820502_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental Qual

,3 IMs [Ms•I I fl e( I i� tip
lit
visionof Water Resources
vision of Soil and Water Conseher AgeecJ'
Type of Visit:om liance inspection Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: 1"1 - Arrival Time: 4 d Departure Time: p County:
Farm Name: L Z Owner Email:
Owner Name: C e b"J& f wc.-5 Phone:
Mailing Address:
Region:
Physical Address:
Facility Contact:�''�i 5 '�, +�1 j.� Irl Title: Phone:
Onsite Representative: % Integrator: f �
Certified Operator: Certification Number: u19 J a
q
Back-up Operator: Certification Number:
Location of Farm: Latitude:
Longitude:
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)?
❑ Yes Q-N-o�~❑ NA ❑ NE
❑ Yes
Design Current
❑-ice'
Design
Current
Design C•nrrent
Swine
Capacity Pop.
Wet 1'oteltry
Capacity
Pop.
Caitle Capacity Pop.
Wean to Finish
La er
Da' Cow
Wean to Feeder
[LiNon-La er
Da Calf
Feeder to Finish
147-
Da' Heifer
Farrow to Wean
Design
Current
D Cow
Non -Dai
Farrow to Feeder D . Poul , Ca aci P,o
Farrow to Finish
Layers
Beef Stocker
Beef Feeder
Gilts Non -Layers
Boars
Pullets
Beef Brood Cnw
-
Turke s
Other
Turke Poults
Other
Other
Discharges and Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes Q-N-o�~❑ NA ❑ NE
❑ Yes
❑ No
❑-ice'
❑ NE
❑ Yes
❑ No
[3 -XX
❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes ❑ No
❑ Yes [E�Ro
❑ Yes 2jrN0
[ NA
❑ NE
❑ NA
❑ NE
❑ NA
❑ NE
Page I of 3 21412015 Continued

Faciji Number: S 0.1, Date of Inspection: /. Z s
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ['-N7C ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5 Structure 6
❑NA
Identifier:
❑ Yes
Eo
Spillway?:
❑ NE
❑ Yesfo
Designed Freeboard (in):
❑ NA
❑ NE
Observed Freeboard (in):`
❑ NA
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes _ �N_o ❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
❑ NE
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes No ❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes E3 - o_ ❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
[:]Yes [10 ❑ 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 �fo ❑ NA
❑ NE
maintenance or improvement?
_Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes 62,l�o ❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes ED< ❑ 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 p Application Outside of Approved Area
12. Crop Type(s): _... Q� I� t,J'CL &
13. Soil Type(s): (�J
14. Do the receiving crops differ from those
in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑Yes
[i] o
❑NA
C] NE
❑ Yes
Eo
❑ NA
❑ NE
❑ Yesfo
❑ NA
❑ NE
❑ Yesfob
❑ NA
❑ NE
❑ Yes
[-iqo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes E:J'No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check [—]Yes r. o ❑ 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 D 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 ®No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes Ej No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facile Number: Date of Ins ection: - .
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
ZL T o
[] NA ❑ NE
�5. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
0,N6_- ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey E] Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List stmcture(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes
� o
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
[1,11fo—
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
[]rNo
❑ 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?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
[—]Yes L!l ammo- ❑ NA ❑ NE
[—]Yes NA ❑ N -E
❑ Yes g - <o ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? D Yes E No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative? ❑ Yes oNo ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? [::]Yes �j(No ❑ NA ❑ NE
Reviewer/Inspector Signatui
Page 3 of 3
Date: � � ACVUu Is
2/4/1015

Type of Visit:Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: t04outine 0 Complaint tD Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: �P`� Departure Time: d County:
Farm Name: Owner Email:
Owner Name:_ '—`�'iAf! i �`� [_WW Nth Phone:
Mailing Address:
Physical Address:
Facility Contact: des zwCG Title:
Onsite Representative. 1(
Certified Operator: k
Back-up Operator:
Location of Farm:
Latitude:
Region: tv�D
Phone:
Integrator: PI'L-S49W.,
f ,
2
Certification lumber: f � 3 q
Certification Number:
Longitude:
Discharses and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes. notify DWR)
e, 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 Haters
of the State other than from a discharge'?
❑ Yes [Aio [] NA ❑ NE
[] Yes
Design Currents}*Design
Cur er nt' �� �: Design Current
Swine
Capacity Pop.
1Vet Poultrv� `Capacity ;Popo- =
Cattle". C•apacity Pop.
❑ NE
Wean to Finish
La er
Dai Cow
Wean to Feeder
on -Layer
Dai Calf
Feeder to Finish
j (
.',; _
Dai Heifer
Farrow to Wean
�� Design Current
Cow
Farrow to Feeder
D , P.nult F Ca actty 1'0 `i`y
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -La ers
Boars
Pullets
LeefFeeder
Brood Cow
-
Turkeys.
Qther �.._.
Turkey Poults
ITM
Other
Other
*-
Discharses and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes. notify DWR)
e, 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 Haters
of the State other than from a discharge'?
❑ Yes [Aio [] NA ❑ NE
[] Yes
❑ No
CJ -NA
❑ NE
0 Yes
❑ No
OINA
❑ NE
❑ Yes ❑ No
❑ Yes �- o
❑ Yes 7No
rn"NA
❑ NE
❑ NA
❑ NE
❑ NA
❑ NE
Page I of 3 2/4/2015 Continued

lFalcility Number: iJ Date of Ins ection:
Waste Collection & Treatment
S 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [;.Ne-- ❑ NA ❑ NE
a. if yes, is waste level into the structural freeboard? ❑ Yes ❑ No [ ❑ 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 �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
PTNo
❑ NA
❑ NE
waste management or closure plan?
❑ NA
❑ NE
❑ Yes
[3,'No
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
OErNo
❑ NA
❑ NE
S. Do any of the structures 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
0No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
[] Yes
[f No
❑ NA
❑ NE
maintenance or improvement?
I 1 _ Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes Qlo ❑ 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): 15e"L� JCj "b
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the1CAWMP'?
15. Does the receiving crop and/or land application site need improvement?
16_ Did the facility fail to secure and/or operate per the irrigation desigm or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment'?
_Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ Yes
[Vo
❑ NA
❑ NE
❑ Yes
[3'No
❑ NA
❑ NE
❑ Yes
[3,'No
❑ NA
❑ NE
❑ Yes [ No ❑ NA ❑ NE
[]Yes E30'No ❑ NA ❑ NE
❑ Yes [jrNo ❑ NA 0 NE
❑ Yes dNo ❑ NA ❑ NE
❑ WUP []Checklists ❑ Design ❑ Maps ❑ Lease Agreements El other:
21. Does record keeping need improvement? If yes, check the appropriate box below. [—]Yes ffl No
❑ Waste Application p Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ t20 Minute Inspections ❑ Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes �No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes dNo
[:INA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑NA ❑NE
Page 2 of 3 2/4/2015 Continued

