820473_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental Quai

Type of Visit: Qisit:7outineyance Inspection U Operation Review U Structure Evaluation VTechnical Assistance
Reason for VO Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: 6tf Arrival Time: Departure Time: } County: , Region:
Farm Name: 1 Owner Emall:
Owner Name: �V-LtfpLy Phone:
Mailing Address:
Physical Address. -
Facility Contact:
' vt' V 4d( 'G 6/ Title: Phone:
Onsite Representative: `
Certified Operator:
Integrator: y' r J'~ jeo,
Certification Number: P I?SQ T
Back-up Operator: Certification Number:
Location of Farm:
Latitude: Longitude:
Design Current
Swine @specify Pop.
Wean to Finish
Wet Poultry
Layer
Non -La er
_ -
Dr, P,onit >
Design
C**specify
I
Design
Ca aei
Cnrregt
Pop.
I
-
Current
I;o
Design Current
Cattle Capacity Pop.
Dai Cow
lf
Dai Heifer
Dry Cow
Non -Daily
Wean to Feeder
Feeder to Finish gtco
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Other _
Other
Pullets
Beef Brood Cow
Turkeys
Turkey Poults
Other
Discharges and Stream Impacts
I . Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DW R)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DW R)
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 Na ❑ NA ❑ NE
❑ Yes ❑ No ❑-ITA_� ❑ NE
❑ Yes ❑ No 2-NV- ❑ NE
❑ Yes ❑ No ❑'NA ❑ NE
❑ Yes Ou ❑ NA ❑ NE
❑ Yes F5No ❑ NA ❑ NE
Page I of 3 21412015 Continued

Facility Number: - a-73 Date of Inspection: 5 DG
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [! l 6 ~ _A ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (iny Sd
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes [4].1- [] 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
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 environme
tal threat, notify DVVR
7. Do any of the structures need maintenance or improvement?
❑ Yes
"Na ❑ NA
❑ NE
S. 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
, o ❑ NA
❑ NE
maintenance or improvement?
Waste Aotillcation
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No ❑ NA
❑ NE
maintenance or improvement?
I I . Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes 1__l l"o ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > I0% or 10 Ibs. ❑ Total Phosphorus ❑ Failure to Incorporate ManurefSludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑��E�vi�d�eQn�cce of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): ��jf""`�"y"` `SC - -- -.
13. Soil Type(s): tj tL
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes ❑ - Jb—o ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes Q� �o ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
t�"uj
❑ NA
❑ NE
acres determination?
/
IT Does the facility lack adequate acreage for land application?
❑ Yes
Ct No
❑ NA
❑ NE
ig. Is there a lack of properly operating waste application equipment?
❑ Yes
00
❑ NA
❑ NE
Required Records & Documents
N
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
WN
❑ 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 l" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No ❑ NA ❑ NE
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE
Page 2 of 3 21412075 Continued

Facilitj Number: Z [( Date of Ins ection:
DG�r
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
ED-No ❑ NA
❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? if yes, check
❑ Yes
IJ "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
e')q_o_ ❑ NA
0 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
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.
0 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 L;-N'tt- ❑ NA ❑ NE
❑ Yes 0 o ❑ NA ❑ NE
❑ Yes �o ❑ NA ❑ NE
❑ Yes �o 0 NA ONE
❑ Yes
�No
❑ Yes
fEa"glo
[] Yes
E]'No
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (referfto question #) Explain aoyYES answers and/or any additional recommendations or any oth;erfco>iineiits. {
- ss� E�
Use, drawings of>factLty to >bet#er explain situkifils (ose dditional pages as necessary}..'` +"CA-41aldoo-1 5r�&.ri
5�
Reviewer/Inspector Name: (1I
Reviewer/Inspector Signature: lJ�� ti.1 r
Page 3 of 3
Phone: L
Date: � S C %� {
21412015

1
1 ype of VISIT: I::f T_;ompuance Inspecuon V VperanOn Kev1ew V atruciure r Valuation U I eCnnICal ASSISianee
Reason for Visit: (Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit:. Arrival Time: Departure Time: I La�J County: S'. ut Region:
Farm Name: A TEA,, i r `( ,e-1^ ' Owner Email:
Owner Name: a 019 Phone:
Mailing Address:
Physical Address:
Facility Contact: ll ��+-�-GCtp,1[ Title:
Onsite Representative:
Certified Operator: MDR' U_>0t cl'y D'd
Phone:
Integrator: ^
Certification Number: a.1-3 lal Y
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current
Design Carrent Design
Curreat
Swine Capacity Pop.
Wet Poultry CapacityCattle Capacity
Pop.
Wean to Finish
Layer DairyCow
Wean to Feeder
Nan -La er
Dai Calf
Feeder to Finish I
�JUD&"
` Dai Heifer
Farrow to Wean
Desiga -Current D Cow
Farrow to Feeder
: Ga aci Po Non -Dairy
Farrow to Finish
Beef Stocker
Gilts
HT
s Beef Feeder
Beef Brood Cow
urke s
Boars
Other
Turkey Poults.
Other
Other
Discharp-es and Stream Impacts �
1. Is any discharge observed from any part of the operation? ❑ Yes L' rgo ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No 0-KA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes [] No
LJ-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
[a�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 Zo
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412015 Continued

acili Number: - 7 Date of Ins ection: v q&-
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes QNe---❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No [q' 1KA ❑ 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 P3 340 ❑ 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 DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes NNo ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes Q"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 2 "'o ❑ NA ❑ NE
maintenance or improvement?
Waste ADDlieation
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes fo ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [Z[- o ❑ 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 JJ ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): 61`Q ( d G 0
13. Soil Type(s):
14. Do the receiving crops differ from those
U
.G vct
in the WMP?
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?
❑ Yes
23-<o
❑ NA
❑ NE
❑Yes
�o
❑NA
❑NE
[:]Yes
�o
❑ NA
❑ NE
[:]Yes EZ�No ❑ NA ❑ NE
❑ Yes [D'1Qo ❑ NA ❑ NE
Remuired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes [ql�o ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes E3-fVo ❑ 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 [;do
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
[3 Rainfall [] Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes Ef No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 21 No
[]NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑NA ❑NE
Page 2 of 3 21412015 Continued

