310816_INSPECTIONS_20171231

NUH I H UAHULINA
Department of Environmental Qual

Type of Visit: ercomoiance Inspection 0 Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: Routine O Complaint O Follow-up O Referral O Emergency Q Other O Denied Access
Date of Visit: Arrival Time: Departure Time: County: Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: % r Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Phone:
Integrator:
Certification Number:
Certification Number:
Longitude:
Design Current Design
Swine Capacity Pop. Wet Poultry C*apacity
Wean to Finish Layer
Current Design Current
Pop. Cattle Capacity Pop.
Dairy Cow
W n to Feeder
]Non -Layer
Dairy Calf
Feeder to finish
Dairy Heifer
Farrow to Wean
Farrow to Feeder
I)r, P.oultr.
Design
Ca ucit
C«urrent Dr3rGow
P■o Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
rnott�her
Turke s
Turke Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
[:]Yes No ❑ NA ❑ NE
❑ Yes [] No ❑ NA ❑ NE
b. Did the discharge reach waters of the State`? (If yes, notify DWR)
❑ Yes
0 No ❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
❑ No ❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ YesF24qq/❑
NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
No ❑ NA
❑ NE
of the State other than from a discharge?
Page l of 3
21412015 Continued

Facili Number: - IDate of Ins ection:
Waste Collection & Treatment
4: Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes to ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
StructTe 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: r1r-
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): L( 2-- =�
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
❑ Yes IeNo ❑ NA ❑ NE
❑ Yes E5No [DNA ❑ NE
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 Ef �"'o
— ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes ❑ 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 n No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes C rNo❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [:]Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
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 EyNT ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes E rNo ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box.
❑WUP []Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield [:1120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections _C] Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ Ng�'❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facifi Number: 131 - 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
❑ 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
o
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
❑ No
❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
No
❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
[] Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
[3/No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
No
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
[]
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
u No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
C] N
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
No
❑ NA
❑ NE
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Reviewer/Inspector Name: 0(a'- ( e C' '_t I
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 1 r7 7 1 G 73 P�
Date: 1 zZ lG
21412015

Type of Visit: Co iahce''Inspection Operation Review 0 Structure Evaluation 0 Technical Assistance r
Reason for Visit: Routine �Q Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other0 Denied Access
Date,of Visit: O / Arrival Time:® Departure Time: i0917 County: Region:
4
Farm Name: Owner Email:
Owner Name:. Phone:x
Mailing Address: x ,
Physical Address:��'
Facility Contact: Title: Phone:
Onsite Representative: _p S k
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Integrator:
Certification Number:
Certification Number:
Longitude:
Design Current
Design
C•urrcnt
Design Current
Swine Capacity Pnp.
Wet Poultry
Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
W to Feeder
to Finish Z
La er
Non -Layer
Dairy Cow
Dairy Calf
airy Heifer
,feeder
Farrow to Wean
Design
Dry CowF'
Farrow to Feeder
Dr. P,ouItr.
C•.a aeit
P■o
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
rIBeef Brood Cow
Turke s
Other
Turke Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Fieid ❑ Other:
+r '
a. Was the conveyance man-made?
❑ Yes No ❑ NA ❑ NE
❑Yes ❑No ❑NA ❑NE
b. Did the discharge reach waters of the State'? (If yes, notify DWR)
❑ Yes
[] No ❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
❑ No ❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
❑NA
❑ NE
;,,3. Were there any observable adverse impacts or potential adverse impacts to the waters
[]Yes
TNo�o NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412015 Continued

Facility Number: -Z4 jDate of Ins ection j
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 1_ I o ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA [] NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: t 2--
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
(q,5 jQ, S
2 16' -L *7
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 0 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 DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
Now
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
RNo
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
E�No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
ZrNo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
i
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes QNo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [<J]No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable [] Yes F!fNo ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application? ❑ Yes ff No ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes FJ'No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? Yes ❑ No [] NA ❑ NE
N0 20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [DNA ❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Oth :
f
21. Does record keeping need improvement? If yes, chec he appropriate box below. Yes [] No ❑ NA D 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 EI�No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes F(No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

r
Facility Number: _ 34 - ��4 [Date of Inspection:'�I/ 3 P
4C
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes 3 <Nq❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes Ej No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
Yes ❑ No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes ❑ No NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes o ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
[� Yes ❑ No ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes No ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes <No ❑ NA ❑ NE
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes 6 'No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes No ❑ NA ❑ NE
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Reviewer/Inspector Namet vC Phone: Va 7Q6 2321
Reviewer/Inspector Signature:
Page 3 of 3
Date:
21412015

0 r IS t_i b
Type of Visit: 0 Com ance Inspection Q 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: Z j b Arrival Time: Departure Time: O County: Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative: / - t^Integrator:
Certified Operator:
Back-up Operator:
Location of Farm: Latitude:
Certification Number:
Certification Number:
Longitude:
Design Current
Design
Current
Design
@.urrent
Swine Capacity Pop.
Wet Poultry
Capacity
Pap.
Cattle
Capacity
.Pop:
Wean to Finish
Layer
Dai Cow
can to Feeder
I INon-Layer
I
Calf
Feeder to Finish `jam
Farrow to Wean
Design
+
Current
Dairy Heifer
Dry Cow
Farrow to Feeder
Farrow to Finish
Dr; P,oultr,
Layers
Ca _aci
P■o P.
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turke s
Other
Turke Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes ]�No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes ❑ o ❑ NA ❑ NE
❑ Yes o ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Page l of 3 21412015 Continued

Facilit Number: `'j - YJ Date of Inspection: 1-2—
Waite Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ErNo ❑ 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:Z—
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): -2
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes [2"-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?
C] Yes
�No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
Fj"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
dNo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
I No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
C 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 [E No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes l 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
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑ Yes ❑ No ❑ NA �NE
❑ Yes ❑ No ❑ NA ]
❑ Yes No ❑ NA ❑ N�
❑ Yes ❑ No ❑ NA 0 NE
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ Nc
❑ 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?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes ❑ No
❑ Yes ❑ No
❑ NA 0-NE
❑ Weather Code
❑ Sludge Suey
❑ NA Survey
❑ NA FfNE
Page 2 of 3 21412015 Continues!

Facili Number: - 16' 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 <E
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a PDA 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? El Yes [] No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [] No NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes Ef No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes [I No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the ❑ Yes ❑ No ❑ NA ETNE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. [] Yes ❑ No ❑ NA NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes [%No NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes 0 No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes if"No ❑ NA ❑ NE
Commentseefr'fo uestlorr`#)' E�xpliin7anlu�YESkanswer's,'and/or any additional recommendations orany other comments..
wige�liiqtUsedrans,nffciliyAtoVbetterexplain sitatio : use a dditinnal,pages� s'necessary).
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Reviewer/Inspector Name: Co �`� r Phone:
Reviewer/Inspector Signature: �"�--'ter'r Date: Z-
Page 3 of 3 21412015

Type of Visit: p Corrlpliance Inspection U Operation Review Q Structure Evaluation Q Technical Assistance I
Reason for Visit: 7Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access rf
Date of Visit: Arrival Time:® Departure Time: (4SCounty: Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Owner Email:
Phone:
Onsite Representative: �Nlfi IL�d Integrator:
Phone:
Certified Operator: Certification Number: J000 S"7-0
Back-up Operator:
Location of Farm;
Certification Number:
Latitude: Longitude:
Design C►urrent
Swine Capacity Pop.
Design Current
Wet Poultry Capacity Pop.
Design Current
Cattle Capacity Pop.
Wean to Finish
La er
airy Cow
Wean to Feeder
Non -La er
airy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Dairy -Farrow to Finish
Design Curren
D)!, P,oultr. Ga aclt l;o .
ILavers
Non -Layer
Pullets
[Dry Cow
Non -
Beef Stocker
Gilts
Beef Feeder
Boars
Beef Brood Cow
Qtber
Other
Turkeys
Turkey Poults
Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes CZ No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR) ❑ Yes ❑ No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)? _
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑Yes ❑N ❑NA ❑NE
❑ Yes rNo
❑ NA ❑ NE
❑ Yes ❑ NA ❑ NE
Page I of 3 21412014 Continued

Facility Number: e2� - Date of Inspection: t t 2't I ►{
Waste Collection & Treatment
4:' Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 2 /No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: LACetq LAGMJZ
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
�(No ❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
No ❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or env' nmental 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
D 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
[;21<o ❑ NA
❑ NE
maintenance or improvement?
Waste Application
No
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
❑ ❑ NA
❑ NE
maintenance or im rovement�
p
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes Z/No ❑ NA ❑ NE
❑ Excessive Pending ❑ 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
[]I No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
rZ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
[i] No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
�FNo
❑ 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
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.
Zyes
❑ No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspectio;/Jl�o
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
[::]Yes
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
o
❑ NA
❑ NE
Page 2 of 3 21412011 Continued

Facili Number: - Date of Inspection: I i
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes o ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes 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 fait to provide documentation of an actively certified operator in charge? Yes WNo
o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ NA ❑ NE
Other lssues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
2 No
❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
[:]Yes
No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
�o
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
L� 1V
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
No
❑ NA
❑ NE
Comments (refer to giiest►ony#,):.`Explain-any$YES ariswers,and/ar i ny;additlonal recoinnieridatipns or�any'other comments: `.
Use;drawings;of&facility to.°better°explain'situations;(use`additidnafapages�as necessary} �:��;�'��4,��'a ������ •�,' k,�,� �, ;�,�'•�,.�� .m �'.
Q, ) C.kt-A W 6A Ck-SIDE- oC D1106 WA U. ro f.- j_•A G..O I
CAq `i XC-ub . SO.D.- 5AMP-- ?uY E,0b JE19{z,
2L. ) CP'A 0 &'C CC on C.
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
DE 5X6t) AT_t.0 � �on.i�n nXE MD,
Flo Jj Phone:C cb 6i '71 1370
Date: i i 2 l
2/4 014