F cili Number: 5 Q 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
E No
❑ NA [] NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance.
26. Did the facility fail provide documentation of an actively certified operator in charge?
[:]Yes
�o
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
[r No
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately_
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes �o ❑ NA ❑ NE
❑ Yes E No ❑ NA ❑ NE
❑ Yes [TNo ❑ NA ❑ NE
❑ Yes [2No ❑ NA ❑ NE
❑ Yes [2140
❑ Yes D -N- o
❑ Yes c2rNo
[] NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
Comments (referto question#): Explain any YES answers and/or any additional recommendations or any other cotnmerits
Use drawings offacility to better explain sit iations (nse;,additional pages as necessary):
c'[ it a,", , �0'), s- /(,
SLAP, Su'�f�_ t
1
Reviewer/Inspector Name: Y v1) 1 Nf4o Phone: ` jS -S,3 J
Reviewer/Inspector Signature: 4K, A.A At 1% Date:
Page 3 of 3 V 21412015

i ype of v isii: ap t,ompnance inspection V uperanon iceview V structure r vaivanon L} i ecumcai Assistance
Reason for Visit: O'R'outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: CountyRegion:
Farm Name: Owner Email:
Owner Name: Lv ha jn c' Y t^��K. f Phone:
Mailing Address:
Physical Address:
Facility Contact: `S J"(c,&Title: Phone:
Onsite Representative: t Integrator: N 4" _
Certified Operator: C( Certification Number: (? r
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
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)?
❑ Yes [J. [:] NA ❑ NE
❑ Yes
Design CurrentDesign
[2 -NA
❑ NE
Current
Design Current
Swine
Capacity Pop.
Wet Poultry
Capacity
Pop.
Cattle C•a acity Pop.
Wean to Finish
Layer
DairyCow
Wean to Feeder
IL
J_Nogn-Uyer
Dairy Calf
Feeder to Finish
( ,z
Dairy Heifer
Farrow to Wean
Design
Dry Cow
Farrow to Feeder
D . P,oul
Fa aci
Po
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
Other
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
C. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes [J. [:] NA ❑ NE
❑ Yes
[:]No
[2 -NA
❑ NE
❑ Yes
❑ No
P�NA
❑ NE
d. Does the discharge bypass the waste management system? (if yes, notify DWR) ❑ Yes [:]No NA ❑ NE
c
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes [21 No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes J� No ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412014 Continued
r
J l

lAcil1 ty Number: IDate of Inspection*
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes EP46- ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ©JNK ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in): _
Observed Freeboard (in): L
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
Structure 5 Structure 6
❑ Yes 2190 ❑ NA ❑ NE
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 DVM
7. Do any of the structures need maintenance or improvement? ❑ Yes JE!rNo ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes ❑moo ❑ 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 [l<o- ❑ 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 or improvement?
1 I . Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes 0 -Ko ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload D 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. CropType(s): ` — - 6"C_� 5(0
13. Soil Type(s):
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
14. Do the receiving crops differ from those designated in the CA4?
❑ Yes
�10
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
�o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
2No
❑ NA
❑ NE
acres determination?
❑ Yes No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
17. Does the facility lack adequate acreage for land application?
❑ Yes
<o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
Ej`No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes VNo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMF readily available? If yes, check
❑ Yes YNo
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists El Design [] Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑Stocking ❑ Crop Yield [:1120 Minute Inspections ❑ Monthly and 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 ❑ No
❑ NA
❑ NE
Page 2 of 3 2/4/2014 Continued

FAility Number: jV jDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? [:]Yes [ oo [:INA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [0- 0 NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes 2<0 ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes 2(No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document [] Yes D/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 [XNo ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the ❑ Yes ['No ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface file drains exist at the facility? If yes, check the appropriate box below. ❑ Yes eNo ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CA WMT? ❑ Yes [�('No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative? ❑ Yes bNo ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? [] Yes j2r�o ❑ NA ❑ NE
Comments (refer to question #):: Explain any YES answers_andlor any additional recommendations of any. other comments:
Use drawings of facility to better explain situations;{use addition's! pages as necessary).Cj
A
GA
Reviewer/Inspector Name:
L
Reviewer/Inspector Signature:
Page 3 of 3
Phone: �3 3r— 333 l
Date: 9fW 1 l:/
214414

Type of Visit: EKomplinnec inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: &ioutine 0 Complaint ,0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: County:_ Region
Farm Name: Z—Q 2 Owner Email:
Owner Name: v`1n, Phone:
Mailing Add_ gess:
Physical Address:
Facility Contact: Cu �� t t'�''� Title: Phone:
Onsite Representative: l� Integrator: y -
Certified Operator: L Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude: Longitude:
Discharges and Stream impacts
1. Is any discharge observed from any part of the operation?
Discharge originated ac ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes <o ❑ NA ❑ NE
[:]Yes []No C]"NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
Design Current
❑ No
Design
Current
Design
Current
Serine
Capacity Pop.
Wet Poultry
Capt' acity
M.
p.
Cattle C►apacity
Pop.
2. Is there evidence of a past discharge from any part of the operation?
Wean to Finish
C3 No
❑ NA
Layer
3. Were there any observable adverse impacts or potential adverse impacts to the waters
[:]Yes
�o
Da Cow
❑ NE
of the State other than from a discharge?
Wean to Feeder
I INon-Laycr—]__Dairy
Calf
Feeder to Finish
N,165
Dairy Heifer
Farrow to Wean
esCnrrent
M
Cow
Farrow to Feeder
D . P,o iltr.
aci Pio
Non -Da'
Farrow to Finish
La err
Beef Stocker
Gilts
Non -La err
Beef Feeder
Boars
Pullets
Beef Brood Cow
--, r
Turkeys
Turkey Poults
Other
Other
ry"'
Discharges and Stream impacts
1. Is any discharge observed from any part of the operation?
Discharge originated ac ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes <o ❑ NA ❑ NE
[:]Yes []No C]"NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
❑ No
DNA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (if yes, notify DWR)
❑ Yes
❑ No
[3'—NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
C3 No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
[:]Yes
�o
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 2/417014 Continued

11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes E]Xo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l 0 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s),.L"�
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[5-M
❑ NA
❑ NE
Facility Number: Date of Inspection:
❑ Yes
[2 -No
❑ NA
❑ NE
Waste Collection & Treatment
[] Yes
[3 3N0
❑ NA
❑ NE
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
B -M
[] NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
�� N`°E
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
U No
Identifier:
❑ NE
❑ Yes
No
❑ NA
Spillway?:
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
No
❑ NA
Designed Freeboard (in):
Observed Freeboard (in):_
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
❑-?,ro
❑ 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
[aJISK
❑ 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 DVM
7. Do any of the structures need maintenance or improvement?
❑ Yes
M-1go
❑ NA
❑ NE
S. Du any of the structures lack adequate markers as required by the permit?
❑ Yes
Qd-'_
❑ 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
C31G
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
���
[` " o
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes E]Xo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l 0 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s),.L"�
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[5-M
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[2 -No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
[] Yes
[3 3N0
❑ NA
❑ NE
acres determination?
[]Other:
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
U No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
E?(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.
❑1VUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
[]Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
[]Yes
[?"No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield [:1120 Minute Inspections ❑ Monthly and V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
No
❑ NA
❑ NE
Page 2 of 3 2/4/2014 Continued

