820513_INSPECTIONS_20171231

NORTH CARULINA
Department of Ernr1ro olmlial Qui

di"vi"sion of Water Resources
facility Number ®_ ZMMDivi ion of Soil and'WaAte r Gonservatiou
O Other Agency
type of Visit: Q Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: • Routine 0 Complaint 0 Follow-up Q Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: 2'j Arrival Time: Departure Time: 103'• County: faL1 Region:
/' '1
Farm Name: —q _ _ Owner Email:
Owner Name: �/ Phone:
Mailing Address:
Physical Address: j
Facility Contact: si''"CJ Title: Phone:
U
Onsite Representative:
Certified Operator: _ {7y(jl Sph
Integrator: l�s
Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Discharges and Stream Impacts
I. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance roan -made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes 09 No ❑ NA ❑ NE
❑ Yes [] No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes No
❑ Yes No
0 NA ❑ NE
[P NA ❑ NE
® NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
Page ! of -3 21412015 Continued
Design Current
Design
Gnrren#
I' Desi n Current
�I -.. li
Swine
d p7 iA
Capacity uI,1CPo�
i.7
'i, We#'Poultry'
Capacity
Pop!
f
Cattle Capacity Pop
�...
Wean to Finish
..
La er
Dai Cow
Wean to Feeder
Non -La er
Dai Calf
Feeder to Finish
Dai Heifer
V,Farrow to Wean
'j Y
Design
Current'
D Cow
Farrvw to Feeder
�
D . P,outtry
Ca acity
"d,
_ P:o .:',,;�,
-
Non Dai
Farrow to Finish
Layers
Beef Stocker
Gilts„
Non -La ers
E
Beef Feeder
Boars
Pullets
! E
Beef Brood Cow
.'
Turkeys
;� �I1,
Other
i*
Turkey Poults
Otho
f
Other
Discharges and Stream Impacts
I. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance roan -made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes 09 No ❑ NA ❑ NE
❑ Yes [] No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes No
❑ Yes No
0 NA ❑ NE
[P NA ❑ NE
® NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
Page ! of -3 21412015 Continued

l
Facili Number: Date of Ins ectiow-
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier: _
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 7 L z't4
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?
[-]Yes ID No r NA
Structure 5 Structure 6
❑ NE
❑ NE
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
❑ NA
❑ NE
❑ Yes
No
❑ Yes
o No
❑ NA
❑ NE
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
'�j No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
❑ NE
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No
0 NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? 1 f yes, check the appropriate box below. ❑ Yes V No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 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):h^- A 1- r r1: Cc' ► P h ' Ute"( �RQ.r�f
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
IT 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 ail components of the CAWMP readily available? If yes, check
the appropriate box.
❑ Yes
INo
❑ NA
❑ NE
E] Yes
[�jNo
❑NA
❑NE
❑ Yes
[P No
❑ NA
❑ NE
❑ Yes [ No ❑ NA ❑ NE
❑ Yes [� No ❑ NA ❑ NE
❑ Yes [jFNo ❑ NA ❑ NE
❑ Yes [� No ❑ NA ❑ NE
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes W No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis [] Waste Transfers
❑ rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ YesNo
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes TNo
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 2/4/2015 Continued

I
Facility Number:- Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ' No 0 NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail 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 No ❑ NA ❑ NE
OtherOther 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 ReviewerAnspector fail to discuss reviewlinspection with an on-site representative?
34. Does the facility require a follow-up visit by the same agency?
[:3 Yes
T No
E] NA
❑NE
❑ Yes
[P No
❑ NA
❑ NE
❑ Yes
�3 No
❑ NA
❑ NE
❑ Yes ® No
❑ NA
❑ NE
❑ Yes No
❑ NA
❑ NE
❑ Yes No
❑ NA
❑ NE
❑ Yes No
❑ NA
❑ NE
Convricots (refer to q tzoa #fjExplain any YES answers andlor'any, additional recomnnendations or any other7comments.
-tea T'. - � .. , .
Use ditwjingg'.- rfacrhty to tttr, explain situations (use additional pages as necessary) l> ,. ,L,
Reviewer/Inspector Name-
Reviewer/Inspector Signature:
Page 3 of 3
Phone: Rl0 T a7 ;�3CO
Date: 1-74
2;,0615

Jf+G V• • •JIL. qW 1LL3pCLLLVLI L/ VFICLaLIVLI K%CVM" `J JLIM-LLLIC L` Va1LIaL1VIL t! ■CGIILIMAN M]J17 LauG6
Reason for Visit: 0 Routine O Complaint O Follow-up O Referral O Emergency O Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: g,� County: ISQI__ Region
Farm Name: Owner Email:
Owner Name:y^�S rvl� Phone:
Mailing Address:
Physical Address:
Facility Contact:
tq
Onsite Representative:
Certified Operator:
Title:
Back-up Operator:
Location of Farm: Latitude:
Phone:
Integrator: �s
Certification Number: ff q -77 00
Certification Number:
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 DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (]f 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
.: _-_
Destgn Current
:;
. „ .
Resign -.Current
Design rrent
Swine
Capacity_ Pop:
WeYPaultty
Capacitifty I'op.
Cattle Capacity Pop.
Wean to Finish
❑ NE
fl ILayer
I
ai Cow
Wean to Feeder
Nan -La er
I
ai Calf
Feeder to Finish
an Heifer
Farrow to Wean
f `
Design Current
Dry Cow
Farrow to Feeder
D . P,oultrir
Ca acttvPo
Non_ -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Turkeys
Beef Brood Cow
Otho
-f
Turkey Pavlts
I IM
�;.
:
Other
10ther
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (]f 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
NA
❑ NE
❑ Yes
❑ No
[ NA
❑ NE
❑ Yes
❑ No
PNA
❑ NE
❑ Yes
1W No
Lff
❑ NA
❑ NE
[] Yes
'® No
❑ NA
❑ NE
Page I of 3 2/4/2011 Continued

