820326_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental Quai

Date of Visit: EZ�Arrival Time: 'tom( Departure Time: County:,- Region:
Farm Name: p2',5 , q Owner Email:
Owner Name: - c/�j�, ;Ord- �"O'-WS Phone:
Mailing Address:
Physical Address:
Facility Contact: 6qr7-r7r /%�DD/� Title:2?�z 1
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm: Latitude:
Phone:
Integrator:rt,�
J
Certification Number: 11��213
Certification Number:
Longitude:
Design Cnrrent
Design �Cnrrent Design Current
Swine Capacity Pop.
Wet Ponl#ry
Capacity' °Pap. Cattle - Capacity Pop.
Wean to Finish
I
11-ayer
Dai Cow
Wean to Feeder
Non -La er
Dai Calf
Feeder to Finish
Dai Heifer
Farrow to Wean
Design Current Dry Cow
D . P,onl
Ca aci P,fl Non -Dairy
Beef Stocker
Farrow to Feeder
Farrow to Finish
Layers
Gilts
''!
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turke s
ot
I
ITurkeyPoults
Other
I 10ther
Discharges and Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DW R)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes [F]` Ioo ❑ NA ❑ NE
❑ Yes
❑ No
[I NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
[7] No
❑ NA
❑ NE
❑ Yes
[]'—No
❑ NA
ONE
Page I of 3
21412015 Continued

Facili Number: - Date of Inspection:
Waste Collection & Treatment
!� 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ 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 El 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 No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement?
Yes
[] No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[3'—No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
O 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 El"No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10%or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): 23eny-In L, /'9yY/jyro�f L p
13. Soil Type(s): _ .l��ia.`Y"� � � "� / Ali: - fyi�! e.
14. Do the receiving crops direr from those designated in the CAWMP?
❑ Yes
�o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[]N
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
No
❑ NA
❑ NE
acres determination?
17. Does the facility tack adequate acreage for land application?
❑ Yes
[�T`No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes [J"No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [] No ❑ NA ❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [3--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 C] N ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes dNo ❑ NA ❑ NE
Page 2 of 3 21412015 Condnued

Facili Number: - Date of Inspection:
4 24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No [] NA ❑ NE
❑ C� ❑ ❑
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check Yes No NA NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey [] Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes ONo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ENo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes ETNo ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes / No ❑ NA ❑ NE
❑Yes [D-10 ❑NA ❑NE
❑ Yes [3'vo ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CA W M P? ❑ Yes LJ "'o ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes [/�">\lo ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ YesFI-No ❑ NA ❑ NE
rprse
ExplamranyIYESanswers.' d/oraay additional recomihendatiod wings of fartbty to. bettser explainsit atii (q addifi©oalpages as necessary)-
f 1GGJd
�ejn1 �CJu`C_ `jaG ; •�
C-�f�cr�ct Ce-
004111:,j P_/(Opf 0ot'tj Imo- tit -tom
Reviewer/Inspector Name:
Phone:
Reviewer/Inspector Signature:
Page 3 of 3
Date:
21412015

Date of Visit: Arrival Time: Departure Time: County: Region: TfJ
Farm Name: mar u.t f 3 Owner Email:
Owner Name: � � ✓� ✓ F lWM 5 Z � Phone:
Mailing Address:
Physical Address:
Facility Contact: �r'�z-✓�" Title:
Onsite Representative:Z-
Certified Operator: -
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator: i
Certification Number:
Certification Number:
Longitude:
Design Current
Design
Cnrren#
Design Current
Swine
Capacity Prop.
.We# Poultry
Capacity
Pop.°
Cattle Capacity P.
I
I
I
Dairy Cow
Dairy Calf
Dairy Heifer
Wean to Finish
I
ILayer
Wean to Feeder
I
INon-Layer
Feeder to Finish
';=
Farrow to Wean
31 ID Z:)
G
D Poult . ;
Design
Caaci
Current
'P,o
Dry Cow
Non -Dairy
Farrow to Feeder
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -Layers
Pullets
Beef Feeder
Beef Brood Cow
Boars
Turkeys
Other""h'!
Turkey Poults
Other
Other
Discharees and Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes EkNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑Yes
No
❑NA
❑NE
❑ Yes
[] No
❑ NA
❑ NE
❑ Yes
allo
❑ NA
❑ NE
❑ Yes
C-No
❑ NA
❑ NE
Page I of 3 21412015 Continued

Facility Number: 3 Date of Inspection: -
4 Waste Collection & Treatment
`. 4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes F-No ❑ NA ❑ NE
a. if yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): ff77��� J `} 17 g
Observed Freeboard (in): -33 0 3 s�--
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
ZNo
❑ 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
RNo
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental
threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
0 No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
L&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
[�jNo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
allo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below_ ❑ Yes JR1 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 Sane Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13_ Soil TYpe(s)=
14. Do the receiving crops iffer from those designated in the CAWMP?
❑ Yes
PI�No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
MNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
2-No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
Q No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
�No
❑ NA
❑ NE
Rgquired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
g No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[KNo
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other-
2 1. Does record keeping need improvement? If yes, check the appropriate box below. [:)Yes [ No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? [:]Yes ® No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes allo
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412015 Continued

• Facility Number: - a li Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes 3 No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑ No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes ND No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes W 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 the drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes RNo ❑ NA ❑ NE
❑ Yes L&No ❑ NA ❑ NE
❑ Yes Wo ❑ NA ❑ NE
❑ Yes [LNo ❑ NA ❑ NE
❑ Yes R[ No
❑ Yes RNo
❑ Yes [&No
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
,r to ogpesbon #) Explain m apy:YES.answers and/or any additional recomendations or;any other cofnments' °-
nmeats (rele drawings of faeilUV 4o better explain situations (use additional oases as necessary).
Reviewer/Inspector Name: _ �cr-rr���t.� Phone: 9�y--3QX—c7<� f
Reviewer/Inspector Signature: Date: �� _f_;z
Page 3 of 3 21412015

