820370_INSPECTIONS_20171231

NORTH CAROLINA .�
Department of Environmental Quai

ivi"sion of Water Resources
I
Facility Number � - 3 70 Division of Soil and Water Conservation
(§ Other Agency
Type of Visit: 7Routine
'Hance Inspection Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: 'Z jo T,, Arrival Time: Departure Time: Q County: M SO A) Region:
Ll
1 '
Farm Name: l r S rtflt
Owner Name:
Mailing Address:
Physical Address:
Owner Email:
Phone:
!T
Facility Contact: c.< r g �a✓`Lv{LI Title: Phone:
Onsite Representative: Integrator: J S
Certified Operator: SD G fi Certification Number: q %
Bach -up Operator:
Location of Farm: Latitude:
Certification Number:
Longitude:
Design. Current
Design
Current
Design Current
Swine Capacity Pop.
Wet Poultry
Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
Layer
Dairy Cow
Wean to Feeder
SS Z
n FfNon-LMer
Da' Calf
Feeder to Finish
Da' Heifer
Farrow to Wean
Design
Current
Cow
Farrow to Feeder
D. I
Ca nci
Ro
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Keys
Beef Brood Cow
- -
Other
Turkey Poults
Other
Other
Discharees and Stream IMD8Ct5
1. Is any discharge observed from any part of the operation?
❑ Yes
[J_ie-- ❑ 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
I—] No
E]-NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
❑ No
[3IA
❑ NE
2_ is there evidence of a past discharge from any part of the operation?
❑ Yes
[3-No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters [—]Yes O o ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 21412015 Continued

Facili Number: P5 rl - 3TO Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
B-ND—❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No D-NA7-D NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): z $�
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
D-ado ❑ 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
Cie ❑ 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
❑.K6_ ❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
©.irr- ❑ 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
[]'1 o- ❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[]_N'65_ ❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ❑,*K ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑-1 i�o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
to
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
❑'lro
❑ 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
0'N-o
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[c -? o
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
01-W- 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
[D-Nn
❑ 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
[Ej`&o
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
[:]Yes
[E No
[DNA
❑ NE
Page 2 of 3 21412015 Continued

[FaciUty Number: - D jDate of inspection: -(J
• 24, Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
C]J�❑ NA
❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes[]
NA
❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge Ievels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes
['No ❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
I_ -Ko ❑ 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 To ❑ NA ❑ NE
❑ Yes L__J 1Vo ❑ NA ❑ NE
0 Yes [g<o ❑ NA ❑ NE
❑ Yes L_D Ko ❑ NA ❑ NE
❑ Yes
[1No
❑ Yes
El, o
[:)Yes
❑.No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Commentsa(refer to quesbonc'#) �Eaplam any _YI S answers and/or any'a"dditiotialirecommendations or;any otleer cann_inent's.
Use`dravvingssof facil�tyltotbet#er, a _-lain'situatian5' ose addilional` a
c J YP q ( [+p jges.as necessary}.'
J
o- 4 97v
Reviewer/Inspector Name: 6 111
Z o4o Phone: qj a —
C �QReviewer/Inspector Signature: Date: -d�
Page 3 of 3 21412015

�31 rA S 6 ti
" Division of -Water Resources
Iiacility, Urn IF i I r -7o Q Division of Sai! and Water Conservation
Other Agency
Type of Visit: OTompliance Inspection 0 Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: e'IFoutine Q Complaint O Follow-up O Referral O Emervency O Other O Denied Access
Date of Visit: ( Arrival Time: ; ? Departure Time: i J County: ff4 44
Tj
Farm Name: l y.a t VS Owner Email:
Owner Name: '•lJr�ytv�� Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
r�
Certified Operator:
Back-up Operator:
Phone:
Integrator: /1�113
Certification Number:
Certification Number:
Location of Farm: Latitude: Longitude:
Region
` Design Current L Design Current ,Design Current
Swtne - R
Pop. Wet Poultry Capacity Pap. '�Cattl Capacity Pop.
{,Capacity
�
Finish
Layer
DairyCow
Feeder
•
Nan -La er
DairyCalf
Finish
VFarrow
'5y -moo--
Current
DairyHeifer
D Cow
o WeanDesign
Dr Point . Ga aci Pa P.
o Feeder
Non -Dairy
o Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
--
Other.
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes [�O NA ❑ NE
❑ Yes ❑ No D-NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR) ❑ Yes ❑ No []-N❑ 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)
?. Is there evidence of a past discharge from any part ofthe 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 Ea No
[:]Yes f] No
E iA
❑ NE
❑ NA
❑ NE
[] NA
❑ NE
Page I of 3 21412015 Continued

Facility Number: IDate of Inspection: 965
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes Q! -fib ❑NAB ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes �`Q'1VA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): l
5. Are there any immediate threats to the integrity of any of the structures observed'?
❑ Yes/
E j Nb
❑ 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
No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[]-5—o
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require,
❑ Yes
E:[-No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
En No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [a -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): �✓.�e: j{F,� S C4 e7
13. Soil Type(s): p
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [D"'No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes E31�o ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes O'1g0 ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[]I o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[]'l l�o
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available`?
❑ Yes
�o
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
E]F o
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ErNo
❑ 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 o
23, If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes �fNo
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facility Number: d' Z3'70 jDate of Inspection: FS
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes C l<o ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes []•1Go ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond - ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
[3-90
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
[]5,?<o'-
❑ NA
❑ NE
❑ Yes [r]No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes ��o ❑ NA ❑ NE
❑ Yes [�No ❑ NA ❑ NE
❑ Yes E—No ❑ NA ❑ NE
0 Yes E2-No ❑ NA ❑ NE
Comments (refer to question #): 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).
f,� ���t �1 �4�.5-�6 0 317 t-
Reviewer/Inspector Name: t���Vdo
Reviewer/Inspector Signature: Z J
Page 3 of 3
Phone: LC�r bl_3 3 —33 3�1
Date:
2/4/2 1 S

Type or visit: om ante Inspection 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: 7- Arrival Time: Departure Time: D County: f Region:
Farm Name: ; n �� ,� .�- a r`r". Owner Email:
Owner Name: r t r� Phone:
Mailing Address:
Physical Address:
Facility Contact: e-r-- /ylgV'- 7- Title: rI C
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
. Phone:
Integrator: D
Certification Number:
Certification Number:
Longitude:
Swine)
Wean to Finish
DestgtiCurreot
Capa tty�Pop a
Wet Poultry
Design
Capacity
Current
Pop.
Cattle
Design Current
Capacity Pop.
La er
Dai Cow
Wean to Feeder
er
Dai Calf
Feeder to Finish
D . Pout
"`"` `'
Design
Ca aci
Current
P,o
Dai Heifer
Farrow to Wean
Farrow to Feeder
Cow
Non -Dairy
Farrow to Finish
Lilts
Boars
Other0 M�k_`'
Other
Layers
BeeFStocker
9 .. Z
Non -La ers
Beef Feeder
Pullets;
Turkeys
TurkeyPoults
Beef Brood Cow
Other
Discharges and Stream Impacts
I . is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes [gNo ❑ NA ❑ NE
[] Yes
[] No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
[—]Yes [:]No
❑ Yes JZ No
❑ Yes 5No
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
Page I of 3 21412015 Continued