Facili Number: jDate of Inspection: eJ z
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes Wo ❑ NA ❑ NE
a. If yes, is waste level into the structural frceboard? ❑ Yes b No (IQ
NA 0 NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: i , 50
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
/1/)
N
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a ❑ Yes No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes [rpNo ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ YesNo ❑ 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 rm No ❑ NA ❑ NE
maintenance or improvement? yd
Waste ADDlieatiOn
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ YesNo ❑ NA E]NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes Fo] 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 Croo W' doowwj� ❑ idence of Wind D plication OutsC�V�
de of Approved Area
l2. Crop Type(s): �� l " �' S I �` ,,�A
J� 1 s� ' �"` "—"
13. Soil Type(s): o
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
V No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
1P
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box.
❑WLIP ❑Checklists ❑ Design ❑ Maps [3 Lease Agreements ❑Other:
21. Does record keeping need improvement? if yes, check the appropriate box below. ❑ Yes No E] NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard E] Waste Analysis E] Soil Analysis E] Waste Tra TI,ers ❑ 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 No ❑ NA ❑ NE
Page 2 of 3 2/4/2011 Continued

ii'acili umber: -I Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes 1D No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [] Yes [)VNo ❑ 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 N 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 W No ❑ NA ❑ NE
❑ Yes �U No ❑ NA ❑ NE
❑ Yes 03 No ❑ NA ❑ NE
❑Yes
�No
❑ NA
❑ NE
❑ Yes
0 No
❑ NA
❑ NE
❑ Yes
" No
❑ NA
❑ NE
❑ Yes
[�? No
❑ NA
❑ NE
Comments (refer to:question #): Explain any YES answers andtor:any additional recommendations or any other comments
Use.drawings.of-facility to better explain situations (use additional pages as necessary). ' s
Reviewer/Inspector Name:
Reviewer/Inspector Signature.-
Page
ignature:
Page 3 of 3
Phone: 9 f 0-q)33- 33co
Date: ' M 6p
2/4!2011

,tulit,
Division of Water Resources
CICHIMENUMnem ®- © Division of Soil and Water Gonservafion
© Other Agency
Type of Visit: 4D Compliance Inspection 0 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 Departure Time:County: T=�tS44/ Region: 14W
Farm Name: P-9 Owner Email;
Owner Name:
Mailing Address:
Physical Address:
Phone:
Facility Contact: �5 Cl.t'►121 Title:
Onsite Representative: Integrator:
Certified Operator:
Phone:
Pis 4a�_
�p
Certification Number: % 7 % /LV
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design @urrent
Swine Capacity Pap.
Wean to Finish
Wet P uul!ry
La er
Design
Capacity
Current
Pop.
Design Current
Cattle Caparaty Pop.
at Cow
® No
Wean to Feeder
Non -La er
❑ Yes
Da Calf
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
D . Poul
Layers
Non -Layers
Design
Ca aci
Current
P10
Da Heifer
D Cow
Non -Dai
Beef Stocker
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkc s
IJther 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)?
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 0 No ❑ NA ❑ NE
[:]Yes [] No NA ❑ NE
❑ Yes ❑ No 9 NA ❑ NE
❑ Yes
❑ No
NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
Page I of 3 2/4/2014 Condaued

[Facility Number: - Date of Inspect -ion:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
[] Yes
1p No
❑ NA
❑ WE
a. If yes, is waste level into the structtual freeboard?
❑ Yes
[:]No
O NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 5
Identifier:
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
[-]Other:
Spillway?.
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
Rg No
[] NA
Designed Freeboard (in):
❑ 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?
Observed Freeboard (in):
No
❑ NA
❑ WE
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
fg] 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
q No
❑ NA
❑ WE
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
69 No
❑ NA
❑ WE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
W 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
M No
❑ NA
❑ WE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
® No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yesj� No E]NA
[j 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 CropW
indow❑ Evidence of Wind Drib [:]Application Outside of Approved Area
ep�!
12. Crop Type(s): [ � el 6�(5 CP4S,4 1. � u • 9 -�0
❑ NE
1.3. Soil Type(s): 666,UhLB -
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 No ❑ NA ❑ WE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes 0] No ❑ NA ❑ WE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Reauired Records & Documents
❑ Yes ® No ❑ NA ❑ NE
❑Yes No DNA E] NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
[:]Yes
[P No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWM P readily available? if yes, check
[:]Yes
0 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
Rg No
[] NA
❑ WE
❑ 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
❑ WE
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
® No
❑ NA
❑ NE
Page 2 of 3 21412014 Continued

Facili Number: 2 - Date of Inspection: j
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes L] No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes 15,71 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?
❑NA ONE
❑NA 0 N
❑NA ❑NE
❑ NA ❑ NE
❑ Yes RNo ❑ NA ❑ NE
❑Yes PNo 0 N ❑NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes M No ❑ NA ❑ NE
❑ Yes ® No
❑ Yes ��]` No
❑ NA ❑ NE
❑ NA ❑ NE
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 9 e"
Date: 1l -71
21412014

iype of visit: 41P Compliance Inspection U Operation Review U Structure Evaluation U Technical Assistance I
Reason for Visit: * Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: 1 2p Arrival Time: 4th Departure Time: County: -`54 ,_SOA) Region: PAO
Farm Name: t.- -74ogalOwner Email
Owner Name: rES4 ,(qe_ g Phone:
Mailing Address:
Physical Address: I
Facility Contact: �C V.es Title:
Onsite Representative: IA
Certified Operator: f
Bach -up Operator: ko*A$
Location of Farm:
Phone:
Integrator:
Certification Number:
Certification Number: 0
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 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 [O] NA ❑ NE
❑ Yes ❑ No NA ❑ NE
❑ Yes
❑ No
NA
❑ NE
DP iQ ny Cur nt
b 'x7
No
❑ NA
Design Current
❑ Yes]
Swine C•a aci P01).
Wet Poult Ca aci
ry
Po
Capacity Pop.
Wean to Finish
La er
Dai Cow
Wean to Feeder
Non -La er
- - Dai Calf
STM;
Feeder to Finishyi'
I �
Dai Heifer
Farrow to Wean
�
Wx05-Umv-,
D Cow
Farrow to Feeder
Farrow to Finish
DCa "aci
La ers
PLo
Non -Dai
Beef Stocker
Gilts
Boars
Non -Layers
Pullets
Beef Feeder
Beef Brood Cow
a z
Turkeys
Other
Other
m.-
TurkeyPoults
Other
R5
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes ® No ❑ NA ❑ NE
❑ Yes ❑ No [O] NA ❑ NE
❑ Yes ❑ No NA ❑ NE
❑ Yes
❑ No
NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes]
No
❑ NA
❑ NE
Page I of 3 2/412011 Continued

