑ Yes LN_ No ❑ NA ❑ NE
❑ Yes [R No ❑ NA ❑ NE
❑ Yes ® No 0 NA ❑ NE
❑ Yes
®No
❑ NA
❑ NE
[:]Yes
N No
[_]NA
❑ NE
❑ Yes
®-No
❑ NA
❑ NE
Comments {refe'r to 4uestion,#} Explain.any YES Ads*ers and/or any. Additional, recommendations or, any other comments ,� i
Use drawia s of factli to hette3r ei lain situations use additional es as necessa t
g ty. P ( �g ry)• .
Reviewer/inspector Name:
Reviewer/inspector Signatui
Page 3 of 3
Phone:
Date:
21412015

V410
UDivision of Water Resources
Facility Number ®- 17 O Division of Soil and Water Conservation
O Other Agency
Type of Visit: ompliance Inspection 0 Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: outine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: - a' Arrival Time: 'fl Departure Time: County: Region: /70
Farm Name: UJ ma Cr
z,- Fa.r-ln Owner Email:
Owner Name: 1 In Phone:
Mailing Address:
Physical Address:
Facility Contact: t�'�r�-r/ f �i'i r�/'"r Title: 5Phone: /
Onsite Representative: Integrator:
-� 4 —
Certified Operator: ACV- r7hv i— %% �r /Y� f Certification Number: 2 9,ZZ0 3
Back-up Operator:
Location of Farm:
Certification Number:
Latitude: Longitude:
Design Current Design Current
Swine Capacity Pop. Wet Poultry Capacity Pop. Cattle
Wean to Finish
Wean to Feeder
eeder to Finish 00
Farrow to Wean
farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Layer
Non -La er
Pullets
Other
Poults
Design Current
Discharges and Stream Impacts
i . Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
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?
Design Current
Capacity Pop.
Dairy Cows
Dairy Calf
Dairy Heifer
Dry Cow
.Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes J,No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes [:]No
❑ Yes js.No
[:]Yes 1No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3
21412015 Continued

Facili Number: - 3 f Date of Inspection:
_ Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 0 No ❑ NA ❑ NE
a. if yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
o No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[N 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
LaNo❑
NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land 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 l0 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): CfJ%✓t
.. / -13. Soil Type(s): g---� l�s,.� 'v/ ��
14.
Do the receiving crops differ from those des Hated in the CAWMP? If
❑ Yes
D4,No
❑ NA
❑ NE
15.
Does the receiving crop andlor 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
[�J_No
❑ NA
❑ NE
acres determination?
17.
Does the facility lack adequate acreage for land application?
❑ Yes
Eallo
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
[RNo
❑ NA
❑ NE
Required
Records & Documents
19.
Did the facility fail to have the 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
allo
❑ 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 SNo
❑ 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 faciiity fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ;&No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
DNA ❑NE
Page 2 of 3 21412015 Continued

Facili Number: - Date of Ins ection:
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
allo
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
[allo
❑ NA ❑ NE
the appropriate box(es) below.
Failure to complete annual sludge survey []Failure to develop a POA for sludge levels
Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes
C�g_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?
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
❑ Yes ®,No ❑ NA ❑ NE
[:]Yes �ANo ❑ NA ❑ NE
❑ Yes lm No ❑ NA ❑ NE
❑ Yes allo ❑ NA ❑ NE
❑ Yes MNo
❑ Yes ® No
[-]Yes R1 No
❑ NA ❑ NE
❑NA ❑NE
❑NA ❑NE
Phone:
Date:
214120I S

Facility Nun
F
ype of Visit:
eason for Visit:
1
Inspection U Operation Review U Structure Evaluation Q Technical Assistance
0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: 1 Arrival Time: 3, Departure Time: 3 ES County Region:/--�Z
14-11
Farm Name: Y At-r ��1`Z-r {� �`�'f"-� Owner Email:
Owner Name: r10 tiTi` %� i /� ��' '% Phone:
Mailing Address:
Physical Address:
Facility Contact: �'�-f x / ✓�'! Oc�2 Title:
Onsite Representative: Jf z—
Certified Operator: ftr r7 -7-��
z— e' • Phone:
Integrator: 1'tT
Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current
Design
Current
Design Current
Swine Capacity Pop.
Wet PIltry
Capacity
P.
Cattle
Capacity Pop.
Finish
La er
Dai Cow
Feeder
Non -La er
Da' Calf
o Finish ,D n 17
Da' Heifer
o Wean
E
Design
Current
D Cow
o Feeder
D . 1',oult ,
Ca aci
P,o
Non-Daio
Finish
La ers
Beef Stocker
Non -La ers
Beef Feeder
Pullets
Beef Brood Cow
Turke s
Other
Ll
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes 53-No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
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 [n�No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes [No ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 21412014 Continued

Facility Number: - 3 J Date of Ins ection: — - /
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes �o ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No D NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
[:]Yes
® 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
J No
❑ NA
C] 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
�ZNo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
[:]Yes
allo
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
2 -No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
f4 No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
[:]Yes
allo
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved
Area
/
12. Crop Type(s): Co "rt (LWftr / 5 6��-•:��11'I^-
13. Soil Type(s):h� (Nd a •�-� lip l��
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
Ul"No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
[&No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
0 No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[LNo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
,E�LNo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
MNo
❑ 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. [D Yes kNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis [:]Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall [] Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ,&No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes gNo ❑ NA ❑ NE
Page 2 of 3 21412014 Continued

Facility Number: - J Date of Inspection:
�. 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 ® No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes 0 No ❑ 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 � No ❑ NA ❑ NE
[:]Yes ® No ❑ NA ❑ NE
❑ Yes ®No ❑ NA ❑ NE
❑ Yes 10 No ❑ NA ❑ NE
❑ Yes � No
❑ Yes 0 No
❑ Yes tallo
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
Comments (refer.to question;#.) ;Eaplaun any; YES a..nswers>and/or any addrtiona) recommendatlonsior any,other comments: 1'
Use drawings of facility to better e=ptain situations (use additional pages as necessary.),
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date:
21412014

