820478_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental dual
2 V
v

t3 tYhs a � ka.,,It I �
(Type of Visit: iJCo�ltance Inspection V Operation Review Q Structure Evaluation O Technical Assistance I
Reason for Visit: Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access 1
Date of Visit: ---I WArrival Time: Departure Time: i _3i) County: OWEVA Region-1
Farm Name: -f'c' 64-.5'd soLv 4--4.,'1A Owner Email. -
Owner Name: ,S ifOL 'oex s+ C-' Phone:
Mailing Address:
Physical Address:
Facility Contact: `u-'ye z 9 o�L l/ Title: Phone:
Onsite Representative: ] � Integrator: ►/ i 17
Certified Operator: �l Certification Number: T ! y S �c
Back-up Operator:
Certification Number:
Location of Farm: Latitude: Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Design Current
Wet Poultry Capacity Pop.
Layer
Design Foment
C ittie Capacity Pop.
Dairy Cow
Wean to Feeder
Non -La er
Dairy Calf
Dairy Heifer
Feeder to Finish
Farrow to Wean 11670
Farrow to Feeder
Farrow to Finish
] Op
Design Current
D . P,oul Ca aei P,o
Layers
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers ers
Pullets
Beef Feeder
Beef Brood Cow
Boars
Other
Other
Turkeys
Turke Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
E;-- ❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
[—]No
[3;-KA
❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWR)
❑ Yes
❑ No
Ej`N_A
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (if yes, notify DWR)
❑ Yes
❑ No
[31NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
[]1Co
❑ 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 21412015 Continued

Facili Number: jDate of Inspection:
c,•�
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
�-3-��
L_'- o
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
f�J-NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 0 �r
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[ o
❑ 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
Jo
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat, notify DWR
7_ Do any of the structures need maintenance or improvement?
❑ Yes
No
❑ NA
❑ NE
8_ Do any of the structures lack adequate markers as required by the permit?
❑ Yes
j "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
E3<o
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
<o
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
leNo
❑ 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): 'Lid
13. Soil Type(s): 0
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
E]_No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
D-No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
❑ o
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application'?
© Yes
No
❑ NA
❑ NE
I S. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[j]'-No
[DNA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[! N
❑ 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
[!7No
❑ 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
dNo
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
ej--No
❑ NA
❑ NE
Page 2 of 3 21412015 Continued

1:acili Number: - Date of Inspection: jL�
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
E3-11-6— ❑ NA
❑ NE
25. is the facility out of compliance with permit conditions related to sludge? if yes, check
❑ Yes
L31VO ❑ 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
[3�'Qo ❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
[2-1 ° ❑ NA
❑ NE
Other Issues
28. Did the facility fail to property dispose of dead animals with 24 hours and/or document [—]Yes C3'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 ❑ 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
or -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
❑-go
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[3"No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
[SNo
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
2 No
❑ NA
[] NE
1-7
Vr-
53
Reviewer/Inspector Name:
Reviewer/]nspector Signatw
Page 3 of 3
Date: /!
21412015

9 1,0 1
Type of Visit: Q"Comppliance Inspection C? Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit: al outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: tLcf Arrival Time: Departure Time: F Countyr!i:a R4
Farm Name: S,>A �* 4•�vt-� Owner Email:
Owner Name: � u cm— 4 -IL �Yl utz t4 Phone:
Mailing Address:
Physical Address:
Facility Contact: •
I i
Onsite Representative: t
i(
Certified Operator:
Back-up Operator:
Location of Farm:
Title:
Latitude:
Regis
Phone:
Integrator:'
Certification Number:
Certification Number:
Longitude:
*�
Design Current. Design Current
Design Current
�5wine
C*apac�ty- _Pop_^,Wet Poultry
Cap city�Pop
Gattic Capacity Pop.
Wean to Finish
Layer
=
Dairy Caw
Wean to Feeder
Non -Layer
-
Daia Calf
Feeder to Finish
aa,.. }"t'—"'' r =* `
Dairy Heifer
Farrow to Wean
j e C'iDesign
Current,
D Caw
Farrow to Feeder
Dr_ fouIt.
c `u -
actPo Ca _
Non -Dairy
Farrow to Finish
Beef Stocker
Gilts
Non-Layers
Beef Feeder
Boars
Beef Brood Cow
u Other:1
s
r
Other_
t:
La ers
Pullets
Turkeys
Turk Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man -trade?
b. Did the discharge reach waters of the State? (I (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 ❑-#A—_❑ NE
❑ Yes [:]No � ❑ NE
❑ Yes ❑ Na
❑ Yes [D"No
[:]Yes [✓] No
[] NA
❑ NE
❑ NA
❑ NE
❑ NA
❑ NE
Page 1 of 2/4/20I5 Continued

Facili Number: - Date of Inspection:
{WLaste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ❑ NA NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No IA 0 NE
Structure
I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): j
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes [a10 ❑ 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 allo ❑ 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 [3'1`io ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes [2-10o [] 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 ENo ❑ 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 'fNo 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 Wind/;ow ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): C 'ey
13. Soil Type(s):
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[DNo
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
[3] N
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
[3' oo
❑ NA
❑ NE
acres determination?
17.
Does the facility lack adequate acreage for land application?
❑ Yes
[2'<o
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
[3No
❑ NA
❑ NE
Required
Records & Documents
19.
Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
Flo
❑ NA
❑ NE
20_
Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
Cj N
[] 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 EyNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I " Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes E!TNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes Lj No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facility Number: - i-j7 Date of Inspection:
24, Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ]s `vV ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes LJ 1 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?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal? .
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
❑ Yes
[g-N-o
❑ NA
❑ NE
❑ Yes
D-146
❑ NA
❑ NE
❑ Yes
[]' o
❑ NA
❑ NE
❑ Yes �o ❑ NA ❑ NE
[] Yes [:1110 ❑ NA ❑ NE
3 I. Do subsurface the drains exist at the facility? if yes, check the appropriate box below. ❑ Yes Q No
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes [2110
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes [-4 No
34. Does the facility require a follow-up visit by the same agency? ❑ Yes Q/ "No
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
Commepts (refer to gneshop ft Explliiiii any YES answers"andlor"anyadditional reenmmendations or;;any'o-the" eornmenti: 0,
�; , , _;
Use drawings of.facility to better explain situations use additional pages as rt essary). ; ., {13 .
C-Cl I, V - (; - 6 gs �
ReviewerlInspector Name: I �!
Reviewer/inspector Signature:
Page 3 of 3
Phone:'7/,() I ,
Date:/ I
21412015

Type of Visit. UCom liance Inspection Q Operation Review O Structure Evaluation p Technical Assistance
Reason for Visit: Routine O Complaint Q Follow-up Q Referral O Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: eparture Title: County:
Farm Name: Owner Email:
ra
Owner Name: �S'C�aGO �d}3!1d >< i Phone:
Mailing Address:
Physical Address:
Facility Contact: `I t-'t
Title: Phone:
Region:
Onsite Representative: Integrator: ag --s
Certified Operator: '' Certification Number: l 8 e';�
Back-up Operator:
Location of Farm:
Certification Number:
Latitude: Longitude:
Design @urrent
Design
Current
Design C nt
Swine Capacity Pop.
Wet Poultry
Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
La er
jDairyCow
Wean to Feeder
I JNon-Layer
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
pD Poul
Ca aci
Po .
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
k ..
Non -Layers
Pullets
Turlce s
Beef Feeder
Boars
Beef Brood Cow
e
Poults
Other
Other
Discharrtes and Stream Impacts
1. Is any discharge observed from any part of the operation? 4P
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes [3 No ❑ NA ❑ NE
Yes [1) No El'FiA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
[:]Yes
❑ No
Ln A
❑ NE
c_ What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
❑ No
CfNA
❑ NE
2. Is there evidence of past discharge from any part of the operation?
❑ Yes
[31R'o
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
[] Yes
[DNo
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412015 Continued

Facili Number: Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [A-W ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No � ❑ NE
Structure I S turc 2 Structure 3 Structure 4
Identifier:
Structure 5
Structure 6
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): �T
5. Are there any immediate threats to the integrity of any of the structures observed?
Yes
QWo
❑ 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
[?I-Ko'
❑ 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
❑-<o
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[]'5-o
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
Eg} Koo-
[] NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
Q-No--
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
[f 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):
I3. Soil Type(s): AL&
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
�o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[ -I o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
0 o
❑ NA
❑ NE
acres determination?
i
17. Does the facility lack adequate acreage for land application?
❑ Yes
r;;Mo
Ir-
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[�No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
❑'Ro
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
G Mb
❑ 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. ETIM [rNo
❑ Waste Application �eekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes E fNo
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? 0 Yes dNo
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facili Number: - H Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes
the appropriate box(es) below.
❑ Failure to complete annual sludge survey 0 Failure to develop a POA for sludge levels
0 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?
2T Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30_ Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
to O NA ❑ NE
[],�W [_]NA ❑ NE
❑ Yes E ❑ NA ❑ NE
❑ Yes Ej io ❑ NA ❑ NE
❑ Yes
L' Jio
❑ NA
❑ NE
❑ Yes
A
❑ NA
❑ NE
2Yes
�j o
❑ NA
❑ NE
❑ Yes No [:]NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes [? No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes []ro ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes EjNo ❑ NA ❑ NE
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Ff4o" -1, F4 Pute- 4-;z>
+.'
�A (,.o Phone:
Date: 0 p
2/4/201

(Type of Visit: O'Comptiance Inspection Q Operation Review Q Structure Evaluation p Technical Assistance I
Reason for Visit: Zkoutine Q Complaint O Follow-up O Referral 0 Emergency O Other 0 Denied Access
Date of Visit: Arrival Time: t r3a Departure Time: S o County: XAVK Region
Farm Name: 54,,�„;�...�_ Owner Email:
Owner Name: � C•CAJ �rse.d Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator: i
Back-up Operator:
Phone:
Integrator: NL19 `
Certification Number: p
Certification Number:
Location of Farm: Latitude: Longitude:
Design Current
Design
Current
Design Current
Swine Capacity Pop,
Wet Poultry
Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
Layer
airy Cow
Wean to Feeder
Non -La er
E�]
airy Calf
Feeder to Finish
aiHeifer
Farrow to Wean
ONon-La
Desi�11
Cow
Farrow to Feeder
I3 . P,oWtj
Ca
Non-Da'Farrow
to Finish
La ers
Beef Stocker
Gilts
ers
Beef Feeder
Boars
PulletsBeef
Brood Cow
Turke S
Other
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes [aNa---0 NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other: �•
a. Was the conveyance man-made? ❑ Yes ❑ No Ea'NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR) ❑ Yes [—]No 0< ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (if yes, notify DWR)
2. Is there evidence of a past discharge from any pan of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
[—]Yes
❑ No
❑ Yes
[T1 io
[—]Yes
ErNo
[],'<A ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 21412014 Continued

Facility Number: 7T - Date of Inspection:. M.
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
[�j Ato❑
NA
❑ NE
a. if yes, is waste level into the structural freeboard?
❑ Yes
❑ No
E] nA ❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure
6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): Za
5. Are there any immediate threats to the integrity of any of the structures observed?
[:]Yes
D o
❑ 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
to
❑ 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
U N'o
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[s '<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
No
❑ NA
❑ NE
maintenance or improvement?
Waste An0cation
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
2115
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes m-Ko ❑ 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 Hare Soil
❑ Outside of Acceptable Crop Window [] Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑WUP ❑Checklists ❑Design ❑Maps ❑ Lease Agreements
❑ Yes
[!j NNo
❑ NA
❑ NE
❑ Yes
[20Vo
❑ NA
❑ NE
❑ Yes
EK
❑ NA
❑ NE
❑ Yes
❑ NA
❑ NI:
❑ YesF?yNo
❑ NA
❑ NE
❑ Yes
[3N
❑ NA
❑ NE
❑ Yes
EKo
D NA
❑ NE
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. [:]Yes . No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes . No
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NF.
❑ NA ❑ NE
Page 2 of 3 21412014 Continued