i
Facili Number: - Date of Inspection: j �p
Waste Collection &.Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
No ❑ NA ❑ NE
❑ No [m [:]NE
Structure 6
Spillway?:
Designed Freeboard (in):
r l `I
Observed Freeboard (in): q-6—
L lj
5. Are there any immediate threats to the integrity of any of the structtu-es observed? ❑ Yes [P No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a ❑ Yes �] No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and tate 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 r No ❑ NA ONE
(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 h No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 6 No ❑ NA ❑ NE
maintenance or improvement?
1I. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ YesNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground [:]Heavy Metals (Cu, Zn, etcT
❑ PAN r] PAN > 10% or 10 lbs. [] Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable CropWindow
`—{ Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): C�as-�Q Ver as`� 7fLe- 0LA�
13. Soil Type(s): R
14. Do the receiving crops differ from those designated in the CAWMP? E] Yes OW No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes M No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes ® No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes [54 No
❑Yes � No
❑ NA ❑ NE
❑ NA ❑ NE
Required Records _& Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ['J] No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ® No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No
❑ NA ❑ NE
❑ Weather Code
❑ Studge Survey
❑ NA ❑ NE
0 NA ❑ NE
Page 2 of 3 21412011 Continued

,FgcWty Number: Z 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 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 [P No E] NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? E] Yes T(� No ❑ NA ❑ NE
Other Issues TT
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes ® No ❑ NA ❑ NE
and report mortality rates that were higher than normal? T`
29. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes No ❑ NA D 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 [P No ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below. ❑ Yes E No ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32_ Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative? ❑ Yes No ❑ NA ❑ NE
�� MC" 1� �
Reviewer/Inspector Name: Phare: � —3.3VO
Reviewer/Inspector Signature: �=6 Date: 3
Page 3 of 3 2/412011

�1.7i
'Divi"sioa of Water Resources
Facility Namber - O Division of Soil and Water Coliservatian
OO Other Agency
type of visit: RIF Uompttance Inspection V Operation Kevtew Q Structure Evaluation V Technical Assistance
Reason for Visit: *Routine O Complaint O Follow-up 0 Referral t) Emergency 0 Other 0 Denied Access
Date of Visit": I i Arrival Time: 7,� 2r,� Departure Time: County: Region:
Farm Name. q ! � �a't1 �� Owner Email:
Owner Name:?(G '�f Phone:
Mailing Address:
Physical Address:
Facility Contact: Amb Title:
Onsite Representative:
Certified Operator:
Phone:
Integrator: ,,�}
Certification Number: ^ 97760
Back-up Operator: Certification Number:
Location of Farm:
Latitude: Longitude:
Design Current
[] No
Design
Current
Design Current
Swine '11%, 1 Capacity Pop.
Wet Poultry
Capacity
Pop.
Cattle Capacity Pap.
Wean to Finish
airy Cow
Wean to Feeder
Non -La er
airy Calf
Feeder to Finish
airy Heifer
Farrow to Wean
Dry Cow
Farrow to Feeder
D . P,oul
Ca aci
Po
Non -Dairy
Farrow to Finish Lay -en
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
L Beef Brood Cow
7'ur1e s
--
C?ther
Turke Poults
Other
Other
Discharges and Stream Im acts
I _ is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes [P No [] NA ❑ NE
❑ Yes
[] No
[gNA
❑ NE
❑ Yes
[] No
® NA
❑ 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 No
[:]Yes No
NA ❑EVE
❑NA ❑NE
[DNA ❑ NE
Page 1 of 3 2/4/2014 Continued

Facility Number: - �Tl if
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? [:]Yes � No [3 NA E] 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: R— q_ Z-!�
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.)
❑ Yes [N No ❑ NA ❑ NE
6. Are there structures on-site which are not properly addressed and/or managed through a ❑ Yes a No
❑ 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 DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
acres determination?
❑Other:
9. Does any part of the waste management system other than the waste structures require ❑ Yes No
❑ NA
❑ NE
maintenance or improvement?
❑ Yes
®No
Waste Application
❑ NE
18. Is there a lack of properly operating waste application equipment?
10. Are there any required buffers, setbacks, or compliance alternatives that need [—]Yes 5a No
❑ NA
❑ NE
maintenance or improvement?
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [:]Yes ® No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ NE
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
KI)No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
P No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
O No
❑ 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
0 No
❑ NA
❑ NE
Reauired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
® No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes�{i
No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists [:]Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
® 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

Faciti - Number: - Date of Inspection: u
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes R No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ® No
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 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
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑NA ❑NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
V 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
[!TNo
❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
34. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
Pallo
❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
R No
❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
M No
❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
�2 No
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
'R No
❑ NA ❑ NE
omments(refer to question #): Explain any VES answers and/or. any additional recommendats
tions or any other commend.
rUs
_
e drawinss_of facility to better explain situations fuse additional oaees as necessarv) '.
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: ?10 3dV
Date: V21QI�4
2/412014

Type of Visit: Compliance Inspection 0 Operation Review 0 Structure Evaluation O Technical Assistance
Reason for Visit: 0 Routine O Complaint Q Follow-up O Referral 0 Emergency O Other O Denied Access
Date of Visit: IZ Arrival Time: 0y:00 Ij Departure Time: County: 904gb Region:
Farm Name: P-9 W/ �aT7 Orl Owner Email:
Owner Name: �sC-jams �✓lC r Phone:
Mailing Address:
Physical Address:
Facility Contact: �� = _ Title: Phone:
Onsite Representative: Integrator. ff
Certified Operator: Ti?_Yj riIt S rT7 la�'L((, Certification Number: 9 g (1'5—
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Discharges and Stream ImRacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Ficld ❑ 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
©esigu _Current
[]NA
r in"i n 'Current
Design Curren#
'Swore'"Ca-
p ciri Pop.
We Poultry
C paei#y Prtp,
Cattle. _ C•apacity Pop.
Wean to Finish
❑ NE
La er
Non—Layer
❑No
Da' Cow
Dai Calf
Wean to Feeder
Feeder to Finish
Dairy Heifer
)61 Farrow to Wean
D ,P,aul
Layers
Non -Layers
Design Current
[ a achy Po
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Pullets
I
113cef Brood Cow
- -
Turke s
Qther
Turkey Poults
Other
Other
Discharges and Stream ImRacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Ficld ❑ 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
fQNo
[]NA
❑ NE
❑ Yes
❑ No
NA
❑ NE
[:]Yes
❑No
NA
ONE
d. Does the discharge bypass the waste management system? (if yes, notify DWQ) ❑ Yes ❑ No [P NA E] NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes No T❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes M No ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 2/4/2011 Continued