[Facility Number: - Date of ins ection:' t7
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
E - o
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
�lo
❑ 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
Di 4o
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
[ "No
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CA WMP?
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 �o ❑ NA ❑ NE
❑ Yes [_�No ❑ NA ❑ NE
❑ Yes �o ❑ NA ❑ NE
❑ Yes [D No ❑ NA ❑ NE
❑ Yes [frNo
❑ Yes �o
❑ Yes dNo
❑NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
� (c, q estwn #) Explarn)_any YES 'ans�veifi and/or any,additional r m nendations ormny other Coin[�nts.
Commen ngts of fsctl�tj P . .. ( � P g 3')=.a � g3
Use dra to`better ex lam teiatjans. ,use<addttional a es as necnssa ,...r, , C-1 to
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: V3
Date: ti ,Ta- _L
214120I

r
ype or v isir, kvt ompuance tnspecnon v operation xeview l.J notructure r valuation t-J i ecnntcal Assistance I
Reason for Visit: Q.(outine O Complaint Q Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: (Q Departure Time: i 30 County:" Region:
Farm Name: �; t �� G i Owner Email:
Owner Name. _ Phone:
Mailing Address:
Physical Address:
Facility Contact:
I
Title:
Phone:
Onsite Representative: Il Integrator: r ! 1 1
Certified Operator: !"�A,(,— Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design Current
Design
Current
Design Current
Swine
Capacity Pop.
Wet Poultry
Eapacity
Pop.
Gattfe Capacity Pop.
Wean to Finish
11
Layer
Dairy Cow
Wean to Feeder
lNon-Layer
Dairy Calf
Feeder to Finish
fi
Dairy Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
Dry I;oul
Ca aci
P.o
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
urkeys
Other
Turke Poults
Other
Other
Discharges and Stream Immpacts
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 M4%1(r- ❑ NA ❑ NE
❑ Yes ❑ No g-pr-A ❑ NE
[:]Yes [] No E&fA ❑ NE
❑ Yes ❑ No
❑ Yes [3No
[:]Yes 12 No
[KNA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
Page I of 3 21412015 Continued

JFaolity Number:hz ' Date of Ins ection: V-
Waste Collection & Treatment �
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes E?Ko' ❑ NA ❑ WE
a. If yes, is waste level into the structural freeboard? ❑ Yes [:]No [ A ❑ NE
Structure I Structure 2 Structure 3 Structure 4
Identifier:
Spillway?: _
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
Structure 5 Structure 6
❑ Yes ❑e '�io ❑ NA ❑ WE
r
❑ Yes o ❑ NA ❑ WE
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 [2-14 ❑ NA ❑ WE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes [2'1�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 ffNo ❑ NA ❑ WE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [3No ❑ NA ❑ WE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [�J No ❑ NA ❑ WE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 101% 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): DrC(,a(.r r tm 10 &.1Lt--
13. Soil Type(s): I 7 .13 e'jj" -5(ov
14. Do the receiving crops differ from those designated in the CAWMP4 ❑ Yes [r N�o ❑ NA [] WE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes CDle [] NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable [—]Yes [Dko ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. is there a lack of properly operating waste application equipment?
Required Records & Documents
❑ Yes [31�o ❑ NA ❑ WE
[—]Yes R; No ❑ NA ❑ WE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes [31% D NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check [:]Yes [ErNo ❑ NA ❑ WE
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 [DNA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ RainfalI ❑ 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 [fNo ❑ 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

lFarility Number: jDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
0'1 Igo
❑ NA ❑ NE
25. is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
No
❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26_ Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes
F; ' <to
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
E No
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes 0"No ❑ NA ❑ NE
❑ Yes [ No ❑ NA ❑ NE
❑ Yes �o ❑ NA ❑ NE
❑ Yes ffNo ❑ NA ❑ NE
❑ Yes [] No
❑ Yes [a'No
❑ Yes ffNo
❑ NA Q NE
❑ NA ❑ NE
❑ NA ❑ NE
t V
Revi ewer/] nspector Signature: Date: W
Page 3 of 3 214120

II

Type of Visit: WC
fiance Inspection O Operation Review 0 Structure Evaluation Q Technical Assistance
Reason for Visit: 0 Complaint Q Follow-up O Referral O Emergency 0 Other 0 Denied Access
Date of Visit: W Arrival Time: Departure Time: County: - c] Region:, /``v
Farm Name: �� ���(,l 4 ( Owner Email:
Owner Name: f L LC Phone:
Mailing Address:
Physical Address:
Facility Contact: b aLV M1 ,61ot t/ Title: Phone:
Onsite Representative: t l Integrator: �)r (/J
FT
Certified Operator: �bweq Certification Number: ;�' � J O 7
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design Current
Design
Current
Design Current
Swine Capacity Pap.
Wet Poultry
Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
Wean to Feeder IL
Feeder to Finish
ILayer
JNon-Laer
I
I
Dairy Cow
Dairy Calf
Dairy Heifer
Farrow to an
Design
Current
Dry Cow
Farrow to Feeder
D . P.oul
Ca aci
P,o _.
Non -Dairy
Farrow to Finish
Gilts
Boars
JLayers
Non -Layers
Pullets
Beef Stocker
Beef Feeder
Beef Brood Cow
Turke s
Other
Turkey Poults
Other
Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify 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 �❑ NA ❑ NE
❑ Yes []No �] NE
❑ Yes []No QNA ❑ NE
❑ Yes [—]No
❑ Yes [I�o
[3 Yes allo
0-N-A ❑ NE
[] NA ❑ NE
❑ NA [] NE
Page 1 of 3
21412014 Continued

Facility Number: - Date of Inspection'
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [p3-W—[:] NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No 1 ] gA- 0 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
E Vu ❑ 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
LCS N ❑ NA
❑ NE
waste management or closure plan?
eat, notify DWR
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environm7No
7. Do any of the structures need maintenance or improvement?
❑Yes❑
NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
❑'I 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
allo ❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
[] Yes
I'_I 'moo ❑ NA
❑ NE
maintenance or improvement?
11. is there evidence of incorrect land application? if yes, check the appropriate box below. ❑ Yes E No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift 0 Application Outside of Approved Area
12. Crop Type(s): G� 't r 6 o (�DlC �
I3. Soil Type(s): W k
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes Qa>o ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes �le ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable [:]Yes E2-Ko' ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
Q Ni5
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
[-]Yes
LgKo
[] NA
❑ NE
Required Records & Documents
19_ Did the facility fail to have the Certificate of Coverage & Permit readily available?
[:]Yes
EJ Xb
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check
❑ Yes
®-Ko
❑ 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
[2-Na
❑ 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
FffNo
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
[:]Yes
FJ/No
❑ NA
❑ NE
Page 2 of 3
21412014 Continued