Type of Visit: Compliance Inspection Z3 Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: (2rRoudne O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: s=- Arrival Time:. Departure Time: County:. 1�
h Falmr�r
Farm Name: � Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Phone:
Region: W
Onsite Representative: r►J'Au l'm 1J1 -Aev Integrator:
1
Certified Operator: Certification Number: v� ao+3
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Design Current Design Current
Wet Poultry Capacity Pop. Cattle Capacity Pop.
Layer Dairy Cow
Wean to Feeder
Nan -La er
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Design Current Dry Cow
1)n P,oultr, Ga aci P,o P. Non -Dairy
I Beef Stocker
Farrow to Finish
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turkeys
Turke Poults
Other
Discharses 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 VNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes ❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (if yes, notify DWQ)
❑ Yes ❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes No
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

Facility Number: JDate of Inspection:
r
Waste Collection & Treatment
4, Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
4 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
R�No
[DNA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
.0 No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
[:]Yes
21 No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
�j No
`j�"'
❑ 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
WNo
❑ NA
❑ NE
maintenance or improvement?
Waste ADOIication
W. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 101bs. ❑ 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 o ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes 0 No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes Z 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?
Reauired Records & Documents
❑ Yes
VfNo
❑ NA
❑ NE
❑ Yes
;6 No
❑ NA
❑ NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
[:]Yes
No
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? if yes, check the appropriate box below.
❑ Yes
5TNo
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
[] Weather
Code
❑ Rainfall ❑ Stocking ❑ Crop Yield [:1120 Minute Inspections ❑ Monthly and V Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
ILJ No
❑ NA
❑ NE
23, If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
E] No
❑ NA
❑ NE
Page 2 of 3 21412011 Continued

Facility Number: jDate of Inspection: a3
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ZjNo
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 P�No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ZNo
Other Issues
❑NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
No
❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
JZ No
❑ NA ❑ NE
permit'? (i.e., discharge, freeboard problems, over -application)
3 I. Do subsurface the drains exist at the facility? If yes, check the appropriate box below,
[:]Yes
ZNo
❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
0 No
❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
P No
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
P-No
❑ NA ❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments. .
Use drawines of facility to better explain situations (use additional uaees as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date:
21412011

iType of Visit: t0 pliance Inspection U Operation Review Q Structure Evaluation Q Technical Assistance I
Reason for Visit: Co7outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency Q Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: ® County: 1044q2yj Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator: _
Back-up Operator:
Location of Farm:
3vo USijER-
Title:
Phone:
Integrator: r
Certification Number:
Certification Number:
Latitude: Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Design
Wet Poultry C**specify
Layer
Current
Pop.
Design
Cattle Capacity
Dairy Cow
Current
Pop.
Wean to Feeder
I
INon-Layer
I
Dairy Calf
Feeder to finish
Design
Dr P,oultr. C*.a aci
Layers
Current
Dairy Heifer
D Cow
Farrow to Wean
Farrow to Feeder
Farrow to Finish
P,o
Non -Dairy
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turke s
Turke Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other: _
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes No ❑ NA ONE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
[:]Yes ❑ No ❑ NA ❑ NE
❑ Yes o ❑ NA ❑ NE
[:]Yes WNo ❑ NA (] NE
Page 1 of 3 21412011 Continued

[Facility Number: - Date of Inspection: ) /
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
21O ❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No ❑ NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: L96D
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):----
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No ❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
[:]Yes
ZNo ❑ 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 environmen 1 threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes
No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes No D NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 101bs. ❑ 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?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
t9. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
Yy
es E+ No ❑ NA ❑ NE
es ❑ o ❑ NA ❑ NE
[:]Yes [No ❑ NA ❑ NE
❑ Yes 10
❑ Yes N
❑ Yes o
❑ Yes fNo
❑ Oth
21. Does record keeping need improvement? If yes, check the appropriate box below. [ Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ eekly 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 ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes VNo ❑ NA ❑ NE
Page 2 of 3 21412011 Continued
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE

Facility Number: - Date of Ins ection: Q j
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes N ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes 6X0 ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? Yes ❑ No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [:]Yes I_J4/o ❑ 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 [P/No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative? ❑ Yes
34. Does the facility require a follow-up visit by the same agency? ❑ Yes
No ❑ NA ❑ NE
9 !�o [DNA ❑ NE
0,
❑ NA ❑ NE
Comments (refer to�questton;#) Explain,,any`iYES answers.and/dnany additional,reeomi-'endationstor�any',other comments E
.r
��,_:.fin x�r : nnnAa :.� �"• r� .a �- � � ��;
r`t ol.tra,.,�.,..�•`.;x�or.tt4, i.. hot�or,ov..la.., �;r.;o�..,.,a#i.,�o.o.t.isr..,.,ot; .,oa.. � ., r .� .,i.7�.��s ��4 A;���.::; ,., a �.-:r� �..`:�� �d� �g:;�•.� �.�. � `a�
!s,) time- voefi IdLcf rfcKcr
uPORrE C9w
SEND ck/ OS C, D6sQl ✓ re'11CM Tz
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
kfa4 IOW
Phone: C �(�
Date:
2/4 01I

Type of visit: V compliance Inspection V operation Keview V Structure Evaluation V Technical Assistance
Reason for Visit: dRoutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: It 15 Arrival Time: p Departure Time: County: DueUMiJ Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Owner Email:
Phone:
Title: Phone:
Onsite Representative: 11.t, &Iuck Integrator:
Certified Operator: Certification Number:
Certification Number: T° yZ
Back-up Operator:
Location of Farm:
Latitude: Longitude:
Design Current
Swine Capacity Pap.
Wean to Finish
Design Current
Wet PoultWV_a c i K= Pop. C•atde
Layer I Dairy Cow
Design Current
Capacity Pop.
Wean to Feeder
Non -La er
I
Dairy Calf
Feeder to Finish
q
p
Dairy Heifer
Farrow to Wean
Design Current
[)r, Itr, C►_a aci_ l;o
Da Caw
Farrow to Feeder
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turkeys
Turkey Poults
Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ o
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
�o
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
No
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 o, f 3 21412011 Continued

Facility Number: IDate of Inspection: tj t5
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes o ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes o ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: LA&ODfJ CA
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 35 31
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
❑ Yes No ❑ NA ❑ NE
❑ Yes [7/No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
�No
❑ NA
❑ NE
S. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
CZ(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
No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
dNo
❑ 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): 3E w.uo �C,O (;4tA AP Fi=3CJE GCAI.C9ii Ck)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
dNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
[;k'�o
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑Yes
No
❑ NA
❑ NE
Required_ Records _& Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[] NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
VN
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis [] Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections A
Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? 0 Yes ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: SV - Date of Inspection: tt
24, Did the facility fail to calibrate waste application equipment as required by the permit? P�::M'Yes �o ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes �o ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? Yes VNo
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes [I/No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No ❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
/
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
❑ No [] NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility'? If yes, check the appropriate box below.
❑ Yes
pia ❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No ❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
N ❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
No ❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any othercomments:
Use drawings of facility to better explain situations (use additional pages as necessary).
O�Ofl'fiE OSC. �b�L yh -� (� DU >3A Gc OP �C
Reviewer/Inspector Name: '�9'!Wj,j f7t4iym-LL Phone: Rib —1 g
Reviewer/Inspector Signature: Date: i ( t S
Page 3 of 3 21412011

Type of Visit Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 16outine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: Departure
�Time: County: �-il�c Region:
Farm Name: «
(}LPL K E- 5 r�i��S + " `'� Owner Email: i f f
Owner Name: Q I S i� R�-M S INC Phone; q) d _ Q�q _ 0q9
` Mailing Address: 'c)• 1 Csx T S'+ �QSe_� 11_ , NC OHO `1�
Physical Address:
Facility Contact: Title:
Onsite Representative: YNGN {4IU —
Certified Operator: A M F� GW JVe7jj &VAIOX�-�Q
Back-up Operator:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: ❑ e 0 6 = Longitude: = ° 0 ` =
Design Current
Swine Capacity Population
Design
Wet Poultry Capacity
Current
Population
Design Current
Cattle C►apacity Population
❑ Wean to Finish
❑ Layer I
I
❑ Dairy Cow
❑ Wean to Feeder
ID Non -Layer I
I
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
El Beef Feeder
❑ Beef Brood Co
Number of Structures:
❑ Feeder to Finish
Dry Poultry
❑ Layers
❑ Farrow to Wean
❑ Farrow to Feeder
El Farrow to Finish
❑ Gilts
❑ Non -Layers
❑ Pullets
❑ Boars
❑ Turkeys
Other ❑ Turkey Pouets
❑ Other JEI Other
Discharges & 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 discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
No
ElNA
[INE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
El
No
El NA
El NE
other than from a discharge?
12128104
Continued

Facility Number: 1 - EJ(o I Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? Yes ❑ No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):9.
n
Observed Freeboard (in): 1 a
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes W No
❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No
ElNA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? if yes, check the appropriate box below. ❑ Yes No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ 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) 5 lG L ���iZ-�1�� V`C-.SC_L 4 C (P� �l�j J 1 J
13.
Soil type(s)�_jZ
14.
Do the receiving crops differ from those designated in the CAWMP?
XYcs
No
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
Cl 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
"0 No
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
N No
❑ NA
❑ NE
w . H 1 b1 u
5118�a9 )• y 1. )
use 009 w
Mq,.Gj) Al141 GL VX^MPl IV 6, F%WfYl L_O Gil ) , a d T'a 6 T_-_V0c4 , o f
S v,cr�ctt�L - wi LA- se -Al D 300PL:� Pa s tzclL13crr4 �_�0a,v_s I11410
q &J09 �rnn,AiC C-UC r
ReviewerAnspector Name 4 § MAIM Phone: 6 1 6-`- 5'_
Reviewer/inspector Signature: LVMOIi'1�f` `�_ �.. rA i Date: Mj Ing
12128104 Continued

f ~
Facility Number: 3 — [q Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box. El WUP ❑ Checklists ❑ Design El Maps El Other
❑ Yes
❑ No
❑ NA
t4NE
❑ Yes
�9kNo
❑ NA
❑ NE
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
*o
❑ NA
❑ NE
❑ Waste Application 0 Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑/nual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V
Rain Inspections ❑
Weather
Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
� No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
N No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
0 Yes
❑ No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No
❑ NA
WNE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
tNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes ix No ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes]
No
❑ NA
❑ NE
Ad`ditionaltCoininenEsandlo iDww gs:'
a�5 . �OiS SLwsDG� U. C-f'U 6L G)cao - WSCN COS o
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DG� S�RuCy Q� �N ar 1 /10 *S�N IJ I-o �I.t. ;
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C>
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G'E7 L'Au�zew 1c>h/ Da74c ASAP
E�7 '61 5o1C_ sArnPGr A-S �P �
ppN,_r6-aG�T TD 1N1T1aL_ I�1N�Rc-c� 1 OVGREA��fZ
y�ou�cfZOpS
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IQ. }, Wll� S�) 0 0LaC
12128104