Facility Number: 0 IDate of Inspection:
7 /
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
Yes [Z No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes D 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 0 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 No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes E�No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes allo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes Callo
❑ 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
t2. Crop Type(s): r r
r r
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
Cff-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
UNo
❑ 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
XNo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
[] Yes
5g-No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
ENo
❑ 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
JO(No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather
Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 " Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
Jallo
❑ NA
❑ NE
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
12 No
❑ NA
❑ NE
Page 2 of 3
214120I5 Continued

Facili Number: - 7� Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes Wo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes M7NO ❑ 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 j2q_No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes { o ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
ELNo
❑ 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
CHjNo
❑ 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
CZ 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
CENo
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
;K'No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
VNo
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
[Z�Alo
❑ NA
❑ NE
Comments (refer:to ques#ton #)ExplainFany.YES answers. and/or any additional•recom endations or any other.comments.4
-:.. = x ,.
[3se drawings of facility to betteryexplain situations (use additional pages as necessary). "9
Reviewer/Inspector Name:
Reviewer/Inspector Signatur
Page 3 of 3
Phone: '12149—
jI-7y— D / 5—/
Date: %Z 27 2-0
21412015

_eCa. f1—:3 .;bjL
Type of Visit: iroutine
nee Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: Q Complaint 0 Follow-up 0 Referral O Emergency O Other Q Denied Access
Date of Visit: ® Arrival Time: ` eparture Time: 3 ca County: Z Region:FarmName: �l x- y �`s-i/ z Y,•�R o%'�-� Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: e,
Integrator:
Certification Number:
Onsite Representative:
Certified Operator:- ppJ S/z
Phone:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current
Design
Current
Design Gurreat
Swine Capacity Pop.
Wet Poultry
Capacity
Pap.
Cattle Capacity Pop.
Wean to Finish
Wean to Feeder D a
La er
Non -La er
Da' Cow
Da' Calf
Feeder to Finish
Da Heifer
Farrow to Wean
Farrow to Feeder
Dr Poul
Design
Ga aci
Current
P,o ,
D Cow
Non-Dal
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
rTurkeys.
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
TurkeyPoults
Other
Other
Discharges and Stream Impacts
I. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts orpotential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes KNo ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes [—]No
❑ Yes ❑ No
❑ Yes CZ -No
[:]Yes Eg-No
❑ NA ❑ NE
[DNA ❑NE
❑NA ❑NE
❑NA ❑NE
❑NA ❑NE
Page 1 of 3 21412014 Continued

I:
]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
B No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): Ae
S. 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
® No
❑ NA
❑ NE
8. Do any of the structures. lack adequate markets 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
allo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [jNo ❑ 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): f k-
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes �o ❑ 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 [g--No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes Ea -No ❑ NA [] NE
[—]Yes allo ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes [2.No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [�,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 allo
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? [:]Yes ❑,No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes 5�-No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑NA ❑NE
Page 2 of 3
21412014 Continued

Facili Number: - Date of Inspection: J
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes allo
125. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ®-No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes a No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes B No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface file drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes 25 No ❑ NA ❑ NE
❑ Yes �allo ❑ NA ❑ NE
❑ Yes Cn-No ❑ NA ❑ NE
❑ Yes [Z No ❑ NA ❑ NE
❑ Yes 0 No
❑ Yes allo
❑ Yes D! -No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question #(7 Explain any -YES answersand/ounny additional recommendations or -_any other comments
Use�'drawings of facityt b tier ea plain,situations (use-additional,pages,<as necessary).„
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date:
2/4/2014

-7-10
" i�isioe of Water Quality
Facility Number ®- 3 7a Division of Soil and Water Conservation
� Other Agency
Type of Visit: om Hance Inspection Operation Review 0 Structure Evaluation Q Technical Assistance
Reason for Visit: Routine O Complaint O Follow-up 0 Referral 0 Emergency O Other O Denied Access
Date of Visit: Arrival Time: I D' v O I Departure Time: p County:
Farm Name: , �y frcoa�,yL _ Owner Email:
Owner Name: M� n '-se, f I Phone:
Mailing Address:
Physical Address:
Facility Contact: /t[ r r— Title:
Phone:
Region:
Onsite Representative: _ 5eEr� Integrator:
Certified Operator: Certification Number: l//9
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design Current
Design Current
ram,. :.
Design
Current
Swine
Capacity Pop.
Wet Poultry
Capacity Pop.
E •CHUUL e � i
Capacity
Pop.
Wean to Finish
La er
Da Cow
I
i Wean to Feeder
Non -La er
Da Calf
Feeder to Finish
�j
"`
4 ' '
Dai Heifer
Farrow to Wean
-�
Design so . , - t
D Cow
Farrow to Feeder
DPou1
Ca aei P,o
Non -Dairy
Farrow to Finish
Layers
I
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turke s
Other ..: ; .
Turke PouIts
Other
Other
Discharges and 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)
c. What is the estimated volume that reached waters of the State (gallons)?
[:]Yes E3-No ❑ NA ❑ NE
❑Yes
[:)No
❑NA
❑NE
❑ Yes
❑ No
❑ NA
❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes ❑ No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes toNo ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters [] Yes �allo ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

[Facility Number: - jDate of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes Cil-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 ;S.No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
EZ 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
[Z No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
[:]Yes
® No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
0,No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? if yes, check the appropriate box below. ❑ Yes [A 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): Iwao&
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 21 No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes F1 No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18_ Is there a lack of properly operating waste application equipment?
❑ Yes [Z No ❑ NA ❑ NE
❑ Yes t.No ❑ NA ❑ NE
Required 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 CS -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 [allo
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes 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 3 21412011 Continued

F'acili Number: - I Date of Inspection: /
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes E. No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes O-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
[:]Yes UNo
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 E@ No
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
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
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes ® No
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes ® No
34. Does the facility require a follow-up visit by the same agency?
❑ Yes No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments(referto question #i): Explain any YES. answers and/or any additional recommendations or ah#gther comments:
_7
Use.drawings of.facility to better explain situations (use additional pages as necessary).
)V"_C0d3 7g, e-`� P `G -) q
Reviewer/Inspector Name:
Reviewer/inspector Signature:
Page 3 of 3
Phone:
Date:
21412011

