820523_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental Qual

J
. ype of v Esit: %_gf-i.ompuance inspecuon V qjperauon xevtew V atrucrure r vaivauon lJ + ecnntcai Assistance
Reason for Visit: (r/Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: tQrZ County:
Farm name: ��*'A"/��-n�.S Owner Email:
Owner Name: F_Ogkl r s Phone:
Mailing Address:
Physical Address:
Region: rKo
Facility Contact: AR WZ C K Title: Phone: RR
Onsite Representative: o5 A M6 Integrator: AJ vg Q) "I &ecx�_1)
Certified Operator: '��vrv�_s ykotfiE Certification Number:
Back-up Operator:
Location of Form:
Latitude:
Certification Number:
Longitude:
Y
D g
sign n
Cetrrent
^
wDes' n Cirr
ig rent
Design Current
S«�ne
apacity
Pop.
R'et Poultry
Capacity' .Pop.
(aatlie Capacity Pop.
Wean to Finish
La er
a. Was the conveyance man-made?
Dairy Cow
Wean to Feeder
Q`NA
❑ NE
Nvn-Laver
❑ Yes
Dairy Calf
Feeder to Finish
UWDairHeifer
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
A
Farrow to Wean
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
o
Design Current
Dry Cow
Farrow to Feeder
❑ Yes
�tNo
I)ry 1'vult , "
j,apaci Pop.
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Q'I 161-
_
Turke s
[other
Turkey Poults
Other
Other
. -
`1QliLwai:S'u',.1\aJ'1_3:
fx
�y.•�y'.�•'l
lliMYirl'.Ye - _ ... ..
Discharges and Stream Impacts
1. is any discharge observed from any part of the operation?
❑ Yes
eNo
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
[] Yes
❑ No
Q`NA
❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
❑ Yes
❑ No
F3/NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
A
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
o
❑ NA
❑ NE
3_ Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
�tNo
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 2/412011 Continued

l V
[Facility Number: Date of Inspection: :s1j1
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [>(No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No [a NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): 1 C1
Observed Freeboard (in): L_% L-)
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes [`]N o ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a ❑ Yes gNo ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ❑ No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes ['4io ❑ 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 [2No ❑ 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 E3/No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l 0 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): Cp p��x R �, k7 ZkVV.'vD4
13. Soil Type(s): f'-'A'Aa l
14. Do the receiving crops differ from those designated in the CAWMP? [-]Yes [gl<o ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? Lam' I es ❑ 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 ❑'No ❑ NA ❑ NE
❑ Yes 02f No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes Ej"'No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes VNo ❑ NA 0 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 EV(No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield [:1120 Minute Inspections ❑ Monthly and 1 " 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
0 Weather Code
❑ Sludge Survey
0 NA ❑ NE
d NA ❑ NE
Page 2 of 3 2/4/2011 Continued

Facility Number: IDate of Inspection: p
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [DAo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [3fo ❑ 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 ❑ No ❑ NA Eg<E
Other Issues
2$. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.c.; discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
34. Does the facility require a follow-up visit by the same agency?
VA R rr, EQa �; �,A,�£ Q tir.e� No U . 13 I 'docs 9
❑ Yes &No D NA ❑ NE
❑ Yes allo ❑ NA ❑ NE
❑ Yes V❑'No ❑ NA ❑ NE
❑ Yes [BNo ❑ NA ❑ NE
❑ Yes &No
[—]Yes 3No
❑ Yes Ef No
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
l� �-P�oc�n V �.� ��+��� n3E.L�•5 �o b� A�aR;`�EO - � n�stZ� 1 s�cJao rJ
-� 1 A[� '�-S ia�4F'� �ot�.q bv\- o�S�� U►i`e�t= CZ �E.i�m� .
-i�1�£.05 AO b cv� w EELS N��D
C) N�R�55��
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: go 30frie$SI
Date:
2/4/2011

