310792_INSPECTIONS_20171231

NORTH CAROLINA J
Department of Environmental Qua

Type of Visit: Q Com ance Inspection O Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit:i1'] Arrival Time: 3 Departure Time: 4 County: Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: 'M 0 � �e RC4 , 7 -�,
Certified Operator:
Sack -up Operator:
Location of Farm:
Latitude:
Phone:
Integrator:
Certification Number: I U P 7�`
Certification Number:
Longitude:
Design Current Design Current Design
Swine Capacity Pop. Wet Poultry Capacity Pop. Cattle Capacity
WeaNLd Finish Layer Dairy Cow
Current
Pap.
an to Feeder Non -La er
Dairy Calf
ecder to Finish po
Dairy Heifer
Farrow to Wean Design Current DEZ Cow
Farrow to Feeder D , P,oulte, C•.a ac! l;o Non -Dairy
Farrow to Finish Layers Beef Stocker
Gilts Non -Layers
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?
❑ Yes
❑❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
[]Yes
❑ No ❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
[]Yes
[] No ❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
[] No NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
No _ ❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes��No
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412015 Continued

Facili Number: - Date of Inspection: 7 7rz-
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes Jo ❑ 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): Z.l
5. Are there any immediate threats to the integrity of any of the structures observed? [] Yes I No DNA 0 NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes ffNo ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental th�tify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes ❑ �Vo NA ❑ NE
R8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes E3,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 1'_2 IQO ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 2 to ❑ 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 Types):_..
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
C:Ihfo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
Eg-TQo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
[E] No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
E3<o
❑ NA
❑ NE
Reauired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
,�}
I -1 iVo
❑ 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 rNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE
Page 2 of 3 214,12015 Continued

Facili Number: - 'P Date of Ins ection: 2
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey [:]Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
Gist structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/ Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
W ! j (1/Q -..c- E/
❑ Yes
No
❑ NA
❑ NE
❑ Yes
❑ No
❑-577
❑ NE
❑ Yes ❑ to 0 NA ❑ NE
❑ Yes Eq o ❑ NA ❑ NE
[—]Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes
❑ Yes
❑ Yes
No ❑ NA ❑ NE
1011<0 NA ❑ NE
N NA NE
❑ ❑
Phone: 7 + 5 714
Date: 7 a'"e f
21412015

Type of visit: tam ce Inspection Operation Review Q Structure Evaluation 0 Technical Assistance
Reason for Visit: Routine O Complaint 0 Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: Departure Time: County: Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Phone:
Title: Phone:
Onsite Representative: -5c-- p� / l ,4,� Integrator:
Certified Operator:
Sack -up Operator:
Location of Farm:
Latitude:
Certification Number:
Certification Number:
Longitude:
Design
Swine Capacity
Wean to Finish
Current
Pop.
Design Current
Wet Poultry Capacity P. Cattle
Id
Dai Cow
Design
C*apacity
Current
Mop.
t�
W n to FeederJILLINoLn-Layer
I
i Calf
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
�3 2
Dairy Heifer
Design Current Dr Cow
Dr, $oultr. C'a acit Po Non -Dairy
Layers Beef Stocker
Gilts
Boars
Non -Layers
Pullets
Beef Feeder
Beef Brood Cow
er fOther
urke s
urke Poults
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
EfNo ❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No ❑ NA
❑ NE
b. Did the discharge reach waters of the State`? (If yes, notify DWR)
❑ Yes
❑ No ❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
❑ No ❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
❑ NA
VN
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes❑
NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412015 Continued

Facilit Number: -31 Date of Inspection:
W t C ll ct' n &Treatment
as e o e �o
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
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
t3
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
❑ Yes DINo ❑ NA ❑ NE
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes ❑'Ka ❑ 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 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 IJ '"o ❑ NA ❑ NE
maintenance or improvement'?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ARioo 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
Ln No ❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[�❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
04q ❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ NA
❑ NE
18. is there a lack of properly operating waste application equipment?
❑ Yes
F No ❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? Ifyes, check ❑ Yes YNo ❑ 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 6No ❑ 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 2"No
NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Eacility Number: jDate of Ins ection: 14LS`
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes �o NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes a<0 ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
25. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No CIA' ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
Reviewer/Inspector Signature:
❑ Yes �No
❑ Yes LJ *No
❑ Yes No
❑ Yes LJ No
❑ Yes
❑ Yes
❑ Yes
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
T❑ NA ❑ NE
o ❑ NA ❑ NE
[ to ❑ NA ❑ NE
Date: t
21412014
Page 3 of 3

Type of Visit: ompliance 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 0 Denied Access
Date of Visit: [I Arrival Time: Departure Time: County: Region:
Farm Name-ju— T7041yl Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Onsite Representative: �3 r t ! �' Integrator: I1
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Certification Number:
Longitude:
Design Current
Swine Capacity Pap.
Wean to Finish
Wet Poultry
Layer
Design
Capacity
Current
Pop.
Design
Cattle Capacity
Dai Cow
Current
Pop.
Wean to Feeder
Nan -La er
DairyCalf
Feeder to Finish
Dr. P.oultr�
Layers
Design
Ca acit
Current
P,o
DairyHeifer
D Cow
Non -Dairy
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Non -Layers
der
od Cow
Boars
Pullets
Other
Other
Turke s
Turke Poults
Other
6Beecker
Discharges and Stream Imuacts
1. Is any discharge observed from any part of the operation? []Yes LDINo ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
4
a. Was the conveyance man-made? ❑ Yes ,j* 10 ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR) ❑ Yes �_, � o ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)? T
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 2]�No
❑ Yes ,�!fNo
[]Yes �o
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 21412014 Continued

[Facility Number: / - 7 f2L jDate of Inspection: / 2
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes',ETNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes [�frNo ❑ 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?
❑ Yes7PNo ❑ 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 .0F,,;'N0 ❑ 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 )2yNo ❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes 0 No ❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes ,f No ❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes �7No ❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes oNo ❑ 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 ,0 No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes .5 No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes [allo ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes ❑'No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes ;�[`No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes [�f'No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes [2,Po
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists [:]Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate bVntthly
��t(iy❑ Yes �`No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysisil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes 21R10
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes E No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412014 Continued

Facility Number: -7
jDate of Inspection:
24. W the facility fail to calibrate waste application equipment as required by the perm/ ❑ Yes ,j No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ZNo
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;
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes J21INo ❑ NA ❑ NE
[:]Yes ONo ❑ NA ❑ NE
❑ Yes ;2 No ❑ NA ❑ NE
❑ Yes ZNo ❑ NA ❑ NE
❑ Yes P�No ❑ NA ❑ NE
❑ Yes ;2 No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes JZNo ❑ NA 0 NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes VNo ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes VNo ❑ NA ❑ NE
Comments (refer to question #): Explainany YES answers a'ndlor anyadditional-recommendations or any other -coEninenta`s='
Use drawings of facility to better exJilain situations (use additional pages as necessary).
714V��y G�qy
3 / -zq//X
Reviewer/Inspector Name: Phone: q/t�) 706 -7?-9R
Reviewer/Inspector Signature: Date: -7- r!
J/ V
Page 3 of 3 21412 di4