Division of Water Quality
Facility Number O Division of Soil and Water Conservation
0 Other. Agency.
Type of Visit XCompliance Inspection O Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit V Routine 0 Complaint Q Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: a0 Departure Time: County: L Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: �^ Title:
Onsite Representative: j< F-N11e TH r- ► ht 1 L— L
Certified Operator: ICFNNC_ HILL
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
LJ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Phone:
Phone No:
Integrator:
Operator Certification Number. WC900
Back-up Certification Number:
Latitude: = o = d = tl Longitude: 0 ° = d = "
Design Current Design Current .
Capacity Population Wet Poultry Capacity Population Cattle
❑ Layer
❑ Non -Layer
Dry Poultry
LJ Non -Layers
❑ Pullets
Pou
i.]U Other _ L
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design -Current
Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
I
i
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?
Page l of 3
❑ Yes ANo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
;gNo
❑ NA
❑ NE
❑ Yes
�&No
❑ NA
❑ NE
12128104 Continued

Facility Number: IS I— 91/&
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: l __
Spillway?:
Designed Freeboard (in): / I .45 19. S
Observed Freeboard (in): 3 )
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes ANo
❑ NA ❑ NE
❑ Yes ❑ No
❑ NA ❑ NE
Structure 5
Structure 6
❑ NA ❑ NE
❑ Yes 4 No
❑ Yes JWNo ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes �No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes 9.lNo ❑ 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 C�No ❑ 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 ] 0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14, Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
JgNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
jVNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
9 No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
ecK
IN No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
1XNo
❑ NA
❑ NE
Comments (refer to question ft Explain any YES answers and/or any recommendations or any other comments:
Use drawings of facility to better explain situations. (use additional pages as necessary):
19. ET �Py d rr CoCat cAT w I tZCCOM S . 1F UAIAI CtX- To t<cx,aTG Cap
( Y m KNOW 4 w, �� F T R coP(� 1=0R u t�ok .
i. SET A AIVNLt9L_ AU64 F-OfZ 5 iocIC(A' KEF_ w� �EcaR�s
Reviewer/Inspector Name F lh A i 1 X% tc .S Phone: 9 K) + ?(o 9
Reviewer/Inspector Signature: Date:
Page 2 of 3 12128104 Continued

Facility Number: — �� Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes X No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [XNo ❑ NA ❑ NE
the approprrate box. ❑ WDP ❑ Checklists ❑ Design
g El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes M No [INA ElNE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall 0 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
[ANo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
%No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
ro
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
1�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
OPo
❑ 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
A�No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
4 No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
RNo
❑ NA
❑ NE
tsAa �y �raw4iii3.•P �T '�°� a-
AddihonalICommen]and,,onril)ings_ 7 t
Page 3 of 3 12128104
Page 3 of 3 12128104

0 Division of Water Quality
Facility Number O Division of Soil and Water Conservation
0 Other Agency
Type of Visit 0 ;7Routine
pliance Inspection Q Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Complaint 0 follow up 0 Referral Q Emergency 0 Other ❑ Denied Access
Date of Visit: O 1' q'I Arrival Time: S Departure Time: County: _ DORMIi Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Onsite Representative: n1 R t_ Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Other
❑ Other
Phone No:
Operator Certification Number:
Back-up Certification Number:
Latitude: = o = d = Longitude: = ° = 6 =
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
i❑ Non -La er
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other. --
Discharees & 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 Heifej
❑ 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 WNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
El NA
El NE
❑ Yes
❑ o
❑ Yes
No
❑ NA
❑ NE
❑ Yes
[)io
❑ NA
❑ NE
12128104 Continued

Facility Number: 1 - $[6 Date of Inspection ! 07
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: LA&doAJ I _LA_GM,1j Z
Spillway?:
Designed Freeboard (in): 19, 1 .5
Observed Freeboard (in): 3 9
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes CrNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes ffNo ❑ 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? 12Yes ❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes Ef 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 QrNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 5a No ❑ NA ❑ NE
maintenance/improvement? ,�
11. Is there evidence of incorrect application? If yes, check the appropriate box below. El Yes LJ No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
El NA
El NE
15. Does the receiving crop and/or land application site need improvement?
El Yes
YN
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination? ❑ Yes
2 No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
2
El NA
❑ NE
18. Is there a lack of properly operating waste application equipment`?
❑ Yes
�Wo
❑ 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):
j GZ.IcAN BAUCUM DZcs WALL of TALL G rLo,,./Tj4, Lax
o(/i 6( NouSE Nao -r: ,r
We UPY aF 0AISt OCeOf CoC 4 Pep_j -zt- wj j�cicay-Ds,
2l,} e G
To
(or(,A SCRA0GE).
S=L- r �iSS leb (' rVaSST N &'f O A VS 0oC Zoo?
�,L ANA rrolL
Reviewer/inspector Name S6W
l !
Phone: %)
_- )3YW.
T tt,_
I
Reviewer/inspector Signature:
Date: !oo
12178104 Continued

Facility Number: Date of Inspection
• Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropiiate box. ❑ Wu r ❑ Checklists ❑ Design ❑Maps ❑Other
Yes ❑ No ❑ NA ❑ NE
❑ Yes L/J No ❑ NA ❑ NE
21.
Does record keeping need improvement? If yes, check the appropriate elow.
Yes
❑ No
❑ NA
❑ NE
ly Freeboard ❑ Waste Analysis Analysis ❑ Waste Transfers
�4cil
❑ Waste Applicat' ❑ �Icrop
❑ Annual Certification
❑ Rainfall Stocking Yield ❑ 120 Minute Inspections ❑ Monthly and 1"
Rain Inspections
❑
Weather
Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
2Ko
❑ NA
[I NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
Wo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
WNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
o
i(WNO
❑ NA
El NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
ElNA
ElNE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
V NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
0 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
U 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
El Yes
L No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
�
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
No
❑ NA
❑ NE
Additional Comments and/or Drawings:
12128104

)&Drvision of Water Quality..
Facility Number , g �p 0 Division,of Soil and`Water Conservation
— 0 Other Agency
Type of Visit j6compiiance Inspection O Operation Review O Structure Evaluation Q Technical Assistance
Reason for Visit ZRoutine 0 Complaint 0 Follow up Q Referral 0 Emergency 0 Other ❑ Denied Access
i
Date of Visit: /`Z p Arrival Time: Q County: eparture Time: , _ PGA Region:
Farm Name: !��� fT _ Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: J/ Title: Phone No:
Onsite Representative: ni��7�i �i�ffZG L Integrator: / 1�.�/�_�•
Certified Operator: fsi%t1�f7�i `� J/��� Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: ❑ e = = Longitude: = ° = , = „
Swine
❑ Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
El -Boars
Other
❑ Other
Design CurrentDesign Current Design Current
Capacity Population: :Wet Poultry Capacity` Population Cattle , Capacity" Population'
Discharees & Stream Impacts
❑ La er I 1 11
1"
❑ Non -Layer
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
❑
Dairy Cow
❑
Daia Calf
❑
Daia Heifer
❑
Dry Cow
❑
Non -Dairy
❑
Beef Stocker
❑
Beef Feeder
❑
Beef Brood Cow
Number of StructuresEz
1. Is any discharge observed from any part of the ope�tion?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page 1 of 3
❑ Yes /No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
El Yes
❑No
El NA
El NE
El NA
El NE
El yes
El No
❑ Yes
No
X
❑ NA
ElNE
."❑ Yes
/No
❑ NA
❑ NE
12128104
Continued

Facility Number: —8 Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure i Structure 2 Structure 3
Identifier:
Spillway?: A19 Ajo
Designed Freeboard (in):
Observed Freeboard (in): ie,,, 2? d
Structure 4
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 gNo
❑ Yes ❑ No
Structure 5
❑NA ONE
❑ NA ❑ NE
Structure 6
❑ Yes
VNo
❑ NA
❑ NE
❑ Yes/d
No
❑ NA
❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes XNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes No ElNA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks) P
9. Does any part of the waste management system other than the waste structures require ❑ Yes )21No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ;ZNo ❑ NA ❑ NE
maintenance/improvement?
II. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes VNo ❑ 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 l
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area S5'6 ����2�_'6 1
12. Crop type(s) rTOn1 i.C/i71f ft/JS / J U� �f� ela JJJ
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
QI No ❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
ONo ❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
No ❑ NA
ElNE
17. Does the facility lack adequate acreage for land application?
ElYes
/0No ❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
ZZ 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):
Aw r, &Z tee'-' n L�Z'6/3
p lil>lE-7L K/K r`f-ZrtJ ��/ZG%5 .
A-7, �5 d,{',PosEo �,�, ,Q�Tcf/ES /r/�"Co T
Reviewer/Inspector Name f Phone: C /v
Reviewer/Inspector Signature: Date: Z D
Page 2 of 3 12128104 ' Continued

