820325_INSPECTIONS_20171231

NORTH CAROLINA .�
Department of Environmental Qua

r
I Xari l
Type of Visit: OCom Hance Inspection O Operation Review Q Structure Evaluation O Technical Assistance I
Reason for Visit: 0 Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: Departure Time: County: S
Farm Name: L, 0,421 rfy t6& L-3 Owner Email:
Owner Name: rd tif.%r f,e S Phone:
Mailing Address:
Physical Address:
Facility Contact: CV4 + S [9eL-4ZytV1& Title:
Onsite Representative: V
Certified Operator: `t
Phone:
Region: rk
Integrator:
Certification Number: /, 3 Y-9
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
51Ij5
Design Current
Design
Current
Design Current
Swine
Capacity Pop.
Wet Poultry
Capacity
Pap.
Catt3e Capacity Pop.
Wean to Finish
(Layer
Non -La er
DairyCow
DairyCalf
Wean to Feeder
Feeder to Finish
? / L
Dai Heifer
Farrow to Wean
Design
Current
D Cow
Farrow to Feeder
lt
Ea aci
P,o
Non-Dai
Farrow to Finish
Beef Stocker
Gilts
Boars
RNon-Layers
Beef Feeder
Beef Brood Cow
Other
ouets
Other
Discharges and Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
❑ Yes [❑ NA ❑ NE
a. Was the conveyance man-made? [—]Yes [—]No E NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR) ❑ Yes ❑ No [✓]" Vl*A ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR) ❑ Yes [:]No EEr A ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes [ErNo ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters [:]Yes [allo ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412015 Continued

Facili Number: Date of Inspection: /
Waste Collection & Treatment
4. JV 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 2-<A ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):�
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ 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 ❑ 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 ENo ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? [:]Yes QNo ❑ 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 Q o ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need [:]Yes ErNo ❑ NA ❑ NE
maintenance or improvement?
1 I . 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): 6 56 0
13. Soil Type(s): /,( '/ 0— ft &C-
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
D<o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
ED-Ko
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
I'�' "o
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
dNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
21�o`
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
Q No
❑ NA
[] NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
EZo
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
E� No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather
Code
❑ Rainfall O 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
U;No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
Ej'No
❑ NA
❑ NE
Page 2 of 3 21412015 Continued

Facility Number: OUL- q -1-< I IDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
CTF<o
❑ NA ❑ NE
25. is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
F-1'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
E�JlNo
DNA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
[i]'No
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
®'No
❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
CjN-o
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
�Io
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface file drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
E],iGo
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[ 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
Q No
❑ NA
❑ NE
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
10 ` 15 -r �
I G Q)U
C
T9 7
Phone: ` Q
Date: ` U
1/4 O15

Type of Visit: (rj CotrJpliance Inspection O Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit ArriV-al'rime: Departure Time: County: s v _ Region:
Farm Name: Aaf, 7-3 Owner Email:
Owner Name: (2,61r�e e�s Phone:
Mailing Address:
Physical Address:
Facility Contact: C is u�w`GFi Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
I
Phone:
Integrator: &4r=1 le —
Certification Number: -1 b 3 0
Certification Number:
Location of Farm: Latitude: Longitude:
Design Current
Capaciapacity
Design Ci rrent
° Design Current
PoXo
Finish
La er
Da Co«
o Feeder
Nan -La er
Da Calf
to Finish
7 ? '�
`"
Dai Heifer
to Wean
Designer CurrenE
D Cow
to Feeder
LEFeedLr
D IP,oult .
Ca aci is -Po
Non -Dairy
to Finish
La ers
Bcef Stocker
Non -La ers
Beef Feeder
Pullets
Beef Brood CowTurke
s
rTurke
Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made`?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)"
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes Q No ❑ NA ❑ NE
❑ Yes
[:]No
P?rVA
❑ NE
❑ Yes
❑ No
K] NA
❑ NE
❑ Yes
[] No
[!fNA
❑ NE
[:]Yes
❑'No
❑ NA
❑ NE
❑ Yes
17rNo
❑ NA
❑ NE
Page I of 3 214120I5 Continued

Facili Number: OM A jDate of Ins ectio
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 0-llo- ❑ 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
01_o
❑ 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
u too
❑ 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
R�:f`No
❑ NA
❑ NE
8_ Do any of the structures lack adequate markers as required by the permit?
❑ Yes
allo
❑ NA
❑ NE
J
(not applicable to roofed pits, dry stacks, and/or wet stran
9. Does any part of the waste management system other the waste structures require
❑ Yes
E3 no
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
El"No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [ZNo ❑ NA ❑ NE
❑ Excessive Pending D 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 D Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): �5 cn��>
13. Soil Type(s): - 1.[ WCL
14_ Do the receiving crops differ from those designated in the CAWMP? ❑ Yes EfNo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement'? ❑ Yes [TNo ❑ NA 0 NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes [3No ❑ 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?
Re wired Records & Documents
❑ Yes [�No ❑ NA ❑ NE
[] Yes La fro ❑ NA ❑ NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
ffNo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[!fNo
❑ 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 O 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
[ ff No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
6No
❑ NA
❑ NE
Page 2 of 3 21412015 Continued

Facility Number: - Date of Ins ection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ON.
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes fNo
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
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
❑ Yes 2<o ❑ NA ❑ NE
❑Yes 2-fro— [3 NA ❑NE
❑ Yes C;❑ NA ❑ NE
❑ Yes q3 No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes do ❑ NA ❑ NE
[—]Yes 12<o
[] Yes [rNo
❑ Yes [xNo
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any ethem r coments.
Use drawings of facty to better explain situations (use additional pages as necessary).
GEC roe-
Reviewer/Inspector Name: 11 1 U
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Dat � l
1/4/ZOl S