t*
R'
or visit: %ruompuance inspection V Vperation Review V structure Evaluation V Technical Assistance I
Reason for Visit: �} Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: ///Z/// Arrival Time: Departure Time: r County:
Farm Name: t/ytr Owner Email:
t
Owner Name: one:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator:
L_ Title:
Phone:
Integrator: +�-r
Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Region: 1::AV
} DesignGurrent
Swine) Capacity , Pop.
Wean to Finish
_ s
W.etPoultry
La er
Desrgn Current
Capae�tvPRop.
Design Current
Cattle Capacity Pop.
Dai Cow
Wean to Feeder
Non -La er
Dai Calf
Feeder to Finish p..
;r
Dai 1leifer
Farrow to Wean
Desi�Current
Dry Cow
Farrow to Feeder
D P,oult ,
Ca aci " P.o
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Caw
'...
Turke s
Other
JFr
TurkeyPoults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: p Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes Ejl�o ❑ NA ❑ NE
[:]Yes ❑ No [RIA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) [:]Yes ❑No f NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes [:]No A ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes [Z�No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes VNo ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

Facili Number: - Date of ins ection: I
. Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes �Io ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? [:]Yes ❑ No [211�A ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): %
Observed Freeboard (in): Q
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
Ej No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
[ffNo
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
Q o
❑ NA
❑ NE
S. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
�o
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
E3"No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
�io
❑ 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): _]�aCY1u_J-6L_ LA.�441.� /66-0
_..
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [�'I�o ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes Q I] o ❑ NA D NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes [ o ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes [2'Ro ❑ NA ❑ NE
❑ Yes [l"No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes Ka'lgfo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check [:]Yes V�po ❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other: f
21. Does record keeping need improvement? If yes, check the appropriate box below. [—]Yes [1 3<0
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes Q o
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No
❑ NA ❑ NE
[] Weather Code
❑ Sludge Survey
❑ NA ❑ NE
j(NA ❑NE
Page 2 of 3 2/4/2011 Continued

Facility Number: - Date of Inspection:
[:]Yes
24. Did the facility fail to calibrate waste application equipment as required by the permit.
❑ Yes [D"&o ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes D<o ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge
levels
❑ Non-compliant sludge levels in any lagoon
❑ Yes
List structure(s) and date of first survey indicating non-compliance:
❑ NA
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes 2�No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes ❑ No ❑ NA
Other Issues
❑ NE
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes [ o ❑ NA ❑ NE
and report mortality rates that were higher than normal?
❑ NA
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes [D"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 dNo ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? if yes, check the appropriate box below.
[:]Yes
[0"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
[]T -No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
[ R'"Ro
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
Cgl o
❑ NA
❑ NE
n I
use,drawin(s of feel/ to,.better explain situations (use additional pages as necessary).. ons or an other comments.
Comments re er to uestion # • Explain an YES answers and/or -an additional recommendatt
��c.c� A_��SS `�y`E'i '�X-�-'SSS►.!° t!-��2� G"v�CQ,[n—� '%�D.
I-
� �-� t tri `t_I t �i� C L-t..j � Lt_,.e \C,,.,jCar
& 41
Reviewer/Inspector Name:
Reviewer/Inspector
Page 3 of 3
e'�� 1 6,4- 5 _� I � �_�4 -tz;
Phone:
Date: Z /
/2011

