820481_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental Qual

Type or visit. v,&�r,ompuance inspection V wperauon meview V atructurervaivauun V recnmcai Assistance I
Reason for Visit: 43 Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: ' U Departure Time: o County: �i' fh !v Region:
Farm Name: `R�k RrvK Owner Email:
Owner game: Q it (w Phone:
Mailing Address:
Physical Address:
Facility Contact: C t'-4 fs f a rr,�a rt"� Title: Phone:
Onsite Representative: t ` Integrator: 6 & 5'
Certified Operator: L 0c ,
Certification Number: *! C 3
Sack -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 Current
Cattle Capaci Pop.
DairyCow
Wean to Feeder
Non -La er
DairyCalf
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Z o
7 Z.D
Design Current
D , P,oul Ca aci P.o P.
La ers
DairyHeifer
D Cow
Non -Dairy
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
I
Beef Brood Cow
Qther
Other
Turkeys
Turkey Poults
Other
I
E
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at. ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (if yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes Q`Ko ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
[] Yes [ -lqo
❑ Yes [�No
G-NA ❑ NE
U �1' ❑ NE
[3 CIA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 21412015 Continued

Facility Number: R,7 - Liel Date of inspection: Z
rite Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes Elegy❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? E] Yes ❑ No [❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): z'q A
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
E . 6_
❑ 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
Q 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
',❑- -55
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[3' I�o
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
o
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
E3'15o
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below_ ❑ Yes [Zj4 U ❑ 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):— S% O
13. Soil Type(s): V (} i Ile
14. Do the receiving crops differ from those designated in the CAWMP7 ❑ Yes [R-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 0 Yes Eg,< ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes No
❑ Yes FTNo
❑ NA ❑ NE
❑ NA ❑ NE
Required Records & Documents
N
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes e
❑ NA
❑ NE
20_ Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes No
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
[]Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes Vivo
❑ 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 El Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ NA
❑ NE
23. 1f selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes ONO
❑ NA
❑ NE
Page 2 of 3 21412015 Continued

Eacilt Number: - q Date of inspection:
�A. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [_Altf" ❑ NA ❑ NI~
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes EfflRio ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey [—]Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes E],itT ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ET o ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes die- ❑ NA ❑ NE
and report mortality rates that were higher than normal?
4_
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
❑.N
[] NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
3 I. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
tSJ o
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
Yes
[D-No-
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
[T' o
[] NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
0-Tqo-
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
ar
G- -fy -e-3,3 C(
TZ
c'A 0110 -- 3 v g .- � 9 s(
Reviewer/Inspector Name: J-
Reviewer/Inspector Signature:
Page 3 of 3
PhoneN q 3 3j - n l(
Date:: 16
2141201

type of Visit: (67 20Utine
Hance Inspection V Operation Review U Structure :valuation U 7 echnical Assistance I
Reason for Visit: 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of visit: J Arrival Time: i, v Departure Time: F—jT1?TPj County: J/- Region:
Farm (Name: �C�.�i level
Owner Name: ",kor-rct j
Mailing Address:
Physical Address:
Owner Email:
Phone:
Facility Contact: (.1aA6t L &&ctAte Title: Phone:
Onsite Representative: 1( Integrator: 0 6 — 5
Certified Operator: L, Gc 11,713 �G�/t t Certification Number:
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Design Current DesignCurrent Design C•arren#
Swine Capacity Pop. W l Poultry Capdc1ty Pop. C•arile Capacity Pop.
. =-
Wean to Finish La er DairyCow
Wean to Feeder
Non -La er
DairyCalf
Feeder to Finish'�_'�'''
�.. ` DairyHeifer
Farrow to Wean
D�s>gn Current D Cow
Farrow to Feeder
Dry P,oultr Ca aci _Po , Non -Dairy
Layers Beef Stocker
Farrow to Finish
Gilts
Non -Layers Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Othe,
Turkey Poults
`
J[LjOl.her
10ther
DiseharQes and Stream Imgacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (I f 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 � 'o ❑ NA ❑ NE
[] Yes [:]No [G]'s'�A ❑ NF
❑ Yes [:]No [q<A ❑ NE
❑ Yes ❑ No
❑ Yes E31R o
❑ Yes [ffNo
[]:�<A
❑ NE
❑ NA
❑ NE
C] NA
❑ NE
Page I of 3 21412015 Continued

Facili Number: Date of Inspection- r�
Waste Collection & 'Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
CiphrD NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
[] No
[E�KA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3
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
[?fAo
❑ 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
S. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[!rNo
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
[;4'No
[] NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[fNo
❑ NA
❑ NE
maintenance or improvement'?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes dNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > I0% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window
j [3 Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): (.} eeKtt"& s 4,_o 1PdaT / �G v_,
13. Soil Type(s): L[rfy`Gl f%1 1/4?
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[t—No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[tr'No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
EfrNo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[fj No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[2'No
❑ NA
[] NE
R uired 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
[!I —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 [�fN
❑ Waste Application [3 Weekly Freeboard El Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall El Stacking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [I No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes �N
o ❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
o ❑ NA ❑ NE
Page 2 of 3 2/4P-015 Continued

Facility Number: Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes eNo ❑ NA ❑ NE
25. is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [fr"To ❑ 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:
2b. 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 rile 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 CAW MP?
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
GTNo
❑ NA
❑ NE
❑ Yes
[fj No
❑ NA
❑ NE.
❑Yes
QNo
❑NA
❑NE
❑ Yes ErNo DNA ❑ NE
❑Yes [ No ❑NA ❑NE
❑ Yes [2rf�o ❑ NA [] NE
0 Yes [�No
❑ Yes ❑'No
❑ Yes []No
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
Comments (refer to question # ): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
q,13-NS
r, e_X�e_ 51 r,,e
7 16
o -3o't-bps
Reviewer/Inspector Name:
Reviewer/Inspector Signatur
Page 3 of 3
tfY7U
Phone: 0 `,V4
Date:
21412015