I
Type of Visit: 9<ompliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: 0-1routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: ® Arrival Time: ! 3 D Departure Time: U-7-7h-7-1 County - s�D— Region:1
Farm Name: LC% J/1 r_ ee-ZI-fC /'—a" Owner Email:
� I
Owner Name: /%jY i Xoo Y Z Phone:
Mailing Address:
Physical Address:
Facility Contact: ��rrd' XIWDDlL Title: 24el
Onsite Representative: sue: 172 y Z ji70,e r C_
Certified Operator: n rJ' A" z i_I /%I 00/c
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator: /711AI'P4 z;Ca lV"_
Certification Number:
Certification Number:
Longitude:
Swine
Wean to Finish
Design Current
Capacity Pop. Wet Poultry
MW
Layer
Design Gurreut
Capacity Pop. Cattle
iry Cow
Design Current
Capacity Pop.
Wean to Feeder
Non -La er
I ' Calf
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
W D
c{ ov
Dr, foul
La ers
Dai Heifer
Dry Cow
Ca aci Pip P. Non -Dairy
Beef Stocker
Beef Feeder
I 113eef Brood Cow
Gilts
Boars
Non -La ers
Other
Other I I I 10ther
Turke s
Turkey Poults
Discharrees 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 E� No ❑ NA ❑ NE
❑ Yes [] No ❑ NA ❑ NE
❑ Yes [] No ❑ NA ❑ NE
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 Q No ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of
21412014 Continued

Facility Number: - Date of inspection: J
1 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): ��L
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes [Z 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 4 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 LK No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes [R No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require [:]Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [ No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ®No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop jWindoyw / ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
/ LUf�
12. Crop Type(s): Co/n -5Dri6 s,
13. Soil Type(s): ZL2 / vi Y.
-
14. Do the receiving crops differ from those esignated in the CAWMP?
[:]Yes
® No
❑ NA
❑ NE
IS. Does the receiving crop and/or land application site need improvement?
❑ Yes
10 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
ER No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[K No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
fo No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[gNo
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ 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 L. No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [3-No
[DNA ❑NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑ NA ❑ NE
Page 2 of 3 21412014 Continued

Facility Number: Date of Inspection: /j — -7— if
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑Yes Callo
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 tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes � No ❑ NA ❑ NE
❑ Yes ®, No ❑ NA ❑ NE
❑ Yes R[ No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes ® No
❑ Yes [ No
❑ Yes No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question #�: Explain any YES answers and/or any additional recommendations orjany other co_mments� a
Use drawings of facility to better explain situations (use additional pages as necessary).,:
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date:
21412014

Type of Visit: &Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: V xoutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: L, Arrival Time: ��� Departure Time: / a s O I County: Region:
Farm Name:
Owner Name: /j co,-,-- 7r•
Mailing Address:
Physical Address:
Owner Email:
Phone:
Facility Contact: r�- /"en- Title: Phone:
Onsite Representative: �jr ,.,r /IlDc'- j ,y2a,/ Lgrr Integrator:
Certified Operator: nrj7��_j�j AA -If y is r Certification Number: 9_9A;;7_8
Back-up Operator:
Certification Number:
Location of Farm: Latitude: Longitude:
Design
Current
Cu"rrerit
DesignCnSwine
Capacity
Pop R'et Poultry[Design
apacity
Pop
Cattle Capacity Pop.
an to Finish
La er
Da Cow
an to Feeder
Non -La er
DairyCalf
der to Finish
Qa
=
�'
'1,.
y y:"
DairyHeifer
row to Wean
Design
Criirrent
Cow
row to Feeder
t
D , P,oult ,
@a .aci
Po
Non -Dairy
row to Finish
LayersN.
Beef Stocker
s
Non -La ers
Beef Feeder
rs
Pullets
rood
Beef Brood Cow
a=..,..
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-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 [a -No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
[:]Yes ❑ No [] NA ❑ NE
❑ Yes
❑ No
❑ NA
[] NE
[:]Yes
fR!.No
❑ NA
❑ NE
❑ Yes
a No
❑ NA
❑ NE
Page I of 3 21412011 Continued

Facility Number: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
® No
❑ 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): o_
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
®--No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
0 No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
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
EL No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[2 No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes gLNo ❑ 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 l ❑ Evidence of Wind Drift / ❑ /Application Outside of Approved Area
12. Crop Type(s): ey pt 1W1, 20 /s�� , /T '/�1r a X #.ems / s�f /�,/�
13. Soil Type(s): .
14. Do the receiving crops differ from thos designated in the CAWMP?
❑ Yes
0 No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
5j�No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
0 No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
®, No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
K No
❑ NA
❑ NE
Reauired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[A No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
54 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
5� No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking [:]Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
[LNo
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
C&No
❑ NA
❑ NE
Page 2 of 3 21412011 Continued

1
Facility Number: fr- Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No
25. is the facility out of compliance with permit conditions related to sludge? If yes, check [:]Yes ® No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey []Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes gLNo
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?
24. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ Yes P_No ❑ NA ❑ NE
❑ Yes fi4 No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes rkL-No ❑ NA ❑ NE
❑ Yes
0 No
❑ NA
❑ NE
❑ Yes
[4 No
❑ NA
❑ NE
0 Yes
[allo
❑ NA
❑ NE
Comments;(refer to question # ): Explain any YES answers and/or any additional recommendations or any otlier'comments
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: �3Do
Date:
21412011