I ype of visit: r::�rc.ompnance inspection V uperauon tceview V btructure evaluation V recnmcai Assistance
Reason for Visit: Q-Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time:l_1IJ County: s�
Farm Name: _Lam t L: �_ Owner Email:
Owner Name: G'"--c � Phone:
Mailing Address:
Physical Address:
Facility Contact: {" rC 5 Vim' Title:
Onsite Representative: t
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Region:
Phone:
Integrator:
Certification Number: 3 V 7 _
Certification Number:
Longitude:
1)estgn Current
Design
Current
Design Current
Swine
Capacity Pap.
Wet Poultry
Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
RLayer
Dai Cow
to Feeder
Feeder to Finish
Non -Layer
"'
Dairy Calf
Heifer
Farrow to Wean
Design
"Current
—Dairy
Dry Cow
Farrow to Feeder
Farrow to Finish
Div P,oeil
La ers
Ca aci
P,o
Non -Dairy
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
1pullets
Beef Brood Cow
-_
Turkeys
Other
_
Turkey Poults
Other
Other
Dischar es and Stream Im acts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
❑ Yes 4L34" ❑ NA ❑ NE
a. Was the conveyance man-made? ❑ Yes ❑ No E]14A ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR) [—]Yes ❑ No [9-<A ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR) ❑ Yes ❑ No Ej'*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 F(No ❑ NA ❑ NE
of the State other than from a discharge?
Page l of 3 21412014 Continued

Facili Number: - Date of Inspection: or
jq
,r
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes K ""' tWA
❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes [:3 No ❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): g -
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
VNo
❑ 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
Ej�qo
❑ 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
[a�No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[TNo
❑ 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
C2'Wo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
ff No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes UNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): 6 e, S G cam.
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes RfNo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [fNo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
�'Io
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[*fNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
CaXo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
❑' o
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[TN o
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
[2rNo
❑ 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
[TNo
[DNA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[TNo
❑ NA
❑ NE
Page 2 of 3
21412014 Continued

Facility Number: - 15 jDate of Inspection:
24,Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [&W ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? if yes, check ❑ Yes [3-<o ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? [] Yes 130&o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes IE 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
pen -nit? (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 La No
❑ Yes WfNo
❑ Yes &No
❑ Yes P410
❑ Yes O No
❑ Yes VfrNo
❑ NA ❑ NE
❑NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
Comments (refer to question ft Ezglain any, YES answers and/or -any additional recommends ions:or any other comments
Use drawings of facility to better explain situations (use additional pages as necessary)
SL�'J_
--�-�s
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 3 `
Date: F3
214412014

type of visit: wuompuance inspection v uperanon Keview ti nn•ucture tvaivanon V fecnnicat ASsistance
Reason for Visit: V Routine 0 Complaint Q Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: 116 Madd 5 Arrival Time: Departure Time: Fa County: J Region��
Farm Name: L-q- 00ek Y` _ Owner Email:
Owner Name: Co L'- c%^'HS _ _ Phone:
Mailing Address:
Physical Address:
P
Facility Contact: Cfl w 1 af Title:
Onsite Representative: t i integrator:
4
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Certification Number: O-3 `[ l
Certification Number:
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
U
F
Non -La er
DairyCalf
Feeder to Finish
'l
DairyHeifer
Farrow to Wean
Design
Current
Cow
Farrow to Feeder
D , P,oult ,
Ca aci
P,o
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
Turke Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes [ —Na--❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No [a ftA ❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWR)
❑ Yes
❑ No
[}NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
[:]Yes
[:]No
E NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
[:]Yes
�o
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
[3'1�o
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412014 Continued

Facility Number: - Date of Inspection: S
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes Q No [DNA ❑ NE
a. If yes, is waste level into the structural freeboard? [—]Yes [�J#Q PPNA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3
5. Are there any immediate threats to the integrity of any of the structures observed? [:]Yes [a> ❑ 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
[Z>a
❑ 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
Q'No
[DNA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
!] 1<o
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
[:j"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 [],N-o ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload [] Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑Evidence of Wind Drift ❑ Application Outside of Approved Area
� � j�1At
12. Crop Type(s): ' A s GO
13. Soil Type(s): ty v
14. Do the receiving crops differ from those design ed in the CAWMP? V
❑ Yes
EJ Woo'
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[ -Ko
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
n l>e-
❑ NA
❑ NE
acres determination?
v
IT Does the facility lack adequate acreage for land application?
❑ Yes
L`_T <o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
2-Io
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
Jo
❑ 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 V Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
[:]Yes
❑,Flo
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[3-K*o
❑ NA
❑ NE
Page 2 of 3 21412014 Continued

Facility Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes o ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes �10 ❑ 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 [n No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ErNo ❑ 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)
❑ Yes No ❑ NA ❑ NE
[] Yes E rNo❑ NA ❑ NE
❑Yes ❑No ❑NA ❑NE
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. ❑ Yes
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes
34. Does the facility require a follow-up visit by the same agency? ❑ Yes
.6-_�
[:]No ❑ NA ❑ NE
['No
❑ NA
❑ NE
[6 No
❑ NA
❑ NE
L_1 1f o
❑ NA
❑ NE
Comments (refer to question f: 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) r ii
[:w`jrot& "
s-- 3(_ / �
Reviewer/Inspector Name: Wt
Phone:
Reviewer/Inspector Signature:
Date:
Page 3 of 3 1 21412011

Type of Visit: 'Compliance Inspection O Operation Review O Structure Evaluation Q Technical Assistance I
Reason for Visit: erRoutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: County: cs� VA,
Farm Name: t/ �� L Owner Email:
Owner Name: `e t%(� Phone:
Mailing Address:
Physical Address:
Facility Contact: n-t q�e%tlJl�it l Title:
Onsite Representative: c u- F
Certified Operator: 0
Back-up Operator:
Location of Farm:
Latitude:
Phone:
lntegrator:'_BLC 5
Certification Number:) '[
Certification Number:
Longitude:
Design Current � �-��� _�
Design Cur± �_t Desiga Enrrent
Swine
Capacity .. Pop. Wet Poultry
@apacity Pop. Cattle Capacity Pop.
Wean to Finish
La er
DairyCow
Wean to Feeder
on -Layer
DairyCalf
�-
` "" Dai Heifer
Feeder to Finish
Farrow to Wean
* .
Design Current D Cow
Farrow to Feeder
D I?ouitry
Ca aci Po 5 Non-Dai
Beef Stocker
Beef Feeder
jBeef Brood Cow
Farrow to Finish
Gilts
La ers
on -Layers
Boars -
.?;
Pullets
Turkeys
O#her
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:
❑ Yes U2,I ❑ NA ❑ NE
a. Was the conveyance man-made? ❑ Yes UJ.I ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) [-]Yes [J e ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes [j o ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes ED I ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑.Yes lVo ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