R V( S 9_7 .
(Type of Visit: 0"Cliance inspection Q Operation Review Q Structure Evaluation O Technical Assistance I
Reason for Visit: eRoutine O Complaint O Follow-up O Referral O Emerp-ency O Other O Denied Access
Date of Visit: Arrival Time: Departure Time: ,'i�f County: Region:
Farm Name: Owner Email:
Owner Name: $st Phone:
Mailing Address:
Physical Address:
Facility Contact: CC41CK5 3 q,,t ,L Title: Phone:
Onsite Representative: qIntegrator: 1413_ 5
Certified Operator: Qut,� Certification Number: L
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Design Current
Design
Current
Design Current
Swine
Capacity Fop.
Wet Poultry
Capacity
Pop.
Cattle Capacity Pap.
Wean to Finish
Layer
Dai Cow
Dairy Calf
Wean to Feeder
I
—7 cro
INon-Layer
I
Feeder to Finish
7.a
Dairy Heifer
Farrow to Wean
Dry Cow
Farrow to Feeder
D , Poul
Ca aci
P.o
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Beef Feeder
Gilts
Non -La ers
Boars
Pullets
Turkeys
Beef Brood Cow
-
Other _
Turkey Poults
Other
Other
Discharges and Stream Impacts
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 D WR)
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 [L]. 4e--E] NA ❑ NE
❑ Yes
❑ No
[:�<A
[] NE
❑ Yes
[:]No
[3NA
❑ NE
❑ Yes
[]No
[j]A
ONE
❑ Yes
❑'No
❑ NA
❑ NE
[:]Yes
ENo
❑ NA
[] NE
Page 1 of 3 21412015 Continued

Facili Number: - Date of Inspection: U^'t-' 161
Waste Coilection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ❑ No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ED-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 [P<o ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
T 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 []34o ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes �o ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 1310 ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes la ❑ NA
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 100% or 1.4 Ibs. ❑ 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): C 'Cf �' L -& J G 0 P a s �J`i ram,
13. Soil Type(s):
ti
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or Iand 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?
Reauired Records & Documents
❑ Yes Ea4o
❑ Yes U�rNo
❑ Yes 2<o
INIM
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes io ❑ NA ❑ NE
❑ Yes EF1Go ❑ NA ❑ NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
R o
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[2,5o
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
2 1. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
[�JJfo
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall [:]Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
[—]Yes
. No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
[:]Yes
F3<
❑ NA
❑ NE
Page 2 of 3 21412014 Continued

Facili Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [9'<o ❑ NA ❑ NE
25. is the facility out of compliance with permit conditions related to sludge? if yes, check ❑ Yes E�r<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 to provide documentation of an actively certified operator in charge? ❑ Yes 2�No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes C114o ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAW?"?
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?
Cal;
s t u�e'
Reviewer/Inspector Name
ReviewerAnspector Signature:
Page 3 of 3
�L
❑ Yes �o ❑ NA ❑ NE
❑ Yes [3To D NA ❑ NE
❑ Yes E]No ❑ NA ❑ NE
Yes [�o ❑ NA ❑ NE
[:]Yes 2rNo ❑ NA ❑ NE
❑ Yes [;?14o ❑ NA ❑ NE
❑ Yes [''No ❑ NA ❑ NE
Phone:
Date:
21412011

•1 � f _
Farm Name: L aJ ✓�1 Owner Email:
Owner Name: Yrt Phone:
Mailing Address:
Physical Address:
Facility Contact:
5 ✓UJ'10 Title:
Onsite Representative: {
Certified Operator: p✓t
Back-up Operator:
Location of Farm:
Latitude:
PhoneeJ:� `�
Integrator: ' "[ -
Certification Number:
Certification Number:
Longitude:
Design Current
esign Current
Design Current n DII
Swine
Capacity Pop.
Wet Poultry Capacity PopeCattie Capacity Pop.
5
Wean to Finish
La er Dairy Cow
Wears to Feeder
Layer Dairy Calf
Feeder to Finisliy"
2p
.. Dai Heifer
Farrow to WeanPle
Cuurrt"'
nDesign ,�; D Cow
en
Farrow to Feeder
ultCa aci P,`o " Non-Dai
Farrow to Finish
Layers Beef Stocker
Gilts
Non -Layers Beef Feeder
Boars
Pullets Beef Brood Cow
Turkc s - -
Other
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes CS -NO- ❑ NA ❑ NE
[—]Yes [:]No [g-N/�❑ NE
[—]Yes [:]No ❑DNA ❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) [—]Yes [:]No E NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes No ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

Facili %Yumber: - Date of Inspection:
Waste Collection & Treatment ir
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No F_1_UA—❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
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
Ea_ND__ 0 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
Q�N� ❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[Z]I� ❑ 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-Na­o NA
❑ NE
maintenance or improvement?
Waste Apylication
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[3-NT—f] NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [:]Yes E4-NO-0 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,, � f ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
Cr
12. Crop Type(s): ° i e- 1�{ ��1 '� b 0 to, �,ci-�{
' 13. Soil Type(s): I, c -s°
14. Do the receiving crops differ from those designated in the CA WMP?
❑ Yes
EjNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
U3 o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
IJ wu
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
�
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
Y(N o
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
21No
❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
[:]Yes
F3rNo
❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design [:]Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
No
❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall [:]Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
�o
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[Z No
❑ NA ❑ NE
Page 2 of 3
21412011 Continued