Facili Number: jDate of Inspection:,
24, Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ETIro ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes Q-tgo­ ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
D Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
2h. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [:]Yes [2-5o ❑ 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.
34. 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 0-90 ❑ NA ❑ NE
❑ Yes [24o [] NA ❑ NE
❑ Yes [ N" o ❑ NA ❑ NE
❑ Yes []3 l"o ❑ NA ❑ NE
Q Yes
['No
Q NA
❑ NE
[:]Yes
[�No
[DNA
❑ NE
❑ Yes
Ea'No
❑ NA
❑ NE
Comments refer to; uestion # Ez lain any YFS answers -and/or any_additional'recommendations or any otheu6ifiments
Use drawings of facility -to better=explain situations:(use,additional pages.as,necessary): ?
r
�cr4lOn J 3 r0 -ram I
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date: ti
"24120

rl
(Type of Visit: ®•CornpHance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance I
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. County: � V Region:
Farm Name: S4V'Ljd..qjDKr Owner Email: r
Owner Name: v Phone:
Mailing Address:
Physical Address:
Facility Contact: _1 1
Title: Phone:
'1 Onsite Representative: r � Integrator:
Certified Operator: + Certification Number: I a D
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Design Cnrrent
Design
Current
Design Current
Switue . Capacity Pop.
Wet Po ultry
Ca}�acity
Pop.
Cattle Capacity Pop.
Wean to Finish
[Layer
Dai Cow
Wean to Feeder
Non -La er
Dairy Calf
Feeder to Finish
Da' Heifer
Farrow to Wean
Design
Current
Cow
Farrow to Feeder
ME P,oal
Ga aci
P,o
—Dry
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turke s
Other
Turkey Poults
. oil
Other
Other
Discharges and Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes [4<o ❑ NA ❑ NE
[:]Yes [:]No [�IA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
[:]Yes
❑ No
[i '9A
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
❑ No
❑'NA
❑ NE
2. is there evidence of a past discharge from any part of the operation?
❑ Yes
[R" o
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
[:]Yes
[;3'1Vo
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412014 Continued

FaciliNumber: 0 k.-I Date of ins ectiow
J Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
D Yes
Rj � ❑ NA
❑ NE
a If yes, is waste level into the structural freeboard?
❑ Yes
❑ No E3'1�X`
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure b
Identifier:
Spillway?:
Designed .Freeboard (in):
Observed Freeboard
(in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[Z>i4 ❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
No ❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
❑d -No ❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
Elo ❑ 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
0 No ❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
ED>a,❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
E� ❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload 0 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
�j❑
12. Crop TYPe(s): %OrV' , •L7 [p�1i �1
13. Soil Type(s): 1V0
14. Do the receiving crops ffer from those designated in the CAWMP?
Yes
❑e -'idol ❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
E]rl o ❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
❑Ko ❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
[] Yes
lr 90 ❑ NA
❑ NE
18. is there a lack of properly operating waste application equipment?
❑ Yes
L3,' ❑ NA
❑ NE
Re uired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[a< ❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
[] Yes
C?.l'tf [] 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 Up4o
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis [:]Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes E�I<o
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes FErNo
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412014 Continued

I
IFacllity Number: A 4 -%/t --j jDate of inspection:, !�
24. Did the facility fail: to calibrate waste application equipment as required by the permit? ❑ Yes [a-Ua
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [4]NO
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26_ Did the facility fail to provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
❑NA ❑NE
❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes [�o ❑ NA ❑ NE
❑ Yes [�-M ❑ NA ❑ NE
❑ Yes t❑,Wo ❑ NA ❑ NE
❑ Yes 2< ❑ NA ❑ NE
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. ❑ Yes
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CA WMP? © Yes
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes
34, Does the facility require a follow-up visit by the same agency? ❑ Yes
D. Mo
❑ NA
❑ NE
O No
❑ NA
❑ NE
[3No
❑ NA
❑ NE
[3-No
[DNA
❑ NE
Comments re erto quest
ion ExAercomr. eas`�_�%anYES answers:a�dlor any addihonai.recommendations or any oth
Use I
draw�n�s offaahty to better eplain;siituations"(use additional pages as necessary) _'; ,
SW sue,- 2,-j
Reviewer/Inspector Name: -WAX 4 Phone:
Reviewer/Inspector Signature: Date:
Page 3 of 3
21412014

l ype of visit: W compliance inspection V Uperatton tceview V btructure Evaluation V t echnical Assistance
Reason for Visit: 40 Routine Q Complaint Q Follow-up O Referral Q Emergency 0 Other Q Denied Access
Date of Visit: S 2 -fZ Arrival Time: ' r„ Departure Time: County:�a/" Region:
Farm Name; L?,;rs�SQ _57
Owner Name:
Mailing Address:
Physical Address:
Owner Email:
Phone:
Facility Contact: ► ` r ` e f'Jy/7a S Title: Phone:
Onsite Representative: Integrator: .�►
Certified Operator:�GT�-� �1`- Certification Number:G�
Back-up Operator: 1?�1 qz7 fr Certification Number:
Location of Farm: Latitude: Longitude:
Swine rat �C pac ty CPop nt Wet Eaullry -a Ike ty CPrrpent . Cattle
#., '
Desigu Current
Capacity Pop.
Wean to Finish
La er
Dai Cow
Wean to Feeder
Non -La er
Dai Calf
Feeder to Finish
4 `
Design Current
D . Poul Ca aci I;o .
DairyHeifer
Farrow to Wean
Farrow to Feeder
Cow
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Beef Feeder
Gilts
Non -La ers
Boars
Pullets
Beef Brood Cow
Dther
OtherI
Turkeys
Turkey Poults
Mill
H
10ther
Discharges and Stream lmuacts
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
Q0 NA
❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
❑ Yes
❑ No
(ANA
❑ 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
P NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
49 No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
2] No
❑ NA
❑ NE
of the State other than from a discharge?
Page l of 3 21412011 Continued

(FaciliWNumber: 'Z =�� Date of Inspection: -2 —/Z-
Waste Collection & 'Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [� No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes [:] No Q9 NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): Soy
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
No
P1
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
® No
TM
❑ 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
q3No
❑ NA
❑ NE
maintenance or improvement?
I I. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
EpNo
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate
Manure/Sludge
into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved
Area
12. Crop Type(s):
13. Soil Type(s): 1,
A n
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
® No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
�] No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
I]p No
ff
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No
❑ NA
❑ NE
the appropriate box.
TT
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements []Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes Y No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall [3 Stocking ❑ Crop Yield ❑ 120 Minute Inspections [:]Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes EP No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [] YesLF
No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facili Number: 191 - q297 I Date of Inspection: 5-2l
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No 0 NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? [:]Yes [� No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes Pg No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes 1P 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 [DNA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes ® No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes TT�� No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes No ❑ NA ❑ NE
Comments (refer to question`: ft Explain any YES answers and/or any additional recommendations or any other comments '
r
Use drawings of facility to. better, explain situations (use additional pages as necessary).
Pp,,ds
-12
j _JIA41�,OL 7 5'- 2, %-t
W05 rzmo-tkd Afe;`( 2n, -2.
Reviewer/lnspector Name:
Reviewer/lnspector Signature:
Page 3 of 3
Phone:
Date: ? Z`{ .f L
21412011

U
- 4 Division of Water Quality
Facility Number - _ e Division of Soil and Water Conservation
0 Other Agency
Type of Visit & Compliance Inspection 0 Operation Review O Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0EOther
_ ,��❑ Denied Access
Date of Visit: Z Arrival Time: Departure Time: d County: 54ryte F�V Region:
Farm Name: (ems n Owner Email:
Owner Name: ca Phone:
Mailing Address:
Physical Address:
Facitity Contact: A�M" O f 1i Title:
u
Onsite Representative: % j
Certified Operator: _�N f ` itam �TT�'"
Back-up Operator: ft'� _
Phone No:
Integrator- 4u
Operator Certification Number:a�'�,',C
Back-up Certification Number:
Location of Farm: Latitude: = o = Q16 Longitude: [� ° = i 0 f,
i
DesiIfflCu;ient
Design Current
Design Current
Swine Capaution
Wet Poultry Capacity Population
❑ La er
Non -Layer
Came Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Wean to Finish
❑ Wean to Feeder
I
❑ Feeder to Finish I
❑ Dairy Heifer
DR Farrow to Wean
Dry Paul iry
❑ Dry Cow
El Farrow to Feeder
❑ Layers
El
❑ Farrow to Finish
El Stocker
❑ Gilts
❑ Non -Ls ayers
ElBeef Feeder
El
❑ Boars
❑ Pullets
Beef Brood Cu
El Turkeys
Other
❑ Other
❑ Turkey Poults
❑ Other
Numtser of Structures:
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
TNA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
[P NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
❑Yes
❑ No
19 NA
❑ NE
2. is there evidence of a past discharge from any part of the operation?
❑ Yes
No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes]
No
❑ NA
❑ NE
other than from a discharge'?
Page 1 of 3
12128104
Continued

c Facility Number: Date ofInspectiion
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes �No El NA [I NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ip NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): TM
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 r No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 46 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require [] Yes [D No ❑ NA ❑ NE
maintenance or improvement'?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes Qr No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes y No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 Ibs ❑ Total Phospborus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
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
o ❑ NA
❑ NE
Comments (refer to -question #): Explain any.YES answers and/or any recommendations orany other comments '
Use drawings of facility to better explain situations. (use additional pages as necessary) £
w
Reviewer/Inspector Name F Phone:
Reviewer/Inspector Signature: Date: o
Page 2 of 3 I2128104 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 ❑ Checklists ❑ Desig
n ❑Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes P No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 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
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
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
JgNo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No
❑ NA
❑ NE
Page 3 of 3 12128104

r \
'� i , , � -�- : i Division of Water Qaality �
Facility Number+-� y'/�j�, ' ®'Division ofSoii_andRaterConser�ation
�� O Other Agency
Type of Visit: 0 Compliance Inspection Operation Review 0 Structure Evaluation O Technical Assistance
Reason for Visit: 0 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Rl Arrival Time: ® Departure Time: County: Region:
Farm Name:tm RSon SO l,J Owner Email:
Owner Name: esLL(_ Phone:
Mailing Address:
Physical Address:
Facility Contact: rn 16 P"yw.,o Title: Phone:
N
Onsite Representative:
Certified Operator: U; (49,r S' 44v n
Back-up Operator: Mr m oru
Location of Farm:
Latitude:
Integrator: _� 1d.I �Ylt t —�i� eel v►�
Certification Number:
Certification Number:
Longitude:
� . � Design Current �,, Design Current Design Cnrrent
Swine
wm ' e Capacity Pops Cattle Capacity Pop.
Wean to Finish La er Da'y Cow
Wean to Feeder Nan -La er r Dairy Calf
Feeder to Finish _ Da Heifer
Farrow to Wean (+1 Design Current**~ Dry Cow
Farrow to Feeder . , .Fault Ca act Eo _` .,,^ Non -Dairy
Farrow to Finish Layers Beef Stocker
Gilts Non -Layers Beef Feeder
Boars Pullets Beef Brood Cow
Turke s
O#her =' Turkey Pouets
Otl'cr� �Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
❑ Yes go No ❑ NA ❑ NE
a. Was the conveyance man-made? ❑ Yes [] No 1W NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) ❑ Yes [] No NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)? 91
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes [] No �0] 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 T� No ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

1 w
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?
❑ Yes
❑ No
P NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 71 ! to
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
EpNo
❑ 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
MR No
❑ NA
0 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
0 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 P 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): Gwy, I w�r � _s
13. Soil Type(s): A44 V 'I to l0„
14. Do the receiving crops differ from those designated in the CA WMP?
[:]Yes
[P No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
Cq No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
[] Yes
`1� No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No.
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
[:]Yes
P No
❑ NA
❑ NE
20_ Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
fp 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 [P No
[:]Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes M No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes `P No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ONE
Page 2 of 3 21412011 Continued

