820733_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental Quai

Mal
09ion of water Res©nrces —
Fac' ,ty Number Z - 3 n' Divisiono Soil and Water Conservation
Q Other Agecy
Type of Visit: CMompliance Inspection 0 Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: t�utige Q Complaint Q Follow-up Q Referral O Emergency O Other O Denied Access
Date of Visit: t lie: ( Arrival Time: FIV U 17 . Departure Time: County: s�0�Sd V Region:
Farm Name: (,J.11r.r-S IS 40 S _ � Z Owner Email:
Owner Name: tJ�f;e f5 6 Yd S _ L. L. Ci Phone:
Mailing Address:
Physical Address:
Facility Contact: Ck. �f`s 43 Q,-wJc4 Title: Phone:
Onsite Representative: + l( Integrator: ME-- S
Certified Operator: I L�� tjq,4' Certification Number. tOo 4f 6
Back-up Operator:
Certification Number:
Location of Farm: Latitude: Longitude:
Swine
Wean to Finish
PHFeeder
Design Ciirregt
Capacity Pop.
Wet Poultry
La er
Design
Capacity
Current
Pop.
Design Current
Cattle Capacity Pop.
Dai Cow
Wean to Feeder
Non -La er
a. Was the conveyance man-made?
Dai Calf
to Finish
2 VI D G411
❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWR)
❑ Yes
Dai Heifer
Farrow to Wean
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
Desigte
Cnrreat
D Cow
Farrow to Feeder
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
D . Poul
Ca aci
Po
Non -Dairy
Farrow to Finish
❑ Yes
La ers
❑ NA
❑ NE
Beef Stocker
Gilts
E] No
Non -La ers
❑ NE
of the State other than from a discharge?
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turke s
Other
Turke Poults
Other
Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
0 -No
[] NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
r] Yes
❑ No
EJ -11A
❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWR)
❑ Yes
❑ No
C -I' A
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
❑ No
B A
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
[E[No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
E] No
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 2/412015 Continued

Facili Number: IDate of Ins ection:
[:]Yes
Q -No
❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
Waste Collection & Treatment
❑t _No
[] NA ❑ NE
the appropriate box.
4.1$ storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
M.Ne— [] NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
[D -N -PC
[] NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
❑ Weather Code
Identifier:
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
[3'lq'o
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
❑-Ko
❑ 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
�o
❑ 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
Io
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[f 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
Q -No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [al Ido ❑ 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
[:]ce of Wind Drift Application Outside of Approved Area
12. Crap Type(s): R ��i -'A We
13. Soil Type(s): tj 1, Al DIj
_
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes Q 10 ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes iJ'f"" ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes QNo- ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application? ❑ Yes M -No ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes [:I -No ❑ NA ❑ NE
Reauired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
[:]Yes
Q -No
❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
❑t _No
[] NA ❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ ]ease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
[D -Ne
❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall [] Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
[3'lq'o
[] NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes �o ❑ NA ❑ NE
Page 2 of 3 214/2411 Continued

lFacility Number: - 3 jDateof Inspection: /
❑ Yes
ED No
❑ NA
•
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
UD No
❑ NA ❑ NE
25.'ls the facility out of compliance with permit conditions related to sludge? Ifyes, check
❑ Yes
EJ -Ko
❑ NA ❑ NE
the appropriate box(es) below.
❑ NA
❑ NE
if yes, contact a regional Air Quality representative immediately.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
❑'D
List structure(s) and date of first survey indicating non-compliance:
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes
B -I' o
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
[g' <o
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
ED 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
❑'D
❑ 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
[3-11 o
❑ NA
❑ NE
❑ Application Field 0 Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
[3 -No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
[3 -No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
��t -�[
_t7 — �<< tom_ �� �z7c
L/ 7 c:::,
Reviewer/Inspector Name:
Reviewer/Inspector Signatur
Page 3 of 3
e rI — 17r0- 301;s— 6 �s[
Phone:
Date:1.1 Mom it
2A015

ivi"siooH 0. Water Resources
i
Facility Number � - �� ®,,laivisiion of Soii and Water Conservation
- Q Other Agency
Type of Visit: �iance Inspection Operation Revie0 Structure Evaluation Q Technical Assistance
Reason for Visit:tine O Complaint Q Follow-up Q Referral O Emergency 0 Other O Denied Access
Date of Visit: Arrival Time: :9p Departure Time: ' 3S County: `s "t Region:"
Farm Name: _ uQ )t&,�5 R" _ Owner Email:
Owner Name: /, ),,.,te,- 4 l_j It, v -►n &---S 41::�- Phone:
Mailing Address:
Physical Address: _ G
Facility Contact: t ��a L u'� Title: Phone:
Onsite Representative: ( Integrator: k O —S
Certified Operator: �Y JS Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Design Current
Design Cul rent -
Design C►urrent
Swine 1111
Capacity Pop.
Wer Poultay
Capacity Pop.
C►attic Capacity Pop.
Wean to Finish
[:]Yes
Layer
�A
Dairy Cow
Wean to Feeder
I
lNon-Layer
[/] NA
Dairy Calf
Feeder to Finish
Z, E40 Vi rill-
Dai Heifer
Farrow to Wean
"'
❑ Yes
_
Desi n--Cu_rree
Dry Cow
Farrow to Feeder
2. Is there evidence of a past discharge from any part of the operation'?
©, P.oult
Ci i Po
Non -Dai
Farrow to Finish
3. Were there any observable adverse impacts or potential adverse impacts to the waters
Layers
No
Beef Stocker
❑ NE
Non-La ers
Beef Feeder
FEa
Pul lets
Beef Brood Cow
-_..-
Other
. _. _ ...
TurkeyPoults
Other
10ther
>_. ..
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
ED'lao 0 NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
[:]Yes
❑ No
�A
❑ NE
b_ Did the discharge reach waters of the State? (If yes, notify DW R)
❑ 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
C7 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 2/4/2015 Continued