Facility Number: — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ;ErNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ZNo ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. 9Yes OIo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield 7120 Minute Inspections
❑ Monthly and I" Rain Inspections Weather Code
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did ReviewerlInspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes
oNo
❑ NA
❑ NE
❑ Yes
Ell
❑ NA
❑ NE
ElYes
XNo
❑ NA
❑ NE
❑ Yes
,Z No
❑ NA
❑ NE
❑ Yes
9No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
)2rNE
❑ Yes ANo ❑ NA ❑ NE
❑ Yes VfNo ❑ NA ❑ NE
❑ Yes FfNo
❑ NA
❑ NE
❑ Yes evNo
❑ NA
❑ NE
❑ Yes No
❑ NA
❑ NE
'0
❑ Yes 1p�No
❑ NA
❑ NE
Additional Drawings:
)Comments
'and/or
//ao
/��5 ,CJ ��/ ��11 p1�0✓�� ,
r
Page 3 of 3 12128104

..►
Type of Visit Oj Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral loEmergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: eparture Time: County: L Region:
Farm Name: ,.C�r�L.:�f Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: 'Title:
Onsite Representative_ � ���C�'si` ✓��,
Certified Operator:
Back-up Operator:
Location of Farm:
�o
Latitude:
Phone:
e No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Longitude: = ° =
Design C*urrent
Design Current
Design Courrent
Swine Capacity Population
Wet Poultry C►apacity Population
Cattle Capacity Population
❑ Wean to Finish
10 Layer
❑ Dairy Cow
❑ Wean to Feeder
❑ Non -Layer
❑ Dairy Calf
❑ Feeder to Finish
Dry Poultry
❑ Dairy Heifer
❑ Dry Cow
❑ Farrow to Wean
❑ Farrow to Feeder
[INon-Dairy
❑ Farrow to Finish
❑ La ers
El Beef Stocker
El Gilts
❑Non -La Non -Layers
❑ Beef Feeder
❑ Boars
❑ Pullets
ElBeef Brood Cow
❑ Turkeys
Other
❑ Other
❑ Turkey Poults
❑ Other I
mber of Structures:
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if,
yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page 1 of 3
❑ Yes IoNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes [],No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Xyes ❑ No [INA ElNE
❑ Yes VNo ❑ NA ❑ NE
12128104 Continued

Facility Number: — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? Xyes ❑ No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? PYes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
or
Spillway?: C�
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes �No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.) //
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes PNo ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? 0 Yes ❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ❑ No ❑ NA P11NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA/eNE
❑ 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)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ Yes
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
17. Does the facility lack adequate acreage for land application? ❑ Yes
18. is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
❑ NA ZNE
❑ No
❑ NA XfNE
❑ No
❑ NA�Z NE
❑ No
❑ NA
❑ No
ZZNE
❑ NA gNE
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):
1S�,LC ��tJ ��/Y� �'� �5/� �d --•Gzc g �ZY9� �t^�Ztl40
/ dam ��✓���,4-�� 2 �o c��•� �02 D•� �J�f.� ��,��
`
Reviewer/Inspector Name I 41 �/J? I Phone:
- Oft
Reviewer/Inspector Signature: Date: f>(O
Page 2 of 3 `__ 12128104 Continued .

Facility Number: — Date of Inspection Oro
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ❑ No ❑ NA NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ❑ No ❑ NA NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design [I Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ No
❑ NA
VNE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
❑ NA
XNE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
❑ NA PNE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No
❑ NA
FNE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
❑ No
❑ NA
�NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ NA
�NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
❑ No
❑ NA
NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
❑ No
❑ NA
NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
❑ No
❑ NA
VNE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
XNo
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
/ZNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
;XNo
❑ NA
❑ NE
Additional Comments and/or Drawings:
q
r p7�G'6:O 0 alv p 11119 od 12/v d O (a
E0
� L �v2nti RNr s �o �� !`¢ Z � 1:5
SY� �o�
, ,/
Z 5p0c, VD 6C114A6 D 646r)-,o 19A)
G i41OOr)
Page 3 of 3 mil' f 12/28/04 (�,�

Type of Visit gCompliance 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
� / Q
Date of Visit: d Arrival Time: r .�i _ Departure Time: %' County: ��Gz� Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:L-�'�sl
Certified Operator: �.1�1-S7�.ti✓
(,ls
Back-up Operator:
Integrator:
Phone No:
M _ c S :711 -C
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: = 0 = = li Longitude: = ° 0 I 0
11
Design Current
Design lCurrenti
Design Cu"l rrent
Swine
Cap�iity Population
Wet Poultry
Capact�'ty Population
Cattle
Capacity Popull vn
❑ Wean to Finish
❑ La er
❑ Dairy Cow
❑ Wean to Feeder
L
Dairy Calf
Feeder to Finish
❑ Dairy Heifei
El Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
❑ Non -Dairy___
❑ Farrow to Finish
❑ La ers
❑ Beef Stocker
❑ Gilts
❑ Non -Layers
❑Beef Feeder
❑ Boars
❑ Pullets
❑ Beef Brood Cow
❑ Turkeys
Other
❑ Turkey Poults
Number of Structures:
❑ Other
❑Other
Discharp,es & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
PTNo
❑ NA
❑ NE
Discharge originated at; ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State'? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation'?
❑ Yes
YTNo
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
;2�No
❑ NA
❑ NE
other than from a discharge?
12128104
Continued

Facility Number: — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier: 441 &
Spillway?: O
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any ofthe 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 9 No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes
fZ No
❑ NA
❑ NE
❑ Yes
VNo
❑ NA
❑ NE.
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes �No ElNA ElNE
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 XNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes W(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 0 PAN > 10% or 10 Ibs ❑ 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)
13. Soil type(s)
14. Do the receiving cropsdiffer from those designated in the CAWMP?
Zyes
❑ 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
J0
LNo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
18, Is there a lack of properly operating waste application equipment?
[]Yes
ONo
❑ NA
❑ NE
❑ Yes
-['No
❑ NA
❑ NE
-12 6pi Z� A{w Dnzo"o fd�cds_ 6�ww lVor i�� 1n/
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Ct�a,
Reviewer/Ins ector Name " * ` '' `� �' �.
p 6 � � ` ,��.,�� � �,. Phone: 49-
Reviewer/Inspector Signature: Date:
12128104 Continued

Facility Number: 3 — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 0No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes gNo ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. OYes ❑ No ❑ NA ❑ NE
Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ffCrop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22,
Did the facility fail to install and maintain a rain gauge?
❑ Yes
0 No
❑ NA
❑ NE
23,
if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
V1 No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[7(No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
;M No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
gNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ NA
VNE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
VfNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
�No
El 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
VNo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
/� No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
No
❑ NA
❑ NE
Additional Comments'and/or Drawings!
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type of Visit Compliance Inspection
Reason for Visit 9*1�outine Q Complaint
Q Operation Review Q Lagoon Evaluation
p Follow up p Emergency Notification p Other
❑ Denied Access
Facility Number Date of Visit: .7ta O Time: %
O Not Operational O Below Threshold
Permitted 13 Certified [3 Conditionally Certified 0 Registered Date Last Operated or Above Threshold: .........................
FarmName: C..l. 2, ... 1/:tr7................................................................. County: LAPJ.r1....................................................
OwnerName: ................................................... ...................................................... ................. Phone No:.......................................................................................
MailingAddress: ..................................................................................................................... .................................................................... ........ ..........................
FacilityContact: ............-..{............................................................ Title: ................................................................ Phone No:...................................................
Onsite Representative: ..1..u.F.Y]......5.>(..................................................... Integrator: .%.�tY1.�4LIM�.......................................................
Certified Operator: ...................................... . ........... .. . .... . .......... . ....................................... Operator Certification Number:.........................................
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude Longitude �• �� ���
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes Af o
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? (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 —ZI&D
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes �o
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes )�Wo
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ............. I.................. .....,........................................................................................................................................................
:"
Freeboard (inches): s
12112103 Continued

3 /— ? l
Facility Number: Date of Inspection d o�
Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes f �No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑ Yes 2-No
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? 8'Yes ❑ No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes 0,No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes 0 No
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes 0'No
11. Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes ;'No
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type %�D�.,..,,. /(r, /Cx toffy.. ) . �/- r, /� JV"&', y, vrr r
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes ja'No
14.
a) Does the facility lack adequate acreage for land application?
❑ Yes
ZNo
b) Does the facility need a wettable acre determination?
❑ Yes
O'No
c) This facility is pended for a wettable acre determination?
❑ Yes
0 No
15.
Does the receiving crop need improvement?
Ol�Yes
❑ No
16.
Is there a lack of adequate waste application equipment?
❑ Yes
❑ No
Odor ]~sues
17.
Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
❑ Yes
❑'No
liquid level of lagoon or storage pond with no agitation?
18.
Are there any dead animals not disposed of properly within 24 hours?
❑ Yes
214o
19.
Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
ErNo
roads, building structure, and/or public property)
20.
At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional
❑ Yes
I'1 No
J,
Air Quality representative immediately.
❑ Field Copy ❑ Final Notes
9-P.)ease recu((' Or devk+ +z) Pf-e�ev'A le"Va5e-
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Reviewer/Inspector Name
Reviewer/Inspector Signature:
Date:
12112103 Continued

3/ - �l
Facility Number: —?-
Date of Inspection
Required Records & Documents
21. Fail to have Certificate of Coverage &. General Permit or other Permit readily available? ,eyes ❑ No
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(iel WUP, checklists, design, maps, etc.) ❑ Yes ❑No
23. Does record keeping need improvement? If yes, check the appropriate box below. 'Yes ❑ No
❑ Waste Application ❑ Freeboard 9waste Analysis ❑ Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes 2No
25.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
❑ No
26.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
❑ No
27,
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
'LkNo
28.
Does facility require a follow-up visit by same agency?
❑ Yes
0"No
29.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
❑fiio
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35) j�Yes
❑ No
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes
0'No
32. Did the facility fail to install and maintain a rain gauge? ❑ Yes
P�No
33. Did the facility fail to conduct an annual sludge survey? ❑ Yes
C;�o
34. Did the facility fail to calibrate waste application equipment? ❑ Yes
2No
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below. ❑ Yes
❑ No
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After 1" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
113 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
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12112103