iviseon of Water Quality -- l t —13
Facility Number ,Division of Sail and Water Conservation
0 Other Agency
Type of Visit: Mompliance Inspection 0 Operation Review O Structure Evaluation p Technical Assistance
Reason for Visit: outine O Complaint O Follow-up O Referral 0 Emergency O Other O Denied Access
Date of Visit: Arrival Time: -o Departure Time: 3 ; County: S' o� Region:
Farm Name_ �,{
C
r
Fa en1.
' Owner dame: _�
� � n �
��
.Mn o r' �r_
T-r
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative s-/ /j2Dor Y z Uj� rt cy xe---
Certified Operator:ff-Zf Alz,i
Back-up Operator:
Location of Farm:
Owner Email:
Phone:
Title: r-G.
Integrator: a ✓
Certification Number: 1�D
Phone:
Certification Number:
Latitude: Longitude:
_ Design
Swine ,Capacity
Cnrrent
Carrent.�,.Cag(
Pop Wet Poultry Pop.
Design Current
Cattle Capacity Pop.
Wean to Finish
La er
Dairy Cow
Wean to Feeder
Non -La er
I
I
Dairy Calf
Feeder to Finish
fJ'o
Cp
- `'sue"
Daia Heifer
Farrow to Wean
©es�ign Current
Dry Cow
Farrow to Feeder
Dry P,oultr Ca "-aci P.o .
Non -Dairy
Farrow to Finish
jBeef Stocker
Layers
Gilts
Non -Layers
JBeef Feeder
Boars
Pullets
01 jBeef Brood Cow
ro
Turkeys
Other :, r
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes J,No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
[:]Yes ❑ No
❑ Yes No
[:)Yes NLNo
❑NA ❑NE
❑NA ❑NE
❑NA ❑NE
Page I of 3 21417011 Continued

Facility Number: -317 Date of Inspection:
Waste Collection & Treatment
1 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): / dj-
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
[—]Yes
KLNo
❑ 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
54 No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
jQ No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
P No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes nNo [DNA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved. Area
12. Crop Type(s): jar—i.� /p�'rs7- 'Z/ -
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 MNo ❑ 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 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 [Z 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 0 No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes kC No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: - DDate of Inspection: — /�
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
No
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
No
❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
❑ Yes
No
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
No
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
r71 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
M No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? if yes, check the appropriate box below.
❑ Yes
® No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
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
g] No
❑ NA
❑ NE
Comments (refer to question#): Explain any YES answers and/or any additional recommendations.or any othericommienU_.
Use drawings of facility to better explain situations (rise additional pates as
Reviewer/Inspector Name: Phone: 9/D y�
J
Reviewer/Inspector Signature:
Page 3 of 3
Date: f"2
21412011

0
Type of Visit: (#^Compliance Inspection U Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: tine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: Departure Time: fl 3a CountysRegion:'
Farm Name: "', Owner Email:
Owner Name: u%; Z I., j+ BE We— I 1 Phone:
Mailing Address:
Physical Address:
Facility Contact: w i c+..' Fp W r (( Title: &C.0 1 YJ La Phone:
Onsite Representative: S e�
Certified Operator: 1��
Back-up Operator:
Location of Farm:
Latitude:
Integrator: IWWW6
Certification Number:
Certification Number:
Longitude:
Des�gn� Current,
MIHPIfk.Ca p�acEtyop y et Poultry Capty Pop
Cattle
Capacity Pop.
Wean to Finish ELLa er
Wean to Feeder„ Non -Layer
Da Cow
a D Calf
Feeder to Finish J pp
Da' Heifer
Farrow to Wean Design Current
D Cow
Farrow to Feeder D , P,oul
Ca aci P,o P.
Non -Dairy
Farrow to Finish Layers
Beef Stocker
Gilts Non -Layers
Beef Feeder
Boars Pullets
Beef Brood Cow
Turkeys
Other TurksPoults
Other I 10ther
Discharzes and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
[:]Yes MLNo ❑ NA ❑ NE
[3 Yes
[] No
❑ NA
❑ NE
[D Yes
[] No
[DNA
❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes ❑ No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes 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 21412011 Continued

Facili Number: -717 Date of Inspection: /
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):�
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
Pq 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
5Q 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?
2g 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
[a No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
[:)Yes
[�No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes � No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): &/" /j3,ir161-s'
13. Soil Type(s): ry'
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [&No ❑ NA ❑ NE
• f
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [RNo ❑ NA ❑ NE..,
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes No ❑ NA ❑ NE . r
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
RNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
q No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
M No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
[]Yes
VRJ'No
❑ NA
❑ NE
the appropriate box.
4.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
[]Other:
1
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
VqNo
❑ 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
[S�No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
R No
❑ NA
❑ NE
Page 2 of 3
21412011 Continued

Facility Number: -3 Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
& No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
CK No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
❑ Yes
§� No [] NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
23,No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
BNo ❑ 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
PitNo ❑ 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
gKNo ❑ 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
FO 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
RNo
❑ 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
FUNo
❑ NA
❑ NE
Comments (refer to question ft Explain any YES answers and/or.any additional, recommendations or any other comments. -
Use .drawings of facility. to better explain situations (use additional pages. as necessary)..
_
el D
c �
Reviewer/Inspector Name: Phone: 21�3300
Reviewer/Inspector Signature: Date:
Page 3 of 3 21412011

- iivis`ion of Water Quality
Facility Number ®- ,3) ®Division of Soil and Water Conservation � . �/ f
QQ Other Agency
Type of visit: ompliance Inspection 0 Operation Review p Structure Evaluation O Technical Assistance
Reason for Visit: &I routine O Complaint Q Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: ,'DD Departure Time: ; c7 County: Region:
Farm Name: awn-11Fkr - Owner Email:
Owner Name: i� t_ �1 �1u ef- Foto e—/l Phone:
Mailing Address:
Physical Address:
Facility Contact: �%i��F+e.� %�ou�r r/ Title: Phone:
Onsite Representative:
Certified Operator:'���, -
Integrator:
Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current
Design
Current
Design Current
Swine
Capacity Pop.
Wet Poultry
Capacity
Pop.
Cattle
Capacity Pop.
Wean to Finish
La er
DairyCow
Wean to Feeder
-Layer
DairyCalf
Feeder to Finish
04
DairyHeifer
Farrow to Wean
Design
Current ,
D Cow
Farrow to Feeder
D ,P©il
Ga aci
Po P.
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
Tu ey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes gg..No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
0 No
❑ NA
❑ NE
❑ Yes
1Z No
❑ NA
❑ NE
Page 1 of 3 21412011 Continued