Facility Number: - Date of Ins ection:
Z' 24. Did the+facility fail to calibrate waste application equipment as required by the permit? ❑ Yes E;J,� ❑ 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 structures) and date of first survey indicating non-compliance:
26_ Did the facility fail to 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 D'No ❑ NA [] NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes E31 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 B-90 ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the [:]Yes . No ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below. ❑ Yes O- 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 T No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes EfNo ❑ NA ❑ NE
Comments (referlo question ft Explain any YES answers andlor any additional recommendations or-anyother comments ;
Use drawings of facility to better explain situations (use additional pages as_'necessary).
C
lI Ic5 f 'J� Q S' V�-�o , 0, - � q- I � 0 -
7
Reviewer/Inspector Name:
Phone: u -1 ��)
Reviewer/Inspector Signaturc:
Page 3 of 3
Date:
21412014

Type of Visit: om iance inspection Operation Review p Structure Evaluation O Technical Assistance
Reason for Visit: OlRoutine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time:Departure Time: County: 5�. Region:YaiD
Farm Name: 3 F&A { '� Owner Email:
Owner Name: V'Q PAQWJ Phone:
Mailing Address:
Physical Address:
Facility Contact:
L� Title:
Onsite Representative:
Certified Operator: A P W,fry '4 AZ 4
Back-up Operator:
Phone:
Integrator: f r l
Certification Number:
Certification Number:
Location of Farm: Latitude: Longitude:
Design
Current-
Design Current Design Current
t
Swine Capacity
Pop.
Wet'P.n�eltty Capacity op. C N Capacity Pop.
Wean to Finish
La er
Dairy Cow
Wean to Feeder
Non -La er
I Dairy Calf
Feeder to Finish92W
Allu"
" F"'
DairyHeifer
Farrow to Wean
Design Current
Dry Cow
Farrow to Feeder
DPoult : , Ca aci- Pti .
Non-Dai
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
1pullets
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?
❑ Yes
M-N—o ❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance roan -made?
❑ Yes
❑ No 3<A
❑ 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
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ YesVNo
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
[] Yes
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

Facility Number: -tj 7 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 tJ KA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? [] Yes � ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a [-]Yes No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes 131' o ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes Q ❑ 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 To ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes []� N ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes No [DNA ❑ 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):c,rA&a-dA_
13. Soil Type(s): 0X< AN G F9 0 f [ 6
14. Do the receiving crops differ from those designated in the CAWMP? U
❑ Yes
N
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
FNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
IVo
❑ 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 [/]1No ❑ NA ❑ NE
Reauired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes 2 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 6io ❑ NA ❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. 0 Yes [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 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes
o
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [—]Yes
WNo
❑ NA
❑ NE
r✓
Page 2 of 3 21412011 Continued

It
Facili Number: rt Date of Inspection:
2t, Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [] No e-N7V- ❑ 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 EDM° ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes LET 1•" ❑ NA ❑ NE
Other Issues
29. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
C TaA d-- V -
141 7- -2-013
Sw,, �-7
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
A �C.
❑ Yes L J N`6 ❑ NA ❑ NE
❑ Yes [, o ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes [�go­ ❑ NA ❑ NE
❑ Yes 10 ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes To ❑ NA ❑ NE
4t 11�_
Phone T U
M'SMa I •
21412014

C I hA C
0
Type of Visit: (Z.eomp ance Inspection 0 Operation Review '0 Structure Evaluation 0 Technical Assistance
Reason for Visit: outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other Denied Access
Date of visit:lgsih�B Arrival Time: .V Departure Time: County: _ Region[5��
Farm Name: l `t 10a n i - 6,4 t 6 4 &VS � l Owner Email:
s
Owner Name: Phone:
Mailing Address:
Physical Address:
1 �( F f ! • I j 4K l) Ue 1 div-4—yt/ c
Facility Contact: iteiA M.Ar Title: �O j Phone:
Onsite Representative: ff Integrator: M
Certified Operator: �t/' uoDa-Q Certification Numberds• 'h 7
Back-up Operator:
Location of Farm:
Certification Number:
Latitude: Longitude:
Design Current
Swine Ca aci Po
P tY P
Design
Wet Portltry "Ca acl
,�P ty
Current
Po P
_ Design Current
Cattle ` Capacity Pop.
Wean to Finish
La er
Dairy Cow
Wean to Feeder
-Layer
airy Calf
Feeder to F4ish
A6 17'`
-
Dai Heifer
Farrow to Wean
Design
CUT e_ nt
Dry Cow
Farrow to Feeder
D t Pou! :Ca aci
P;e .
Won -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
-Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Turkey Poults
Other _
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
[] Yes ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes [—]No
❑NE
NN A ❑ NE
❑ Yes
[:]No
CRWA
❑ NE
❑ Yes
[E"Iqo_
[3_1�A
❑ NE
❑ Yes
R�J-N0
❑ NA
❑ NE
Page 1 of 3 21412011 Continued

r
Facili ° Number: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
EJRa ❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
[jjbier ❑ NA
❑ NE
Structure i Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): let
Observed Freeboard (in): L
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
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,jp- ❑ 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
[D.W ❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
0 Yes
Q 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�X6 ❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
t �`� ❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [S o ❑ 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): _ Cod l —6 P,.,` yv U act _ S 6 0..-
13. Soil Type(s): n [ L
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
Q'1 0�
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
ale
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
[j]•No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
2 pia
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[ale--
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[Z o
❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[Z•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
U2'lffo
❑ NA [] NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall [:]Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
[]Yes
[Ro o
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes dNo ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

acili Number: - Date of Ins action:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes PP-W— ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes GaW— ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal'?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
pertnit? (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 [ ❑ NA ❑ NE
[:]Yes [j].�o ❑ NA ❑ NE
❑ Yes Lg�o ❑ NA ❑ NE
[:]Yes E No ❑ NA ❑ NE
❑ Yes Egt.v ❑ NA ❑ NE
❑ Yes M..ble. ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes Gg( "o ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? [:]Yes [ -! o ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes �o ❑ NA ❑ NE
�-
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or arty other comatentst'�
Ilse drawiatjs of faciGt}, to better explain situations (use additional pages as necessary). ��
Cw
i�✓ c044 lei - a'o-1p—
sr 7-e
s,V <r -
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
PhoY p-f4J3 -3 3,3.E
Date: EV 0
21412011