011_
N- S i ..,- ® i p I I I 1 '�1 1 I--•.3-„"�, *'- m.,aekZ ^a _
�,� ..k`r+i
'. _"au p::�15x�.',��� �p'�l;k.�.ar y '�tu� rxuk4i➢rr `a „.. i�`Y�iy riYw �w.�+e-_® 0 I,.. ;y ri7�.yr asp 1. uu. mow. ..ia_ �; p5v��` a4fi"�."?—'k'�E �,�: 'u �is� �'y„r,,
I _
Type of Visit: GKompliance Inspection 0 Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: outine O Complaint O Follow-up Q Referral O Emergency O Other O Denied Access
Date of Visit: ® Arrival Time: ; Oa Departure Time: County: ,z.jz Region:
Farm Name: LOwnerName:
Mailing Address:
Physical Address:
Owner Email:
Phone:
Facility Contact: /trl %%(OBr^r_ Title:22C—,ZPhone:
Onsite Representative: 6.fe--o- ywipwr, `rx Integrator:
Certified Operator: l it fir_ Certification Number: / 5-30
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
urrent
Destgn�C�# Design Current Design Current
Swene Capactty Prop. Wet Poultry#� fapactty *Pop Cattle - Capacity Pop.
Layer Wean to FinishDairy Cow
Wean to Feeder Non -La er I Dairy Calf
Feeder to Finish Dairy Heifer
r
ME
Farrow to Wean Currenntt� Dry Cow
Farrow to Feeder r D �Poultr Ca act Po
Non -Dairy
Farrow to Finish Layers Beef Stocker
Gilts Non -La ers Beef Feeder
Boars Pullets Beef Brood Cow
Turkeys -
Oth�er�, Turkey Poults
MI
Other Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State'? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes [Z-No ❑ NA ❑ NE
❑ Yes 0 No ❑ NA [] NE
❑ Yes [] No ❑ NA ❑ NE
❑Yes
❑No
❑NA
❑NE
❑ Yes
[?�No
❑ NA
❑ NE
❑ Yes
JZ_No
❑ NA
❑ NE
Page 1 of 3 21412015 Continued

Facili Number: (r Date of Inspection: Cp
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier: /�irla JIC�rp/ s� i /�^�yz {�✓
Spillway?:
/
Designed Freeboard (in): / �' %5;1- / 51L
Observed Freeboard (in): 33 -3 0 ,,3 - -33
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
allo ❑ NA ❑ NE
❑ No ❑ NA ❑ NE
Structure 6
❑ Yes MNo ❑ NA ❑ NE
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
IS 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
F�J`No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
Jallo
❑ 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
D�_No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[7No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [] Yes ES.No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window [] Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):/
13. Soil Type(s): �a�Ca�w �y���� - / 1*_714 ;4
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
34-3-No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
[SNo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[RNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
EkNo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[S No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check
❑ Yes
[LNo
❑ 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 JR 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 Q N
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [—IYes�No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
o ❑NA ❑NE
❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facili Number: jDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ®.No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes allo
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes ® No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes IS 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 the drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
�7,aXI / ' LQ[1i Z'G%%Y� //lo
Reviewer/Inspector Name:
Reviewer/Inspector Signatur
Page 3 of 3
❑ NA ❑ NE
❑ NA ❑ NE
[] NA ❑ NE
❑ NA ❑ NE
❑ Yes Ea No ❑ NA ❑ NE
[:]Yes ®No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes 2 No ❑ NA ❑ NE
❑ Yes E� No
❑ Yes 0 No
❑ Yes �No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Phone: /I-P-_3
Date: X; �p2r �lo
21412015

i'.
Type of Visit: O Compliance Inspection U Operation Review U Structure Evaluation U Technical Assistance
Reason for Visit: outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: 3 !7 Departure Time: D Q County��y�--- Region: �/��
Farm Name: �larr'. u� % , ay "� Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: 1WVO1-"--- Title: �-
Onsite Representative:
Certified Operator: '7'0y by `i OVII-et-
Back-up Operator:
Location of Farm:
Latitude:
e_ Phone: Integrator: AV 9
Certification Number:
Certification Number:
Longitude:
Design Current
Design
Current
IN
Design Current
Swine Capacity Pap.
Wet Poultry :- Capacity
Pop.
Cattle
Capacity Pap.
Wean to Finish
Layer
Da' Cow
Calf
Da Heifer
Wean to Feeder
I
INon-Layer
I
Feeder to Finish
-
Farrow to Wean
3
/
Design' .Current
Dry Cow
D , P,oul Ca aei P,o
Non -Dairy
Farrow to Feeder
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turke s
Othe
irkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes MNo ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
[-]Yes
[—]No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (if yes, notify DWR)
❑ Yes
[-]No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
C,No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
[:]Yes
PgNo
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412014 Continued

Facili Number: - Date of Inspection:
E Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
allo
❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?: mil/
Designed Freeboard (in):
Observed Freeboard (in): 132-
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
R71 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
[Z 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
ffj No
❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
® No
❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
[�[No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No
[DNA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes JE� No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop TYpe(s):
13. Soil Type(s):
14. Do the receiving crops diger from those designated in the CA WMP?
❑ Yes
E[ No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
® No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
allo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
® No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[R No
❑ 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
[RNo
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. 0 Yes [allo
❑ Waste Application [] Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? [:]Yes ® No
23.1 f selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes CR No
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412014 Continued

Facili Number: - Date of inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes gj No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes EL 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?
DNA ❑NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes F�gj No ❑ NA ❑ NE
❑ Yes 3,No ❑ NA ❑ NE
❑ Yes [g No ❑ NA ❑ NE
❑ Yes R No ❑ NA ❑ NE
❑ Yes No
❑ Yes No
❑ Yes g] No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question #): Explain any_YES answers :and/or. any additional recommendations or any�otherIcomtnents.
Use drawriigs of;faciLty to betterexplam srtuat,ons'(rse:aifditional pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date: �D}�
21412014

�a 11f
Date of Visit: Arrival Time: ; [i Departure Time: County: Region: FJZ:0
Farm Name:_ Lz=L Au n— ) 33r� d'.s _ Owner Email:
Owner Name: .D �u I jZ ,V t-gr- For ms �� Phone:
Mailing Address:
Physical Address:
Facility Contact: rj('t-ee Title: Phone:
Onsite Representative: S`�� Z Integrator: AiCaqL Oeow`'­ 4
Certified Operator: )7Tn..n, Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design Current . Design Current Design Cnrren#
Swine Capacity ' Pop. Wet Poultry Capacity Pop. Cattle Capacity Pop.
Wean to Finish
Layer
Dai Cow
Wean to Feeder
I INon-Layer
I
lf
Feeder to Finish
""'
Dai Heifer
Farrow to Wean
Farrow to Feeder
JIPA
3Q:!YDesigp
Current Dry Cow
D , P,ouIt Ca aei P,a Non -Dairy
Layers Beef Stocker
Non -Layers Beef Feeder
Pullets Beef Brood Cow
Turkeys
jTurkey Poults
Farrow to Finish
Gilts
Boars
Other
Other
1 10ther
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes R1 No ❑ NA ❑ NE
[:]Yes []No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA E] NE
❑ Yes ❑ No
❑ Yes No
❑ Yes No
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3 21412014 Continued