Type of Visit 9TCompliance Inspection 0 Operation Review 0 Lagoon Evaluation
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Emergency Notification Prother ❑ Denied Access
Facility Number Date of visit:
Permitted [3 Ce ified 0 Conditionally Certified 0 Registered
Farm Name: ZS41
Owner Name:
Mailing Address:
Facility Contact: I Title:
Onsite Representative:���D/ll
Certified Operator:
Location of Farm:
Time:
Date Last Operate r Above Threshold:
County:
Phone No:
Phone
Inte rator:
&az_r
Operator Certification Number:
Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude Longitude
Design Current Design Current Design Current
Swine. Capacity Population Poultry Cavaciltv Population Cattle Cavacitv Population
❑ Wean to Feeder ❑ Layer JEI Dairy
Feeder to Finish ❑ Non -Layer I IONon-Dai
Farrow to Wean -
❑ Farrow to Feeder ❑ Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ Soars Total.SSLW
Number of Lagoons ❑ Subsurface Drains Present ❑ Lagoon Area JE1 Spray Field Area
kolding'Pands / Soll Traps - ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1, Is any discharge observed from any part of the operation? 2Yes ❑ No
Discharge originated at: ❑ Lagoon ,Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes 0"No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) JZYes ❑ No
c. if discharge is observed, what is the estimated flow in gallmin?
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 ❑ No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway 0Yes ❑ No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: Z
Freeboard (inches):
05103101 Continued

Facility Number: 31 — Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes ❑ No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes El No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes ❑ No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes ❑ No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes ❑ No
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes ❑ No
11. is there evidence of over application? ❑ Excessive Ponding ❑ PAN 2TWydraulic Overload 0Yes ❑ No
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes ❑ No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes ❑ No
b) Does the facility need a wettable acre determination? ❑ Yes ❑ No
c) This facility is pended for a wettable acre determination? ❑ Yes ❑ No
15. Does the receiving crop need improvement? ❑ Yes ❑ No
16. Is there a lack of adequate waste application equipment? ❑ Yes ❑ No
Reuuired Records & Documents
17.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
❑ No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
❑ No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
❑ No
20.
is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
❑ No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
❑ No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
❑ No
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
ONO
24.
Does facility require a follow-up visit by same agency?
❑ Yes
❑ No
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
❑ No
0 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Gpo�m. �m�ents!(refer to question #): E plain any &SS answ�a's and/or anyArecommendations or any.ottier comments'- t
Use'deawings of facility to;better explaln situationsr(usedditional'pages as necessary): ❑Field Copy ❑Final Notes
�0��
0iPom 2 44ao,aG�c,�,��o,J��s
ReviewerlInspector Name
ReviewerlInspector Signature: Date:
05103101 Continued

Facility Number-3 1 Date of Inspection l 3
Odor issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours?
28. Is there anv evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure. and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon?
30. % ere any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s). inoperable shutters. etc.)
31. Do the animals feed storage bins fail to have appropriate cover?
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
--*OC;5?V'6V 4r Ap� 1121141 f e7r-- 14407wz
IPv,�7oFF WA5 FOuNA -Z;j ?e Le-1- 5 ,��zo�QzrJ
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5"0019 ` Coy pop
05103101

Type of Visit 0 Compliance Inspection 0 Operation Review &�agoon Evaluation
Reason for Visit O Routine O Complaint O Follow up 0 Emergency Notification 0 Other ❑ Denied Access
Facility Number Date of Visit:
Permitted 13 Certitie on it] ally Certified [3 Registered
Farm Name: ll
Owner Name: C �Jf�tl_f S
Mailing Address:
Facility Contact:
Time:
Date Last Operated � oAa Threshold: _
County: L!
Phone No:
Title: I Phone No:
Onsite Representative: Integrator:
Certified Operator:
Location of Farm:
Operator Certification Number:
❑ Swine ❑ Poultry ❑ Cattie ❑ Horse Latitude 0' ° 46 Longitude • 6 66
Design Current Design Current Design Current
Swine Capacity Population Poultry Capacity Population Cattle Capacity Population
❑ W ry I
S.wrto Feeder 10 La er ❑Dai
ceder to Finish I I I JE1 Non -Layer I n-Dairy
❑ Farrow to Wean
❑ Farrow to Feeder ❑ Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts Total SSLW
' ❑Boars I
Number of.Lagoons 10 Subsurface (Drains Present j1E1 Lagoon Area ❑ Spray Field Area
tlolding'Ponds hSolid,.Traps 10 No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes ❑ No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. 1f discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b, if discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ 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 ❑ No
Waste Collectign _& TrTr a�tme_nt
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ❑ No
Str1 Vucl re 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: �G
I/ [
Freeboard (inches): /0
05103101 Continued

Facility Number: — Date of Inspection O
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes ❑ No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes El No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes ❑ No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes ❑ No
9. Do anv stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes ❑ No
Waste Avulication
10. .Are there any buffers that need maintenance/improvement? ❑ Yes ❑ No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes ❑ No
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
❑ No
14, a) Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
b) Does the facility need a wettable acre determination?
❑ Yes
❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes
❑ No
15. Does the receiving crop need improvement?
❑ Yes
❑ No
16. Is there a lack of adequate waste application equipment?
❑ Yes
❑ No
Reguired Records & Doguments
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
El 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 D VVQ of emergency situations as required by General Permit?
(ie! discharge. freeboard problems. over application)
❑ Yes
❑ No
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
❑ No
24. Does facility require a follow-up visit by same agency?
❑ Yes
❑ No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
❑ No
© No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit,
R"•••.`:..#.-ii .,•CtL....'�."Siai-tom�f. .�N .�li.
Comments;{refer t6`4U'&tioi; )..Eipiam acy YES answers and/or any reed tnendatien9 or aay oMeWthr comments. P, �
Use" drawings of to better ezplatn sttt:a1tions .(nse addEttionap l pages as necessary) b.i-, (� Field Conv ❑ FinaI Notes
�fiacility
.(etc-Xf4.:.�ci+aP7kstis;.P;,v�e�5a`F°!ih'f,%:4;�aR,�..s1�€?./:�.��.«i �adf`w a.9:.::ii4�s.1%,'«'�u'i�dE�!ar>diZ7�4;!:€:.,:.i�.aft,i��..�4xi;z�.�71t3r«v.xee..�ti W1»+r.+.,,R...,...,----'.�'v'•--.-•..+r�r'+en�.w..a .�..�. ,.—nl�, ;.<"Akaa#k:
o h 7t Z F:r K-en�!h� G f
� p
00
laq �
� JJ
a7 15 ry
T
Reviewer/Inspector Name ,7` w •w.� �"$:g,� ,'`
Reviewer/Inspector Signature: Date:
O5103101 v / Continu d

EE +? 5. <' :EJ`: ,.-.1'3: F , �g£P}, fE E E Slh } i ��� � 3 - a �4- dr ' E 3", E { { i ?i P•i �3 :i'
<< e FEc ,DiMilpn pf SpII find WatCt' Cpnservatiptt a u " ' " '4 E i {<s:
E ;k . if Y.. , I )a� id'' ll MI I #k %IEi F st j _ d AjJ
;; %�, k;e i { {0•Qther'Agency P a� FIB 41
.,. r � .- , .:, ai r .. .:. "r, :..... � 1 a.�. ..,. e, .: e, , ,x '� i.'-.�. .:. �+•..' . k' -.. f. n �� ��. _,e z<.'�" .
Type of Visit Compliance Inspection Q Operation Review O Lagoon Evaluation
Reason for Visit Poutine Q Complaint O Follow up O Emergency Notification Q Other ❑ Denied Access
Facility Number Hate of visit: D Time:
Not O erational 0111elow Threshold
0 Permitted 0 Ce' ied 0 Conditional Certified Registered Date Last Operat or Above1Threshold:
Farm Name: "od County:
Owner Name:yLS Phone No:
Mailing Address:
Facility Contact: Title: W, one No:
adeF_.
Onsite Representative:;- A.) 44 ��� Integrator:
Certified Operator:
Location of Farm:
Operator Certification Number:
Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' u Longitude
�► DCStn E:CRrrenl; €3€' ' i I {�!€�11 '" E DCS,ti{ { d E Current
Dest n ., Cuiren#
, ' 1i-3 ,EE:. .:,€1.
Bwtne ,...> :Ca acity`-.Po put
.'1',,Poult . Ca acttv,.Po ulation.. _Cattle Ca aettv:.°Yo ulatton
Wean to Feeder 1 ❑ La er ❑ DaiKy
ii
Feeder to Finish .. ❑Non -La er"k ❑ Non -Dairy
Farrow to Wean
❑ Farrow to Feeder ❑ Other T_
❑ Farrow to Finish ? Total Design Capacity `:
Gilts
'�
l ,� 11 I i i if
GE„ E h1 E
E ❑ ilt .. E i 1..33E € E EEE € (3 l3 E EE;tk 3,, `{�iil 33 �`�E 1 lliEliE € i 33 6.{�17t�1 E41i`lis �! �k •E ' L
3 r ❑ i 4 i 3 � i
E
Boars
3 E
"d Number pf
E 8] Subsurface Drains Present ❑ Lagoon Area
❑iSpray
ray . Field
a Area
`Holdtng'Ponds(Tps ❑No Liquid Waste Management System i
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. if discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier, Jl
Freeboard (inches):
❑ Yes INO
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes /No
❑ Yes XNo
❑ Ye No
Structure
05103101 Continued