type of visit: Lr<7 uompuance inspection v vperanon icevtew U btructure Evacuation V iecnnicat Assistance
Reason for Visit: ("outine O Complaint Q Follow-up O Referral 0 Emergency O Other O Denied Access
Date of Visit: ETWM Arrival Timed 10'.Vb Departure Time: i y County: Region: Fed
Farm Name: N %�A Owner Email:
Owner Name: UC£ Phone:
Mailing Address:
Physics! Address:
Facility Contact: -I1T /rtr4C_hC_1_1_ Title:
Onsite Representative:
Certified Operator: Q w F
Back-up Operator:
Phone:
Integrator: &Iped(�//�
Certification Number:
Certification Number:
Location of Farm: Latitude: Longitude:
Design Current
Design
Current
Design Curren#
Swine '`'-_:Capacity Pap.
«'et P9Itry
Capacity
.Pop.
Cattle. Capacity Pop.
Wean to Finish
Layer
Dai Cow
Wean to Feeder
Non -Layer
Dai Calf
1� Feeder to Finish 31 6q a4co
Dairy Heifer
Farrow to Wean
.Design
Current
Dry Cow
Farrow to Feeder
D . P,aultr.
Ca aci
P■o ,
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Turkeys
Beef Brood Cow
'
Other
Turkey Poults
Other L I
IOther
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)
❑ Yes E6 No ❑ NA ❑ NE
❑ Yes
❑ No
Ed NA
❑ NE
❑ 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 0 No &NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes [✓rNo [] NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes [ +TNo ❑ NA ❑ NE
of the State other than from a discharge'?
Page 1 of 3 21412011 Continued

� M
Facili Number: $ - LA-13 Date of Inspection: '7 I q
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
e1No ❑ NA ❑ NE
FRfo eNA ❑ NE
Structure 6
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): LA
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
[yNo
❑ 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
[]rNo
❑ 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
ffNo
❑ 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 [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
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): [l*\g^tp,\ 1�)E Rv.yOA po'sNsntl CS . G . o
13. Soil Type(s): "F, k W A
I4. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [j No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [fNo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes Eg"'No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
[:]Yes
&No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[ErNo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
j? No
❑ NA
❑ NE
20_ Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[jeNo
❑ 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 dNo ❑ 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 [1f No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [R(No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Wid24,
Number: fA
Date of Inspection: J
the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [EfNo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes EeNo ❑ 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 [B"No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [3/No ❑ NA ❑ NE
Other issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
dNo
❑ 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
[B/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
CEI/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
[B"'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
[21"No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
[tP'No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
[�/No
❑ NA
❑ NE
Continents (refer to question #) Explain any YES "answers.and/or any additional recommendations or.any oth'( comments.
Use'drawingsoffacility to better ezolaln�sttuations (use. additional pages as necessary)
VE�E�s
�Aar. Ci; E
�4 LJt! �� 1t Et7T �>`cofto�
Reviewer/Inspector Name
Reviewer/Inspector Signature -
Page 3 of 3
Phone:
Date: I
21412011

Type of Visit i compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit 0 Routine Q Complaint 0 Follow up O Referral O Emergency 0 Other _[I Denied Access
Date of Visit: Arrival Time: ��� Departure Time: County: SAW)9��'V Region:y
Farm Name:., a ILk 1 Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: 01� Title: Phone No:
" w� LC[
Onsite Representative: _ Integrator:
Certified Operator: _ 1a .� v r-- Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = ` E--] ' =" Longitude: 0 ° = I = "
Design Current
Design Current
Design Current
Capacity Population
Wet Poultry Capacity Population
Cattle Capacity Population
Wean to Finish
❑ La er
❑ Dai Cow
Wean to Feeder
fEl
❑ Non -La er
❑ Dai Calf
Feeder to Finish
❑ DairyHeifer
Farrow to Wean
Dry Poultry
❑ D Cow
Farrow to Feeder
❑ ers
ElNon-Dairy
❑ Farrow to Finish
Non -Layers
❑on -La ers
El Beef Stocker
❑ Gilts
El Beef Feeder
❑ Boars
❑ Pullets
❑ Beef Brood Covd
❑ Turkeys
Other
❑ TurkeyPoults
❑ Other
❑Other
Humber of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes No ❑ NA ❑ NE
❑ Yes ❑ No [rNA
❑ NE
❑ Yes ❑ No NA
❑ NE
❑ Yes ❑ No NA
❑ NE
❑ Yes No ❑ NA
❑ NE
❑ Yes No ❑ NA
❑ NE
Page 1 of 3 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 I Structure 2 Structure 3 Structure 4
Identifier: r
Spillway?:
Designed Freeboard (in):
lr
Observed Freeboard (in):
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 0No ❑ NA ❑ NE
❑ Yes ❑ No �9 NA ❑ NE
Structure 5 Structure 6
❑ Yes [� No ❑ NA ❑ NE
❑ Yes (�] No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes r No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes 4M No ElNA [INE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [ No
❑ NA ❑ NE
maintenance/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 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) LT�t' " S
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes Ep No
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes No
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes No
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes No
❑ NA ❑ NE
Comments refer to 11,1111 # • Ex lain any YES a ( q). p nswee-s andlor any recommendations or grey other comments.
Use drawings offacility to better explainysituations. (use additional pages as necessary):
Q� �f
�
Reviewer/Inspector Name t Phone: /D
Reviewer/Inspector Signature: Date:
Page 2 of 3 12128164
Continued

Facility Number: Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box.
❑ WUP El Checklists ❑Design [I Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
ElWaste Application ElWeekly Freeboard ElWaste Analysis ❑ Soil Analysis ❑ Waste Transfers I Annual Certification
❑ Rainfall ❑ Stocking ❑ Crap Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge'?
❑ Yes
t� No
❑ NA
❑ NE
23.
if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
[�NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
1� 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
No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
No
❑ NA
❑ NE
Other Issues
2$.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
1ONo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
Wo
❑ 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
[__1 NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
F] No
❑ NA
❑ NE
Adtitttonal..Comments andlor Drawer si: ;
-r T 15 �.:� , :'
Page 3 of 3 12128104