fMs �s 11)11 . 116
Type of Visit O�Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit a Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: qn,�„� , Arrival Time:
j 1 Departure Time: i County: l Region: PiQ
Farm Name: U���t &M �-1o/ 17� 4 FQIM Owner Email:
Owner Name: &QEQk'IY�f Phone:
Mailing Address:
Physical Address:
Facility Contact: i sh f -f c i Title: Casal�t Phone No: 3g 5- 000
Onsite Representative: CUI�_ Iu-wick Integrator: H-1
Certified Operator: -Tames 44wie f !i b I M5 Operator Certification Number: 9Q$ Y9
Back-up Operator -
Back -up Certification Number:
Location of Farm: Latitude: =0
=d
= Longitude: = ° = i =64
Design
Current Deng ID CurrenE
= Design Current
Swiney Ca° p city
Population Wet Poultry Ca ci P,o ulation
Cattle Ca aci Po elation
P ty P
❑ Wean to Finish
iry Cow
a. Was the conveyance man-made?
❑ Yes
❑ Wean to Feeder
❑ NA
iry Calf
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
Feeder to Finish
:r
❑ Dairy Heifer
❑ Farrow to Wean=
} "
Dry Popltry� ' `F
❑ Dry Cow
❑ Farrow to Feeder
El Non -Dairy
El Farrow to Finish
❑ La ers
❑Beef Stocker
❑ Gilts
❑Non -La ers
❑Beef Feeder
❑ Boars
❑Pullets
❑Beef Brood Co
❑ NE
❑ Turke s
❑ Yes
Other '4-
��°
❑ Turkey Pouits
❑ NE
_
❑ Other
❑ Other
Number of Structures: F
Page I of 3
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
EINo
❑ 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
NNo
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
&[No
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12/28/04
Continued

Facility Number: —5
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. if yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identificr:
❑ Yes Vallo
❑ Yes ❑ No
Structure 5
[3 NA [I NE
❑ NA ❑ NE
Structure 6
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes allo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed ❑ Yes t5k'No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ®['Yes ❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
RNo
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes
J�-No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
allo
❑ NA ❑ NE
maintenance/improvement?
It. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
[5�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)
13. Soil type(s) $�G�
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
MNo
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes
[S�No
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[:] Yes
UNo
❑ 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
allo
❑ NA ❑ NE
Use'drawm of�facdi` �to_iie'tter ei` IaEauy-'14'ESanswbrs10.'r
us ue additiaU a` as necessa x�efer torquesbon #) Explay recommenations or any othercomments.
1 h P{ p g r3')
Reviewer/Inspector Name Phone: 330 C33
Reviewer/Inspector Signature: Date: 6a d 3 Q O
Paee 2 of 3 U 12/28/04 Continued

y Facility Number: Date of Inspection EUMEJ
Required Records & Documents
19_ Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 5kNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes UNo ❑ NA ❑ NE
the appropirate box.
❑ WUP ❑Checklists ❑ Design El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes &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 t�j No [INA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No "EqNA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
CRNo
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No
5kNA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
U;No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
ERNA
❑ NE
Other Issues
as, Qooa slud e-suo? d x � S;r���,s r + aor0 -a0 t3, �
r �
one die i^ �o�y,
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
Ej?'No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
1K 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
N 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
9No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewerhrispector fail to discuss reviewlinspection with an on-site representative?
❑ Yes
M No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
® No
❑ NA
❑ NE
Additional Comments and/or Drawings
t7am qo&4 Site. # N0 v13 a04q,
001y Q '�ew -SPI -e e f&t e_ yea,in
� r e- C�OOc� rays
01 l�s�de— and ops' 1ayo�, be QCs. 9
Covey"
as, Qooa slud e-suo? d x � S;r���,s r + aor0 -a0 t3, �
r �
one die i^ �o�y,
� "GL"'
hor CAn;0.1n ij�i -bion co��,
Page 3 of 3 12/28/04

