820352_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental Qual

Type of Visit: ® Compliance Inspection 0 Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: 9 Routine 0 Complaint O Follow-up O Referral Q Emergency O Other O Denied Access
Date of Visit: 1Arrival Time: Departure Time: County: SDS Region:
rizo—
Farm Name: - p - q5- /If Owner Email:
—_FOwner Name: 1✓ Phone:
Mailing Address:
Physical Address:
Facility Contact: (fakvq S L" Title:
Onsite Representative: I't
Certified Operator: p P1 lzb(ksroti{
Back-up Operator:
Phone:
Integrator:
Certification Number:
Certification Number:
Location of Farm: Latitude: Longitude:
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify 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 y No ❑NA ❑NE
❑ Yes
[:]No
Design Current;
❑ NE
Design
Current
Design 'Current
❑ NE
Swine
Capacity Pop.
Wet Ppultry,
Capacity
Pop.
Cattle Capacity . Pop.
Wean to Finish
La er
Dai Cow
Wean to Feeder
Non -La er
II
I
Dai Calf
Feeder to Finish
Dai Heifer
Farrow to Wean
DOD
Design
Current
Cow
Farrow to Feeder
D Poul
Ca aci
P.o '.
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
u.i R
TurkeyFaults
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 y No ❑NA ❑NE
❑ Yes
[:]No
NA
❑ NE
❑ Yes
❑ No
[?q NA
❑ NE
❑ Yes
❑ No
NA
❑ NE
❑ Yes
�o No
❑ NA
❑ NE
❑Yes
[ No
❑NA
❑NE
Page 1 of 3 2/4/2015 Continued

acili Number. jDate of inspection:
❑ Yes
No
❑ NA
❑ NE
Waste Collection & Treatment
❑ Yes
No
❑ NA
❑ NE
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
0 No
❑ NA
❑ NE
a. if yes, is waste level into the structural freeboard?
❑ Yes
❑ No
[9 NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
❑ NA
Identifier:
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
Spillway?:
Required Records & Documents
Designed Freeboard (in):
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[PNo
❑ NA
Observed Freeboard (in):
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
P No
❑ NA
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[ No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental
threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
r No
❑ NA
❑ NE
8. Do any ofthe structures lack adequate markers as required by the permit?
❑ Yes
PNo
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
® No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes No ❑ NA
ElExcessive 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 [:]1 Application Outside of Approved Area
512. CropType(s): �SQ 6416
13. Soil Type(s):
❑ NE
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
[PNo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
P 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 El Stocking [:]Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I " Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? 0 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 2/4/2015 Continued

acili .Number: Date of inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit.
❑ Yes
[P No
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
[� No
❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes
No
[:INA ❑NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
No
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than nor -mat?
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?
E] Yes �No ❑NA ❑NE
❑ Yes No ❑ NA ❑ NE
❑ Yes [�j No ❑ NA ❑ NE
❑ Yes [PNo❑ NA ❑ NE
❑ Yes 'M No
❑ Yes `f-' No
❑ Yes [4 No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Reviewer/Inspector Name:
Reviewer/Inspector Signatur
Page 3 of 3
Phone: 90 -4 -OF -1 -?6P
Date: 9 rL n
2/4!2015

Type of Visit: • Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: ®Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: 10 Arrival Time: Departure Time: Z; Q!I County: 51 Region: -40
Farm Name: �j �D �t?Q 0 er Email:
Owner Name: �l''e� M Phone:
Mailing Address:
Physical Address: �
Facility Contact: la 0 - Title: Phone:
Onsite Representative:
Certified Operator: �1 ZZ
Back-up Operator:
Integrator: his
Certification Number: /e / /rte
Certification Number:
Location of Farm: Latitude: Longitude:
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes fp No ❑ NA ❑ NE
❑ Yes
Design qCurrent- ,
NA
Design
F ..}
Current
Design Current
Swme
Gapac�tyPop
Wet Poultry Capacity
Pop
Cattie Capacity Pop.
T...
Wean to Finish
tr
Layer
Dairy Cow
Wean to Feeder
I
iNon-Layer
I I
Dauy Calf
Feeder to Finish
' "
Daia Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
D . Poul p
_ �Ca aci
Po .
Non -Dairy
Farrow to Finish
l-ayers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
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?
❑ Yes fp No ❑ NA ❑ NE
❑ Yes
❑ No
NA
❑ NE
❑ Yes
❑ No
NA
❑ NE
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 1P No
[:]Yes ® No
NA
❑ NE
NA
❑ NE
❑ NA
❑ NE
Page I of 3 2/4/2011 Continued

I
Facility Number: - Date of Inspection: O
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ YesNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes No NA ❑ NE
Struc e 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: F?
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 0,3!i
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
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)
❑ NE
Required Records & Documents
9. Does any part of the waste management system other than the waste structures require
❑ Yes No
❑ NA
❑ NE
maintenance or improvement?
® No
❑ NA
❑ NE
Waste Application
❑ Yes
No
❑ NA
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 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 Cr p Window ❑/Evidence of Win Drifts ❑ Application Outside of ApprVed Area
12. Crop Type(s): Coas4cq -�[R �1 / r 5I ' " rwl" &W_�
1 71,91
13. Soil Type(s): �YQ�rI
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?
IT Does the facility lack adequate acreage for land application?
❑ Yes
h No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
1�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 0 Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes Qg 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 Ij No
[DNA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 2/412011 Continued

