820539_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental Quaff

Type of Visit: (EF -Com . nce Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 011outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: D • oa Departure Time: Q, i7 County:
Farm Name: ' hr ; �a1� LLC- Owner Email:
Owner Name: 77,en /),L tfd r/' Phone:
Mailing Address:
Physical Address:
Facility Contact: �>/'�cl" �t7i�1'c! Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
L Ovation of Farm:
Latitude:
Region: L'—
Phone:
Integrator: sj7t.r/p�
Certification Number:
Certification Number:
Longitude:
Discharp_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 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 ❑ No ❑ NA ❑ NE
❑ Yes ❑ No
[]Yes ❑No
❑ NA ❑ NE
❑ NA ❑ NE
E] Yes
Desiga
Current
EINE
Desig&_.
urrentSwine
❑ NA
❑ NE
Capacity
Pop.
Wet Pogltryy
CapaciPop.
Cattle Capacity Pop.
Wean to Finish
Layer
I
Dairy Cow
Wean to Feeder
1 INon-Layer
I
Dairy Calf
Dairy Heifer
Feeder to Finish
Farrow to Wean
Design ,"'Current
Dry Cow
Farrow to Feeder
D . Paut
Ca aci
Po
Non -Dairy
Beef Stocker
Farrow to Finish La ers
Gilts
Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Cather
Turkey Poults
Other
Other
Discharp_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 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 ❑ No ❑ NA ❑ NE
❑ Yes ❑ No
[]Yes ❑No
❑ NA ❑ NE
❑ NA ❑ NE
E] Yes
E] No
❑NA
EINE
❑ Yes
e]'iGo
❑ NA
❑ NE
[] Yes
[Q'5o'
❑ NA
❑ NE
Page I of 3 1/4/1015 Continued

FaciliNumber: Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No [] NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): _
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes EjNo ❑ 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?
❑ Yes
[a-1ro—
❑ NA
❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat,
notify DWR
-]Checklists Checklists [:]DesignE]Maps ❑Lease Agreements
❑Other:
7. Do any of the structures need maintenance or improvement?
❑ Yes
Zr'No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[30No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
❑ Rainfall ❑Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and €" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
[:]Yes
9. Does any part of the waste management system other than the waste structures require
❑ Yes
�No
❑ NA
❑ NE
maintenance or improvement?
❑ NA
❑ NE
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
E]�No
❑ NA
❑ NE
maintenance or improvement?
1 I _ Is there evidence of incorrect land application? If yes, check the appropriate box below_ ❑ Yes [TNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): _ZVV1'0d'r_
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?
❑ Yes ENo
❑ Yes [fNo
❑ Yes [r�'1�o
❑NA ❑NE
❑ NA ❑ NE
❑NA ❑NE
❑Yes [3-1�'o E] NA ❑NE
❑Yes B o C] NA ONE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
ECJ<o
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? Ifyes, check
❑ Yes
[a-1ro—
❑ NA
❑ NE
the appropriate box_
-]Checklists Checklists [:]DesignE]Maps ❑Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
[-]Yes
No
❑ NA
[:1 NE
❑ Waste Application [] Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste 'Transfers
❑ Weather Code
❑ Rainfall ❑Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and €" 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
<o
❑ NA
❑ NE
Page 2 of 3 2/412015 Continued

[Facility Number: [Date of Ins ction: r
❑ Yes
❑'rNo
❑ NA
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
LJ No
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
C No
❑ NA ❑ NE
the appropriate box(es) below.
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond [D Other:
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge
levels
❑ Non-compliant sludge levels in any lagoon
❑ Yes
Ef No
[] NA
List structure(s) and date of first survey indicating non-compliance:
33. Did the Reviewerlinspector fail to discuss review/inspection with an on-site representative?
❑ Yes
LJ ' o
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes
'�
[�]'No
0 NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
�o
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes [a 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 [a 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
❑'rNo
❑ 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
eo
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond [D Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
Ef No
[] NA
❑ NE
33. Did the Reviewerlinspector fail to discuss review/inspection with an on-site representative?
❑ Yes
LJ ' o
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
E24o
❑ NA
❑ NE
�li �i "�— mac= �jp�: s� �r i ''` C�•S,r �� lvr►�- T-ia ��<STT Guc7
Reviewer/Inspector Name:
Reviewer/inspector Signatut
Page 3 of 3
Phone: 22 D __5�-r�''�' f
Date: /10`����'�
21412015

Type of Visit: 8'Compiiance Inspection O Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit: outine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: a Departure Time: ,' /_f County: 0` Region:
Farm Nance:) i -r— t Z L Owner Email:
Owner Name: -7; ry�1.t.�� ct ; f' r" � Phone:
Mailing Address:
Physical Address:
Facility Contact: C -::,r z r -r /ky/r_ Title:
Onsite Representative: 15 r,Z�
Certified Operator:
Phone:
Integrator:
Certification Dumber:
Back-up Operator: Certification Humber:
Location of Farm:
Latitude:
Longitude:
Dische es 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 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 No ❑ NA ❑ NE
❑ Yes
Design Curreat
❑ NA
Design
Current
Design Current
Swine
Capacity Pop.
Wet Poultry
Capacity
Pap.
Cattle Capacity Pop.
Wean to Finish
airy Cow
Wean to Feeder
;7VO
Non -La er
Dai Calf
Feeder to Finish
17airy Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
D , P,ouIt .
Ca aci
1',0 .
Non -Dairy
Farrow to Finish
ILayers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Caw
Turke s
Other
Turkey Poults
Other
Other
Dische es 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 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 No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
[]Yes ❑ No
❑ Yes ® No
❑ Yes�No
[D NA E] NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3 21412015 Continued

Facility Number: Date of IqS ection: IP—
I
Waste
—1Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes allo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): ^7_
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
(�No
[-]NA
❑ N E
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
❑ No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental
threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
0 No
❑ NA
❑ NL -
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
J2No
❑ 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
0 Yes
qNo
❑ NA
❑ NE
maintenance or improvement?
I. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes c No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10•/0 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): �+ D N �-r`SY r
13. Soil Type(s): ( r /U b rte„ „
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes Pg -.No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes allo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes Eg 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?
_Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ Yes �&No ❑ NA ❑ NE
❑ Yes 5010 ❑ NA ❑ NE
❑ Yes 1`71f No ❑ NA ❑ NE
[:]Yes [3 -No ❑ NA [] NE
❑ WUP ❑Checklists p Design ❑ Maps ❑ Lease Agreements ❑Other_
21. Does record keeping need improvement? If yes, check the appropriate box below. [] Yes FYNo
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking E] Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 " Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [✓�lo
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes MNo
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑NA ❑NE
Page 2 of 3 2/412015 Continued

[Facility Number; Date of Inspection: -t' g— I
;24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ETNo [] NA [] NE
25. Is the facility out of compliance with permit conditions related to sludge? if yes, check ❑ Yes ®-No 0 NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structures) 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 0,No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes &No [] NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes allo [] 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 allo ❑ 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 Eq No [] NA ❑ NE
❑ Application Field ❑ l-agoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes LB No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative? ❑ Yes dg No (] NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes �,No ® NA ❑ NE
Reviewer/Inspector Name:
Reviewer/Inspector Signatut
Page 3 of
Phone:-:3r�3•�!„S %
Date: 1a / `i — / � _ --
2/4/2015