acili umber: - Date of Ins ection:
Waste Collection & Treatment f
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? [:]Yes [3- o ❑ 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 Q-No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes [ No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes [a No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes ❑'� o ❑ NA ❑ NE
(not applicable to roofcd pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes Eq-1qo ❑ NA ❑ NE
maintenance or improvement?
Waste Annlication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes Ejl�o [DNA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes �lo ❑ 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): 1) ej_yvk("� _�1i7 0
13. Soil Type(s):
14. Do the receiving crops differ frd those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
ERI;o
❑ NA
❑ NE
❑ Yes
®-iGo
❑ NA
❑ NE
❑ Yes
[] No
❑ NA
❑ NE
❑ Yes []J'f4o ❑ NA ❑ NE
❑ Yes [Er<o ❑ NA ❑ NE
0 Yes g5*tr ❑ NA
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check ❑ Yes []❑ NA
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? if yes, check the appropriate box below. ❑ Yes ❑ 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 g 3�_N`o�ONA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? Yes o NA NE
❑ ❑ ❑
❑ NE
❑ NE
Page 2 of 3 21412011 Continued

facility Number: - Date of Ins ection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes Flo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes EKo/ ❑ 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 E7 56- ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes LLB wo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes Imo" ' ❑ 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 [(a.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 [;itT ❑ 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
L o
❑ NA
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32, Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
E3<o
❑ NA
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
[-]Yes
Vo
❑ NA
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
to
❑ NA
❑ NE
❑ NE
❑ NE
❑ NE
Comments (refer to question { : Explain any YES answers and/or any additional recommendations or any other comments p' v
Use drawings of facility to better explain situations (use additional pages as necessary).
C4
Reviewer/Inspector Name: U N \� Phone:
Reviewer/Inspector Signature:
Page 3 of 3
Date:
21412011

I
Type of Visit: ompliance Inspection 0 Operation Review p Structure Evaluation Q Technical Assistance
Reason for Visit: utine O Complaint Q Follow-up O Referral 0 Emergency Q Other O Denied Access
Date of Visit: 1, 51 Arrival Time: ; D O Departure Time: p County: Region: I1R 0
Farm Name: `Z6Z L 3 Owner Email:
Owner Name: �A�.cI^'iY %fly �a/n�� Phone:
Mailing Address:
Physical Address:
Facility Contact: �'/Si^/�3
/3a�'f!/tli�
Title: 2 2!ram.
Phone:
Onsite Representative:
fi
Integrator:
Certified Operator: ja...= Certification Number: /g::'1 7
Back-up Operator:
Certification Number:
Location of Farm: Latitude: Longitude:
Design Cu enC ` " r Design Cu ent Design Current
Swine Capacity Popes Wet Poultry _ Cap�a"city Pop : Cattle Capacity Pop.
Wean to Finish Layer Da Cow
Wean to Feeder Non -La er DairyCalf
Feeder to Finish 7 �fia Dai Heifer
Farrow to Wean i Current4.
Dry Cow
l;n
Farrow to Feeder D ,1? ult VQ
a aci�P,o Non -Dairy
Farrow to 1 inish I Layers Beef Stocker
Gilts Non -Layers Beef Feeder
Boars Pullets Beef Brood Cow
Turkeys
Other Turkey Poults
Other � Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
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 Q No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes [:]No ❑ NA ❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) []Yes [:]No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes �No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes I No ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

Facili Number: - Date of Ins ection:S — /
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 IM 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
UQL
(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
21 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
21 No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
RNo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes RNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable CropWindow❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12, Crop Type(s):a_ 1 6 V_�C'4_r rr9'
13. Soil Type(s):
14. Do the receiving craps differ from those designated in the CAWMP?
❑ Yes
ZNo
❑ NA
❑ NE
15_ Does the receiving crop and/or land application site need improvement?
❑ Yes
M�No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
My No
0 NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
g[No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
allo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
0 No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
lgl_No
❑ NA
❑ NE
the appropriate box.
❑ WUP []Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I " Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? [:]Yes ® No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [—]Yes C§ No
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

t
Facility Number: - Date of Inspection: �5_2;710
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [R No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [& No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes [. No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [:]Yes � No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31, Do subsurface 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 [4No ❑ NA ❑ NE
❑ Yes Z_No ❑ NA ❑ NE
❑ Yes No
❑ Yes No
❑ Yes 5;�No
❑ NA ❑ NE
❑NA ❑NE
❑NA ❑NI;
Comments (refer to question ft Explain any YES answers and/or any additional recommendations orany`other comments ,-
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name: Phone:
Reviewer/Inspector Signature: Date: .3
Page 3 of 3 21412011

I
`#(
(Type of Visit: (,WCompliance Inspection V Operation Review U Structure Evaluation O Technical Assistance I
Reason for Visit: VRoutine Q Complaint O Follow-up O Referral O Emergency Q Other O Denied Access
Date of Visit: �� Arrival Time: '3o Departure Time: JCz�QO County:x§AmMf) Region: f Rh
Farm Names ��ii:�g Q{t5 _��C- L 3 Owner Email:
Owner Name: C, pV A UV E _VARle'S Phone:
Mailing Address:
Physical Address:
Facility Contact: Ckj&SMb �+AiZ1.�'[ e Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator: &EiS jA 2e _
Certification Number: /63 9,
Certification Number:
Longitude:
'-
Swine
Wean to Finish
Design
Capacity
-w
@urrent yMIMS
Pop.
.
Wet Poultry
Layer
on -Layer
1?ry P,oult
Lavers
Non -Layers
Pullets
PT Design
Capacity
Design
Ca_ aeity
Ca
Pop.
Current
P`o
Desigurrent
Cattle C►apacin
Ciy Pop.
DaiEy Cow
Wean to Feeder
Daia Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
D Cow
Farrow to Feeder
Non -Dairy
Farrow to Finish
Gilts
Beef Stocker
Beef Feeder
Boars
Beef Brood Cow
Other
Turkeys
Turkey Poults
,. .
Other
Other
Dischar es 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 Q�No ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes allo
❑ Yes 0 No
0 NA ❑ NE
[R'NA ❑ NE
[YNA
❑ NE
❑ NA
❑ NE
❑NA
❑NE
Page 1 of 3 21412011 Continued