Facili Number: - Date of Ins ection: 124 Yki
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ YesNo
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes 4No
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:
25. Did the facility fail to provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ NA ❑ NE
❑ NA ❑ NE
❑ YesNo ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes T No ❑ NA ❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
`� No
❑ NA
❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes ip
No ❑ NA ❑ NE
33. Did the Reviewer/inspector fail to discuss review/inspection with an on-site representative? ❑ Yes No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes No ❑ NA ❑ NE
ents (refer to question #): Explain any YES answers andlor any additional recotnmend:ttions or au other comments.;
drawings of facility to better explain situations (use additional pees as necessary)._
Reviewer/Inspector Name:
Reviewer/inspector Signature:
Phone: qmJ/5?-3_z0
Date: /f
Page 3 of 3 2/4/2011

type of visit: p compliance inspection U Operation Review U Structure Evaluation U Technical Assistance
Reason for Visit: ® Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time:;^ Departure Time: UUaJCounty: ,7�Region:
Farm Name:1— 5 ii-� Owner Email:
Owner Name: Trt,3`�Cny2. RL41e1� Phone:
Mailing Address:
Physical Address: ((__
Facility Contact: �uctr►r�s `n�lJ Title: Phone:
Onsite Representative: N
Certified Operator:+� 8�
Back-up Operator:
Integrator: 2MPR� e
Certification Number: 'Iffyy"6
Certification Number:
Location of Farm: Latitude: Longitude:
Swine
Design Current
C15.13
apacity Pops .
Wet Poultry
Design Current
Capacity Pop.
Design Current
Cattle Capacity Pop.
Wean to Finish
i'
Layer
a. Was the conveyance man-made?
Da' Cow
❑No
Wean to Feeder
❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWR)
Non -La er
❑ No
NA
Da' Calf
c. What is the estimated volume that reached waters of the State (gallons)?
Feeder to Finish"
--
Dr, Poul
Design
Ca aci
Current '__
Pa`:' "`�`
Da' Heifer
NA
Farrow to Wean 0
D Cow
[:]Yes
Farrow to Feeder
Non -Dairy
❑ NE
Farrow to Finish
[::]Yes
No
Layers
❑ NE
of the State other than from a discharge?
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turkeys
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
O No
❑ NA
❑ NE
Discharge originated at: E] Structure E] Application Field F-1 Other:
i'
a. Was the conveyance man-made?
[:]Yes
❑No
NA
❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWR)
❑ Yes
❑ No
NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
[:]Yes
❑ No
NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
[:]Yes
No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
[::]Yes
No
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 2/4/2014 Continued

Facility Number: 199. jDate of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier:_ 9 -
No ❑ NA ❑ NE
❑ No NA ❑ NE
Structure 6
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes P] 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 [6 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 Mi 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 P No ❑ NA ❑ NE
maintenance or improvement?
Waste Apalication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes E] No D 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): �4eL( 0. C,,cLSs 7" _ l: �n `�4 1
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?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ Yes
P No
❑ NA
❑ NE
❑ Yes
F0] No
❑ NA
❑ NE
❑ Yes
� No
[-]NA
❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes CR No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes LU 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 [P No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes ED No
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 2/4/2014 Continued

Facifi Number: - W91 Date of inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes P) 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?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes
M No
❑ NA
❑ NE
[] Yes
[P No
❑ NA
❑ NE
❑ Yes No
❑ Yes [ No
❑ Yes P No
[:]Yes No
❑ NA ❑ NE
❑ NA FINE
❑ NA ❑ NE
❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative? ❑ Yes No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? [:]Yes 9§ No 0 NA ❑ NE
Comments refer to uestton E fain any YES answers and/or an additional. recommendations or as foth646fiimea
Use drawings of facility tobetter explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
A"
Phone:
Date: l t
2/4/2014

N .
Type of Visit: 4D Compliance Inspection O Operation Review 0 Structure Evaluation O Technical Assistance
Reason for Visit: *Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: 41 Arrival Time:Departure Time: r County:_%P*=
Farm Name:? 4,5 i, Owner Email:
Owner Name: asiS4(Ox S Phone:
Mailing Address:
Physical Address:
Region: A�b
Facility Contact: N L.O " Title: Phone:
Onsite Representative: Lo-c'Jo Integrator: ?fC'JQ_C�C_
Certified Operator: o7 Certification Number: I y
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Discharrees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes
® No
DesignCurreut
❑ NE
Design
Current
Design Current
❑ NE
❑ Yes
.00ISwine Capacity Pop.
Wet Poultry
Capacity
Pop.
Cattle Capaciiy Pop.
Wean to Finish
Layer
Dairy Cow
Wean to Feeder
Nan -La er
I I
Dairy Calf
Feeder to Finish
Da'y Heifer
Farrow to Wean
=:U
Design
Curreut
D Cow
Farrow to Feeder
D . P,oultr
Ga aci
P,o P.
Non -Dairy
Farrow to Finish
Layers
I
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
Turkey Pouits
Other
Other
Discharrees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
❑ No
NA
❑ NE
❑ Yes
❑ No
NA
[] NE
❑ Yes ❑ No
❑ Yes ® No
[]Yes ® No
® NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 114/2014 Continued