Facile Wumber: -I 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 ❑ 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:
—❑ NA ❑ NE
Eff-NV—_❑ NA ❑ NE
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes mo [] NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
�o
❑ NA
❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
D-N-6
❑ 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
r 'l�o
❑ 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
0-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
0
❑ 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
ra s"u
0 NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
E:rNo
❑ NA
❑ NE
Comments (refer to question #fJ Explamxany'YES� savers and/or any additional recommendations or: anyAather comments
Use drawings of fac' ' #o-:better eaplaut situatibnns (use.; additional pages as necessary)."..,
44t 9-1 71 1 5-
P d �-03 S T0L,-e t q
Reviewer/Inspector Name:
0
Reviewer/Inspector Signature:
Page 3 of 3
� V1_ ( 1-5
Phone: .3q
Date: kr_v�
21412014

q fll
_1q
Type of Visit: (Compliance Inspection U Operation Review U Structure Evaluation U Technical Assistance
Reason for Visit: routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit:
Arrival Time: [S ; J
Departure Time: ; i]c7
County
Farm Name:
Owner Email:
Owner Name: _
�_ �LiJ'rr—
Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: 7rel _Lr217 Phone:
Onsite Representative: �$� Integrator: �!`�4%�
/ 01
Certified Operator: Certification Number:
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Region:
Iiiiiii
Design Current
- "Design
Current
Design
Current
Swine
Capacity Pop.
Wet Poultry
Capacity
P p.
Cattle Capacity
Pop.
F
Wean to Finish
La er
Dairy Cow
Wean to Feeder
Non -La erI L
- %� :,�, �. .. ..
��4:_
Dairy Calf
DairyHeifer
Feeder to Finish
Z20r
o '~
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
D ,fault% .._Ca
La ers
-Layers.
Pu]lets
Turkeys
aci
PoP.
Non-Dai
Beef Stocker
Beef Feeder
Beef Brood Cow
Farrow to Finish
Gilts
Boars
Other
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes P$.No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
Page I of 3
21412011 Continued

[Facility Number: GE- Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes E, 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): 1 . `�
Observed Freeboard (in): 1;2 �9 -
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes ® No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement? [S Yes ❑ No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes C& 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 W No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes JZLNo
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Pbosphorus ❑ 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): _ r_ynu�
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [l No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes P61, No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes [. No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
[:]Yes allo ❑ NA ❑ NE
❑ Yes §No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes gNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes M.No ❑ NA ❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ®, No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 " Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes 0 No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes E ..No
LZ:
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA [] NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facili Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE
li
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 JQ No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the ❑ Yes E�No ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
®.,No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
[ No
❑ NA
❑ NE
Comments (refer to question_#): Explain any YES answers and/or any additional recommendations or any other com!nents
Use drawings of facility. -to Oetter explain situations (use additional pages as necessary). _..
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: p'/r1—q 73—"�3�
Date:
21412011

Fr
Type of Visit: Compliance Inspection U Operation Review U Structure Evaluation U Technical Assistance
Reason for Visit: 9-1routine 0 Complaint 0 Follow-up O Referral 0 Emergency O Other 0 Denied Access
Date of Visit: L Arrival Time: Departure Time: County: a+ti- Region: F� 0
101*'
Farm Name: _ ��j FZZ rw Owner Email:
Owner Name. Phone:
Mailing Address:
Physical Address:
Facility Contact: J�7ez:ry/ lnop,l—y Title:
Onsite Representative:
Certified Operator. , 2n,,
Phone:
Integrator:
Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current
, '
Design
Cnrrent
Design Current
Swine Capacity Pop.
Wet PoultryVW
,.
Capacity
Pop.
Cat#ie Capacity Pap.
x
Wean to Finish
1: giver
-Lager
Dairy Cow
Dairy Calf
Dairy Heifer
Wean to Feeder
Feeder to Finish
Farrow to Wean
Current
Dry Cow
Farrow to Feeder
D . Fault .
La ers
,Ca aci
P.,o
Non -Dairy
Beef Stocker
Farrow to Finish
Gilts
-Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Teske Puults`
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 M No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) ❑ Yes ❑ No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes
❑ No
❑ Yes
CR No
[:]Yes
® No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 21412011 Continued

Facility Number: - 1 Date of Ins ection: //— —/3
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 0 No ❑ NA ❑ NE
a. if yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes F-A No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7_ Do any of the structures need maintenance or improvement? ❑ Yes &] No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes & No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ® No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes Lo No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [:]Yes FXLNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, 2,n, etc.)
❑ PAIN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift❑ Application Outside of Approved Area
12. Crop Type(s): I /
/"M A O-- le LIA
I3. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes (,No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes C3.No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes EKLNo ❑ NA ❑ NE
❑ Yes allo ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes 0,No ❑ NA ❑ NE
20. Does the facility fail to have al components of the CAWMP readily available? If yes, check 0 Yes gLNo ❑ NA ❑ NE
the appropriate box.
❑ WUP ❑Checklists [:]Design ❑ Maps ❑ Lease Agreements ❑Outer:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes fa No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes r5fNo
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [&No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facili Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ®, No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes E4 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 fast survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? [:]Yes M No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes Ea No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface 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?
❑NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
[:]Yes ®,No ❑ NA ❑ NE
❑ Yes �a No ❑ NA ❑ NE
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
[g No
❑ NA
❑ NE
❑ Yes
[3-No
❑ NA
❑ NE
Comments (refer to question;# ): Explain any.YES answers and/or any additional recommendations or anyothencomments:
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: V-' 3 ��exD
Date:
21412011

a
iiiii— D Water Qnallty (J
Faeiiity Number ff% "� Division of,SoiE and Ware
_ �; Otgency
Type of Visit: GrCompliance Inspection Operation Review 0 Structure Evaluation O Technical Assistance
Reason for Visit: GI outine 0 Complaint 0 FoIlow-up Q Referral a Emergency Q Other 0 Denied Access
Date of Visit: —/ Arrival Time: / Departure Time: County: Region: r
100,
Farm Name: 0f- Owner Email:
Owner Name: 0,'I j k /` Phone:
Mailing Address:
Physical Address:
Facility Contact: or — Title: Phone:
Onsite Representative: Integrator: �g
> >
Certified Operator: l� r- f��/li � Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current
Design Current
Design Current
Swine
Capacity Pop.
Wet.Poultry Capacity Prop._
@tittle Eapacity Pop.
3_
_
Wean to sh
La er
Dairy Cow
Wean to Feeder
I iNon-Layer
I
Dairy Calf
Feeder to Finish
-
Dai Heifer
Farrow to Wean
Di U Curnrent
_
Cow
Farrow to Feeder
D . 'nova."
;m;,�_Y.,Ca aei P.o
Non-D '
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
411
Turkeys
Other a
Turke Puults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
[:]Yes
5INo
❑ NA
[] NE
Discharge originated at: [: Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
0 No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
® No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
No
[] NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Caxunued