Facility Number: — Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑ Yes
�NO
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
El Yes
�No
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
❑ Yes
No
9. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
ElYes
�No
Wastg Application_,(
10. Are there any buffers that need maintenance/improvement?
❑ Yes
�(J o
11. Is there evidence of over application? ❑ Excessive Pondi ❑ PA ❑/Hydraulic Overload
❑/Yes
/ No
12. Crop type F D FiL�' F zr- �7 Q�i
C,D
p
195,9 1�j,
13. Do the receiving crops differ with those desigdated in the Certified Animal Waste Management Plan (CAW P)?
Yes
No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes`-
VNo
b) Does the facility need a wettable acre determination?
❑ Yes
No
c) This facility is pended for a wettable acre determination?
❑ Yes
No
15. Does the receiving crop need improvement?
❑ YesNo
P
16. Is there a lack of adequate waste application equipment?
❑ Yes
No
Reauired Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
[/No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
No
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
No
21. Did the facility fail to have a actively certified operator in charge?
❑ Yes
No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ YesNo
XNo�
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
El
24. Does facility require a follow-up visit by same agency?
El Yes
No
Me
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
El Yes
N
113 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Comments:{refer to question #) Explain any YES answers and/or "any.recommen�atinns,or aoy other comments'
„
Use drawings of facility to bettaner explasituations. (use additional pages as necessary) "' Field Copv ❑ Finat.....r.L...-......,-....0..;,_L,o......-..P�....y-.....�LNotes
�8Al ,- I- IV 4
1
; 71.I. r {`I � ' F'E{!{ . � S? � i ^*CEr' - lj a �f
Reviewer/Inspector Name T� .IE .. 3 1x Et S€ �1€
Reviewer/Inspector
Reviewer/Inspector Signature: Date: c�
05103101 Continued

Facility number: — Date of Inspection
dar Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours?
28. is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon?
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
orb roken fan blade(s), inoperable shutters, etc.)
31. Do the animals feed storage bins fail to have appropriate cover?
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes ❑ No
❑ Yes ,(r
❑ Yes No
❑ Yes XN 0
❑ Yes 0l.No
❑ Yes /—r
❑ Yes ❑ No
Additional Comments andlor,:Drawings:`
1J�� jd/YIIE !��%',Q trl�f✓�lZDG / '� �0.�"� �/� �'l9D/✓ ,T�� f}-,�
l
05103101
1--;2E �G�/ 7257 f✓/�+�S�,S�S
e:�'00'0 '0� 40,94�'5 4&�nez—c- Alo
PAI

t�Divisiorn of Water Quality
r 0 Division of Sail and•Water Conservation
L
k t3 >0, Other Agency; ;.
L
f Visit Compliance Inspection O Operation Review O Lagoon Evaluation
n for Visit 10"Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number
Uate. of Visit: /D 30 �! Time: � ZO Printed opt: 7/21/2000
1
ro Not O eration. Q Belo►s• Threshold
Permitted ❑ Certified ❑ Conditionally Certified [] Registered Date Last Operated or Above Threshold: .......................
11 ,
Farm Name: eer-k �^;SI, Var Y-ti1 A I-Wf 2,................................ County: TV191ijz................... .........
..................................
G 6 r�� .................Owner
Name '�, °tiV Phone No:.......................................................................................
... '.......
Facility Contact: .............................
Mailing Address:
Title: ................................................................ Phone No:.............
Onsite Representative: , '� S� "" I)SACar lntegrator: ..yrf
.......................................................................................... m v ...:
Certified Operator: ................................................... ............................................................. Operator Certification Number:..........................................
Location'o# Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude �• �+ ��� Longitude �• �• �«
:.t Design
Current Design Current Design Current
Swlin� - :r ac
n Poultry CatteCa
Po ulatioCa aci ' Po aiati6n
..�e Feeder
❑ Layer ❑ Dairy
Finish
-Layer ❑Non -Dairy
Alt' Wean
i:: Feeder
rFarrow
Other
Finish
Total Design Capacity
'` N
Total SSLW
t.
y t NomAr
ber of I:agooris (
Z
ICI Subsurface Drains Present
❑ Lag.n Area
Spray Field Area
F.
Hohdi�g Poisds:{ 5ot1d Trsps
1*56
❑ No Liquid Waste Management System
Discharges & Stream Im acks
1. Is any discharge observed from any part of the operation? ❑ Yes ,ZNo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made'! ❑ Yes Jc�pNo
b. If discharge is observed, did it reach Water of the State? (if yes, notify DWQ) ❑ Yes No
c. ll'discharge is obscrvcd. what is the estimated flow in gal/min? i7 a
d. Does discharge bypass a lagoon system'? (if yes, notify DWQ) ❑ Yes 0No
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? Wes ❑ No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier: .....I...........r................Z .................. ............... ................................... ............ ... ..................... ............ I.......................
Freeboard (inches): Z 4 Z
5100
❑ Yes O No
Structure 4
Continued on back

Facility Number: ?) Date of inspection 1 3D O
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes )dNo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes ;!fNo
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes ;° No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes J9 No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes ONO
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes JUNO
11. Is there evidence of over application? ❑ Excessive Ponding ,J�PAN ❑ Hydraulic Overload .0Yes ❑ No
12. Crop type rest ue G'✓r-Le , _8r_ Iowok 15vr-ze, Ca ✓►, LA at, + 1So4 64tr t I `r"ll G/`Id.
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes.,ZNo
14. a) Does the facility lack adequate acreage for land application? ❑ Yes ❑ No
b) Does the facility need a wettable acre determination? _�es ❑ No
c) This facility is pended for a wettable acre determination? ❑ Yes ❑ No
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17, 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?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ 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 application)
23, Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? !
Yt tro :oi' d�f c epcic •vv're A'Qt:�• �w` .mg tbisAsit; - Yoo wail tooite 40 rlutth��
co . .
rrespondence: a�atit: this :visit:
Yes ❑ No
❑ Yes J2(No
❑ Yes J?j No
❑ Yes J2f No
Yes ❑ No
❑ Yes A!fNo
❑ Yes .!fNo
'Oyes ❑ No
❑ Yes_'0$To
❑ Yes 014o
Yes ONO
l„ 1 cts4e, i �, a el na.; n"acl Way e k i r Zrc I�v� o vaes! 4
s'4 e ) . 4e(I'ese ►'rl-4; v e fa ys � a3 f o 4 Cl e%-.e -�'�e t,r ex f h Wo c ,, . 14d l es
haze, bee► dv j ;vi tLe 9ro "r,4 W;4� A, Gl v r• A, -YGt;S area. Z
�1vts4,rv,C4CA 4"�-�vaUre-�ie'3f�7I�s���Gwy Slwtlpi. Pv,fed into
laoon • PeeQ( 10 make Sjv-e 4tud �, es � qra;$A 1h"cA6res ih�o laJsoo4J_
q,ie vim GrAGjted ; 1{ Q re G�AG�cCA � �'Ep�t+�- iem r
;E E 11., 3 7
ector Name p
Reviewer/Ins {_ t
Reviewer/Inspector Signature: � ,�, Date: 1d3D O1 5100

Facilit}PNumber: Date of.luspection
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes )ZNo
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes'ONo
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes ONO
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes ZNo
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes J0 No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ❑ No
Additiopalomrnents an or,. Dirawings• r r
3, /V eedt as ,rew..ot•G 01eacl COL'/ -re—r+-"
I1. �Z,e✓� was some ove r,a1o� �; rc� I oh Gif' rVAJ ov► i e loi ) �17d
0,1 2,041 "7be"hS by ei6ew; 5lkleure. —XI Atp fghfs ��t�t} ovC.-Ol0 i'ati
,4 T7)9 Al a c"-"M o h 2001 r s-Gd c o,.. r; clol f �. P I d B. I
1y . Fqc' 4i ►�eQds1 q well-ibje Acre1 wi4l, q
Gi la( record kferi~9 kepi R.GGo✓�'�jr�.
)5, reszve *eeads 4o k ,S2eAcd
,�ecnrd deep Iex ,s ;n �000�' cane n ,There i --e
�fe✓re►i be5-6 e►n&S b.iweerN ►^�
a pt S1e12-2-'s wh;c1, rya 1cc , of•-F.�; CV0 4,0 know w� al9f l;ut-�;ohs
,ola.ce in here, The -'-rlCiR` Z's Ae n04 i►VG. [vd e ill o�
4hC everid"5 -for eeelai n wkIOLt etrze xhown oyi q e
�:G?d sl�►ce�s , 4 ttias4& A al f: s 4+ed wf44, %Oda ys 6f
�p�Jfrrt e-, 1e V5 - e bWt oh ql\e aKK-S,s. I
W 140W A1iel,ieA i� -1J�e WZbJJG Fl a P%% ~T-fie �12 -2�s SL,v�J
�es��C IS be) ►-.� a�1a1;e� -�o a) n-�A++�e �f yO�i^an4 .� L,, h
�iP✓'^'►iJD�G� i1 �� C rpP �T�S�Y1-� �'1 hG .Ej e10� 1 46 use k y d /ctt?'h u
5/00

all
rivision`of Sotl aridLWater Conservation
v,r m fQ Other'A. en
r
aW i r t y �rii�rsrkr��y�E
Type of Visit %Compliance Inspection Q Operation Review O Lagoon Evaluation
Reason for Visit 01 Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Uate of Visit: �� d7-OfJ Tirne:
Facility Number Printed on- 7/21/2000
NNot O erationa1 0 Below Threshold
KPermitted 0 Certified [3 Conditionally Certified 13Re'gisterpd Date last Operated or Above Threshold: ........ ......
FarmName:.......�.�.....1..�4........�.�.1............... .............. ..... ........................... .............
OwnerName:........... 4/.+r�••................ L............................, Phone No:.......................................................................................
FacilityContact: ........ ....... d4k ! . Title:................................................................ Phone No:...................................................
Mailing Address: ............... ........................ ...........
�""'"'--' .... ....
OnsiteRepresentative:.�,•.,..- integrator: •,,.. •••„•,,,••„•„•,•,•,••„•
Certified Operator: ................................................... ........... Operator Certification Number: . ..............................
Location of Farm:
Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude �' �i ��� Longitude
Design Current Design Current Design Current
Swine Capacity Population Poultry Capacity Population Cattle Capacity Population
❑ Wean to Feeder ❑ Layer I I❑ Dairy
eeder to Finish JE1 Non -Layer I I ❑ Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder JE1 Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ Boars Total SSLW
Number of Lagoons ❑ Subsurface Drains Present ❑ Lag---n .Area ❑Spray Field Area
Holding Ponds / Solid Traps ❑ No Liquid Waste Management System
Discharges & Stream Impac.t5
I. Is any discharge observed from any part of the operation? ❑ Yes �No
Discharge originated at: El Lagoon ❑ Spray Field ❑ Other , 1
a. If discharge is observed, was (lie R:onveyance Dean -made' ❑ Yes ❑ No
h, If discharge is ohserved. did it reach Water of the State'? (If yes, notify DWQ) El 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 XNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes KNO
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes 5XNO
Stru ,turc I Structur11e``2r, Structure ; StrUCIkire 4 Structure 5 Structure 6
Identifier: ............ .. I. r.......................'.........
...........................................................
Freeboard (inches):
5/00 Continued on back