Facility No. 'P -45a3 Farm Name
Permit COC
r-- A
, A
..%r i�
OIC
FB
a0sgg2
Date 1MU11Q
NPDES (Rainbreaker
PLAT Annual Cert )
La 1 2 3 4 5 6 7
Spillway
Design freeboard
Observed freeboard inS
Sludge Survey Date Slruln^�
Sludge Depth ft
Li uid Trt. Zone ft
Ratio Sludge to Treatment Volume
1u
Calibration Date 1 ill(FIft,2 3 4 5 6 7 8
Desi n Flow
Actual Flow #
Design Width
Actual Width
Soil Test Date 1 ��( -7 � � t��
Wettable Acres RAIN GAUGE
pH Fields
Lime Needed �1�_
WUP .." Dead box or incinerator
Weekly Freeboard Mortality Records
Lime Applied
Cu -1 ✓Zn -I
Needs P o
1 in Inspections ✓
120 min Insp. .�
Weather Codes
Crop Yield
Transfer She is r�
Pull/Field Soil Crop Acres PAN
Window Max Rate Max Amt
7:0
-k-
��- K<<r ,o
�.T
- k
Verify PHONE NUMBERS and affiliations
Date last WUP FRO d 7 Date %IasktPat farm
FRO or Farm Records
Lagoon #
Top Dike
Stop Pump
Start Pump
Conversion- Cu -1 3000= 108 Iblac; Zn -I 3000= 213 Ib/ac
App. Hardwa e
jo i s S, -

$IIMS 12--2-9 -ZOOq
Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit • Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: 149,019AA% I Departure Time: County:
r
��+
Farm Name: r1 S 661 Yy1 8 50"�n !qrM Owner Email:
Owner Name: hr4 Phone:
Mailing Address:
Physical Address:
Region: X�
Facility Contact: f�i15 Title: Phone No:
M �p ft,
�cL
Onsite Representative: Integrator:
910, �z , qa.T��� 20$58
C"fied Operator: S (ou5[ �gs.aGS R • Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm:
Latitude: = =1 = Longitude: =0=4 004
Design G*urrent
Design Current
Design Current
Swiue Capacity Population
Wet Poultry Capacity Population
Gattie Capacity Population
to Finish
❑ Layer
❑Dai Cow 71
to Feeder
❑ Non -Layer
❑ Dai Calf
r to Finish (nQU 0
❑Dai Heifer
El w to Wean
Dry Poultry
❑ D Cow
to Feeder
❑ Non -Dairy
to Finish
EGilts
❑ La ers
❑ Beef Stocker
❑ Non -Layers
❑Beef Feeder
❑ Pullets
❑ Beef Brood CoiAj
❑Turke s
❑ Turke Poults
❑
Number of Structures:
Other
Discharges & Stream Impacts
1. Is any discharge observed from any pan of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes No ❑ NA ❑ NE
Ix
❑ Yes ❑ No I5 N ❑ NE
❑ Yes ❑ No NA ❑ NE
❑ Yes ❑ N ENA [3 NE
El Yes:>No
NA El NE
❑ Yes ❑ NA ❑ NE
12128104 Continued

ti
Facility Number: T sv`1 Date of Inspection 1 3
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 0 No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ YesNo ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 26
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(ic/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed ❑ Yes EfNo ❑ 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 environmentalthreat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes L' I No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes Lf 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
maintenance or improvement?
Waste Application
10. Are there any required buffers. setbacks, or compliance alternatives that need
maintenance/improvement?
❑ Yes RIC ❑ NA ❑ NE
Yes ❑ No ❑ NA ❑ NE
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes No
❑ 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 Soi
❑ Outside of Acceptable j�C' Crop Window II❑ Evidence of W' d Drift ❑ Application Outside of Area
12. Crop type(s) �Sl�l tit[. F'Y'40(0 r5._ 'S Z
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?
❑ Yes
❑ Yes
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
17. Does the facility lack adequate acreage for land application? ❑ Yes
1 S. is there a lack of properly operating waste application equipment?
❑ Yes
❑ NA ❑ NE
['_No ❑ NA ❑ NE
No ❑ NA ❑ NE
3N ❑ NA ❑ NE
No LINA ❑ NE
[31q_o'� [:INA ❑ NE
_s; '3rE` :ter- :...: - :.: %t .:�-3yy"Ak-
Comments�(refer to questton_#} Explain any. YES answers and/or any reeommendat�ons or ally other eottimen"ts
Use d=awtngs of facility to better..ezlain situations.: {use additional pages as necessary..) h -
>;TP
/�, p w..►t-✓ r...�s t tP c['i-cAL
P... ;A"3 rczo✓ds a., d Fa,r 4-
busp uQda.C. i_c_c.erci S +o bQQ a
/Va.W(-e a`r!' Via[a�io,.t w�`If._ Tel�A + -i-,c>,EAtAip�t � I[ b, drae�-ea
Reviewer/Inspector NamePhone: 1/19
Reviewer/Inspector Signature: Date:
12/28/04 Continued