jFaciUty Number: - ZDate of inspection: W V I
c(
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: + Q>
Spillway?:
Designed Freeboard (in):
c� s!
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?
❑ NE
15. Does the receiving crop and/or land application site need improvement?
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)
acres determination?
9. Does any part of the waste management system other than the waste structures require ❑ Yes [g No
❑ NA
❑ NE
maintenance or improvement?
❑ Yes
O No
Waste Application
❑ NE
18. Is there a lack of properly operating waste application equipment?
10. Are there any required buffers, setbacks, or compliance alternatives that need [:]Yes E] No
❑ NA
❑ NE
maintenance or improvement?
Required Records & Documents
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.)
❑ Yes
EBNo
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
[a No
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
E) 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
[R No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
O No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[�j No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
EBNo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[a No
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes R] No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ® No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 11412014 Continued

Facili Number: Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(cs) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ® No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
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 �D No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes �B No ❑ NA ❑ NE
[:]Yes Pj No ❑ NA ❑ NE
[:]Yes H No
❑ Yes No
[] Yes ® No
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
g r mendalions or any other comments.
U�
Use drawrn s:of facih. to better a plam.sltuat ons (use additional pages as o"ents re er to ueshoas lainyan answers and/or an additional recpm
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: r 7
Date: Lq
2/4 Q 4

type of visit: i Compliance Inspection V Operation lZeview V Structure Evaluation V 'l echnical Assistance
Reason for Visit: 0 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: ({ Qty- Departure Time: I (01f 3CQ County: 2LIf
Farm Name: P y 6J 0 l sect Sys) Owner Email:
Owner Name: �iY 5 �� Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative: L4
Certified Operator: $ S rt B,r
Back-up Operator:
Location of Farm:
Latitude:
Region: i
Integrator:
R"_26 t -
CKAZ�4')
Certification Number: Io 7 4A
Certification Number:
Longitude:
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes ®No ❑ NA ❑ NE
❑ Yes
Design Current =
Design
C�rrenl
_ Design Current
Swine
Capacity Pop. Wet Poult
Capacity
r_
❑ Yes
Cattle Capacity Pop.
Wean to Finish
❑ NE
Layer
Dai Cow
Wean to Feeder
Non -Layer
Dai Calf
Feeder to Finish
Dai Heifer
Farrow to Wean
l i
Design
Current
D Cow
Farrow to Feeder
D . tP W , ufi.
Ca aci
P,o
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turke s
Other
Turke Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes ®No ❑ NA ❑ NE
❑ Yes
❑ No
101' NA
❑ NE
❑ Yes
❑ No
NA
❑ NE
❑ Yes
❑ No
® NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
Page I of 3 21412011 Condnued

Facility Number: 3 =;;Z, Date of Inspection:
i`
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes M No ❑ NA ❑ NE
a. if yes, is waste level into the structural freeboard? ❑ Yes ❑ No ® NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: /+
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): [�
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 P] 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
P No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
P No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does.any part of the waste management system other than the waste structures require
❑ Yes
5D No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
9D 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 Cro Window 1 ❑ Evidence of Wind Drift ❑Aptplication Outside of Approved Area
12. Crop Type(s): l ©QS /I�Yu i.WQ I��rt CS Ch, �M • �'"` ._�U�! �'O' /►���
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?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ Yes No
[—]Yes No
❑ Yes No
❑ Yes No
❑ Yes No
❑ Yes No
❑ YesLA
] No
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes W No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections [:]Monthly and I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes N
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑NA ONE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
No ❑ NA ❑ NE
Page 2 of 3 2/4/2011 Continued

Facility Number: Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes T No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes Tn No
the appropriate box(es) below. 7�
❑ 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 [B No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ® No
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ YesNo
❑ NA
[:]NE
and report mortality rates that were higher than normal?
i
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes]
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
10No
❑ NA
❑ NE
33. Did the Reviewer/inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
P No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
No
❑ NA
❑ NE
Com�teents (refer to .queshoui#) Explain any YES answers and/or any additional recommendations or any other comments.
[ase, drawings of facility toµbetter.explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Reviewerlinspector Signature:
Page 3 of 3
Phone: g/o34O
Date: !�
214/2011