Facility Number: — Date of Inspection di' Printed on: 7/21/2000
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes �tNo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes NNo
(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 APullcation
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of oov}er� application? Excessive Pondin ❑ PAN gI Hydraulic Overload
g/f
12. Crop type l�vLl �_.. rl Tt '3
f
13. Do the receiving crops differ with &sc designated n the Certified Animal Waste Management Plan (CAWMP)?
14, a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15, Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certificd Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ic/ 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 application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes No
❑ Yes KNo
❑ Yes j No
❑ Yes ZNO
o
ElYes
❑ Yes No
El Yes No
❑ Yes No
❑ Yes No
❑ Yes No
❑ Yes KNO
❑ Yes jx No
El Yes `o
ELY—es
❑ Yes -R-No
❑ Yes tgNo
Q VlO�ali1QI1S,Q1' de>FCIeItC�E'S were I10{Cd iitrrtnghIS.VISlt. You witl teceiyeo; further
ctirres otzidence: abi7itt this :visit: :: .
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):
❑ Yes EZNO
❑ Yes No
❑ Yes VNo
❑ Yes ONO
Reviewer/Inspector Name
Reviewer/Inspector Signature �_L) � Z / ; A Date: 11 M7/ PO _ 5/00

Facility Number — Date of Inspection Printed on: 7/21/2000
Odor Issues
26.' Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge At/or hPlow []Yes J2fNo
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes KNO
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes �'N0
roads, building structure, and/or public property) \
29; Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes KNo
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or \\
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes jCJ'No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes &No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? V-Yes ❑ No
Additional �Cornrnen ts; and/of Drawing
c�
MC�2r< e r ,
S/00

Q Division of Soil dndgWaterConservatJionI
{ 'I. I f f.
it r j [� Division of Soil and Watee,Conservatiun Compliance Inspection
' $ Division of Water Quality ''Compliance Inspection
o �l 13 Other Agency ;,Operation Review i' f ; I'
... .. r. .Fib. �'� . ,..,, a h'�.4a,f= ..s9'L
laRoutine Q Complaint Q Follow-up of DWQ inspection O Follow-up of DSWC_review Q Other
Facility Number Date of Inspection I I Viom
Time ofinspection I J Z 5 124 hr. (hh:mm)
29 Permitted © Certified © Conditionally Certified 0 Registered E3 Not Opera Date Last Operated:
Farm Name: ........6a6 kF1 s11 { ,.�, S- � -D Z County:.... P v...................................... I .........................
............................... .......................
Owner Name: ....... !;r... .5... ' �....DA .\�..;X.................... .............. Phone No:........................................
Facility Contact: ...GJ...V.-S'�.�.'......Ske.r.......................Title• C` Phone No: ..... gs..a....
...........
MailingAddress; .............�.....................,.,.............%......................................................................................................................................................... .-........................
Onsite Representative: US� t'� "j hr Integrator:....M.1 !. pk .......ot'l 1`�...'L;1;3.......
............................................e..................................................... . Fes..........)........' ...
1
Certified Operator: ,,,J„+�,s-,!,,,,,,,,... SLIT ....................................................... Operator Certification Number: 3a Z
Location of Farm:
........................................................... ........................................................... ...............
Latitude Longitude �• �° 0°
ti.Design
Current i !`;, Design„ Current:''
'Design 'Curi6t :'
" 'S'
I Capacity
Population Poultry aa-ci4l-
y Population Catlewine
Capacity Populatiorii.
❑ Wean to Feeder
❑ Layer ❑ Dairy
® Feeder to Finish
9f1. ❑Non -Layer 10 Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder
❑Other'
^❑ Farrow to Finish
Total Design Capacity
I ❑ Gilts
k I !I �, i I E .�ff€ ! k -=i.
� 9.. t
❑ Boars
' _ jota1 SSLW
�!, {,M4mber af'-Lagoons
�. ❑ Subsurface Drains Present ❑ Lagoon Area
;
❑ Spray Field Area
Holding Ponds / Solid Traps
❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. 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'?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/inin'?
d. Does discharge bypass a lagoon system? (If ycs, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier: i 2-
Freeboard(inches): ........�.o...........................4.4................................ .......... ............................................ .............................
❑ Yes C9 No
❑ Yes 91 No
,n/g
❑ Yes JR No
❑ Yes J3 No
❑ Yes `f 9 No
❑ Yes 19 No
Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
. seepage, etc.)
3/23/44
❑ Yes P; No
Continued on back

Facility Number: J — J (o Date of Inspection l r
6. Arp there ,Aructures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes A No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes X No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ;9 Yes ❑ No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes J% No
Waste Armlication
10.
Are there any buffers that need maintenance/improvement?
❑ Yes
No
11.
Is there evidence of over application? ❑ Excessive P�o+nding ❑ PAN
El Yes
No
12.
l
Crop type t esue :5 j!A C—_ �l s YI1 Wj1lQ S�Lt4�1
_ � �er'`�vAek b �a„�x,,.�b_ brean
to
13.
Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
[:]Yes
No
14.
a) Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
b) Does the facility need a wettable acre determination?
❑ Yes
❑ No
c) This facility is pended for a wettable acre determination?
® Yes
❑ No
15.
Does the receiving crop need improvement?
❑ Yes
® No
16.
Is there a lack of adequate waste application equipment?
❑ Yes
:9 No
Required Records & Documents
17.
Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
19 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
0 No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
FNo
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
15 No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
A No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
Er 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
Na
�: �'No'*'OaflO is'o, t, d'O icie'ncie5 -"re noted• 00ing (his'visit'. • yoo wiil•i•eeeive Rio #'u>�thetr.
ctirres' oric�eitce: about this .visit. . • .. • ' ' ' . ' '
CormiY I 3 € € I. E ' d , E 3 ;. t§
nt nts ('refer Eo ;questicsn #) EExplarn any,YES�answers and/or any; recorti�nendations or,any other earmtnents A
e drawings of facility., to.betterpexpllain'situations: (use-addittopal pages as;necessary) , ,3i } �3 j �s y } US
a - €i
ToS4;.? U5ktr' fs new/ 1,2af; ij 4ke -rct,•M. -rrom Crjs4o Pei. VP's,
$� }l � jra hr_ aver' {oc.ict, has Qcuered fine( iJ qo 410 OLCUr
ot� T— ei4 I pull 3 � L, 32 000 Sq{/. -ge C'q'W'u) nv}
-�o ex�ee�f. hyolr�.ul+c. pVer l au�.�n� :n �'u-Ivre . sha�l� yta-� .x�IYa�
r�.t 8r ¢ -�'�t.cr'•L 2 f%f A 0 p �j R � ��tL r'e
14. Fct 1 ��7 ; s e rid ewe a �c AC f e d e-,fie✓m;'ut�t'ct
i5. Work kQ e�a�ur�, Fcsc.ue
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Date:
3123/99

Facility Number: f— l
Date of I nspection
Odor tissues
26.
Does the discharge pipe from the confinement building to the storage pond or lagoon faii to discharge at/or below
® Yes
❑ No
liquid level of lagoon or storage pond with no agitation?
27.
Are there any dead animals not disposed of properly within 24 hours?
❑ Yes
H No
28,
Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
19 No
roads, building structure, and/or public property)
29.
Is the land application spray system intake not located near the liquid surface of the lagoon?
❑ Yes
19 No
30.
Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
❑ Yes
2TNo
31.
Do the animals feed storage bins fail to have appropriate cover?
❑ Yes
9No
32.
Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
Yes
❑ No
'Additional C6rndiefits,and!9jr1DraWlllgS..l , ,s, . u n �' , •� _ _�. � i� . +'; ; `b �;' � i% : `;i:,, , E .� t,-:" :° P � �jit it i �s�,�' 1 1 t �� 1, ,l . t i�'
Sj- i s well M-1het1-4anof in Jewy Go-4 4.'or+� , y
3/23/99

`,*'`: a'�`� �-*- , �.,.w�w°�,aw�»„a.'".•.. Wy;E --�- - r�-0.w�.....::.m,....-'..;,,.::f;�"�.�...�x..rz�o-„�..a:a,.i�'�'«.''s;�`a:�.�.=�„ '' '�' "� - �
Division of Soil and Water Conservation [3 Other Agency J�
.y, r� �® Division of Water Quality,
10 Routine Q Complaint O Follow-up of DWQ inspection O Follow-up of DSWC review O Other
Date of inspection q
Facility Number gf Time of I:nspeTtion � 24 hr. (hh:mm)
D Registered .M Certified 0 Applied for Permit 1SPermitted IMNotOperational 1 Date Last Operated:
FarmName: .............../K++ .......� 4 i xY►5......�.............. ...................... County :...... u��(.r..........,.....................................................
Owner Name: ........................ l.�".5ikl......... ........ A k:`!L3................................................. Phone No:.... `11.4�...? �.-...................................•........
Facility Contact:.................&k7j..�k....... . ........... Title:................................................................ Phone No:
MailingAddress: ............. ...4...... .....~?5............................................................. .......... ....u5�C.... i.��.4..N{........................................ .. �` .5�........
Onsite Representative: ............. SZ.&.;Le.U....3.0�Nnsj ................... ..... Integrator.......(! LX_P
Certified Operator. ..................................................
Location of Farm:
........ Operator Certification Number:............ I ............................
:.r�.....t�af...... �i c..........•.....tt.tal...}....!?.,....cwl�.�......50 ,s....af......5......{1��-................................................................
.. . ......................
Latitude 0 1 46 Longitude • 1 "
General
1.
Are there any buffers that need maintenance/improvement?
❑ Yes
No
2.
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 Surface Water? (If yes, notify DWQ)
❑ Yes
® No
c. If discharge is observed, what is the estimated flow in gal/min?
pi
h
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
❑ Yes
® No
3.
Is there evidence of past discharge from any part of the operation?
❑ Yes
No
4.
Were there any adverse impacts to the waters of the State other than from a discharge?
❑ Yes
® No
5.
Does any part of the waste management system (other than lagoons/holding ponds) require
❑ Yes
E2 No
maintenance/improvement?
6.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
PNo
7.
Did the facility fail to have a certified operator in responsible charge?
❑ Yes
09 No
7/25/97