IL
/1-2 / //_
Type of Visit: i '�70'U�Itinne
ce Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: I
O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: �� Arrival Time: /,' '7 Departure Time: t7 County:egion:
Farm Name: J77 N .� /�j ! + 5 Owner Email:
Owner Name: it Phone:
Mailing Address:
Physical Address:
Facility Contact: �d��✓ /%�Di'7 ✓ C Title:
Onsite Representative: ^
Certified Operator: U Lia 112
Back-up Operator:
Phone: 1
Integrator:
Certification Number:
Certification Number:
Location of Farm: Latitude: Longitude:
Swine
Designs Current-
Capacity -ak 0 .
Wet Poultry
Design
Capacity
Current
Pop.
Design Carrent
Cattle Capacity Pop.
an to Finish
❑ NE
Layer
Dai Cow
Wean to Feeder
VV
Non -La er
Dai Calf
Feeder to Finish
` _ `
Dai Heifer
Farrow to Wean
Design
Current
D Cow
Farrow to Feeder
D e Poul Ca aci P,o Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turke s
Other
mow', °
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify 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?
Page I of 3
❑ Yes ff No ❑ NA ❑ NE
❑ Yes
[:]No
❑NA
❑ NE
[:]Yes
❑No
❑ NA
❑ NE
❑ Yes ❑ No
❑Yes [+ o
[:)Yes V No
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
21412015 Continued

r
FaciliNumber: - Date of Inspection: -
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfatl) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
# Spillway?:
Designed Freeboard (in): 'e % g
Observed Freeboard (in): _7L
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
[allo ❑ NA ❑ NE
❑ No ❑ NA ❑ NE
Structure 6
❑ Yes ®-No ❑ NA ❑ NE
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
E[ No
❑ NA
❑ NE
waste management or closure plan?
❑ Yes
allo
❑ 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
® o
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
[:]Yes
RNo
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
the appropriate box.
9. Does any part of the waste management system other than the waste structures require
[:]Yes
eg-No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
14 -No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes EFWo ❑ NA ❑ NE
❑ Excessive Ponding [] Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):-
14- Do the receiving crops differ from those designated in the CAWMP? [:]Yes allo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes CNo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable [:]Yes 53No ❑ NA ❑ NE
acres determination?
n 17. Does the facility lack adequate acreage for land application?
❑ Yes
Ca -No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
allo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
allo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[!yNo
•. ❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists 0 Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ED -No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes Ivo
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes CZ -No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 2/4/2014 Continued

r
Facili Number: - Date of [ns ection: /— 6
4: 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 Eig-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?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
ED -No
❑ NA
❑ NE
❑ Yes
allo
❑ NA
❑ NE
❑ Yes
Jallo
❑ NA
❑ NE
❑ Yes [Ef-No ❑ NA ❑ NE
❑ Yes tPLNo ❑ NA ❑ NE
❑ Yes ,E _No ❑ NA ❑ NE
[]Yes
0 No
❑ NA
[] NE
❑ Yes
J;4 -No
❑ NA
❑ NE
❑ Yes
ED -No
❑ NA
❑ NE
Commeiits (refer to question #) Explain any YES answers and/or any additional recommendations or any other t:ommen
Use &Bawines df facility to better eap611i situations (use additional owes as Q" =�
�f-5w
Reviewer/Inspector Name.
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 3a�rD
Date:
2/4/2014

Type of Visit: Q'Coroutine
nce Inspection O Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit: O Complaint O Follow-up O Referral Q Emergency O Other O Denied Access
Date of Visit: Arrival Time: %; Departure Time: County:
Farm Name: i'2K Z,,,r r -a (&-\-, Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: i �jGxi�` Title: ��jf Phone:
Onsite Representative:��
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Integrator: W—Z,
Region:fZ
Certification Number: _TZ
Certification Number:
Longitude:
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 DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
[l Yes 2.No ❑ NA ❑ NE
❑ Yes
Swine
Wean to Finish
gn Current
Im"alpis.2,ity Pop.
Wef�Poultry
La er
Design
Capaci#y
Current
1?op.
Design Current
Cattle Eapaeity Pop.
Dai Cow
❑ NE
Wean to Feeder
7j>
Non -La er
Dai Calf
Feeder to Finish
Dai Heifer
Farrow to Wean
Design
Current
Cow
Farrow to Feeder
Farrow to Finish
D , foul#
]Layers
Ca aci
,Po
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
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 DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
[l Yes 2.No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWR) ❑ Yes [:]No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? [:]Yes C3.No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters 0 Yes M -No ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 2/4/2014 Continued

Facility Number: Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
allo
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes
❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): /
5. Are there any immediate threats to the integrity of any of the structures observed?❑Yes
" 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 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
10 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
[a 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):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, chgck
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑ Yes [Z -No
[]Yes ® No
❑ Yes allo
❑ Yes 0 No
❑ Yes Eg-No
❑ Yes 0 No
❑ Yes LNo
❑Other:
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
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 p Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield 0120 Minute Inspections ❑ Monthly and V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes allo ❑ NA ❑ NE
❑ Yes [A_No ❑ NA FINE
Page 2 of 3 2/4/2014 Continued

Facility Number: - Date of Inspection: —�3J
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes P.No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [,3,No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes ®,No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [—]Yes allo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
[—]Yes
® No
❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
r<A, 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
RNo
❑ 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
allo
❑ NA
❑ NE
Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
RNo
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
J4 No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
Eallo
0 NA
❑ NE
Gomtnents.(refer to question.#): Explain any YES answers and/or any additional recommendations or,any other comments.
Use drawings. offacility to better explain situations (use additional pages as necessary): u
[�.4
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: /�33
Date:
2/420!4

Type of Visit: OCom fiance Inspection 0 Operation Review 0 Structure Evaluation Q Technical Assistance
Reason for Visit: (Routine Q Complaint O Follow-up O Referral O Emergency Q Other O Denied Access
Date of Visit: Arrival Time: Departure Time- County: St ' ` Region:
Farm Name: X�t�/L - oR✓`�j fA Owner Email:
Owner Name: IZ,.tS pN6 OtNphone;
Mailing Address:
Physical Address:
Facility Contact: ezeoA rim' Title:
Onsite Representative: i
Certified Operator: 1tC
Phone:
Integrator:
Certification Number:CZ / 1
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 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 [�J o ❑ NA ❑ NE
[—]Yes ❑No E3<A ❑ NE
0 Yes [—]No E3 A ❑ NE
❑ Yes [:]No
[:]Yes [3 No
[] Yes 13"�o
❑'NA
❑ NE
Current
Design
CnrrentyDeslgn
Current
Design
Swine
Capacity
Pup: Wet Poultry
Capacity
:.Pop.
pacity Po
Cattle Cap.
Wean to Finish
La er
-
Dai Cow
Wean to Feeder
7
6a
- Non -La er
Dai Calf
Feeder to Finish
Dai Heifer
Farrow to Wean
Design
_
Current
D Cow
Farrow to Feeder
D . $oul
Ca aci
Po
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
Turkey Poults
Other
HOther
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 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 [�J o ❑ NA ❑ NE
[—]Yes ❑No E3<A ❑ NE
0 Yes [—]No E3 A ❑ NE
❑ Yes [:]No
[:]Yes [3 No
[] Yes 13"�o
❑'NA
❑ NE
❑ NA
❑ NE
❑ NA
❑ NE
Page I of 3 21412014 Continued

` M
Facili Number: - Date of—Inspection: bG
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes �o ❑ NA ONE
a. If yes, is waste level into the structural freeboard? ❑ Yes [] No [D.NIV ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? [—]Yes []-1Qb ❑ 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
[3'lgo
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
[Z],Xa
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[:�4o
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
[g'1\lo
0 NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
Ej o
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. C -]L S Yes [:]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 � ,,[ AEvidence of Wind Drift [:]Application Outside of Approved Area
12. CropT /
Type(s): : eJ U-� [ t X I
13. Soil Type(s): . . v /V
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes E3<(o ❑ NA ❑ NE
15_ Does the receiving crop and/or land application site need improvement? ❑ Yes F2 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?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑WUP ❑Checklists ❑Design ❑Maps ❑ Lease Agreements
❑ Yes Qlo
❑ Yes [;3"'No
❑ Yes 13'f o
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ Yes V],Pdo ❑ NA [] NE
❑ Yes Q,5o ❑ NA [] NE
❑ Other:
2 l . Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes dao
❑ 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 eNo
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes IBJ No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
[] NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 2/4/2014 Continued