FaciliNumber: - Date of Inspection:
L
0 No
❑ NA
Waste Collection & Treatment
waste management or closure plan?
[ No
❑ NA ❑ NE
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: —per
Mr No
❑ NA
❑ NE
Spillway?:
21412011 Continued
Designed Freeboard (in):
9. Does any part of the waste management system other than the waste structures require
[] Yes
No
' I� Q
Observed Freeboard (in): �7 '1j�a
❑ NE
maintenance or improvement?
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
EP 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
0 No
❑ NA
❑ NE
waste management or closure plan?
[ No
❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
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
0 No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
D Yes
Mr No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
21412011 Continued
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
0 No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ® No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window j❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):�viotSS� �_h nx_o— . .
13. Soil Type(s): wcce;'
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes P 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
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Rem ed 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.
C:] Yes RNo ❑NA ❑NE
[:]Yes P No ❑ NA ❑ NE
E] Yes E�No ❑NA ❑NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑WUP ❑Checklists ❑ Design [] Maps ❑ Lease Agreements
❑Other.
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
[ No
❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 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
21412011 Continued

o FaNumber: Date of Ins ection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? E] Yes [ja No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check Yes EP 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? E] Yes fn No E] NA E] NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
[a No
[] NA
[] NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
E] Yes
ER No
NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
[] Yes
® No
❑ NA
E] NE
If yes, contact a regional Air Quality representative immediately.
30, Did the facility fail to notify the Regional Office of emergency situations as required by the
[:]Yes
No
❑ NA
[] NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
Yes
® No
[] NA
NE
[D Application Field 0 Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CA WW?
E] Yes
EP No
NA
NE
33. Did the Reviewer/inspector fail to discuss review/inspection with an on-site representative?
E] Yes
[5g No
NA
NE
34. Does the facility require a follow-up visit by the same agency?
E] Yes
Ce No
E] NA
0 NE
Comments (refer to question ft Egpiain any YES answers and//or any additional recommendations.or any other'comments ; i"Iw
Use drawings of.faeility to better egplam. situations (use additional ages as necessary):
Reviewer/Inspector Name:
Reviewer/inspector Signature:
Page 3 of 3
Phone: '7%a3�33i
Date: 91 Al
114/2011

II'ype of Visit: • Compliance Inspection U Operation Review U Structure Evaluation U 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: D ;OD4 Departure Time: pSraO County: 5v4*Lj?J0ftJ
Farm Name: Owner Email:
Owner Name: TEE..r. LT?4t. Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative:
Certified Operator: �(4-L4*5 Ad,/_7
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator: �vCje-
Certification Number:
Certification Number:
Longitude:
Sw .
ine
Capac ty Cpopnt _ow
4' _ _T_..
ppDes�gn,� Curre2ultry Capacity�Pop
_
Cattte Capacity Pop.
❑ Yes
Wean to Finish
� NA
La er
Dairy Cow
T02 No
Wean to Feeder
❑ NE
Non La er
Dai Calf
Feeder to Finish-
Farrow to Wean"
Farrow t Feder
DesignCurreitt
D . Po 1 Ca acsP0
Dai Heifer
D Cow
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts Non -Lavers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
t]ther F s Turke Poults
Other Other
Dischar es and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes [)j No ❑ NA ❑ NE
❑ Yes
❑ No
[RNA
❑ NE
❑ Yes
❑ No
� NA
❑ NF
❑ Yes
❑ No
NA
❑ NE
❑ Yes
C4 No
❑ NA
❑ NE
❑ Yes
T02 No
❑ NA
❑ NE
Page I of 3 21412011 Continued

Facility Number: Date of Ins ectioa:
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier: ::V�^
No ❑ NA ❑ NE
No NA ❑ NE
Structure 6
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): bu 4V
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a ❑ Yes No ❑ NA ❑ NE
waste management or closure pian?
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 [!p No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes T 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 �0 No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes 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). 35zkj &q_4> _,
13. Sail Types): �02>
`" 1
—
14. Do the receiving crops differ from those designated in the CAWMP?
❑ YesLTJ
No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
ER No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
1p No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
0 NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
0 No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
q 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 W No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? [:)Yes [jq No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [] Yes [g No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 214/2011 Continued

FaciliNumber: jDate 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 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 No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes ❑ No [ANA ❑ NE
T
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes P No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes K] No ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? I f yes, check the appropriate box below.
❑ Yes P No ❑ NA ❑ NE
❑ Application Field E]Lagoon/Storage Pond [:]Other:
32. Were any additional problems noted which cause non-eornpliance of the permit or CAWMP?
❑ Yes [5g No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes §aNo [—]NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes P No ❑ NA ❑ NE
Comments (refer to question #): Explain any YE answers an m
or any additional recomendations or any other comments
,
Use drawings of facile to better explain situations- use additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 1?/Q_/53-:3AV
Date: 9 ` 14 '14
2/4/2011

e
Type of Visit • Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit 0 Routine O Complaint Q Mow up O Referral O PTwrgency O Other ❑ Denied Access
Date at Visit:�% Arrival Time: b Departure Time: I ( County': Region:
Farm Name:Q�nn Owner Eroail_
Owner Name: � fM s �' Phone:
Mailing Address:
Physical Address:
Facility Contact: .� j,, Title: Phone No:
Onsite Representative: > YDS Lamb Integrator*
�r
Certified Operator:nt n
Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: =0
=6
=66 Longitude: = °
J
Design Current
Design Current
Design Current
Swine Capacity Population
Wct Poultry Capacity Population
Cattle Capacity Popula "an
❑ Wean to Finish
❑ Layer
❑Dai Cow
❑ Wean to Feeder
❑ Non -Layer
❑ Dai Calf
❑ Feeder to Finish
❑ NF.
❑ Dairy Heifer
Farrow to Wean
Dry Ponitr3 -
❑ D Caw
El Farrow to Feeder
❑ Layers
El Non -Dairy
Farrow to Finish
❑ NA
❑ Beef Stocker
Gilts
ro
❑Non -La ers❑
Beef Feeder
Boars
❑ Pullets
❑ Beef Broad Cow
❑ Turke s
Other,
❑ Other
❑Turke Pblllt5
El Other
Dumber of Structures:
Discharges & Stream Impacts
I . Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (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?
❑ Ycs � No El NA El NE
❑ Yes
❑ No
NA
❑ NE
❑ Yes
❑ No
NA
❑ NE
NA
❑ NF.
❑ Yes
❑ No
❑ Yes]
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
Page I of 3 12128/04 Continued