I
Facility Number: -41 jDateof inspection: 2
24. Did the facility fail to calibrate waste application equipment as required by the permit? [] Yes )a No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes P No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any Iagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other-
❑ Yes
&g No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
[:]Yes
No
❑ NA
❑ NE
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes F No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes No ❑ NA ❑ NE
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
qlo-g33-33ano
�t iz�f t t
1/4/1011

Type of Visit & Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: 2 �,. Departure Time: 10 �ti..ti County: ' ►V+ Region:
Farm Name: SQ w1QSf)yA SOW Owner Email:
Owner Name: _ T — , ��-C' Phone:
Mailing Address:
Physical Address:
Facility Contact: j f I- I tw - ti In M ()rl-> Title:
Onsite Representative: jA�1
Certified Operator: v v I NI ar'` 5L,-A n
Back-up Operator ' ' `tkeAm rK D n`5
Phone No:
Integrator:
Operator Certification Number: .240%
Back-up Certification Number: `
Location of Farm: Latitude: [=] o [=]' = Longitude: = o = ' Q u
Design Currents Design Curren#"� Design Current
Swine Capacity Pop ulon� et Poultry "Cap ¢city Populatiou Cattle Capacity Population
❑ Wean to Finishj
10 Layer
I
Dairy Cow
❑ Wean to Feeder
❑ Non -Layer
1
❑ Da'X Calf
❑ Feeder to Finish
❑ Dairy Heifer
.:Drye y El Dry Cow
- Poultry <�.:-.
- `` Non -Dairy
ers
❑ Beef Stocker
Farrow to Wean
.:
Farrow to Feeder
-
ElLa
Farrow to Finish
❑ Gilts
El Feeder
❑ Boars
ElBeef Brood Cow
-
-
Other {
❑ Other
Number of Structures:
❑
El Non -Layers
❑ Pullets
ElTurke s
El Turkey Poults
❑ Other
Discharges & Stream Impacts
1. is any discharge observed from any part of the operation?
❑ Yes
hNo
El NA
El NE
Discharge originated at: El structure El Application Field El Other
a. Was the conveyance man-made?
El Yes
El No
(1NA
El NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
El Yes
El No
$,NA
El 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
1'NA
El NE
2. is there evidence of a past discharge from any part of the operation?
El Yes
allo
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
El Yes
)9 No
El NA
El NE
other than from a discharge'?
Page I 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? ❑ Yes �*No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No JP NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: Q
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 4 U
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes �o ❑ NA [I 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 [INE
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 1P No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes �9 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 Annlication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ElNA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes [29 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 ElEvidence of Wind Drift ElApplication Outside of Area
�
12. Crop type(s) � V r V\ l.V 5_2215
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
V No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
10 No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ yes
)lNo
❑ 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
RNo
❑ NA
❑ NE
Comment�s{re. fer togneshont#) Explain anyytY,ES�snsweis and/orNanyvrecor�mendagons ar any other commei<tts.-
`drawtngsiifgfattlitv�toibetter ex Iatntsituahons� nse addtttoiial a es as necess # _ )-
i
w
Reviewer/Inspector Name �— Phone:
Reviewer/Inspector Signature: Date: S f3 O
Page 2 of 3 12128104 Continued

IL
Facility Number: — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes r No ❑ NA ❑ NE
20, Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 6No ❑ NA ❑ NE
the appropirate box. ❑ WUp ❑ Checklists ❑ Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes PSNo ❑ 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 VNo ❑ NA ❑ NE
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 0 No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
V)No
❑ NA
❑ NE
25, Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
ONo
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
XNo
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ❑ Yes 99No ❑ NA ❑ NE
Other Issues
2$.
Were any additional problems noted which cause non-compliance of the permit or CA WMP?
❑ Yes
'M No
❑ NA
❑ NE
29_
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
5!�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
lU 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
SNo
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32,
Did ReviewerlInspector fail to discuss review/inspection with an on -site representative?
❑ Yes
00 No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
2!�No
❑ NA
❑ NE
Addihonal=Comments andfor Drtiwm s:`
T
Page 3 of 3 I2128104

is Division of Water Quality C) I I I LJ
Facility Number 0 Division of Soil and Water Conservation
0 Other Agency
(Type of Visit V Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance I
Reason for Visit V Routine O Complaint 0 Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: i9 d Arrival Time: 0_9s7 Departure Time: 1 ':730 1 County
Farm Name: - �a Owner Email:
Owner Name: �LL.I'�A�SY �Y b�� D Phone: _
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: I ' t t �"
� (� j
Certified Operator: ll 1 t(Nm
Back-up Operator: 1 f l : IC t—
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
.arrow to Wean
Farrow to Feedei
Farrow to Finish
Gilts
Boars
Other
❑ Other
Title: l N t t \ Phone No -q _kl \ I .yC\ 1
I Integrator: t l t "8
`Uh Operator Certification Number: Q "' O�Q�
r MorZ Back-up Certification Number: q C
Latitude: = o ='
= Longitude: = ° = = u
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -La et
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
Cattle
Design Current.
Capacity Population
i
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures: ®i;
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 r!�No ❑ NA ❑ NE
❑ Yes
❑ No
[N NA
❑ NE
❑ Yes
❑ No
NA
❑ NE
❑ Yes
❑ No J�9 NA
❑ NE
❑ Yes
'�'No
❑ NA
❑ NE
❑ Yes
P No
❑ NA
❑ NE
12128104 Continued

Facilih' Nuntber: 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 frechoard?
Structure I Structure 2 Structure 3 Structure 4
Identifier:
❑ Yes No
❑ Yes No
Structure 5
El NA ❑NE
❑NA El NE
Structure 6
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? [] Yes An No ElNA ❑ 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 R 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 �esP�No ❑ NA ❑ NE
maintenance or improvement?�yy
Waste Apglication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes PoNo. ❑ NA ❑ NE
maintenance/improvement?
11 _ Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes �(No ❑ NA ❑ NE
❑ Excessive Pending ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or i0 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) Q-Ot IN ` k — Q--k-
13_ Soil type(s) 1� U 23 - t�'N t] N
14. Do the receiving crops dSffer from those designated in the CAWMP?
❑ Yes
"M No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
KNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
M No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
kNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
_kNo
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of f2CWty to better explain situations. (use additional pages as necessary):
CShf�,✓ Z �r tam rte LA__R4 nn Cam✓ r, Is e.)c o .,
d G r .
11
�
Reviewer/Inspector Name C Q `TI uE &JI-0
Phone: _10433
Reviewer/Inspector Signature: ue"
Date: {�
12128104 Continued "

.Facility Number: Date of inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes CKNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check ❑ Yes 1Z No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? 1 f yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and l" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
[:]Yes ,M 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
3&No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
�3 No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
)S No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
gNA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CA WMP?
❑ Yes
t +No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
�No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
No
❑ NA
Cl NE
General Permit? (iel discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
No
❑ NA
❑ NE
Comments and/or Drawings:
I Z✓29104

Facility -No- Time In Time Out Date
Farm Name %S6-r,, `-�Z3-� _ Integrator M _
Owner Site Rep fb -As-4
Operator U+c��cNy No.
Back-up No.
COC
PDES
Design
Current
Design
Current
Wean — Feed
Farrow — Feed
Wean — Finish
Farrow — Finish
Fee
Gilts / Boars
arrow -Wean
Ib
Others
FREEBOARD: Design 9
Observed AC T
Crop Yield 161�
Rain Gauge
Soil Test nWettable Acres
Weekly Freeboard Daily Rainfall
Spray/Freeboard Drop
Weather Codes 120 miNlnspectior
Waste Analysis: Iq
Date Nitrogen (N)
iii 2_o
T
sludge survey •43
Calibration/GPM 1
Waste Transfers
Rain Breaker -�
PLAT
1-in Inspections
Date Nitrogen (N)
Pull/Field Soil Crop Pan Window
1 Z

® Division of Water Quality
Facility Number- O Division of Soil and Water Conservation
Q Other Agency
Type of Visit 9 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 10 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: `} Arrival Time: I f�0.104T Departure Time: / ' County: 5*"/`150rj Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Irll -Q 1 r,-06 Title: Phone No:
Onsite Representative: L1 Integrator: --!^ t4..l24.Z
Certified Operator: Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = o = , = ,, Longitude: = ° =1 =
Design Current
swine capacity Population
❑ Wean to Finish
❑ Wean to Feeder
❑ Feeder to Finish
Farrow to Wean 11 04D I
El Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Design Current
Wet Poultry Capacity Population
❑ Lamer
❑ Nan -La et
Dry Poultry
❑ Layers_
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation'!
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made'?
Cattle.
Design Current-:-
Capacity Population' _;
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifei
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures:
b. Did the discharge reach waters of the State'? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
IN
❑ Yes IrNo ❑ NA ❑ NE
❑ Yes
❑ No
0 NA
❑ NE
❑ Yes
❑ No
rp NA
❑ NE
❑ Yes
❑ No
IF NA
❑ NE
❑ Yes
19 No
❑ NA
❑ NE
❑ Yes
P No
❑ NA
❑ NE
12128104 Continued

- Facit"ity Number: UO— Date of Inspection' �d
Waste Collection & Treatment
4_ Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
IM No ❑ NA
❑ NE
a. if yes, is waste level into the structural freeboard?
❑ Yes
❑ No NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 31 4 3 r
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
Ep No ❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
A No ❑ NA
❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
§jNo ❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
® No ❑ NA
❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
to No ❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
E� No ❑ NA
❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
V 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 ElEvidenceof- Wind Drift ❑ Application Outside
of Area
12. Crop type(s) [_-dY_rc . 041. <L� f . �-+ Sol-25f.4w► , S ,vt RAI
13. Soil type(s) 6P A'
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes k3 No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes 10 No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ yes ® No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes ®No ❑ NA ❑ NE
❑ Yes QSNo ❑ NA ❑ NE
Comments (refer to'.question #):..Explain any YES answers and/or any recommendations or any other comments
`Ilse drawings.of faciliity to better explain situations. (use additional pages asinecessary):
Reviewer/Inspector Name I
— Phone:°3l360
Reviewer/inspector Signature:
Date: ,r vI
Page 2 of 3 I21 5IU4 Continued

Facility Number: Date of Inspection 6 i
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 W No ❑ NA ❑ NE
the appropriate box. ❑ WUp ❑ Checklists
❑ Design ❑Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below_ [:1 Yes V] No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
T No
El NA
[I NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[P No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
�] No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
® No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
9 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? (iel discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
119 No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
® No
❑ NA
❑ NE
ddrK gT 9
Additional Comments and/or Drawrngs:. , i
i
Page 3 of 3 12128104

Type of Visit &'Comp nce Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit outine 0 Complaint 0 Follow up 0 Referral 0 Emergency QOther ❑ Denied Access
Date of Visit: f. Arrival Time: E 07 Departure Time: County. Regio�
Farm Name:O�vvrL` Owner Email:
Owner Name: YC�t_.A _ Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: of
Certified Operato_ 1 k
Back-up Operator:
M 5 Title:
S
14 Phone No: Wo A,?
Integrator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: ❑ o = d ❑ « Longitude: ❑ o = I = u
Design Current
Swine Capacity Population
Design Current
Wet Poultry [~specify Population
Cattle ffaDesign Current
apacity Population
❑ Wean to Finish
❑ Layer
❑ DairyCow
❑ Wean to Feeder
❑ Non -Layer
❑ DairyCalf
❑ Feeder to Finish
❑ DairyHeifer
Egzarrow to Wean
Dry Poultry
❑ D Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
❑ Layers
El Beef Stocker
El Gilts
Non -Layers
❑ Beef Feeder
❑ Boars
❑ Pullets
ElBeef Brood Cow
El Turkeys
-
Uther
❑ Other
❑ Turkey Poults
❑ Other
Number of structures: l
Discharges & Stream lmaacts
1. Is any discharge observed from any part of the operation?
❑ Yes
"``"'''" �o El NA
IIIIII
El NE
Discharge originated at: ❑ Structure El Application Field El Other
a. Was the conveyance man-made?
❑ Yes
❑ No A
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No A
❑ 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 XNA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
INo ❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
�No ❑ NA
❑ NE
other than from a discharge?
Page I of 3
12128104 Continued