Facility Number: jDate of ins ection•
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes
25. is the facility out of compliance with permit conditions related to sludge? If yes, check [] Yes
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
34. Does the facility require a follow-up visit by the same agency?
gr K& ❑ NA ❑ NE
Zie- ❑ NA ❑ NE
❑ Yes
[f No
❑ NA
❑ NE
❑ Yes
�
❑ NA
❑ NE
❑ Yes
R2,X6
❑ NA
❑ NE
❑ Yes 2].lrib ❑ NA ❑ NE
❑ Yes [t], 4o ❑ NA ❑ NE
❑ Yes M Ko ❑ NA ONE
❑ Yes
[ rwo
❑ Yes
❑ Yes
ErNo
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Reviewer/Inspector Name: Phone:
Reviewer/Inspector Signature:
Date:
Page 3 of 3 2/4/2014

'3 im -c v� D t5`C/H (RN _-, 4
Type of Visit: ®'Congptiance Inspection O Operation Review Q Structure Evaluation 0 Technical Assistance
Reason for Visit: Routine O Complaint 0 Follow-up O Referral O Emergency O Other Q Denied Access
Date of Visit: Arrival Time: Departure Time: j j ="o County& t'1, Regio
Farm Name: 14e6t &,f _ Owner Email:
I'
Owner Name: s 6�,^ Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
S Rj 0 bYrte Title:
lr
Certified Operator: 11
Back-up Operator:
Location of Farm:
Latitude.•
Phone:
Integrator:
Certification Number:
Certification Number:
Longitude:
Design Current
SweinCapacity Pop.
Wet Poultry
DesignCurrent
Capacity
Pop.
Design
Cattle Capacity
Current
Pop.
E§,KA
Wean to Finish
Layer
Dairy Cow
Wean to Feeder
Non -Layer
Dairy Calf
Feeder to Finish
D . Poultr
Design
Ca aci
Current
PLo P.
Dai Heifer
Dry Cow
Non -Dairy
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Layers
Non -Layers
Beef Stocker
Gilts
Beef Feeder
Boars
Pullets
Beef Brood Cow
-
Turke s
Other
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes ❑ NA ❑ NE
[:]Yes
❑No
[XA
❑ NE
[:]Yes
❑No
E§,KA
❑ NE
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 Woo ❑ NA E] NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes rR ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

Facili Number: - Date of Inspection:
c
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [3'No ~ ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes Q>6 ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
13. Soil Type(s):
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes tg- V ❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
❑ NA
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?
[j],lGo
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? [:]Yes Na ❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes [lo ❑ 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 `J - [] NA
❑ NE
maintenance or improvement?
Waste Application
17. Does the facility lack adequate acreage for land application?
10. Are there any required buffers, setbacks, or compliance alternatives that need [] Yes [&-Il<o ❑ NA
❑ NE
maintenance or improvement?
❑ NE
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [ZjKo ❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground D Heavy Metals (Cu, Zn, etc.)
❑ NA
❑ PAN [] PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
Required Records & Documents
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): &-l;;,
13. Soil Type(s):
I4. Do the receiving crops differ from those designated in the CAWMP?
[:]Yes
I. o
❑ NA
❑ NE
15. Does the receiving crop andfor land application site need improvement?
❑ Yes
[j],lGo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
[;,Nn
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
Q156
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[!,'<o
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[Z�kn
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
❑.bio
❑ 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 RNO ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
[:]Rainfall ❑Stocking [:]Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [B1�0 ❑ NA ❑ NE
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 02<o ❑ NA ❑ NE
Page 2 of 3 2/4/2011 Continued

FaciEi %lumber: -Date of inspection:
P. ' %P TI
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes E3<o ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? if yes, check ❑ Yes tl� 'u ❑ 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 io ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [Plo ❑ 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:
❑ Yes 9 No ❑ NA ❑ NE
❑ Yes r7l< E]NA ❑ NE
[:]Yes [�o ❑ NA ❑ NE
❑ Yes [;�No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes [g"f4o ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative? ❑ Yes �lo ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes E10 ❑ NA ❑ NE
FConi'ments (refer.to question #)::Explain any YES answers and/or any additional recommendations or any other comments
x
drawings of facility to better explain situations (use additional pages as necessary).
C/-la-Iz
G- Iz-t a
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
sc� �
Clof
6_�N'4_�
a3 q
Phony: j - - 3
Date: t& b
2/4/2011

d a44
jType of Visit: (R'Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance I
(Reason for Visit: CYRoutine 0 Complaint 0 Follow-up 0 Referral 0 Emergencv 0 Other 0 Denied Access
Date of Visit: $ I Arrival Time: 7: 0 Departure Time: County: Zg, r \ Region: rilka
Farm Name: (�� {Z Owner Email:
Owner Name:Phone:
Mailing Address: vAos dp app e '\_1KAb(y qj C a %Na 9
Physical Address: 1601 R NE. �NSU,1= Q\.Op6fl �INM-5bn RA *MbA:� CISI O
Facility Contact: Title: _0 W at (Z
Integrator: M ho 0'0n4 t'.
' ;Phone:
Onsite Representative: 1=
Certified Operator: �ASDI
Back-up Operator:
Location of Farm:
Latitude:
Certification Number: 1-1-\RLl
Certification Number:
Longitude:
Discharges and Stream Impacts
©,esi� GnrrenYEliDesign
Current
Design Current
1d/ No
Swine
Capacity P.op,
Wet Poultay
Capacity.
Ppp.: _
Cattle Capacity Pop.
Wean to Finish
4 Yes
Layer
Non -La er
"`
❑ NE
D Cow
Da' Calf
Dai Heifer
❑ Yes
Wean to Feeder oB (f
Ej�<A
Fecder to Finish
e. What is the estimated volume that reached waters of the State (gallons)?
Farrow to Wean
Design
Curren#
Cow
❑ No
Farrow to Feeder
❑ NE
D , P,oul
@a aci
Po P.
Non -Dairy
[] NE
Farrow to Finish
[] Yes
Layers
Non -La ers
❑ NA
❑ NE
Beef Stocker
I 113eef Feeder
Gilts
Boars
Pullets
I 113eef Brood Cow
Turkeys
t?iher
Turkey Poults
Other
Other
Discharges and Stream Impacts
I . Is any discharge observed from any part of the operation?
❑ Yes
1d/ No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
4 Yes
❑ No
E5rNA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
Ej�<A
❑ NE
e. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
G2fNo
❑ NA
[] NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
[] Yes
[j�rNo
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 2/4/2011 Continued

T.. i
❑ Yes
EEfNo
❑ NA
0 NE
Facili Number: - Date of Ins ection: $ p
Z
gNo
❑ NA
❑ NE
Waste Collection & Treatment
❑ Yes
g 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 I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): let
Observed Freeboard (in): 4,4_
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
dNo
❑ 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
[g$Io
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
dNo
❑ 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
[B'**No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffets, setbacks, or compliance alternatives that need
❑ Yes
dNo
❑ 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 [3Application Outside of Approved Area
12. Crop Type(s):yt�A RAS �DA7k_y'£ ) , Z-). '-r-)
13. Soil Type(s): IC
14. Do the receiving crops differ from those designated in the CA WMP? ❑ Yes WNo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? [:]Yes gNo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable [:]Yes [gNo ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
EEfNo
❑ NA
0 NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
gNo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
g No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
dNo
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design p Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. [-]Yes dNo ❑ 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 d No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No [DNA ❑ NE
Page 2 of 3 214/2011 Continued