i
/Facility Number: 9j - 3,,1 Date of Ins ection: 1
4 Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier: ri��L 22�i r C-1 psY�
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3 1 p +-
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
[3 No ❑ NA ❑ NE
❑No ❑NA ❑NE
Structure 6
❑ Yes [allo ❑ NA ❑ NE
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
® No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[ No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ YesLnk
No
❑ NA
❑ NE
maintenance or improvement?
11 _ Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes �No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): ifr!lpfa x. 1 yell rr'I _
13. Soil Type(s): 1'll� s_lr /B� a�—/ Yf/t I /r-
14. Do the receiving crops ciffer from those designated in the CAWMP?
❑ Yes
jj� No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[Q No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
rUr No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
allo
❑ NA
❑ NE
Reauired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[A No
❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
[:]Yes
® 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
[gNo
❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
® No
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ® No 0 NA ❑ NE
Page 2 of 3 21412014 Continued

Facility Number: - Date of lns ection: j
* 24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[g No
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
[Z[ No
❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
❑ Yes
R No
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
KNo
❑ NA ❑ NE
Other issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
[KNo
❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
allo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
[a No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
[Z No
❑ NA
❑ NE
❑ Application Field 0 Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[R No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
®, No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
[2�No
❑ 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) : „.
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date:
21412014

�type or visit: L-z,ompu ce inspection kj tiperanon Kevtew u asrucrure r vamauon U i ecnnrcai Assistance I
Reason for Visit: outine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: // � Arrival Time: Departure Time: ; Do County. Region:
Farm Name: �G• r / 3 Owner Email:
Owner Name: i-L Phone:
Mailing Address:
Physical Address:
Facility Contact: woo Title: ZA Z�•
Onsite Representative: n n i• pofze-
Certified Operator: Tic
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator: _ Z jj.y c
Certification Number: / 2jAZY
Certification Number:
Longitude:
Design
Current
Design Current
Design Current
Swine
op�
Wet Poultry
Capacity Pop.
Cattie ._ Capacity Pop.
Wean to Finish
La er
Dairy Cow
Dairy Calf
Wean to Feeder
on -Layer
Feeder to Finish
`" `"
,
Dai Heifer
'Farrow to Wean
71
'
D , ,P,ouI
DesEga
Ca aci
. Current
PRo
Cow
Farrow to Feeder
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
-
Non -Layers
I
113eef Feeder
Boars
Pullets
I
113eef Brood Cow
`x Turkeys
Other
Turkey Poults
Other
larjother
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 CE�-No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
[:]Yes [:]No
❑ Yes No
❑ Yes No
DNA ❑ NE
❑NA ❑NE
❑NA ❑NE
Page I of 3 21412011 Continued

Facili Number: - Date of Inspection:
Waste Collection & Treatment
` 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? 0 Yes ONO
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No
Structure I Structure 2 Structure 3 Structure 4
Identifier: ���r+' C
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): a 7 � D
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
❑ NA ❑ NE
❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes ® No ❑ NA ❑ NE
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
0 No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
Vj No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
allo
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
[Z No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
VLNo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [] Yes allo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc_)
[] PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window
r ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):jiytr
13. Soil Type(s):
14. Do the receiving cropsrdiffer from those designated in the CAWMI ?
❑ Yes
No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
ZNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
ONO
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
QNo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check
❑ Yes
0 No
❑ NA
❑ NE
the appropriate box.
❑WUP []Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21_ Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ®-No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute inspections ❑ Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ® No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes E&No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑NA ❑NE
Page 2 of 3 21412011 Condnued

Facility Number: - Date of Ins ection: /-!
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes C, No ❑ NA ❑ NE
L
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes MNo ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey []Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of fast survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes E' No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes !! No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
0 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
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
R[ No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
allo
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[Z No
❑ NA
❑ NE
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
® No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
[A No
❑ NA
❑ NE
Comments.(refer to question f: Explain any YES answers and/or any additional recommendatidns.or any othertcomments: `
Use.drawings of facility to better explain situations (use additional pages as necessary).
ryas _2�
Reviewer/Inspector Name: Slrv77_
Phone:
Reviewer/Inspector Signature:
Page 3 of 3
Date: Ij— ZL )3
21412011

Type of Visit: . QVompliance Inspection Z3 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit; eloutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: D 6 1 County
Farm Name: tf L 4—Qr c �, 3 d-S Owner Email:
Owner Name: ��� ��C v c r r—a em, G Phone:
Mailing Address:
Physical Address:
Region: io"%Z 0
Facility Contact: O r Title:��-� �G.. Phone:
Onsite Representative: � ta!'�''L / i*9LxZ '0%Vr4_ Integrator:
Certified Operator: �'t�e_ Al y Nfibf_r__ Certification Number: Z-3 "0
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Swine �
Design
•a
Capacity
Current§ Design Current : , ,
"* err :Po
ap WettPoultry, Capacity p
Layer
I jNon-l.ayer
Design Current
,. D . fault': ;..,_ Ca aci Po
La ers
Non -Layers
Pullets
k-.. ,.. Turkeys
Turkey Poults
Other
. Design Current
Cattle Ca aci Po
p
airy Cow
airy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
allo
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
[] Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
% No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
Q No
0 NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

Facility Number: - 3 Date of inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
®. No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure
6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):- a _ .3 D
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
[—]Yes
® No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
® No
❑ NA
❑ NE
S. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
® No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
Q No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
L4kNo
❑ NA
❑ NE
maintenance or improvement?
11. 1s there evidence of incorrect land application? if yes, check the appropriate box below. ❑ Yes (4 No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): fi- Zn Pjtj_ /
e -
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
g] No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[,-a No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[allo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
1Mv v No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 2] No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ®No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facili Npmber: - ,3 Date of Ins ection: —/
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ® No ❑ NA ❑ NE
• 25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes fallo NA ❑ NE
the appropriate box(es) below.
Failure to complete annual sludge survey [] Failure to develop a POA for sludge levels
Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes ® No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes rM No ❑ NA NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
❑ Yes Z. No ❑ NA NE
Yes Co No ❑ NA ❑ NE
Yes Cg No ❑ NA ❑ NE
[] Yes ® No E3NA NE
Yes 0 No
Yes Cq No
Yes R1 No
NA NE
NA NE
NA NE
Phone: .33a13
Date:
21412011
Page 3 of 3