[Facility Numbers - Date of Ins ection: —
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 E] No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes ® No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses no immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
Yes
E!I-No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
allo
❑ NA
[3 NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
E&No
[] NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
� No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [:]Yes [3-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): .6-rm Kd a< / ay,�/S
13. Soil Type(s): t"V'W"
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes a No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [g 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
U�.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
® No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
V[ No
❑ NA
❑ NE
the appropriate box.
❑ WLIP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
( No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
[S No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
�0 No
❑ NA
❑ NE
Page 2 of 3
21412011 Continued

FaciliNumber: jDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ZLNo ❑ NA ❑ NE
25. is the facility out of compliance with permit conditions related to sludge? if yes, check [:]Yes fNo ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
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
El No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes [a No ❑ NA ❑ NE
❑ Yes (a No ❑ NA ❑ NE
❑ Yes C�j No ❑ NA ❑ NE
❑ Yes allo
❑ Yes allo
❑ Yes [21No
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
Comments (refer to question #1):. Explain any YES answers and/or any additional recommendations or�any otWcommFE6..
Use drawings of facility io,better.explain situations (use additional gapes as necessary) .' .
r--
Reviewer/Inspector Name:
Phone: ':):-/ D-- 33-33 a o
Reviewer/Inspector Signature:
Page 3 of 3
Date:/�-
2/4/2011

Type of Visit: ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: / r CountyRegion: zmn
Farm Name: 4— .3 E—arWL, Owner Email:
Owner Name: � ,7. 3 �,o t- Phone:
Mailing Address:
Physical Address:
Facility Contact: Z®-17 /fk_11_el Title: Phone:
Onsite Representative: -G
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Integrator: zl<'
Certification Number:
Certification Number: ,
Longitude:
Design :Current""Design
•Current
Design Current
Swine = C•apacity • Prop.
Wet Poultry _ Capac�tvw Pop.
Cattle C►Po apaclty p.
Wean to Finish
Wean to Feeder
La er
Non -La er
Dairy Cow
Dairy Calf
Feeder to FinishZ292Dairy
Heifer
Farrow to Wean,Des
ign-- Gurrent
Dry Cow
Farrow to Feeder
a ci
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
Turkey Poults
Other
-.�c �•—�....::w-..:aem:sa.�v.�.uaaa..�r..��.�:.W,.�.-sai....ra.+W,*,,:�m�;s_..
Other
-..
Discharges and Stream Impacts
I _ Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
❑ Yes RNo ❑ NA ❑ NE
a. Was the conveyance man-made? ❑ Yes ❑ No ❑ NA
b. Did the discharge reach waters of the State? (If yes, notify DWQ) ❑ Yes ❑ No ❑ NA
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes ❑ No
❑ Yes Ill No
❑ Yes D§ No
❑ NE
❑ NE
[] NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 21412011 Continued

Facili Number: - / Date of inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 21 No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
® No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
JZ No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
tRYes
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
allo
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
[Yes
10
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
J No
❑ NA
❑ NE
maintenance or improvement?
11. Is `there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes Z] No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
t2. Crop Type(s); ;"ea&--
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
PINo
❑ 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
® No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[allo
❑ NA
❑ NE
Renuired Records & Documents
19. Did the facility fail to have the 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 Co 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 [g No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes E[No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [allo ❑ NA ❑ NE
♦ a..,
Page 2 of 3 21412011 Continued

Facili Number: - Date of Inspection:
. 24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ® No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes 0 No ❑ NA ❑ NE
the appropriate box(es) below.
0 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 �KNo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ® No ❑ NA ❑ NE
Other lssues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
�No
❑ NA
❑ NE
and report mortality rates that were higher than normal?
24. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
�R 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
C,,fo
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
jj 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
No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
® No
❑ NA
❑ NE
Comments refer to question;#): Explain any -YES answers -and/or any additional recommendations pr s. — ' { y other comments- '
IJse drawings of facility twbetter explain situations (use. additional pages as necessary) ::. ,
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date:
21412011

I
Type of Visit compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit Q)<outine Q Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: Arrival Time: :J 07 Departure Time: a a County: Region:
Farm Name: Z Owner Email:
Owner Name: " Ar- Phone:
Mailing Address:
Physical Address:
Facility Contact: d z; !��' "` Title: Phone No:
Onsite Representative: Integrator:
Certified Operator: �t -- �lY� Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: a o E--]' I --]"
Longitude: [� o 0 ` = «
Design Current Design Current Design Current
Swine Capacity Population Wet Ptsttltry Capacity Population Cattte Meapacity Population
to Finish
❑Layer
❑ Dai Cow
to Feeder
❑Non -La er
❑ Dai Calf
❑ Dai Heifer
D Cow
Non-Dairyw
r to Finish
Poultry
to Wean
to Feeder
FFFF
to Finish
La ers❑
Beef Stocker
Non -La ersPullets❑
❑ Turke s ❑ Turke Poults
Beef Feeder
❑ Beef Brood Cowl
of Structures:
❑ Other INumber
Discharges & Stream Impacts
I . Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (Ifyes, 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 KNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
RNo
❑ NA
❑ NE
❑ Yes
MNo
❑ NA
❑ NE
Page 1 of 3 12128104 Continued