Facility Number: - Date of Inspection: 'a-
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [FrNo
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes (O 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 [grNo
2T Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes WNo
I&05
❑ 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
[�'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
dNo
❑ 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)
3 t. Do subsurface tile diains exist at the facility? If yes, check the appropriate box below.
❑ Yes
E4 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
dNo
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
[:]Yes
dNo
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
[gfNo
❑ NA
❑ NE
Comments (refer to question'#): Explain any YES answers and/or any additional recommendations or any other coitimeuts: r'
Use drawings of facility to better explain situations (use additional pages as necessary).
'..�
Stu . ZQewp i l P-ywXXVMes\At Cp,1s on , � o -ko bt C6MJAz_­VL0 3.3
X_P. ,CpON Fg&,L boARb vr\p%9,*E.R %N4LO.5 4-0 �E SA0.eas�A 'CV)
1, ?,xtzMS \J L\\ Y," -T
* FA I V\ \..1 %S\ V\V zXCAP►a+3tp
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: `il 0'�
Date: 8 pi* 01a
2/4/2oll

ypc w visa: TV %.vMpnance inspecnon V uperanon xeview V airucrure r,varuanon l,! iecnmcal Assisrance
Reason for Visit: 0 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: I 111.9 Xapt Arrival Time: ' p Departure Time: ' U M County: Region: fXv
Farm Name: � sEt bEA FAQ, Owner Email:
Owner Name: ��,�� Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative:
Certified Operator: u khg Q
Back-up Operator:
Location of Farm:
Latitude:
Integrator: AURII Aeo wnJ
Certification Number:
Certification Number:
Longitude:
©esiga Current .,
. agn Current
- Design Current
Swine _ ° Capacity Pop. _
Wet Poultry
.
Capacity Prop.
Cattle Capacity Pop.
Wean to Finish
La er
Dai Cow
Wean to Feeder `Itl O
Nan -La Ler
Dai Calf
Feeder to Finish
Dai Heifer
Farrow to Wean
,.
'Desig Current
D Cow
Farrow to Feeder
D . P,oul
Ca ael P,a
Non -Dai
Farrow to Finish
Layers
Beef Stocker
Gilts I
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
Turkey Poults
Other
Other
Dischar es 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 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 0 No ❑ NA ❑ NE
❑ Yes ❑ No N] NA ❑ NE
❑ Yes ❑ No (V NA ❑ NE
❑ Yes [:]No
[:]Yes No
❑ Yes LTJ No
[ANA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 21412011 Continued

s.
Facility Number: IDate of Inspection:
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 ^T NA ❑ NE
Structure 6
Spillway?:
Designed Freeboard (in): 19
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures 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
0j No
[:]NA
[:]NE
waste management or closure plan?
77''��
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. Leo any of the structures lack adequate markers as required by the permit?
[:]Yes
R) No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
[t No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
E] No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [:]Yes D] 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): C c t C, ST Lit ��R rev I?A, C� (Le►S 5 iraa--) �. Ds� � S' ttl , 4 RArr't 13,LEe.S
13. Soil Type(s): >�ppv V
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?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
❑ Yes U] No ❑ NA ❑ NE
❑ Yes Do No ❑ NA ❑ NE
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 E� No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall [:]Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes lip No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes ftNo ❑ NA ❑ NE
Page 2 of 3 2/412011 Continued

V 6
Facili Number: - Date of Inspection: I 1
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes U] No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes V] 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:
25. Did the facility fail 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
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?
f 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? 1f 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?
0 N ❑NE
❑ NA ❑ NE
❑ NA [] NE
❑ NA ❑ NE
❑ Yes [4 No ❑ NA ❑ NE
❑ Yes- ® No ❑ NA ❑ NE
❑ Yes W] No ❑ NA ❑ NE
❑ Yes U) No ❑ NA ❑ NE
❑ Yes No
[:]Yes No
❑ Yes No
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: T(( -g33 -n2, _
Date: III
2J /2011

Division of Water Quality f
===aTci1 Division of Soil and Water Conservation
Q Other Agency
Type of Visit W Compliance Inspection Q Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit a Routine Q Complaint C) Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: ro Arrival Time: Q�' Departure Time: I I �` :Y5 a., County: Region:
Farm Name: �S P` �' "419e— Owner Email:
Owner Name: _ J �� 1��+' Phone:
Mailing Address:
Physical Address:
�a J,r
Facility Contact: _ -. � , Title: Phone No:
Onsite Representative: Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = o =I
❑ u Longitude: ❑ ° =' E-1-1 W
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
gLNo
IR'De Current
❑ NE
Design Curredt Design Current
Swine Capacity Population
Wet Iltry
Capacity Popuurlation Cattle Capacity Population
❑ Wean to Finish
❑ Layer
❑ Dairy Cow
91 Wean to Feeder I Q21y I 70M❑
Non -Layer
❑ Dairy Calf
Feeder to Finish
❑ Yes
❑ Dairy Heifer
❑ Farrow to Wean9�
❑ Farrow to Feeder
.
�-D Poul �� � ����= ❑ Dry Cow
- ❑ Non -Dairy
❑ Farrow to Finish
❑ La ers
❑ Beef Stocker
❑ Gilts
❑Nan -La ers
❑Beef Feeder
❑ Boars
El Pullets
❑ Beef Brood Co
❑ NE
❑ Turkeys
❑ Yes
Other
❑ Other
❑ Turkey Poults
❑
Number
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
Other
of ructures:111111
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
gLNo
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
ANA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
Yom' 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
P NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
PNo
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
bqNo
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
12/28/04
Continued

. ti.
A.
FacilityNumber: Date of Inspection 111�J
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
�1 No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No [)INA ❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure
5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 30�
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
Ej 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
JU No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
C& No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evide ce of Wind Drift ❑ Application Outside of Area
12. Crop type(s) 6Xj7&d &ijy4 AA Q M
11
13. Soil type(s) f � -,da,
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
M No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
17. Does the facility lack adequate acreage for land application? ❑ Yes
18. Is there a lack of properly operating waste application equipment? ❑ Yes
�No ❑NA El NE
�] No ❑ NA ❑ NE
�No [I NA 0 N
1PNo El NA El NE
Comments (refer to question #t): Explain any YES answers and/or any recommendations or any other comments. rr
Use drawings of facility to better explain situations. (use additional pages as necessary):
A.
Reviewer/Inspector Name T-- Phone: 3 3 Sao
Reviewer/Inspector Signature:Date: Z1110
Page 2 of 3 12/28/04 'Continued

.r
4
Facility Number: Date of Inspection lhqtp
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
❑ Yes NNo ❑ NA ❑ NF
❑ Yes ® No ❑ NA ❑ N E
21. Does record ]seeping need improvement? if yes, check the appropriate box below. ❑ Yes b 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?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
3I. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/inspector fail to discuss review/inspection with an on-site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes
EA No
❑ NA
❑ NE
❑ Yes
3 No
❑ NA
❑ NE
❑ Yes
,
L) No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
,® No
❑ NA
❑ NE
❑ Yes §0 No ❑ NA ❑ NE
❑ Yes (§ No ❑ NA ❑ NE
❑ Yes §5 No ❑ NA ❑ NE
❑ Yes F0 No ❑ NA ❑ NE
❑ Yes
1P No
❑ NA
❑ NE
❑ Yes
$ No
❑ NA
❑ NE
Additional Comments and/or Drawings:
Page 3 of 3 12128104
Page 3 of 3 12128104