Type of Visit: • Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance I
Reason for Visit: 0 Routine 0 Complaint O Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: I q12 -17112.-I Arrival Time: :per•, Departure Time: /p County,_!;0jPU��y✓ Region: RIO
a � p
Farm Name:/ 1 y �p TQ Sow f irvowner Email:
Owner Name: ieq Phone:
Mailing Address:
Physical Address:
Facility Contact: )2aodw Title: Phone:
Onsite Representative: S LLI�r�-� Integrator:
Certified Operator: SiC�t'iP�-1 ��� Certification Number: �D 7
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Discharges and Stream Impacts
I. Is any discharge observed from any part of the operation?
❑ Yes
X No
❑ NA
❑ NE
Design CurrentDesign
Current
Design Carrent
Swine
Ca aci PoWetrP�oultry
Capacity
Pop.
Cattle Capacity Pap.
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
[] No
P NA
Wean to Finish
c. What is the estimated volume that reached waters of the State (gallons)?
La er
iry Cow
Wean to Feeder
❑Yes❑
Non -Layer
NA
❑ NE
Da' Calf
Feeder to Finish
[ No
""
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
Dairy Heifer
Farrow to Wean
❑ NA
❑ NE
Design
Current
Dry Cow
Farrow to Feeder
D , Poul ':
Ca aci
P,o
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turke s
Othe
urkey Poults
Other
Other
Discharges and Stream Impacts
I. Is any discharge observed from any part of the operation?
❑ Yes
X No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
[—]No
[N NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
[] No
P 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
No
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 2/4/2011 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:_ jai
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a
waste management or closure plan?
❑Yes U No
❑ Yes No
❑ NA ❑ NE
❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the 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 [3NA ❑ NE
maintenance or improvement? T
Waste Auniication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 0 No ❑ NA ❑ NE
maintenance or improvement?
I I . Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes �@ No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground [] Heavy Metals (Cu, Zn, etc.)
❑ PAN 0 PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of
Wind`❑/A�pplicationn Outside of Appro/veed Area
12. Crop Type(s): Grj—W -Mu CL LASS } . S/h i LTYA4-t Ci r hl,//�
13. Soil Type(s): C -,v A- i 141
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
[-]Yes [� No
❑ Yes No
❑ Yes No
❑ Yes No
❑ Yes No
❑ NA ❑ NE
[] NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No [] NA ❑ NE
❑WUP ❑Checklists El 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 `P 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 2/4/2011 Continued

Facili Number: 2 - S,2 Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes P No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [A 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?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes No
❑ Yes No
❑ NA ❑ NE
❑NA ❑NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes N No ❑ NA ❑ NE
[:]Yes [�@ No ❑ NA ❑ NE
[:]Yes Qg No ❑ NA ❑ NE
[:]Yes No
[:]Yes No
[—]Yes No
❑NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
1Comments (refer to question #) Explain any YES answers and/or any additional recommendations or any other coinmjenfs."" -
0iie,drawings of facility totbe'tterexplarn>situ�tians (use additional pales as necessary
Reviewer/Inspector Name:
Reviewer/Inspector Signature: T&±194a"
Page 3 of 3
Phone: 0-9,41 j5 she)
Date: Gj L'7 Z
214/2011

Type of Visit: 0 Compliance Inspection O Operation Review O Structure Evaluation Q Technical Assistance
Reason for Visit: ® Routine O Complaint O Follow-up O Referral 0 Emergency O Other �� "0� Denied Access
Date of Visit: Arrival Time: : qp Departure Time: County: �rlrrTSvl egion:
Farm Name: P-45 144 1; 0 L/ 1Paf'1 ELq 5kJ 4 GWv( e� Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: S C
Certified Operator:
Back-up Operator:
Location of Farm:
Title:
Latitude:
Phone:
Phone:
Integrat
Certification Number: 8
Certification Number:
Longitude:
16%Design Current
- urgent
Design C
Design Current
Swine
+Capacity Pap.
Wet Poultry ;Capacity, P.op:
Cattle Capacity Pop.
-,..
Wean to Finish
La er
Dairy Cow
Wean to Feeder
jDairy Calf
Feeder to Finish
jDairy Heifer
Farrow to Wean
Designn Current
D Cow
Farrow to Feeder
D , P,ouE Ca adPo
Non -Dai
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
-
Turkeys
Other
Turkey Poults
Other
Other
Discharees and Stream 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 D WQ)
c. What is the estimated volume that reached waters of the State (gallons)? _
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes ® No ❑ NA 0 NE
Yes [:]No
Yes ❑ No
Yes [:] No
❑ Yes E6 No
❑ Yes �0 No
QP NA ❑ NE
® NA ❑ NE
�NA
❑NE
❑NA
❑NE
❑NA
❑NE
Page 1 of 3 2/4/2011 Continued

Fa4futy Ndmber: Date of Inspection: . Zp
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? [] Yes ❑ No NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:_
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3"
❑ Yes
F No
❑ NA
❑ NE
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ YesNo
[ No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
❑ YesNo
ElNA
ElNE
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ YesNo
❑ NA
❑ NE
waste management or closure plan?
❑ Yes
No
❑ NA
❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
fo No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ YesNo
1P
❑ NA
E]NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check
❑ Yes
® No
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [Y3 No ❑ NA
❑ 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 ❑/�Evideence of Wind Drift E] Application Outside of Approved Area
`-'�'
12. Crop Type(s): a941 Q Cc-, ai S &2 j ! �
13. Soil Type(s): (SJ6 A Uj')
❑ NE
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
F 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
❑ YesNo
ElNA
ElNE
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 El Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. [:]Yes [�] No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Wastc 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 T 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 2/4/2011 Continued