70
Type of Visit: 'Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: (�,' fJ Departure Time: D County :�S�.r�8z-- Region:
Farm Name: , n fir- Q �� Owner Email: TT
Owner Name: %'S r—r1 J Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: s'
Certified Operator:
Title:
Integrator: 31 Gc/f_
Certification Number:
Phone:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
� Destgn�Current � I I De�ig�C ent
Design Cterrent
Swtn CapsctyCapactty�Pop .
Cattlemccl
ti
..a
DairyCow
Wean to Finish
`
La er
can to Feeder
Nan -Layer
DairyCalf
Feeder to Finish
Da' Heifer
Farrow to Wean
Design�Ct &rent
D . P,oul Ga act tr ,Po
D Cow
Farrow to Feeder
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other, �
Turkey Poults
Other
Dther
Discharges and Stream Impacts
I . Is any discharge observed froin 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 C, No ❑ NA ❑ NE
[:]Yes ❑ No
[:]Yes [:]No
[—]Yes ❑ No
[—]Yes No
❑ Yes �RLNo
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3
21412011 Continued

Facili Number: - 3 Date of Inspection:
13
Waste Collection & Treatment
• 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
Jallo
❑ 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): 19
Observed Freeboard (in): 626—
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
01 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
E� No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
131 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
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
n No
❑ NA
❑ NE
maintenance or improvement?
11. is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes allo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes ® No ❑ NA ❑ NE
15_ Does the receiving crop and/or land application site need improvement? ❑ Yes No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes ® No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
[:]Yes [Z No ❑ NA ❑ NE
❑ Yes allo ❑ NA ❑ NE
19. Did the facility fail to have the 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
E0 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
Eg_No
❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield [] 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
® No
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes R No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: - Date of Ins ection: 3
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [�KNo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes &No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey [:]Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes F2q No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes 5ZNo ❑ 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:
[] Yes El No ❑ NA ❑ NE
❑ Yes O No ❑ NA ❑ NE
❑ Yes §fl No ❑ NA ❑ NE
❑ Yes fR No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes E[No ❑ NA ❑ NE
33. Did the Reviewer/inspector fait to discuss review/inspection with an on -site representative? ❑ Yes ®,No ❑ NA ❑ NE
Reviewer/inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: D23Z Oa
Date: cfJ 1
21412011

' ivision of Water Quality '
IN
Number ®- 7D o0 Division of SoilI
nd Water Conservation !0 y�
MOOO Other Agency
type of Visit: ,,<�ommp�pliance Inspection Operation Review 0 Structure Evaluation 0 Technical Assistance
teason for Visit: +ditoutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: tIU_/J Arrival Time: /D: 0[7 Departure Time: CountyRegion: F].z-'D
Farm Name: 'l n = y Owner Email:
Owner Name: rC if. r` S� 1 - Phone:
Mailing Address:
Physical Address:
Facility Contact: C2 rrt-- hlbz) r-r— Title: �pt`• Phone:
Onsite Representative: Integrator: /jlN/P
Certified Operator: L�rk)ao �-- j`C Spry) Certification Number: / g J/,9
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Des ggn C n Current's :� DesignCu�rent� Desiurrent
Swine Ca a qrcWet Poul Ca acr rI'a y ..Cattle Ca aci Po .
.p�+ ��i=��. tea,,_ fr°J' p ty���LL_ P �,"
Wean to Finish 3?0]Layer DairyCow
Wean to Feeder .� Nan -La er I I J=v­Dairy Calf
Feeder to Finish Dairy Heifer
Farrow to Wean rDeslgn;��.Curreut' D Cow
Farrow to Feeder D Poul �Po Non -Dairy
Farrow to Finish Layers Beef Stocker
Gilts Non -Layers Beef Feeder
3
Boars Pullets Beef Brood Cow
. e s Turk
;.
Other •'• tTM � �` '"� Turkey Points
Other Other
Discharges and Stream Impacts
I. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d_ Does the discharge bypass the waste management system? (If yes, notify DWQ)
Z. 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 ZLNo [DNA ❑ NE
[—]Yes
[:]No
❑ NA
[] NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
®,No
❑ NA
❑ NE
Page 1 of 3 21412011 Continued

Facility Number: - 3 D Date of Ins ection: )0— 1
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 23,No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA 0 NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): 1
T--/3q
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
E, 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
[U 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
allo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
0 No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
® No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
r"No
❑ NA
❑ NE
maintenance or improvement?
11 _ Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes 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 Approved Area
12. Crop Type(s): ���`i"� 0 it c,5e
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? 0 Yes E,No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [RNo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes ® No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes ®,No ❑ NA ❑ NE
❑ Yes ®,No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes ® No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [g No ❑ NA ❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [B 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 ® No
❑ NA
❑ NE
❑ Weather Code
❑ Sludge
Survey
❑ NA
❑ NE
❑ NA
❑ NE
Page 2 of 3 21412011 Continued

Facili Number: - [Date of Ins ection: i
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes E-No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes allo ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes Ej No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes Ej No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes gLNo ❑ 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 5�jNo ❑ NA ❑ NE
❑ Yes ®, No ❑ NA ❑ NE
❑ Yes E No ❑ NA ❑ NE
❑ Yes [allo
❑ Yes [a No
❑ Yes allo
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question #f): Explain any YES answers and/or any additional recommendations or anyother comments
Use drawings of facility to.better explain situations (use additional pages as: necessary)._
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Phone:
Date: %U -/ / +d20 ) 1;2-
2./4120I1
Page 3 of 3

ion of Water .11
Facility Number ®- 3 %p OO Division of Soil and Water Conservation
®Other Agency
Type of Visit: ,,��ommp�pliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: CTitoutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit:
�(J— Arrival Time:
Departure Time: ;
County: Region:
Farm Name:
rl V- y Cn >/ 7"/ I'a / rLti..
Owner Email:
Owner Name: �,o PIt Sal // Phone:
Mailing Address:
Physical Address:
Facility Contact: /5/`Yr'r }j/� Title:Phone:
Onsite Representative:
Certified Operator: _ f�'�c� S�r•��
Back-up Operator:
Location of Farm:
Latitude:
Integrator:
Certification Number:
Certification Number:
Longitude:
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes 0 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)
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
❑ NA [] NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 21412011 Continued