Fachi Number: - Date of Ins ection: 7X I
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ED-NoC] NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [—]Yes �o ❑ NA ❑ NE
the appropriate box(es) below_
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
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 ®.?Q'o--?❑ NA ❑ NE
❑ Yes [;Ko ❑ NA ❑ NE
❑Yes ❑. E] NA ❑NE
❑ Yes ❑<o ❑ NA ❑ NE
❑ Yes [].No ❑ NA ❑ NE
❑ Yes Cjm° ❑ NA ❑ NE
❑ Yes [2<o
[:]Yes ErNo
[:)Yes [q -No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA [] NE
Comments (refer to question 9): Explain any YES answers and/or any additional recommendations or :an) other comments.,
Use :drawings of facility to better explain situations (use additional pages as necessary). ,Z ;
5('O�t / �'- a-4' Iq
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Phone: `kss ls__�
Date:
Page 3 of 3 y 2/4/2011

5
'Type of Visit: UCompfiance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: (+Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: 0 Departure Time: County..L Region��_
Farm Name: Z �u <% j L "2 Owner Email:
Owner Name: V-1 `tom ' 0 �� Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: ellv` t5 19a0wig
Certified Operator: 4
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator: t 22
Certification Number: ,% .3 i �Q 1
Certification Number:
Longitude:
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes [s oo [] NA ❑ NE
❑ Yes
Design Cu rent n. i Design Current
R IWetf
Design Current
❑ NE
Swine
Ca acr Po
p ty p.
Poult ,
ry
Ca ac
p qty Pop
Cattle Capacity Pap.
n to Finish
Layer
Da' Cow
n to Feeder Non -La er
L
Da' Calf
er to Finish,
¢r
Da' Heifer
ow to Wean
e _
Design Currents
Dry Cow
Farrow to Feeder
Dr. P,oultr.
Ca aci * -0 � "
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
t7ther
Turkeys
Turkey Poults
Other
Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes [s oo [] NA ❑ NE
❑ Yes
❑ No
❑.P3:4-
❑ NE
❑ Yes
❑ No
E3 --M
❑ NE
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 �10 ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters [—]Yes [5 o ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 2/412011 Continued

Facili Number: - tDate of Inspection`"( P'�dsVV , ( I
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ffNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes Q N ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in): _
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a
waste management or closure plan?
Structure 5 Structure 6
❑ Yes EJ -No ❑ NA ❑ NE
❑ Yes P7—No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes 2<o ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes [ o ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks) e
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
RNo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [:)Yes
C�No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground
❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure
to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift
❑ Application Outside of Approved Area
12. Crop Type(s): 6 ec! "560
13. Soil Type(s): e
1
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes
❑ No
❑ NA
0 NE
acres determination?
IT Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes VJ-No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ZP?6 ❑ NA ❑ NE
the appropriate box.
❑WVP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [ ,Woo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections [:]Monthly and l" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes �No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes U3r o ❑ NA ❑ NE
Page 2 of 3 2/4/2011 Continued

a
Facitity Number: U EDate of Inspection:" ff%/Ltf I
24. Did the facility fail to calibrate waste application equipment as required by the permit?? ❑ Yes ff3'� ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? if yes, check ❑ Yes [� o ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes []-iso' ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑.Pdo ❑ NA ❑ NE
Other Issues
2$. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes Z�X6 ❑ NA ❑ NE
❑ Yes O.N$ ❑ NA ❑ NE
❑ Yes [0>o ❑ NA ❑ NE
❑ Yes L�Wo ❑ NA ❑ NE
[:]Yes [ErNo
[:]Yes [frNo
[:]Yes ErNo
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Reviewer/Inspector Signature:
Page 3 of 3
Date:
2/4/2011

type of visit: t%.omptiance inspection U Vperation Review U structure Evaluation U i ecnnicai assistance I
Reason for Visit: (Mine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: ; oa Departure Time: County*__5_.__
5 .__ Region:
Farm Name: r- Q� G L OwnerEmail:
J`
Owner Name: pPhone:
Mailing Address:
Physical Address:
Facility Contact: ��� a��lc,� Title:
Phone:
Onsite Representative: Integrator:
Certified Operator: S'v - - Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: 0 Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes [&No ❑ NA ❑ NE
❑ Yes [:]No
[:]Yes ❑No
❑ Yes ❑ No
❑ Yes [§d No
❑ Yes ® No
❑ NA ❑ NE
❑NA ❑NE
❑NA ❑NE
[:3 NA ONE
❑ NA ❑ NE
Page I of 3 1/4/1011 Continued
Desigit Current
Swine Capacity Pop.
Vet Poultry��,;.� Capacity Pap.
Cattle - Capacity Pop.
Wean to Finish
La er
Dai Cow
Wean to Feeder
Non -Layer
Dai Calf
Feeder to Finish
•:: =
Dai Heifer
Farrow to Wean
``Desi n Current
Cow
Farrow to Feeder
Dry Poul -z C ci Pzo
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turke s,'.
4
Qtl r
Turke Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: 0 Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes [&No ❑ NA ❑ NE
❑ Yes [:]No
[:]Yes ❑No
❑ Yes ❑ No
❑ Yes [§d No
❑ Yes ® No
❑ NA ❑ NE
❑NA ❑NE
❑NA ❑NE
[:3 NA ONE
❑ NA ❑ NE
Page I of 3 1/4/1011 Continued

Facili Number: - 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 ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): _ rg
Observed Freeboard (in): _ y�-
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes R 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 RNo ❑ 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 r17 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 g No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [ Q No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [—]Yes (0 -No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s): 1r�%zc
14. Do the receiving crojK differ from those designated in the CAWMP?
[—]Yes
J<No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
ZI 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
M No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
Imo, No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
E No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
[] Yes
KNo
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes JR 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 No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes QJ -No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 2/4/2011 Continued