Facility Number: —
Date of Inspection
Waste Collection & Treatment
`1 4. Is storage capacity (structural plus stonn storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
❑ Yes RNo
❑ Yes ❑ No
Structure 5
❑ NA ❑ NE
❑NA ❑NE
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): �9
Observed Freeboard (in): �'(1
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
RNo
❑ 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
S 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
,�,�y6
l�No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
® No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ® No ❑ NA ❑ NE
❑ Excessive Pending ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes (,K No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
17. Does the facility lack adequate acreage for land application? ❑ Yes
18. Is there a lack of properly operating waste application equipment? ❑ Yes
RNo ❑ NA ❑ NE
5LNo❑ NA [I NE
K No ❑ NA ❑ NE
RNo ❑ NA ❑ NE
Comments (refer to question #): Eaptain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessatyj:
lei
Reviewer/inspector Name yI FP Phone:
Reviewer/Inspector Signature: Date: %D
Page 2 of 3 r � 12128104 Continued

Facility Number: 99— Date of Inspection
Re uired Records & Documents
# 19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes j,No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [&No ❑ NA ❑ NE
the appropriate box. ❑ wup ❑ Checklists ❑ Design El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes &_No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain inspections ❑ Weather Code
22,
Did the facility fail to install and maintain a rain gauge?
❑ Yes
L3 No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
CR 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
[B 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
;Z No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
9No
❑ 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, contract 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
tO No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
U No
❑ NA
❑ NE
A,ddithWq-OjGomutegts and/_o_r Drawings:
L
t
Page 3 of 3 12128104

Type of Visit ompliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit a outine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: `y"7S —YT7 Arrival Time: rf v �! Departure Time: ��f County:. Region:
Farm Name: :U _ Owner Email:
Owner Name: (l�D �1 / Phone:
Mailing Address:
Physical Address:
Facility Contact:✓ Title: Phone No:
Onsite Representative:Integrator: T .:!a�
Certified Operator: 2�' , � �L- tOIf Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude:[--] o E=I ' 0 " Longitude: = ° = `
Design Current
Design Current
Design
Current
Swine
Capacity Population
V1`et Poultry Cgpacity Population
Cattle Capacity
Population
❑ Wean to Finish
❑ Layer
❑ DairyCow
❑ Wean to Feeder
❑ Non -Layer
❑ DairyCalf
ceder to Finish O 70 0
❑ Dai Heifer
❑ Farrow to Wean
Dray Poul
❑ D Cow
❑ Farrow to Feeder
❑ Non -Dairy
to Finish
La ersElFarrow
❑Beef Stocker
❑ Gilts
rEl
Nan -La ersElBeef
Feeder
❑ Boars
Pullets
❑ Beef Brood Co
❑ Turkeys
Qther;
❑ Turkey Poults
❑ Other
❑ Other
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes Q No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
Pg-No
❑ NA
❑ NE
❑Yes
PNo
❑NA
❑NE
12128104 Continued

Facility Number: L Date of Inspection p [%-
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?
Stnscture I Stncture 2 Structure 3 Structure 4
❑ Yes IRNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
5lructurc y Siruetur%, 6
Identifier:
Spilhwy?:
Desianed freeboard (in): %
Observed freeboard (in): L
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes (g.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 0Tlo ❑ 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? F5.Yes ❑ No ❑ NA ❑ NE
S. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes NNo ❑ 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 KNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 9LNo ❑ NA ❑ NE
maintenance/improvement?
11. is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes SCNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[]PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drifl ❑ Application Outside of Area
12. Crop type(s) - /�1 rr�► _-
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
❑ No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
I
/- 7pe7—
j
AL
Reviewerlluspectar Name �� ,J r v , �.� Phone: 7�-y
Reviewer/Inspector Signature: / Date:
I
I212KIU4 Continued

Facility Number: — Ll Date of Inspection r
k+ Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes VKNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes .,No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes RNo ❑ 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 9,No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes L,No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
RNo
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
E[No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
CgNo
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
Jallo
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
allo
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
9io
❑ 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
ELNo
❑ 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
.53No
❑ NA
ElNE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
E$ No
❑ NA
❑ NE
33, Does facility require a follow-up visit by same agency?
❑ Yes
�No
[I NA
❑ NE
12128104

Type of Visit ompiiance inspection O Operation Review © Structure Evaluation Q Technical Assistance
Reason for Visit outine O Complaint Q Follow up O Referral O Emergency Q Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: 307 County: Region:
Farm Name: `" ' Owner Email:
Owner Name: �f�?2 �iC.�IL�'/" _ Phone:
Mailing Address:
Physical Address:
Facility Contact: gri Title: Phone No:
Onsite Representative:��� /�l��/Y Integrator:
Certified Operator; 42E!2_ /� _ _ iOperator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: =o =' =is Longitude: 00 =. [� «
Design Current
Design Current _ _. Design Current
Swine
Capacity Population
WetPl� y ,
�Capac�ity Populah'orn Cattle Capacity Population
❑ Wean to Finish
❑ La er
If f El Dairy Cow
❑ an to Feeder
Layer
1 110 Dairy Calf
Feeder to Finish
- T;_= - - "` ❑ DataHeifer
❑ Farrow to Wean
A-= ❑ Dry Cow
v�
❑ Farrow to Feeder
"N ❑Non- Dairy
'
❑ Layers
❑ Farrow to Finish
❑ Beef Stocker
❑ Gilts
❑ Non -Layers
❑ Beef Feeder
❑ Boars
❑ Pullets
Beef Brood Co
_
Otber z._
❑
turkeysWHOM
--❑
❑ Other
_t
❑ Turkey Poults
❑ Other
�I
Number of Structures:
Discharges & Stream Impacts
I. is any discharge observed from any part of the operation?
❑ Yes
R[No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c_ What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
allo
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
[V No
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12128104
Continued