FacMityNumber: Date of Inspection l0
❑ Yes
No ❑ NA
❑ NE
Waste Collection & Treatment
12178104
Continued
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes [VNo
❑ NA
❑ NE .
a. If yes, is waste level into the structural fi ceboard?
❑ Yes ❑ No
P NA
❑ NE
Structure I Structuum 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier -
Cp�S'�a9
J
12. Croptype(s) tt� - -,7 �
"
Spillway?:
13. Soil type(s) P�OB ,
Designed Freeboard (in):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
0 No ❑ NA
Observed Freeboard (in): o�D� 33
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No ❑ NA
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.)
❑ Yes
[7$No ❑ NA
❑ NE
6. Are there structures on-site which are not properly addressed and/or managed
❑ Yes "'No
No
ElNA
[INE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes V No ❑ NA ❑ NE
S. Do any of the stuctures lack adequate markers as required by the permit? ❑ YesNo [:INA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks) le
9. Does any part of the waste management system other than the waste structures require ❑ Yes [aNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No ❑ NA
❑ NE
maintenance/improvement'?
12178104
Continued
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
;n No ❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift El Application Outside of Area
Cp�S'�a9
J
12. Croptype(s) tt� - -,7 �
"
13. Soil type(s) P�OB ,
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
0 No ❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No ❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
[7$No ❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment? [:]Yes UNo ❑ NA EINE
L'� '�-W(kV4 qm�Vf
Reviewer/]nspector Name �� :�!' ��r ,(�"'
Reviewertinspector Signature:
Phone:
Date: /D
Page 2 of 3
12178104
Continued

a
Facility Number: �-� Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ;9 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ YesNo ElNA ElNE
the appropriate box, ElWUP ElChecklists ❑ Design ElMaps ElOther 1P
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 0 No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes PNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No P NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
MNo
[INA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
IZI 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
tffNo
❑ 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
Cl yes
�, ""
O 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
n No
❑ NA
❑ NE
Add _itional Cauuments aiid/or_Drawings
Page 3 of 3 12128104
Page 3 of 3 12128104

Jr
Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: ��-� Departure Time: %%. County:
Farm Name: 1 ws aT't0''i Owner Email:
Ll �
Owner Name: _ t" P,5 tago Phone:
Mailing Address:
Physical Address: 1
Facility Contact: l Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Region: 6@Q_
Phone No:
Integrator: St
Operator Certification Number: 17�Rfo
Back-up Certification Number:
Location of Farm: Latitude: [=O =1 =a Longitude: = ° E--] ' 0 "
Discharges & Stream Impacts
1. is any discharge observed from any part of the operation? ❑ Yes F No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
llesign Current
Design Current
Design Current
Swine
Capacity Population
Vet Poultry Capacity Population
Cattle Capacity Population
❑ Wean to Finish
❑ Yes ❑ No
❑ La er
❑Dai Cow
❑ Wean to Feeder
iry Calf
❑ Feeder to Finish
❑ Yes ❑ No
�NA
❑ Dairy Heifer
Farrow to Wean
1 95
Dry Poultry
❑ Dry Cow
El Farrow to Feeder
ElYes No
Layers
❑
El Non -Dai
El Farrow to Finish
[:1 Beef Stocker
Gilts
r �Q
E1 Nan -La ers
❑ Beef Feeder
1Soars
❑ Pullets
10 Beef Brood Co
❑ Turke s
Other
❑ Other
❑ ITurkey Poults
❑Other
Number of Structures:
Discharges & Stream Impacts
1. is any discharge observed from any part of the operation? ❑ Yes F No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes ❑ No
[JINA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes ❑ No
NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes ❑ No
�NA
❑ NE
2, is there evidence of a past discharge from any part of the operation?
❑ YesNo
[:1NA
[:1NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
ElYes No
❑ NA
❑ NE
other than from a discharge?
12/28/04
Continued

f
Facility Number: — 1 Date of Inspection
❑ Yes
Waste Collection & Treatment
ElNA
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes WIo ❑ NA ❑ NE
a. if yes, is waste level into the structural freeboard?
❑ Yes ❑ No NA ❑ NE
Stnlcture I Structure 2 Structure 3 Structure 4
/4
Siructure Siructure 6
Identifier:
[jN No
Spillway?:
❑ NE
Designed Freeboard (iia): ly
Observed Freeboard (in): 4
❑ Yes
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ YesONo C1NA El NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed
❑ Yes 9?No ❑ NA ❑ NE
through a waste management or closure plan?
❑ 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 1�No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
(Not applicable to roofed pits, dry stacks and/or wet stacks) ❑Yes jNo [I NA ❑ NE
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 [V�'No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ® No El NA El NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground El Heavy Metals (Cu, Zn, etc.) f
❑ PAN ❑ PAN> 10% or 10 lbs ❑ TotaI Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window /❑ Evidence of jWind
� Drill[I Application Outside of Area
12. Crop types) Q.S Yet �X t Y1 �T` J r mit' ► , iF. jq ve(�
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
iN No
ElNA
ElNE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
i* No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination',[] Yes
[jN No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
(9 No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
E�No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/Inspector Name 1412L Maylp Lo Phone: of o _g3.3'.3,3b0
_
Reviewer/Inspector Signature:Date:
12125/04 Continued

r
Facility Number: — `3 Date of Inspection
Reguired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 10No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 0 No ❑ NA ❑ NE
the appropriate box. ❑ WUp ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes P? No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
q No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ YesNo
❑ 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
25.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT") certification?
❑ Yes
No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
h No
❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
0 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
JDNo
❑ 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
V9 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
PNo
❑ NA ❑ NE
12128/04