Facili Number: 80, - aZ Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [2rNo [DNA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ffNo ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:.
Spillway?:
Designed Freeboard (in): cj
Observed Freeboard (in): �a+
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
ErNo
❑ 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
[yNo
❑ 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
[g�No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[gNo
❑ 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 gNo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes 52rNo
❑ 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): I` (3'M V D. � ' Ear'/
13. Soil Type(s): _ L Z P�S;PjVk rn i -I Ah ka na U- S dir
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 [TNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes [ErNo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
[:]Yes
ff No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
vgNo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[ErNo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
[:]Yes
[g No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [v"No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall [:]Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 " Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ff No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [-]Yes [!�No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
[DNA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facili Number: a Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [ErNo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [RNo ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes [ ?No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification'? ❑ Yes Ej-'No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes [ No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
[:]Yes
[�rNo
❑ 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
E24No
❑ 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
[yNo
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[dNo
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
[� No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
No
❑ NA
❑ NE
Comments (refer to question: Explain any YES answers and/or any additional recommendations oranyaohr com_in nts.
Use drawings of facility to better explain situations (use additional pages as necessary)• ,� v
Reviewer/Inspector Name: '
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date:
21412011

&t4 5 v 0—
Type of Visit: tMompliance Inspection 0 Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: outine Q Complaint O Follow-up O Referral 0 Emergency O Other O Denied Access
Date of Visit: Arrival Time: Departure Time:1 County: Region:
Farm Name: L-4�'x G'U -c.�nr+g L�� L3 Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: C_. c r- g lC_ Title:
Onsite Representative: /� {
Certified Operator:
Phone: 011�
Certification Number: ziuY L
Integrator
Back-up Operator: Certification Number:
Location of Farm:
Latitude: Longitude:
� Design �Current� F h �� ��, � �Design Current���'
Swine Capacity PopWetP� ultry -' Capacity Pop`
Design C*urreat
Cattle Capacity Pop.
Finish
Feeder
Layer
Non -La er
Da' Cow
Da' Calf
o Finish ']
o Wean
o Feeder
pFarrowtoFinish
o , 'Y F
k 5" +�
1x ��-Design Current
;D Paul# Ca` aei P;.o
Dairy Heifer
D Cow
Non -Dairy
.
La ers
Beef Stocker
Non -Layers
Beef Feeder
Boars
Puilets
Beef Brood Cow
Other
Turkey Poults
Other
Discharges
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 DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes [? o ❑ NA ❑ NE
❑ Yes ❑ No Ej A ❑ NE
Yes ❑ No [R<A ❑ NE
[::]Yes
❑ No
2NA
❑ NE
[::]Yes
[] No
❑ NA
❑ NE
❑ Yes6-<O"*'
❑ NA
❑ NE
Page 1 of 3 21412011 Condnued

Facili Number: - Date of Ins ection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ENo ❑ NA D. NE
a. If yes, is waste level into the structural freeboard? ❑ Yes eNo ❑ 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?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
❑ Yes [] N ❑ NA ❑ NE
❑ Yes D `5o ❑ 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 520<o ❑ NA ❑ NE
8. Do any of the structures lack adequate markets as required by the permit? ❑ Yes g�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 �10 ❑ 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 20 ❑ 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): �'_D r ,
!!nn
13. Soil Type(s): W 0 `&
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑'1 o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[?Ko
❑ NA
❑ NE
16_ Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
[[}iVo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
Q o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[gNo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
E ' o
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
E5'5'o
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes IJ 1"u ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes E'No ❑ NAB ❑ NE
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [] No B- A ❑ NE
Page 2 of 3 21412011 Continued

Facili Number: jDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [g o ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? if yes, check ❑ Yes t rJ] ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? if yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes
EEJ-t4o
❑ NA
❑ NE
❑ Yes
❑ No
+ NA
❑ NE
[:]Yes
[] No
❑ NA
❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes E N ❑ NA ❑ NE
❑ Yes [�No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes Io ❑ NA ❑ NE
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative? ❑ Yes �fo ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes Z ❑ NA ❑ NE
Comments .(refer to question ft Explain any YES answers and/or any additional recommendatronsidriany other coil ments:i "`
Use'drawinQs of facility to better eanlain situations (use additional Danes as necessarv). { r
CUIti'S�vt�c„Tc C�'L
Otiv�. its .
Reviewer/Inspector Name:
Reviewer/Inspector
Page 3 of 3
Phone:
Date: l
114/ 11

Sj-CKjS /-Z7'-2_0/0
Type of Visit i�I'bompliance 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: 9: 30 Departure Time: County: f!!2 Region: 1CA00
Farm Name: C — 3 Owner Email:
Owner Name: � 0 VPhone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: C u✓l-�S 3 a_V-.j C.
fP��hone No:
Integrator: CorlQUV%t le-1
Certified Operator: Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: =] o E--] ` ="
Longitude: E__1 e = f = u
Design Current
Current Design •urrent
Swine Capacity Population
_itDesign
Wet Poultry
*apacih Population Cattle Capacity Population
❑ Wean to Finish F
❑ Layer
❑ Dairy Cow
❑ Wean to Feeder I
I[--] Non -Layer I
❑ Dairy Calf
❑ Feeder to Finish I
❑ Dairy Heifer
Farrow to Wean 2300 1 OS3 pry Poultry
❑ Dry Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish ❑ Layers
❑ Beef Stocker
❑ Gilts ❑ Non -Layers
El Beef Feeder
❑ Boars ❑ Pullets
❑ Beef Brood Cowj
❑ Turkeys
Other ❑ Turkey Poults
Number of Structures: 1
❑ Other ❑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?
ElYes
❑ No
/
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
�9NNA
EJ 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
❑ NokA
❑ NE
2, is there evidence of a past discharge from any part of the operation?
❑ Yes
NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
Yes
ElL7
,EY5o�❑
No
LJ NA
❑ NE
other than from a discharge?
12128104
Continued

/ — Z/—Z&/O
Facility Number: 02 -3 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 ffNo ❑ NA ❑ NE
the appropriate box. ❑ W`Up ❑ Checklists ❑ Design ❑ Maps ❑ Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
No ❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1"
Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
' No ❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
No ❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ NA
El NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
El Yes
�.,�fo
L1 No ❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
OK. ❑ 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
to
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
C 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 concem?
❑ Yes
CTNo
❑ 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?
ElYes
�eo
❑ NA
❑ NE
12128✓04