Facili Number: - Jp Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure I Structure 2 Structure 3 Structure 4
Identifier:
Spillway?: _
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
Structure 5
No ❑ NA ❑ NE
❑ No ❑ NA ❑ NE
Structure 6
[:]Yes K No ❑ NA ❑ NE
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
[g No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental
threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
[]Yes
® No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[2 No
❑ NA
0 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 Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
Q No
❑ NA
❑ NE
maintenance or improvement?
11. is there evidence of incorrect land application? if yes, check the appropriate box below. [] Yes M No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):--
13. Soil Type(s):`
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes Q No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ZI No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes kRI No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes P No ❑ NA ❑ NE
❑ Yes takNo 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 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 I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? [:]Yes EQ No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ® No
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facili Number: - 3 p 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(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 R] No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑Yes 21 No ❑ NA ❑ NF
Other issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes [3 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 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 ReviewerlInspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
ReviewerlInspector Name:
Reviewer/Inspector Signature:
❑ Yes EC No ❑ NA ❑ NE
❑ Yes ®No ❑ NA ❑ NE
❑ Yes ,� No ❑ NA ❑ NE
❑ Yes ® No
❑ Yes E No
❑ Yes 0 No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Phone: 2La 16�-7— =oaf'
Date:
21412011
Page 3 of 3

type of Visit Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit l�utine 0 Complaint O Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: ©Q Arrival Time: D ' Departure Time: County: Region:
AV
Farm Name: 4 tom' f `! Owner Email:
Owner Name: SOU Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Prone No:
Onsite Representative: Integrator:
Certified Operator: �'-''� v�,P_ I-- Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = o = 6 = Longitude: = o = 4 = Ii
Swine
Design Current
Capacity Population Wet Poultry
esign On Design
Capacity Population Cattle Capacity
DL
Current
Population
❑ Wean to Finish
Layer
❑ Dai Cow
Wean to Feeder
HNon-L]jer
❑ Dair Calf
❑ Feeder to Finish
❑ Farrow to Wean Dry Poultry
❑ Farrow to Feeder
❑ Farrow to Finish ❑ Layers
❑ Gilts ❑Non -La ers
Pull
❑ Pullets
❑ Boars ❑ Turkeys
ElTurke Puults Other ❑ Other
LEE
❑ Dai Heifer
❑ Pry Cow
ElNon-Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes gNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
El Yes
El No
❑NA
❑NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
10 No
❑ NA
❑ NE
❑ Yes
RNo
❑ NA
❑ NE
Page 1 of 3 12128104 Continued

Facility Number: — 3� Date of Inspection[Z%
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 7
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes DKNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes &No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes 9[No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes 54 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 Z�No ❑ NA ❑ NE
maintenance or improvement'?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes EkNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes �LNo ❑ 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) ­� / 0 ri -e
13. Soil type(s) 191—FPIA
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
21No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
M No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
EL' No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
El No
❑ NA
❑ NE
18- Is there a lack of properly operating waste application equipment?
❑ Yes
K[No
❑ NA
❑ NE
Comments (refer t6*estion #) Explain any YE5 answe%iidl6r any recominOiidations or„any other comments. F ,;
oexplain-. (s i i_ J Pages rY)
Use.drawmgs;of factlity to better situati6hs use additional a es as necessa ... -
I Reviewer/inspector Name yr�L°11 „aP�fi �j I
1 a�;Y� �" Phone: D (, 3`33D�
Reviewer/Inspector Signature Date: 7--"AD
Page 2 of 3 12128104 Continued

Facility Number: 9 — Date of Inspection
Re aired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes [ff.No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes Iallo ❑ NA ❑ NE
the appropriate box_
❑ WUP El Checklists El Design El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes CgZ!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 J.No ❑ NA ❑ NE
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes RNo ❑ NA ❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?'
❑ Yes
NjNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
[�No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
OLNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
2,No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
9,No
❑ 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
&,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
9No
❑ 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
allo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
&,No
❑ NA
❑ NE
Additeonal Comments ancflor Drawtn s:
Page 3 of 3 1212&104

12 07- Zon 9
}W.Drvision of Water Qttaltty a
Facility Number 2 3� O O Dtvistaa of Soil aad Water Coaservaboa
O Other. ca "'---:-• -,. -
Type of Visit ompllance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit OeRoutine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Dale or visit: l2—b7-09 ArrivaI "I'imc: %/: Q Departure Time: III County: Sq�..Prtnl Region:
Farm Name: �inlE y Gree�I Farms Owner Entail:
Owncr Name: Ke ^f SQL (1 Prone:
Mailing Address:
Physical Address:
Facility Contact:
Title: Phone No:
Onsite Representative: Integrator:
Certified Operator: lDe-rwood K • 5 zli Operator Certification Number. A M -l9119
Back-up Operator:
Location of Farr}:
Swine
Back-up Certification Number:
Latitude: = o ❑ 1 = " Longitude: =o = ` ❑ a
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
35525 Z ❑ Non -Layer
❑ Wean to Finish
Wean to Feeder
❑ Feeder to Finish
[I Farrow to Wean
El Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Dry Poultry
❑ Layers
❑ Non -Layers
El Pullets
ElTurkeys
❑ TurkeyPoults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: El Structure El Application Field El Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Popnlrttion
❑
Dai ' Cow
❑
DairyCalf
❑
DairyHeifei
❑
D Cow
❑
Non -Dal
El
Beef Stocker
❑
Beef Feeder
El
Beef Brood Co
Number of Structures: a]
b. Did the discharge reach waters of the State? (I f 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 ETNo ❑ NA ❑ NE
❑ Yes ❑ No i-KAA ❑ NE
ElYes ❑ No E< ❑ NE
❑ Yes ❑_, No E7NA El NE
❑ y
Yes I,< ElNA ElNE
ElYes a<. ❑ NA ❑ NE
12128104 Continued

Facility Number: $Z-37D
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier: -4 1
Spillway?:
Designed Freeboard (in): /9
Observed Freeboard (in): 27
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 [3 o ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes ffNo ❑ NA ❑ NE
❑ Yes `LTNo ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ffNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes [B o ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks) �/
9. Does any part of the waste management system other than the waste structures require [] Yes L3 No ❑ NA ❑ NE
maintenance or improvement?
Waste ADDIication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes L7 No ❑ NA ❑ NE
maintenance/improvement?
11. is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 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) 8�0_6 MW .X4-,. C02 r&s�u YL J , S G 0V"-5 --
13. Soil type(s) /YDrry I K
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, El Yes
17. Does the facility lack adequate acreage for land application? ❑ Yes
18. Is there a lack of properly operating waste application equipment? ❑ Yes
ETNo
❑ NA
❑ NE
10
El NA
El NE
[ 'No
❑ NA
ElNE
E No
El NA
❑NE
3 o ❑NA ❑NE
Reviewer/inspector Name t K = 2Phone: 9/0. 3L-33 . 33�
Reviewer/Inspector Signature: 14�4 ✓.Nr l.�� Date: lZ-47 2,04) 9
12/2&04 Conhinued