.[Facility Number: - DInspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes M No ❑ NA ❑ NE
t
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes Oa No ❑ NA ❑ NE
the appropriate box(es) below.
[�] Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? []Yes ® No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes 0 No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/storage Pond p 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 ® No ❑ NA ❑ NE
❑ Yes Q No ❑ NA ❑ NE
❑ Yes [Z�No ❑ NA ❑ NE
❑ Yes Dg -No ❑ NA ❑ NE
❑ Yes No
❑ Yes No
❑Yes[No
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other coniffi.eIiQ 1
Uic drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name: `��r.�_ (i!2 'I.—
OF
Reviewer/Inspector Signature: _A2ff:;;iL
Page 3 of 3
Phone: }/!?' 5 y c'
Date:
2/412011

i
I ype of visit: Cy Compliance Inspection V Operation Review O Structure Evaluation U Technical Assistance I
Reason for Visit: (YRoutine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access 11
Date of Visit: Arrival Time: 1 am Departure Time: F cj! ad Ainj County: �q
Farm Name LC,4 F 14 £ rAR 00 L Lf - L 2 Owner Email: T
Owner Name: ag Ettms
Mailing Address:
Physical Address:
Phone:
Region: +IBRO
Facility Contact: C. UPOaS p►RwteK Title: Phone:
Onsite Representative: oTpi^r►S- Integrator: PREs4af c
Certified Operator: _C U R %S A R 1.-, it K Certification Number: L X 4 7
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes [3No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a_ Was the conveyance man-made? ❑ Yes ❑ No [2 NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) ❑ Yes [:]No [�NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) [] Yes [:]No [�NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑Yes+❑�No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes &No ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 2/4/2011 Continued
Design Current
Design Current
Design Current
Swine
ji
Capacity Pop.
Wet Poultry
Capacity °Pop.
Cattle Capacity Pop.
Wean to Finish
Layer
Dairy Cow
Wean to Feeder
411,3 g
Non -La er
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
- DesignCurrent
Dry Cow
Farrow to Feeder
Dr. Poul_
,Ca aci ,�P�o ,
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
�a
Turks s
Other __
Poults
Other
—.Turkey
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes [3No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a_ Was the conveyance man-made? ❑ Yes ❑ No [2 NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) ❑ Yes [:]No [�NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) [] Yes [:]No [�NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑Yes+❑�No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes &No ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 2/4/2011 Continued

. 1
Facility Number:- p Date of Inspection: y
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes b No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? [—]Yes V No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
14. Do the receiving crops differ from those designated in the CAWMP.
❑Yes
[ f No
❑ NA
Spillway?:
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
E�No
❑ NA
Designed Freeboard (in): q
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
[g No
❑ NA
Observed Freeboard (in):�
acres determination?
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[v7 No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
18. Is there a lack of properly operating waste application equipment?
❑ Yes
EJ'No
❑ NA
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
M No
❑ NA
❑ NE
waste management or closure plan?
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
ff No
❑ NA
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
[ f No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
D 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
[yNo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
[:]Yes
[D'No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [:]Yes [TNo ❑ 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): R v p pry a
13. Soil Type(s): p 40 &
14. Do the receiving crops differ from those designated in the CAWMP.
❑Yes
[ f No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
E�No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
[g No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
dNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
EJ'No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
ff No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[g'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 0 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 ;No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes [ yNo ❑ NA ❑ NE
Page 2 of 3 2/412011 Continued

I
Facility Number: a a Date of Inspection: M
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [5No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [a' No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes [.f No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes allo
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.
p Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the ReviewerAnspector 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
E] NA ONE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes [ti]'No ❑ NA ❑ NE
❑ Yes [TNo ❑ NA ❑ NE
❑ Yes [g'No ❑ NA ❑ NE
❑ Yes [q -No ❑ NA ❑ NE
❑ Yes [g No
❑ Yes (2 No
❑ Yes [LrNo
❑ NA ❑ NE
❑ NA ❑ NE
❑NA 0 N
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
lise_drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: C(ka
Date: a
_4311
,Oi I

-- smtn ofWater. Quality
Facility Number �O ®�Divisron of�So>1and Water Conservation
DQ Other. Agency
Type of Visit: ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: r V County: Region:
Farm Name: -Q 5 L(�_ -- L Z- Owner Email:
Owner Name: 0,11 K­vx Phone:
Mailing Address:
Physical Address:
Facility Contact: CL,_r-�s [L Title: Phone:,
Onsite Representative: „Q Integrator: .tl—
Certified Operator: -IS lJq/'[..� f (� - Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current
SO,_, ..... _
I)esrgn Current Design Current
SwineJCapacity Pop.
We# P.,oultry p p. Cattle Capacity Pap.
Ca ac�ty Pa
❑ Yes
f
Wean to Finish
La er Da' Cow
Wean to Feeder
Non -La yer
Da' Calf
Fee er to Finish
`"`_* f Da Heifer
Dry Cow
Farrow to Wean
Farrow to Feeder
D Poultry Ca acr Po , Non -Dairy
Farrow to Finish
Layers
Non -Layers
Beef Stocker
Gilts
Beef Feeder
Boars
Pullets
Turke s
Beef Brood Cow
Other
Turke Poults
Other
Other
Discharges and Stream Im acts
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 2<o ❑ NA ❑ NE
❑ Yes
❑ No
g,?(A
❑ NE
❑ Yes
[:]No
[�1�A
❑ NE
d. Does the discharge bypass the waste management system? (if yes, notify DWQ) [:]Yes ❑No Q -<A ❑ NE
2, is there evidence of a past discharge from any part of the operation? ❑ Yes 2R<o
m❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters [:]Yes NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 2/412011 Continued

acili Number: jDate of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [f7`No ❑ NA ❑ NE
a. if yes, is waste level into the structural freeboard? ❑ Yes oto ❑ 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 Ej 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 [t�To
❑ NA
❑ NE
waste management or closure plan?
❑ NE
15. Does the receiving crop and/or land application site need improvement?
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 g3"N-o
[DNA
❑ NE
8. Do any of the structures lack adcquatc markers as rcquired by the permit? ❑ Yes QXo
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
acres determination?
9. Does any part of the waste management system other than the waste structures require ❑ Yes [J"Io
❑ NA
❑ NE
maintenance or improvement?
❑ Yes
M -No
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes M Vo
❑ NA
❑ NE
maintenance or improvement?
[ to
❑ NA
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yesfoo
❑ 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): 0
13. Soil Type(s): v 1, lt__ �[io nl+.w. _ D --L 67^
14. Do the receiving crops differ rfrom those designated in the iA W MP? -
❑ Yes
UEr<o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[too
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
Ero
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
M -No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[ to
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes �oo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CA WMP readily available? If yes, check ❑ Yes ❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists [I Design ❑ Maps ❑ Lease Agreements [—]Other.
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes o ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers D 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 PrNo ❑ NA NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes [D No A ❑ NE
Page 2 of 3 214/1011 Continued

acili Number: enz IDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes dNo
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [g -Ko
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] No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ 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
E j A ❑ NE
[] Yes G3 5v ❑ NA ❑ NE
[—]Yes a]�N� ❑ NA ❑ NE
❑ Yes 0 <No ❑ NA ❑ NE
❑ Yes G3<o ❑ NA ❑ NE
❑ Yes 0 'No
❑ Yes L`_7 No
❑ Yes ErNo
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
lComments (refer to question Explain any YESanswers and/or any additional recommendations or any other comments.
uig4di-iwings.of facility to better._explain situations (use additional pages as necessary)„,
G-�L �e ['�[ t,�> 1 1-1 4 P\(L) 6tA- L
t' - LA J �s
Reviewer/Inspector
Reviewer/Inspector
Page 3 of 3
Phone: 9/v 42 --
Date:
—*z2lzz-
21412011