a %
Facility Number: Yg—&-a Date of Inspection
Renuired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
2l. 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
B<oo
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
BNo
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
Ngo
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
0-<.
❑ NA
❑ NE
26. Did the facility fail to have an actively terrified operator in charge?
❑ Yes
ffNu
❑ NA
❑ NE
❑ No ❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
❑ No ❑ NA
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
No ❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ yes
EJ'No ❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No ❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
❑ No ❑ NA
❑ 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
❑ No ❑ NA
❑ NE
Adct�liottalCoiments andfur�rDra►vmgsr n�� "� -
12/28/04
12/28/04

P.
Type of Visit 4P Compliance Inspection Q Operation Review U Structure Evaluation Q Technical Assistance
Reason for Visit a Routine 0 Complaint O Follow up Q Referral Q Emergency O Other ❑ Denied Access
Date of Visit: $ Arrival Time: - Qi+i Departure Time: 1 %D t,04.% 1 County: - 0A Region:
Farm Name: t+ns on Owner Email:
Owner Name: FAt'nr Phone: pI0 "53a q,26 2
Mailing Address:
Physical Address:
Facility Contact: Grreey- AAWre— Title:
r
Onsite Representative: t '
Certified Operator: U
Back-up Operator.
Phone No: R1()-53.2 —yq?3
Integrator: GUrP n`:f 'I�rDt.Jtn
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: = = =" Longitude: = ° = I = u
J
A ; Design Current
�Po ulation_
Swine C pacrty p�
Design Current
W,et Ea ultry Capacity Poput�ton
,.
Design Current
Cattic Capachy Population
❑ Wean to Finish
❑ La er
❑ Dai Cow
ElWean to Feeder
❑Non -La er
❑Dai Calf
Feeder to Finish
❑ Yes
❑ Dai Heifer
El Farrow to Wean
rYl''
❑ Dry Cow
❑ Farrow to Feeder
`=�"ry
El Non -Dairy
El Farrow to Finish
❑Lavers
❑ Beef Stocker
❑ Gilts
❑Non -Lavers
❑ Beef Feeder
❑ Boars
❑ Pullets
El Beef Brood Co
,.. k
Other
❑ Turkeys
El Turkey Points
2. is there evidence of a past discharge from any part of the operation?
❑ Other
❑ Other
Number of Structures:
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
Discharees ,& Stream Impacts
. is any discharge observed from any part of the operation?
❑ Y cs
No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
1W NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
F0 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
q NA
❑ NE
2. is there evidence of a past discharge from any part of the operation?
❑ Yes
No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
No
❑ NA
❑ NE
other than from a discharge?
/
Page 1 of 3
12/28104
Continued

Facility Number: —
Date of Inspection .�
Waste Collection & Treatment
4_ Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [kNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No .�9NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: 1
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 01 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 C'No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes PNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes UNo ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes J] No ❑ NA ❑ NE
maintenance or improvement?
Waste Anolication
10.
Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
Wo
❑ NA ❑ NE
maintenance/improvement?
11.
Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
RNo
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of AcceptableCrop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12_
Crop type(s) C { J, C,q
13.
Soil type(s) - A4_ rj0
14.
Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
[PNo
❑ NA ❑ NE
15.
Does the receiving crop and/or land application site need improvement? ❑ Yes
19 No
❑ NA ❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[:] Yes
1�?No
❑ NA ❑ NE
17.
Does the facility lack adequate acreage for land application? El Yes
[�No
❑ NA ❑ NE
I&
Is there a lack of properly operating waste application equipment? ❑ Yes
9No
❑ NA ❑ NE
Reviewertinspector Name
Reviewer/Inspector Signature:
Phone:
Date:
Page 2 of 3 IIIZ Y4 Uonnnuea