Facility Number: 82 —3]D Date of Inspection /z'oT c_
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes o ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropirate box. ❑ WLJP ❑ Checklists ❑ DesignMaps
❑ ap ❑ 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? El Yes a o ❑ NA ❑ NE
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑'<o ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
❑ Yes
❑ NA
ElNE
❑ Yes
�2<oo
El NA
❑ NE
El Yes
,I_j�<oo
E o
ElNA
El NE
❑ Yes
B o
❑ NA
❑ NE
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?
Comments and/or Drawings:
❑ Yes
ff No
❑ NA
❑ NE
❑ Yes
T<o
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
I TNo
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
El, o
❑ NA
❑ NE
1228104

j?.ri-sx
/-08-oq /z2
Type of Visit Or'Compliance Inspection 0 Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit outine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: /%'Of" Departure Time: //;aS County: T Region:
Farm Name: / j ms �r��,r 1-► w, _ Owner Email:
Owner Name: let.,... ,!;Ip CW Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: c _ ZPhone No:
Onsite Representative: P`�-t-� csv_v_� Integrator: &xa::� g�ti
Certified Operator: Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: 0 0 = t = Longitude: = ° [= t = «
Design Current Design Current Design Current
Swine Capacity. Population Wet PoultryC�apacity Population Cattle Cbapacity Population
❑ Wean to Finish
to Feeder
La er
L�_Wean Non -Layer
Dai Cow
s$Z
DairyCalf
Feeder to Finish
Dry Poultry_A.
❑ La ers
❑ Dairy Heifer
❑ Dry Cow
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Non -Dairy
❑ Beef Stocker
❑ Farrow to Finish
❑Non -La ers
❑ Gilts
❑Beef Feeder
❑ Pullets
❑ Boars
❑ Beef. Brood Co
❑ Turkeys
Other
❑ Other H
Number of Structures:
❑ 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 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 NA ❑ NE
❑ Yes
❑ No
BITA
❑ NE
❑ Yes
❑ No
[]'TqA
❑ NE
D-N-A
❑ NE
❑ Yes
❑ No
❑ Yes
[ o
❑ NA
❑ NE
❑ Yes
RTTo—
❑ NA
❑ NE
Page I of 3 12128104 Continued

Facility Number: l —37p
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
[T'No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
D-NO
❑ NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identilier:
Spillway?: PhD _
Designed Freeboard (in): / q �r
i
Observed Freeboard (in): 2 T
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
f No
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
El Yes
,,..
3 o
❑ NA
❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement'?
❑ Yes
E No
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
O'go
❑ 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
9-95-
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
ffNo
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
Elm
❑ 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)
(a• S
13. Soil type(s) 1lo A
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
EE7, 1
El NA El NE
15. Does the receiving crop and/or land application site need improvement?
El Yes
l.�N000
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
❑' fo
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
ff No❑
NA ElNE
18. is there a lack of properly operating waste application equipment?
ElYes
2'1qow❑ NA ❑ NE
Reviewer/Inspector Name iL� `; �,rrS;;� Phone: q/0, �,33,33�
Reviewer/Inspector Signature: r �.e Date: j2 —O S/ —zeg&
Page 2 of 3 12128104 Continued

Facility Number: Sz —3 Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 31 to ❑ 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. ❑ ArUp ❑ Checklists ❑ Design ❑ Maps p ElOther
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes %o ❑ 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
21qo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[3'5lo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
2'1�O
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
9-go
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
[3-No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
87Ko
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWM P?
❑ Yes
511�_o
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
L=1 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
EJ_o
❑ 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
EflNo
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
M—NO
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
0-No
❑ NA
❑ NE
Addittoitalic, omments anidlar Drawings:;
Page 3 of 3 12128104

Z5ZIA(S lz// 9/zoo 7 '
® Division of Water Quality
Facility NumberM2-E
} O Division of Soil and Water Conservation
- O Other Agency
Type of Visit • 19 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: /1 IO' D7 Arrival Time: o'_I 3%r M Departure Time: O2 Q County: 15iv J_0Af Region: `
Farm Name: P1 rrarw, Owner Email:
Owner Name: Ke'p-
ket lI Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: 1 �-� • 5P e L Phone No:
Onsite Representative: G r-c G it fAuV-'—C_— integrator:
Certified Operator: �a1 K •�-i� Operator Certification Number:
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
Back-up Certification Number:
Latitude: = o = A Longitude: = o = ` ❑ u
Design Current Design Current
Capacity Population Wet Poultry Capacity population
❑ Layer
355z- 13&00 I ❑ Non -La er
Dry Poultry
❑ L a ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Dischames & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes [51 No ❑ NA ❑ NE
❑ Yes
[A No
❑ NA
❑ NE
❑ Yes
INo
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
�ffNo
❑ Yes
P No
❑ NA
❑ NE
❑ Yes
VINo
❑ NA
❑ NE
12128104 Continued

Facility Number: a Date of Inspection -/a -O
-71
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?:
x
Designed Freeboard (in): j G]
Observed Freeboard (in): dw
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
P No
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
EYNo
❑ 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
[P No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[P No
❑ NA
❑ NE
maintenance/improvement?
11.
Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
Q� No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12.
Crop type(s) FB 9- rv.Au► CIO'.,
13.
Soil type(s) ALA - -_
14.
Do the receiving crops differ from those designated in the CA WMP? ❑ Yes
LG 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
['-3 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
[] 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):
4 Fr. ,- w• w L's, 6 c. e- -,
Reviewerlinspector Name r G C.-4 C_ t S Phone: Ile, fe33, 33,Y
Reviewer/Inspector Signature: Date: /2 -1Ci -2U D 7
12128104 i.ontlnued

Facility Number: Fz -37o Date of Inspection
Required Records & Documents
19. Did the facility fail to have 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 1� 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 P 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
0No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
QfNo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
P No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
P No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
[;'No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
ZNo
❑ 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
PNo
❑ 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
O 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)
1
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
01 No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
P No
❑ NA
❑ NE
nal Comments and/or Drawings:
12128104

Type of Visit 4W 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: Arrival Time: O/:/S"r Departure Time: County: �OSo.�/ Region:
Farm Name: � /rct Owner Email:
Owner Name: K�^J SDz Lf Phone:
Mailing Address:
Physical Address:
Facility Contact: mim r-p - Title: Phone No:
Onsite Representative:
Certified Operator:
Back-up Operator:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: =1 o = I = 11 Longitude: = 0 0 d =
4.
Design Curren# Design
Swine Capacity Population Wet Poultry Capacity
C>urrent Design Current
Population Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
a ❑ Dairy Heifer
El Dry Cow
❑ Non -Dairy
❑ Beef Stocker
El Beef Feeder
; ❑ Beef Brood Cowl
dumber of Structures:
❑ Wean to Finish
❑ La er
Wean to Feeder
❑ Feeder to Finish
1-"
❑Non -La er
r:
Dry Poultry
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑
Non-ersLayers
❑ Gilts ❑Nan -La ers
❑ Boars ❑ Pullets
li - ElTurkeys
Other ❑ Turkey Poults
❑ Other El Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
P No
❑ NA
❑ NE
Discharge originated at. ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
q 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
N No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
� No
El NA
❑ NE
other than from a discharge?
Page I of 3
12128104
Continued