Type of Visit: 4EMompliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: outine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: /G-/ Arrival Time: 9 : 3-D I Departure Time: ; 3 County: Region: %� Q
Farm Name: �,��r- -;�u" I „2 3 y t- Owner Email:
Owner Name: T i y, r z1arm S -T-- 4 e-, I Phone:
Mailing Address:
Physical Address:
Facility Contact: �j frr.�Oei` rl� Title: jr'a� Sir Phone:
Onsite Representative: AA/ `ry&&,g Afpp/'r- Integrator: r
Certified Operator: Hl± .ex &1-1n/ r- Certification Number: /23LL3
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Current
Design eCurrent Design Current
SwineDesign
' ,Capacity Pap.
Wet PoultrCapac fv Pop. Cattle Capacity Pop.
'it
La er Dairy Cow
Layer Dairy Calf
- Dairy Heifer
Wean to Finish
can to Feeder
Feeder to Finish
Farrow to Wean
)
^ - - : -~Design `Current Dry Cow
D . Point (F Ca parity = Pso Non -Dairy
Farrow to Feeder
Farrow to Finish
La ers jBeef Stocker
Non -La ers Beef Feeder
Pullets Beef Brood Cow
Turkeys
Gilts
Boars
MEN, Other
TurkeyPoints
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
[23_No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
[] Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
[&No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
[RNo
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

Facili Number: - L Date of Inspection: -- /
* Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes El No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in).
Observed Freeboard (in): _ (� —
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ® No ❑ NA ❑ NE
(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?
M Yes
[] No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
[]Yes
® No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
fo No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below, ❑ Yes [Q No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): .' "�
13. Soil Type(s): Wzr Z�•-• r
14. Do the receiving crops differ from those designated in the CAWMP?
[:)Yes
® No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
® No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
® No
[] NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
® No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
® No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
® No
❑ NA
❑ NE
the appropriate box.
❑ WUP []Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ® No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stacking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ® No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes MI No
❑NA ❑NE
[] Weather Code
❑ Sludge Survey
❑NA ❑NE
❑NA ❑NE
Page 2 of 3 21412011 Continued

Facility Number: - V Date of inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes Z] No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes Ed 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 (0 No ❑ NA ❑ NE
27. Did the facility fait to secure a phosphorus loss assessments (PLAT) certification? [:]Yes ® No ❑ NA ❑ NE
Other lssues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes 54 No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes �No ❑ NA ❑ NE
❑ Yes & No ❑ NA ❑ NE
❑ Yes 4 No ❑ NA ❑ NE
❑ Yes No
❑ Yes No
[:]Yes allo
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations ccohiineufs.
Use drawings of facility to better explain situations (use additional pages as necessary). _
U
Reviewer/Inspector Name:
Phone: 2'D `zJ 9? --33eo
Reviewer/Inspector Signature: 1M Date:
Page 3 of 3 21412011

Type of Visit (9-Cio-mpliance Inspection 0 Operation Review Q Structure Evaluation 0 Technical Assistance
Reason for Visit outine 0 Complaint 0 Follow up 0 Referral 0 Emergency Q Other ❑ Denied Access
Date of Visit: �nn—! Arrival Time: ; p t7 Departure Time: : p p County: Region:
Farm Name: _[��n'✓ i�c,�K �Gt'r/YL %�. �`� Owner Email:
Owner Name: 7�-at �l�c f2 ✓rd`" s L L G Phone:
Mailing Address:
Physical Address:
Facility Contact: r fly / /Y=/" , Title: _,�,, e • Phone No:
Onsite Representative: D 2) Integrator: f�n� T�va4✓+i.
Certified Operator: /iT-04 INODr Operator Certification Number: 1 �3
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: [—] o [--] ' E::] u Longitude: = 0 =' = µ
Design
Current Design Current Design Current
Swine
Capacity
Population Wet Poultry Capacity Population Cattle Capacity Population
❑ Wean to Finish
❑ La er
❑ DairyCow
❑ Wean to Feeder
❑Non -La er
❑ DairyCalf
❑ Feeder to Finish
-
Dry Poultry
❑ DairyHeifer
❑ D Cow
Farrow to Wean
❑ Farrow to Feeder
❑ Non -Dairy
❑ Beef Stocker
❑ Farrow to Finish
❑ Layers
Gilts
❑ Non -La ers
❑Puilets Beef Feeder
❑ Beef Brood Co
PE] Boars
- ❑Turke s
Other,
❑ Other
❑ Turkey Points
❑ Other
Number of Structures:
Discharges & Stream Impacts
I. Is any discharge observed from any part of the operation?
❑ Yes
BNo
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b" Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. is there evidence of a past discharge from any part of the operation?
❑ Yes
[X No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
J.No
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12128104
Continued

Facility Number: — b 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?
❑ Yes CgNo
❑ Yes ❑ No
❑NA El NE
El NA El NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5 Structure 6
Identifier: y rrawu D;
Spillway?:
Designed Freeboard (in): 19
Observed Freeboard (in): 13D sL d
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes 54,No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes 0 No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes 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 Dd No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes &d No ❑ NA ❑ NE
maintenance/improvement?
I I. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes RNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable' Crop Window El Evidence of/Wind Drift El Application Outside of Area
12. Crop type(s) &A ..,.4 a=, =, �Au�lSr-rvT _
13. Soil type(s) ' A-U Tj
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [allo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
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
CI No
❑ NA
❑ NE
R No
❑ NA
❑ NE
RNo
❑NA
El NE
E& No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
P
Reviewer/Inspector Name r Phone:
Reviewer/Inspector Signature: - Date:
12.128104 Continued

Facility Number: — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes D.No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [RNo ❑ NA ❑ NE
the appropriate box. ❑ WUp ❑ Checklists ❑ Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes &No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute inspections [:]Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes SNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 17No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
allo
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
allo
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
KNo
❑ 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
Q 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
ER 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
F[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
%tNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
JgNo
❑ NA
❑ NE
AdditionalCopnments and/or Drawtn s
f +
l
.1
Page 3 of 3 12128104