r
Facility Number: —Sa Date of Inspection
Re uired 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 CA WMP readily available? If yes, check ❑ Yes M 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 5aNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and i" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes tBNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes JSNo ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
X) No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
Jallo
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
Q 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
1�33No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
;g 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
Pallo
❑ 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)
to
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
KNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
� No
❑ NA
❑ NE
Add!d0';Ual,Coiuim-intsand/or ©ravings.
Page 3 of 3 12128/04
Page 3 of 3 12128/04

0 Division of Water Quality
Ficility Number 0 Division of Soil and Water Conservation
- - - 0 Other Agency
Type of Visit 0 Compliance Inspection 0 Operation Review O Structure Evaluation Q Technical Assistance
Reason for Visit 0 Routine 0 Complaint O Follow up Q Referral 0 Emergency O Other ❑ Denied Access
� ^
Date of Visit: 1 4,1671 Arrival Time: $ : u Departure Time: ��' 4h• County: yAnL-_0fJ Region:
Farm Name: — Owner Email:
t
Owner Name: S Phone:
Mailing Address: ,
Physical Address:
Facility Contact: &'a:t7- e rt nS Title: Phone No:
Onsite Representative: 14 Integrator: AL,
Certified Operator: H Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm:
Swine
Latitude: [=
0'
= Longitude: ❑ e =I
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Wean to Finish ❑ Layer
❑ Wean to Feeder 10 Nom -La et
Feeder to Finish QQ SO
Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Daig Calf
❑ Dairy Heifez
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
Mn eef Brood Co 11:
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
MNA
❑ NE
❑ Yes
❑ No
NA
❑ NE
NA
❑ NE
❑ Yes
❑ No
❑ Yes
No
❑ NA
❑ NE
❑ Yes
fp No
❑ NA
❑ NE
12128/04 Continued

Facility Number: Date of Inspection it
Waste Collection & Treatment
Reviewer/Inspector NamePhone: 910 X33-33oD
Reviewer/Inspector Signature: Date: it
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
[A No
❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
[:]Yes
❑No
55NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
4
Observed Freeboard (in); -10
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[RNo
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed
❑ Yes
[3 No
❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
[,'g No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
® No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
f] No
❑ NA ❑ NE
maintenance or improvement'?
Waste Application
10. Are there any required buffers, setbacks, or compliance altemati ves that need
❑ Yes
�2 No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
5j No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc_)
❑ PAN ❑ PAN 7 10% or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Cro indow El Evidence of Wind Drifl El Application Outside
of Area
12. Crop type(s) 1"1-14!0.
13, Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
® No
❑ NA ❑ NE
17, Does the facility lack adequate acreage for land application?
❑ Yes
® No
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
W 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):
T
Reviewer/Inspector NamePhone: 910 X33-33oD
Reviewer/Inspector Signature: Date: it
12/2$/04 Continued

Facility Number: �j�-�j Date of Inspection
Re uired Records & Documents
19_ Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes Ed No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check [3Yes F9No ❑ NA ❑ NE
the appropirate box. [:1 WLJp 0 Checklists
❑ Design E] Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. []Yes [gNo [:INA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers [:]Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes Q No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes U2No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
JgNo
[INA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
0 No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
®No
[INA
❑ NE
27.
Did the facility fail to secure a phosphorus Ioss assessment (PLAT) certification?
❑ Yes
ER No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
V9 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
El 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
Fx] No
❑ NA
❑ NE
Comments and/or Drawings:
12128104