Fatalli -Number. f3 9 - Date of inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes � No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [:]Yes P7 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 I] No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No [�g 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 file drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
34. Does the facility require a follow-up visit by the same agency?
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
❑ Yes IM No [:]NA ❑ NE
❑ Yes C, No ❑ NA ❑ NE
❑ Yes P No ❑ NA ❑ NE
❑ Yes V No ❑ NA ❑ NE
❑ Yes No
[-]Yes No
❑ Yes No
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
V0-- ` 5_ 33V
.so -t
21412011

� � Division of Water Quality
[=a 5 �: � — — Q Di<zsion of Soil and WRte—FW o—Hs ervation
_ Other Agency -0
(Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 49 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: O Arrival Time: L�"J Departure Time: L' County:
Farm Name: n� iia ±l _'570a.)krm- _ Owner Email:
Owner Name: JV Igic.%� Ll P`Li.�� Phone:
Mailing Address:
Physical Address: rr
Facility Contact: t°`t OC�� Title:
Onsite Representative: ja r"-; 1�
Certified Operator: 51 JAJ` 7
Back-up Operator:
Location of Farm:
Region: FM
�7 Phone No:
integrator:
Operator Certification Number: 11W4
Back-up Certification Number:
Latitude: [ o 06 = Longitude: 1=10E],
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 P No ❑ NA ❑ NE
❑ Yes ❑ No NA
❑ NE
❑ Yes
❑ No
Design Current
Swine Capacity Population
❑ Wean to Finish
❑ Wean to Feeder
Design Current
Wet Poultry C■apacity Population
❑ Layer
❑ Non -Layer
Design Current
Cattle C►apacih Population
❑ Dai Cow
❑ Dai Calf
❑ Feeder to Finish
91 Farrow to Wean
Dry Poultry
❑ Dai Heifer
❑ D Cow
❑ Non
❑ Yes
PNo
El Farrow to Feeder
❑ Layers
❑ Non -Layers
-Dairy
❑ Beef Stocker
El Beef Feeder
❑ Farrow to Finish
❑ NA
❑ Gilts
❑ Pullets
❑ Beef Brood Co
❑ Boars
❑ Turkeys
❑Turke Poults
❑Other
Number of Structures: ED
Other
❑ 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?
❑ Yes P No ❑ NA ❑ NE
❑ Yes ❑ No NA
❑ NE
❑ Yes
❑ No
NA
❑ NE
❑ Yes
❑ No
NA
EINE
❑ Yes
PNo
❑ NA
EINE
❑ Yes
W No
❑ NA
❑ NE
Page 1 of 3 12/28/04 Continued

Facility Number: Sa-35�
Waste Collection & Treatment
Date of Inspection
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes r No ❑ NA ❑ NE
a_ If yes, is waste level into the structural freeboard? ❑ Yes ❑ No NA ❑ NE
Structure i Structure Structure 3 Structure 4 Structure 5 S cture 6
Identifier: A A
Spillway?:
Designed Freeboard (in):
jf ff
Observed Freeboard (in): _ Y7
5. Are there any immediate threats to the integrity of any of the structures observed?
El Yes No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed
❑ Yes No ❑ NA ❑ NE
through a waste management or closure plan?
Date: toldl L?
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
i
(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 El NA [__1 NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes I& 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.'Croptypes) s Cd 4� In
la-
9rtLU
13_ Soil type(s) Go bq
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes R No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes (D No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes ® No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes W No ❑ NA ❑ NE
❑ Yes [RNo ❑ NA ❑ NE
omments ref to uestton Explain an YES answers and/or an
U_ se drawings of facility to be er explain situations. (use additional p ges as necessary) _ f
e wW recommendations or an 6th
:..•. R;y� � +� x�.'•' comments.'. t:•,
C&
Reviewerllnspector Name 1
l a, ' ' Phone: --Y-3300
Reviewer/Inspector Signature:
Date: toldl L?
Page 2 of 3 12128/04 Continued

f
Facility Number: Date of Inspection 1
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ig No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ER 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 N No ❑ NA EINE
❑ Waste Application ❑ Weekly Freeboard [:]Waste Analysis ❑ Soi] 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?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes
EDNo
❑ NA
❑ NE
❑ Yes
❑ No
®NA
❑ NE
❑ Yes
PE No
❑ NA
❑ NE
❑ Yes
JZ No
❑ NA
❑ NE
❑ Yes
[,No
❑ NA
❑ NE
❑ Yes
5d No
❑ NA
❑ NE
❑ Yes
[j�No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
[;RNo
❑ NA
❑ NE
❑ Yes q No ❑ NA ❑ NE
❑ Yes
5 No
❑ NA
❑ NE
❑ Yes
[d No
[:INA
❑ NE
Page 3 of 3 12/28/04