.14 T'
Type of Visit: ® Compliance Inspection O Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit: O Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: !/ Arrival Time: L /' . ; 3D ;n Departure Time: County: n Region: Tito
Farm Name: A7 �'� 4-1! 1�2 M.5i1 F 12.S__X1 I j Owner Email:
Owner Name: k1u.
I �k v w f- Phone:
Mailing Address: - f f OA (' 14 -r krni %)iU L; 6;c'' 1,JS ACs-eo, &1 C ;2 2j
Physical Address:. I ThQln o-se- ? gu . (tl,.
Facility Contact: %1`n�` m� � ,ti 11 Title: L�C�, . `a; .Z_c-T <� Phone: SY -739 `_352 4
Onsite Representative:
Certified Operator: [� R U C_ F tit C,.,) L
Back-up Operator:
Location of Farm:
Latitude:
Integrator: % t;,%�1Y 13I�C'. J'j
r
Certification Number:
Certification Number:
Longitude:
Design G&W gent 2. Design Current
Swore a ty ` '' �aultry Cprty -' Pop.
ach Pop. V4'et P
Design Current
Cattle Capacity Pop.
Wean to Finish
La er
Non -La er
Dai Cow -
Wean to Feeder
Dai Calf
Feeder to Finish
Farrow to Wean
21 .
Design- Current
achy P,o
La ers
Non -La ers
DairyHeifer
D Cow
Farrow to Feeder
Farrow to Finish
Non -Dairy
Beef Stocker
Gilts
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other '�
Turke s
TurkeyPo ults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
❑ Yes JS� No ❑ NA ❑ NE
a. Was the conveyance man-made? ❑ Yes ❑ No R] NA ❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWQ) ❑ Yes ❑ No q 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 [�D 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

Facili Number; - Date of Ins ection: I f 'Q
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
[A No
❑ NA ❑ NE
a. if yes, is waste level into the structural freeboard?
❑ Yes
[ No
0 NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: , A Se 0 `� �s
Spillway?:
Designed Freeboard (in): r�
r
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 O 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 M1 No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes [ No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No
LAJ
[] NA
❑ NE
maintenance or improvement?
I I . Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes 06 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): L.[r;1Ey : pt VJt Trkp, —l�:'�i;ti t __5F1T r]t r 4141 CAS -
13. Soil TyPe(s): C
14. Do the receiving crops differ from those designated in the CAWMP? ❑Yes 10'No ❑ NA ❑ NE
15. Does the receiving; crop and/or land application site need improvement? ❑ Yes No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. is there a lack of properly operating waste application equipment?
❑ Yes Z No ❑ NA ❑ NE
❑Yes [4No ❑NA ❑NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes Q No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check ❑ Yes tK] 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 6Q No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall 0 Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes NJ No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 1� No
❑ NA ❑ NE
❑Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

[FacHity Number: - 7 Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes 1� No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes �] No ❑ NA ❑ NE
the appropriate boxes) 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
M 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
[ 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
[M 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
E] No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
® No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
[:]Yes
16 No
❑ NA
❑ NE
Comments refer;ta uestion.# Explain any YES,answers and/or -an additional recommendatronsyoir an Tither co en
Use;drawin s.of facili to better ex lain situations: use additional pages as necessary).
0trs-gtcid5 7�y
Reviewer/Inspector Name: � z o .S Phone: 910 A 3j ,3 7 j - _
Reviewer/Inspector Signature: r7-/� Date: i[2d�L:l
Page 3 of 3 Z/4/1Oil

Division of V4'ater Quality
Faeility Number 7 Q Division of Soil and Water Conservation
Other Agenry
Type of Visit Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: 77��'� Arrival Time: �•` Departure Time: .art County:
Farm Name: �� 11i (� Owner Email:
Owner Name. + J' ue'OL —PJrvw f, (kc Phone:
Mailing Address:
Physical Address:
Region:
Facility Contact: V'`'-- Title: Phone No:
u &wn UC
Onsi#e Representative: Integrator: � ,_„
Certified Operator:yQS �` Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = o =' = " Longitude: [:�:] ° =' =
Design Current
Design Current
Design Current
Swine
1.1
Capacity Population
Wet Poultry Capacity Population
Cattle Capacity Population
❑ Wean to Finish
❑ Layer
❑ DairyCow
❑ Wean to Feeder
❑Non -La er
El Dairy Calf
❑ Feeder to Finish
❑ DairyHeifer
Farrow to Wean
(2--0
Dry Poultry
❑ Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow t0 Finish
❑ Layers
❑ Beef Stacker
Gilts
❑ Non -La ers
❑ Beef Feeder
EBoars
❑ Pullets
[I Beef Brood Cowl I
❑ Turkeys
Other
❑Turke Poults
❑ Other
❑ Other
Number of Uqft—urd-s-.111
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes No ❑ NA ❑ NE
❑ Yes ❑ No qbNA
© NE
❑ Yes ❑ No NA
❑ NE
❑ Yes ❑ No �°] NA
❑ NE
❑ Yes �] No ❑ NA
❑ NE
❑ Yes No ❑ 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?
❑ Yes No
❑ NA
❑ NE
a. if yes, is waste level into the structural freeboard?
❑ Yes ❑ No
FNA
❑ NE
tru lure 1 Structure 2 Structure 3 Structure 4
Strut
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): �u
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 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 EP 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 10lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Sane Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of wind Drift ❑ Application Outside of Area
12. Crop type(s) D�s5 ��5 SM •4-► D
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
15. Does the receiving crop and/or land application site need improvement? ❑ Yes
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
17. Does the facility lack adequate acreage for land application? ❑ Yes
18_ Is there a lack of properly operating waste application equipment? ❑ Yes
�] No
❑ NA
❑ NE
�No
El NA
❑NE
No
❑ NA
❑ NE
TNo
❑ NA
❑ NE
LI] No
❑ NA
❑ NE
Comments refer to questioll # - E lajjn>an YES answers and/or an _'recommendations or an��other comments.,
Ilse drawings of facility to better expiAn`otuaiians. (use additional pages as
ReviewerAnspector Name Phone:
Reviewer/Inspector Signature: Date: It, D
12128104 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 appropriate box. ❑ WUp ❑ Checklists ❑ Desig
n El Maps ❑ Other
❑ Yes lNo ❑ NA ❑ NE
❑ Yes 1] No ❑ NA ❑ NE
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 1PNo ❑ NA ElNE
❑ Waste Application [IWeekly Freeboard ElWaste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
[FNo
❑ NA
❑ NE
ElYes
❑ No
In NA
❑ NE
❑ Yes
[P No
❑ NA
❑ NE
❑ Yes
q3 No
❑ NA
❑ NE
❑ Yes
[�No
❑ NA
❑ NE
❑ Yes
❑ No
F NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
TNo
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
1 Z 7VO4