8_rms iz - zz -zoo 9
Type of Visit Q",�pliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit (5rmrtonutine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: 2-17-p Arrival Time: �O; OO,F,ir. Departure Time: `�%B� m County: s Sba! Region: F/LQ
Farm Name: Clew,- R U of �2 Z )31, 4) i S Owner Email:
Owner Name: 2)6; Ve-r EartKs Li-C. Phone:
Mailing Address:
Physical Address:
Facility Contact: G ri � KAva Vr t_ Title: —rca, so ram- • Phone No: "
Onsite Representative: Integrator:
Certified Operator: Maori, k e.14..j y N, Operator Certification Number:
Back-up Operator:
Location of Farm:
Back-up Certification Number:
/93*3
Latitude: = c = , = Longitude: = ° 0 ' EDu
Design Current Design Current
SHine Capacity Population Wet Pou1091W.apacity Population
Design C►anent
Cattle Capacity Population
❑ Wean to Finish
❑ Layer
❑ DairyCow
❑ Wean to Feeder
❑ Non -Layer
❑ DairyCalf
❑ Feeder to Finish
® Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
3 l2
312 � pry Poultry
❑ DairyHeifer
❑ D Cow
❑ Non -Dairy
❑ Layers
❑ Beef Stocker
❑ Gilts
❑ Boars
Other
❑ Non-LaNetsers
El Beef Feeder
❑ Pullets
❑ Turke s
❑ Turkey Pouets
ther
❑ Beef Brood Co
ures:
❑ Other
I
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation'?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes ' No ❑ NA ❑ NE
❑ Yes ❑ No L`1 NA
❑ NE
❑ Yes ❑ No D<A
❑ NE
❑ Yes ❑ No
❑ NE
❑ Yes rNc, ElNA
ElNE
ElYes ❑ NA
❑ NE
12128104 Continued

Facility Number:? -3Z Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes VNo
El NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ NA ❑ NE
s,A - `Tra..c ► r ` P.ewpp i *
Structure 1 Structure 2 StructurStructure 4 Structure 5 Structure 6
Identifier: 11� /.2-i 3,, y SA ;ti'
Spillway?:
Designed Freeboard (in): 1 9 % q / 9
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes U 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 eNo ❑ 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 environmentalat, notify DWQ
7. Do any of the structures need maintenance or improvement? ElYes No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes El"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 [ I No ❑ NA ❑ NE
maintenance or improvement?
Waste Annlication
10. Are there any required buffers. setbacks, or compliance alternatives that need El Yes 21 No ❑ NA ❑ NE
maintenance/improvement? �
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes El No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphors ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) SK P-IA (; v--,
13. Soil type(s) Rwlyy ville. , 8IOA1 o nt , Wnej r-&& -�
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? ❑ Yes
18. Is there a lack of properly operating waste application equipment? ❑ Yes
L`7 No
❑ NA
❑ NE
Q NNo
ElNA
❑ NE
3"'No
❑ NA
❑ NE
E No
❑ NA
❑ NE
ER'No
❑ NA
❑ NE
Comments refer to tsestion.# t Explain any
( q' }. p y YES answers and/or any recommendations or any other comments
Use drawings of facility to'better explain situations. (use additional pages as necessary): x,
r
Reviewer/Inspector Name F_1Z+c.kc,- : e-ye 1-S Phone: 9/0, 433, 3300
Reviewer/Inspector Signature: R err- Date: /2-/7- ZODcj
12128104 Continued

Facility Number: 82 —32(a Date of Inspection /Z -/ 7-0 9
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ WIJP ❑Checklists ❑Design ❑Maps El Other
❑ Yes CT/No ❑ NA ❑ NE
❑ Yes E No ❑ NA ❑ NE
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1"
Rain Inspections ❑
Weather
Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
E2rNo
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
QrNo
❑ NA
❑ NE
24, Did the facility fail to calibrate waste application equipment as required by the permit?
El Yes
El NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
El Yes
,E(NNo
LfJ No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
E(No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
0 No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
El Yes
��
LJ No
❑ NA
❑ NE
29_
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
E No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
f
30.
At the time of the inspection did the facility pose an odor or air quality concern?
El Yes
LI 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
��/
LrJ 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
LI No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
LE No
❑ NA
❑ NE
12128104

I-o B - oq /z/Z—
%9-01"sion of Water Quality
Facility. Number g2 32 Q. Division of Soil and: Water Conservation
`0.OtherAgency _ . >.
Type of Visit Q-C!5mpliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Q11outine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: /z /(i -1i Arrival Time: Departure Time: County: Region: 1iC
Farm Name: C f e4;� 1r F_mjv �L-- S Z oTV� Owner Email:
Owner Name: lac, ► ve r Fo .--ems` , L I- C- Phone:
Mailing Address:
Physical Address:
Facility Contact: 6rtu- itMav Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
`Swine
❑ Wean to Finish
❑ Wean to Feeder
❑ Feeder to Finish
Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
� tc- • Phone No:
Integrator: %! u r,94 SJ-,1 WA1
Operator Certification Number:
Back-up Certification Number:
Latitude: [ 0 [=]' [=] " Longitude: = o I = `
esign Clow-
urrent,t E Design Current
patty Pop l ttop Wet Poultry Capacity Population
Non-
�I . Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation'?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
Cow
Heifer
❑ Yes [j No ❑ NA ❑ NE
❑ Yes
❑ No
E DNA
❑ NE
❑ Yes
❑ No
[VITA
❑ NE
[�A
El NE
❑ Yes
❑ No
El Yes
L'I No
❑ NA
❑ NE
❑ Yes
Q No
❑ NA
❑ NE
12128104 Continued

t
Facility Numbdr: g2 —32 to
Date of Inspection P2-16-o
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?
❑ Yes dNo
❑ Yes �o
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier: 2, 3—� S = %Y+�,v S r�uT_
Spillway?: A10 A10 NO /V b
Designed Freeboard (in):
Observed Freeboard (in): 30
[I NA ❑NE
❑ NA ❑ NE
Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes [31�o ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes Dfo ❑ 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? [IYes RNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes l_Pro ❑ 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 D o ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes E No ❑ NA ❑ NE
maintenance/improvement?
11.
Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
3<o
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12.
Crop type(s) JBv►-k..�� t� a5%Yc�� S,. it G, .?,J CO .S.
13.
Soil type(s) Aq A & I LA
14.
Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
L7 No
❑ NA ❑ NE
15.
Does the receiving crop and/or land application site need improvement? ❑ Yes
o
[I NA ❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[]LI Yes
�Bl
No
❑ NA ❑ NE
17.
Does the facility lack adequate acreage for land application? ❑ Yes
❑ NA ❑ NE
18:
Is there a lack of properly operating waste application equipment? El Yes
E�lo
L] No
❑ NA ❑ NE
Reviewer/Inspector Name C_/s Phone: `7/�.4i33. 333 p
Reviewer/Inspector Signature: Date: %Z - 14 - Zoo
Page 2 of 3 12128104 Continued