Facility Number: / Date of Inspection
t
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 0 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): _Z2--
Observed Freeboard (in): r-
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ yes CkNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed []Yes JgNo ❑ 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? E&Yes ❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes MNo ❑ 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 J,No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes JgNo ❑ NA ❑ NE
maintenance/improvement?
I t . Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes CNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[:]PAN ❑ PAN > l0% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
[:]Outside of Acceptable Crop Window [:]Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) rt U6 - -
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CA WMP?
[] Yes
N No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
RNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
Wo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
RNo
❑ NA
❑ NE
18. is there a lack of properly operating waste application equipment?
❑ Yes
®.No
❑ NA
❑ NE
a any recommendations or any other connments, Comments refer to ues on;# Eg tarn an YES answers and/o
Use drawtngs oifa #"titter e$plaui situ ho'"n_s(ns�dt#ionAA
pages as necessary):
Reviewer/inspector Name :_ Phone: /_c7. �3
Reviewer/Inspector Signature: Date: G�
Page 2 of 3 - r 12/2VO4 Continued

Facility Number; Date of luspecti;on
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes JO No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes C3No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Desig
n ❑Maps El Other
21. Does record keeping treed improvement? If yes, check the appropriate box below. ❑ Yes ,0 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
[0 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
[9 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
W 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
3 No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
® No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
CkNo
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
ElYes
Q l.No
❑ NA
❑ NE
on$I,CO m ots�antior Dra�vtn k
Addttt
L
7
Page 3 of 3 1228104

ision of Water Quality
FFae�iity Number :::O Division of Soil and Water Conservation
O Other Agency
Type of Visit Ort—ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit L'7 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: �Arrivaall Time: =Departure Time: ® County:
Farm Name: 13 - r aOwner Email:
Owner Name: 02a. _rc^I _, r __ __ ________ Phone:
Mailing Address:
Physical Address:
Facility Contact: 0 Ji�lYt�_ _ �� e� Title: Phone No:
2
Onsite Representative: t�rye-r — Integrator:
Certified Operator: 42'-_ TZ4 . Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Region: ! L-0
Location of Farm: Latitude: 0 0 0 f =is Longitude: 0° 0 I= 4
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Design Current,. Design Current
Capacity Population Wet Poultry Capacity Population
❑ Laver
�❑ Non -La ei
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 Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures: M'
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 R1 No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
[gNo
❑ NA
❑ NE
[:]Yes
CB�No
❑ NA
❑ NE
12128104 Continued

Facility Number: 60a— f Date of Inspection ! a
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
19No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No
❑ NA
❑ NE
(ic/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
No
❑ NA
❑ NE
through a waste management or closure plan'?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental tbreat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
MYes
❑ 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
❑ Yes
[4 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 CKNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 100/. or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)1
13. Soil type(s)-
14. Do the receiving crops differ from those designated in the CAWMP? [:]Yes L,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
R No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes
X No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/Inspector Name Phone: a--' ors
Reviewer/Inspector Signature: Date:
12128104 Continued

r
Facility Number: I Date of Inspection ' 3 `10
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 0 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes �&No ❑ NA ❑ NE
the appropriate box. ❑ WUp ❑ Checklists
❑ Design ❑Maps El Other
2 L Does record keeping need improvement? if yes, check the appropriate box below. ❑ Yes 19 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 fait to install and maintain a rain gauge?
❑ Yes
R) No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
C,No
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[KNo
❑ 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?
0 Yes
[9 No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
[3 No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
A No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
JZ 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
[9 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
KNo
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
§1 No
❑ NA
❑ NE
Comments and/or Drawings:
12128104

�i
Type of Visit ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance c
Reason for Visit routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: YJ ; C�? Departure Time: County: s +-- Region: JEb -
Farm Name: FAr r,, Owner Email:
Owner Name; 43 utk er Phone:
Mailing Address:
Physical Address:
Facility Contact: 00M Title:
Onsite Representative: e fr _-maorrr_
Certified Operator:
Back-up Operator:
Phone No:
Integrator- `e; &'
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: F] e 0 I = t[ Longitude: = o =' 0 "
Design Current
Swine Capacity Population
❑ Wean to Finish
Wet PFairtvvAVWC-aaMacitv*Poniuil=a5,tioF]n
❑ Layer
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Wean to Feeder 1
10 Non -Layer I I
❑ Dairy Calf
Feeder to Finish D b 91
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
❑ Layers
❑ Beef Stocker
❑ Gilts
❑ Non-t.a its
El Feeder
❑ Boars
❑ eks
El Beef Brood Co
❑ Tuurke s
keys
Other
❑ Other
❑ Turkey Pouits
❑ Other
Number of Structures:
Discharses & Stream impacts
1. Is any discharge observed from any part of the operation?
[]Yes
JgNo
❑ NA
❑ NE
Discharge originated at: ❑ Structure [] Application Field ❑ Other
a_ Was the conveyance man-made?
❑ Yes
No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
E.No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
qNo
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
CK No
❑ NA
❑ 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
[allo Cl NA ❑ NE
a. If yes, is waste level into the structural Freeboard?
❑ Yes
00 No ❑ NA ❑ NE
Structure_I Structure 2 Structure 3 Structure 4
Structure
5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in).
5. Are there any immediate threats to the integrity of any of the structures observed?
[]Yes
PINo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
9 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?
C8 Yes
❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
14 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
19 No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[Z No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
KNo ❑ 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 C1 Application Outside of Area
12. Crop type(s)
13. Soil type(s) _/� y"f•I� ✓i ��>! --�
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes Callo ❑ 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
0No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
K No
❑ NA
❑ NE
�,Wi f- bA re artrL o-rt-- -"n. 4LJ
r b2V-1M
Reviewer/Inspector Name y a «. Phi
� _ y - c ,q, one: 3.332-
Reviewer/Inspector Signature: Date: 6-,177722 60
12128104 Condnued