.a 'BI-i"'t S I ZZ Z a }
- ivision of Water Quality
Facility dumber �,'� - j 7a O Division of Soil and Water Conservation
Other Agency
Type of VisitCom/�pliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit (-Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: /-2/-ZO Arrival Time: Departure Time: County: fif! -76A/_ Region:
Farm Name: C-2- Owner Email:
Owner Name: Got^av-1 4e i` s Phone:
Mailing Address:
Physical Address:
Facility Contact: %A- �a'r"`�' L Title: I 5p1-` -. Phone No:
Onsite Representative: Integrator:
Certified Operator: C uYsw'`�!�- Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: E--] o E__1 ' E__1 " Longitude: =0=0
o❑0 ❑
it
Design Currenntj
5wiae Capacity Population Wet Paultry Capacity Population
❑ Wean to Finish ❑ La er
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Wean to Feeder
❑ Non -Layer
1. Is any discharge observed from any part of the operation?
❑Dai Calf
B o
❑ NA
❑ Feeder to Finish
Farrow to Wean -75Z, -75
Dry Poultry
❑ La ers
❑ Dairy Heifer
❑ Dry Cow
El Farrow to Feeder
Non -Dairy
❑ No
El Farrow to Finish
❑ Gilts
❑ Beef Stocker
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
El Non-LayMetsers
El Pullets
❑ Beef Feeder
[2"9A_
❑ Boars
[IBeef Brood Cowl
Other
❑ Turkeys
❑ Turkey Poults
❑ Other
Number of 5trueture ---
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
B o
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
BNA
❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
❑ Yes
❑ No
[2"9A_
❑ 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
[�lA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
[�'�lo
ElNA
[:1 NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
B <o
❑ NA
❑ NE
other than from a discharge?
12/28/04
Continued

r 1
Facility Number: S2" $OZ
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No [:1NA ElNE
a. If yes, is waste level into the structural freeboard? ❑ D Yes o ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): , > Z r/
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes LTJ No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed ❑ Yes No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ONo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes E 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 ElYes B<. ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 2No ❑ NA ❑ NE
maintenance/improvement?
11.
Is there evidence of incorrect application? I f yes, check the appropriate box below.
❑ Yes
RNo ❑ 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 El Application Outside of
Area
12.
Crop type(s) �2+[�^-M d a �� r J a L/,D,
5
13.
Soil type(s)
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No El NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
El yes
,T
L�',F oo El NA
[:1 NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
El Yes
L"J No ❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ YesNo
NA
ElNE
1$.
Is there a lack of properly operating waste application equipment?
❑Yes
:0No LI NA
El NE
Use drawingst`of facility toi better exp! n attons (use. ddg
itiongl pages as necessary)ns orAany other�eommen�ts�n
Reviewer/Inspector Name ` 'K P, (S Phone: 910,Y33-3340
ReviewerA nspector Signature: Date: /—Z/— Z0J10
12128/04 Continued

j . w
/ - 2/-zev0
Facility Number: 15 Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
❑ Yes
No
❑ NA
❑ NE
❑ Yes
Q<o
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
No ❑ NA
❑ NE
No ❑ NA
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1"
Rain Inspections ❑ Weather
Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
[" No ❑ NA
❑ NE
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
io ❑ NA
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[3 NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
ElE Yes
���,'I om ❑ NA
El NE
26.
Did the facility fail to have an actively certified operator in charge?
El Yes
E]NA
[3NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
[IYes
;7No ❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
To [:INA
❑ 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
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
io ❑ NA
❑ NE
General Permit? (ic/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
o❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
,DI
Leo/ ❑ NA
❑ NE
Addttonai Comtnentsand/o';D„rawings:
12/18/04
12/18/04

UWMIVI�
Division of Water Quality
Facility Number 0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit utine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: 9-%b(-� AArrival Time: .2 �D$' Departure' Ti me: County: �'�`F"'- Ems✓ Region:
Farm Name: Owner Email:
Owner Name: 5 Phone:
Mailing Address:
Physical Address:
Facility Contact: urY r S r4%:�t� Title: �� �''�y Phone No:
Onsite Representative: Integrator: Vr_ C
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Other
❑ Other
Operator Certification Number:
Back-up Certification Number:
Latitude: [ o [ ` F--1" Longitude: = ° = ` = µ
Design Current Design Current
Capacity Population Wct Poultry Capacity Population
❑ a er
❑ Non -La et
Dry Poultry
❑ La ers
❑ 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'?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures: ©�
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes 9< ❑ NA ❑ NE
❑ Yes
❑ No
El NE
[I Yes
C3 No
,[-�'1VA
L� 9A
❑ NE
l' I A
❑ NE
❑ Yes
❑ No
❑ Yes
KK
El NA
❑ NE
❑ Yes
ISNo ❑ NA
❑ NE
12/28/04 Continued

Facility Number: — p Date of Inspection
Waste Collection & Treatment ��
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? El Yes 2 No NA El NE
a. If yes, is waste level into the structural freeboard? E] Yes o ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
❑ Yes
GKNo
Designed Freeboard (in):
[j NE
15. Does the receiving crop and/or land application site need improvement?
Observed Freeboard (in): `7
[3//No
❑ NA
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
1110 ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed
❑ Yes
No ❑ NA ❑ NE
through a waste management or closure plan?
17. Does the facility lack adequate acreage for land application?
El Yeso
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
To ❑ NA ❑ NE
[0--1NA
[:1NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
U<0__�o NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
0 No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn,
etc.)
❑ PAN ❑ PAN > 10% or 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
—
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
GKNo
❑ NA
[j NE
15. Does the receiving crop and/or land application site need improvement?
El Yes
[3//No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[:] YesP'No
No
[3 NA
[__1 NE
17. Does the facility lack adequate acreage for land application?
El Yeso
NA
F-1NE
equipment? 18. Is there a lack of properly operating waste application ui ment?
ElYes
[0--1NA
[:1NE
Reviewer/Inspector Name /"�,y , G ' ,. Phone: 9/G�•Sd�3 -J%y
Reviewer/]nspector Signature: Rl... Date:
Page 2 of 3 12/28/04 Continued