Facility Number: gZ -326 Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes B No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check D Yes L] 1 o ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps El Other //
21. Does record keeping need improvement? If yes, check the appropriate box below. El Yes D"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
❑ &o
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
B No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
El"No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
El NA
El NE
Did the facility fail to have an actively certified operator in charge?
Yes
Elh26.
,D'l�fo
El NA
NE
2T
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
ElL7 Yes
,3,N�o
1vo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
FZNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
[l Yes
D10
❑ 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?
El Yes
,��
L'7 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
,,��,,//
BNo
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss reviewhnspection with an on -site representative?
❑ Yes
L_l Noo
ElNA
ElNE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
B o
❑ NA
❑ NE
Additional Comtnentts aridlor Drawings .`
w
Page 3 of 3 12128104

(5 'Wov/zoos
0 Division of Water Quality
Facility Number $Z 3Z (F 0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit ® Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: 12 -i 2 - D-7 I Arrival Time: t ° OQ A Departure Time: County:
Farm Name: Ck P_Ao r [rrxr wts t ..7;0T'�1.5 _ Owner Email:
Owner Name: 1ciLk i vc . httra.► L L L Phone -
Mailing Address:
Physical Address:
Facility Contact:
Title: 1 ��-t-+ • �G �� Phone No:
Onsite Representative: _ G rcG� „iupo? Z MM JucorL _ Integrator: Aftttp X ., Ri`bla.'l
Certified Operator: Operator Certification Number:
Region: Fieo
Back-up Operator:
Location of Farm:
Gre-`r- ftkaorL
Back-up Certification Number:
Latitude: 0 0= j 0« Longitude: 0 0= I= u
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population Cattle
❑ Wean to finish
❑ Wean to Feeder
❑ Feeder to finish
fnFarrow to Wean 3i Z
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
❑ La er
❑ Non -La ei
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pallets
❑ Turkeys
❑ Turkey Pouits
❑ Other
Discharges & Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
,5v
Design Current;
Capacity Population,:;
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifej
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocket
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures: ©'
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
O
❑ Yes ®No ❑ NA ❑ NE
❑ Yes
[0 No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
® No
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
CO No
❑ NA
❑ NE
12128104 Continued

Facility Number:.- 327(,p
Date of Inspection
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes �fl No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes (4 No ❑ NA ❑ NE
Structure,9 Structured) Structure© Structurco Structure 5 Structure 6
Identifier: 1, 7,3,_^ STre,vs£y S Pur5Q4_ CJoSSc.d l�n✓
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3 Z 10
37
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ElNA ❑ 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 0 No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes [M No El NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement? f
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 [P No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. CroptyPe(s) �erv��c�al �PaS��.+-c_� Sw.�U �►��n1 �OvsrS
13.
Soil type(s) Z p "i � l►.S $
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
P No
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
[j9 No
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
M No
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
[M No
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
0 No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Re-dewer/Inspector Name +'�k Rew QA S Phone:
ReviewerAnspector Signature: R t—til Date: f Z -_ I Z - Z6a 7
12128104 Continued

Facility Number: $Z — 32(o Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes [9 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes P5 No ❑ NA ❑ NE
the appropiate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [MNo ❑ 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 V 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
0 No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
[6 No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
VI No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
V] No
❑ NA
❑ NE
Otherlssues
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
I] No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
No
❑ NA
❑ NE
Comments and/or Drawings:
12128/04

Type of Visit ® Compliance Inspection Q Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit ® Routine O Complaint O Follow up Q Referral Q Emergency O Other ❑ Denied Access
Date of Visit: 0- - Arrival Time: ,� Departure Time: S2d ounty: M ,s6n/ Region:
Farm Name: `� 2-Owner Email:
Owner Name: �� � R,,, ✓fit, GC Phone:
Mailing Address:
Physical Address:
Facility Contact: mere_ Title: /ec—1 Ste. _ Phone No:
Onsite Representative: ,Grec ✓` /lean✓.t_ / f �,t /Woof-e Integrator: �B.V
Certified Operator: Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: 0 0 0 10" Longitude: = ° = t 0 "
Design Current
Design Current
ICL-,!at
Design Current
Swine
Capacity Population
N
Wet Poultr, ii( ity Population
e
Capacity Population
❑ Wean to Finish
❑ La er
❑ Dairy Cow
❑ Wean to Feeder
❑Non -La er
❑ Dairy Calf
Feeder to Finish
ZOO
j=
❑Dai Heifer
Farrow to Wean
Z75V'
❑ Dry Cow
❑ Farrow to Feeder
ElNon-Dairy
❑ Farrow to Finish
El Layers
El Beef Stocker
❑ Gilts
❑Nan -La ers
❑ Beef Feeder
❑ Boars
❑ Pullets
❑ Beef Brood Cowl
-.-k
�`��
❑ Turkeys
Other
❑ Other
❑ Turke Puults
❑ Other
Number. of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
[]Yes
[!WNo
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
[A No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
[� No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
[M No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
[MNo
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
[1jNo
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
12128104
Continued

Facility Number: SZ-32(p Date of Inspection 0/01
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
(YNo ❑ 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: 1 3 S! STr�nJS� o
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): - 2Cf 3D 32
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
(XNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
[XNo ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
�No El NA El NE
8_ Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
[3 No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
® No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
Are there any required buffers, setbacks, or compliance alternatives that need
ElU Yes
No
No ❑ NA ❑ NE
Ur
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
0 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)L„�
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? ❑ Yes
18. Is there a lack of properly operating waste application equipment? ❑ Yes
VM No ❑ NA ❑ NE
(�No El NA El NE
(A No ❑ NA ❑ NE
29 No ❑ NA ❑ NE
R No ❑ NA ❑ NE
Reviewer/Inspector Name ,; > , S Phone: (9/V f-73 - 33—?0
Reviewer/Inspector Signature: Date: /0 -- /p — ZOo li
Page Z of .3 12128104 Continued

Facility Number: $2 Date of Inspection O/O-4
Required_ Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes [� No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [4No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [B No ❑ NA ❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[8 No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
VfNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
TfNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
R9 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
1�1 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
2n No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
[P No
❑ NA
❑ NE
Additional Comments and/or. Drawings:.
AL
Page 3 of 3 12128104