• Facility Number: Date of Inspection'
iRequired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes J.No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes JK 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 VkNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
PQ No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
ER No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
9 No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
K No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
Z No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
19 No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
EK No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
NNo
❑ 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
M No
94
ElNA
ElNE
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
9) 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
K No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
9No
❑ NA
❑ NE
Additional'Comments andlorgl)rawtngs:
Page 3 of 3 12128104
Page 3 of 3 12128104

Type of Visit *Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: ui.�Departure Time: % � tlt County: Region:-"
4
Farm Name: r� � �y f! Owner Email: �' M
Owner Name: D-0@1 �� i L�� Phone: -� `+l�d�
Mailing Address: _6 50.1 Ea"vt —Fo �^►`� r . �-ti TDs.� Ai
Physical Address:
Facility lily Contact: 61t eet� oar ,e Title:
Onsite Representative:
Certified Operator: tC4�'►'
Back-up Operator:
Location of Farm:
Swine
Phone No:&/P) L—�iA�43
Integrator: S 4i
Operator Certification Number:
Back-up Certification Number:
Latitude: 0 c 0 4 ❑ Longitude: ❑ ° = ❑
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -La et
❑ Wean to Finish
❑ Wean to Feeder
Feeder to Finish
t?
t) O
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turke s
❑ urkSy Poults
❑ Other
Discharges & Stream Impacts
. Is any discharge observed from any part of the operation'?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State'? (If yes, notify DWQ)
Design Current
Cattle Capacity. Populati0n
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heife)
❑ Dry Cow
❑ Non-Dai
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures:
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 �lo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
El No
❑ NA
❑ NE
❑Yes
❑NA
[I NE
[I Yes
,MN'�o
o
El NA
❑NE
12128104 Continued

i
t '4
Date of Inspection
Facility Number: f 2, — yf j
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
Eg"No
❑ NA ❑ NE
a_ If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA ❑ NE
Structure I Structure ? Structure 3 Structure 4
Structure
5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): 20.
Observed Freeboard (in): 0 0_
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[jrNo
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
[ErNo
❑ 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
[jrNo
❑ NA ❑ WE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
[Rio
❑ 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
GYNo
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
0 No
❑ NA ❑ NE
maintenance/improvement?
11, Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
,--,/
ltd No
❑ NA ❑ WE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drifl ❑ Application Outside of Area
12. Crop h'Pe(s)
13. Soil type(s) �4 .
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
MINo
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
UNo
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination',
El Yes
0;; No
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
01fgo
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment?
ElU yes
o
❑ NA ❑ NE
@ammcttts fer to gtie5ttan #fj Explain any YES answelrs tinfl%r•=any+reeommeuliatlons ar flny
atber comments.
IIse drawietgs"±'ofcfaellity_twbeWr'ie plain sltuatiotts: {nse a�ditioni i�pages ssrnecessary) ,
94ert eki- +Lt /uttals ��6,.-:ks 0+� tic �.�gos� �� /%a�.-+�i*�tteol Ae-
S;0P a S ,
Reviewer/Inspector Name �'� „ Phone:
Reviewer/Inspector Signature: Date: 02 —.'tsl-4�
12128104 Continued

4
Facility Number: i — glj I Date of Inspection �d1�z9/—os'I
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 3 No ❑ NA ElNE
G
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box-
❑ WUP El Checklists ❑Design ❑Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes E�INo ❑ NA ❑ NE
❑ ❑ w*&iy �❑ Writ aaF� ❑ %ff*=tyst ❑ Waste Transfers' ❑ n
~i-
[IRainfall ❑ Wig— ElCrop ►YieldA El120 Minute Inspections ❑ ll ❑ WkeaheHE
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
['3No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[a'No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
53No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
RNo
❑ NA -
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
0; j%
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
[j�,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
53'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
ERNo
❑ 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
EkNo
❑ 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
[rNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
K�No
❑ NA
❑ NE
Addit}on2dw"ateuts
12128104

Type of Visit • Compliance Inspection Q Operation Review Q Lagoon Evaluation
Reason for Visit 40 Routine 0 Complaint O Follow up Q Emergency Notification O Other ❑ Denied Access
Facility Number Date or visit. -o Time: o
� Not eratinnal Q Below Threshold
F
�Certited ©Conditionally Certified Registered Date Last Operated or Above Threshold:
Farm Name: County:
Owner Name: -----©an _ Di �7er - 'Phone No:
Mailing Address: _ yp� .iAgJr -- - - /f � - _ ... 42 '12Ln
Facility Contact. Title:.____ Phone No-
dnsite Representative: - - �l�n N a 0 re Integrator: &Cg e
Certified Operator: •_,,,,_,_,_­ Ht _ _ Operator Certification Number:
Location of Farah:
M19M11 ne ❑ Poultry ❑ Cattle ❑ horse Latitude • L� �" Longitude •
Discirames & Stream lmoacts
1. Is any discharge observed from any part of the operation? ❑ Yes BQo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a- If discharge is observed, was the conveyance man-made? ❑ Yes 214o
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/thin?
d. Does discharge bypass a la -goon 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 Coiieetion & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier: — i
❑ Yes
allro
l
❑ Yes
[?50
❑ Yes
allo
❑ Yes
[No
❑ Yes B oo`
Structure 6
Freeboard (inches):
t
12112103
Cormumd