Type of Visit ®Compliance Inspection O Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit ®Routine O Complaint Q Follow up Q Referral Q Emergency Q Other ❑Denied Access
Date of Visit: �-�ZCC'0(p Arrival Time- Departure Time 12'11,9 County: Region:
Farm Name: GQ S _ / D 6Ct rwl Owner Email:
Owner Name: G �a «'.v S Phone:
Mailing Address:
Physical Address:
Facility Contact: (�;a-KL'#.f S Title:
Onsite Representative:
Certified Operator: �� Eed"s -71'-.
Back-up Operator:
Phone No:
Integrator: . Wyv41.4 — A, 1/D Hl ►`%
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: =10
=1"
Longitude: = ° = I = 4
Discharges & Stream Impacts
❑.La ers
❑ Non -Layers
❑Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
1. Is any discharge observed from any part of the operation?
Design Current
Design Current Design Current
❑ NA
Swine
Capacity Popu tion Wet Poultry
Capacity Population, Cattle Capacity Population
❑ Wean to Finish
a. Was the conveyance man-made?
❑ Layer
[�No
❑ Dai Cow
❑ NE
K 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)?
❑ Wean to Feeder
❑Non -La er
❑Dai Calf
❑ Yes
Feeder to Finish,,._.,
D -.5'O
3 ❑Dai Heifer
❑ Farrow to Wean
.S
r*�
PouItry
❑ D Cow
2 No
❑ NA
❑ Farrow to Feeder
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
s
� ❑ Non -Dairy
ONo
❑ Farrow to Finish a
""
l ❑Beef Stocker
Gilts
A
❑ Beef Feeder
PEJBoars.
Page I of 3
❑ Beef Brood Co
Continued
­777Other ��
~^
❑ Other
"�'iVumber of Structures:
Discharges & Stream Impacts
❑.La ers
❑ Non -Layers
❑Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
1. Is any discharge observed from any part of the operation?
❑ Yes
NNo
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
[�No
❑ NA
❑ NE
K 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
2 No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
ONo
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12128104
Continued

Facility Number:
Date of Inspection U - _2Z -b
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:
❑ Yes [&No
❑ Yes IN No
Structure 5
❑NA El NE
❑ NA ❑ NE
Structure 6
Spillway?:
i
Designed Freeboard (in): r
Observed Freeboard (in): `"3 �
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes IN 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 [I No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes P No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ;9 No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes 10 No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [INo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. El 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) 6 1yt�l! Ya �nJ �VWSe�
13. Soil type(s) Rog
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 V1 No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes No ❑ NA [:1 NE
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 [ANo ❑ NA ❑ NE
Comments (refer to question ft. Explain any YES answers and/or any recommendations or any other comments.
Use drawings of faeflity to better explain situations. (use additional pages as necessary):
Reviewer/Inspector Name eVuS —� Phoneg6 —/ST
Reviewer/inspector Signature: Date: s' Z Z — ZOO [p
Page 2 of 3 12/28/04 Continued

f
Facility Number: $Z —5Jk3 Date of )Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes �%No ❑ NA ❑ NE
rw
20. Does the facility fail to have all components of the CAWW readily available? if yes, check ❑ Yes Lm No ❑ NA ❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑Design ❑Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below_ ❑ Yes 14 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
0 No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
ICI No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[�yNo
❑ NA
ONE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No
UNA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
PC No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
[3 NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
q No
❑ NA
❑ NE
29_
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
[g No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30,
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
[;9 No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
E% 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
[ No
❑ NA
❑ NE
Comments and/or
Page 3 of 3 12/28/04

of Visit • Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit A Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number a �r� Date of Visit: UJ Time: sa
FO Not O erational Q Below Threshold
M Permitted 13 Certified r] Conditionally Certified 0 Registered Date Last Operated or Above Threshold: ...... ..................
Farm Name: _.._.........F..W._......._..__. County- .......,. ..rZa
Owner Name: �a 'pus Phone No: C4� 4�aG
Mailing Address: .•__ __As:c &Jes nee /�c�
FacilityContact: ... ........... .................................. ....... _............. -Title:.._.. ............................ ........................ Phone No:
Onsite Representative: ......... .._.__.. Integrator:
Certified Operator:...s�,.,Z,,,,,,1...............Operator Certification Number• .._
Location .__q.....�....G......Y.....7....o..Z...
of Farm:
kA,
[swine ❑ Poultry ❑ Cattle ❑ Horse Latitude Longitude �• ���
Dischac es & Stream Imparts
1. Is any discharge observed from any part of the operation? ❑ Yes No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made'? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min? 6
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 E'No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ® No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ....-....._................ ....... .... ...._.__..... __------ ......... ......... __...........
Freeboard (inches):
12112103 Continued