Type of Visit 9 Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit 4PRouttne O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
' Yb Departure Time: s+p County: _."f PW Region:
Date of Visit: t � Arrival Time: ,.
ICAD—
Farm Name: l Owner Email:
Owner Name: 0 uC Phone:
Mailing Address:
Physical Address: //�� �__
Facility Contact: CT�SC Title:
Onsite Representative:
Certified Operator: Taxnt s g.
Back-up Operator:
A Phone No:
Integrator M—Br'V'_jln, LA-C
Operator Certification Number: .261
Back-up Certification Number:
Location of Farm: Latitude: ❑ o = L = Longitude: ❑ o = 1 0 "
Design CurrentDestgnt ,Current w Design Current
i Swine Capacity Papulation WePoultry.Capacityopulahon," Cattle Capacity Population
❑ Wean to Finish ❑ La er ❑ Dairy Cow
❑ Wean to Feeder ❑Non La er ❑ Dairy Calf
❑ Feeder to Finish - *' ❑ DairyHeifer
Farrow to Wean 2d �' " ❑ D Cow
Dry P�ouitry .
❑ Farrow to Feeder ❑ Non -Dairy
❑ Farrow to Finish ❑ La ers
❑ Beef Stocker
❑ Gilts ❑ Non -La ers
El Pullets El Beef Feeder
❑ Boars ❑ Beef Brood Co
a ❑ Turke s ,.•.
Other , u ❑ Turkey Poults
❑ Other ❑ Other Number of Structures:
Discharges & Stream Impacts
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
rNA
❑ 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
{ INA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
q'No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
[]Yes
EDNo
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12128104
Continued

Facility Number: — Ljq3j Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes '4ZVo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No /19NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes PNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6_ Are there structures on -site which are not properly addressed and/or managed ❑ Yes Wo ❑ 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 V No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes J,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 [ 1 Yes PNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
maintenance/improvement?
❑ Yes 1FNo ❑ NA ❑ NE
I I. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes WIo ❑ 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 Accep�ta_ble Crop Window �❑` Evidence of Wind Drift ❑ Application Outside of Area
12. Crop �(s) GaSj� u44 �tS6 C Kz 1 S M . 1)ffxsej
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
PNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
EANo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[:] Yes
11INo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
%No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
(ANo
❑ NA
❑ NE
'Commeot5��(*refer,�tt (question #} �E�xpta�in�any 1'ES�ans �ers��andlor�yommendations�grtany�ather comments.
IUse dravt'iii ofsfacility #o better explain sitaatiaAs. {use�addihonal�pages�aecess yy a��"�"�{ �_
ie .ien i. • i+-- 5"*i Y= r - , :�..��cA7]C?l�:T�� Y � 2 �.s "`� _'fir a _
d.� 1
7
Reviewer/Inspector Name I Phone: Zan
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 T No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes NNo ❑ NA ❑ NE
the appropirate box. ❑ WUp ❑ Checklists ❑ Design El Maps ❑Other
21, Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes JANo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and F Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes 0 No ❑ NA ❑ NE
23. 1f selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
JpNo
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
ice' No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit'?
❑ Yes
QTNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
�LNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
kNo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
KNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
W 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
DQ 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
NINo
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
;M No
❑ NA
❑ NE
33,
Does facility require a follow-up visit by same agency?
❑ Yes
,No
❑ NA
❑ NE
Additi4"rl :6mments antl/orlDrawingsx,
r
Page 3 of 3 12128104

Drviston of ter Quality
mb e iFaciiL N
~ Ung___. y_ 0 Dsion of Soil and Water Conservation
'ty u r a 7
Type of Visit v Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit a Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
J. Fft
Date of Visit: `� 3 Arrival Time: :I]OQ Departure Time: F^A l County:`PS Region:
Farm Name: M2 1 4`I _1 Owner Email:
Owner Name: f, `�'p r`"�. Prow Phone:
Mailing Address:
Physical Address: r _
Facility Contact: Title:
Onsite Representative: t
Certified Operator:
Back-up Operator:
Phone No:
Integrator: Nw-'ek, r ro L4 P7
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: 0 0 E::] ' 0" Longitude: ❑ 0 0 ` 0 "
I
Design C►urrent
Design t'
Current' Design Current
w
Swrne
Capacity Population Wet Poultry
Capacrty Population 1Cattle `. Capacrty Population
❑ Wean to Finish
❑ La er
;.. ❑ Dairy Cow
❑ an to Feeder'
' ❑Non -La et
-
❑ Dairy Calf
❑ Feeder to Finish
`'
w
❑ Dai Heifei
❑ Farrow to Wean
' '; Dry Poultry
±rr
❑D Cow-
' � ' x Y t �.
Farrow to Feeder
(000' ps
❑Non -Dairy
Farrow to Finish
El Layers
❑ Beef Stocker
❑ Gilts
❑ Nan -Layers
1 ❑ Beef Feeder
❑ Boars
❑ Pullets
❑ Turkeys
ElBeef Brood Cowl
Other
❑Turkey Poults
'
❑ Other
M
❑ Other,
of Structures:
yNumber
Discharges & 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
l
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
1.
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
r No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
10 No
❑ NA
❑ NE
other than from a discharge?
12128104
Continued

Facility Number: — 13 Date of Inspection I a
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 1PNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No fiS Y NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
u
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
WNo
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes
;S 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
99No
❑ 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 pan of the waste management system other than the waste structures require ❑ Yes
e3No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
g5No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
F No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[:]PAN ❑ PAN > I0% 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) tJA Cs-,�i
13. Soil type(s)
v
14_ Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
ED No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
[5 No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[.No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/Inspector Nameyyvilk.Phone: rro �3 ^33�v
Reviewer/inspector Signature: Date: `3 DI
121128104 ' Continued

Facility Number: k 31 Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes A No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 8 No ❑ NA ❑ NE
the appropirate box. ❑ wup ❑ Checklists ❑ Desig
n ❑Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes J9 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
❑ 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
F3 No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
)M No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
PNo
❑ NA
❑ NE
Other Issues
2$_
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
P No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
El Yes
p 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
P 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
N No
❑ NA
❑ NE
General Permit? (ief discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
§a No
❑ NA
❑ NE
12128104