• Facility Number: SZ -
Date of Inspection i�
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes QfNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes [PNo ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): / g
r/
Observed Freeboard (in): 2-62
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes [ No El El 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 [XNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes [ONo ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
4. Does any part of the waste management system other than the waste structures require ❑ Yes �Vo El NA ❑ NE
maintenance or improvement? rr
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [Vlo ❑ NA ❑ NE
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 El Application Outside of Area
12. Crop type(s) S Y� 4 - .�-A' 51t1GC� a-"''-j
� J
13. Soil type(s) A V fly
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
R9 No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination'?
❑ Yes
No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
J@ No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
ER No
❑ NA
❑ NE
Comments (refer to question # ): Explain any YES answers and/or any recommendations or any othevcs'' '&RMen
Use drawings of facility, to better:explain situations. (use additional pages as necessary): r
Reviewer/Inspector Name F—K 1 ej _-,_ L-K �V Phone: (9 0�'33 —3330
Reviewer/Inspector Signature: Date: 2 Q4:0

Facility Number: FZ --y5 Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 0 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes T] No ❑ NA ❑ NE
the appropriate box.
❑ WUP El Checklists El 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 V Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
04 No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
ONo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
q No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
[XNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
7No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
10 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
4FNo
❑ 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
V No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
ONo
❑ NA
❑ NE
s aodlar'Drawiags:
Page 3 of 3 12128104

Type of Visit 0 Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit 0 Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: t%`�,3-OS Arrival Time: : /D Departure Time: County: .Sases9%n Region: r/fd
Farm Name: /� Owner Email:
Owner Name: rO�� v ✓ Phone: 1/0- 5G �l- `/t of
Mailing Address: -2.7 49& p r her
A �SZ3�9
Physical Address:
Facility Contact: Zan, i��=,tTitle: Phone No: `//y" 95o - 4 097
Onsite Representative: 100"'M)e _ ✓..„'n Integrator: Ls^,oN
T
Certified Operator: 7d ✓.„„ Operator Certification Number: /G 7s S-
_
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = o ❑ 4 =" Longitude: = ° 0 I =
11
Swine
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
ElLayer
3 s .� 3Go0 ElNon-La yei
❑ Wean to Finish
2Vean to Feeder
El Feeder to Finish
El Farrow to Wean
El Farrow to Feeder
El Farrow to Finish
❑ Gilts
❑ Boars
Other
Dry Poultry
ElLayers
❑ Non -Layers
El Pullets
ElTurkeys
El Turkey Pou Its
El Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: El Structure El Application Field ❑ Other
a_ Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑
DairyCow
El
Dairy Calf
❑
DairyHeifei
❑
D Cow
ElNon-Dairy
❑
fSt kEl
Be
ef oc et
Beef Feeder
Beef Brood Co 1
Number of Structures:
b. Did the discharge reach waters of the State? (If yes. notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system`? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes [J<o ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
D No
❑ NA
❑ NE
❑ Yes
2<o
❑ NA
❑ NE
12128104 Continued

Facility Number: 8 —3 o Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
21go
❑ 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?: In p
Designed Freeboard (in): • R o• y
Observed Freeboard (in): T�
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
D 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
[a'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
ONO
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes aNO ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes 2 No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes DINO ❑ NA .❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes [�io ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drifl ❑ Application Outside of Area
12. Crop type(s) S^►a%� .: ` -) der F'%A"A S rase la AtJdv �
13. Soil type(s) -Al. 4
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes (2`No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [a'No ❑ NA ❑ NE .
le'"j3
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination',[]Yes Plo ❑ NA �E
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes ❑ No ❑ NA [ENE
❑ Yes 2*&o ❑ NA ❑ NE
Reviewer/Inspector Name IR RI QPhone: g/O-yam, .if-y1 Cw73e>
Reviewer/Inspector Signature: ,B Date: y-/3-off
ll/l6/U4 c.onunueu

Facility Number: 82 —3r]p Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? []Yes ❑ No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [P'No ❑ NA ❑ NE
the appropirate box. ❑ ❑ Ch fists ❑ Dpao ❑ Mpps"_❑ C """
21. Does record keeping need improvement? If yes,
check the appropriate box below. 2"Yes ❑ No ❑ NA ❑ NE
❑ Vft9Mkpp4Ga&ym ❑ Weolgy Ff:eeb ❑ his ❑ Soii Analysis ❑ Vftste Trarisfeis ❑
❑ li- ❑-Steelciag [- Crop Yield E3120 Minute Inspections ❑ ❑ Wraffierev
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
2 No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ Yes
❑ No
❑ NA
91NE
❑ Yes
❑ No
❑ NA
ED-VE
❑ Yes
91Qo
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
[9-10E
❑ Yes
2Flo
❑ NA
❑ NE
❑ Yes
9-No
❑ NA
❑ NE
❑ Yes
D-No
❑ NA
❑ NE
❑ Yes
2NO
❑ NA
❑ NE
❑ Yes
,Flo
❑ NA
❑ NE
❑ Yes E?I�o ❑ NA ❑ NE
Addttioiial Con ents and/or Drawiiat
�. lam,
Varim fits J p«�,' I" IIn iT�s OTri'rR �ci 401we . I°leG.e r;17A1#'Pe .G tr/„
Df die s,�„ Per••.f a,ri Cep{:><:'rarle af' Coverose ayod 1reryo cv"/� A,, '/
re. ce r r,I S 0�1 l�ai r7
31• Re" 'eev�el G.v/o r'�/a/ �or.•ic. /�/�arg ,�.'{�{ .i1�PR-�-fer..� fdr /�v �%nv�e
i175pac {r'ons
12128104

Type of Visit ® Compliance Inspection Q Operation Review Q Lagoon Evaluation
Reason for Visit • Routine Q Complaint Q Follow up Q Emergency Notification O Other ❑ Denied Access
Date of Visit: — L• �%� Tirne:
FacilinNumber
Kot O erational Below Threshold
0 Permitted ® Certified [3 Conditionalli Certified ❑ Registered Date Last Operated or Above Threshold:
Farm Name: Pa �OM G r,•-1 Count.: -S o�
Owner name: a . Phone No: 1-f19 q
Mailing Address: aA C" '00"A /A r l'lP•►vf"r '/ - C4� / n ze/G
Faciliri- Contact: Title: Phone No:
Onsite Representative: Off_ 1140h Integrator: /'rM✓��Ay �!� '-'PA) h
Certified Operator: /3dl/+f ✓ ���fNrl Operator Certification Number: 16 75S
Location of Farm:
X Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' ' " Longitude 0 0
Design Current
Swine (as aAty Pnnnlatinn
10 Wean to Feeder
f-Z
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Design Current Design Current
Poultry Capacity Population Cattle Capacity Population
❑ Laver ---d ❑ Dairy
❑ Non -Laver I I ❑ Non -Dairy
❑ Other
Total Design Capacity
Total SSLW
Number of Lagoons ❑ Subsurface Drains Present 110 Lagoon Area 10 Spray Field Area
Holding Ponds / Solid Traps E] No Liquid Waste Management System
_Discharges & Stream Impacts
1. Is any discharge observed from any pan of the operation?
❑ Yes M-No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Rater of the State? (If yes, notify DWQ) ❑ yes [] No
c. If discharge is observed. what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes ®No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes 0 No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes JU No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard (inches): .3711
05103101 Condnried