Facility Number-. A — % 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>VA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
r
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes Mo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes ❑ NA El NE
through a waste management or closure plan? )R�o
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 ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yeses)0o ❑ 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 Ig No ❑ NA [INE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes <No ❑ NA [-INE
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 l0 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Windef�D�r]ift_,�❑.�—Application Outside
ofArea
12. Crop type(s) S ,_ Qfn C'11�QA1 A , Wkm: , (Sfo_'Ln
Soil type(s)
14. Do the receiving crops differ from those desi6mated in th—e CAWMP?
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ Yes
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
17. Does the facility lack adequate acreage for land application? ❑ Yes
18. Is there a lack of properly operating waste application equipment? ❑ Yes
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):
❑ NA ❑ NE
El NA ❑NE
o ❑ NA ❑ NE
El NA El NE
❑ NA ❑ NE
Reviewer/Inspector Name Phone: ��� C
ReviewerlInspectorSignatare: +C �. Date: a—G
Page 2 of 3 12/2VO4 Continued

Facility Number:�jm Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes o ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes �%No ❑ NA ❑ NE
the appropriate box. ❑ WUp 0 Checklists ❑ Design El maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes�o ❑ NA El NE
El Waste Application El Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis El 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 *o
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes Doo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes ;k�TNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes )QNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes EJ--No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes gNo
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes No ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document ❑ Yes No ❑ NA ❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
ONo
❑ 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
*o
El NA
El NE
General Permit? (ie/ discharge, freeboard problems, over application)
��/��/ ```"```"
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
[�To
El NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
Wo
❑ NA
❑ NE
Additional Comments and/or Drawings:.:. `a
•
W
Page 3 of 3 12128104

Facility No. Time In Time Out Date
Farm Name c,Zr1 ")DW_ Integrator U _ f
Owner �D," C [Y1 A*--_ C__D_n Site Rep _U G_ky� ►r oYl-'s
Operator No.
Back-up ===ft No. -
COC Circle: (Gen�e or NPDES
Design
Current
Design
Current
Wean — Feed
Farrow — Feed
Wean — Finish
Farrow — Finish
Fee — h
Gilts / Boars
arrow — Wean
X7
Others
r REEBOARD: Design —
Judge Survey
Crop Yield A�
Rain Gauge
Soil Test It
Weekly Freeboard
Spray/Freeboard Drop
R Y2,
Tt r
PLAT
• •
Observed
Calibration/GPM 1
Waste Transfers
Rain Breaker
Wettable Acres
Daily_Rainfall `� 1-in Inspections
Weather Codes 120 minifispections
Waste Analysis: A 6
Date Nitrog n (N)
Date Nitrogen (N)
�r � I
4 � •
Egg
�` _ - •
r
1

/.
i
1z
Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit & Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: O Arrival Time: �q � Departure Time: � County: Region: Fe-0
Name: _ �- ..Pgo ?to-�a Owner Email:
T��
Owner Name: s 0.Gdas*— 6Lr &,p _ u-G Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: _ 6 CA �r �
Certified Operator: M +mot G[ —AA-Viderms
Back-up Operator:
Location of Farm:
Phone No:
Integrator•
Operator Certification Number:
Back-up Certification Number:
Latitude: =1 o =1 ' E__1 Longitude: = o = i =
it
Design
Current
; DesigQ �y CuFrerit
�, Design Current
Swine Capacity
Population
Wet Poultry k -Capact Po ula4ort
ty p
Cattle Capacl Population
%
❑ Wean to Finish
❑ La er
❑Dai Cow
❑ Wean to Feeder
❑Nan -La et
I
I
i Calf
❑ Feeder to Finish
,�� .a.»r`"
El Dairy Heifer
El D Cow
Farrow to Wean 100
Q b
�b t �r+^'
Dry Poultry " .
❑ Non -Dairy
❑ Farrow to Feeder
❑ La ers
❑ Farrow to Finish
❑ Beef Stocker
❑ Gilts
❑ Non -La ers
❑Beef Feeder
❑ Boars
El Pullets
❑ Beef Brood Co
-
Other r
❑ Turkeys
❑ Turkey Poults
4 u
mj1
Number of Structures:
❑ Other ❑Other
Dischar es & 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 M No ❑ NA ❑ NE
❑ Yes
❑ No
9 NA
❑ NE
❑ Yes
❑ No
0NA
❑ NE
FNA
❑ NE
❑ Yes
❑ No
❑ Yes
g) No
❑ NA
❑ NE
❑ Yes D9 No ❑ NA ❑ NE
12128104 Continued

Facility Number: Z —
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 l
Structure 2 Structure 3 Structure 4
Identifier: A
Spillway?: no
Yv+4
Designed Freeboard (in): ZOO
`2Y �?
Observed Freeboard (in):
t 3�
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes A No ❑ NA ❑ NE
❑ Yes ❑ No 20 NA ❑ NE
Structure 5 Structure 6
❑ Yes 9d No ❑ NA ❑ NE
❑ Yes [M�o ❑ 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 �fNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes
No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
[A No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
® No ❑ NA ❑ NE
❑ Excessive Pending ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drib []Application Outside of Area
12. Crop type(s) _ Cofw- c+traei = sa l t�s► ..� . µ '� ci r k� •� - 'rkPA
_ ac (ckL +A�
13. Soil type(s) �o ,
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
LKNo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes
ERNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination,[] Yes
[RNo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes
ZNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes
allo
❑ NA
❑ NE
�4. Nod Pes,i-i.re arr-
r
w� f`e
Va(V�er , ���
IZI a G(taw- Cx,-"
.� a...-5''�r�
reA-C.Cj S.
Reviewer/Inspector Name �r ' " ' Phone: Wd
Reviewer/inspector Signature: Date: 2
12128104 Continued

Facility Number: Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? 60 Yes ❑ No ❑ NA ❑ NE
20. Does the facility fail to have all components of theCAWMP readily available? If yes, cheek ❑ Yes §dNo ❑ NA ❑ NE
the appropir ate box. ElWUII-'❑ Checklis`K✓❑ Desig
n '0 Maps Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ® Yes ❑ No ❑ NA ❑ NE
❑ Waste ApplicadotoID Weekly FreeboaM"'10 Waste Analysi✓' ❑ Soil Analysir-®Waste Transfers ❑ Annual CertificatioQl .,
❑ Rainfa4Y' 0 Stocking ❑ Crop Yiel j/❑ 120 Minute Inspections✓❑ Monthly and I" Rain Inspection❑ Weather CodsY
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26, Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit'? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
❑ No
RNA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
J4 No
❑ NA
❑ NE
❑ Yes
($No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes [9 No ❑ NA ❑ NE
❑ Yes 91No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
® No
❑ NA '
❑ NE
❑ Yes
2�No
❑ NA
❑ NE
1A Iditfonal Comments andfor..Drsiwutgs
19 me e; 4 c ark- *e-Aa t,%o, ,t ?e,cmii- iw6 vx-Sim re e_,v s
L� . �'� `�a..a i�.� w-a.si{�-�-r`u,4.-s.�e ct-� �-w � a�►�--4 -�a a��.1
W tTL+I Vl:q 4l� s� ��2 ►+� f�+C„r•j . �C4 5� 1
tick per- Sim re_r_�S . `T .4v. 1 qL l6-3 ew" 1p_�l PU
f; ooLt ILs- ` we- . cep LAY �►y ite
SCR - [lZ S •, we c e cs a�asFe-rS tr• wro%-t 4 rbv•s,
c7K —o �e— io_-'-v 5
12128104

~r.� �-�3'c'nc- � �xs -wk � O VILeT'1�ej n�� `f'� - �� �.w...4- _ � �".�.. s"�' �.�-t � 5%: _� _t�" S ^� �.�{,-':s��3�' �'.' �:"-X�- c11
Type of Visit ® Compliance inspection O Operation Review O Lagoon Evaluation
Reason for Visit *Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Faciliri' Number Datc of Visit: � Time:
— -ro Not Operational 0 Below Threshold
M'fermitted ❑ Certified ❑ Conditionally Certified © Registered Date Last Operated or Above Threshold
Farm Name. -- SGL}�+dSA�. 5 e Countv: 5 a� tosnAJ AC
Owner Name: 5 tea` [_ ryas '� t . C• Phone No:
Mailing Address-,
Faciiity Contact:
Title:
Phone No:
Onsite Representative: Integrator: #An iar — r- w.i
Certified Operator: O [Sr.1�t Operator Certification Number- .l.S.s7a
Location of Farm:
R Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' ' 0" Longitude '
Design Current
Design Current Design Current
Swine Capacity Population
Poultr
Ca acitv Population Cattle Ca atitV POIDUhtiOU
❑ Wean to Feeder
P Laver
I
❑ Dairy
❑ Feeder to Finish
10 Non -Lave:
I
I
❑ Non -Dairy
❑ Farrow tc Wean
❑ Farrow to Feeder
❑Other
❑ Farrow to Finish
Total Design Capacity
❑ Gilts
❑ Boars
Total SSLW
Number of Lagoons it ❑ Subsurface Drains Present ❑ Lagoon Area ❑ Spray Field Area
Holding Ponds / Solid Traps ❑ 1\o Liquid Waste Management System
Discharges & Stream Impacts
1. Is anv discharge observed from any part of the operation? ❑Yes No
Dischar-ae originated at: ❑ Lagoon ❑ Sprav Fie€d ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑Yes ❑ No
b_ If discharge is obsmed, did it reach Water of the State? (If yes. notify DWQ) El Yes ❑ No
c. If discharge is observed. what is the estimated flow in ealimin? MIA
d. Does discharge bypass a lagoon system? (If yes. notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes ❑ No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes EyNo
Waste Collection 8- Treatment
4. is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillwav ❑ Yes M No
Structure I Structure 2 Structure 3 Structure 4 Structure ; Structure 5
Identifier: A B tV B
Freeboard (inches): 3
05IV3101 Condnzied

1
Facility lumber: 7.2 — y7,F
Date of Inspection G a
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage. etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 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?
4. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
'VIVaste Aonlication
❑ Yes M No
❑ YesMA
ICJ No
❑ Yes No
❑ Yes No
❑ Yes ® No
10. Are there any buffers that need maintenance/improvement? ❑ Yes ES No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes ® No
12. Crop type i -Fds
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes ® No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes EP No
b) Does the facility need a wettable acre determination? ❑ Yes QI No
c) This facility is pended for a wettable acre determination? ❑ Yes No
15. Does the receiving crop need improvement? ❑ Yes ( No
16. Is there a lack of adequate waste application equipment?
❑ Yes
No
Rggyt•ed Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
[ No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
No
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
(� No
21. Did the facility fail to have a actively certified operator in charge?
❑ Yes
® No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes
[0 No
(ie/ discharge, freeboard problems, over application)
23, Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
51 No
24. Does facility require a follow-up visit by same agency?
❑ Yes
M No
25, Were any additional problems noted which cause noncompliance of the Certified AVt'MP?
❑ Yes
[Z No
Q No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Comments -(refer ta'gtustioin #l) Ezplaiti any ICES"ansRe sad/or any trecotztnieu"dons or an other cummertm,
.Use drawings ni fac_rty tnbctter expEaut sstiwddz s.;(use additionalFpa es es necessary) .`• ' [� Field Conv - ❑Final Notes - -
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date:
05103101 a e " Continued