• Facility Nu7ber:.31 — i
8, Are there lagoons or storage ponds on site which need to be properly closed?
Structures (Lagoons.11olding ttnld,g,,•,EjUsltl'ils. etc.l
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure I Structure 2 Structure 3 Structure 4
Identifier:
Freeboard(ft):..............3.3................................................................
10. Is seepage observed from any of the structures?
11. Is erosion, or any other threats to the integrity of any of the structures observed?
12. Do any of the structures need maintenance/improvement?
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
❑ Yes M No
❑ Yes 0 No
Structure 5 - Structure 6
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
Waste Application
14. Is there physical evidence of over application?
(If in excess of WMP, or runoff entering} waters of the State, notify DWQ)
15. Crop type ............�. L1Jz........ �°e�rn�1!�1.t------------------ W..'�!A........ : ft*. ..................................................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
22. Does record keeping need improvement?
For Certified or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
24, Were any additional problems noted which cause noncompliance of the Certified AWMP?
25. Were any additional problems noted which cause noncompliance of the Permit?
0�No:violati(ns-or. deficiencies.were•noted during this.visit.•:YoiUmill receive•no' •fiirther-
: correspondence about this' visit'.,',',
❑ Yes IR No
❑ Yes ® No
® Yes ❑ No
❑ Yes IN No
❑ Yes 12 No
U, Yes ❑ No
❑ Yes 13 No
'ZYes ❑ No
❑ Yes f Q No
CQ Yes No
❑ Yes No
Yes ❑ No
❑ Yes ® No
Yes ❑ No
M Yes ❑ No
lZ•&►t o+�as o►• Quilt,- c1:� tati�l o� aoloor -# Z 5kauiJ b� +n vege� C.4& Odke JiKt we Its e�
6W � n.5 Ir.Owetl.
Ito• ?MemS P �� it Gelds JA IR +4. Nc ovwser�
CRAW �Or 31% +4
M %esrw'Uhi, s,",Q b. i+M ��`o>/cc) 1� �'-� cfJ ZB
7-7_ k9as+c -4 sal � Sayhti 65 ! 'slautO 6e, u�G tU. i o+
1-�rrr� ytctY�S. m Cc.+r �� t vs tA'tKd1l� Nrr�ns *-w—
1
Itetj 2_g iS
1
weet) comkro`
c,pyytcf OLCVM e izrt_Oo-Ar` �,U11 7/25/97
Reviewer/Inspector Name
Reviewer/Inspector Signature: &
Date:

[Facility Number: ... 3A ..... . ..... Date of Inspection:
4/30/97

® Routine O Complaint O Follow-up of DWQ ins ection O Follow-up of DSWC review O Other
Date of Inspection 2
Facility Number l
Time of Inspection l D : 24 hr. (hh:mm)
Total Time (in fraction of hours
Farm Status: ❑ Registered ❑ Applied for Permit (ex:.1.25 for I hr .15 min)) Spent on Review
Certified El Permitted or Inspection includes travel andprocessing)
❑ Not Operational Date Last Operated:
Farm Name:....1�G �.... 5..�.� 1....... Y...Y...14..2 .... ..... » ......... ......
Land Owner Name:.... r'il.hd.... .... V.. ^!1.A............ ............. ». ...............
Facility Conctact:
Title:
county: .... D.L.�.� a..xk.........».................... w` 1`
Phone No: ...i..i..l�.... Z.$.....2....1...............
Phone No:
MailingAddress:.....p.�..»... � .» ...1•.....f............... »......................».»............... ..... �...6S.G,...1T1..� �..y.... :........... � .. .
Onsite Representative: ...................... ............... .......... Integrator:... . ...............................................
Certified Operator: ...... »Aale........ F.................... ...dli".f?F..............................., Operator Certification Num er:..... (?r tr....................,
Location of Farm:
�...5? :!�.}...�.r.�a.x.. ....�4-.�......:>.L ....10. ..................... �.�.�.r..a.X�.+::►:�.r�...........f�.:...�.......w�.a....�.�........,�Q.0 .. �-:a.�..�... ...... 4
l ^..Tr:...... ............................... ..................................... ........................................................................
.......................,
Latitude ®• ®' ®" Longitude F 7 2� "
Sengral
1. Are there any buffers that need maintenance/improvement? ❑ Yes UNo
2. 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 Surface Water? (If yes, notify DWQ) ❑ Yes ® No
c. If discharge is observed, what is the estimated flow in gal/min? t� ) A
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ® No
3. Is there evidence of past discharge from any part of the operation? ❑ Yes Jj� No
4. Were there any adverse impacts to the waters of the State other than from a discharge? ❑ Yes No
5. Does any part of the waste management system (other than lagoons/holding ponds) require ❑ Yes No
4/30/97 maintenance/improvement?
Continued on back

Facility Number: 3.. ,......—■,.�.),...
6, Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes 49 No
7. Did the facility fail to have a certified operator in responsible charge?
8. Are there lagoons or storage ponds on site which need to be properly closed?
StrUctures (Lagoons and/or Holding Ponds]
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Freeboard (ft): Structure 1 Structure 2 Structure 3
10. Is seepage observed from any of the structures?
Structure 4
11. Is erosion, or any other threats to the integrity of any of the structures observed?
❑ Yes ®No
❑ Yes 0 No
❑ Yes E•No
Structure 5 Structure 6
12. Do any of the structures need maintenance/improvement?
(If any of questions 9-12 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
Waste Application
1
14. Is there physical evidence of over application?
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15, Crop type ................... ..................... .....CIJ�............................. ........... ............... ..........
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
For Certified Facilities Only
22. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
23. Were any additional problems noted which cause noncompliance of the Certified AWMP?
24. Does record keeping need improvement?
❑ Yes ® No
R Yes ❑ No
J& Yes ❑ No
❑ Yes ® No
❑ Yes RNo
R Yes ❑ No
[:]Yes ® No
&Yes ❑ No
❑ Yes ® No
❑ Yes 19 No
❑ Yes JR No
❑ Yes No
❑ Yes No
❑ Yes B No
Comments„(refer to;questwn'#)' Explain°any,YES,'answers and/or any recommendations�or any other comments x y
Use drawings of facility to better explain situations. (use additional.pages as necessary). " r r
r .., A ;
11. 12 s ► a ,., v -r-� 1► a -re w� w e,-e- a&J a 4
Tk v +S o�
!� k-e v b-.L yr e.v f-
C v-t f .t 1 Vr' j C t'L� ! a (� " 44� &-i d 'L d-" I V-IL
i.- ti' Q. C e�y_ t-t 4-t e44_ p p_•ya , P �"�-•+�• S k -8 u L4
19. W o v K a v, t_ o r r-j_c, I~ i a e- Q-4 -g i .-ti S P i .,144 r o..,,...c�
�e 5 k� 1e I i .% kA t- w �-z .
Reviewer/Inspector Name » ffwwl" : >.-'
Reviewer/Inspector Signature: Date: 7 ZZ 491
cc: Division of Water Oualitv. Water Oualitv Section. Facility Assessment Uni 4/30/97

State of North Carolina
Department of Environment,
Health and Natural Resources
Division of Water Quality
James B. Hunt, Jr., Governor
Wayne McDevitt, Secretary
A. Preston Howard, Jr., P.E., Director
CERTIFIED MAIL
RETURN RECEIPT REQUESTED
Crystal Davis
Rockfish Farm #2
PO Box 757
Rose Hill NC 28458
Farm Number: 31-816
Dear Crystal Davis:
August 14, 1997
You are hereby notified that Rockfish Farm #2, in accordance with G.S. 143-215.1OC, must apply
for coverage under an Animal Waste Operation General Permit. Upon receipt of this letter, your farm has
thirty (30) days to submit the attached application and all supporting documentation. In accordance
with Chapter 626 of 1995 Session Laws (Regular Session 1996), Section 19(c)(2), any
owner or operator who fails to submit an application by the date specified by the
Department SHALL NOT OPERATE the animal waste system after the specified date.
Your application must be returned within thirty (30) days of receipt of this letter. Failure to submit the
application as required may also subject your facility to a civil penalty and other enforcement actions for
each day the facility is operated following the due date of the application.
The attached application has been partially completed using information listed in your Animal
Waste Management Plan Certification Form. If any of the general or operation information listed is
incorrect please make corrections as noted on the application before returning the application package. The
signed original application, one copy of the signed application, two copies of a general location map, and
two copies of the Certified Animal Waste Management Plan must be returned to complete the application
package. The completed package should be sent to the following address:
North Carolina Division of Water Quality
Water Quality Section
Permits and Engineering Unit
Post Office Box 29535
Raleigh, NC 27626-0535
If you have any question concerning this letter, please call J R Joshi at (91.9) 733-5083 extension
363 or Dave Holsinger with the Wilmington Regional Office at [phone].
Sinc ely,
A. Preston Howard, Jr., P.E.
cc: Permit File (w/o encl.)
Wilmington Regional Office (w/o encl.)
P.O. Box 29535, Raleigh, North Carolina 27626-0535 Telephone [phone] FAX [phone]
An Equal Opportunity Affirmative Action Employer 50% recycled/ 10% post -consumer paper