'. a Division of Nater Quality
rFac=yumber 6;Z = s3 Q Division of Soil and Water Conservation
Q Other Agency
Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit:5�" Arrival Time: I 3.' /h Departure Time: County.
�SG�✓
Farm Name:h Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative- J�s tgmL Integrator: /L°s
Certified Operator:
Back-up Operator:
Operator Certification Number:
Back-up Certification Number:
Region: 9V2
Location of Farm: Latitude: = o =I
=" Longitude: = o = I EJ
Swine
❑ Wean to Finish
El Wean to Feeder
Design Current. Design Current .. Design Current
�,
Capacity Popuul tion Poaltry Capacity Population» , Cattle Capacity Population
❑ Layer ❑ Dairy Cow
❑ Non -La er ❑ Dairy Calf
El Feeder to Finish
❑DaiHeifer
Farrow to Wean
Dry=Poultry
❑ Dry Cow
❑ Non
Farrow to Feeder
❑ Layers
-Dairy
❑ Farrow to Finish
Beef Stocker
Gilts
❑ Non -Layer
❑Beef Feeder
PE]Boars
El Pullets
❑ Beef Brood Co
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Turkeys
❑ No
Otherp,
N ❑ T urkey Poults
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Other
❑ Other
N umber of SVuctures:
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
Ko
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
&NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
�9No
I15
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
�io
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
12/28/04
Continued

acility Number: 571 Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes PNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No QMA ❑ NE
S re I Structure Structure 3 Structure 4 Structure 5 Structure 6
Identifier: �' Q
Spillway?:
Designed Freeboard (in):
i
Observed Freeboard (in);
5. Are there any immediate threats to the integrity of any of the structures observed?1
(ie/ large trees, severe erosion, seepage, etc.) ❑Yeslo [I NA El NE
6. Are there structures on-site which are not properly addressed and/or managed ❑ YesNo [INA [:1NE
through a waste management or closure plan? ffr
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 P§No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ YesNo ❑ 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 ❑ YesNo ❑ NA [INE
maintenance or improvement? 111111
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need [] Yes 9 No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable (Crop Window ❑ Evidence of Wind
Drift ❑ Application Outside of Area
12. Crop type(s) �� l� � "CS Lief t Sj^'t�
13. Soil type(s) 'nW'+0A-
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes 99 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
q No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes
[P No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes
P No
❑ NA
❑ NE
Reviewer/Inspector Name 1 - ?j Phone: f
Reviewer/Inspector Signature: Date: kZyA I
Page 2 of 3 12128/04 Continued

Facility Number: Ap,-613 Date of Inspection G�
Re aired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes F1 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes V No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 19No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield [:1120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
�9 No
❑ NA
❑ NE
23,
if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
® No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
10 No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
EDNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
[8 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 CA WMP?
❑ Yes
§5 No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
M 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
IONo
❑ 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
1P 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
[gNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
$3 No
❑ NA
❑ NE
Comments and/or Drawings:
12128104

letq�?
Division of Water Quality
Facilitty Number �a fir. ' Q Division of Soil and Water Conservation
Q Other Agency
Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral Q Emergency 0 Other ❑ Denied Access
Date of Visit: Q 'r Arrival Time: �� Departure Time: County: `� Region: Fo
Farm Name: P` I w—��,4'� Owner Email:
Owner Name: �iN"[S7tsQe Phone:
Mailing Address:
Physical Address:
Facility Contact:"moi �l►DJ Title:
Onsite Representative:
�i
Certified Operator:
Back-up Operator:
Location. of Farm.,
Swine
Phone No -
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: = =4
Longitude: 0 ° ❑ I =
x,.
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Wean to Finish ❑ La er
❑ Wean to Feeder 10 Non -Layer
❑ Feeder to Finish
Farrow to Wean '] A
Farrow to Feeder
❑ Farrow to Finish
Gilts r7d
Boars
Other
❑ Other
Dry Poultry
❑ Lavers
❑ Non -La ers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & 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?
Design Current
Cattle Capacity Populatiod;
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifei
❑Dry Cow
❑
Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number'of Structures: ®:
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes P No ❑ NA ❑ NE
❑ Yes
❑ No
)9 NA
❑ NE
❑ Yes
❑ No
BNA
❑ NE
❑ No )N NA
❑ NE
❑ Yes
❑ Yes
No
❑ NA
❑ NE
❑ Yes
ONo
❑ NA
❑ NE
12/28/04 Continued

Facility Number:a �f 3 Date of Inspection 07
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 [N No ❑ NA ❑ NE
Structure i Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): LN
❑ Yes
F No
❑ NA
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
M No
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
❑ NA
❑ NE
6. Are there structures on-site which are not properly addressed and/or managed Cl Yes
WVNo
El NA El NE
through a waste management or closure pian?
17. Does the facility lack adequate acreage for land application?
❑ Yes
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 _F1 No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? [❑ Yes
{WNo
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
❑ NE
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?
1
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
[ No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[:]PAN ❑ PAN > 10%orf 0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
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
EP 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
RNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
�j 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):
A.
Reviewer/Inspector Name ! r l Phone: Cr/O) 30o
Reviewer/Inspector Signature: Date: of
12/28/04 Continued

Facility Number: Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ( No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists
❑ Design 1:1 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
)91 No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
IQ No
XA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
bd No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
P No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
r'o No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
'KNA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
+
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
(P No
❑ NA
❑ N1;
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
IR 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
1 yNo
❑ NA
❑ NE
12/28/04

Type of Visit Q Compliance Inspection 0 Operation Review O Structure Evaluation Q Technical Assistance
Reason for Visit 0 Routine O Complaint Q Follow up O Referral 0 Emergency Q Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: County: SSOr� Region: ► r
E
Farm Name: .-9 ('T50) Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Phone:
Phone No:
Integrator: P �-
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: = = = Longitude: = o ='
EJ "
Design Current
DesIlMurrent
Design Current
Swine Capacity Papulation
Wet Poultry. Capipulation
Cattle Capacity Population
❑ Wean to Finish
❑ I a er
❑ Dairy Cow
❑ Wean to Feeder I
ILI Non -Layer 1
[:1 Dairy Calf
❑ Feeder to Finishh---�.
w.
❑ Daia Heifer
RI Farrow to Wean
Dry Poultry
❑ DEy Cow
❑ Farrow to Feeder
E] Layers
El Non -Dairy
❑ Farrow to Finish
❑ No
El Stocker
❑ Gilts
El Non-Layers
ElBeef Feeder
El
[:1 Boars
El Pullets
❑ Beef Broad Cowl I
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Turkeys
❑ o
Other
❑Other 1110
❑ Turkey Poults
Other
Number of Structures:
El YesZo
❑ NA
Discharges & Stream impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
MNo
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
wis
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
7NA
❑ 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
❑ o
ET 'NA
El NE
2. Is there evidence of a past discharge from any part of the operation?
El YesZo
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
0 Yes
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12128104
Continued