Type of Visit: OTompliance Inspection 0 Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: 011outine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: Departure Time: County: 1__VJJ � Region: kipyI
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator: M %
Back-up Operator:
Location of Farm:
Title:
Latitude:
Phone:
Phone:
Integrator:
Certification Number:
Certification Number:
Longitude:
Design Current11
111
Il luesign
Current
Design Current
Swine Capacity Pop.
Wet Poultry
Capacity
Pop.
Cattle C►apacity Pop.
Wean to Finish
La er
Dairy Cow
Wean to Feeder
Non -La er
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design
Current
22 Cow
Farrow to Feeder
P.
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
TurkeyPoults
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 7 No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes ❑ No ❑ NA [] NE
2. Is there evidence of a past discharge ftom any part of the operation? ❑ Yes J6 No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes gTNo [DNA ❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

Facility Number: - Date of Inspection: -j
Waste Collection & 'Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes Z 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 ;ErNo
❑ 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 ONo
❑ 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 ,�Vo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes 1;2'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?
7T"
Waste Application
W. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes ONo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below,
❑ Yes KNo
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 tbs. ❑ 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 _E?rNo
❑ 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 TV[ -No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑Yes o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes �No
❑ NA
❑ NE
Reauired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
VTNo
❑ NA
[] NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
Vr 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
ZNo
❑ 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
ETNo
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[;�No
❑ NA
❑ NE
Page 2 of 3 21412011 Continued

Facili Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes Fo ❑ 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 WNo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes 7No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately. .
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes �o ❑ NA ❑ NE
❑ Yes ;'No ❑ NA ❑ NE
❑ Yes VfNo ❑ NA ❑ NE
❑ Yes �No ❑ NA ❑ NE
❑ Yes eNo
❑ Yes ;'No
❑ Yes �' o
❑NA ONE
❑ NA ❑ NE
[]NA ❑NE
Reviewer/Inspector Signature: %Date: �y 1
Page 3 of 3 21412011

Type of Visit: qkCompliance Inspection U Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: OkRoutine O Complaint O Follow-up 0 Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: ® Departure Time: County: 1 `I 1 JU/1l Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Owner Email:
Phone:
Facility Contact: (� Title: Phone:
Onsite Representative: Sco-iT AgwTGR- Integrator:
V_V_tL1&qLCertified Operator: l�l�,►t-RGc_Aertilclakion Number:
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Design
Current
Design
Current
pesign Current
Swine
Capacity"lwp
Pop.
We13uINltyP,
Capac
p.
Cattle
Capacity Pop.
Wean to Finish
La er
Dairy Cow
Wean to Feeder
Non -La er
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
Dr, P,oultr.
Ca aci
P,o
Non-DaIry
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
Turkey Poults
Other
I
I
10ther
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes )(No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) [:]Yes ❑ No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
No
0 NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
Page I of 3 2/4/2011 Continued

Fhcili ` Number: - Date of Inspection: f
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: L 6pc,%
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): f
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.) KNo
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes ❑ 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 tNo
o ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes [DNA ❑ 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 .4 No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes A
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): SG qed� ^_
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
r No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ YesKNo
No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
�No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
XNo
❑ NA
❑ NE
the appropriate box.
o❑ WUP ❑Checklists 0 Design Q Maps [:]Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the agnro riate box below. IKYes [:]No ❑ NA ❑ NE
Q Waste Application Q Weekly Freeboard ❑ Waste Analysis Soil Analysis [] Waste Transfers • Weather Code
Q Rainfall ❑ Stocking ❑ Crop Yield 0120 Minute Inspections Q Monthly and V Rainfall Inspections ❑Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facili Number: - jDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
'N No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
Yes
777T❑���i 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
❑ No NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
[] Yes
14No ❑ 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
tNo ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
tE�Yo ❑ NA ❑ NE
Use drawings. of facility, to;
w.P�.
91g) ))
S� T, CAc��i v.�RSiE gNA 1S �
C
�Q1 � - �dlDsor� off- G.PIT of)n Q _ AS
(l�r/o - 6 e7j- for �d
Sty-uC'�
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date: to
214.12011

Type of Visit: 3kcompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Cj j /I Arrival Time: Departure Time: County: G1N Region:
Farm Name: �LANZCCL r_P(Z Vl Owner Email:
Owner Name: 1 1 ! 1 Cth G L_ S . 1AuN 1 € Phone: q f0 - 999 - M L
Mailing Address: lY D/ V C l S C_ t�,IgRI N, f'VC a8 s a l
Physical Address:
Facility Contact:
Onsite Representative
Title: Phone:
: Integrator:
Certified Operator: 1 GNR6L S . 1" `kJ: HTO­ Certification Number: 1 g0'4 S
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current
Design
Current
Desigu
Current
Swine
Capacity
Pop.
Wet Poultry
Capacity
Pop.
Cattle Capacity
Pop.
Wean to Finish
La er
Dairy Cow
Wean to Feeder
-Layer
Dairy Calf
Feeder to Finish
A1260
Dairy Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
Dr. P,oultr,
C_a acit
P,o P.
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
1pullcts
Beef Brood Cow
Turke s
Other
Turkey Pouets
Other
her
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes #
No
❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes jrNo
o
Yes
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3 21412011 Continued

Facility Number: - Date of Inspection:jC)jZjjjj
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? D Yes P No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
LAQXW—
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.) 5
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes 9No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require [] Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes 0 No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): 6 V_ cr `) '5/' _
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
0
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, check
the appropriate box.
OWUP []Checklists ❑Design [] Maps ❑ Lease Agreements
❑ Yes No ❑ NA ❑ NE
❑ Yesf
NA ❑ NE
❑ YesNo D.NA ❑ NE
❑ Yes
0 No
[] NA
❑ NE
❑ Yes
�No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes j�ij No
Q Waste Application [] Weekly Freeboard M Waste Analysis Q Soil Analysis ❑ Waste Transfers
Q Rainfall ❑Stocking ❑ Crop Yield Q 120 Minute Inspections Q Monthly and I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes h] No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No
❑ NA ❑ NE
❑ Weather Code
Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: ---Z 1 - Date of In3nection: 1!1 tq 11
24. Did the facility fail to calibrate waste application equipment as required by the permit? El Yes No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes 9
No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No T4 NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
No
❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes]
No
9
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
[ No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
T�1
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ YeslNo
No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.',,,, �g
Use drawings of facility to better explain situations (use additional pages as necessary).. ,-
W . `bof;5 NOT GOUE� Ju.N �Jc�np 1NC�
�1$II I - �i Jfilrr U o�►�s c�-r�
a�d - MAKE Suq-F ti o �a�.6 w�z,E sAM
Ipill - sras�if � Qu��N4
310s/� 1 1 -� c�
CpX,11aU-POV b(A as i a
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: k _i (0 T91
Date: 1aI19/1 r1
21412011