Type of Visit O Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit O Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
2 Qate of visit: Time:
Facility Number
Not Operational 0 Below Threshold
Permitted 0 Certified [] Conditionally Certified 0 Registered Date Last Operated or Above Threshold:
Farm Name: 5'�,�,, aat s g3+i ___._ County:
Owner Name:
Mailing Address:
Facility Contact: Title:
Onsite Representative: _ r2 43 f r-f J—
Certified Operator: 12 o 3 r t 4
Location of Farm:
Phone No:
Phone No:
Integrator:
Operator Certification Number:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' 4 " Longitude e
Design Current
bwme
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Number of Lagoons Q
Holding Ponds /Solid Traps
Design Current Design Current
Poultry Ca acity Po ulation Cattle Capacity Population.-__
❑ Layer El Dairy
I
❑ Non -Layer I 1 ❑ Non -Dairy
❑ Other
Total Design Capacity
Total SSLW L
Subsurface Drains Present I ❑ Lagoon Area
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Laeoon ❑ Spray Field ❑ Other
a_ If discharge is observed, was the conveyance man-made?
b. if discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Struc re I Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
I Spray Field
❑ Yes ZNo
❑ Yes No
ElYes to �o
❑ Yes NN
ElYes VNo
El Yes
❑ Yes o
Structure
Freeboard (inches): eR 1 4 fl
05103101 Continued

Facility Number: SP, — 7 (late of Inspection �/ 0
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(if any of questions 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?
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
12. Crop type tv ! '-t w -1 A , ef-rJ1— n , f"? , Ile-4
❑ Yes 2 Rio
❑ Yes No
❑ Yes 1,2<0
❑ Yes Q No
❑ Yes ErNo
❑ Yes 0/r
N
El Yes
13. Do the receiving crops differ with those designa[ed in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes VNo
14, a) Does the facility lack adequate acreage for land application? El Yes
b) Does the facility need a wettable acre determination? ❑ Yes ❑ No
c) This facility is pended for a wettable acre determination? ❑ Yes ❑ No
15. Does the receiving crop need improvement? Cl Yes ❑ No
16. Is there a lack of adequate waste application equipment? Cl Yes ❑
Reatured Records & Documents /
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes ,It—S, N/o
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc_) ❑ Yes
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports) ❑ Yes
20. is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes N
21. Did the facility fail to have a actively certified operator in charge? ❑ Yes No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes Ng/
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes [ N
24. Does facility require a follow-up visit by same agency? ❑ Yes No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes o
No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Commeati(refer to question:#): E06in any YES.answers and/or any recommendations or anyother comments -
Use drawings.of facilmtyto better explitim situations: (use additional pages as necessary):: ❑ Field Copy ❑ Final Notes
Reviewer/Inspector Name �� l
Reviewer/Inspector Signature: Date: 3
,
05103101 Continued

F� f..� r4 ?y,.�T �µ�sa�.
6isron of Water Quality � �r
.0
D�10jristoo of Soil and Water Conservation
R
�Y0-0ther Agencyt "a � S.r.,s �'-,iY
x f
k
{ - �
H•'xF'x. a �.�
' R i i A -s .�� '{•!\ y] .J ] h £ rh Ni 1 �'Cf -�'� 1 ..fd +i -t -• �' if i _-
hf.'..T.L'� 54�:?Cf'`•et-2-LtW,`���ftµ...--•..f,ti•'-v..-.s,.i,w?,C�l.j4:iT1.i���-X_ZSI i'h�-.•.N.$"iT r-R's�'4:`;j '°'�.\ 1.
'st 4
'C_ . ',w'�v S];_ `'?LF +,
:-,R':'T.�hS�.h':'L%� .. v .:a .Y: S��<.
of Vi:sit *Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit O Routine O Complaint O Follow up 0 Emergency Not cation 0 Other ❑ Denied Access
Facility, Number 82 478 Date of Visit: 08-04 2{103 Time: 2:OOpm
I -Q Not O erational Q Below Threshold
® Permitted M Certified 13 Conditionally Certified d Registered Date Last Operated or .Above Threshold_
Farm Name:$gl1ASQtl.Sl11Y'aTlll.................... Countv:
.. .. Stu[tRso,0................................. FRO--•--•--•
Owner Name:.-------------------____-- Seaga t-Gruup..LLC----------- Phone No: 4J�Q2435�48.-----------------------------
Mailing Address: l`t4,Z7.jjg.YkttM.jj?ji.Y.e..................................
...................................... .l?!'.itltaalagtant,.N............... ...................... ............... 21#0...............
Facility Contact: .....-•-• ...................................... l'itle: .... Phone No: ......._..- .....-
OnsiteRepresentative:---------------------------_-__._._.---____-- Integrator:Lpilj�aatpi�Y�Brluc-------.___.-•----.
Certified Operator: ScQlt.F,.................................. Bite-}c1:aad.... ................ ........_....... Operator Certification Number: 2j, 41.......... ..............
Location of Farm:
an the west side of SR 1406 approx..8 mile south of its intersection with SR 1414, northwest of Roseboro, NC. +
® Swine ❑ Poultry []Cattle []Horse Latitude 35 • 01 48 Longitude 78 • 34 12
Design' Current Design Current " Design `";Current
Swine �:,7--�Capacity Population Poultry • Capacity Population Cattle Caaci Po nla ion
❑ Wean to Feeder JE1 Layer „' ❑Dairy
Feeder to Finish JEJNnn-Layer ❑ Non -Dairy
Farrow to Wean 1 100
❑ Farrow to Feeder ❑ Other
Farrow to Finish Total Design Capacity 1,100
Gilts _
❑ Boars ,Total SSLW 476,30U
Number of Lagoons 2 ❑ Subsurface Drains Present ❑ Lagoon Area JOSprayField Area
'Holding Ponds I Solid Traps ❑ No Liquid Waste Management System
Discharaet & Stream Impacts
1 _ Is any discharge observed from any part of the operation? ❑ Yes ❑ No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. if discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) El Yes ❑ No
c_ lfdischarge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system'? (Il-yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes ❑ No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ❑ No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ❑ No
Structure I Stricture 2 SMICture 3 Structure 4 Structure S Structure 6
Identifier: .............I.........:... ............2............ .......................................................... .................... ...........................
Freeboard (inches):-_.._.._.._1Q"_.._.._.._...._.._.__.11.°'.__.._.....
0si0.T/0I rnati►iued

FaAlity Number: 82-478 Date of Inspection 08-04-2003
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion. ❑ Yes ❑ No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? El Yes ❑ No
(if any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes ❑ No
8. Does any part of the waste management system other than waste structures require maintenancelimprovement? ❑ Yes ❑ No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes ❑ No
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes ❑ No
1 l . Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes ❑ No
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes ❑ No
14,
a) Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
b) Does the facility need a wettable acre determination?
❑ Yes
❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes
❑ No
15.
Does the receiving crop need improvement? '
❑ Yes
❑ No
16.
Is there a lack of adequate waste application equipment?
❑ Yes
❑ No
Required
Records & Documents
17.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
❑ No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
❑ No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
❑ No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
❑ No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
❑ No
22.
fail to notify regional DWQ of emergency situations as required by General Permit?
(ic/ discharge, freeboard problems, over application)
❑ Yes
❑ No
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
❑ No
24.
Does facility require a follow-up visit by same agency?
❑ Yes
❑ No
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
❑ No
No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit
- - ,- r �-� .�,r rr �.♦ � rt ". 4 �- i� ewe"`�r
xComnients (refer to question #) E'xplain any answers and/or any recommeodahans or any other eutnmeots�
N
Use drawings of facility to better explain sttuattons (use additioitel p>i ges as necessary)b' �t ' "
Y❑ Field Copy ❑ Final Notes
Visited the farm after they reported their lagoons were in the strucrural freeboard. Walked both lagoon banks looking for possible
+
seepage or trouble spots. Spoke with area represenative RO Britt on possible actions for the future.
Reviewer/[aspector Name Larry Baxley:
ReviewerlInspector Signature: Date:

y
Type of Visit (L Compliance Inspection 0 Operation Review 0 Lagoon Evaluation
Reason for Visit IlRoutine O Complaint O Follow up 0 Emergency Notification 0 Other ❑ Denied Access
Facility Number I
Date of Visit:
14 Permitted Certified 0 Conditionally Certified [3 Registered
Farm Name: �J 4 C 14ea 2L.c ,
Owner Name:. Mom'+ �4 n
Mailing Address:
1 "Z Time. ` 3d
rO Not Overational 0 Below Threshold
Date Last Operated or Above Threshold:
County: a
Phone No: C1IL. - 531--
Facility Contact: 10 ILI ` re-1 0-it, 'Title: Ci�jn'r Phone No:
Onsite Representative: _;5cQ] P0.1lel44e44n Integrator: lr L
Certified Operator: 1 a'G 1y n P- fC� Operator Certification Number: 112
Location of Farm:
[!A Swine El Poultry ❑ Cattle ❑ Horse Latitude �� Longitude a
I - Number of Lagoons ® __' ID Subsurface Drains Present]❑ Lagoon Area 10 5 ra4 Field Area '-
�,
Holdin'Ponds 1 Solid Traps ^.I ❑ No Liquid R`aste. Management System
Discharges & Stream impacts
I . is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Sprav Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. if discharge is observed. did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed. what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If ves, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Freeboard (inches):
05103101
❑ Yes No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes
❑ No
❑ Yes
No
❑ Yes
`p No
❑ Yes [ No
Structure b
Continued

16
Facility lumber: lw— $'
Date of Inspection ` oil Da
S. Are there any immediate threats to the integrity of any of the structures observed?. (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 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?
S. 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?
❑ Yes [V No
❑ Yes [)0 No
❑ Yes No
❑ Yes No
❑ Yes q No
Waste .Apiplicatign
10. Are there any buffers that need maintenance/improvement? ❑ Yes M No
11. Is there evidence of over application? j ❑ Excessive Pounding El PAN ❑ Hydraulic Overload ❑ Yes No
12. Crop type Co M /0 ! S�4 �[dn3 1L �' rmja_ ti &V"U can v. S �.
13- Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes ❑ No
b) Does the facility need a wettable acre determination? ❑ Yes ❑ No
c) This facility is pended for a wettable acre determination? ❑ Yes ❑ No
13_
Does the receiving crop need improvement?
[�2 Yes
[:]No
16.
Is there a lack of adequate waste application equipment?
❑ Yes
[9 No
Required Records & Documents
17.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
[% No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
® No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
[ No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
No
21 _
Did the facility fail to have a actively certified operator in charge?
❑ Yes
I § Ne
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
® No
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
[A No
24.
Does facility require a follow-up visit by same agency?
❑ Yes
No
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
® No
0 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Catnatents (refer to question #) Eiiplaru any YES avers"attd/or any reeottttttetsdataons or any otEetr wmmeuts:
[tse'drawtags of facility to Better explata siattous..'(�e atliltiorutl`pages as necessary)
_El Field Cory ❑ Final Notes
_
l$ Con`tinV-r- on ijej crrjrel in rxr'n'J'L #,'e��s. I't1� f;"rc.k
w:I'll sfe�er
�'>G �`^- �lctecc� G���:comma•, rotes can Se :d� `�
ftkyeb to
- � &tees is cor►p1je. 0^9 cLcr'COL�cs
Reviewer/Ins pector lame
Reviewer/Inspector Signature: Date, §;p?I 0�7_
05103101 Continued

wi
Faciiih Number: g — Date of lospcesinn aZl DZ
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes Q9 No
28. Is there any evidence of wind drift during land application? (i_e_ residue on neighboring vegetation, asphalt, ❑ Yes [P No
roads. building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s). inoperable shutters. etc.) ❑ Yes No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes M No
32. Do the flush tanks lack a submerged fill pipe or a permanentitemporary cover? ❑ Yes ❑ No
05103101