Facility Number: IT7- —sp Date of Inspection UP "�0-
Re uired Records & Documents
14. 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 0 Yes allo ❑ NA ❑ NE
the appropirate box. ❑ WUp ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 0<01 -0 --NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers Cl Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute inspections ❑ Monthly and 1" Raine Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes To ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [—<o ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
9< ❑ NA
❑ NE
❑ Yes
M<. [:1 NA
❑ NE
C3 Yes
L<O —[INA
❑ NE
ElB Yes
o ❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
33. Does facility require a follow-up visit by same agency?
Comments and/or Ura
12/28/04
❑ Yes
No ❑ NA
❑ NE
❑ Yes
9'No [INA
❑ NF
❑ Yes
9'No ❑ NA
❑ NE
❑ Yes
ffNo ❑ NA
❑ NE
❑ Yes
�N�PNA
[:1NE
El Yes
No ❑ NA
❑ NE
12/28/04

it
-s ius 9-a.y-0g
Vision of Water Quality
[Facility Number �� SOz O Division of Soil and Water Conservation
O Other Agency
Type of Visit tmpliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit outine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: 8-//`479 1 Arrival Time: ��i�� Departure Time: rp:00 County: � Region:
Farm Name: • r/►'"�-e d� h'1 -� Owner Email:
Owner Name: C.,ho k- c_ f r Phone: _-
,Mailing Address:
Physical Address:
Facility Contact: S fGri,/f 4� Title: �� s�'�'—-P/hone Na:
Onsite Representative: C" , -S 'ea'"tot Integrator: t..v.�•�
Certified Operator:
Back-up Operator:
Location of Form:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Operator Certification Number:
Back-up Certification Number:
Latitude: E__1 o = ` = Longitude: = ° 0 =
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
I� ❑ Non -Layer
Other
❑ Other
Dry Poultry
❑ La ers
❑ 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?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
E]Dairy Heifet
❑
Dry Cow
❑
Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co.
Number of Structures: ELI
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 El"No ❑ NA ❑ NE
❑ Yes ❑ No WVA ElNE
❑ Yes [INo WNA ❑ NE
❑ Yes
❑ N NA
❑ NE
❑ Yes❑
NA
❑ NE
Yes❑
ZN❑ NA
❑ NE
12128104 Continued

Facility Number: 2- Z
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus stormm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier:
❑ Yes El
El Yes �Co
Structure 5
El NA El NE
❑ NA ❑ NE
Structure 6
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed ❑ Yes No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental) threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes E ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑yes U No (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 �O El NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes2-4 ElNA EINE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes No ❑ NA EINE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Cropes _ D.. COY=• 4 G �r-:.'.✓ C D+��c-� cid j
13. Soil type(s) AL& wg- &
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ Yes
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
17. Does the facility lack adequate acreage for land application? ❑ Yes
18. Is there a lack of properly operating waste application equipment?
Reviewer/inspector Name I
Reviewer/Inspector Signature:
❑ Yes
LJ ElNA
❑ NE
o E]NA
El NE
0[
❑ NA
❑ NE
o ❑NA
Fo
❑NE
No ❑ NA
❑ NE
Phone: 910 ��33-3338
Date:
Page 2 of J 121-75/04 uonnnuea

Facility Number: 17Z -SO2 Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 24 iErNA
A ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes NoA [INE
the appropirate box, ElWUP El Checklists [:1 Design El Maps El Other fe
21. Does record keeping need improvement? If yes, check the appropriate box below. 1:1 Yes No ❑ 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? El YesW)qo
o El NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? El Yes El NA [:1 NE
24. Did the facility fail to calibrate waste application equipment as required by the permit? ElYes YNo El NA ❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit? ❑ Yes o ❑ NA ❑ NE
26. Did the facility fail to have an actively certified operator in charge? ❑ Yes o ❑ 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 o ❑ 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 ❑ 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? ❑ Yes7No
ElNA El NE
33. Does facility require a follow-up visit by same agency? ❑ Yes ❑ NA ❑ NE
Page 3 of 3 12/28/04

Division of Water Quality
Facility Number p�, O Division of Soil and Nater Conservation
- - -. 0 Other Agency
Type of Visit ® Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit ®Routine O Complaint 0 Follow up 0 Referral Q Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time:�� . s� County: Sawcera�/ Region:
/ Departure Time: ty: eg
Farm Name: C — z— Owner Email:
Owner Name: Co kc v 3 s_ F;r- >'i, 5 Phone:
Mailing Address:
Physical Address:
Facility Contact: Ctj✓-ii S Savi ii-c..k „Title: Phone No:
Onsite Representative: Integrator: 64,arP ,_ Fay+�s
Certified Operator:
Back-up Operator:
Location of Farm:
Operator Certification Number:
Back-up Certification Number:
`ZV
Latitude: 0 c F --T = a Longitude: = ° =I = v
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population Cattle
❑ Wean to Finish
❑ Wean to Feeder
❑ Feeder to Finish
® Farrow to Wean Z
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
❑ Layer
❑ Non -Layer
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Imnacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
Design;< Curfent'
Capacity.lPopniatiou:
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge'?
❑ Yes %) No ❑ NA ❑ NE
❑ Yes
;9 No
❑ NA
❑ NE
❑ Yes
[1 No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
0 No
❑ Yes
M No
❑ NA
❑ NE
❑ Yes
El No
❑ NA
❑ NE
12/28/04 Continued

w �
AL
Facility Number: $z —s4 Z Date of Inspection
Reviewer/Inspector Signature: Date: `j -- 17 — Zo d 7
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
1PNo
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed
❑ Yes
& No
❑ NA
❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental
threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
[] No
❑ NA
❑ NE
8, Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
No
❑ NA
❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No
❑ NA
❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes P No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > l0°/s or l4 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ }Evidence of W` find Drifl ❑ Application Outside of Area
12. Crop type(s) 6rrt�t k r� ( [ ;<-J .�<u
13. Soil type(s) AALf v,' c�`^` "`
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes (ANo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [3 No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes [ANo [:INA ❑ NE
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes 0 No ❑ NA ❑ NE
❑ 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
AL
Reviewer/Inspector Name �i l� eive els Phone: `'j' /0, LI333. 336Z,
Reviewer/Inspector Signature: Date: `j -- 17 — Zo d 7
12/28/04 Continued