Type of Visit Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit yRoutine 0 Complaint 0 Fallow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: I %L fO I Arrival Time: Departure Time: County: UA/ Region:
Farm Name: 1AL-wT e ?- �A4ZN` Owner Email:
Owner Name: I' , ICH19C—t` SCCTT &A17f-(Z Phone:
Mailing Address: ! L0 T(4 NC 1 } V5 _ C]14LA'�8pj,#/ , !y e. 0 Soe
Physical Address:
Facility Contact: f I Title:
Q
Onsite Representative: .COT-r
Certified Operator:.. 0 1. C Y 9 EL S. lyOLA 7 6-R
Back-up Operator:
Phone No:
Integrator:
'pal q
Operator Certtiication Number:
Back-up Certification Number:
Location of Farm: Latitude: = 0 = 0 Longitude: = o =' = "
Design Current
Design Current Design
t►urrent
Swine Capacity Population
Wet Poultry C•spscity Population Cattle Capacity
Population
❑ Wean to Finish
JE1 Layer ❑ Dairy Cow
El Wean to Feeder
JE1 Non -Layer I 1
❑ Dairy Calf
19 Feeder to Finish
❑ Daia Heifer
❑ Farrow to Wean
Dry Poultry
❑ D Cow
❑ Farrow to Feeder
❑ Non -Dairy
El Farrow to Finish
❑ La era
El Stocker
❑ Gilts
❑Non -La era
El
❑ Beef Feeder
❑ Boars
❑ Pullets
❑ Beef Brood Cow
❑ Turke s
Other
❑ Turkey Poults
❑ Other
❑ Other
Number of Structures:
Discharges & Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (Ifyes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes *No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes Y,No ❑ NA ❑ NE
❑ Yes �Lo ❑ NA ❑ NE
12128104 Continued

6acility Number: 3 — 9,Q Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes IANo ❑ 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: LAC0co'l
Spillway?:
Designed Freeboard (in): C1. S
Observed Freeboard (in): KNo
5. Are there any immediate threats to the integrity of any of the structures observed'? ElYes ElNA ElNE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes No [INA ElNE
through a waste management or closure plan? 0
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes [.No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
maintenance/improvement?
❑ Yes XNo ❑ NA ❑ NE
11. Is there evidence of incorrect application? if yes, check the appropriate box below. ❑ Yes XNo ❑ NA ElNE
❑ Excessive Ponding [IHydraulic Overload ElFrozen Ground ElHeavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s) ALA-1 auu) U-E C T�C-ULS �'� (AN T
14, Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ Yes
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
17. Does the facility lack adequate acreage for land application? ❑ Yes
18. Is there a lack of properly operating waste application equipment? ❑ Yes
*o ❑ NA ❑ NE
IUI No ❑ NA ❑ NE
INNo ❑ NA ❑ NE
o ❑ NA ❑ NE
o ❑ NA ❑ NE
S'04 p' \ �A' 1',
.Comments (refer to question;#) Explain any YES answers and/or�any recommendations ar,any:otherecomments
Use drawings of facility `to better ex' lain situations (use addit�onaltpageds;as necessary)` ° T.(yyS ,e yy?; ss ff
i.I.�.§�.3s
e7-Cal OF �.( C Kl TIC)N CE TC--GZ G � SLu�f]C,E �-
pug ; 121=co2Ds
'd9 co �G: coQO�
- f F flc� / cPl eta
�T A- ��� GAc.tG3Q�-r;I� '�
Reviewer/[ns ector Name �'
p :5:`i. �., t
�� �-43
Phone: Q� �1
Reviewer/]nspector Signature:
Date: Ll IS d
Page 2 of 3 12128104 Continued

Facility Number: 3 Date of Inspection � O
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes )�No [INA ❑ NE
0the appropriate box. WUP ElChecklists Design � Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No [INA [INE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑.Wh"ste Transfers ❑ Yinual Certification
❑ Rainfall ❑ Stocking ❑yrop Yield 0 120 Minute Inspections El Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes VNo ❑ NA ❑ NE
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/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes
ONo
❑ NA
❑ NE
❑ Yes
[:]No
❑ NA
�rNE
❑ Yes
❑ No
❑ NA
KNE
❑ Yes
XNo
❑ NA
❑ NE
❑ Yes
❑ No
�fNA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
KNo
❑ NA
❑ NE
❑ Yes
VNo
❑ NA
❑ NE
El Yes
)]No
El NA
❑NE
Additional Cor►tments and/or Drawings.. 1 5
t A
r
LA- L" Q-Ew�p S
?�
7 H Ne-n A CJJ���rr d V�-Gt-1 �
5
cc��p
tt7 W
,�— P(L?�JJ�D � P 0 B'4UC��J
�AN.p�EF cics�tr� s N
salt pus
J
S�
�JO SQJ4����iES
Page 3 of 3
12/28104

f
Diivision of Water Quality
(Facility .Number ��'j� O Division of Soil and Water Conservation
-- __ _ Other Agency
Type of Visit ��C((ompliance Inspection O Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit w,coutine O Complaint 0 Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: r1 Arrival Time: ® Departure Time: County: u AL Region:
Farm Name: ��lJl1�1TF_�A1Z iYi Owner Email:
Owner Name: 0CiI LN(4C L SCC5r7 HC&N7 - Q— Phone:
Mailing Address: � �N�— l 1 1� ��P� A/C C Ok-39
Physical Address:
Facility Contact:
Title:
Onsite Representative: CLAZT1 1 Integrator:
Certified Operator:
Back-up Operator:
Phone No:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: 0 e 0 & 0 Longitude: 0 ° = i rI «
Swine
Design
C�apce city
Current
A�op Lion
Design Current
Wet Poultry C•apadcity P�pula�tion
Cattle
Design
Capa�ci�ty
Current
Population
❑ Wean to Finish
❑ La er
iry Cow
❑ Wean to Feeder
-Layer
iry Calf
Feeder to Finish
Dry Poultry
❑ La ers
❑ Dairy Heifer
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Farrow to Finish
❑ Non -Layers
❑ Gilts
❑ Beef Feeder
❑ Pullets
El Turkeys
❑ Boars
Other
❑ Other
❑Beef Brood Cow
p
❑ Turkey Poults
❑ Other
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
)� No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
IxNo
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
0,No
El NA
ElNE
other than from a discharge?
'' 11
Page I of 3
12128104
Continued