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

Facili Number: X2 -3I Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes Ej No ❑ NA ❑ NE
25. Is the facility out of compliance with permii conditions related to sludge? If yes, check ❑ Yes ® No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ® No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
Q 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
[Z No
❑ NA
❑ NE
33_ Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
No
❑ NA
❑ NE
Comments (refer to question.ft Explain any YES answers and/or any additional recommendations or: any other comments..
Use drawinns of facility to better exolain situations fuse additional oases as necessarvl .
_'��7p,,_ , _� j �-�--,.
rh "5
Reviewer/Inspector Name:
Phone:p df33 - �3 ao
Reviewer/Inspector Signature:
Page 3 of 3
Date: % / f
21412011

Type of Visit Q-Compliance Inspection 0 Operation Review 0 Structure Evaluation O Technical Assistance
Reason for Visit D46-utine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit:
Arrival Time:
; Q
Departure Time:
,'/
County: .'-- Region: D
Farm Name: �Euzc�-./&
�ariy�
- Owner Email:
Owner Name: &2,- //:
� _
�a u% r
_ _ Phone:
Mailing Address:
Physical Address:
Facility Contact: T' Law— r11__ Title: Phones No:
Onsite Representative: Sr _ __ Integrator: IX uOls
Certified Operator: Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: ❑ o = I ❑ u Longitude: ❑ o = 1
Design
Current
Design Current
Design
Current
ne
Capacity
Population
Wet Pouulltt Capacity Population
Cattle Capacity
PoL.pulation
�7EJWean to Finish
❑ La er
❑Dai CowWean
to Feeder
❑Non -La er
❑ DairyCalf
Feeder to Finish
1/00
c7
Dry Po_ ultry
❑ La ers
❑ DairyHeifer
❑ D Cow
Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑Non -La ersPullets
Beef Stocker
El Pullets.
❑ Beef Feeder
❑ Beef Brood Cowl
EGilts
Boars
❑ Turke s
other
❑ Turke Poults
10 Other
Number of°Structures:El
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes ®..No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
RNo
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
RNo
❑ NA
❑ NE
other than from a discharge?
12128104 Continued

` Facility Number: — Date of Inspection /®
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ® No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 2 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 RNo ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
KNo
❑ 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
0-No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
® No
❑ NA
❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
[[ No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil.
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of
Area
12. Croptype(s) / Ys 47vr/3rr�
13. Soil type(s)'�.�i-�—
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?
291yes
❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
a No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
RNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
Z�No
❑ NA
❑ NE
fer to question-# Explain an YES answers and/or an recommendations or any other comments
Use dranwm{s of facili #o better eg lain situations. use additional a es as...necessary
q ) p Y Y�
g ty P { P g cessary) 1 �p
4cgv IJ
Reviewer/Inspector Name �''$t "' Phone:
Reviewer/Inspector Signature: Date: �// 12'�s�/o
Page 2 of 3 ' 12128104 Continued

Facility Number: Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 0,No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes &No ❑ NA ❑ NE
the appropriate box. ❑ WUp ❑ Checklists ❑ Desi g n El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 0,No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections [:]Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes allo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes �No El NA El NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
0,No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
ERNo
❑ 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
Otherlssues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
allo
❑ 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
E.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
ERNo
❑ 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
O No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
[ZNo
❑ NA
❑ NE
AdditionaLComments`andlor Draw
►ngs
Page 3 of 3 12128104

Type of Visit A compliance Inspection 0 Operation Review O Structure Evaluation 0 Technical Assistance
Reason for Visit outine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: d— Arrrival Time: i i� Departure Time: ® County' ��'—' Region:
Farm Name: fo%VL" ` fI oc:�►'v%._ _ _ Owner Email
Owner Name: U t �� tt?'► `� f Di,U� lj Phone:
Mailing Address:
Physical Address
Facility Contact: _1 1 ! 11 444`1-1 Title: 4�wm& t Phone No:
Onsite Representative: , ��� Integrator:
Certified Operator: Operator Certi cation Number:
Back-up Operator:
Location of Farm:
Back-up Certification Number:
Latitude: n Longitude: =
u
Design Current
Design
Curren# Design Current
Swine
Capacity Population
Wet Poultry
Capacity
Population Cattle Capacity Population
❑ Wean to Finish
❑ Layer I
JE1 Non -Layer I
I ❑ Dai Cow
❑ Da4y Calf
❑ Dairy Heifer
❑ Wean to Feeder
Feeder to Finish
❑ Farrow to Wean Dry Poultry,
❑ D Cow
❑ Farrow to Feeder
El Non -Dairy
❑ Farrow to Finish ❑ Layers
❑ Beef Stocker
❑ Gilts ❑ Non -Layers
❑ Beef Feeder
❑ Pullets
❑ Boars
❑ Beef Brood Cowl
❑ Turke s
Other ❑Turke Poults
❑ Other ❑ Other
Number of Structures:
Discharges & Stream Impacts
. is any discharge observed from any part of the operation?
❑ Yes
bNo
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
[:]No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
X No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
ANo
❑ NA
❑ NE
other than from a discharge?
12128104
Continued