Type of Visit t! Compliance Inspection O Operation Review O Structure Evaluation Q Technical Assistance
Reason for Visit O Routine Q Complaint O Follow up Q Referral a Emergency O Other ❑ Denied Access
Date of Visit: Arrival Time: JJ r� Departure Time: County: szN Region:
Farm Name: �as'+�+o�+r' '� Owner Email:
Owner Name: • �GtSQQ+r �' Phone:
Mailing Address:
Physical Address:
Facility Contact: & Title: Phone No:
Onsite Representative: Integrator:��-�-C-
v
Certified Operator: Operator Certification Number: 17j
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: 00
❑ t =" Longitude: = ° =' 0
J
Design Current
Design Current
Design Current
e Capacity Population
Wet Poultry Capacity Population
Cattle Gapac!ty Population
tc!ean to Finish
❑ Layer
❑ Dai Cow
a. Was the conveyance Fran -made?
ean to Feeder $ Q�
-Feeder
H
❑ Non -Layer
�IA
`�A
❑ Dai Calf
I�
b. Did the discharge reach waters of the State? (Ifyes, notify WQ)
-1
to Finish
Dry Ponttry
❑ Dai Heifer
❑ D Cow
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Layers
❑ Non -Dai
El Beef Stocker
❑ Farrow to Finish
❑ Gilts
❑Non -La Non -Layers
❑ Pullets
El Turkeys
❑ Beef Feeder
❑ Beef Brood Cowl
❑ Boars
CPA
Other
❑ Other
El Turkey Poults
❑ Other
N rnber of Structures:
1p No
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation'?
❑ Yes
ro
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance Fran -made?
❑ Yes
❑ No
�IA
`�A
[INE
I�
b. Did the discharge reach waters of the State? (Ifyes, notify WQ)
❑ Yes
❑ No
❑ 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)
E] Yes
❑ No
CPA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
1p No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
U� No
❑ NA
❑ NE
other than from a discharge?
12128/04
Continued

Facility Number: 99
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`?
Stnttture I Stmetur-e 2 Structure 7 Structure -1
Identifier:
Spillway'?:
Designed Freeboard (in):
Observed Freeboard tin): f
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 SA No EJ NA El NE
❑ Yes ❑ No 12 NA ❑ NE
Structur' slructurL:0
❑ Yes `INo ❑ NA ❑ NE
❑ Yes l 3 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 �4No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes KNo ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes 4 No ❑ NA ❑ NE
maintenance or improvement?
Waste auulication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 06 No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 29 No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[--]PAN ❑ PAN > 1 o% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑EvidFK
of Wind Drill ❑ Application Outside_ of Area
12. Crop type(s) &r .S S�sI
13. Soil type(s) 41—
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes Sj No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination'[] Yes
17. Does the facility lack adequate acreage for land application? ❑ Yes
18. Is there a lack of properly operating waste application equipment? ❑ Yes
RNo
❑ NA
❑ NE
XNo
❑NA
❑NE
Z�No
❑ NA
❑ NE
XNo
❑ NA
❑ NE
IComments (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):
l7 QS i't 0 � it
Reviewer/Inspector Name /i7 Phone:
Reviewer/Inspector Signature: Date:
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 El NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes kjNo ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 09No ❑ 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
%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
&Nb ❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
M No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
XbNo
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
;RNA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
M No
❑ NA
El NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
(;9 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? (iel discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
)No
❑ NA
Cl NE
Addi§9KI Comments and/or Drawings:
7F
OP
�6-sd
►� S�u�� V �w�-�-✓eL t
1228/04

i ype or Visit • Compliance Inspection Q Operation Review U Structure Evaluation ()Technical Assistance
Reason for Visit *Routine Q Complaint O Follow up Q Referral Q Emergency Q Other ❑ Denied Access
Date of Visit: Arrival Time: I C±� Departure Time: i r County: 5jn2fS6Aj Region:
Farm Name: {J h^^—' Owner Email:
Owner Name: S I� ` Phone:
Mailing Address:
Physical Addre _ _ __ _
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
K
Design Current
Swine Capacity Population
❑ Wean to Finish
Wean to Feeder
Feeder to Finish
U Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Phone No;
Integrator•P '
i ` Aqn
Operator Certification 112iq
Back-up Certification Number:
Latitude: = c E:1' E u Longitude: = ° =I = "
Design Current
Wet, Poultry Capacity Population
[Ell Ia er
❑ Non -Layer
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharses & Stream Impacts
_ Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Desig
Cattle_,, Capac
❑ Daia Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ D Cow
❑ Non -Dai
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
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 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?
Page 1 of 3
❑ Yes P No ❑ NA ❑ NE
❑ Yes
❑ No
1P NA
❑ NE
❑ Yes
❑ No
J9 NA
❑ NE
)�NA
ONE
❑Yes
❑No
❑Yes
'PNo
0 N
0 N
❑ Yes
D9No
❑ NA
❑ INE
12/28/04 Continued

Y
0-50 1
Facility Number: o} Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes No �NA (3 NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 /Structure 6
Identifier: I
Spillway?:
Designed Freeboard (in):
iJ
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yeso [INA [INE
(ie/ large trees, severe erosion, seepage, etc.) 91
6. Are there structures on-site which are not properly addressed and/or managed ❑ Yes No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes No ❑ NA EINE
(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 �ONo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes RD No ❑ 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 Acceptable Crop jWindow El Evidence of Wind Drift El Application Outside of Area
12. Crop type(s) �"` ,Z "SS 9al. 1�a5`1-hz ' _<"'� ` Gm'ri 6wUlpol
13. Soil type(s)
C6� LagoD+tit5.. u.�
S
S
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
fM No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
W No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
fn No
❑ NA
EINE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[&No
❑ NA
❑ NE
Comments {refer to questeany#) Explain gyYESaas�ers andlor any�irecotinmendabons or anyothecnmme
Use d ngs of facility to betterlex situations(nse%addrttonal pages as necessary)
•,L PJrmR' 7 .1n'"'v"c- '4-: $ `C aL S_; _ 5+y . yL��+�j[, +} ^ Vii. • y _
C6� LagoD+tit5.. u.�
S
S
w
EReviewer/]nspector Name
Phone:
Reviewer/Inspector Signature:
Date: QE I The
Page 2 of 3 12/28/04 Continued

Facility Number: S Date of Inspection /1
Re wired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes EpNo [:INA ❑ NF,
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 2'No [:INA ❑ NE
the appropirate box. ❑ wUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 6No ❑ NA ❑ N E
❑ 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
0 No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
19 No
❑ NA
❑ NE
24,
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[allo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
[)-PNo
❑ NA
❑ NF,
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
A No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
® No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
1XI No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
IM 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
f9 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
P 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
19 No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
[&No
❑ NA
❑ NE
Additional'.Comments and/or Drawings r r
Page 3 of 3 12/28/04