Type of visit AErCompliance Inspection U Operation Review 0 Structure Evaluation U Technical Assistance
Reason for Visit routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: 1 fl Arrival Time: Q Departure Time: �' r County' Region:
Farm Name: .'r-- z+1-15 Owner Email:
Owner Name: Phone:
i er'�ir,�� Phone:
Mailing Address:
Physical Address: 11
Facility Contact: Yi_ wr 16O/rL_ Title: y sfti'/'� Phone No:
Onsite Representative: Integrator:
Certified Operator: ��"'�r Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: =0
=4
❑di Longitude: [--I o = , ❑
Discharges & Stream Impacts
. Is any discharge observed from any part of the operation?
Design Current Design Current
Design Current
SRine
C*apacity Pvpulatiaa Wet Poultry Capacity Population
Cattle Capacity Population
❑ can to Finish
❑ La er
❑ Dairy Cow
a. Was the conveyance man-made?
❑ Wean to Feeder
❑ No
❑Non -La er
❑ Dairy Calf
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Feeder to Finish
❑ No
❑ NA
❑ Dairy Heifer
e. What is the estimated volume that reached waters of the State (gallons)?
Farrow to Wean
fiD c3 to DD
Dry„Roultry
❑ Dry Cow
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Farrow to Feeder
❑ No
❑ NA
❑ La ers
❑ Non -Dai
❑ Yes'0No
❑ Farrow to Finish
❑ NA
❑ NE
❑Non -La ers
❑ Beef Stocker
[$ No
❑ Gilts
❑ NE
other than from a discharge'?
❑ Beef Feeder
Boars
❑ S
❑ Pullets
❑ Beef Brood Co
❑ Turkeys
Other
❑ Turkey Poults
❑ Other
❑ Other
Number of Structures:
Discharges & Stream Impacts
. Is any discharge observed from any part of the operation?
❑ Yes
[:To
❑ 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
e. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes'0No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
[$ No
❑ NA
❑ NE
other than from a discharge'?
12/28104
Continued

Facility Number: — Date of Inspection
Waste Collection & ireatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes RNR ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Stnicture I Stricture 2 Structure 3 Structure 4 Structure i Structure 6
ldendfler:
Spillway?:
®No
❑ NA
Designed Freeboard On): jq
17. Does the facility lack adequate acreage for land application? ❑ Yes
[gNo
Obsmed Freeboard (in):
❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes
S. Are there any immediate threats to the integrity of any of the structures observed?
❑ yes �&No
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed
❑ YesNo
❑ NA [:1NE
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?
9 -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
El Yes �No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes JNo ❑ NA ❑ NE
maintenance/imgrovement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes KNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN> 10%oor 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)
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 %LNo ❑ NA ❑ NE
S -Yes 2110 ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination',[] Yes
®No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes
[gNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes
ERNo
❑ 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):
llu ,
AC(f 1Y` �f�I isrl t'04 �I4�n I��i [�D7�af
Reviewer/inspector Name Phone: 9o, -1P -#J_3—_3:3=
Reviewer/Inspector Signature: Date: O
12./28/04 Continued

a
FacilityNumber: —
Date of inspection
Re wired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes allo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes KNo ❑ NA ❑ NE
the appropirate box. ❑ WUp ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes KNo ❑ 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 5�,No [INA, ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 0 No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
KNo
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
[ANo
❑ NA
❑ NE
26. Did the facility fait to have an actively certified operator in charge?
❑ Yes
XNo
❑ 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?
❑ Yes
�Zvo
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
RNo
❑ 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
L&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
[XNo
❑ 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
XNo
❑ NA
❑ NR
33. Does facility require a follow-up visit by same agency?❑
❑ Yes
�.No
NA
El NE
Comments and/or Drawings:
12'28/04

Type of Visit &Complia ce Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit outine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: Arrival Time: �0.1�D Departure Time: County: Region: lef;_���
Farm Name: / �P>ul �4/ n'! �_ Owner Email:
Owner Name: �. f Phone:
Mailing Address:
Physical Address:
Facility Contact: 10erl . Title: Phone No:
Onsite Representative: 1'I IlaY /h- Integrator.
Certified Operator: Operator Certification Number: 951GI5%9 .-
Back-up Operator: A4gr ri Back-up Certification Number: 94�flly �
Location of Farm:
=Design :Current
ono Capacity Population
❑ Wean to Finish
❑ Wean to Feeder
❑ Feeder to Finish
® Farrow to Wean E'7
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
ier
Other
Latitude: =0 E�' ❑ u Longitude: ❑ ° ❑ ❑
Design Current
Wet Poultry Capacity Population Cattle
10 Layer
❑ Non -Layer
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharees & Stream Impacts
I. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
c. What is the estimated volume that reached waters of the State (gallons)?
Dumber of Ot
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes [&No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes CRNo ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
12/28/04 Continued