Facility Number:
/—Z/—Zcy/O
Date of Inspection 0
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier:
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes ;No ❑ NA ❑ NE
Structure 5 Structure 6
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3 3
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes CTNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc_)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental thre t, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ETNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes [3 o ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks) �
9. Does any part of the waste management system other than the waste structures require El2 Yes o ❑ NA ❑ NE
maintenance or improvement?
Waste AnWication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes IN' o ❑ NA ❑ NE
maintenance/improvement? ,��
11, Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes L2No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) C.vo.; ,q
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes 2 No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ,3,, NNoo ❑ NA [I NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes ,1._f NoNo ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? El Yes LET, o [I NA El NE
18. Is there a lack of properly operating waste application equipment'? El Yes 2 ❑ NA ❑ NE
nts refer to uestion # Es`lain an YES answers andlar an recomm�endattons or an other comments.
Comme (g T 9) P`` ,y ( pages r5')= y v
=Use drawings of facilityto better- lain situations. use additional a es asnecessa
_
Reviewer/Inspector Name C K lZlev.e— S Phone: `�� V. Y33.3300
Reviewer/Inspector Signature: Date: Z/— 7-0119
12128104 Continued

A3 .l-7 — 7_66 ?
Division of Water Quality
Facility Number gZ ij 0 Division of Soil and Water Conservation 2:2Q Other Agency`
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
r
Date of Visit: �-/C O `% Arrival Time: � Departure Time: 3 ,��� County: G=2 J r Region: 11:r�4-0
Farm Name: /�^ �11 Owner Email:
Owner Name: C�_ Nc ^� 'L— _ FZ &0, Phone. -
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: CiAv- j9GK4_j: <--/4�_
Certified Operator:
Back-up Operator:
�' Phone No:
Integrator: COZ41-r'c_
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: a o E=I' El" Longitude: 0 ° = { = "
Swine
Wean to Finish
Wean to Feeder
Fe der to Finis
arrow to we
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
[--]Layer
❑ Non -La et
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
I. Is any discharge observed from any part of the operation'?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Curren
.Cattle iCapacity Populatia
❑ Dai Cow
❑ Dairy Calf
❑ Daia Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures: f I E '
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 M<O ❑ NA ❑ NE
❑ Yes ❑ No LTNA ❑ NE
❑ Yes ❑ No ErNA ❑ NE
❑ Yes ❑ No NA ❑ NE
❑ Yes R<0 ❑ NA ❑ NE
❑ Yes �No❑ NA ❑ NE
12128104 Continued

Facility Number: KZ_ —.32SI
9-Io--o 9
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:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes E No
❑ Yes LJ No
Structure 5
❑NA El NE
❑ NA ❑ NE
Structure 6
❑ Yes 2<o ❑ NA ❑ NE
❑ Yes LTNo ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental thre 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? El Yes No ❑ NA El NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require [❑ NA ❑ NE
maintenance or improvement? ❑ Yes No
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 o ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen -Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus 0 Failur to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift []Application Outside Area
12. Crop
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
t7 No NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
El Yes
No.D NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
,.,
I'No ❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
NA
❑ NE
P18. is there a lack of properly operating waste a plication a ui ment?
qP
❑Yes
Zo�
LJ NA
[INE
Reviewer/Inspector Name �� 7 rrG� Phone: / IU r�
Reviewer/Inspector Signature: Date:
Page 2 of 3 12/28/04 Continued

r v
Facility Number: 72, —325 Date of Inspection
Rtguired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes fNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ETNo ❑ NA ❑ NE
the appropirate box.
❑ WUP ❑Checklists El Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes E 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
R1Go
❑ NA
❑ NE
23 _ If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
T NA
TNo
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the pen-nit?Elyes
2
❑ 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 _O No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
E__frvo
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
941_"❑ 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
1l'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
ffNo
❑ NA
[INE
33. Does facility require a follow-up visit by same agency?
ElYes
� o
❑ NA
❑ NE
Additional Comments and/or Drawings:
12128104

or
r
a lyq S
9-D'-0$ IZk-
Facility Number 8z Z Ste.
1.
ivision of Water Quality.
O Division of Soil and Water Conservation
Q Other Agency
Type of Visit Oe(;6mpliance Inspection Q Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit outine 0 Complaint O Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: r Departure "Time: 6i® County: Y&Me Region: 14�ekv
Farm Name: D (la it t ` &Y-M,%S �� _ Owner Email:
Owner Name: CO �'` Q r i e-- 4 yl^ Phone:
Mailing Address:
Physical Address:
Facility Contact: _ 1. > S P�o rW.I e. Title: � r 51-ZG f Phone No:
Onsite Representative: 00 k � &vua C_ Integrator: 001 vi 77, 1, �s
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Operator Certification Number:
Back-up Certification Number:
Latitude: ❑ o = 6 ❑ Longitude: = ° ❑ , ❑
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -Laver
❑ Wean to Finish
❑ Wean to Feeder
❑ Feeder to Finish
Farrow to Wean
2
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Pot Its
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge ori-inated at: ElStructure ❑ Application Field ElOther
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑
Dairy Cow
❑
Dairy Calf
❑
Dai a Heifei
❑
Dry Cow
❑
Non -Dairy
❑
Beef Stocker
❑
Beef Feeder
❑
Beef Brood Cow
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)?
(dumber of Structures:
d. Does dischar+ee 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?
r'
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No E] NA ❑ N E
❑ Yes ❑ No ZNNA ❑ NE
ElYes [INo O NA ❑ NE
❑ Yes L' i No ❑ NA ❑ NE
❑ Yes �No❑ NA ❑ NE
12128104 Continued

i
Facility Number: fZ 3zs
Date of Inspection �� Q
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
❑ Yes • No NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): Z
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes oo
NA [INE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental thre t, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes El No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ yes ONo ❑ 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 flo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs [:]Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) 13e-i-m Grc e—J YA,.I C3 Tar N C 0.5,
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ Yes
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?
18. is there a lack of properly operating waste application equipment?
❑ Yes
❑ Yes
0-No ❑NA
❑NE
�3NC ❑ NA
❑ NE
I3No El NA
El NE
No NA
❑ NE
No ❑ NA
❑ NE
Reviewer/Inspector Name �G i&_vC [..S Phone: . 33' CJ
Reviewer/Inspector Signature: Date: g l/—
Page 2 of 3 12128104 Continued