sion of Water Quality
Facility Number �3g Division of Sail and Water Conservation
Agency
Type of Visit 18 Compliance Inspection O Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit * Routine O Complaint 4 Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: �aZ Departure Time: O . County: t� Arrival Time: ' Coun SA�rnPS0^) Region: 0
Farm Name: �s n�IM Owner Email:
OwnerName: `Sass RPhone:
Mailing Address:
Physical Address: y ,
Facility Contact: '�WVt� Title:
Onsite Redresentative: Q
V
Certified Operator:
Back-up Operator:
Phone No -
Integrator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: =0 01 =" Longitude: =0=6
e06 = «
.,`
❑Non -La on -Layers
❑ Pullets
Turkeys
_ ❑Turkc Faults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes � No [:INA ElNE
Discharge originated at: El Structure ❑ Application Field El Other
a. Was the conveyance man-made? E] Yes ❑ No IRNA El NE
b. Did the discharge reach waters of the Stale? (If yes, notify DWQ)
Design , Carrent�" Y Design Current Design Cu rrent
swine
Capacity Papulation Wet'Poultty" Capacity
Popnlatian Cattilc Capacity Population
❑ Wean to Finish
FOL
` ❑ La er
❑ Dai Cow
Wean to Feeder
8`�D 5 '0 La er
❑Dai Calf
Feeder to Finish
ElFarrow
fi"` "'- - E] Dairy Heifer
o
to WeanD
Poult�
: ' ❑ D Cow
❑ Farrow to Feeder
El Layers
El ❑ Non -Dai
❑ Farrow to Finish
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Beef Stocker
El Gilts
El NA
❑ Beef Feeder
❑ Boars
El Beef Brood Co
Other
Page l of 3
❑res
Other
u
Number of Structu:
.,`
❑Non -La on -Layers
❑ Pullets
Turkeys
_ ❑Turkc Faults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes � No [:INA ElNE
Discharge originated at: El Structure ❑ Application Field El Other
a. Was the conveyance man-made? E] Yes ❑ No IRNA El NE
b. Did the discharge reach waters of the Stale? (If yes, notify DWQ)
❑ Yes
❑ No
A
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
El No
[� NA
[:1 NE
2. Is there evidence of a past discharge from any part of the operation?
Q Yes
93 No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
�INo
El NA
El NE
other than from a discharge?
Page l of 3
12128/04
Continued

r Facility Number:
Date of Inspection / 8
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes P No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No IULNA ❑ NE
Structure l 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
No
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
6. Are there structures on-site which are not properly addressed and/or managed
❑ Yes
No
❑ NA
❑ NE
through a waste management or closure plan?
Crop type(s) �fyyN"Ja Q'zw, Sly,. LTi. Di1e=
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
T Do any of the structures need maintenance or improvement?
❑ Yes
IFNo
❑ 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)
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
12 No ❑ NA ❑ NE
17.
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
❑ NE
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
[:]Yes
too
❑ NA
❑ NE
maintenance/improvement?
11 _
Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
Mo ❑ 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 El Evidence of Wind Drift ❑ Application Outside of Area
12_
Crop type(s) �fyyN"Ja Q'zw, Sly,. LTi. Di1e=
13.
Soil type(s) Ajm k
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
Dj No ❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
12 No ❑ NA ❑ NE
17.
Does the facility lack adequate acreage for land application? ❑ Yes
toNo ❑ NA
❑ NE
1$_
Is there a lack of properly operating waste application equipment? ❑ Yes
09 No ❑ NA
❑ NE
` C_ PRY lA�) +-e2 JdDr i 5 t.J k,,, 4A S i til le 6r k— f(1�tLX - 5 IOC/ a � JA50,D r, i
Reviewer/Inspector Name.�Q Phone ft y333M _
Reviewer/Inspector Signature:
Page 2 of 3
Date:
12/28/04 Continued

Facility Number: OgX S Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes V) No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes VgNo ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21- Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes R No ❑ 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
IN No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
O NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
q No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
;fl No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
P No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
IRNA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
lgNo
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
PNo
❑ 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
W 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
"71No
❑ 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
[4 No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
allo
❑ NA
❑ NE
S1+ C(,191r)) PC)5L1r'A4-4_e Of—
Page 3 of 3 12/28/04

� Division of Water Quality <
.,.O'Division-of Soil and'WaterCouservation
Other Agency.
Type of Visit 0 Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit 0 Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of visit: /i'3O-Of Arrival Time: /O:l o Departure Time: County: Region: _ Region: o�
Farm Name: B.,11,Oel �. Bgre Fenn Owner Email:
Owner Name: Tagg r?egeier Phone: 9/0-`33- 7/y
Mailing Address: 17z73- Ogee If aG�.'y��� NL -7g3JIy
Physical Address:
Facility Contact: _ J��a� 9.,Ze, Title:
Phone No: /o -S3?- 21>re
Onsite Representative: Glc F..j - Integrator:/9v4ev
Certified Operator:Jlls.Ke Operator Certification Number: 1779y
Back-up Operator:
Location of Farm:
Swine
Feeder
Wean
Feeder
Other
❑ Other
Back-up Certification Number:
Latitude: =0 =, Longitude: =o =1 ="
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
7ggo IfiimqZr 0I JU Non -Laver
Dry Poultry
❑ La ers
❑ Non -La •ers
❑ Pullets
❑ Turkevs
❑ Turkey Poults
❑ Other
Discharges R 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
Number of Structures: ELI,
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge'?
❑ Yes 2N'o ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
EINE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
El NA
El NE
Yes
ElLN
,�lKoo
'No
❑ NA
❑ NE
12/28/04 Continued

r
Facility Number: 1 — 3 Date of Inspection is 3p as
Waste Collection & Treatment ��
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? El Yes 2 o ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?: no
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 9-16 ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed ❑ Yes UNo ❑ 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
Q -Ko
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes
�o
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
❑-No
❑ NA EINE
mai ntenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
9 -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
310 .26012. Crop type(s) Sis7 G a �u
13. Soil type(s) Nar/r{
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
ED -No
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? Owes
❑ No
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determinations ❑ Yes
❑ No
❑ NA [SNE
17. Does the facility lack adequate acreage for land application? ❑ Yes
[�94_1,
C]NA [94E
El18. Is there a lack of properly operating waste application equipment? Yes
,N,,//o
l_o
❑ NA ❑ NE
,�lrS�! "'1aw�hp Gi/`aVi�GC_ �r�oon w�tt�1 lve.�.�rr �r-.pJ
ee6[i �f4gS 7`d S�/'°') S/ei"`r �'o�d feridrrw. �r WG+olSr
Reviewerllnspector Name
r "tie , Phone:yt '73
Reviewer/inspector Signature: Date: li -30-off
12128/04 Continued

l~ acility Number: — 3 Date of Inspection G • o -o
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? Q Yes ❑ No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check B*Ves ❑ No ❑ NA ❑ NE
the appropirate box. ❑ ❑ Ch
sts 015esign ❑ NU<s❑ O>h�r
21. Does record keeping need improvement? If yes, chck the appropriate box below. DIfes ❑ No ❑ NA ❑ NE
LC�L-,F'wa�aste Application [;Weekly Freeboard ❑ ElSeil.wa4wis- ❑ Elt1xatnfall ❑ 6teeldmg 9 rop Yield [9'110 Minute Inspectionsonthly and V Rain Inspections D-VV—eatber Code
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/]nspector fail to discuss review/inspection with an on-site representative?
33. Does facility require a follow-up visit by same agency?
P<s ❑ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
2 -NE
❑ Yes
❑ No
❑ NA
[9 -NE
❑ Yes
❑ No
❑ NA
a1gE
❑ Yes
[9<o
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
[!]-
❑ Yes
G'No
❑ NA
❑ NE
❑ Yes
g No
❑ NA
❑ NE
❑ Yes
Eallo
❑ NA
❑ NE
❑ Yes
Q -NO
❑ NA
❑ NE
❑ Yes
Dl} o
❑ NA
❑ NE
9'es
❑ No
❑ NA
❑ NE
�"ddihunal�CoraM ats and/or Drawings 5
1 9, PnN%/Vedw A,,,r not eeeiv; v.,�/*rlew �ot�./.,,'f ra >/r �f tavt.a9t . Pra.r/vrsr
+✓OJ ►10 f 'Fa �/ /Or W44 rwe 'pfv.11 f GIYn1Gr rel ! CM I!•1 L �f
TAT Fe�wy u Sade C7�rrti,'an '�n a narSP�% 1.ht�stc�or W. ll �/+Cc�' an ne��fr.,'{,
�a PIe est pl�Q u pr /a e w '9 �
s,;44 A -em ree 1.1
�I Pleasa/` I!rep �R�O C Forms wrs/ry &es6oarc.( ree�.�s re, ,,r ircer.IS/
f y;r
T�eleoI'
41enl l�• 1 1
/ h, �ir�.nl Lun li.7s T�r bola✓e/rrr wus LihTA. �r ryl/,�
2�spec.Yo�
writ co -10 �7ack a fallow F vll
3�. Please rhs�a/� Gn�
�:rtJ`A,h /'rrI'M 94 1. t drn ia.,•+.
c k
Por a Jfol/" - v�o V,s.'+ o rCvl ew ney� �
�0<rr..
12/28/04