Facility Number: — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
XNo ❑ 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: L4COC11V
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
ANo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
[2,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
KNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
;No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
XNo ❑ NA ❑ NE
maintenance or improvement?
Waste Apelication
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
JKNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu,
Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) f> C-1 rj e, ( LP)
13. Soil type(s)
W. Do the receiving crops differ from those designated in the CAWMP?
❑Yes
7�"(s� No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
XNo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
P No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
„Z,No
❑ NA
❑ NE
".o, ry=�� t�h"m`�'Er ents��y�"ti'.'^,'�YES answers andlur,anyrecomdations tm'Coments'(rcfr to.question#) ,Explain any
rsex ainstuati6ns. (use additi6hal Pa es'as necesJse drawin s'of facilit to-bette'r
Reviewer/Inspector Name - --- -
- - j ,hJ �' - -----1 Phone:
ReviewerlInspector Signature:
Date:
Page 2 of 3 12128104 Continued

Facility Number: '3 Date of Inspection d
Required
Records & Documents
19.
Did the facility fail to have Certificate of Coverage & Permit readily available?
❑ Yes
XNo
❑ NA
❑ NE
20.
Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
�lo
❑ NA
❑ NE
the appropirate box. 0 WUP 0 Checklists 0 Design El Maps El Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
0 Waste Application 0 Weekly Freeboard 0 Waste Analysis ❑ Soil Analysis ❑ V/aste Transfers
❑ Ainual
Certification
❑ Rainfall 0 Stocking ❑/rop Yield 0 120 Minute Inspections ❑ Monthly and I" Rain Inspections
[]
Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
36 No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
XNo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
1ANo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
'WNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
KNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
PA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
9No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
14No
❑ 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
4No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
9No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
ONo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
0 No
❑ NA
❑ NE
Page 3 of 3 12128104

u W Division of Water Quality
Facility Number .3 �� 0 Division.of Soil and Water.Conservation
- -- Q Other Agency
Type of Visit 01
Compliance Inspection
0 Operation Review 0 Structure Evaluation
0 Technical Assistance
Reason for Visit
0 Routine 0 Complaint
0 Follow up 0 Referral 0 Emergency
0 Other ❑ Denied Access
Date of Visit: ® Arrival Time: 1 10 1 0 1 Departure Time: County: Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Phone:
Facility Contact: Title: ' 1 Phone No:
Onsite Representative: GLQ_1I S n " CLWICK 1 Integrator:
Certified Operator: I' ► Ct- 5 • A)uN76L _ Operator Certification Number:
Back-up Operator:
Location of Farm:
Design Current
Swine Capacity Population
❑ Wean to Finish
❑ Wean to Feeder
Feeder to Finish O O 185b
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Back-up Certification Number:
Latitude: = o = i Longitude: = ° = ' = {1
Design Current
Wet Poultry Capacity Population
❑ Layer
❑ Non -La er
Dry Paultry
Pullets
Other
Pouets
Design Current
Cattle Capacity Population
❑
Dairy Cow
❑
Dairy Calf
❑
Dairy Heifei
❑
Dry Cow
❑
Non -Dairy
❑
Beef Stocker
❑
Beef Feeder
❑
Beef Brood Cowl
I
Number of Structures:
Discharges & Stream Impacts
I. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State`? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes ANo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
[:]Yes
[:]No
❑ NA
❑ NE
❑ Yes
kNo
❑ NA
❑ NE
❑ Yes
�(No
❑ NA
❑ NE
12128104 Continued

. FcilityNumber: j — a2 Date of Inspection 9
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
XNo
❑ 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: LAGAW
Spillway?:
Designed Freeboard (in): 0.5
Observed Freeboard (in): G
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
KNo
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
XNo
❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes %No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes fil No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes XNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drifl ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
A No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
qNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
,KNo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
AQ No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
Z 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):
1N 1114L 000L T 1 / C)F ►Z pIN P—AL-(—
AL
ReviewerlInspectorNome 611411VraS Phone: 9J6 _i9& __�307
Reviewer/inspector Signature: clvY&, Date: Lf OE-
12128104 Continued

Facility Number: 31 — Date of Inspection aH 6
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes (9 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes §,No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 0 No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes rM No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes E�No
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes I�No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes S'No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes [(No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes Z�No
JZNA
❑ 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 INo
❑ 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 jNo
❑ 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 ,QNo
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes VKNo
❑ NA
❑ NE
Additional Comments and/or Drawings:
Page 3 of 3 12128104

0
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: .3 Z O Arrival Time: ; O4 Departure Time:
Farm Name: Own
Owner Name: /��L' hr�!tF� '5CoT7 & ?f Ph
Mailing Address:
Physical Address:
County: Region: ev,
er Email:
one:
Facility Contact: Title: Phone No:
Onsite Representative: ? �i!!1 Tam Integrator:
Certified Operator: ,' '��L- ��✓�'� Operator Certification Number:
Back-up Operator -
Location of Farm:
B
ack -up Certification Number:
Latitude: = e = 4 ❑ Longitude: 0 0 = ` ❑
Swine
Design Current Design Current Design Current
Capacity Population Wet Poultry C►apacity Population Cattle Capacity Population
❑ Layer ❑ Dairy Cow
❑ Wean to Finish
❑ Wean to Feeder
I ❑ Non -La er
❑ Dairy Calf
Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
Z00
❑ Dairy Heifer
Dry Poultry ❑ Dry Cow
❑ Non -Dairy
❑ Layers
❑ Beef Stocker
❑ Non -Layers ❑ Beef Feeder
❑ Pullets
❑ Turkeys
❑Turkey Poults
❑ Other
❑ Boars
Other
❑ Other
❑ Beef Brood Cow
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page 1 of 3
❑ Yes )2fNo ❑ NA ❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes ❑ No
❑ Yes fi No
❑ NA
❑ NE
❑ Yes /No
❑ NA
❑ NE
12128104 Continued

Facility Number:-7�21Date 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
S211
ture I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?: /1�0
Designed Freeboard (in):
Observed Freeboard (in): 2 JJ
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No
❑ NA
ElNE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
;Z(No
❑ NA
❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
�No
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
No
X
❑ 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
dNo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need -
maintenance/improvement?
❑ Yes VNo ❑ NA ❑ NE
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[:]PAN ❑ PAN > 10% or 101bs []Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑Yes
No ❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[[J No ❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
/0 No ❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
io ❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
X No ❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any: other. cowments:.::
Use drawings of facility to better explain situations. (use additional pages as necessary):;:
/5 .1 Z5 Olv _75Vrc
7Z5T
S/ -2-Z -3
S�3
Reviewer/Inspector Name �
�� l Q - — -
Phone: /O cil/-73Z<7
Reviewer/Inspector Signature:
&&2L Date: L
Page 2 of 3 12128104 Continued