Facility Number: Date of Inspection 8
�4 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): %9
Observed Freeboard (in): 3-3
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 EgNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes ® No ❑ NA ❑ NE
❑ Yes 9 No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? 9 Yes ❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
19No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
`I �i � �a.� �"�Ga►if� ��u� �`�aG � �v ��� GlJas7� i� ��cY'i�� ��D� C1��1 rG' I.
I
�� l H ��Q'�e°✓` u•wL i'� t ��CC7v�__ L✓d� fr DLI���v/e1 Tp ate° Da��
9. Does any part of the waste management system other than the waste structures require
[R Yes
❑ No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
EgNo
[INA ❑NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below_
❑ Yes
C4 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) >, m U
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
® Yes
❑ No
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
® Yes
❑ No
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
0 No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
® No
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
10 No
❑ NA ❑ NE
Comments (refer to question Explain any YES answers and/or anyrecommendations or any other continents.
._Use drawings of facility to better explain situations. (use additional pages as necessary)
�+ 4
r -bay "ea_ a--- �VV-_b -5 L Lrlu
`I �i � �a.� �"�Ga►if� ��u� �`�aG � �v ��� GlJas7� i� ��cY'i�� ��D� C1��1 rG' I.
I
�� l H ��Q'�e°✓` u•wL i'� t ��CC7v�__ L✓d� fr DLI���v/e1 Tp ate° Da��
�
Reviewer/Inspector Name I Phone:
L o
Reviewer/Inspector Signature: Date: wI�Da1�
Page 2 of 3 " ' 12128/04 Continued

{
Facility Number: — Date of Inspection
Required Records & Documents
19. Did the facility fail to have 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 EgNo ❑ NA ❑ NE
the appropirate box.
❑ Wi7P El Checklists ❑Design El Maps E3 Other
21. Does record keeping need improvement? if yes, check the appropriate box below. ® Yes ❑ No ❑ NA ❑ NE
JZ 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
® No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[4 No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
5& No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
EgNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
® No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
M No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
O 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
fgNo
❑ 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
JR No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
R Yes
❑ No
❑ NA
❑ NE
Additional Comments and/or Drawings:
�We
AL
/J7�r'4�YI�
05,
12/28/04

Division of Water Quality �•--f �,�
Facility Number s 0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit Compliance Inspection O Operation Review O Structure Evaluation 0 Technical Assistance
Reason for Visit outine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: Arrival Time: fl i0 Departure Time: , aD I County:
Farm Name: GIt Owner Email:
Owner Name: �-- C� f _ Phone:
Mailing Address:
Physical Address: 1
Facility Contact: _� r't (�J r LA fl rys— Title:
Onsite Representative:.,�av,
Certified Operator: &) e^$. -
Back -up
^$
Back-up Operator:
Location of Farm:
Region: 1�
Phone No:
Integrator:
Operator Certification Number: a.E%2 77
Back-up Certification Number:
Latitude: =0
❑ ' = Longitude: [= ° =
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population Cattle
❑ Wean to Finish
❑ Wean to Feeder
❑ Feeder to Finish
Farrow to Wean A1000
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
❑ Layer
❑ Non -La et
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ TurkeX Poults
❑ Other
Discharges & Stream Impacts
_ 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)
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifep
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocket
❑ Beef Feeder
❑ Beef Brood Co
c. What is the estimated volume that reached waters of the State (gallons)?
Design Current
Capacity Population
Number of Structures: M
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 �4 No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
[A No
❑ NA
❑ NE
❑ Yes 93 No ❑ NA EINE
12/28/04 Continued

Facility Number; 941-3 Date of inspection
❑ Yes
® No
Waste Collection & Treatment
❑ NE
15. Does the receiving crop and/or land application site need improvement?
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
fgNo ❑ 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: .p
� No
El NA
Spillway?:
18. Is there a lack of properly operating waste application equipment?
❑ Yes
Designed Freeboard (in): g
❑ NA
❑ NE
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
10 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
9 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 E-1NA❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
10 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
S No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
A No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
E�_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 Drifi ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
® No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
5.No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
SNo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
� No
El NA
El NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
XtNo
❑ 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):
/
AL
G�'�-
l por zo le��r 7-Vr �D�/� GU���� IA��a rr ��//�'1��3
Reviewer/inspector Name Phone:
ReviewertInspector Signature: Date: — !7
12/28104 Continued

9
Facility Number — Date of Inspection: a
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes E4 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ❑ No ❑ NA ❑ NE
the appropirate box.
❑ WUP El Checklists ❑Design [:1 Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. EYes Ngo ❑ NA ❑ NE
X 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?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27.. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes
f ffNNo
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
E� No
❑ NA
❑ NE
❑ Yes
N No
❑ NA
❑ NE
❑ Yes
®.No
❑ NA
❑ NE
❑ Yes
19 No
❑ NA
❑ NE
❑ Yes
0 No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
&No
❑ NA
❑ NE
❑ Yes
IgNo
❑ NA
❑ NE
❑ Yes
BNo
❑ NA
❑ NE
JZYes ❑ No [:INA ❑ NE
Additional Comments and/or Drawings:
rxP-''-' 1 s' uJQ w I C'v�e
d 3� ol- J D
A9 L9
ray- 7 0 7
12128/04