Facility Numbet:V oZ.'- 3 Date of Inspection
Waste Collection & Treatment
��,//
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
El Yes 6dNo
❑ NA
❑ NE
a. if yes, is waste level into the structural freeboard?
❑ Yes ❑ No
[XA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier;
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): rfy
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 WN0
❑ 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 tat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No C3NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes 9<0 ❑ 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 fNNo ❑ NA ❑ NE
maintenance or improvement?
Waste Avolication
14. Are there any required buffers, setbacks, or compliance alternatives that need
mai ntenance/improvement?
El Yes 5 N [:1 NA El NE
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes V9 No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l{1 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) big�r 5 e ryv_u�
13. Soil type(s) 1 , nDb - -
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes D9 No ❑ NA ❑ NE
I S. 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 0 No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes 03 No ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes 0 No ❑ NA ❑ NE
Comments (refer to question ft Explain any YRS answers and/or any recommendations or any other comments.
Use drawings of faeility to better explain situations. (use additional pages as necessary):
Reviewer/Inspector Name TLA " f Phone: '710 X33 -3 Sao
Reviewer/Inspector Signature: - Date:
- -0 '�20 (a]
Page 2 of 3 1212M4 Continued

Facility Number: —q3 Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes f�]-No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check ❑ Yes 0 No ❑ NA ❑ NE
the appropriate box. ❑ WUp ❑ Checklists ❑ Design ❑ Maps ❑ Other
21, Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes �j No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes P 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
N No
[:INA
❑ 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
VS No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
® No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
® No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
M 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?
❑ Yes
[j] No
❑ NA
❑ NE
Additional Comments and/or Drawings: -
T
Page 3 of 3
a
12128104

Division of Water Qualit}
aeitity httmbt?r /� Division of Soli and Vater Conservation ,
Q other Agency
Type of Visit ® Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit•R .?/ Arrrrriival Time: .3 PU Departure `rime- County: -" :,i.2 Region:
Farm Name: _ /"� 9 Owner Email:
Owner Name: PC G1�04e—i` F r m 5 Phone:
Nailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Title:
,,C.6_ -
Certified Operator: i- Ir -
Back -up Operator:
Phone No:
Integrator:. Pr c .S. 4 CLI e
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: =1 o =I
="
Longitude: ❑ ° ❑ 0 "
Swine
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Wean to Finish ❑ Layer
❑ Wean to Feeder ❑Non -La c�
❑ Feeder to Finish
[9 Farrow to Wean ~v1
❑ Farrow to Feeder
❑ Farrow to Finish
®Gilts
❑ Boars
Other
❑ Other - - -
Dry Poultry
❑ La ers
❑ Non -Lavers
Pullets
Turkeys
Turkey Pouits
Other
Discharges & Stream Impacts
I . is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Papulation
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Da Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
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)?
Number of Structures: ®;
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
2. is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes (W No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NF
El NA
❑NE
El Yes
[]No
❑ Yes
0 No
❑ NA
❑ NE
[I Yes
t]No
0 N
[:1 NE
12/28/04 Continued

! lb
Facility Number:
Date of Inspection •�f v�
Waste Collection & Treatment
4_ Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in): / f
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes X No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes [ff No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes [� No ❑ NA ❑ NE
S. Do any of the stuctures 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 [� No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
maintenance/improvement?
❑ Yes [P No ❑ NA ❑ NE
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 50 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. Croptype(s) rw,ag
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes 9 No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [P No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination',[] Yes V1 No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application'? ❑ Yes [P No ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes X) No ❑ NA ❑ NE
Reviewer/Inspector Name ®�� Phone:
Reviewer/Inspector Signature: Date:�[—
12128/04 Continued

Facility Number: ga —,s-/3 Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 9 No ❑ NA ❑ NE
20. Does the facility fail to have ail components of the CAWMP readily available? If yes, check ❑ Yes jq No [INA ❑ NE
the appropirate box.
❑ WUP El Checklists ❑Design ❑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 l" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
[jNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
P No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[p No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
[� No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[A No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
Q0 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
[0 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
19 No
❑ NA
❑ NE
General hermit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fait to discuss review/inspection with an on-site representative?
❑ Yes
$1 No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
W No
❑ NA
❑ NE
Additional 64zurtlegts,and/oi Dia*'iQgs:
�9�/r1cJ��G /i�/LT �I' �' rfn
! �i� On r�
/► Air
�t73 (j
p'r�+tJ1-try
1.128104

M
of Visit ® Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit QF Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Date of Visit: 'lane:
S� 0 Not Operational Q Below Threshold
04ermitted GF ertified © Conditionally CertMed Q Registered Date Last Operated or Above Threshold: .....
Farm Name: ............ _.... . �- 9.. (d!i%1 .-�f� ark - - - .... County:
Owner Name: _P1 t�LarfL_.. 1 ��+ _ _.. _ . Phone No:
-Mailing Address:... ......--------- 4./'1'4y_a.............
Facilitv Contact: ...... & x............ Title:.. .......-•---_---
Onsite Representative:..
Certified Operator:.......„........
Location of Farm: V M13 X055 %JC�r�Sor'1
................................. Phone No: .. W_. ._� ...... - W...
Integrator: . `f.�C&r5�
Operator Certi kation Number:, ,
.:2p yofi
9'�W'ine ❑ Poultry ❑ Cattle ❑ Horse Latitude • 4 « Longitude • 4 49
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes Flo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? [:]Yes M- o
b. If discharge is observed. did it reach Water of the State? (If yes, notify DWQ) Yes [�'I�o
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 MNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes DNo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes B No
Structure i Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ...... f!. - ........ 6 ... ........... ..... .......... I.- .......... .--....... ........................... ...... .............. ..................... .................. .... ..........
Freeboard (inches):'
12112103 Continued