Facility Number: — 2 Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box. ❑ WUP ❑ Checklists ❑ Design El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes ZNo
❑ Yes VNo
[I NA ❑NE
[I NA El NE
21 Yes ❑ No ❑ NA ❑ NE
Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" 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
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes
0 No
El NA
❑ NE
El Yes
❑No
9NA
❑NE
[IYes
�No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
P No
❑ NA
❑ NE
❑ Yes
❑ No
7NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
�] No
❑ NA
❑ NE
❑ Yes
No
/gfNo
❑ NA
❑ NE
❑ Yes
❑ NA
[j NE
❑ Yes]
No
ElNA
❑ NE
ElYes
dNo
❑ NA
❑ NE
Additional Comments and/or. Drawings:
Ak
ZJ�� C.OLrG4 IVO 7-
Page 3 of 3 12128104

i
Type of Visit 10 Compliance Inspection O Operation Review O Structure Evaluation
Reason for Visit Routine O Complaint O Follow up O Referral
,i O��Emergency
Date of Visit: % 0 Arrival Time: 2;� Departure Time: County:
Farm Name: Owner Email:
�o r �f
Owner Name: C,[�Af�� Phone: _
Mailing Address:
Physical Address:
Q Technical Assistance
O Other ❑ Denied Access
Region: AZ A0
Facility Contact: di Title:
Phone No:
Onsite Representative:
A�
Integrator:.
Certified Operator: �
Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = e = A ❑ N Longitude: = ° = I 0
di
Design Current
Design Current
Design Current
Swine Capacity Population
Wet Poultry Capacity Population
Cattle Capacity Population
❑ Wean to Finish
❑ Layer
❑ Dairy Cow
❑ Wean to Feeder I
❑ Non -Layer I
❑ Dairy Calf
Feeder to Finish &170
❑ Dairy Heifer
El Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
❑ Layers
El Beef Stocker
❑ Gilts
❑Non -La Non -Layers
❑Beef Feeder
❑ Boars
El Pullets
❑ Beef Brood Cow
❑ Turkeys
Other
❑ Other
❑ T rkey Poults
❑ Other
Number of ''Auctures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
), No
❑ NA
❑ NE
Discharge originated at. ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
No
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
12128104
Continued

r .r
Facility Number: —
Date of Inspection 5I /
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
Identifier:
Spillway?: /iIO
Designed Freeboard (in): t
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes XNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes VNo ❑ NA ❑ NE
❑ Yes /;�No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
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)
4. Does any part of the waste management system other than the waste structures require ❑ Yes XNo ❑ NA ❑ NE
maintenance or improvement?
Waste ADDIICHHOn
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ElNE
maintenance/improvement? 10
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes XNo ❑ 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 Windo/� �❑ Evidence of Wind Drift
inddDrift D Application Outside of Area
12. Crop type(s) /` l/,0 ;a?
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No ❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No ❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
No ❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
o ❑ 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):
�9
r-0q/J,3 '
Reviewer/Inspector Name
J�f - - _ - - Phone: D Zto
Reviewer/Inspector Signature:
Date:
Page 2 of 3 12128104 Continued

-_
Facility Number: 13Z — Date of inspection
Required Records & Documents T�
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
Gtt
esNo ❑ NA ❑ NE
20.
Does the facility fail to have all components of CAWMPrP readily available? If yes, check
the appropriate box. ❑ WUp heckli t Design ❑ Maps ❑ Other17
Yes
����"`"����
?No
❑ 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 ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V
Rain Inspections ❑
Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
/No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
;dNA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
VrNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
VNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
0 No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
JZNA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
o
X__J?
ElNA
ElNE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
ElYes
No
❑ NA
El NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
#No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
El Yes
,�,/
LQNo
❑ NA
El NE
33. Does facility require a follow-up visit by same agency?
Cl Yes
zNo
❑ NA
❑ NE
Additional Comments and/or Drawings:
GO f
Page 3 of 3 12128104

a,
Type of Visit fd Compliance Inspection O Operation Review O Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine Q Complaint 0 Follow up 0 Referral 0 Emergency O Other ❑ Denied Access
Date of Visit: F Arrival Time: Departure Time: County: Region:ZZ/AC
Farm Name: Owner Email:
Owner Name: C Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: 11a1i� __/dr9G yw'CIntegrator:rN�
Certified Operator:
Back-up Operator:
Location of Farm:
Operator Certification Number:
Back-up Certification Number:
Latitude: = o = i = 4{ Longitude: = ° = 4 =
di
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population Cattle
❑ Wean to Finish
❑ Wean to Feeder
Feeder to Finish D� Z
El Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Cilts
❑ Boars
Other
❑ Other
❑ Layer
❑ Non -Layer
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turke Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
Design Current
Capacity Population
❑
Dairy Cow
❑
Dairy Calf
❑
Dairy Heifej
❑
Dry Cow
❑
Non -Dairy
❑
Beef Stocker
❑
Beef Feeder
❑
Beef Brood Cow
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures: ©'
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes RfNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
oNo
❑ NA
❑ NE
❑ Yes
r� No
❑ NA
❑ NE
12128104 Continued

Date of Inspection
Facility Number: —
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes ;1No ❑ 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: 7 ll
Spillway?: 0
Designed Freeboard (in):
Observed Freeboard (in): 3(,gf_
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes No ElNA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes VNo ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
,_,(
El Yes jCJ No ❑ NA El NE
maintenance or improvement?
/
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes -ANo El NA' El NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes /No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window 0 Evidence of Wind Drift PApplication Outside of Area
t2. Crop type(s) �i�i�4tt/ofj CAz SCc, Q(/Fo25,LG�i4
13. Soil type(s) Ad/
14. Do the receiving crops differ from those designated in the CAWMP? El Yes No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ;_1 No ElNA ElNE
16, Did the facility fail to secure and/or operate per the irrigation design or wettable acre determinationi❑ Yes No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes N❑ 7�1
o NA ElNE
18. Is there a lack of properly operating waste application equipment? ElYes No ❑ NA ❑ NE
to.question.#) ' Ezplal
S 3 t Zwc5 ' rt �s ���o er ,�owf o : SHFZ /./ ro.✓ zz W., ac
Reviewer/Inspector Name I ' " "";�' Phone: �'��- •�p —°�Z
Reviewer/Inspector Signature: Date:
12128104 Continued