Aw
Division of Water Quality
Facility Number O Division of Soil and Water Conservation
- - -- O 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
J
Date of Visit: Arrival Time. Departure Time: County: 4 Region: ::W�
Farm Name: J n� 1 - Owner Email:
Owner Name- �asR�-r �� &'r Phone:
Mailing Address:
Physical Address:
Facility Contact: �Q t"'^� �'Y Title:
tl
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Other
❑ Other
Integrator:
Phone No:
NW n
I J77`?4
Operator Certification Number:
Back-up Certification Number:
Latitude: [=]' 0 = =" Longitude: [=] ° =' 0 w
Design Current Design Current
Capacity Population WetPoul" Capacity Population
❑ La er
g`]aQ I $ODS I ❑ Non -La et
Dry Poultry
Nan -L;
Pullets
Poults
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity' Population
❑ Dairy Cow
❑
Dairy Calf
❑
Dairy Heifer
❑ Dry Cow
❑
Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow,
b. Did the discharge reach waters of the State? (I f yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures: ED
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 A No ❑ NA ❑ NE
❑ Yes
❑ No
VbNA
El NE
❑ Yes
❑ No
5 --INA
El NE
PaNA
❑ NE
❑ Yes
❑ No
❑ Yes
Wo
❑ NA
❑ NE
❑ Yes
'Wo
❑ NA
❑ NE
12128/04 Continued

IrFacili NuNumber:U� j3
Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes Vo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ,2 NA EINE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): �$
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
E10
ElNA ElNE
(ie/ large trees, severe erosion, seepage, etc.)
13. Soil types) 1�o r� I k-- 4 A
6. Are there structures on-site which are not property addressed and/or managed ❑ Yes
P No
❑ NA ❑ NE
through a waste management or closure plan?
14. Do the receiving crops differ from those designated in the CAWMP?
❑ 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
OVNo
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
4PNo
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
1P No
❑ NA
9. Does any part of the waste management system other than the waste structures require ❑ Yes
Pa No
❑ NA [I NE
maintenance or improvement?
❑ NA
❑ NE
Waste Application
❑ Yes
[&No
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
-No
El NA El NE
maintenance/improvement`?
]L Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
SA No
[:1 NA El NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[]PAN ❑ PAN > 10% or ] 0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence pf Wind Drift ❑ Application Outside of Area
12. Crop type(s) k-atr• i Mf =01
p( 5d- c&e,, t Pbfur4
13. Soil types) 1�o r� I k-- 4 A
Reviewer/Inspector Name Phone:
Reviewer/Inspector Signature: Date:
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
09 No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement'?
❑ Yes
09 No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
1P No
❑ NA
❑ NE
IT Does the facility lack adequate acreage for land application?
❑ Yes
W No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[&No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
p( 5d- c&e,, t Pbfur4
Reviewer/Inspector Name Phone:
Reviewer/Inspector Signature: Date:
12/28/04 Continued

Facility Number: Date of Inspection
Re wired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes fpo [:INA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check ❑ Yes Wo ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes P9 No ❑ 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
(A No
❑ NA
❑ NE
23.
if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
�j No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
Q9 No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
F No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
Cj�No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
P 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
05: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
12/28104

Type of Visit 0 Compliance Inspection '0 Operation Review 0 Lagoon Evaluation
Reason for Visit 4PRoutine O Complaint O Follow up ()Emergency Notification 0 Other ❑ Denied Access
Facilit.v Number 53 Date of Visit: la7%'D Time: I A, ap +7»9
10 Not O erational 0 Belo-' Threshold
01 ermitted 19<ertilled 0 Conditionally Certified ❑ Registered pate Last Operated or Above Threshold:
Farm Name: T go.-Zer r0" Countv:-54.1esvn
Owner Name: Aa --4,e.- Phone
/ Phone No: 9/0 - S,3 3 32 t/
Mailing Address. _ /70S !Ove a,./ �/.'t/biz- ��
p
Facility Contact: Jaypt� �a•/�✓t� Title: Phone No
Onsite Representative: J A',P_ Integrator: _ ! G12 // t
Certified Operator: Z-17-11rr- Operator Certification Number: P-71 9
Location of Farm:
R -Swine ❑ Pouttry ❑ Cattie ❑ Horse Latitude ' L " Longitude �� �• 0�
Design Current
Swine Canariiv Pnnnl9rinn
❑ Wean to Feeder
Feeder to Finish
Farro-w ro 'Wean
arrow to Feeder S-00 vU FLY
rr
❑ Farrow to Finish
❑ Gilts
❑ Boars
Design Current Design Current
Poultry Ca acity Population Cattle Capacity Population
❑ Laver ❑ Dairy
Q :Von -Laver ❑ Non -Dain
❑ Other
Total Design Capacity
Total SSLW
Number of Lagoons � ❑ Subsurface Drains Present ❑ Lagoon Area ❑ 'S ray Field Area
Holding Ponds f Solid Traps D No Liquid Waste Management System
Discharges g Stream Impacts
1. Is any discharge observed from any pan of the operation?
Discharge originated at: 0 Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b_ If discharge is obsen-ed, did it reach Water of the State? (if yes. notify DWQ)
c, if discharge is observed. what is the estimated flow in gallmin?
d. Does discharge bypass a lagoon system? (If ves. notify DWQ)
?. Is there evidence of past discharge from any pan of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 3 Structure 3 Structure 4 Structure 5
Identifier:
Freeboard (inches):
03/03101
k
❑ Yes 2bio
❑ Yes 15'90
❑ Yes Q<No
❑ Yes G -No
❑ Yes
❑ Yes D -No
Q Yes [31go
Structure 5
Continued

Facility Number:
r
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 46 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenancelimprovement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? If yes, check the appropriate box below.
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type 8er',••v,14 -Sma/1 (r�a;n , W,,.,Iler /4nr,✓��
❑ Yes L Ifo
❑ Yes []'No
❑ Yes LKo
❑ Yes 9-110
❑ Yes DNO
❑ Yes B No
❑ Yes ONO
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAVRAP)?
❑ Yes
- B lqo
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
Q O
b) Does the facility need a wettable acre determination? -
❑ Yes
UNo
c) This facility is pended for a wettable acre determination?
❑ Yes
G�No
15. Does the receiving crop need improvement?
❑ Yes
❑ No
16. Is there a lack of adequate waste application equipment?
❑ Yes
ONO
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
❑ Yes
❑ No
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours?
❑ Yes
QNo
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
B'No
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
Ubla
Air Quality representative immediately.
Commeats {%fer W>gaesttod#) Facplan orgy YES answers and/or any, recommendattoi�t or anq atb µmmenrts'= c
=ruse drawrngs of Faci7ify to better cxglsin sit or . {use additms pages as nei'essairy") [� Field COPY ❑Final Notes
wer/Irispector Namewer/Inspector
E
Signature: „` Date. _117-0i
12112103 / Continued