Facility Number:
aX
Date of Inspection 0;; 0
Waste Collection & Treatment
- 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
��}},,��
El Yes IZTNo
❑ 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 9-No
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes 9No
❑ 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?
FAves ❑ No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes !$JNo
❑ 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 C-No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes P No
❑ NA ❑ NE
maintenance/improvement?
11. is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes KNo
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13.
Soil type(s)�Q--�� v
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
RNo
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
J& No
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
UNo
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
RNo
❑ NA
❑ NE
Gomnients (refer to question.#): Explain any,YES answers and/or any.recommendabnns ar3anylother�comments
.Use drawings of facility to better explain situations. (use additional pages asnecessary)s ►�.d`° y
Reviewer/Inspector Name _ram Phone:a1�33
Reviewer/Inspector Signature: Date: /d -4-IR0
LZAM/U4 c.onnnuea

Facility Number: Date of Inspection O
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes M No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 25 No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 9No ❑ 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
j-No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
f.No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
RTNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
RNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
Wo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
O�No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
010
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
0No
❑ 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
glo
❑ 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
RNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
t&No
❑ NA
❑ NE
12128✓04

a
Type of Visit
ompliance Inspection
0 Operation Review 0 Structure Evaluation
0 Technical Assistance
Reason for Visit
outine 0 Complaint
0 Follow up 0 Referral 0 Emergency
0 Other ❑ Denied Access
Date of Visit: Arrival Time: ; Departure Time: .3 D County Region:l /'
Farm Name: IV (A_J 'e I F-4.z-% / Owner Email:
Owner Name: 1.L/ r %�. n-`-� �f]GU /� _ __ __ Phone:
Mailing Address:
Physical Address:
Facility Contact: A , d"'. ���C l / Titic
Onsite Representative: S'—
Certified Operator:
Phone No:
Integrator:
Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: = c [=] I Q u Longitude: = ° ED I = U
Design Current
-Design Current
Design Current
Swine
capty Population
WVP
Wet Poultry Capacity Population
Cattle Capacity Population
❑ Wean to Finish
❑ Layer
❑ DairyCow
❑ Wean to Feeder
❑Non -Laver
❑ DairyCalf
Feeder to Finish
❑ Da Heifer
❑ Farrow to Wean
Dry Poultry
❑ D Cow
❑ Farrow to Feeder
ElNon-Dairy
El Farrow to Finish
❑ Layers
❑ Beef Stocker
❑ Gilts
❑ Non -Layers
❑Beef Feeder
❑ Boars
❑ Pullets
❑ Beef Brood Co
_...
❑Turke s
Other
❑ Other
1
❑ Turkey Poults
10 Other
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
99-No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system`? (If yes, notify DWQ)
ElYes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
[&No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
®,No
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
12128104
Continued

Facility Number: &;Z-317Date 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
Identifier:
❑ Yes E.No ❑ NA ❑ NE
El Yes ❑No El NA El NE
Structure 4 Structure 5 Structure 6
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): pQ
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 JRNo ❑ 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 ZI No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ,® No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
4. Does any part of the waste management system other than the waste structures require ❑ Yes RNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 0 No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes &No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window [I Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) ,%J�/`iylke[rs / f961e"_/•
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
�KNo
❑ 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
9 No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes
[9No
❑ NA
❑ NE
Reviewer/Inspector Name Ilj-- Phone:
Reviewer/]nspector Signature: Date: O
D,.,... 7 _f 7 17/7Q1114
e- -

Facility Number: Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ® No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ❑.No ❑ NA ❑ NE
the appropiate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps
p ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes �RNo ❑ 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 JE[No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
ONo
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
®No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
21 No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
F9[No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[RNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
®.No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
-
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
E 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
[RNo
❑ 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
N No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
R No
❑ NA
❑ NE
Page 3 of 3 12128104

Facility Number �y
wvtvision of Water Quality S
0 Division: of Soil and Water Conservation ��`
0 Other Agency
Type of Visit (DriTo—mpliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit outine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: O Arrival Time: D Departure Time: �J� County Region:
Farm Name: Pn f.1) �f Fa "-n' Owner Email:
Owner Name: w i `!Jt 41-F1�Po W e Phone:
Mailing Address:
Physical Address: I
Facility Contact: �%''I p ""�� "J" if Title: Phone No:
Onsite Representative: =_ Integrator:
Certified Operator: �j�� Operator Certification Number:
Back-up Operator:
Location of Farm:
�o
Latitude:
Back-up Certification Number:
="
Longitude: = ° 0 ` = u
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population
❑ Wean to Finish
❑ Wean to Feeder
Feeder to Finish 1{00 1749 as
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other -
Fa eon -Layer
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turke s
❑ TurkeX Poults
11
❑ Other
k
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 Heifei
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures: ELI
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 pan 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 IN No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
0 No
❑ NA
❑ NE
❑ Yes
N No
❑ NA
❑ NE
12128104 Continued

' � 1
FacilityNumber: S~ =3f Date of Inspection
' Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
[-]Yes
J!� 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
® 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
R No
❑ NA
[I NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
No
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
R] No
❑ NA
❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
® No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
El Yes
No
❑ NA
El NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ®No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ FAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window El Evidence of Wind Drift ElApplication Outside of Area
12. Crop type(s) ,23ntGi
13. Soil type(s) I�
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ® No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes ® No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes ® No ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment'? ❑ Yes [Z No ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/Inspector Name Phone:
Q
Re-viewer/Inspector Signature: Date:
I2/25/U4 c.onnnuea

J
Facility Number:D� —3 J Date of Inspection
Required Records & Documents ��yyyy
19. Did the facility fail to have Certificate of Coverage & Permit readily available? El Yes J'S.1 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ® No ❑ NA ❑ NE
the appropirate box. ❑ WUp ❑ Checklists ❑ Design [I Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 13 No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ® No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 10 No ❑ NA ❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
® No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
CRNo
❑ 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
(K 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
[0 No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
® No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
&No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
® No
❑ NA
❑ NE
Comments and/or Drawings:
12/28104