Facility Number: Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ic/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Anolication
❑ Yes N3 No
❑ Yes [Ul No
❑ Yes No
❑ Yes No
❑ Yes ® No
10. Are there any buffers that need maintenancelimprovement? ❑ Yes [10 No
11_ is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes QI No
12. Crop type q
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes [9 No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes [A No
b) Does the facility need a wettable acre determination? ❑ Yes 0 No
c) This facility is pended for a wettable acre determination? ❑ Yes No
15. Does the receiving crop need improvement? ❑ Yes No
16. Is there a lack of adequate waste application equipment? ❑ Yes] No
Reouired Records & Documents
17.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
® No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
® No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
® No
20,
is facility not in'compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
® No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
® No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, Gceboard problems, over application) ❑ Yes No
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes ® No
24. Does facility require a follow-up visit by same agency? ❑ Yes ® No
25_ Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes No
No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Commeals refer to,`' uestson E lath any YE esw ean an s d/oranv e&_Mendatrons or+any other cn -RP--
( q �F
a sitnatrons:�(use tidEt,anal pages ss necessary)•
#er ez e x - ❑ Field Copy El Final Notes
p
Use drawEngs�fa�ty to b�etla ��. , : ��'�� •��u. ..- � � , .,:, t
Reviewer/inspector Name
i/ v
Reviewer/InspectorSignature: Date: %`r�p-0y
05103101 if Continued

March 21, 2(1[?(i
NCDENR DWQ
Jeffery Brown
Fayetteville,N.C. Office
Subject: Pat -Tom Farms Freeboard of Lagoon
Facility NcNZUfflr
Sampson County
Dear Mr_ Brown
As per letter faxed to you at your office on Fdi* :2000.( copy attached ), By the end of 2-04-2000
my Lagoon freeboard.levelbmmsA97---A1so please see attached copy of my Farm inspection dated March
01,2000, inspected by Scott Faifcloth with Div.of Soil & Water Conservation. He noted Lagoon freeboard
was 23"_
Thank you for all your help.
Sincceieiy;—
�'om�rrry Vann
2286 Parker Memorial Road
Clinton,N.C.28328
[phone]

Oyj
To: NCDENRJDwQ
Jeffery Brown
Fayetteville.N.C_
From:
Tommy Vann
2286 Parker Memorial Rd_
Clinton,N.C.28328
910-564-4509
February 04,2000
In reference to form -B left on farm site :
I have pumped and now have freeboard down to app_ 18 1/2 " I will have freeboard down to 19" or
better today(Feb.4,2000).
Thank you for your help.
Tommy Vann

Routint
review
Facility Number Date of inspection ,
.�. ...,........... j lime of Inspection 17 24 hr. (hlt:mm}
10 Permitted Certitiad] Conditionally Certified [Q Registered Not a Date Last O�taa:
lii
Fares Name: � .r � .— _ _ _ _� __ _� - - _. t9 -
--------- Coup t
ff, ,
Ovaser Name: _-1 A� Phone No:...A_.�
Facility Contact: lsos:e No: - -
Mailing Address: ----- �k..._------ _���.l�- . .
Orrsite Representative:.. ! 4L' 1�'.:�i .»r�. _ _ _ ---- �'ator:...1'.1.�.�i���
Certffled Operator:._ ; kt� f'� _ �o liiAft _ _ _ _.._. _._._ _ Operator Certification Nundxr:.._........�
Location of Farm:
Em
-------------- i ongitude
Design: ` ;fit Desi� Carrel Via.
Swine _pbg . Poultry p a# :Csifi `Ca - n}attnn
Wean to Feeder ❑Layer Dairy
Feeder to Finish JU Non -Layer I Non-D
Farrow to Wean ..•..:.:,: ,: - _ _ _ __ - _
❑ Farrow to Feeder
....... -
❑ Farrow to Finish
❑ Gilts
Boars = TWO.
s:
1,
I•TttraOer agoo�t „ Shc:surface Drains Present isgaanArm
7 �� Area
d}iig Pvils f'isr No Liquid Waste Management System `
,u
Discharges & Stream hnpacts
1 _ Is any discharge observed from any part of the operation? ❑ Yes No
Discharge onginated at: ❑ Lagoon ❑ Spray Field ❑ Other
a, if discharge is obserycd, was dw conveyance fnan-made., ❑ Yes No
b. If discharge is ohserved, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes No
L. If discharge is observed, what is the estimated flow in gaVrain?
d. Does discharge bypass a lagoon system'? (If yes, notify DWQ) ❑ Yes No
2- IS there evidence of past discharge from any part of the operation? ❑ Yes No
3_ Were there any adverse impacts or potential adremc impacts to the Waters of the State outer than from a disc-harge? ❑ Yes (� No
3j:cite couectiva & Imtruent
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes No
Structure I structure 2 Structurc 3 Structure 4 Structure S Structure 6
Identifier:
Frceboard (inches). _ _ .... �. ... .................».._ . _ ... _.._ ... ... _----------- _
S. Are there any immediate threats to the integrity of any of the structures observed? (iel trees, severe erosion, [I yes rl No

FacWty Number-. L 1 — Hate of Inspection
6. Am there stru-cLu.us on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify' DWQ)
7- Do any of the structures treed maintenance.Ctmprnverner.t?
S. roes any part of the waste management systam other than waste structures require mainteratceJimprovemcnt'T
9- Do any stuctures lack adequate, gauged markers with required maximum and mini imn liquid level
elevation markings?
R'asze Application
10. Are there any buffers that need maintenancclimprvvemeni?
11- 1s there evidence of ever anolicat=_Qn? []Excessive Ponding ❑ PAN
12. Crop type Krrn.*tla '.;Ft.l%I[A �A1II {fi,l1
❑ Yes
❑ No
❑ Yes
❑ No
a Yes
[]No
Q Yes
❑ No
U Yes
❑ No
❑ Yes
❑ No
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14- a) Does the facility lack adequate. acreage for lmd application?
b) Does the facility need a wettable acre determination?
c) 79us facility is pended for a wettable acre determination?
,a_ Does the receiving crop need tulprv-,v lent?
lb. Is there a lack of adequate waste application equipment?
Reuuired Records & Documents
IT Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
be/ WUP, checklists, design, maps, etc.)
19- Does record keeping need improvement? fie/ irrigation, freeboard, waste analysis & soil sample reports)
20. is Facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22- Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge. freeboard problems, over applicationl
23. Did Reviewer/]nspector fail to discuss mviewlirtsp<:cuo . With on -site representative?
24. Does facility require a follow-up visit by same agency?
25. were any additional problems rioted which Cause roncomp;iance of the Certifier) AVi.%M
�: filii-yiorh Q }s o - 0004�i� v"tvre p i ig this:vj4- .................
b jk WM- ti 46 fWhO
�eorit�spotid�ce:tlbaif this nisilt:::: ::...:::.:::::::...:::: :
111
3er Eti`grs n . R Akin alit 'YES answers ai
E
lA
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
Q Yes ❑ No
Q Yes [)No
❑ Yes ❑ No
Yes ❑ No
0 Yes ❑ No
❑ Ye-s ❑ No
❑ Yes 0 No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
Ak
Revdewer/Inspecter'`I<7me 4�,�rjs��s
it _„„.+c-�a-�-r._d -r a.