Facility Number: — Date of Inspection
_Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes[ No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 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
No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit'?
❑ Yes
No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
//❑ No
X NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
11� No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
No
❑ NA
ElNE
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
ElNA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
ko
❑ NA
❑ NE
Additional+Cominenfs and(ot Drawings ;, ;�. -,:,.: � `.fix la ,a r ..4 . i ; tiry 1+,, v� ;,..
12128104
12128104

Type of Visit .,1Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit 'P Routine 0 Complaint 0 Follow up 0 Emergency Notification O Other ❑ Denied Access
Facility Number Date of Visit: Time: � Ob
Fb
Q Not Operational Q Below Threshold
Permitted kertified [3 Conditionalllly Certified 13 Registered Date Last Operated or Above Threshold: .........................
FarmName: ............. !4Qgs�.�......S.117�!'...1....................................... •..............•.... County:.... Vp.................................................
OwnerName: ...................................................
Mailing Address:
Phone No:
FacilityContact: ......................................................................... Title:................................................................ Phone No:...................................................
V.
Onsite Representative:....SoT......1-�.'<c}' .................................................Integrator:............rs...........................................
Certified Operator:.... ................................................
Location of Farm;
Operator Certification Number: .............................. . ..........
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude a ` " Longitude • ' 64
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes A0
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other /
a. if discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min'?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes INo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes /No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: .............. i.................... .............................. .... .................................... ................................... ................................... ...................................
Freeboard (inches):
12112103 Continued

m
FORUM IRRt%-o
Farm Owner
Operator
rMichael Stott Hurter
3ar"
LAGOON UGIiiu IRFWAMON FIR f2ECQRD
FOR RECORDING IRRIGATION EVENTS ON OIFFE 49NT FIELDS
FncrlttyI61mber 317Q2
mm
"Weattler Cotfw C-Clear, PCB'- aWC4oudy, CI-Claudy, Rftain� Snav#Sle� N/-V ncly -
Persons coneft Hgalion inspect ons mast initia# t4 agrdy irmpedbm r►ere completed all least emy 120 minks
NOTE Af tondillons beVOM pera+ittee'�B Ocadroil haw causW Doncampftwe wltt U=CP�WMP or perrmrt, explabt on reverse
"Weattler Cotfw C-Clear, PCB'- aWC4oudy, CI-Claudy, Rftain� Snav#Sle� N/-V ncly -
Persons coneft Hgalion inspect ons mast initia# t4 agrdy irmpedbm r►ere completed all least emy 120 minks
NOTE Af tondillons beVOM pera+ittee'�B Ocadroil haw causW Doncampftwe wltt U=CP�WMP or perrmrt, explabt on reverse

Facility Number: 31 — 2— Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑ Yes
10
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes FNo
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes
elevation markings?
Waste Al2Rlication
10. Are there any buffers that need maintenance/improvement? ❑ Yes gN(o
o
11. Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type &4'mum (Cn) SMALL r-3fZA.n1 f�UCGZCe�O
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes
14. a) Does the facility lack adequate acreage for land application? ❑ Yes
b) Does the facility need a wettable acre determination? ❑ Yes
c) This facility is pended for a wettable acre determination? ❑ Yes
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge attor below
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours?
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional
Air Quality representative immediately.
❑ Yes
❑ Yes
0
0
No
No
❑ Yes 2(No
❑ Yes
❑ Yes VNo
❑ Yes INNO
Field Copy ❑ Final Notes
-D4AoIL I oU fraR THE ToiLK `q 1r-T--trgC L cLr_-a0 --)P F'a—ow• t� �zous C3V'j&iEV_
I
�_ccaaA)s �A2M (Dort (�o�D
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Date:
12/l2/03 Continued

Facility Number:
Date of Inspection I I9 iI ny i
Required Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WIT, checklists, design, maps, etc.)
23. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
25. Did the facility fail to have a actively certified operator in charge?
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
28. Does facility require a follow-up visit by same agency?
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 3I-35)
3I . If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
32. Did the facility fail to install and maintain a rain gauge?
33. Did the facility fail to conduct an annual sludge survey?
34. Did the facility fail to calibrate waste application equipment?
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After 1" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
❑ Yes No
❑ Yes
❑ Yes No
❑ Yes
❑ Yes 7No/
❑ Yes
❑ Yes No
❑ Yes [� N
El Yes ; No
❑ Yes /No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
12112103

Facility Number
Date of Visit, --�=f Time: Z M
Z
Not Operational Below Threshold
10 Permitted M Certified /0 Conditionally Certified 0 Registered Date Last Operated or Above Threshold.•
Farm Name: G h County: ,,
Owner Name: oPhone No:
Mailing Address:
Facility Contact: Title: f�Phone No:
y�/t Onsite Representative: zoy- — Integrator: &-aulm S 4- C cF v�/,ri►G t
Certified Operator: Operator Certification Number:
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 0' 4 Li Longitude 1 cf
Design Current
swine Capacity ro ulation
❑ Wean to Feeder
Feeder to Finish
❑ Farrow to Wean i
Farrow to Finish
Gilts
Boars
Design Current Design Current
Poultry Capacity Population Cattle Ca aci ty Population
❑ Layer I Dairy
❑ Non-Layer-L I ❑ Non-Dai
❑ Other
Total Design Capacity
Total SSLW
�� iHoldin Ponds I Solid Troop. �� ' ❑ No Li Liquid Waste Management Ili System
Area �❑ Spray Field Area
Number of Lagoons % ❑ Subsurface Drams Present ❑ L _
g p
Discharges _ Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes ❑ No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. is there evidence of past discharge from any part of the operation? ❑ Yes ❑ No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ❑ No
Wast ColleCtion & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ❑ No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard (inches): �%1f
05103101 Continued

Facility Number: ZI — Z I Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes ❑ No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes ❑ No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes ❑ No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes ❑ No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes ❑ No
jVa5te AipRlir tipn
10. Are there any buffers that need maintenance/improvement? ❑ Yes ❑ No
11. Is there evidence of over application? ❑ Excessive Pending ❑ PAN ❑ Hydraulic Overload ❑ Yes ❑ No
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
❑ No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
b) Does the facility need a wettable acre determination?
❑ Yes
❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes
❑ No
15. Does the receiving crop need improvement?
❑ Yes
❑ No
16. Is there a lack of adequate waste application equipment?
❑ Yes
❑ No
Reouired Records & Document
17.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
❑ No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
❑ No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
❑ No
20,
is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
❑ No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
❑ No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
❑ No
23,
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
❑ No
24.
Does facility require a follow-up visit by same agency?
❑ Yes
❑ No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes ❑ No
0 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
0ihment§7Q.6f6f;'t6 questionranyother com,e drawingsgnf facility to better explain situatios(use additional pagesas nee s ) ❑Field Copy ❑ Final Notes
dNtsr his 4e..d D�/1 ems /9.frr�
7/07 e 744r
Long/IT y
Reviewer/Inspector Name
Reviewer/Inspector Signature:
05103101
Date:
Continued