Fac$ity Number: g2 -S3 q Date of Inspection
i
Required Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
®-NQ
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
AL
%le41!' HOT bee”
(ie/ ; chooklists, dm4gir, etc.)
❑ Yes
51 -No
23. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
Hal �p�S 70 b"SA h ✓�Jr
❑ '❑ l aid- ❑ was- Ant"Zs ❑firwr
�Q9 adn .
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
[moo
25. Did the facility fail to have a actively certified operator in charge?
❑ Yes
❑-No
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
[3 -No
27. Did Reviewer/Inspector fail to discuss review/inspection with on-site representative?
❑ Yes
OW6.
28. Does facility require a follow-up visit by same agency?
❑ Yes
Q'&o
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
ONo-
NI MES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
❑ Yes
0446'
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
32. Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ No
33. Did the facility fail to conduct an annual sludge survey?
❑ Yes
❑ No
34. Did the facility fail to calibrate waste application equipment?
❑ Yes
❑ No
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below.
❑ Yes
❑ No
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After 1" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
�13 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit~
lttonal _COiiimCRLS'andlOT: DrawingS
Mr. 84�r�{r ►3 searf'n' wos�e wr.11 so,'l Sa„��� �or1• s
AL
%le41!' HOT bee”
flaf LhG...,ca�! �o S/prpy �•S SPrar F.•./r�s !s.•rfY dvr �d L✓s::rl�9 Foy^ pr�j,
A/ CwAP/'. ! lee_jre /+1 5 p� as /7,re
Hal �p�S 70 b"SA h ✓�Jr
�Q9 adn .
w
12/12/03

Farm Nan
Mailing A
County:
Integrator:' &&/, Ij
On Site Representative:
Physical AddresslLocat
Site Requires Immediate Attention:
Facility No. 8Z_-sr39
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: S 1995
Time: f ^
CfAfr je, •� RNs
PA
Phone:
ir Phone:
`f -r 4Y;of its
Type of Operation: Swine P' Poultry Cattle
Design Capacity: Number of Animals on Site: U�
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: Longitude: -ro lc�! 'e4t_
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot+ 5 year 24 hour storm
(approximately 1 Foot + 7 inches) e�s)or No Actual Freeboard:�Ft. Inches
Was any seepage observed from the lagoon(s)? Yes or l� o Was any erosion obsgved? Yes or Nd
Is adequate land available for spray? Xe� or Nos the cover crop adequate? Yes' or No
Crop(s) being utilized: Aly A_
Does the facility meet SCS minimum setback criteria? 200 Feet from Dweliin j� _ or No
100 Feet from Wells? s or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or IQ
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line: Yes or
Is animal waste discharged into water of a state by man-made ditch, flushing system, or other
similar man-made devices? Yes orI6) If Yes, Please Explain.
Does the facility maintain adequate waste management recon (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? s or No
Additional Comments:
N` L
Inspector Name
Signature
cc: Facility Assessment Unit Use Attachments if Needed.
event

JUL 14 "t5 11;4f --HM
NORTH CAROLINA DP.PART)MC OF ENVI. ONX=, FALSE A NATURAL RFZ013RCES
DMSIO 1 OF ON)=AL MANAGMU=
Fayetteville Regional Office
Animal operation Compliance Inspection roz-=
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533 -- 3714--
All. questions answered negatively will be discussed in sufficient detail in
the Comments Section to enable the deemed Permittee to perform the appropriate
corrections:
SECTION I
.-mal Doeration T
Horses, cattle ,, poultry, cr sheep
SECTION II
91© :.
1. Does the number and type of animal meet or exceed
the (_0217) criteria? [Cattle (100 head),
horses (75), swine (750), sheep (1,000), and
Poultry (30,000 birds with liquid waste
system)] .
2. Does this facility meet criteria for
Animal Operation 8LG1STRAT1W.
3. Are animals confined fed or maintained
in this facility for a 12 -month period?
4. Does this facility have a IBD AMMAL
iii NAMGZMENT PLAM.
S. 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?
R

RV= c�J Vv Vv �V
Field Site Ma_-saoeme..nt.
Is a-ainal waste stockpiled or lagoon
construction within 100 £t. of a USG5
Map Blue Line Stream?
2. Is ani=al waste land applied or may
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 appiication'site have a
cover crop in accordance With the
CZRTIFICATION PLAN?
S_ Is animal waste discharged into waters of
the state by man-made ditch, flushing system,
or other similar maze -made devices?
6. Does t}ie animal Waste management at this
farm adhere to Best Management. Practices
(BM?) of the approved MCATIM
7. Does animal waste lagoon have sufficient
freeboard' Flow much? (Approximately }
S. Is the general condition of this CAFO facility,
including manage.mer_t and operation,
satisfactory?
SE= ION N
COM -re-; t s
jUL 14 j55 11 = 4GA'n-

V

4 .E
DIVISION OF ENVIRONMENTAL MANAGEMENT
April 19, 1996
Mr. Rusty Barber
Route 2
Clinton, N.C. 26328
SUBJECT: Compliance Inspection
Rusty Barber Farm
82-5; 9
Dear Si r:
Sampson County
On April 18 1996 , an in ection of your animal operltion was performed
by the Fayetteville Regional Office (FRO). Please find enc used a copy of our
Compliance Inspection Report for your information.
It was observed that this farm had deficiencies on this date as follows:
There is evidence of discharge from breakage of the barn waste drain
ipes via overland flow to an onsite drainage ditch. While no discharge
o surface waters was observed this date it is apparent that the sand
bags placed across this ditch have been placed to prevent such discharge
and the natural surface drainage from the barns and the spray fields
enters this ditch.
The above surface flow from the barn area is currently directed into a
broken influent pipe to the lagoon. This allows not only this waste
stream but also barn roof and area rainfall to enter the lagoon, thereby
diminishing the storage capacity of the lagoon. On the date of the
inspection the freeboard was approximately 1' 7"• however, this normal
minimum freeboard is unacceptable because o the surface water
contribution to the lagoon.
The irrigation pipe crosses the drainage ditch to Gilmore Swamp and is
not considered properly supported or secured. It is unclear how leakage
at the joints is prevented trom entering the drainage ditch.
The spray irrigation field at this site appears limited for acreage and
buffer area.
This office is requesting that the broken drain pipes be repaired and all
waste on the ground be cleaned up and placed in the lagoon. The lagoon
levels should be maintained at a minimum of 1 7 after the removal of
surface water drainage. The irrigation pumping and pipe system should be
secured in the area ot the drainage ditch_
Because of these deficiences this office is requesting that the Rusty
Barber Farm obtin a certified waste management plan prior to the
December 31, 1497 deadline. It is our understanding from our
conversation with you that the Sampson County NRCS representative is

currently working on a certified plan.
To remain a deemed permitted facility,all corrective actions must be
made within 30 days. Failure to do so ay result in the facility losing
it's deemed permitted status and being required to obtain an individual
non discharge permit for the facility.
Please be aware it is a violation of North Carolina General Statutes
to discharge wastewater to the surface waters of the State without a permit.
The Division of Environment 1 Management has the authority to levy a civil
penalty of not more than $ ,000 per day per violation.
When the required corrective actions are complete, please notify this
office in writing at the address below. Ifyou have an questions concerning
this matter, please call me Ed Buchan or myself at ( 91Y) 486-1541.
Sincerely,
Michael C. Wicker `
Regional Water Quality Supervisor
Enclosure
cc: Facility Compliance Group
Sampson County Soil and Water Conservation District
Sampson County Health Department
Chris Walling
Carrolls Foods, Inc.

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