Type of Visit ® Compliance Inspection Q Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: -le, "6 i' Arrival Time: Departure Time: County: Region: FRO
Farm Name: f l eow- ism— EniahcOwner Email:
Owner Name: "e K PTA e, FoLy_ k L C- Phone: 410 _ S3 z — -Y? �2
Mailing Address: PO,Zo 6
Physical Address:
Facility Contact: e) k-0,e ogo_;!�_e Title:
Onsite Representative: ``)� G1r ,vyi°`°✓{ f ..� f�toc: r____
Certified Operator: JA—r•� !ii[vort
Back-up Operator:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: [=] o =' ❑ Longitude: = ° =' = "
Design
Current��;Des�gn
Current ,; `, Design
Eurrent
ne
p ty
Ca aci
Po ulahon
p
L xk* Fi
Wet Poult �, � C' '' ` Ca aci Po ulanon
ry Capacity Populatton tittle p ty p
6
Wean to Finish
to
❑ La er
❑Non -La et
,; t � ; '
Dry Poultry; 1 zt�_
"" 3 '� 1" `
❑ Dai CowWean
; ❑ DairyCalf
❑ DairyHeifez
❑ D Cow
❑Non -Dairy
to Feeder
[Feeder to Finish
o O
arrow to Wean
D
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Layers
❑ Non -La ers❑ Pullets❑Beef
❑ Turke s
❑ Beef Stocket
Feeder
❑ Beef Brood Cori
Gilts
POBoars
OthNff
er
d
;�,
❑ TurkeyPoults
❑Other
w
, ;
=; ..:..._.,,�
NisrnWr6f- , ctures
I..:�ir=
❑ Other
Discharges & Stream Impacts
I. Is any discharge observed from any part of the operation?
❑ Yes
,��
LyNo
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State'? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes. notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
[2 No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
LRNo
❑ NA
❑ NE
other than from a discharge?
12128104
Continued

Facility Number: L Date of Inspection ' - -,O1
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes �0340 El NA [I NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check El[ Yes o ❑ NA ❑ NE
the appropiiate box. ❑ WUP ❑ Checklists ❑ Design [I Maps [I Other ,,�-,,!!
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [3 o ❑ 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
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
/No
o
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
El
,L��,
M<o
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
LYNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
02'lglo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
03,lo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
Uiqo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
ONo
❑ 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
EYNo
❑ 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
[a No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
M(No
❑ NA
❑ NE
12128104

Facility Number:8'y — 5 )L-C,
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): 16,�,4e_ /#7& a ij I
Observed Freeboard (in): �� � 3 30
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 Q�Vo
❑ Yes ❑ No
Structure 5
El NA El NE
El NA El NE
Structure 6
❑ Yes [YNo ❑ NA ❑ NE
❑ Yes 62'�4o ❑ 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 EZNo ❑ NA [:1 NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes Ej] 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 gNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application ,/
10. Are there any required buffers, setbacks, or compliance alternatives that need ElN Yes No ❑ NA ❑ NE
maintenance/improvement?
11.
Is there evidence of incorrect application? if yes, check the appropriate box below. ❑ Yes
UNo
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload [:1 Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > ]O% or lO lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop ❑ Evidence of Wind Drift ❑ Application Outside of Area
12.
/Window
Crop type(s)rwn�_ b{st nri[�.�ti" K �cs .srr�f ✓�t�
13.
Soit type(s)� t 7 C
14.
Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
E�No
❑ NA ElNE
15.
Does the receiving crop and/or land application site need improvement? ❑ Yes
[,(( No
❑ NA ElNE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination%❑ Yes
EJ No
❑ NA ❑ NE
17.
Does the facility lack adequate acreage for land application? ❑ Yes
&No
❑ NA ❑ NE
18.
Is there a tack of properly operating waste application equipment? ❑ Yes
E](J
No
[:1 NA ❑ NE
Reviewer/]nspector Name4,0 44Zw� _, Phone: /u /J
Reviewer/Inspector Signature: Date: - % — a
12128104 Continued

Type of Visit 0 Compliance Inspection O Operation Review O Lagoon Evaluation
for Visit / Routine O Complaint Q Follow up O Emergency Notification Q Other ❑ Denied Access
Date of visit.: -? -0 Tune: �o E ee ON s •wc, yr
F_ Facility Number
Q Nat Operational! Q Below Threshold
�ermitted artertified 13 Conditionally Certified 0 Registered Date Last Operated or Above Threshold:
Farm Name: .. G�i Y.� ! ....gtn.5........ 7, f-+S_.- - - County:
Owner Name: , Phone No:
Mailing Address:....P_� .....g11 .-......... ------ ------- 21yyl_............
Facility Contact:LCL....... �!�! Od <t. _ Title:.. .. -_. _ Phone No:
Onsite Representative: P [Pl �e l Gf ---T ;�,.... !�....------- Integrator: _. L—/ - �...
Certified Operator ......................... 1'vA f4_---- -- ..... Ad c! a ... Operator Certification Number:
Location of Farm:
06"W"ine ❑ Poultry ❑ Cattle ❑ Horse Latitude • t 66 Longitude • 4 �u
Design X Current ` Design Current¢ - _ Design Current-
-
Swine .. _- -
_- .;'Ca .a .=Po-ala6on - Poultry
.: - s -
Ca ri Po-dlatiai►_.. Catde� .• - a -�-Po hop__
Wean
Wean to Feeder
_ ❑Layer
El
pederto Finish
El Non -Layer
4f El Non -Dairy
arrow to Wean 7
Farrow to Feeder
w Other
Farrow to Finish
n
- Total Dego Capac><ty t
Gilts
- _ t s
- -
El Boars
� .."'
' � Total-SSL. a =:
F
ry
Number of Lagoons -
s
"��
_
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?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure i
Identifier r 3
Freeboard (inches): 'f Na a r� a 29 —
12/12103
❑ Yes ❑-K
❑ Yes 010
❑ Yes FKo
F_�
❑ Yes a0-o
❑ Yes
Gio
❑ Yes
[31qo
❑ Yes
�0
Structure 6
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, ❑ Yes [ io
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑ Yes [31�o
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes
8. Does any part of the waste management system other than waste structures require maintenancelimprovement? ❑ Yes g lqo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes ENo
elevation markings?
Waste Anolication
10. Are there any buffers that need maintenancehmprovement? ❑ Yes �Fo
11. Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes ❑,o
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type 9eC-Mv6&_�_6:ra71'J SMPJ1 Grn;n ' Crfi2ror. Sara/� (ru:h lHoX
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes ❑-KO,-
14. a) Does the facility lack adequate acreage for land application? ❑ Yes ®'No
b) Does the facility need a wettable acre determination? ❑ Yes [9-No
c) This facility is pended for a wettable acre determination? ❑ Yes ®Ihio
15. Does the receiving crop need improvement? ❑ Yes [3-1q6-
16. Is there a lack of adequate waste application equipment? ❑ Yes ®-No
Odor Iti_sues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes 31�o
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes ❑ll10
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional ❑ Yes To
Air Quality representative immediately.
Reviewer/Inspector Name / if/I %�. _ !S s�llviT/6—.
Reviewer/lnspector Signature: �,,� JJ4,,,, Date:
12112103 Continued