Facility Number: 31 — Date of Inspection
Odor Jum
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours?
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon?
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
31. Do the animals feed storage bins fail to have appropriate cover?
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
Additional Comments, and/orgDrsw„p s: r _
05103101
05103101

3 1 — qRZ
Karen Thomas Farm
242 Jackson Store Rd.
Beulaville, NC 28518
March 20, 2002
NC Division of Water Quality
127 Cardinal Drive
Wilmington, NC 28405
Subject: DWQ inspections
To Whom It May Concern:
O APR 12AS
2002 D
a
The DWQ inspections performed on my farm have been completed with the pumping
operator being Mrs. Peggy Campbell for the past three years; however, as of February 8,
2002 she is no longer the pumping operator for this farm. The hog operation and farm
has been sold. The new operator and owner of this farm is Michael Scott Hunter. As of
February 8, 2002 Mrs. Campbell and myself have no obligations concerning DWQ
inspections.
Please call me at [phone] or write me and let me know if you need any further
information concerning this matter.
Sincerely,
mow(
Karen Thomas

F WATF
`OHO ROG � Michael F. Easley, Governor
William G. Ross Jr., Secretary
APR 1 y2002 North Carolina Department of Environment and Natural Resources
p -C Gregory J. Thorpe, Ph.D., Acting Director
Division of Water Quality
April 8, 2002
Michael Scott Hunter
Hunter Farm
1676 NC 111 South
Chinquapin, NC 28521
Subject: Certificate of Coverage No. AWS310792
Hunter Farm
Swine Waste Collection, Treatment,
Storage and Application System
Duplin County
Dear Michael Scott Hunter:
In accordance with your Notification of Change of Ownership received on March 6, 2002, we are
forwarding this Certificate of Coverage (COC) issued to Michael Scott Hunter, authorizing the operation
of the subject animal waste collection, treatment, storage and land application system in accordance with
General Permit AWG100000. This approval shall consist of the operation of this system including, but
not limited to, the management of animal waste from the Hunter Farm, located in Duplin County, with
an animal capacity of no greater than 1600 Feeder to Finish and the application to land as specified in
the Certified Animal Waste Management Plan (CAWMP).
The COC shall be effective from the date of issuance until April 30, 2003 and shall hereby void COC
Number AWS310792 dated March 18, 2002. Pursuant to this COC, you are authorized and required to
operate the system in conformity with the conditions and limitations as specified in the General Permit,
the facility's CAWMP, and this COC, with no discharge of wastes to surface waters. An adequate
system for collecting and maintaining the required monitoring data and operational information must be
established for this farm. Any increase in waste production greater than the certified design capacity or
increase in number of stocked animals above the number authorized by this COC will require a
modification to the CAWMP and this COC and shall be completed prior to actual increase in either
wastewater flow or number of animals.
Please be advised that any violation of the terms and conditions specified in this COC, the General Permit
or the CAWMP may result in the revocation of this COC, or penalties in accordance with NCGS 143-
215.6A through 143-215.6C including civil penalties, criminal penalties, and injunctive relief.
Upon notification by the Division of this COC's expiration, you shall apply for its renewal. This request
shall be made within 30 days of notification by the Division.
Non -Discharge Permitting knit
1617 Mail Service Center, Raleigh, NC 27699-1617
Internet httpJ/h2o.enr.nc.r.tate.us/ndpu
Telephone [phone] Fax [phone]
'telephone 1 Bo0 623-7748
50% recycled/10% post -consumer paper
Now,
NME R
DENR Customer Service Center
An Equal Opportunity Action Employer

The facility's CAWMP meets all requirements in place at the time of certification. However, it appears
that the irrigation system on site may not adequately cover all acreage listed in the Waste Utilization
Plan. The owner should begin to address this inconsistency as soon as.possible.
This COC is not automatically transferable. 'A name/ownership change application must be submitted to
the DWQ prior to a name change or change in ownership.
If any parts, requirements, or limitations contained in this COC are unacceptable, you have the right to
apply for an individual non -discharge permit by contacting the engineer listed below for information on
this process. Unless such a request is made within 30 days, this COC shall be final and binding.
The subject farm is located in the Wilmington Regional Office. The Regional Office Water Quality Staff
may be reached at [phone]. If you need additional information concerning this COC or the
General Permit, please contact Michelle Barnett [phone] ext. 544.
Sincerely,
regory J. Thorpe, Ph.D.
cc: (Certificate of Coverage only for all cc's)
Duplin County Health Department
Wilmington Regional Office, Water Quality Section
Duplin County Soil and Water Conservation District
Water Quality Central Files
NDPU Files

Notification of Change of Ownership
Animal Waste Management Facility
(Please type or print all information that does not require a signature)
In accordance with the requirements of I5A NCAC 2H .0217(a)(1)(H)(xii) this form is official notification to the Division of
Water Quality (DWQ) of the transfer of ownership of an Animal Was ee .cement Facility. This form must be submitted to
DWQ no later than 60 days following the transfer of ownership.
General Inforrnatiioffn: % aid
Name of Farm:_ 17 vn-}>°t- f a��t+ t of-� r J���^`-1 _ral.n,� -Facility No:_-�
Previous Owner(s) Name: Ka /le it n ej n a r _ Phone No:
New Owner(s) Name: Sep # ✓01 Phone No:_ 4lo -ZM- k? 64
Mailing Address: ���6 n! C 1/1 �or4A; ^q &n A C___2?f2.1_
p r A, O I u --
Farm Location: Latitude and Longitude: � _L W / _ �� I 3 ` County:_ 0,4 ll i n _
Please attach a copy of a county road map with location identified and describe below (Be specific: road names, directions,
milepost, etc.): C)A S '' i,[2L J-,4-n EL4,- �� 77 D�� n, l lam, weft` e74 _
l g6if T.k—
Operation Description:
Type of Swine No. of Animals
D Wean to Feeder
weeder to Finish _ „16Qc7 _
Zr Farrow to Wean
::.t Farrow to Feeder
0 Farrow to Finish
D Gilts
D Boars
Type of Poulrn• No. of Animals
D Laver
I Non -Lave, -
Type of Beef No. of Animals
D Brood
D Feeders
D Stock.crs
Orher Type of Livestock:
Type of Dairy No. of Animals
::.I Milking
D Dry -
:7 Heifers
D Calves
Number of Animals:
Acreage Available for Application: r{. � Reauired Acreage: _ %S d
Number of Lagoons / Storage Ponds: Total Capacity: 3 3 Cubic Feet (ft').
iia[ii!Yi.aa: >t a, lS ac ac a[i Ki sat a:iy`�`i i MW.. Kac.........Kflt*.*............ .... sac....**s[......*.....
Owner / Manager Agreement
I (we) verify that all the above information is correct and will be updated upon changing. I (we) tnderstand the operation and
maintenance procedures estabiished in the approved animal waste management plan for the farm named above and will
implement these procedures. I (we) know that any expansion to the existing design capacity of the waste treatment and storage
system or construction of new facilities will require a new cenitication to be submitted to &.-- DWQ before the new animals :;re
stocked. I (we) understand that there must be no discha: ge of animal waste from the storage or application system to surface
waters of the state either directly throueh a man-made conveyance or from a storm event less severe than the'S-year. 24-hou,-
storm and there mLst not to run-off from the application of anim'..t xasEe- I (we) understand that run-off of pollutants from
lounging and 'heavy use areas must be minimized using technical standards developed by the Natural Resources Conservation
Se -vice. ine approved plar. will be filed at the farm and at the office of the local Soil and N' ater Conservation District. I Ove)
know that anv modification must be approved by a technical specialist and submitted to the Soil and Water Conservation.
District prior to imoiemcntatior.. A change in land own:rs'= reau :-,:s wTiiten notificatior. to DWQ or a new certification i if
the approved plan is changed) within 60 days of a title transfe.-. -
Name of. ew Land Owner; Al;r,�cle i Scd H1.' e'r t
5iature• k Lft`t at' �a cr _ � - Date:
:n—
Name of Manager (if different from owner):
Signature: Date: r--, r,-
Please sign and return this form to: NC Di,.ision of Water Quality
Non -Discharge Compliance S Enforcement Unik.
1617 Mail Service Center
Raleigh. NC 27699-1617 f' �. � (j,+ i ; 'Y
;l~ala,1J.:2000