Facility Number: Z — Date of Inspection /- O
Required Records & Documents, ,..f
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ICJ o ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropirate box.
❑ WUP El Checklists El Design El Maps ❑Other
21.
Does record keeping need improvement? if yes, check the appropriate box below.
❑ Yes
. No ❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ 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
2< ❑ NA
El NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
El Yes
7 ❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑Yes
7N�,❑NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑Yes
❑ 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?
El
No ❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
r❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
❑ NA
Zo
❑ 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
V I 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
N ❑ NA
[I NE
33.
Does facility require a follow-up visit by same agency?
El Yes
No ❑ NA
❑ NE
Page 3 of 3 12129104

I
e„tA j_,mod 9-/7- 0 7 lele-
Facility Number
Division of Water Quality
0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit 0 Compliance Inspection O Operation Review O Structure Evaluation 0 Technical Assistance
Reason for Visit b Routine O Complaint O Follow up 0 Referral O Emergency O Other ❑ Denied Access
Date of Visit: Q-t3`07 Arrival Time: f2:SZ7 Departure Time: County: S«+psi N Region:
Farm Name: /C 3 Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: C .Ar`k 5 & YW i e k_ Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone No:
Integrator: CpA'o 1, c „ Bits S
Operator Certification Number:
Back-up Certification Number:
Latitude: = 0 0 1 �" Longitude: = ° = I
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population
❑ Wean to Finish
❑ Wean to Feeder
❑ Feeder to Finish
` Farrow to Wean U
Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
Other
❑ Other
❑ Layer
❑ Non-Layet
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turke s
❑ Turkey Poults
❑ Other
Discharses & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure El Application Field El Other
a. Was the conveyance man-made'?
Design,,,".Curr
Cattle Capacity ;Popula
B
,.I
ee oc er
Beef Feeder r`
Beef Brood Cow-EE I
1-:
77
eT
Number of Structures: �I
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
e. 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?
[_1 Yes � No [I NA ❑ NE
❑ Yes 09 No El NA El NE
El Yes ® No El NA ❑ NE
El Yes [A No ❑ NA El NE
[__1 Yes 0 No El NA El NE
[:1 Yes P No ❑ NA El NE
I
12128104 Continued
I
12128104 Continued

Facility Number:
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure i Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): �Q
❑ Yes 7— No
❑ Yes 09 No
Structure 5
❑ NA ❑ NE
❑ NA ❑ NE
Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7_ Do any of the structures need maintenance or improvement? ❑ Yes P No• ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ® No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes NNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
maintenance/improvement?
❑ Yes [� No ❑ NA ❑ NE
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 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drill ❑ Application Outside of Area
12.
Crop type(s) [3 y p?h/ O V c rL en
13.
Soil type(s) 1 Q� _3 4A It 14y
14.
Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
0 No
❑ NA ❑ NE
15.
Does the receiving crop and/or land application site need improvement? ❑ Yes
P 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
rvq
IL7 No
❑ NA ❑ NE
Comments (refer to question ft Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
If � �i u S t� Crr+•,`�'r N � � w a1. � a ..( Ga t-r���ir� �;� s!°-�--- �. � -� � a!� /aft
Reviewer/Inspector Name C �t_ 1/ Phone: 7/ O , z/33. 330 0
Reviewer/Inspector Signature: Date: Zo 07
12128104 Continued

r
y
Facility Number: gZ —32 Date of Inspection 7
Re uired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes [4 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 El Design ❑ Maps El Other r
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [I 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
❑ No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
® No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[ 9 No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
(� No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
[p No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[P No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
M No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
[�No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
[�'No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
[FNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
EgNo
❑ NA
❑ NE
Comments and/or Drawings:
12128104

® Division of Water Quality'
r
Facility Number $Z,� 3 25 O Division of Soil and Water Conservation
O Other Agency
Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 410 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: 3: 07 Departure Time: County: _ 4 Soi✓ Region: A1W
Farm Name: C O L,0, trl e-- Gxv w. _ C.' _ _ Owner Email:
Owner Name: Cp L on y :s, �Air_te.� Phone:
Mailing Address:
Physical Address:
Facility Contact: C US Soot-w i',c 11�_ Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Phone No. -
Integrator: _ Go jai -fir �6 9,♦ +�r-�
Operator Certification Number:
Back-up Certification Number:
Latitude: = o = f = Longitude: = o [� ,
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Laver
❑ Non -La et
❑ Wean to finish
❑ Wean to Feeder
❑ Feeder to Finish
Farrow to Wean
2300
21 b O
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Dry Poultry
❑ Layers
❑ Non -Lavers
❑ Pullets
❑ Turkeys
❑ urkey Poults
❑ Other
Discharp_es & Stream Impacts
1. Is any discharge observed from any part of the operation'?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design -Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocket
❑ Beef Feeder
❑ Beef Brood Cow
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'? (lfyes, 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 UO No ❑ NA ❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
R No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
® No
❑ Yes
14 No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
12128104 Continued

r
) ficilityNumber: §t-325_ Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes W 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): q
Observed Freeboard (in): =r�
3"
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes [2rNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes [PNo ❑ 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
[ d No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
ED 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
[2fNo
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[X[ No
❑ NA ❑ NE
maintenance/improvement?
1 1 _ Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
[YNo
❑ 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) ��-t�w.bi �_�. �Gt� if f�rr�.nJ
C C7uw�ecc��
13. Soil type(s) t J 164 n!+rl nl
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
C�?No
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
® No
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination%❑ Yes
[3No
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
®No
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
W No
❑ NA ❑ NE
Reviewer/inspector Name i K IL K e�J (?, 4 L'%I Phone: (9 /O� '�6
�..
Reviewer/Inspector Signature: Date: -ZS= 2.04
12128104 Continued

Facility Number: $Z-32 Date of Inspection W`2S-4
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ZI No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 91 No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Desig
n El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes V1 No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
[f No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
® No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
09 No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
(0 No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
[9 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
® No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
5fl No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
® No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
W No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
[?No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
[0 No
❑ NA
❑ NE
1.Addtii. naLComments'and/or Drawings. , g
12128104