sion of Water Quality
iFacility Nttm6er $ ® �� SON
on nservation
Other Agency
Type of Visit 0 Compliance Inspection 0 Operation Review Q Structure Evaluation 0 Technical Assistance
Reason for Visit 1 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency Q Other ❑ Denied Access
Date of Visit: ^{% Arrival Time: Departure Timer County: oM Region: ' '
Farm Name:?� ��t4 11_ _ Owner Email:
Owner Name: AwIf +'1D{.') N Phone:
Mailing Address:
Physical Address:
Facility Contact: r' Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Phone No:
Integrator: �''i� !bW In
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: ❑ 11 ❑ I ❑ u Longitude: ❑ ° ❑ 1 ❑
llesign Current-:.r.
wDesign .. Current
Design Current
Swine Capacity Population
Wet PonitryCipaty .Population
Cattle Capacity Populsteon
❑ Wean to Finish
❑ La er
❑
DairyCow
❑ Wean to Feeder
❑Non -La er
❑ Dairy Calf
❑ Feeder to Finish
z
❑ Dairy Heifer
❑ Farrow to Wean
❑ Dry Cow
53 Farrow to Feeder O!a
""' ¢ Y.° 's' '°'�
❑ Non -Dairy
❑ Farrow to Finish
❑ La erg
El Beef Stocker
❑ Gilts
El Non -Lavers
❑Beef Feeder
❑ Boars
❑ Pullets
❑ Beef Brood Co
❑ Turkeys
OtherIE]TurkeV
Poults I'
❑ Other
❑Other
NuE�A mber of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
1 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
El No
❑NA
El NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ 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? ❑ Yes P! No ❑ NA ❑ NE
a. if yes, is waste level into the structural freeboard? ❑ Ycs W No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: (
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): S
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[Z No
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
0 No
❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
{ No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
4. Does any part of the waste management system other than the waste structures require
❑ Yes
PNo
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
[] Yes
P No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes �] No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, 7_n, etc.)
❑ PAN ❑ PAN > I0% or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window
,,, ❑ Evidence of Wind Drift El Application Outside of Area
12. Crop type(s) �m Lola- ZQ Sr r*'8L'%' a.,
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 �j No ❑ NA ❑ NE
16. Did the facility fait 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?
18. is there a lack of properly operating waste application equipment?
❑ Yes ® No
❑ Yes [3No
❑NA El NE
❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments a
Use drawings of facility to better explain situations. (use additional pages as necessary):
•
Reviewer/Inspector Name /�a�.b%� _ — 1 Phone:�a�
Reviewer/inspector Signature: Date. le-%f 06
Page 2 of 3 12128104 Continued

Facility Number: — loil3l Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 59 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [N No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Desig
n ❑Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes W 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
�9 No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
1P 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
J�jNo
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
V No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
P NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
P No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
® 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
P 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
EjD No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did ReviewerAnspector 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 Cgininents and/or DraviTrngs:
i
7
Page 3 of 3 I2128104

8.2 M. K,3
Type of Visit J& Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 4& Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: 1 Departure Time: County: Region:
Farm Name: �c�h� i*1]`'�� Owner Email:
Owner Name: r�� NOt'O ��- Phone:
Mailing Address: ` Q �e.rG eu N C 2,9
Physical Address:
Facility Contact:
Title: Phone No: I
Onsite Representative: C--r� fJ. Integrator:
Certified Operator: gja_ye 6` a Operator Certif"tcation Number:
Back-up Operator:
Location of Farm:
Swine
Back-up Certification Number:
Latitude: = Q 0 , ❑ Longitude: ❑ o = , =
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
ElLayer
❑ Non -La ei
❑ Wean to Fini
❑ Wean to Fee
El Feeder to Finish
El Farrow to Wean
Farrow to Feeder
000
4
El Farrow to Finish
ElGiits
[I Boars
Other
❑ Other
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ TurkeyPoults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
Design Current
Cattle Capacity Population
El Dairy Cow
❑ DairyCalf
El Dairy Heifej
El Dry Cow
❑ Non -Dairy
❑ Beef Stoeket
El Beef Feeder
❑ Beef Brood Cow
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures: 1 `
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 04No ❑ NA ❑ NE
❑ Yes
❑ No
VNA
❑ NE
❑ Yes
❑ No
KNA
❑ NE
❑ Yes
❑ No
C&NA
❑ NE
❑ Yes
UNo
❑ NA
❑ NE
❑ Yes
P9,No
❑ NA
❑ NE
12128104 Continued

Facility Number: ' 2
Date of Inspection I
Waste Collection & Treatment ��,,{{��
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes �vo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No MFNA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: /,.'
Spillway?: 0
Designed Freeboard (in): f I]
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
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
E6No
❑ 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 t o
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
N[No
❑ NA
❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 5allo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or i 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) ftiWJ1x% - � «ze- . Swt . A rm t to - V-Z(; —•-
13. Soil type(s) ; ct,✓-�t��Ut�t tA)�cr rCt,w�
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 ®,No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination❑ Yes , No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
V
Reviewer/Inspector Name
Reviewer/Inspector Signature:
❑ Yes F91 No ❑ NA ❑ NE
❑ Yes [A.No ❑ NA ❑ NE
Phone: `
Date:
12128104 Continued

Ihacility Number: e)?- — (I�1 Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 0, No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes KNo ❑ NA ❑ NE
the appropriate box. ❑ WLJK ❑ ChecklistiR,- ❑ Desi gn' ❑ Mapsi❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes gNo ❑ NA ❑ NE
❑ Waste Applicatiod" ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis,-'[] Waste Transfers ❑ Annual Certification
❑ Rainfair ❑ Stocking ❑ Crop Yield-/ ❑ 120 Minute Inspections i ❑ Monthly and I " Rain Inspections [I Weather Code -
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
KNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
B 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
® 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
91 No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
ANo
❑ 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
El Yes
®No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewerlinspector fail to discuss review/inspection with an on -site representative?
❑ Yes
91 No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
W No
❑ NA
❑ NE
ll/28/04

- -a-
Type of Visit ® Compliance Inspection 0 Operation Review Q Lagoon Evaluation
Reason for Visit 0 Routine O Complaint O Follow up O Emergency Notification O Other 0 Denied Access
Facility Number Sa y7 Date of Visit; 7 b4( Timc:
dot Operational 0 Below Threshold
CYPermitted ® Certified M Conditionalh' Certified E3 Registered Date Last Operated or Above Threshold:
Farm Name: ___ ��+ a/4►/ County:.-5.arv%12'snkJ
Owner -Name:
flailing Address:
Phone No:
Facility Contact: Title: Phone No:
Onsite Representative: a Integrator: m i. Y k -13, V, w o.J
Certified Operator: ax r. ._ a Iry k o U r L Operator Certification Number: "1?4 S`SS
Location of Farm:
[� Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude �' �' G Longitude �' �• 0
Design Current Design Current Design Current
Swine Ca achy Population Poultry Capacity Po uiation Cattle Capacity Po ulation
❑ Wean to Feeder ❑ Laver ❑ Dairy
❑ Feeder to Finish ❑ Non Laver ❑ Non -Dairy
❑ Farrow to 'wean
® Farrow to Feeder Obd ❑Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ Boars Total SSLW
Number of Lagoons / I ILI Subsurface Drains Present ILL -Lagoon area )Li Spray Field Area J
Holding Ponds / Solid Traps r� �] No Liquid Waste Management System
Discharves & 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 aalimin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any pan of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Wa a 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:
Freeboard (inches): J(o
❑ Yes ;E No
❑ Yes O No
❑ Yes ❑ No
01/Q
❑ Yes ❑ No
❑ Yes ® No
El Yes ®No
❑ Yes ® No
Structure 6
05103101
Continued