r
Type of Visit v Compliance Inspection O Operstlon Review O Lagoon Evaluation
Reason for Visit O Routine O Complaint O Follow up O Emergency Notification Q Other ❑ Denied Access
�.� Date of Visit: ,� O Time: . •,� �
Facility Number d �
Not Operational Q Below Threshold
E Permitted a Certifi
ed. Q Conditionally Certified [3 Registered Date Last Operated or Above Threshold:
Farm Name: - .. L.Y.. »....19�,��. ,.,r✓SwY............................ Coumty:........r9`"~1 ....... __. .....- .........
_- .
Owner Name: _.W . ,. 8�1 .� :. 1� .- ...... Phone No: _ - ..-................- ----.
Facility Contact: ...... .�1..iG'ptle:.................................................. ....... ... . Phone No: .............. ........
__ . -....--
Mailing Address:
�w
Onsite Representative:., -- ..M..- - ........ _- .._.._.. .-» .. ..�_._................... Integrator:.. .1�4 .101>
Certified Operator:.....,r ',p, * ....,�-. ,�frC ......�._... Operator Certification Number :................._..--
Location of Farm:
© Swine ❑ Poultry © Cattle ❑ horse Latitude �• �� ��� Longitude �• �� ��
_ TDesign, Current Design Current Design Current ts
Ca c: ":Po nlstsoa. Ca' ara Po ulatiun Cattle C$ ci Po tilahoa .r
Wean to Feeder '> ❑ Layer Dairy
❑ Feeder to Finish ❑Nan -Layer Non- Dairy -
Farrow to Wean pp
Farrow to Feeder FO Other
❑ Farrow to Finish _ TOtaIMOgn Capacity
Gifts _ - _
❑ Boars Tof d,SS
Number of Lsgootus .Z ❑ Subsurface Drains Present 110 Lagoon Area ❑ Spray Field Area
;_Holding Ponds/Solid-Traps; No Liquid Waste Mena&ement Systems =
Discharges & Stream Impacts
I. Is any discharge observed from any part of the operation? ❑ Yes M No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance than -trade? ❑ Yes amo
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes Ja No
c. If discharge is observed. what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes jNo
2. Is there evidence of past discharge from any part of the operation? ❑ Yes RNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes E5-No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes JR No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ......... ...........................
Freeboard (incites):
5100 Continued on back

U
Facility Number: Re — Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (iel trees, severe erosion,
❑ Yes
;00
seepage, etc.)
b_ Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
❑ Yes
WO
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
2. Do any of the structures need maintenance/improvement?
❑ Yes
J,No
S. Does any pan of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
XNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
No
Waste ARplication
10_ Are there any buffers that need maintenance/improvement?
❑ Yes
No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
❑ Yes
A No
12. Crop type
13_ Do the receiving crops differ with those designated in the Certified Anim Waste Management Plan (CAWMP)?
❑ Yes
)ANo
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
® No
b) Does the facility need a wettable acre determination?
❑ Yes
f'No
e) This facility is pended for a wettable acre determination?
❑ Yes
J$ No
15. Does the receiving crop need improvement?
PjYes
❑ No
16. is there a lack of adequate waste application equipment?
❑ Yes
J!9 No
Reauired Records & Documents
IT Fail to have Certificate of Coverage & General Permit readily available? ❑ Yes M No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ic/ WUP, checklists, design, maps etc.) ❑ Yes KNo
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports) ❑ Yes No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design? [] Yes No
21 _ Did the facility fail to have a actively certified operator in charge? ❑ Yes No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(re/ discharge, freeboard problems, over application) ❑ Yes No
23. Did Reviewer/Inspector fail to discuss reviewfinspection with on -site representative? ❑ Yes No
24. Does facility require a follow-up visit by same agency? ❑ Yes ,j No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes No
('Siq YiQCaf>Etigs . r dgf cue c es rA ngfe g #s. v�5i4 Yo4>F
• corresptt>Eidence: a�otiti this visii:� - ...... .:: � :. � . � . � . � .. - ...:. .. - ... .
,ya� � ���"'� �".,-���.c�,g..� may.✓ �J��r'� .S�y-�i� a�/.s�a� ..r �� .,
a
0
Reviewer/iuspepctor Name :.T �_' , :.z
do
Reviewer/Inspector Signature: - - - Date:

Facility Number: Date of Inspection 3 O
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below Of Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes No
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes RNo
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes &k-No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes &No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ,aYes ❑ No
S/00

...ri.-u-�i fi e ..- .�y S si ° 'i•• .ya,r __ y- r f -'- I s-i �r3 �4..,.i y�spaA'e ,��'1_x-.�Y. x,�+ i�7 ° __�_ O."�'mot ``ti,3•exi ru��A,-..+'gr e- nfi�u.1 i�_k Tt�<.x.� v ��s.�.4'� -r E '' • r _K7-r'�ry'�._��.. Nt'i 3� y,��c'�t_-��r1yv v.• Y'i.'��y 'a••-=z_l"::
� %
4?
M_x
JI
E
f Visit Q Compliance Inspection Q Operation Review Lagoon Evatuation
n far Visit O Routine O Complaint PFollow up 0 Emergency Notification O Other ❑ Denied Access
Facility Number Date or visit: — 23 -O -rime: 8%4Q Printed on: 10/26/2000
NNut Operational O Below Threshold
Permitted E3 �CeJJrtified 13 Conditionally Certified © Registered Date mast Operated or Above Threshold:
Farm Name: .....1.`'. ¢ ._ ...... ... ....... ��.. :...................I......... County: �.......... .........................
Phone .................... . ........ . .. .
Owner name: ,.l ' !4t^t_.J... !` ' G Lf..........----......I............. Phonc No: .-.-... �..................r -- tP..�.3...........................
.. 1 �:�---.--.._
FacilityContact: .......... :yt�< 3 !1e� ........................_...Title:......................................�,•.. ............/Phone No...................................................
,Mailing Address:..........Pl.r'....�.�.. 0F.... _. ............. / '� f .-.3/
OnsiteRepresentative: � - ................ Integrator:............�li��
CertifiedOperator: ............ ............... . ..................... ................................... ....................... Operator Certification Numher:.-............................. ...........
Location of Farm:
A
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude �' ' �_` Longitude • 4 4
Design Current
swine
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Design Current
Poultry Capacity Population
❑ Layer
❑ Nan -Laver
❑ Other
Design Current
Cattle Capacity Po ulation
❑ Dairy
❑ Non -Dairy
Total Design Capacity
Total SSL W
Number of Lagoons I❑ Subsurface Drains Present ❑ Lagoon Area I0 Spray Field Area
Holding Ponds! Solid Traps r ❑ No Liquid Waste 3•lanagement System
Dischartzes A Stream Impacts
. Is any discharge observed from any part of the operation? ❑Yes ❑ No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the Conveyance titan-madc? ❑ Yes ❑ No
b. If discharge is observed. dial it reach Water of the State'? (If yes, notify DWQ) El Yes ❑ No
c. II' disc;harco is observed. what is the estimated flow in gal min'?
d. Does discharge bypass a lagoon system:' (If yes, notify DWQ) ❑ Yes ❑ No
1 Is there evidence of past discharge from any part of the operation'' ❑ Yes ❑ No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge'! ❑ Yes ❑ No
Waste Collection S Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate'? ❑ Spillway ❑ Yes �No
titructurc I `structure 2 Structure Structure 4 Structurc 5 Structure G
Identifier- ..........1................... ..............
f�reclx)ard (inches): ! G
5100 Continued on back

'•
Division of Soil andsWater.Catnservatron - Operation Revrery
"1
[ Division of Soil:and;Water Conservation = p Comlrance=Inspecteon
D:DiVISian of Water.,Qualrty
r
=
Q Other Agency Operatiaan Review-�
. - s __ ._ _
...
JO Routine O Cornplaint O Follow-up of DWQ injection O Follow-up of DSWC review ()Other
Facility Number Date of Inspection zbt�
Time of Inspection ; 41i 24 hr. (hh.mm)
Permitted (3 Certified © Conditionally Certified [3 Registered [3 Not O e'rational Date Last Operated:
Farm Nome: County: .........................................
...........r t. ...aC......., �...-...................... .................
Owner Name:..-.-..,/%��k�l/Y. � 4e Phone No: � ,I /......................................
Facility Contact: ...... ff?e !h# ..-..1"!�!r��'fif ,,....Title• Phone No: ..............................
MailingAddress: ...-:.......�.�� ' �.e�r....�A..��I�.......................................................... ..........................
Onsite Representative:....... ....................................... Integrator: ..... lffu.t� e?,e�!. z........_..............
Certified Operator:.._... �� ��i�........1 J�1,,,_ _ Operator Certification Number: ................... . . . ._........._ ..
---- - -
Location of Farm:
Q
.............. .............. .......................------------------------------------------------------ ....................... ............................. .................................. ................. ......................................... :........
..--'--• T �
Latitude �� �� ��� Longitude �• �� ��°
Design Current:r_, Design Current Design, - .Current
F:7wrne „ - Capacity Population ' Poultry Capacity Population , "'Cattle Capacity Population,
❑ Wean to Feeder
❑ Feeder to Finish
® Farrow to Wean
J/ U D
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts,
❑ Boars
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes ,�yNo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
it, If discharge is observed, was the conveyance man-made'? ❑ Yes R[No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes R[No
c, if discharge is observed. what is the estimated flow in gal/min?
d- Docs discharge hypass a lagoon syttern? (If yes, notify DWQ) ❑ Yes allo
2. Is there evidence of past discharge from any part of the operation? ❑ Yes KNo
3- Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ErNo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes XNo
Structure I Structure ? Structure 3 Structure 4 Structure. 5 Structure 5
Identifier:
Freeboard(inches): ................. /,1...-.--.................-...........--•--................................................... I...................... .......... I........................
..................................
5. Are there any immediate threats to the integrity of any of the structures observed? (iel trees, severe erosion, ❑ Yes XNo
seepage, etc.)
3/23/99 Continued on back