Type of Visit (9-6ompliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit outine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: d` Arrival Time: v Departure Time: .'� County: Region:
Farm Name: Fe9 L41 11 rQ/ys^_ Owner Email:
Owner Name: wi Jr ; amv _ _ Phone:
Mailing Address:
Physical Address:
Facility Contact: r OW e, I I Title: Phone No:
Onsite Representative: _!LZ2 .l Integrator: Al '//1W
Certified Operator: Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = e = { = u Longitude: = o =1 ="
S'P.M.,
urrenPHERIPINqu
Design Current
Design C•urreat
Swine
opulatioltry
Capacity Population
Cattle Capacity Population
❑ Wean to Finish
❑ Layer
❑ DairyCow
❑ Non -La er
❑ Dairy Calf
❑ DairyHeifer
Dry Poultry
❑ D Cow
❑ Non -Dairy
❑ Layers
❑ Beef Stocker
❑ Non -Layers
❑ Beef Feeder
❑ Pullets
❑ Beef Brood Co
❑ Turkeys
Other
❑ Other
❑ TurkeyPoults
❑ Other
Number of Structures:
❑ Wean to Feeder
Feeder to Finish
0
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑Gilts
❑ Boars
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
2. is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes Jallo ❑ NA ❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
[9No
❑ NA
[IN E
❑ NA
❑ NE
❑ Yes
9) No
❑ Yes
DQ No
❑ NA
❑ NE
❑ Yes
4 No
❑ NA
❑ NE
12128104 Continued

r Facility Number: 3�
Date of Inspection
r 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 KNo ❑ NA ❑ NE
❑ Yes RNo ❑ NA ❑ NE
Structure 5 Structure 6
Spillway?:
Designed Freeboard (in): 1 L
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 4 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 KNo ❑ 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? [3 Yes ❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ZNo El 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 04No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes N No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable CropWindow❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop types)
13. Soil type(s)
14, Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [kNo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
[ayes
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
17. Does the facility lack adequate acreage for land application? ❑ Yes
18. Is there a lack of properly operating waste application equipment?
❑ Yes
El No El NA El NE
�No❑ NA❑ NE
[gNo ❑ NA ❑ NE
allo ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments:
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/Inspector Name �e%/ Phone: O — ZJ �.300
Reviewer/Inspector Signature: Date: /Q— fl—mop 6
.5

-31 Date of Inspection
Facility Number:
RecLuired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes IgNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 29 No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes BNo ❑ 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
H No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
S No
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
PU No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
® No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
LZ 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
P No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
5a 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
XNo
❑ 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
[RNo
❑ NA
❑ NE
General Permit? (iel discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss reviewlinspection with an on -site representative?
❑ Yes
No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
No
❑ NA
❑ NE
Additional Comments and/or Drawings: 77
1
Page 3 of 3 12128104

oe 02 - cu
:vision of Water 06ality. s,
lFac�ttt} Number j 7kDtvisiun of Soil and -Rater Canservafion �M
Q.'Other Agency
Type of Visit 4* 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: 05"I — Arrival Time: j0� p Departure Time: County: ��,,��?�e� Region: _k�_
Farm Name: Owner Email:
Owner Name: %7.i jj ltG »tom P004e�i( Phone:
Mailing Address:
Physical Address:
Facility Contact: t1j;LL.c3 e' POW e-11 Title:
Onsite Representative: 4J �_�_ i� �►• �f/[t4�,11
Certified Operator:
Sack -up Operator:
Location of Farm:
Swine
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: = o Longitude: ❑ o ❑ 1
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
❑ Nan -La et
❑ Wean to Finish
❑ Wean to Feeder
afeeder to Finish
.2-Ya a
11 Y6 o
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Dry Poultry
❑ Lavers
❑ Non -Lavers
❑ 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
❑
Daia Cow
❑
Dairy Calf
❑
Dairy Heifer
❑
Da Cow
❑
Non -Dairy
❑
Beef Stocker
❑
Beef Feeder
❑
Beef Brood Co
Number of Structures:
b. Did the discharge reach waters of the State'? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes N No ❑ NA ❑ NE
❑Yes
❑No
DNA
ONE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
BNo
❑ NA
❑ NE
❑ Yes RNo ❑ NA ❑ NE
12128104 Continued

4'-- .
Facility Nvdnher: $ +j
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
Identifier: I
Spillway?:
Designed Freeboard (in): ) Q
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes K(No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes 9No ❑ NA ❑ NE
❑ Yes [ No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? [:]Yes W No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
Callo
❑ 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
El[J Yes
,_ J
No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[0 No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
["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 ❑ Evidence of Wind Drifl El Application Outside of
Area
12. Crop type(s)w�q f J2 y
At
13. Soil type(s)j�.,//
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
L3{No
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[YNo
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination,[:]
Yes
[dNo
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
[d]No
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
WNo
❑ NA ❑ NE
Reviewer/inspector Name ,v- w' A Phone: 41 o —VP - Reviewer/Inspector Signature: 4(4). "bf i s.— Date:
12/28/04 Continued

1~s
Facility N4mber: g Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropirate box. ❑ WUP ❑ Checklists ❑ Desig
n ❑ Maps ❑ Other
❑ Yes
2"N' o
❑ NA
❑ NE
❑ Yes
tad No
❑ NA
❑ NE
21. Does record keeping need improvement? If yes, check the appropriate box below, ❑ Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes L(No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes VNo ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit? [0 Yes ❑ No ❑ NA ❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit? 1 Yes ❑ No ❑ NA ❑ NE
26. Did the facility fail to have an actively certified operator in charge? ❑ Yes 0 No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ❑ Yes dNo ❑ NA ❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes EgNo ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
ER(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
C;rNo
❑ 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
El Yes
�.,/
U/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
0211No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
WN o
❑ NA
❑ NE
Additeoiial:Comments,and/or©rawiugs
:.,,w r•
xtr�%iC�
v. �
dre-Ae yo"ve r"4-5 fah
f.on rGgsc�•�.a-.c f�- ..� •��a�er �`f-�v.` 't
D
(1Olc/`
/�
/ ' e eo0.OIf.
¢s,�.�
12128104