Facility Number: $d — t.i-,
Date of Inspection17/.2.7671
5. Are there any immediate threats to the integrity of any of the structures observed? (icl trees, severe erosion,
seepage. etc.)
6_ Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
I l . Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
12 _ Crop type r �. a., r �[
13_ Do the receiving crops differ with those designated in the Certified Animal
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?
Management Plan (CAWMP)?
16. Is there a lack of adequate waste application equipment?
Require ids & Documents
17. Fail to have Certificate of Coverage & General Permit or other 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 is 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 ® No
® Yes ❑ No
❑ Yes [0 No
❑ Yes [$d No
❑ Yes ® No
❑ Yes ® No
❑ Yes m No
❑ Yes 10 No
❑ Yes R No
❑ Yes 1�1 No
❑ Yes [�D No
El Yes [jNo
❑ Yes Q ]( No
❑ Yes
❑ Yes
❑ Yes
❑ Yes
❑ Yes
❑ Yes
❑ Yes
❑ Yes
[jj No
® No
[ l No
[59 No
No
[� No
/® No
® No
10 No violations or deficiencies were noted during this visit You w ll receive no further correspondence about this visit.
Con"'ne t� (fifer to (InesttOq #� IE:rplaie aey YigS aes�srs sad/OF$ey r�ommeadatioas Or aeV other `4itmt$EittS.
Use drawings of fari[it} to better expiate sttnattaas. (ase $dd:ttonal pages as ttecessary) Field t: fi3na1 Notcc �=
7- C6,4_;, e tc vTcrj__ as �cQce� bc.4L 64r� Spout -
Reviewer/Inspector lame
Reviewer/Inspector Signature: Date: 7-
05103101 1 / Continued

Site Requires Immediate Attention:
Facility No. Z
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: -U 7 1995
Time: 7�S
Farm Name/Owner:
Mailing Address: R R0
i
j
f"`�GOG�
�/
- P, 1 WeA-�SS6
1 /y��c iA�;
n�G '; �' 6`3P 9 f q10—,;?
County:_, Sampson
Integrator: Carroll Foods Phone:
On Site Representative: Don LaCoe Phone:
Physical Address/Location: a"V
Type of Operation: Swine Poultry Cattle
Design Capacity: Number of Animals on Site: M14 D W .4•��� r
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: Longitude: "
Circle Yes or No
Does the Animal Waste Lagoon ha a sufficient freeboard of I Foot + 25 year 24 hour storm event
(approximately l Foot + 7 inches) Ye or Na A Freeboard:__�-_Ft. Inches
Was any seepage observed from the
Is adequate land available for spray?
Crop(s) being utilized: _ G
i(s)? Yes or V9,,Was any erosion ob ed? Yes od-N6
or No Is the cover crop adequate? (Y—a or No
Does the facility meet SCS minimum setback criteria? 200 Feet from
100 Feet from
Dwellings? &4s or No
Wells? �Pg or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or(NV
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line: Yes Oro
Is animal waste discharged into water of a state by man-made ditch, flushing system, or other
similar man-made devices? Yes or& If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure,
spray irrigated on specific acreage with cover crop)? es r No
Additional Comments:
J VAS
Inspector Name
Signature
land applied,
cc: Facility Assessment Unit Use Attachments if Needed.

JUL 14 '95 11:46—"m
NORTH CAROLM DEPARTMENT OF EWMOMGW, EZA TE & NATURAL R=URC -S
DIVISION OF ENMON ENTAL KAiiiAGMWEENT
Fayetteville Regional Office
Animal operation Complia^.ce Inspection Form
FBiiii 14 I ` rs_� `"- SPF:CTiQN `DBTE
-TAM SSA
CAA ' :WEDS C.
7
4!
x. :.. • ]�SitnM4 'ADDRF:�3.' ''.�:s. -
t. _a--�w.i���� .:......w.,.,. •..:n.�-va.�.....r-e:�..�.
.. '"<�' =f FACILITY wTMZPdONSRl�i2KSPR.' =
aq 3 - ,134-
All. questions answered negatively will be discussed in sufficient detail in
the Comments Section to enable the deemed Permittee to perforce the appropriate
corrections:
§ECTIDN I
Anima l 0 eration T
Horses, cattle, .sine poult-:►, or sheep
JSEGTION IT
1. Does the number and type of animal meet or exceed
the (.0217) criteria? (Cattle (100 head),
horses (75), nine (250), sheep (1,000), and
poultry (30,000 birds with liquid waste
system)] .
2. Does this facility meet criteria for
Animal Operation REGISTRATION?
3. Are animals confined fed or maintained
in this facility for a 12-month period?
4. Does this facility have a C RTn= AN7xAL
W S x-- M ►GZMXWr pLAPi?
S. Does this facility maintain waste management
records (Volumes of manure, land applied,
spray irrigated on specific acreage with
specific caves mop)?
6. Does this facility meet the SCS minimum
setback criteria for neighbcring houses,
Wells, etc?
Ps" s �.
IM

�,� _ c.c.cc1 �� �•
J UL 14
�rxo�r irz
Y N CGNR'.Etr : S
Field sits Ma_ a em=
I. is animal Waste stockpiled or lagoon
construction within 100 ft_ of a IISGS
Map Blue Line Stream?
2. is animal waste land applied or spray
irrigated within 25 ft. of a IISGS Man
Blue Line Stre3a7
3. Dues this facility have adequate acreage
cm which to apply the waste?
4. Does the land applieation'site have a
cover crop in accordance with the
CII�TIPIGATION PLAN?
5. Is animal waste discharged into wate_rs of
the state by man-made ditch, flushing system,
or othar similar man-made devices?
6. Does the ardmal Waste management at this
farm adhere to Best Management Practices
[S:�} of the approved Cat 'iYi N?
7. Does animal Waste lagoon have sufficient
freeboard? How much? (Approximately )
S. is the general condition of this CA-FO facility,
including management and operation,
satisfactory?
SECZION IV
Camn�n t s

N
L \\