Facility Number: tf'Z — 7 Date of Inspection
0
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
❑Yes
(If any of questions 4-6 was answered yes, and the situation poses an
eRNo
immediate public health or environmental threat., notify DWQ)
7. Do any of the structures need maintenance/improvement? •-
❑ Yes
eq No
8. Does any part of the waste management system other than waste structures require maintenancelimprovement?
❑ Yes
No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
No
Waste X lieation
10. Are there any buffers that need maintenance/improvement?'
❑ Yes
No
1. Is there evidence of over application? ❑ Excessive'Ponding ❑ PAN
❑ Yes
XNo
/
12, Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
ElYes
No
I4. a) Does the facility lack adequate acreage for land application?
❑ Yes
No
b) Does the facility need a wettable acre determination?
❑ Yes
No
c) This facility is pended for a wettable acre determination?
❑ Yes
No
15. Does the receiving crop need improvement?
Yes
❑ No
16. Is there a lack of adequate waste application equipment?
❑ Yes
X No
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
❑ No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
❑ No
19, Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
❑ No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
RNo
21. Did the facility fail to have a actively certified operator in charge?
❑ Yes
❑ No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) A Yes ❑ No
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes4�lNo
24. Does facility require a follow-up visit by same agency? 'Yes ❑ No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes I No
NO.001ptiptas.oe ilefciertcies •were hofpd-d(W.iog #his;visit' Yoir ;will eeeiye �o #`u�titer: ;
Torres amdence: oU thi visit : :: :
_ s ��
iJse drawings of facility to better explai situati6ns (use atldtbonal "pages a§ necessary) = -
do f,
- ' z_j a c+c.-t�i�•v'� .
&ve Ca.cJ14W v,?X447 � fir,,✓'�+<�. Ca..��A.u�.�
Reviewer/Inspector Name
Reviewer/Inspector Signature- 1814t_4zn!�.A Date: el/Y zd&O

r
` _. vision of Water Quality
_ Q Division of Soil and Water Conservation ' F
Other Agencya. -
s O ' �
Type of Visit ® Compliance inspection O Operation Review O Lagoon Evaluation
Reason for Visit 4 Routine 4 Complaint O Follow up 0 Emergency Notification a Other ❑ Denied Access
Facility Number t)ate or Visit: �� 'rime: / Printed on: 7/21/2000
0 Not O erationa) 0 Below Threshold
13 Permitted M Certified © Conditionally Certified [] Registered Date Last Operated or Above Threshold: ....................
FarmName: ....•.............�.'r.�....�I S� �r�✓..,,............. I............................. County :..........�r?%, '_ _ �.........................................
Owner Name: ,........1!l/P!lJfr�....../!s.......................................... Phone No:/..l �..... .1.s....f ........
Facility Contact: 1.7&-X/ �K C/ .... Title. Phone No:
........................ .. . .................... ................
MailingAddress:.- -- ••••............. .......... - ...... ....•---•... -•••--- — -
Onsite Representative:---•---�� , i,....f`"lF.l ..1`75- .......................... Integrator: --- , - ._.----•--- ..
Certified Operator:.--...--- g , . ,�f,�G /�� .......- Operator Certification Ntimber:....1d4-� a .............
- .....
Location'of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Norse Latitude �• �� ��r Longitude �• ��°
Design Current Design Current Design Current -
Poult
Ca .. cti Po Mahon �' Capacity Population C .. Po nlat,on ' .
Cattle
rto
o Feeder ❑Layer [] Dairy
to Finish Non -Layer ❑Non -Dairy
to Wean
"% ❑Other -
Feeder
tv FinishTotal Design Capaeity
Total SSLW
I1jpp> of LagoriFns �2 ElSubsurface Drains Present ❑ Lag�si Area 10 Spray Field Area
Haldiig Po>s% Solid Traps` No Liquid Waste Management System
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes N No
Discharge originated at: ❑ Lagoon El Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made'? ❑ Yes KNNo
b. If discharge is observed. did it reach Water of the State? (If yes, notify DWQ) 0 Yes R.No
c. If discharge is observed. what is the estimated flue: in galfinin?
d_ Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes �To
2- Its there evidence of past discharge from any part of the operation? ❑ Yes [RpNNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes JK�No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4
ldcntifcr: ............rL..'........... ............... A..'y........... ................................... .............................
Structure S
❑ Yes �R No
Structure 6
Freeboard (inches):
5100
Continued on back

)Facility Number. jpZ 7 Date of Inspection Printed on: 7/21/2000
5. Are there any immediate threats to the integrity of any of the structures observed? (iel trees, severe erosion, ❑ Yes 89:No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes *No
(if any of.questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures treed maintenance/improvement?
❑ Yes
MNo
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
KNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
[]Yes
PNo
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes
)(No
11. Is there evidence of over application?` ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
❑ Yes
P(No
12. Crop type &ge=t/& ('c.6
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
�rNo
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
XNo
b) Does the facility need a wettable acre determination?
❑ Yes
)XNo
c) This facility is pended for a wettable acre determination?
❑ Yes
�kNo
15, Does the receiving crop need improvement?
❑ YesekNo
16. is there a lack of adequate waste application equipment?
❑ Yes ATo
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
t&No
18. Does the facility fail to have all components of the Certified Animal Waste Management flan readily available?
Oel Wi P, des i
❑ Yesl-�)Vo
checklis , maps etc.)
s�
19. Does record keeping need improvement? O trrigatio , freeboard, waste analysis & soil sample reports)
❑ Yes )RNo
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
)R7No
21. Did the facility fail to have a actively certified operator in charge?
❑ Yes
X40
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
RNo
23. Did Reviewer/lnspector fail to discuss review/inspection with on -site representative'?
❑ Yes
,SJ No
24. Does facility require a follow-up visit by same agency?
❑ Yes
IQ No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
�00
U. -Yigl�t>kitiris;ei� d0ffciendbig were h0fpd-during this:visit'. Y66 will-tee*iye iio futt#t�
•eori•es�andence�a�vat.thisvisit�•:.. ..�.�.•.•..... -.- �.-.-...•._.•.•.•. _- ..........
CaunuQents (refer-to:quest,on #) Eaglarn any YES ii s4irs :indlor any recommendations or any oilier comtneiattsr
_ s
Use drawings of�facility.ta°bettei.6 lab situations,{t�.se'additinnal gages as necarssary' ). _
yG� �. ,�,�r./,vas of hr-� ••� �'.r,� �.���� ,,s�.td�/ . � ;�
Reviewer/inspector Name v
Reviewer/Impector Signature: - Date: /l .7- 470 5/00

Facility Number: gZ Date of inspection %/ 1101 Printed on: 7/21/2000
Odor Issues
7-6. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below k Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes �KNo
28. Is there any evidence of wind drift during land application? (i-e- residue on neighboring vegetation, asphalt, ❑ Yes ONO
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes ` ,�No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes 114No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? �<Yes ❑ No
ho Comments.an orDrawings:- _
J
5100

F-
0 Division of Soil and Water Canseivation- Operation Review `
t y a# s Division of Soil and Water,ddta rvation Compliance Iiispectio'n r
.s Division of Water Qual,ty = Gomplignce Inspection JI
h Other Agency. OperatiotaPRevtew"'`r'. '-
an
Routine 0 Complaint 0 Follow-ue of DWQ inspection 0 Follow-up of DSWC review 0 Other
Facility Number Date of Inspection
lime of Inspection ' 24 hr. (hh:mm)
13 Permitted Ac ertified 13 Co' itionally Certified [3Registered JE3 Not Operational Date Last Operated:
Farm Name:.,.../..U..y............................................... County'=.�J''''-.....-............
........
Owner Name �..... f R.... Irv. 'lG .... .........-. Phone No :............... 3...."'...r �. .
Facility Contact: ..Title: ............. Phone No:.............. ..................
Mailing Address: ...., 0.......l� tal.�1�../...y.-c................ ..2y
Onsite Representative:_ `e f� Integrator:
...............................................
P 1,+.�..._................................_......... ('/
Certified Operator:..l>!lR +..yi!�......i.. ...... ! `cl ...._.... Operator Certification Number: ............ .......
__..,..........,...
Location of Farm: I
r.................................. _........... ............................................................ ............. ............................. ........................................................................... ............ ...................----------
Latitude �+ �� ��� Longitude • ��°�
Design Current Destgn Current;= Design Current
aacity Population u.CacitPoulaoSwne : Capacity Population
❑ Wean to Feeder
❑ Feeder to Finish
Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts,
[] Boars
[:]Layer ❑ Dairy
❑ Non -Layer ❑Non -Dairy
❑ Other
x Total Desi Ga adt
-Total SSLW
' Number of Lagoons ❑ Subsurface Drains Present ❑ Lagoon Area ❑ Spray Field Area
__.
B61d* Ponds / Solid.Traps _ ❑ No Liquid Waste Management System - -_-
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes /�J No
Discharge originated at: ❑ Lagoon ❑ Spray Field El Other �Tl
a. If discharge is observed, was the conveyance man-made? ❑ Yes No
b. if discharge is observed, did,it reach Water of the State? (If yes, notify DWQ) ❑ Yes No
c. If discharge is observed. what is the estimated flow in gal/thin'?
& Dgjes discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes 4rNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes `r0
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway es ❑ No
Structure 1 Structur 2 Structure 3 Structure 4 Structure S Structure 6
D
Identifier: New lq�
Freeboard(inches): ......,(.. .............................1. ....................... .............I........... ...................................
S. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes #No
seepage, etc.)��
3/23199 Continued on back
1

Facility Number: — Date of Inspection 1/2 —17 �YA
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? El Yes KNO
(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 maintenancetimprovement? ❑ Yes No
8- Does any part of the waste management system other than waste structures require main ten arice/improvernent? ❑ Yes No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes r 0
Waste % nplication
10. Are there any buffers that need maintenance/improvement? ❑ Yes rNO
o
11, Is there evidence of over app-llicationn? ❑ Exccessiive Ponding ❑ PAN/ElYYes
12. Crop type l Bf1�? `- �ii-/ / I �7/.�tal t� • L[li r r![IG2I3
13. Do the receiving crops differ with those desiArfated in the Ce/tified Animal Waste Mana�4ment Plan (CAWMP)? ❑ Yes ANo
14. a) Does the facility lack adequate acreage for land application? ❑ Yes yr
No
b) Does the facility need a wettable acre determination? ❑ Yes TIO
c) This facility is pended for a wettable acre determination? ❑ Yes D 'No
15. Does the receiving crop need improvement? ❑ Yes MLNo
16. Is there a lack of adequate waste application equipment? ❑ Yes ANo
Required Records & Documents
17.
Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
RNo
18.
Does the facility fail to have all components of the Certified Animal Wash Management Plan readily available?
Oe/ WUP, checklists, design, maps, etc.)
❑ Yes
0No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
qNo
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
KNo
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
NINo
22-
Fail to notify regional DWQ of emergency situations as required by General Permit?
(iel discharge, freeboard problems, over application)
❑ Yes
�Iqo
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
k1lo
24.
Does facility require a follow-up visit by same agency?
❑ Yes
00 No
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
PfNo
i�io yi ioris:oi- &ficWhd.ps -mere inofecl Otu'iQg #his:visit; Yoi� wi�i receive ;no fut-t�t'r : '
.-co,r'rtrspntidence:abatttithisvisit.-::.:...
, • :.:.-.-.-:•:......:............ , .....:: .
as 'kes
1;1?e bo4ral /s h,yk 4e Y 6 X urr; cane!ter` • !r[l �� ��
P dt3n.s
o..sweWr
1rO
�a,ve,
AWS
eS
=ck wivl% cefP A Per OVA,
erm,"ticAc Ga. Caro• Iltiq
will be 0- U4 as &_t/ 0Ird 19s . J
I&
Reviewer/Inspector NameIldf
Reviewer/Inspector Signature: _ Date:
3/23/99

Facility Number: Date ofinspection Vz-f2 :f11
Odor Issues
26.
Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
❑ Yes
P(No
liquid level of lagoon or storage pond with no agitation?
27.
Are there any dead animals not disposed of properly within 24 hours?
❑ Yes
A(No
28.
Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
P1f10
roads, building structure, and/or public property)
29.
Is the land application spray system intake not located near the liquid surface of the lagoon?
❑ Yes
30.
Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
❑ Yes
[rlo
31.
Do the animals feed storage bins fail to have appropriate cover?
❑ Yes
Rio
32.
Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes
LMoNo
�
I'Ackditional-,Conijments'andlo—r.DiaWiii - -
3/23/99