Type of Visit ® Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit ® Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: 3 G a Arrival Time: Departure Time- County: 1 Region: F-OCO_
Farm Name: _ [ _, �ar'. c E? v Owner Email:
Owner Name: C o ► d 4 Fc r Phone:
MaitingAddress: C��►-3Enu,,
Physical Address:
Facility Contact:
Title:
Onsite Representative: C, r -A--k s, a
Certified Operator: _ cfx_rA- r
Back-up Operator:
Phone No:
Integrator: „ _ C. ka"A r
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: = o = I = l{ Longitude: = o = I =1 u
Design Current
Swine Capacity Population
❑ Wean to Finish
❑ Wean to Feeder
❑ Feeder to Finish
Farrow to Wean
a 2 Q o
A
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other �- -
Design Current
Wet Poultry Capacity Population
❑ La er }
❑ Non -Layer
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkev Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Cattle
Design Current
Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non-Dai
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
Number of. Structures: F/31
b_ Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes ® No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
EN No
❑ NA
❑ NE
❑ Yes
E] No
❑ NA
❑ NE
12,128104 Continued

Iracility Number: Y.7 — 3 Date of Inspection
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
D 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: 4
Spillway?:
Designed Freeboard (in): 1-7
Observed Freeboard (in);
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ yes
P No ❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
® No ❑ NA
❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
[� No
❑ NA El NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
[� No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
QNo
❑ NA ❑ NE
maintenance/improvement?
11. is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
® No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of
Area
12. Crop type(s) i1J c.r • -- ��ci J s G
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 acre determination`!
❑ Yes
® No
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
PE No
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
�] No
❑ NA ❑ NE
..:, aAei21.-i.y, :: , .�- ,-. ,.... _ •. -r-: -. .i ., -_ice"� �:Y-. ... CO. {refer to gaes on #} Explaut;any YES ansvFers andlorany recommendatiofls�or any other comments.
oaf , x �C�'.}�
Use drawutgslof faciLty to better expIVA .sitpationV, dse`�ad'dttsonal pagesfas�pecessary):
Reviewer/Inspector Name p ti Phone:
Reviewer/Inspector Signature: Date:
12128104 Continued

Facility Number: g�? Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes C� No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes &I No ❑ NA ❑ NE
the appropiate box. ❑ WUP ❑ Checklists ❑ Desig
n El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes E0 No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
® No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
® No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
R1 No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
® No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
® No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
® NA
❑ NE
Other issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
® No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
(M No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
V1 No
❑ NA
❑ NE
a
Add►honai Comments and/or, Drawings r r,
12128104

Type of Visit ® Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit ® Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: 02 li�� Arrival Time: Departure Time: County: Region:
Farm Name: a h a.- � c "de Owner Email:
Owner ,fame: C o b 0r" c f' "0 4 a v� Phone: E G V--+ - Co G_ 1Ot 6- lL.ex, b -s ", _ -A-) C
Physical Address:
Facility Contact:
Title:
Onsite Representative: _ C Lk ♦ 4is a a f IA.',, -L
Certified Operator: _ C am: i r a a V- wI C,L�
Back-up Operator:
Location of Farm:
Swine
Phone No:
Integrator: _ C o � awe t
ti
Operator Certification Number: 3 9'7
Back-up Certification Number:
Latitude: 0 0 1 Longitude: ❑ ° = 6
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -Layer I 1 1!
❑ Wean to Finish
❑ Wean to Feeder
❑ Feeder to Finish
© Farrow to Wean
7X.F
❑ Farrow to Feeder
❑ Farrow to Finish
10 Gilts
Y3
l Boars
Other
❑ Other
Dry Poultry
❑ Layers
❑ Non -Lavers
❑ Pullets
[--IT k s
❑ TurkeyPoults
❑ 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 Pgpulahou ;::
❑
Daia Cow
❑
Daia Calf
❑
Dairy Heifer
❑
Dry Cow
❑
Non -Dairy
❑
Beef Stocker
❑
Beef Feeder
❑
Beef Brood Cow
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 ,® No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
M No
❑ NA
❑ NE
❑ Yes
Qj No
❑ NA
❑ NE
12128104 Continued

Facility Number: �� —.3�s Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in)_
5. Are there any immediate threats to the integrity of any of the structures observed?
(iel large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes ® No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes ® No ❑ NA ❑ NE
❑ Yes © No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ® Yes ❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
® No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require Yes
� No
El NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need El 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 ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) .f�erl:?LL��t erAy��P. 5G DS
13. Soil type(s) 7 .V
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
13 No
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes
R3 No
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination'[] Yes
,R] No
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes
W No
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes
[Z No
❑ NA ❑ NE
7- 1fcr+�ovG ff��L ,eo,,, 4%�/a'f: 6a7r> /��' s`f:e:,kJ If e .
Reviewer/Inspector Name ii �, ,:'k " Phone:
Reviewer/Inspector Signature: Date:
12129104 Continued

Facility Number: �� 3�?S Date of Inspection
Rewired- 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
El Yes
No
❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps p El Other
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
®No
❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V
Rain Inspections ❑
Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
® No
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [XI No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
®NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No
21 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
® No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
® No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
® No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
(91 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
W No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
N No
❑ NA
❑ NE
ds +y: ,ism
ddi>.lonulCoitimenfs:.andlor.Drawings:
12128104

4
(Type of Visit Qebmpliapee Inspection O Operation Review O Lagoon Evaluation
Reason for Visit Ofroutine O Complaint O i=ollow up O Emergency Notification O Other ❑ Denied Access
Facility Number Date of Visit: Tune: 30
Q Not Operational Q Below Threshold
e tted LJR6;ii ed © Conditionally/Certified © Registered Date Last Operated or Above Threshold: ....... «. ..
Farm Name: ...._.... County: «.
/ « — - ----------------
Owner Name: .. ........
..." Phone No: S1.2 — �� A.2
Mailing Address:...... �DD _ f�t3Y� .:......._ .. _... ��a N 3'
Facility Contact: Title- C_� .......... Phone No:
Onsite Representative: _- F t_._1'"! fir.««.....--.-. —.«-.-«.•--_ .. Integrator: «
Certified Operator:......- �, �......«!� �+�+ i». Operator Certification Number:
Location of Farm:
❑�lne ❑ Poultry ❑ Cattle ❑ Horse Latitude • 4 66 Longitude + 4 4C
,D
Swine Ca
Wean to Feeder
Feeder to Finish
arrow to Wean .2
Farrow to Feeder
Farrow to Finish
Gilts
El Boars
Nunnber of Lagoa
nittl»o'-Pnn�cJ. Cnlui
W
,.
Inez M.
--
O 1� e aErw
- -
Other
Total Deli
- 'Tots
Discharges & Stream Impacts
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 yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
S"
❑ Yes
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes Leo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: .......... ........................ .................« «.«..................................... ........ -.................... .................................— ........ ...................
Freeboard (inches): 33
12112103
Continued