i Facility Number: 92 Lf j
Date of inspection
S. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes LSKO
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑ Yes �O
C105r1rE 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 maintenancefunprovement? ❑ Yes 01vo
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
[] Yes
B-1�0
elevation markings?
Waste Application
10. Are there any buffers that need maintenanceltmprovement?
❑ Yes
[a -No
11. 1s there evidence of over application? If yes, check the appropriate box below.
❑ Yes
[-?No
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
�r0 too
12. Crop type 41.mrt.r
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
2110
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
210
16. Is there a lack of adequate waste application equipment? ❑ Yes &Wo
Odor issues '
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes (W10
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes 0-wo
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional ❑ Yes Ewo—
Air Quality representative immediately.
UPleld Copy ❑ Final Notes
Mr. 16,11%r 4ol a frs� le.It n 4,s /,vie_ Afar fays«` A,.5 le l
10 ef' . Lo�a 0 0,2 Wa4
IA" Bv//Pr � Is ply"s
at �4lr o.y y`�SUz/,
TQ ifCP"'f01 1401ef_L Uh
Please
�en
c., A,/ '{lt
f�c i', gu P '% e $ '(V n�.oir.{ /�al�s Ci�ov.►o�
'fi e j"".
lts,
(ee tore{'{
to ava,`ri rvn o{F,)
Reviewerilhispector Name r-nr ,n.„„ .k x5�T � ?a_,,._ x sc
Reviewer/Inspector Signature: Date: /d - k _y
12112103 Continued

• Facility Number: $ 2 — Date of Inspection �y o
Required Records & Documents
21 _ Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
aw
22_ Does the f ility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie! 'Firr, cl - ts, i , m a; tic.)
❑Yes
23. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
Pi4,0
mac! ❑ Awaffnkmkiysis
y- 2 --;, I y-1,;t (;-1W�). 4 .7 -!Ly - !, j -
24. is facility not in'compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
QX6
25. Did the facility fail to have a actively certified operator in charge?
❑ Yes
&o
26_ Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
ONo
27. Did Reviewer/laspectnr fail to discuss review/inspection with on -sits representative?
Q Yes
9-No
28. Does facility require a follow-up visit by same agency?
❑ Yes
9N6_
29_ Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
0110-
NPDES Permitted Facilities
30_ Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
❑ Yes
31. if selected, did the facility fail to install and maintain rainbrtakers on irrigation equipment?
❑ Yes
❑ No
32. Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ No
33. Did the facility fail to conduct an annual sludge survey?
❑ Yes
❑ No
34. Did the facility fail to calibrate waste application equipment?
❑ Yes
❑ No
35. Does record keeping for NPDFS required forms need improvement? If yes, check the appropriate box below.
❑ Yes
❑ No
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After I" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
12112.f03

State of North Carolina
Department of Environment,
Health and Natural Resources ! W
Fayetteville Regional Office r
James B. Hunt, Jr., Governor
Jonathan B. Howes, Secretary
Andrew McCall, Regional Manager
DIVISION OF ENVIRONMENTAL MANAGEMENT
Water Quality section
August 2, 1995
Mr. Carl Little
Dogwood Farms, Inc_
Post Office Box 49
Clinton, N.C. 28328
Subject: Concentrated Animal Feeding
Operation Inspections
Dogwood Farms, Inc. Facilities
Sampson County
Dear Kr. Little:
Thank you for interrupting your busy schedule to assist in the
inspections of the Dogwood Farms, Inc. swine facilities in Sampson
County August 1, 1995.
Attached please find a copy of the inspection forms for the
facilities visited. We ask that you forward a copy of the forms to
the appropriate growers with the thanks of this office for allowing
timely access to their farms.
Again, thank you and Kr. Brian Spell for assisting in the
inspection process. If you have questions or comments concerning
the inspections please do not hesitate to contact me at (910) 486-
1541.
Sincerely,
K;a� I
Paul E. Rawls
Environmental Specialist
cc: DEK Facility Assessment Unit
Wachovia Builddng, Suite 714, FayetteAe, North Carolina 28301-5= Telephone [phone] FAX [phone]
An Equal Opportunity Affirmative Action Employer 50% recycled/ 10% post -consumer paper

Site Requires Immediate Attention:
Facility No. 0 1
DIVISION OF ENVIRONMENTAL MANAGE 1ENT
ANWAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: August 1 , 1995
Time: 1 l
Farm Nanwowmzr: _ 3 4, -(V:C'r _ _ `l ,n��ax� L1041c-r
Nghng Address:_ Rl t 2e�K 17A nl; n" rJ -Cr2zaw r9Iv) SZ 4 : d:64 s-
County:';;3mp SQnIntegrator:.: Dogwood Farms, Inc. Phone:_(910) 522-2104 ext, 316
On Site Representative: — PhonCZ91 a) 542 2.1 rU
Physical Address[Location: yw, SR t3 t i ray.. le N%0 a L sR i a *-L;a s Imistsec6ow
Type of Operation: Swine x Poultry Cattle
Design Capacity: mom Number of Animals on Site:
DEM Certification Number: ACE DE.M Certification Number: ACNEW
Latitude: 3-5° 03' .3-4" Longitude: 78 ° gr- ' a..?
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of l Foot + 25 year 24 hour storm event
(approximately I Foot + 7 inches) �&or No Freeboard:�Ft. Inches
Was any seepage observed from the lagoon(s)? Yes o�as any erosion observed? Yes or
Is adequate land available for spray? Yes or No Is the cover crop adequate? Yes or No (Not Evaluated)
Crop(s) being utilized:
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings? 6r or No
100 Feet from Wells? (Y& or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes orb
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line: Yes or No (Not
Is animal waste discharged into water of the state by man-made ditch, flushing system, or -other Evaluate
similar man-made devices? Yes or No If Yes, Please Explain.
,Does the facility maintain adequate waste management records (volumes of manure, land applied, Not Evaluated)
spray irrigated on specific acreage with cover crop)? Yes or No
Additional Comments: This was a very bre-1f inspect aa.. n mar,- thorof,vh 1XIsaection wi_1_l__bp _
conducted in the future,
Information noted on this inspection_ was obtained from the JULerg�r.ator or DEM-filpg__
If you have uestions regarding this report please contact Paul Rawls, D M W ity
Section at [phone].
Inspector Name
Signature
cc: Facility Assessment Unit Use Attachments if Needed-