HOZ
Facility Number: —10j] Date of Inspection
Required Records & Documents
19_ Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes R'No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, cheek ❑ yes 8No ❑ NA ❑ NE
the appropirate box.
❑ WUP El 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 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [] No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ,® No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
ED No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
lA No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
R No
❑ 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
0 No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
[21 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
[B No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?[:1NA
❑Yes
No
El NE
Additional Comments and/or Drawings:
12128104

j,
® Division of Water Quality
Facility Number M_ - jl SO Z 0 Division of Soil and Water Conservation
O other Agency
Type of Visit ® Compliance Inspection O Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit ® Routine 0 Complaint O Follow up O Referral Q Emergency O Other ❑ Denied Access
Date of Visit: ZS- D{o Arrival Time: Departure Time: County: Sw- •Sv ��
Farm Name: c O V ..-, C- Z Owner Email:
Owner Name: �"'� V + %#ag &_L1 w, Phone:
Mailing Address:
Physical Address:
Facility Contact: C u L4�++ S CACI W- W k_ �_ Title:
Onsite Representative:
Certified Operator:
Back-up Operator:.
Location of Farm:
Phone No:
Region: X20
Integrator: 4,t i, e- /A0AR'f,4K
Operator Certification Number -
Back -up Certification Number:
Latitude: =0
=1
= Longitude: =11=1 = N
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population Cattle
❑ Wean to Finish
❑ Wean to Feeder
❑ Feeder to Finish
Farrow to Wean Z
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
❑ La er
❑ Non -La et
Dry Pout"
❑ Layers
❑ Non -La ers
❑ Pullets
❑ Turkeys
❑ TurkeX Pouits
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ElStructure ❑ Appiication Field EJOther
a. Was the conveyance man-made?
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
Design Current
Capacity Population
Number of Structures: ED
b. Did the discharge reach waters of the Slate? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes ®No ❑ NA ❑ NE
❑ Yes
W No
[INA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
N No
❑ Yes
Dd No
❑ NA
❑ NE
❑ Yes
[A No
❑ NA
❑ N E
12128/04 Continued

12. Crop type(s) _ (S CVwt u cl �... [ G mlc_ 5i"a // G
Oki 4i/Se-GeL
Facility Number: g2-502_Date of Inspection F47 -Z-5 ---
13. Soil type(s) a v J
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 EINE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5 Structure 6
Identifier:
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination%❑ Yes
Spillway?:
❑ NA
❑ NE
�r
Designed Freeboard (in): 9
❑ Yes
K No
rr
Observed Freeboard (in):
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
Qj No
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
N 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
[3 No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
[9 No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
[gNo [:INA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
[2 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?
It. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 14 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) _ (S CVwt u cl �... [ G mlc_ 5i"a // G
Oki 4i/Se-GeL
13. Soil type(s) a v J
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
Q9 No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
K No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
Qj No
❑ NA
❑ NE
Comments (refer o qii KE
;� �
• . estioa.# E�iplam any YESsanswers and/or any recommendations or any other comments.
tlse drawings of±[ac:Uity to¢better eaglaua situaaans a(tise additi)inal pages as4necessary
Reviewer/Inspector Name Phone: [phone]
Reviewer/Inspector Signature: Date:
12/28/04 Continued

Facility Number: gz --pZ Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes rg No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [5 No ❑ NA ❑ NE
the appropirate box.
❑ WUP ❑Checklists ❑Design ❑Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 09 No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis . ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
® No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
M No
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
[A No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
T� 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
Q9 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
[A No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
® No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
JR No
❑ NA
❑ NE
AdditsonalsComments andlor Dra3ings.
12/28/04
12/28/04

i .A
Type of Visit ® Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit ® Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: Arrirnal Time: Departure Time: County: -5.�1fj
d o�j Region: f ��
Farm Name: Ce; h// dQ c�a�... - Owner Email:
Owner Name: co dei% a � Phone:
Mailing Address:
Physical Address: ��� a2 a
Facility Contact: Title: Phone No:
Onsite Representative: ef'.r iss /3a.,..; integrator: Coko%t
Certified Operator: Cur l �s �a.w��,C _ _ Operator Certification Number:
Back-up Operator:
Location of Farm:
Swine
Back-up Certification Number:
Latitude: 0 0 =I = Longitude: ❑ o = = K
Design Current Design Current
Capacity Population Wet Poultry CIpacity Population
❑ Wean to FinishF-1
La er
El wean to Feeder Non -La et
❑ Feeder to Finish
Farrow to Wean
Farrow to Feeder
® Farrow to Finish G2
Gilts
❑ Soars
Other
❑ Other
Dry Poultry
ge
❑ Laers
❑ Non -Layers
❑ Pullets
❑Turke s
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ElStructure ElApplication Field ElOther
a. Was the conveyance man-made?
Design Current
Cattle Capacity. Populat mi -,�
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
Number of Structures:
b. Did the discharge reach waters of the State'? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Docs 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 [5rNo ❑ NA EINE
❑ Yes
❑ No
❑ NA
EINE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
© No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
12/28/04 Continued

ti
Facility Number: Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ® No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure i Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): .Z 4,
Observed Freeboard (in): 7 "
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
[Z No
❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
® No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
5� 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
[�j No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
N[No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
[2No
[:INA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window [:]Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) r S
13. Soil type(s) �Gi7rcit�; //G l cznraw
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[kNo
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
0 No
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable 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
8 No
❑ NA ❑ NE
L
Reviewer/Inspector Namedlr /�� %. '�':- Phone:
Reviewer/Inspector Signature: Date:
12/28/04 Continued

l
�L
Facility Number: g.2 —,5-0.2 Date of Inspection 2 /S 4f
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes [V No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ElYes QU No ❑ NA ❑ NE
the appropirate box.
❑ WUP El Checklists El Design [I Maps [:1 Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ® No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections [:]Monthly and 1" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
[N 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
[a No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
® No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
[0 No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
[g 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
[)a 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
to 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
WNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
W No
❑ NA
❑ NE
Adtitt�ou"aI Coro ments and/oi Drawtn s
1j n r_
G L.fit er-� h C r c� a .�� Z4- rz G -s
12/28/04

I
(Type of Visit O.CoZu"fine
nce Inspection O Operation Review O Lagoon Evaluation I
Reason for Visit O Complaint O Follow up O {emergency Notification O Other ❑ Denied Access
Facility Number
Date of Visit: �� Time: D ' ds
Q Not Operational O Below Threshold
13 Permitted © Certified © Con/d-itiondl ne ' ed 13 Registered Date Last Opera or Above Threshold: ...----•.•.............•
Farm Name: ....... LSP a' "�'t.. l n.S is _.._._... .._.. ........... County:....... ._.. .........�._ .. .. ..
Owner Name: -----•__o + {y` - -- — one No:
Mailing Address:.. ��r?fD�r
Facility Contact:
Onsite Representative:
Certified Operator:
Location of Farm:
...` W -'-"L X-- .......-- Title:
we('JL
)y4C .__ Phone No:
Integrator:
Operator Certification Number%- lf?y- -.-...--.
Biwine ❑ Poultry ❑ Cattle ❑ Horse Latitude • & 69 Longitude • d 44
Discharges & Stream Im acts
L Is any discharge observed from any part of the operation? ❑ Yes [44fa'
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b- If discharge is observed. did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes Uqo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes 93116 --
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes U-Xt
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:---�.__ ....__._....... _.--- _.
Freeboard (inches): a�
12112103
Continued