Type of Visit • Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit S Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
FDate of visit: $ o?rrolQ Time: : d a
Facility Number 3 f .
Q Not Operational Q Below Threshold
GTermitted (f Certified 0 Conditionally Certified 0 Registered Date Last Operated or Above Threshold: .........................
Farm Name: County:
Owner Name: Phone No: o .5..3.,C).4 I o ..._ ... .
Mailing Address:..... 363 S o ........4 4 r w�i� S
Facilitv Contact: _._...--- ----- Title: - - -- Phone No:
Onsite Representative: .__..'__........._.-..... _..-...�...------•-•�..........Integrator:- ----� `��'1`•.�....... �.r �.!�.� ..._m........
Certified Operator:. ..W...: n ;, �_ 1 ........................ Operator Certification Number - -.---..-
Location
Location of Farm:
EM Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' & 44 Longitude • 4 «
Discharaes & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Outer
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier: ......... /.... ............ ..._............ _......... .._........... -......................... _............................ _............. ... .......
Freeboard (inches): '-2J 1
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes © No
❑ Yes M No
❑ Yes �M No
Structure 6
12112103 Continued

Facility N er: ga — 3 l7 Date of Inspection L ny
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑ Yes
® No
seepage. etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
❑ Yes
® No
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
9KYes
❑ No
S. Does any part of the waste management system other than waste structures require maintenance/improvement?
aYes
❑ No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
R1 No
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes
® No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
❑ Yes
❑ No
12. Crop type 13e_r-f LLCM / Sc / d vCrs �a1L
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
No
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
❑ No
13. Does the receiving crop need improvement?
Yes
❑ No
16. Is there a lack of adequate waste application equipment?
❑ Yes
® No
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
O No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WL'P. checklists, design, maps, etc.)
❑ Yes
® No
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
❑ No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
❑ No
21. Did the facility fail to have a actively certified operator in charge?
❑ Yes
❑ No
22, Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
❑ No
23, Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
❑ No
24. Does facility require a follow-up visit by same: agency?
❑ Yes
❑ No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP7
❑ Yes
❑ No
© No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Gommeats (irefer_to'g6estion #) Txphun,anyz.,recommewmt�ons or any other:oumsnenta. ".
Gse_dravrrings of faciltty to better explasn srtoatton$ Ease additional pages as necessary) ®F3eld Conv Final Notes
Y
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�� }S G(fn.r W[1��� 1La 1lL! Or �6•��:..�!-rc � �au�G �0 �.-K��t ib ati i•.ta�.�3 _1I_r
ii T nn ij cciT,.Q�'
fJrr^ 1'iG�d�- +'WG �1A GUr+p ri*.11Yr C, � rw s�4,y �r"IsJ1 V0 (trQ i.�
So� .r• ct' Y�C6cr=Jr.if_� u.,,.a.,a.1a�.1Ga} ` V4,%6Ai' �Qa+ _\1 C�`� rQ
e— ! r Cy 4 _-1 C - Pk li. 4--0 ,Jr
�^w�—�A� �'..�� oar• ..,,sPccy'�u:.. vw., K�oc„c.11 c._.�.f � wtiLl
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,� i - � � 6 f l : DU N. },.s r art'- c W � e .� u � � � r � c t
71,
Reviewer/Inspector Name -
Reviewer/Inspector Signature: Date: .Z:L� M!f
05103101 i Continued

r qL
'.::^r:C _,-..j :'sue='..1riA:r,Ti.v.»...'i'.„^a�:?`:ti.F�.�..,... �d'•"�%_�a.:. ru,a:�-s-.-gr',..--t .- :: -. .: h,.-. __..s_.�...::...''a�;'.�szs:»:�ir` Y"e":`F:d=
Type of Visit ® Compliance Inspection O operation Review O Lagoon Evaluation
Reason for Visit *Routine O Complaint O Follow up 0 Emergency Notification O Other X ❑ Denied Access
Q3Ie of Visit: �I'��%p`% Time: / .• /...r
Facilitti� lumber
i >\ot O erational 0 Below Threshold
Permitted 0 Certified ©Conditionally Certified 0 Registered Date Last Operated or Above Threshold:
Farm Name: Pow< -fit lo.... Count.: 53-- sow �Kc�
Owner Name: 1 I a w. Pb ., �I { Phone No:
Mailing address:
Facility Contact:
Title: Phone No:
Onsite Representative: Integrator: m ti • ea�� - 13 r o war
Certified Operator: w 1 l ar.. ea L' c ({ Operator Certification Number:
Location of Farm:
Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 0.0° 0` Longitude �• ���
Design CwTent
Swine rgn9rity Pnnnintinn
❑ Wean to Feeder
© Feeder to Finish
1,2q00
❑ Farrow to Wean
❑ Farrow- to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Number of Lagoons
Holding Ponds / Solid Traps
Design Current Design Current
Poultry Capacity Population Cattle Ca acift Population
❑ Laver I 1 10 DaL
❑ Non -Laver ❑ Non -Dairy
❑ Other
Total Design Capacity
Total SSLW
JLl Subsurface Drains Present jLJ Lat:oon'Area JLJ Spew• Field Area
❑ No Li uid Waste Management System
Discharges & Stream lmnacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a, if discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed_ what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (if ves, notify DWQ)
2. Is there e%idence of 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?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Suucttrre I Structure 2 Structure 3 Structure 4 Structure 5
Identifier: /
Freeboard (inches):
05103101
❑ Yes © No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ® No
❑ Yes ® No
Structure 6
Continued

a.
Facility Number: F(a — 3 17 Date of inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes ❑ No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes El No
(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 ❑ No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes ❑ No
9. Do any sluctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes ❑ No
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes ❑ No
11.
is there evidence of over application? ❑ Excessive Pondmg ® PAN ❑ Hydraulic Overload
® Yes
❑ No
12.
Crop hype B z r w, c pPe Cy
0
—
13.
Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
❑ No
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
❑ No
15.
Does the receiving crop need improvement?
❑ Yes
❑ No
16.
Is there a lack of adequate waste application equipment?
❑ Yes
❑ No
R ouired_Records & Documents
17.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
❑ No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
❑ No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
❑ No
20.
is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
❑ No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
❑ No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes ❑ No
23, Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes ❑ No
24. Does facility require a follow-up visit by same agency? ❑ Yes ❑ No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes ❑ No
0 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Field Copy U Final Notes
Oy, S 0 Y -- �- Syr < � \ cl ' a i .� ,p LA, � � 9 N ? 1 a j � � C_ to e X C C_ t R " Q
Reviewer/Inspector Name j
Reviewer/Inspector Signature: ,
Date: 9
05103101 ,f 1 1 Continued