4
Type of Visit 0 Compliance Inspection O Operation Review O Lagoon Evaluation I
!Reason for Visit ® Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number 3 Date of Visit: FT'31 d Trine:
Q Not Operational Q Below Threshold
Ermitted Mertified [3 Conditionally Certified 13 Registered Date Last Operated or Above Threshold: ----.— -. -.
County:......._.
Farm Name: Su.., .°n .............. �Rd
Owner Name: T d ...7a 9:A ................. Drone No: ._7.10._ So?
Mailing Address: _ P 0. 6on G wa /lar e N C __. — 8i/G/
xe')"elA
Facility Contact: .... �. .'- -....--_-Title. ... ........ �.. _......_... .._..- - .... Phone No: .... �� . s.�/o - `�/ 9jo..
Onsite Representative:.
. 1�1.�ztzf�_ _ ,l ��! tj ......... ..._....
Integrator: rP
Certified Operator:-----��P�[t�
I-V"&t"-'1 —_ _ _
_ Operator Certification Number:
Location of Farm:
EIS(Nine ❑ Poultry ❑ Cattle ❑ Horse Latitude • & 64 Longitude ' 4 46
DischMes & Stream Impacts
1. Is any discharge observed from any part of the operation?❑Yes o [W-
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes Q'N`o
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) [] Yes
c. If discharge is observed, what is the estimated flow in gaUmin'?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes E W
2. Is there evidence of past discharge from any part of the operation? ❑ Yes D--N'oo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes QW -6
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes Q_W
Structure 1 Structure 2 Structure 3 Structure 4 Structure S Structure 6
Identifier: ..........z .................... ._�_...��......
Freeboard (inches): .3 8
12/12/03 Continued

4
Facility Number: 8 �2 — 3S
Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 46 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenancerunprovement?
8. Does any part of the waste management system other than waste structures require maintenancelimprovement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenancelimprovement?
11. Is there evidence of over application? If yes, check the appropriate box below.
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
❑ Yes Q#U­
❑ Yes ❑-N6--
❑ Yes B -No
❑ Yes [96'
❑ Yes [ W6--
❑ Yes B -P5
❑ Yes B -No
12. Crop type ,4s 5 Siy,a/� !rr // //�� /SU ��/
-- �(•�7,_ (�C/w�rG�GSS T. IJ_Cr M(/d it � r.0 G 1'e S�Li,r I 1pgr «-1� r
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes RNo '�"".'
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Odor /sues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours?
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional
Air Quality representative immediately.
❑ Yes [].pro
❑ Yes [moo
❑ Yes [].Ale
❑ Yes ONO-
❑ Yes 0 -No -
0 Yes ❑ No
❑ Yeso
❑ Yes E'er
❑ Yes 0 -Ne -
id]' YES answers4fi& onior.any.6ther oomimen
tUse drawurgs of fac�ty to better explain sttostroas. (use sddit,oiml as } ❑ Field Copy ❑Final Notesff
= s
PleGse- cchf,'rfv� Ito �GId esJ`-,, l 41 fie
A,
ave,- ory
S"'966 c, /pvn� �GG 00-7j / Q� SOr / 1,77a xC c��j'PC{ �( /
r-
G /GS's
✓
fd 9 eO t,
A!I`. IV,�6nt 'S Ir/fJr�1•.7t�
ReviewerAkspector Name %( %�' �—
_` ar' r'u T ---�cQ"
Reviewer/Inspector Signature: Date: cf;- - > o - vY
12112103 Continued

Facility Number: $� _ Date of Inspection 5 ► - a
Required Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
[�kltf
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
%
1/�7•,'rS4i� ,� r�+a� /ha }4 1
Oel VZ6T,-_ ts, dasirg'n, Mals, etc.)
❑ Yes
.ONO -
23. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
[9-M
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
2 /9 3
5 '9 J
L� 30> "61 }, ri 15' -7 o.G3/ 0.4.3
24. Is facility in in time design?
❑ Yes
[94iv-
not dompiiance with any applicable setback criteria effect at the of
i4e,e kAe jo4,mr ji+S u7L 14900:, I y li�/�c.rs �,4Ayle
25. Did the facility fail to have a actively certified operator in charge?
❑ Yes
EIMY—
26. Pail to notify regional DWQ of emergency situations as required by General Permit?
5G /-ell 1'e 6D_/"Oji Csv y es
(ie/ discharge, freeboard problems, over application)
❑ Yes
O-Pdti
27. Did Reviewer/Inspector fail to discuss review/inspection with on-site representative?
❑ Yes
2$. Does facility require a follow-up visit by same agency?
❑ Yes
O -No
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
[-No-
NPDES Permitted Facilities le MIT
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35) ❑ Yes
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ONO ----
32.
NOS32. Did the facility fail to install and maintain a rain gauge? ❑ Yes OVe,-
33. Did the facility fail to conduct an annual sludge survey? ❑ Yes E�No
34. Did the facility fail to calibrate waste application equipment? ❑ Yes []-No-
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No
❑ Sleeking Ferff► ❑Crop Yield Form ❑ jainfaf] ❑ In, ectioAfter l" Rain
❑ ❑ Atmual-Gertifrcation"Form
Q No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit
.. w-- . _......m -�-r 7 --- -�•- -
ddtttonal CommentsTandlor Drawings = �— _ - „
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