Facility Number: ft --$'O?, I Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yesled o
seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a waste management or El Yes o
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes ONo
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes o
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes No
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yeso
11. Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes Lo
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type 8l.S wlaN i C
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWNTP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
I5. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
IS. Are there any dead animals not disposed of properly within 24 hours?
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt:,
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
Air Quality representative immediately.
❑ Yes moi o
❑ Yes L� O
❑ Yes No _
❑ Yes No
❑ Yes ,UX°
❑ Yes levo
❑ Yes 9-N'o-
❑ Yes 43*10
❑ Yes fflZ
❑ Yes EJ'No
Comte {refer to quest:on #) Explgtn aay YEfi awwm an►d/or airy ins or anykotlier mi eats.
:Use dr Flap dr facility to better PXplatn sttuattons use addehanal pages as necessary) ❑ Field Copy []FinalNotes t
'''Y'^'�»s,- "��=:_ •... �. a:^,n _..,r .�s.,,,,.;.w »sa�i a- r'^w: -7 _-=i'0-zr, tte.. ,..,.x. .
� i �rai k �AG/�i Dl� Ji 11�uep' 1.+wicr 41 40P;*rM.'L s-1.4, CII�JS �/�i►y fr++ C
9� 1. �
r
/)06
v� .
Cr"rs
.•d
5
ReviewerAns ector Name =
_
Reviewer/Inspector Signature: Date: G b
12112103 ">�
Continued

Fa ' 'ty Number: V - go,_a Date of Inspection
Required Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes OX011
11,
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WT.1P, checklists, design, maps, etc.) ❑ Yes <0
23. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes B40"
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
Leo
25. Did the facility fail to have a actively certified operator in charge?
❑ Yes
leo
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
940
27. Did Reviewer/Inspector fail to discuss review/inspection with on-site representative?
❑ Yes
1_3410
28. Does facility require a follow-up visit by same agency?
❑ Yes
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
L7 fvo
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
❑ Yes
QNo
3I. If selected, did the facility fail to install and maintain rainbreakers 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 NPDES required forms need improvement? If yes, check the appropriate box below.
❑ Yes
❑ No
❑ Stocking Farm ❑ Crap Yield Form ❑ Rainfall ❑ Inspection After I" Rain
❑ 120 Minute inspections ❑ Annual Certification Form
113 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
ddstaanal Edsninents'arid/a� Drawings F _ = z
_
12/12103

Site Requires Immediate Attention:
Facility No. R2 - 57_
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: 5420 -11995
Time: _ jZ '/ -Z_ -
Farm Name/Owner ,-a
Mailing Address:DBo c P� J -l'li...�n., ,,.•� Z��z� -. — --
County:
Integrator: ��,�,n«� ,�c..,.�s --- - Phone:
On Site Representative: t'�� _ �..�� _ Phone.
Physical Address/Location: _5,w- rsj�P
Type of Operation: Swine -f Poultry Cattle
Design Capacity-. . f %y ax_� _ Number of Animals on Site: s.j 4?
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: Longitude: 0 .
Circle Yes or No
Does the Animal Waste Lagoon haayg sufficient freeboard of I Foot + 25 year 24 hour storm event
(approximately I Foot + 7 inches) es r No Actual Freeboard:_-3—Ft. _j�2,lnches
Was any seepage observed from the lagoon(s)? Yes or No Was any erosion observed? Yes or No
Is adequate land available forray? Yes or o Is the cover crop adequate? Yes or No
Crop(s) being utilized; Z012ij -
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellin s? a or No
100 Feet from Wells? Ye or No
Is the animal waste stockpiled within 104 Feet of USGS Blue Line Stream? Yes or Nc
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Erie: Yes or(9
Is animal waste discharged into water of the state by man-made ditch, flushing system,_ or other
similar man-made devices? Yes or 19 If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? Je>r No
Additional Comments:
Inspector Name
Signature
cc: Facility Assessment Unit Use Attachments if Needed.

_ Site Requires Immediate Attention: 1✓6
Facility No.
DIVISION OF ENVIRONMENTAL MANAGEMENT "
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: 2a, 1995
Time: 12' IT
Farm Name/Owner: •-7
Mailing Address:
County:
Integrator: Phone:
On Site Representative: Phone:
Physical Address/Location:__ - - - - -_
Type of Operation: Swine l- Poultry Cattle
Design Capacity: _ : a e,, Number of Animals on Site:
DEM Certification Number: ACE
Latitude: Longitude:
DEM Certification Number: ACNEW
Circle Yes or No
Does the Animal Waste Lagoon have sufficient
(approximately 1 Foot + 7 inches) Ce -Dor No
Was any seepage observed from the lagoon(s)?
Is adequate land available for spray? �or No
Crop(s) being utilized: �'
freeboard of I Foot + 25 year 24 hour storm event
Actual Freeboard:_ 3 Ft. 4 Inches
Yes or No Was any erosion observed? Yes or io
Is the cover crop adequate? Yes or No
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwell' s? Yes'ior No
100 Feet from Wells? ks9or No
Is the animal waste stockpiled within 100 Feet of USGS Blue -Line Stream? Yes or Io
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line: Yes or N
Is animal waste discharged into water of t e state by man-made ditch, flushing system, or other
similar man-made devices? Yes or(uIf Yes, Please Explain_
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? Ye or No
Additional Comments: _
_5 --
Inspector Name
Signature
cc: Facility Assessment Unit Use Attachments if Needed.

1 0 . -- ~1
REGISTRATION FORM FOR ANIMAL FEEDLOT OPERATIONS
Department of Environment, Health and Natural Resources
Division of Environmental Management
Water Quality Section
If the animal waste management system for your feedlot operation is
designed to serve more than or equal to 100 head of cattle, 75
horses, 250 swine, 1.,000 sheep, or 30,000 birds that are served by
a liquid waste system, then this form must be filled out and mailed
by December 31, 1993 pursuant to 15A NCAC 2E.0217 (c) in order to be
deemed permitted by DEM. Please print clearly.
Farm Name: 5 C
Mailing Address: n
County: SA 0�46e ^ Phone No. 6-5.2 - /I2 :2
Owner (s) Name: 0. M- F0.;•, f,, f� W, k, 1j, 4,-5
Manager (s) Name: Eel W,s c - --
Lessee Name: u'
Farm Location (Be as specific as passible: road names, direction,
milepost, etc.): EE�_F C�pz - at, (SP I.�yd a an.,�__,_�'r0
Latitude/Longitude if known:
Design capacity of animal waste management system (Number and type
of confined animal (s) ) : 61`1 -� f ­V . -
Average animal population on the farm (Number and type of animal (s)
-raised) 6;-Y s 1teke,Bodo ,y,re•7,,.
T
Year Production Began ASCS Tract No.: 330 3
Type of Waste Management System Used: Ca4ee 7��1' C,'h.0
Acres Available for Land
Owner (s) Signature(s):
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