Facili Number: jDate of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes a_X/❑ NA NE
a. If yes, is waste level into the structural freeboard? ❑ Yes [:]No A ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway'?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑Yeso ❑ NA E] NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a ❑ Yes No ❑ NA ❑ NE
waste management or closure plan?
If Any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement?
Yes
❑ No
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
D- o
❑ NA
$. Do any of the structures lack adequate markers as required by the permit'?
❑ Yes
Fa<o
[DNA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
❑ NE
acres determination?
9. Does any part of the waste management system other than the waste structures require
❑ Yes
[] No
❑ NA
❑ NE
maintenance or improvement?
[2"'No
❑ NA
❑ NE
1$.
Waste Application
❑ Yes
[Z"No
❑ NA
❑ NE
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
KNo
❑ NA
❑ NE
maintenance or improvement?
19.
Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[3
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes to ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > I00/6 or 10 lbs. 0 Total Phosphorus ❑ Failure to Incorporate ManurefSludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): / cty- ; t'
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
ff No
❑ NA
❑ NE.
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
D- o
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
C3 No
[] NA
❑ NE
acres determination?
17.
Does the facility lack adequate acreage for land application?
❑ Yes
[2"'No
❑ NA
❑ NE
1$.
Is there a lack of properly operating waste application equipment?
❑ Yes
[Z"No
❑ NA
❑ NE
Required
Records & Documents
"No
19.
Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[3
❑ NA
❑ NE
20.
Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
dNo
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below_ ❑ Yes [3"No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall [:]Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [7�No ❑ NA ❑ NE
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment'? ❑ Yes [2/No ❑ NA ❑ NE
Page 2 of 3 2/4/2015 Continued

F acili y Number: Date of Inspection:
24. Did the facility tail 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 El"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 o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [:kK' ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes OZO ❑ 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 04 [DNA ❑ 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 Ea-Ro ❑ 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 ['-2 No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes YNo ❑ NA ❑ NE
Comments (refer to question.ft Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better �explain situations (use additional pages as necessary).
gfsI
Reviewer/Inspector Name:-tl C)V Phone:
C
Reviewer/Inspector Signature: Date: - ,3- - , d
Page 3 of 3 2/4/2015

Type of Visit: Q galince Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit:utiue Q Complaint O Follow-up O Referral 0 Emergency Q Other O Denied Access
Date of Visit: FArrival Time: ❑ Departure Timer County: V+t Region:-
Farm Name: - Owner Email:
Owner Name: � rox L Lv Phone:
Mailing Address:
Physical Address:
Facility Contact: L-. k,4u5 - V:z� Title:
Phone:
Onsite Representative: A Integrator: 010
Certified Operator: I a.-kl/A Certification Number:
Back-up Operator:
Location of Farm:
Certification Number:
Latitude: Longitude:
Diseharaes and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes [gTd�O NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes [] No [ ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) ❑ Yes ❑ No [: 1NA ❑ 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 CINA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? [::]Yes C�T N -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 l of 3 21412011 Continued
Design Current
Design
Current
Design Current
5nine
Capacity - Pop.
Wet PoME
Capacity
Pop:
Cattle Capacity Pop.
Wean to Finish
laver
Dairy Cow
Wean to Feeder
tion -Laver
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design .
Cur_re t
Dry Cow
Farrow to Feeder
D , Paul
Capa
RO —
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
Turkey Pouits
Other
Other
Diseharaes and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes [gTd�O NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes [] No [ ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) ❑ Yes ❑ No [: 1NA ❑ 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 CINA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? [::]Yes C�T N -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 l of 3 21412011 Continued

Facility Number: VT - I I Date of Inspection:
❑ Yes
[:-No'
❑ NA
❑ NE
Waste Collection & Treatment
❑ Yes
EJ'No
❑ NA
❑ NE
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
E5 -N6_❑
NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
9 -NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
❑ NA
Identifier:
❑ 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
Spillway?:
❑ Yes��
o
[:]NA
E] NE
Designed Freeboard (in):
[:]Yes
gNo
❑ NA
❑ NE
Observed Freeboard (in): <K_0 -
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
E3 -Mo
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a
[] Yes
[!J'Iq'o�
❑ 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
QR -b36
❑ NA
❑ NE
S. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
ER -<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
[cJ- o
❑ 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 Io ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
49
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes F3 l"' ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes LJ 1"O ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes [3 [DNA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
❑ Yes Q'No ❑ NA ❑ NE
❑ Yes [5No ❑ 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
EJ'No
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes��
o
[:]NA
E] NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
[:]Yes
gNo
❑ NA
❑ NE
Page 2 of 3 2/4/2011 Continued

Facili Number: Date of Inspection:
24. DiO the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ELbk — [] NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? if yes, check ❑ Yes E3,Na--0 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 [2 ""' ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [Z.Mo ❑ 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 the drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes aKo ❑ NA ❑ NE
❑ Yes EJKo ❑ NA ❑ NE
[:]Yes FO 1"u ❑ NA ❑ NE
❑ Yes D—Mo ❑ NA ❑ NE
[:]Yes Q_Nd' ❑ NA ❑ NE -
Yes [3 1`U ❑ NA ❑ NE
❑ Yes E314o ❑ NA ❑ NE
(Comments (refer to question #i) Explain any YES answers and/or any additional recommendations or _any other commentse---
Use drawines of facility to better. eamlain situations (use additional mages as necessarv).
c6 t bVlj t tv.
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
q-lf- (3
t
0
t)-3.�
Phone:tub TI -1 IAJ
Date: fm
2/4/7014