Type of Visit O Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit O Routine O Complaint O Follow up Q Emergency Notification ® Other ❑ Denied Access
acility Number $2 317 Date of Visit. 3119/2Q04 Time: 11:3Q
LL.r
- - A O Not O erational O Below Threshold
®Permitted ®Certified El Conditionally Certified 0 Registered Date Last Operated or Above Threshold: .........................
Farm Name: ................................................... ...... County: Sampsom ........................................... FRO .............
OwnerName: 1?Ij fiatm---------------------------------- P.QW-CR ......................................................... Phone No: 91,0::5,37.4410 -----------------------------------------------------------
Mailing Address: Ct.al�aathax�ack�lg>blaY��'............................................................. klaairefly.NC........................... ......... Mm. ..............
....................................... .......................
FacilityContact: ----------- ...................................................... •fitle:................................................................ Phone No: .....-------------------------•-- ------
Onsite Representative: ........................................................................................................... Integrator: d&.If..Faxatts............................................................
Certified Operator: .Walti*ttl A. ....................
P.QH :A ............................................... Operator Certification Number: 22.............................
Location of Farm:
?arm Location: Turn west off 421 on to 41, go 1.2 miles to 411 go 4 miles turn right on dirt path go .4 miles to farm. +
® Swine ❑ Poultry ❑ Cattle ❑ Horse
Design , .'.Curr
Swine Ca aci ',Po"uli
❑ Wean to Feeder
® Feeder to Finish 2400
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Latitude 34 • 41 10 Longitude 78 • 13 15
Design Current... Design Current
Poultry Capacity Po"}ulation ' Cattle Cipac"ity'. Po` illation
❑ Layer ❑ Dairy
❑ Non -Layer I I❑ Non -Dairy
❑ Other
Total- Design.Capacity 2,400
Total SSLW 324,000
Number of Lagoons 1
Hn1�1�nv Pnarlc ! Qn1ir#'1'r9r�c sti .i,`n -
Discharges & Stream Impacts
. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. if discharge is observed. Leas the conveyance man-made'?
b. Vdischarge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated Ilow in gal/min?
d. Does discharge bypass a lagoon system'? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
❑ Yes ® No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ❑ No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ❑ No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: 1..................................
Freeboard(inches): ...............2.7....----...---..................................... .................................... ................................... ------......------....................................................
12/12103 Continued

Facility NuFAber: 82-317 Date of inspection 3/19/2004
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, (I Yes ❑ No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑ Yes ❑ No
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 ❑ No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes ❑ No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
❑ Yes
❑ No
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes
❑ No
H. Is there evidence of over application? If yes, check the appropriate box below.
❑ Yes
❑ No
❑ Excessive Ponding [:]PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12, Crop type
13_ Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
❑ No
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
❑ No
15_ Does the receiving crop need improvement?
❑ Yes
❑ No
16. Is there a lack of adequate waste application equipment?
❑ Yes
❑ No
Odor Issues
17. Does the discharge pipe ti-om 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
❑ No
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional
❑ Yes
❑ No
Air Quality representative immediately.
;Comments (refer to gaeshon #) 'Ei4Aatn,any YES ansv►ers and/or any'r'ecommendatio_ns or ady other comments
.Use ii1w- In'sof facili to`lietter ex lain situations use additional a es as necessa �.� J� r a,
`.
l; tJ P ( p 1? rY) Field Cop ❑ Final Notes 10W, ,
Farm visited at the request of SWC to observe a soft spot in the lagoon wall. Lagoon banks have many large bare spots and show signs of
erosion. Steps should be taken to correct these problems. The area around the pump has a green vegetative streak running from the
lagoon wall to the woods nearby. This suggest a possible leak in the waste application system and needs to be addressed.
Reviewer/inspector Name Lam Baxley'. -Danny Edwards k a
Reviewer/Inspector Signature: Date:

Site Requires Immediate Attention:
Facility No. s'z - &! Z
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: - , 1995
Time: _1L
Farm r
Mailing
County
Integral
On Site
Physica
Type Ot 1UPUTALLUI1. aWULr, - rUULUy %.aLuc
Design Capacity: 21­o0 Number of Animals on Site:
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: Longitude: 0"
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches) 4 e1s or No Actual Freeboard: t3 -Ft. Inches
Was any seepage observed from the �11ao:on(s)? Yes or� Was any erosion observed? Yes or toIs adequate land available for spray?o No Is the cover crop adequate? es or No
Crop(s) being utilized: '5Z .¢
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings? dYs)or No
100 Feet from Wells? G)or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes o>E
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line: Yes o No
Is animal waste discharged into water of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes or �If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on spqcific acreage with cover crop)? Yes or No
Additional Comments: 3re-hdci v ✓ A461--i �M
w 7) 1RK
(CSC-3 ��2 f' � ,y �-�I� CfJ�.v�x 2 _ f izR. ! eat e•� ,�,— --
0 AJc 2l4 L
Inspector Name
-::: �rc�-
Signature
cc: Facility Assessment Unit Use Attachments if Needed.