} � � Drv�s�on of Soil and Water Conservation = Opera_bon Review 4 � �� �� _
z Division of Soil and_Water:Conseirvation -Compliance Inspections x n
Ihvrsion of,Water Quahty -Compliance Inspection T
°y Other Agency Operate©n Revlew_ - -`� _� `*
0 Routine Q Complaint Q Follow-up of DWQ inspection O Follow-up of USWC review a Other
Facility Number Date of Inspection a —A©
Time of Inspection AO 24 hr. (hh:mm)
© Permitted A Certified (] Conditionally Certified [3 Registered JE3 Not O erational I Date Last Operated:
Farm Name: 6.X..................
.....................�.....^�7'j�...................---..................__.............._........ County:
Owner Name:.... ................! ph'i!)'��v . .. UG �1_O �.. Phone No: ...........%� ,5�?..T.._:. ..T,r�J�.............
Facility Contact: ............_.. ...... Title Phone No
Mailing Address......... oga` n� ........P rkpl:......f`'.�.�..�.'.!.:1GYia.l......-AVVI' .......................CX ../aC.................. ..... �� /,O
/.
Onsite Representative:........................................................................................................... Integrator:.............�1...� ......!.. ......TG!cir .f...
Certified Operator:.....,.;,. UGt r: Operator Certification Number:,,,...
Location of Farm:
Latitude 0 4 44 Longitude • ' 6;
--Design- Current
�wtne Ca acity Population
Wean to Feeder :;12,
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
Boars
Design Current _ Design.• Current.
Poultry Capacity Population Cattle Ca achy " Po -nliat'oh
❑ Layer ❑ Dairy _
❑ Non -Layer ❑ Non -Dairy
❑ Other _.
Total De signCapacity° 5rj�
- Total SSLW-'
Number of Lagoons JE1 Subsurface Drains Present ❑ Lagoon Area ❑ Are Spray Field a
Holding Ponds-/ Solid Traps- ❑ No Liquid Waste Management System
Discharges & Stream impacts
I. Is any discharge observed from any part of the operation? ❑ Yes ❑ No
Discharge originated at_ ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (ll' yes, notify DWQ) ❑ Yes ❑ No
c. if discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If ycs, notify DWQ) ❑ Yes ❑ No
2. is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate'? ❑ Spillway
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
❑ Yes ❑ No
❑ Yes ❑ No
❑ No
Kuyurp-es
6
Identifier: r
Freeboard(inches): ! . ................ .................................... ......................... .------ .... ............................ ...._.-
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes ❑ No
rt cw,n porS. De t v-�.( -C,.. �uct,p( Gt�Gce • seepage, etc.)
3/23/99 `�� Continued on back
Al06'� art — -arq-1 5� e . ,�t4 gcc, owt t� 1 _::S_ Y J

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A
Divrs�on of So;l and Water Consecration "Operation°Revtew
Ihvislon of Sott and WiiWe C_ooservahon _ Compliance Inspection
F -
�-,.
Other Agencq Rev�ew�-.� ��� -���.
-..•���- �Operahon �.. ,_ �..� _�;•
0 Routine 0 Cum laint 0 Follow-up of DWQ inspection, -0 Follow-up of DSWC review 10 Other
' `Facility Number O
Date of -inspection :2-OO
=
Time of Inspection 24 hr. (hh:mm)
v© © Conditionally Certified Re �stered .. _ t Permitted Certified n ,,�7 g' 0 Not O erad naf Date Last Operated: /'
' ,uAFarm Name: ........................ 47-TO'�'..rt_.... County:............... 6 ,...............
i�� p v — 5� �'50
Owner Name :.................-.........r?7. ? �! ....:w'.-...............! L�'1........ .................... Phone No:...........1.........................�.........T...........��.-----......--.-
Title
•Facility Contact: ...:............ f e................�.............
-MailingAddress:........��..°�g�'.-..... arkC-1-.-../V16':!.:iQ`Ia.-l........Lf. C
f�
Onsite Representative: `
..% .... .....................................................................................
Certified Operator:....................../......CIyY?,h:U�..... ...s....._V A -:!..-....................-
I. Location of Farm:
■ts
Latitude ; ::, • 0` �'�
Swine, ranarity Ponulatinn
Wean to Feeder
[]Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
41.
❑ Gilts
❑ Boars` _'.
, ..
..........I ................. Phone No:...................................................
(7&lc><' ................•• ..........................
Integrator :.............
�t._.
Operator Certification Number:
Longitude • �� ��
:Design Current Design , _ Geri ent
Poultry 'Capacity Population Cattle Ca acity Po ulation
❑ Layer ❑ Dairy
❑ Non -Layer ❑ Non -Dairy
❑ Other =
Total Design Capacit ,
Total SSLW
Nu tier of Lagoons ' ` ❑ Subsurface Drains Present ❑Lagoon Area ❑ Spray Field Area
Holding Ponds / Solid Trl gs ❑ No Liquid Waste Management System =
Discharges & Stream Impacts.
I. Is any -discharge observed from any part of the operation? ❑ Yes ❑ No
Discharge originated at: ❑ Lagoon ° ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance rnan-made? ❑ Yes ❑ No
fib: If discharge is observed, did it reach Water of the State? (If ycs, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system'' (JI•ves, notify DWQ)
❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes ❑ No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ❑ No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? El Spillway Yes ❑ No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 SKture 6
Identifier:
Freeboard (inches):1.I ......................................
5,., •Are there any immediate threats to the integrity of any of the structures observed? (ic/ trees, severe erosion, ❑ Yes ❑ No
re r 7fnf 11�Tl So DP i tlr� PQ be rGf �tiG�u•ri�� - seepage, etc.)
4 3123/99`- Continued on back

02/04/00 13:41 FAI 910 564 5459
To: NCDENR/DWQ
Jeffery Brawn T'
FayettevilleyN_C.
From
Tommy Vann
2296 Parker Memorial Rd_
Clinton,N.C.29329
910-564-4509
TOMMY VANN FARMS
February 04,2000
RECEIVED
FEB 4 2000
FAYETTEVI U-E
REG. OFFICE
In reference to form -B left on farm site:
I have pumped and now have freeboard down to app. 18 112 " I will have freeboard
down to 19" or better today(Feb_4,2000)_
Thank you for your help.
Tommy Vann
<7a -3
Q01