Facility Number: 192,
Date of Inspection
5. Are there any imtnediate 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 tate situation poses an
immediate public health or environmental threat, notify DW'Q)
7. Do any of the structures need maintenance/improvement?
❑ Yes [P No
❑ Yes E] No
® Yes ❑ No
& Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
Q0 No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
7- Rel -k s tr•o i f t* a CA t'*o V 1 Q y Od v is a kk,
elevation markings?
❑ Yes
® No
NVaste Application
❑ Yes
EM No
10. Are there anv buffers that need maintenance/improvement?
C1Yes
r-11
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hvdraulie Overload
El Yes
C9 No
12. Crop type crm ¢
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
M No
A a) Does the facility lack adequate acreage for land application?
❑ Yes
® No
b) Does the facility need a wettable acre determination?
❑ Yes
CEJ No
c) This facility is pended for a wettable acre determination?
❑ Yes
® No
15. Does the receiving crop need improvement?
❑ Yes
®No
16. is there a lack of adequate waste application equipment?
❑ Yes
M No
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
® No
IS. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
7- Rel -k s tr•o i f t* a CA t'*o V 1 Q y Od v is a kk,
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
® No
19. Does record keeping need improvement? (iel irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
EM No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
® No
21. Did the facility fail to have a actively certified operator in charge?
❑ Yes
® No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
�M No
23. Did Reviewer/Inspector fail to discuss review/inspection with on-site representative?
❑ Yes
J�2 No
24. Does facility require a follow-up visit by same agency?
❑ Yes
P No
25. Were any additional problems noted which cause noncompliance of the Certified AV4TMP?
❑ Yes
® No
Q No violations or deficiencies were noted during this visit You will receive no further correspondence about this visit.
s ohecommesetio gnanEor, any- smrr -- L
Uie drawings of -lac -I to better explain situairotes (use addrzt6nst pages as nes�ssar}) - -
,T Field Cop, Final Notes
7- Rel -k s tr•o i f t* a CA t'*o V 1 Q y Od v is a kk,
a A . w b c w w..tAIP(4 6 J 6 "40 4 d r a A,}
G r L C. J
7
Reviewer/Inspector Name -
Reviewer/Inspector Signature: Date:
05/03/01 Continued

Site Requires Immediate Attention:
Facility No. $"A- SZlf
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: 7 Z 7 , 1995
Time:
Farre Name/Owner:
Mailing Address:_
County:
Integrator: -,T-b K Phone:
On Site I
Physical
—1---b
r- % < :7 _
Type of Operation: Swine Poultry Cattle
Design Capacity: 06ng ..v Number of Animals on Site: 4 (-PC0
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: Longitude: "
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately I Foot + 7 inches) Yes o Actual Freeboard: Ft. :*)I Inches -*—
Was any seepage observed from the me
n(s)? Yes or�Was any erosion observed? Yes or�
Is adequate land available for spray?or No Is the cgver crop adequate? ef�r No
Crop(s) being utilized: 5 mroZ r
Does the facility meet SCS minimum setback criteria?
200 Feet from Dwellings? di� or No
100 Feet from Wells? es or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or(90)
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line: Yes oep)
Is animal waste discharged into water of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes orj1io:) If Yes, Please Explain.
— r• A.)ER17"T� __..
Inspector Name
Signature
cc: Facility Assessment Unit Use Attachments if Needed.