Facility Number: — (� Date of .Inspection 7•?( -_61
Renuired Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
Epq-05'
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
etc.)
❑ Yes
QW6
23. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
❑ No
❑.t ication ❑Fraebvm'T ❑ Waft sis ❑ Soil Sampling
(, - /3
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
Q-N(r
25. Did the facility fail to have a actively certified operator in charge?
❑ Yes
Quo
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
❑W6
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
[jW6
28. Does facility require a follow-up visit by same agency?
❑ Yes
❑ No
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
Qzle—
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35) EJAFes ❑ No
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [. N-6
32. Did the facility fail to install and maintain a rain gauge? ❑ Yes
33. Did the facility fail to conduct an annual sludge survey? ❑ Yes EIN6'
34. Did the facility fail to calibrate waste application equipment? ❑ Yes
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below. ❑ Yes �Nd
0 S49sking FQmr ❑ Crop Yield Form ❑4Lainfel+ ❑
❑ ❑
12112103

Site Requires Immediate Attention:
Facility No. S z -"o
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: 7--z 7 , 1995
Time: Z " 3
Farm Name/Owner: _Y 4, 1C Al - d %,e_ RaA.l -5
Mailing Address: -fl a c3� x I., A&a g-//s :!C a S,
County: S*i���✓
Integrator: 73'
On Site Representative: 4
Physical Address/Location:
Phone: 9/0 —_5-3-2 - 7:
Phone:_
,. .�
/Y,
Type of Operation: Swi a PouTtry Cattle
Design Capacity: R - Number of Animals on Site:GLd
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) Yes orS Ac al Freeboard: Ft. 1L-IInches , hfy405f�RH
Was any seepage observed from the lagoon(s)? Yes orgoWas any erosion observed? Yes o o cJor cdc,"b
Is adequate land available for spray? a or No Is the cover crop adequate? N;por No
Crop(s) being utilized: T
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings? r No
100 Feet from Wells?�r No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes o C
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line: Yes okA)
Is animal waste discharged into water of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes oRT9�;_-) 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)? es r No
Additional Comments: �., * &cw.�/ .�NK3 E�73 4 _49 1V1'Pk,)'EZ
�A/ Z60Z ZZ-74—K77
Inspector Name
Signature
cc: Facility Assessment Unit Use Attachments if Needed.

State of North Carolina
Department of Environment,
Health and Natural Resources 4 • 7ejFayetteville Regional Office
James B. Hunt, Jr., , Secrnor
etary C F1
Jonathan B. Howes, Secretary C
Andrew McCall, Regional Manager
DIVISION OF ENVIRONMENTAL MANAGEMENT
December 27, 1994
Mr. Kenny Moore, Owner
J & K Farms, Inc.
P.O. Box 1
Harrells, NC 28444
SUBJECT: Compliance Inspection
Clear Run Farm Nos: 2,3,4, & 5
Sampson County
Dear Mr. Moore:
On December 14, 1994, an inspection of your animal operation was performed by the
Fayetteville Regional Office (FRO). Please find enclosed a copy of our Compliance Inspection
Report for your information. It is the opinion of this office that this facility is in compliance
with 15A NCAC 2H, Part .02179 and that Animal Waste Management is being properly
performed.
Should you have any questions regarding this matter, feel free to contact me at (910) 486-
1541.
Sincerely,
k4j7' k�ez'�
Ricky Revels
Environmental Technician IV
RR/tlt
Enclosure
cc: Facility Compliance Getup
Wachovia Binding, Suite 714. Fayetteville, North Carolina 28301-5043 Telephone [phone] FAX [phone]
An Equal Opportunity Affirmative Action Employer 50% recycled/ 10% post -consumer paper

I
NORTS CAROLINA DEPARMWENT OF ENVIRONMENT, RZRLTK is NATURAL RESOURCES
DIVISION OF ENVIRONMWTAL ID�iiE1�NT
Fayetteville Regional Office
Animal Operation Compliance Inspection Form
rare Maas/Owner Inspection Date Farm No.s
FRarrells,
un Farms/J&K Farms, Inc. 12-14-94 2,3,4,&5
Mailing Address
fice Spz 1 NC Hwy 411
North Carolina 28444 Sampson County
All questions answered negatively will be discussed in sufficient detail in
the Comments Section to enable the deemed Permittee to perform the appropriate
corrections:
SECTION I
Animal Operation type-
Horses, cattle, swine, poultry, or sheep
SECTION 11
1. Does the number and type of animal meet or exceed
the (.0217) criteria? (Cattle (100 head),
horses (75), swine (250), sheep (1,000), and
poultry (30,000 birds with liquid waste
system))
2. Does this facility meet criteria for Animal
Operation REGISTRUION?
3. Are animals confined fed or maintained in this
facility for a 12-month period?
4. Does this facility have a CERTIFIED ANIML WASH
MANAGEMENT PLAN?
5. Does this facility maintain waste management
records (Volumes of manure, land applied,
spray irrigated on specific acreage with
specific cover crop)?
X X Comments
nLa
not
re ucLired

Administration and Proaram Management g g Comments
6. Does this facility meet the SCS minimum
setback criteria for neighboring houses,
-wells, etc.
"CTION III
Field Site Management
g g Comments
1. Is animal waste stockpiled or lagoon
construction within 100 ft. of USGS Map
Map Blue Line Stream?
2. Is animal waste land applied or spray
irrigated within 25 ft. of a USGS Map
Blue Line Stream?
3. Does the facility have adequate acreage on
which to apply the waste?
4. Does the land application site have cover
plan not
crop in accordance with the CERTIFICATION Pam?
_A_ required
S. Is animal waste discharged into waters of the
state by man-made ditch, flushing system, or
other similar man-made devices?
JL
6. Does the animal waste management at this
plan not
farm adhere to Best Management Practices (BMP)
required
of the approved CERTIFICATIQIT?
7. Does animal waste lagoon have sufficient
freeboard? How much? (Approx. 3 ft.)
S. Is the general condition of this animal facility,
including management and operation, satisfactory?
SECTION�Y
SECTION II (No. 5) Section III (Mos. 4 and 6)s
These combined farm units #'a 2, 3, 4, 6 5 are registered operations. A
certified waste management plan is not required until
the end of 1997. These
facilities appear well managed and operated, as
observed during this
inspection.