Division of'Soil and Water Conservation ❑ Other Agency
Division of Water Quality
12 Roteth>r O Cnm hint O Follow-up of DWQ inspection O hollow -up of DSWC review O Other
�I I I -- IYYIY�r
Date of Inspection
Facility Number
- II III, Time of Inspection 24 hr. (hh:mm)
© Registered ACertitied D Applied for Permit © Permitted 10 Not Operational Date Last Operated :..........................
FarmName: .......... N...t.c...... --....... .��,_ . .:....... ............................... County:.....r .A ?!x s........................................
Owner Name• ...,..1'"�f.ar—A.�.!�. ............... Q f .0 ,. L.ifM..............------........... Phone No:..-...... . err �...... iz 3............... .
Facility Contact:........ QW./'LI .........
.......
..... Title:............................................................... Phone No:...............................-...................
Mailing Address...... f � .... ��.............JU...... ....... AJy-y..,Cll..l./�-p.1.....:.. C ................... zF3�y....
Onsite Representative:....-..--••--_Ge,� ..JV----.....R_ .r. rCrIO..... ..................... Integrator:_._._.. ....................... ................................ --...................
Certified Operator:.._ -,per! �r � e .. ¢�"!.�m.fr:d!5AOperator Certification Number: ................
Location of Farm:
........
..... ---... ... ! c7.. 5.�. �..� a ....e.P
. .. .. .. ..... ..... .. ....
e r n
LrJt ....J�► ... .t1t.�i�....!ll G� .....�i.......14f2�i....TQr...................................................................................................................-
Latitude Longitude �• �u
s nes�gn ,Current ^; a" ` De51�T11 Cllr[ent ;; IXS CliI t
Swlne Ca actt '"Po ula ion
p Y p
- Potilto` .: Ca actt Po Mhon aCattle Capacity Population,,_
❑Layer ❑Dairy
4
❑Non -Layer ❑Non -Dairy
❑ Other
r
9.� _•a,� 'R*. r - i
"� Y Tota! Design Capacit"y' pa
1..".A:
rat
R �. ,v a —f.14- .3 n °f�'grV V f>, ,+�'•tl'a #'.
=
Y ;; Total SSCW.
Number of Lagoons ! Holdtrtg Ponds z
❑ Subsurface Drains Present ❑ Lagoon Area ❑ Spray Field Area
b r� s ' ❑ No Liquid Waste Management System, x`-v
Z.—
..
❑ Wean to Feeder
❑ Feeder to Finish
Farrow to We
Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
General
1. Are there any buffers that need maintenancetimprovement? ❑ Yes l�No
2. Is any discharge observed from any part of the operation? ❑ Yes �[ No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other \
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (if yes, notify DWQ) ❑ Yes Q No
I Is there evidence of past discharge from any pan of the operation? ❑ Yes q No
4. Were there any adverse impacts to the waters of the State other than from a discharge? ❑ Yes kNo
5. Does any part of the waste management system (other than lagoons/holding ponds) require ❑ Yes K
No
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes 14No
7. Did the facility fail to have a certified operator in responsible charge? ❑ Yes ONO
7/25/97

Facility Number• Z-
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (Laeyons.11olding Ponds. Flush Pits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure I Structure 2 Structure 3 Structure 4
Identifier:
Freeboard(ft):........... ........................2.....~.............................................
10. Is seepage observed from any of the structures?
11. Is erosion, or any other threats to the integrity of any of the structures observed?
12. Do any of the structures need maintenance/improvement?
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
❑ Yes 0 No
❑ Yes ANo
Structure 5 Structure 6
❑ Yes 0 No
❑ Yes gNo
❑ Yes gNo
13. Do any of the structures lack adequate minimum or maximum liquid level markers? ❑ Yes A No
Waste AnRlication
14. Is there physical evidence of over application? ❑ Yes JSLNo
(If in excess of WMP, or runoff ente ' waters of the State, notify DWQ)
15. Crop type -, I`NL. .�.�.. .. ..1�........ .L...f7T..:l .. _.__� �=...........................................................................................
16. Do the receiving crops differ with ose designated n the Animal Wa Management Plan (AWMP)? ❑ Yes [[ No
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
22. Does record keeping need improvement?
For Certifed-or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
25. Were any additional problems noted which cause noncompliance of the Permit?
No.vitilatioirsor deficiencies4e're noted;during this:visit.: You4ifl. ikei've.no-Airttier
:�:•corres'p#ndeucet�tioutt�tis:visit:::-:�::: •.::-.:-.� �:• •:::::•.�.-.-•:�.:.. :::�
C"AVe TD
a"Oj rec'o'rcIS. I
to✓era It 4 rit f p5 �Gi3G( S��T /!df /i+i� [ Tct r y1 mince .
❑ Yes V No
Yes J6 No
❑ Yes No
❑ Yes No
❑ Yes No
❑ Yes No
❑ Yes A No
❑ Yes 040
[:]Yes ❑ No
7/25/97

r
P.
�� Division of Soil and Water Conservation � Other Agency
.® Division of Water Quality"R f
f1i Routine O Cunt taint OFollow-up of DWQ inspection O Follow-u of WSWC review O Other
Date of Insprelion lz .7-i7
Facility Number
Time of Inspection y: dO ?A hr. (hh:mm)
IlRegistered O Certified D Applied for Permit D Permitted D Not Operational Date Last Operated:.••,, �_„• , •,-.�,•
FarmName: ._........4......1 t........................../.................... ................... County:...........4t..................................
OFvner Name:..... ,¢ E ..., �. .. 'R,I .G aPY ............................. Phone No....... �%d .. .�... D� .............
A4. / i .r~ ! /�
Facility Contact:
Mailing Address: ........�..`. v` �.. T...... �C/ azz
Onsite Representative: .,,.,.r✓zV.—.//..N
��jj
Certified Operator;- .....,�r!..}>�...
Location of Farm: _ 2 41.444
Latitude �• �� �«
❑ Wean toFeeder
Feeder to Finish
® Farrow to Wean
❑ Farrow to Feeder
(] Farrow to Finish
❑ Gilts
❑ Boars
Longitude
❑ Other
-............................... Phone No: .................................................
ill ..A/C .... . ... �e...................................................
integrator: ...."We
-.y,. .... S
Operator Certification Number.. ,.........�-----.--..•..._...--
�i ac
n �4'atilA: �--
J"^ jU Non-Dairyl
esigi Capact£yr
General
1. Are there any buffers that need maintenance/improvement? ❑ Yes No
2. Is any discharge observed from any part of the operation? ❑ Yes No
Discharge ori6nated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. if discharge is observed_ was the conveyance man-made? ❑ Yes No
b. if discharge is observed, did it reach Surface Water? (if yes. notify DIXQ) ❑ Yes No
c. If discharge is observed, what is the estimated flow in gailmin? AJ14
A. Does discharge bypass a lagoon system'? (Il' yes, notify DWQ) ❑ Yes IN No
3. is there evidence of past discharge from any part of the operation? ElYes IN No
4. Were there any adverse impacts to the waters of the State other than from a discharge? ❑ Yes kKNo
5. Does any part of the waste management system (other thaan lagoons/lioldingponds) require ❑ Yes 19 No
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes KNo
7. Did the facility fail to have a certified operator in responsible charge? ❑ Yes No
7/25197 Continued an back

Facility Number:
8. Are there lagoons or storage ponds on site which need to be properly closed? e. No
Structures fLagoons,Holdins Ponds. Flush Pits. etc.1
9. is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes tKNo
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: .. .......... // )) ..... ................................... .......................................................---............
Freeboard(ft) • ............... �. �4..�: g1...........7. .............. ............ ........... .......... ....................................... ................. :............. ................ .........................
10. is seepage observed from any of the structures? ❑ Yes 1ANo
11. is erosion, or any other threats to the integrity of any of the structures observed? ❑ Yes K No
12. Do any of the structures need maintenance/improvement? ❑ Yes CRNo
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
Waste Application
14. Is there physical evidence of over application?
(if in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type...................................................................................
r¢ f....V�r ..._
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
17. Does the facility have a lack of adequate acreage for land. application?
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
22. Does record keeping need improvement?
For Certified or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
25. Were any additional problems noted which cause noncompliance of the Permit?
0 No.viuWions•or deficiencies. we noted -during this:visit:- :You.wiH receive 66ftirther :
c6rrespotidehce about -this: visit:- : : - -
❑ Yes. )f No
❑ Yes )6No
❑ Yes 1 No
❑ Yes PkNo
❑ Yes *NO
❑ Yes ® No
❑ Yes No
❑ Yes eftNo
❑ Yes XNo
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
��V
7/25/97
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date: %Z—.3, — T

Site Requires Immediate Attention; NC)
Facility No.._
DIVISION OF ENVIRON74ENTAL MANAGEM N"r
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE. � 4u tM_ , 1995
Time- 405
Farm Narm/Owner: tk" � V� C`+ A BM ��C.
Mailing Address: o _ 0X Z-0Z F�v { u � i 1 � N . C . ZAA
County: o\rn S-D N
Integrator: , 1j10 �, � 1A ' V Phone:
On Site Representative: W 1 k�_ 5 i A N C 11,, Phone: c l D- 5 3 t- 1(ot 3
Physical Address]Location: J cS tH S 'ESSDMt, , S�', 1 N- U lv
44gs-Z/- 1 w"s!�_ 4&JU6A ,%vet_ 8� IL-Db Ah& 141'A
Type of Operation:
Design Capacity: .
Swine
1010O Sows
Poultry Cattle
Number of Animals on Site: I i 00
DEIM Certification Number: ACE DENT Certification Number: ACNEW
Latitude: Longitude: ,
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of I Foot + 25 year 24 hour storm event
(approximately 1 Foot +'7 inches) es r No Actual Freeboard: _Ft. 0 Inches
Was any seepage observed from the lagoon(s)? Yes o0N Was any erosion observed? Yes o No
Is adequate land available for spray or No Is the cover crop adequate? es or No
Crop(s) being utilized: V C o tiA4 4L 4
Does the facility n;ect SCS minimum setback criteria? 200 Feet from Dwellings . Ye or No
100 Feet from Wells? es r No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes o�
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes 06
Is animal waste discbxged into waters of the state by nun -made ditch, flushing system, or other
similar man-made devices? Yes or(�D If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? Yes or o
Additional Comments: P �).v_.C�
�.•�n � �i ,�� '(fie �, tc. � � ► �.yu n 5 e cv 5n,. � � �, d �e .1`. ` ��� A�. r ���
S� �L Ike. 3vc-, W,�,sNc_ r�eco&45 _I
-1,WN-V�IU0 1
Inspector Name
Si
cc: Facility Assessment Unit Use Attachments if Needed.

r 20
- State of North Carolina '7
Department of Environment,
Health and Natural Resources ` • •
Fayetteville Regional Office
James B. Hunt, Jr., Governor Aldmbmdmbmgft
�T-
Jonathan B. Howes, Secretary p E H N F1
Andrew McCall, Regional Manager
DIVISION OF ENVIRONMENTAL MANAGEMENT
August 26, 1993
United Carolina Bank
Att: Peggy Carter
P. O. Box 170
Clinton, North Carolina 28328
SUBJECT: Inspections Inquiry
Joel Faircloth Hog Farm - CAFO
N 6 C Hogs, Incorporated
NCSR-1406 near Halls Cross Rd.
Autryville, North Carolina
Sampson County
Dear Ms. Carter:
On April 21, 1993, Mr. Ricky Revels, Environmental Technician,
Fayetteville Regional Office, inspected the Faircloth hog farm for the
purpose of evaluating animal waste handling practices. The hog farm is
located off NCSR-1406 and is a Murphy Farms, Inc., contract grower
operation. All waste disposal practices are covered in the
grower/company contract agreement. As a result of the inspection
conducted by Mr. Revels on the above mentioned date, it was determined
that the concentrated Animal Feeding Operation is in compliance with current
Animal Feed Lot Regulations.
Continued best management practices (BMP's) of animal waste
handling facilities is essential to the productivity of farm operations
and to the protection of the Environment.
Please be advised that the Fayetteville Regional Office will
periodically inspect animal feeding operations to assure compliance with
State Law.
Wachovia Building, Suite 714. FayetteAlle, North Carolina 28301-5043 Telephone [phone] FAX 919-48"707
An Equal Opportunity Affirmative Action Employer 5M recycled/ 10% post -consumer paper

Ms. Carter
Page 2
August 26, 1993
Should you have any questions, do not hesitate to contact Mr. Ricky
Revels, Environmental Technician of this office at [phone].
Sincerely,
Kerr T. Stevens
Regional Supervisor
KTS/RR/rr
Enclosures
CC: Kent Wiggins
FRO - CAFO Files