Facility Number: — r J
Date of inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenancelimprovement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation marldngs?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? If yes, check the appropriate box below.
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
❑ Yes R-Iq0
❑ Yes [moo
❑ Yes [moo
❑ Yes E91 0
❑ Yes B14o
❑ Yes [3 -go
❑ Yes Bf4o
12. Crop type _44„11 . re,.'
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes Flo
14. a) Does the facility lack adequate acreage for land application? ❑ Yes 0,f4o
b) Does the facility need a wettable acre determination? ❑ Yes B140
c) This facility is pended for a wettable acre determination? ❑ Yes ONO
15. Does the receiving crop need improvement? ❑ Yes 9 No
16. is there a lack of adequate waste application equipment? ❑ Yes [2,14o
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge attor below ❑ Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes 0140
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes D -Ko
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional ❑ Yes B14o
Air Quality representative immediately.
;Comore is [refer tltr'queshom #) Explain any Y]F5'snsw s ii&a' r airy rrecommendatftm or anyot6er, comments.
Usedriiwutgs of faccfty to better eplam setoabads. ( arllmanal pis as aecessary) (Meld Copy ❑ Final Notes
ReviewerAkspector Name
Reviewer/inspector Signature: Date: 3_ /0-0y
12112103 Continued

A
Facility Number: ' — Date of Inspection
Required Records & Document.+
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
[g -No
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
S UTVPy QnU► rne +�?rt�T�o✓T O� WGje QlrIrCGr.On e�t���pI17P�i
(ie/ W'UP, checklists, design, maps, etc.)
❑ Yes
[9 -No
23. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
[g -No
❑ 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
[9,No
25. Did the facility fail to have a actively certified operator in charge?
❑ Yes
O—No
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
O -No
27. Did Reviewer/Inspector fail to discuss review/inspection with on-site representative?
❑ Yes
O -No
28. Does facility require a follow-up visit by same agency?
❑ Yes
[ No
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
❑-No
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
®-Yes
❑ No
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
UrNo
32. Did the facility fail to install and maintain a rain gauge?
❑ Yes
EI -No
33. Did the facility fail to conduct an annual sludge survey?
0 -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
21qo
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After 1" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
ff7No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
X 3 3 I I/
/y1t, !3u/C�oo�- .s�frrrc 74-AaT` �-Lre GnnvG�� S�vc%9t
S UTVPy QnU► rne +�?rt�T�o✓T O� WGje QlrIrCGr.On e�t���pI17P�i
would ed by 4�e_ e,,d W 41or ! oou
ral'o- /ook 5 9 uvc/
Recor4/5 /vol( 90rod
12112103

State of North Carolina
Department of Environment,
Health and Natural Resources g4j
Fayetteville Regional Office
James B. Hunt, Jr., Governor p FE N R
Jonathan B. Howes, Secretary
Andrew McCdl, Regional Manager
DIVISION OF ENVIRONMEN7PAL MANAGEMENT
November 21, 1994
Mr. Glenn Clifton
Prestage Farms, Inc.
P.O. sox 438
Clinton, NC 28328
SUBJECT: Compliance Inspection
Sampson County
Dear Mr. -Clifton: - -
On November 17, 1994, an inspection of your animal operation was
performed by the Fayetteville Regional Office (FRO). Please find enclosed a
copy of our Compliance Inspection Report for your information. It is the
opinion of this office that this facility is in compliance with 15A NCAC 2H,
Part .0217, and that Animal Waste Management is being properly performed.
Should you have any questions regarding this matter, feel free to contact
me at [phone].
Sincerely,
Grady bson
Environmental Engineer
Enclosure
cc: Facility Compliance Group
Wachovia Building, Suite 714, Fayeftevllle, North Carolina 28301-5043 Telephone [phone] FAX [phone]
An Equal Opportunity Affirmative Aofion Employer 50% recycled/ 10% post -consumer paper

FORTH CAROLINA DEPARTMENT OF ERMtOMMENT, HEALTH h NATURAL RESOURCES
DIVISION OF AL PULKAGEPOW
Fayetteville Regional Office
Animal Operation compliance Inspection Form
All questions answered negatively will be discussed in sufficient detail in
the Comments Section to enable the deemed Permittee to perform the appropriate
corrections:
SBCTION I
Animal Operation Type
Horses, cattle, swine, poultry, or sheep
SECTIOP 11
1. Does the number and type of animal meet or exceed
the (.0217) criteria? (Cattle (100 head),
horses (75), swine (250), sheep (1,000), and
poultry (30,000 birds with liquid Waste
system)]
2. Does this facility meet criteria for
Animal Operation REGISTRATION?
3. Are animals confined fed or maintained
in this facility for a 12 -month period?
4. Does this facility have a C RTIFIED ANIMAL
WASTE , KANAGEKEW PLAN?
5. Does this facility maintain waste management
records (volumes of manure, land applied,
spray irrigated on specific acreage with
specific cover crop)?
6. Does this facility meet the SCS minimum
setback criteria for neighboring houses,
wells, etc?
inn
1�
MOM
lie
low,

SEION III
Field Site Manauemgnt
1. Is animal waste stockpiled or lagoon
construction within 100 ft. of a USGS
Map Blue Line Stream?
2. Is animal waste land applied or spray
irrigated within 25 ft. of a USGS Map
Blue Line Stream?
3. Does this facility have adequate acreage
on which to apply the waste?
4. Does the land application site have a
cover crap in accordance with the
CERT 1 KATION PLAN?
5. Is animal waste discharged into waters of
the state by man-made ditch, flushing system,
or other similar man --made devices?
6. Does the animal waste management at this
farm adhere to Best Management Practices
(BNP) of the approved CERTIFICATION?
7. Does animal waste lagoon have sufficient
freeboard? How much? (Approximately �5 ft,`)
B. is the general condition of this CAFO facility,
including management and operation,
satisfactory?
SECTION IV
Comments
Section III (4): A certified waste management plan is not required until the
end of 1997; however, a cover crop is established which is well managed and
maintained.
:REM
Section III (4): A certified waste management plan is not required until the
end of 1997; however, a cover crop is established which is well managed and
maintained.