Facility Number: —
Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenancelimprovement?
8. Does any part of the waste management system other than waste structures require maintenancelimprovement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenancelimprovement?
11. Is there evidence of over application? If yes, check the appropriate box below.
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12 _ Crop type
N
13. Do the receiving crops differ with thosi/designated it the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge atlor below
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours?
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
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
Air Quality representative immediately.
❑ Yes L3 qo
❑ Yes 8lq6-
❑ Yes No
❑ Yes to
❑ Yes No
❑ Yes B'No
❑ Yes 17 <o
❑ Yes
❑ Yes ❑<
❑ Yes <0
❑ Yes 10
❑ Yes No
❑ Yes No
❑ Yes [?Co-�
❑ Yes LJ No
❑ Yes to
❑ Yes No
Reviewer ector Name - a - - - - ~" /Insp _ w- - y _ - - - _ ..._ . - _ _ W. s
Reviewerllnspector Signature: / /��,�/f '_ 1. Date:
12/l2103 / J Continued

Facility Number: y% _ 3S Date of Inspection
Reauired Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
a<
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
: o
23. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
QkloW
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
EK-
25. Did the facility fail to have a actively certified operator in charge?
❑ Yes
&Wo
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
Yes
���-
(ie/ discharge, freeboard problems, over application)
[Itrzv
o
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
04ro
28. Does facility require a follow-up visit by same agency?
❑ Yes
1 <0
29. Were any additional problems noted which cause noncompliance of the Certified AWNT?
❑ Yes
�'No
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35) ❑ Yes QW6-"--
31. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No
32. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ No
33. Did the facility fail to conduct an annual sludge survey? ❑ Yes ❑ No
34. Did the facility fail to calibrate waste application equipment? ❑ Yes ❑ No
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After V Rain
12112103

r f
Site Requires Immediate Attention: �D
Facility No. -P2_ -
J / DIVISION OF ENVIRONMENTAL MANAGEMENT 3z-r
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: Z, / zU 1995
Time: /z- * 04
Farm Name/Owner:- 4�,Aa�.a fn,.."� e -3
Mailing Address: `fin �T _ _ --- _ _ _ • --
County:
Integrator: Phone:
On Site Representative: Phone:
Physical Address/Location: Al
Type of Operation: Swine _,,� Poultry Cattle
Design Capacity: 2oaL" Number of Animals on Site: 2—'400 ,, -A,
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: 0 Longitude: "
Circle Yes or No
Does the Animal Waste Lagoon haae sufficient freeboard of I Foot + 25 year 24 hour storm event
(approximately I Foot + 7 inches) c es or No
Was any seepage observed from the la oon(s)?
Is adequate land available for spray? e r No
Crop(s) being utilized:
Actual Freeboard:_ J_Ft. 6_Inches
Yes or&Was any erosion obp4yedl Yes or i�o
Is the cover crop adequate? ee or No
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellin %e,5�or No
100 Feet from Wells? Q or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or V
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line: Yes or(9
Is animal waste discharged into water of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes orQ If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? ®or No
Additional Comments:
Inspector Name
Signatu e
cc: Facility Assessment Unit Use Attachments if Needed.

Site Requires Immediate Attention:
" E 2 Facility No. fe -
�t'� 1 DIVISION OF ENVIRONMENTAL MANAGEMENT Cam-3
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: ZA, 1995
Time:
Farm Name/Owner: 4
Mailing Address:
County:
Integrator: _ Phone:
On Site Representative: Phone:
Physical Address/Location:--
Type of Operation: Swine -we"' Poultry Cattle
Design Capacity: Number of Animals on Site:
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: ° Longitude:-- ° "
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) (
Was any seepage observed from the ;
Is adequate land available for spray?
Crop(s) being utilized:
Does the facility meet SCS minimum
No Actual Freeboard: 3 Ft. _Inches
(s)? Yes or No Was any erosion observed? Yes or No
o Is the cover crop adequate? Yes or No
setback criteria? 200 Feet from Dweilin eh or No
100 Feet from Wells? -'e or —No
Is the animal waste stockpiled within 100 Feet of USGS B1ue.Line Stream? Yes or
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line: Yes or wo
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 specific acreage with cover crop)? Desor No
Additional Comments:
Inspector Name
Signature
cc: Facility Assessment Unit Use Attachments if Needed.

i� - • Y
s ti
REGISTRATION FORIM FOR ANIMAL FEEDLOT OPERATIONS
Department of Environment, Health and Natural Resources
Division of Environmental Management
Water Quality Section
if the animal waste management system for your feedlot operation is
designed to serve more than or equal to 100 head of cattle, 75
horses, 250 swine, 1,000 sheen, or 30,000 birds that are served by
a liquid waste system, then this form must be filled out and mailed
by December 31, 1993 pursuant to 15A NCAC 2H.0217 (c) in order to be
deemed permitted by DEM. Please print clearly.
Farm Name: C-,24C4r;r" rrr+s 6-3
Mailing Address: f b, J& k
i;ri-e, C_ ZTV ,.2g131Sr
County: .!To, as: � Phone No. 6'4.2 - //I a
owner (s) Name: �,�?- u;• /aYL� Nr/s.� t✓4k,r
Manager (s) Name: _ T�{y 8, ,d� 4.,
Lessee Name:
Farm Location (Be as specific as possible: road names, direction,
milepost, etc.): F! ti- d- CsP_ /.�ifa)
3 . h in . t - S• . H, o f 41-s2 t f . -(- n/•l z a .. ,,• <4- .rC C ; ,Cz
Latitude/Longitude if known:
Design capacity of animal waste management system (Number and type
of confined animal (s)) d_3U0
Average animal population on the farm (Number and type of animal (s)
-raised) .23A) sc,.s 1--4,,,, s
Year Production Began:_ ASCS Tract No.: 330A
Type of Waste Management System Used: GG9oa re•. 4na
Acres Available for Land AIAL
iati n Waste: S
Owner (s) Signature (s) : DATE: l2-/f-f3
DATE: 1-2 -15 - f 3

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