Facility Number Date of Visit: - Time: 10 7 Z
Not Operational 0 Below Threshold
Permitted M'Certifiied © Conditionally Certified [3 Registered Date Last Operated or Above Threshold:
Farm Name:_
�i _n/!r+ An�✓ �rirz County: ullli°K
Owner Name: _445 e/slZ; - lra&1 _ Phone No:
Mailing Address:
Facility Contact: ' L �j Title: Phone No:
Onsite Representative: �A7T �uh74�/ integrator:
Certified Operator:
Location of Farm:
Operator Certification Number:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • 6 0« Longitude 0' & Du
Design „ Current
Design Current Design Current
Swine
Capacity Population Poultry
Capacity Po ulation Cattle. capacity Po ulation
❑ Wean to Feeder
❑ Layer
❑ Dairy
Feeder to Finish
❑ Non -Layer
❑ Non-Dai
❑ Farrow to Wean
El Farrow to Feeder
❑ Other
❑ Farrow to Finish
Total Design Capacity
❑ Gilts
Boars
❑ Boars
- Total SSLW
N6i'of Lagoons �❑ Subsurface Drains Present ❑ La
ri nboon Area JE3 Spray Field Area
.—Holding Ponds I Solid Tra "sLiquid
g p- ❑ No Waste S stem
Disgh r g5 & Streamlmt)acts
1. Is any discharge observed from any part of the operation? ❑ Yes, jffNo
Discharge originated at: ❑ LaQoon ❑ Spray Field ❑ Other
a. if discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. if discharge is observed, did it reach Water of the State? (if yes, notify DWQ) ❑ Yes ❑ No
c, if discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes Z No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes j� No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes IgNo
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard (inches):
05103101 Continued

Facility Number: 3/ — Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ic/ 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?
(I€ any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes ® No
❑ Yes q No
❑ Yes &No
❑ Yes ®,No
❑ Yes E[No
Waste Aunlication
10. Are there any buffers that need maintenance/improvement? ❑ Yes JgNo
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes M�No
12. Crop type&OeradLL 2
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes ®•No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes ®.No
b) Does the facility need a wettable acre determination? ❑ Yes ❑ No
c) This facility is pended for a wettable acre determination? ❑ Yes ❑ No
15.
Does the receiving crop need improvement?
IQYes
4 No
16.
Is there a lack of adequate waste application equipment?
❑ Yes
® No
Reauired
Records & Documents
1 17.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
® No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
[SNo
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
®.No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
®,No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
R3 No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes FJ No
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes MNO
24. Does facility require a follow-up visit by same agency? ❑ Yes ® No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes E.N0
13 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
, a
Comments (refer<tb'questlon #) ) zplaln anYXES,answers aridlor any rcommendations deany other comments. �` � ,
,.... w x
�U e drawings,of facility to betters explain situations., (use additional, pages as:riecessary).""* , ; ❑Field Copy ❑Final Notes _
)676 19C1115,
CJ7t.hgt/AP1n ZV
Ne flay % ue-� �rlvrel�. �vl! ��rryl rp/rt 124 rm
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date:
05103101 Y Continued

Facility Number: 7 —7YZ_l Date of Iuspection 2 2�D Printed on: 7/21/2000
Odor Issues
25. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge attor below ❑ Yes RNo
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes 0:No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes �2 No
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes CKNo
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes FKNo
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes RNo
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes KNo
1:40ditional Comments and/orDrawings:
-�- on O G G h&-' 6" kats ePit
�v 'lie e'xV- '/0 lgic !vn i l��jr [�c�- ruhS �'ldh� ��`�Q
ime- �ya �'n 6�e-�`�s��
,�e C�eQ �, Q� Ova
'/-P ivc4ee-- P'/-
r.&oq r" t '-4yVs0,
C�L o/r f4r�l� /!� W %�I � c I ii� L' /�-n Pi� O✓�
4
mac/%✓ J),Pd �/-
�
5100
J

,au.
DDivlston of VI'ater Q ual ter C tion.,
r'�Fw0�:
3 r'aj
w�s�on of Soil an Wa onserva ronG a
QOther'Agency. : j. sr + i BSI s ' +° y3# Sli "*�a
5 t+ a s trp s f ksn� M
C
(Type of Visit ®Compliance Inspection O Operation Review O Lagoon Evaluation 1
Reason for Visit 0 Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
1—: 10 Facility Number
[)ate orvisit: dO Time: /S Printed (in: 7/21/2000
�-®
Not Operational Q Below Threshold
[] Permitted ©Ceriified (] Conditionally Certified © Registered Date Last Operated or Above Threshold: .........................
Farm Name: Ad46V . County :......... DCJPL!^/.................................................
Owner Name: ........ <Rcral!�.....M.......................................................... Phone No:...g%O v�.3J� ..........................
FacilityContact: ....,.... .....................................................Title:................................................................ Phone No:..........;.......................................
Mailing Address:....... u .... /���Y��S r� 6.......1W ........................ .......h.�'�G1L.,................................. ..........................
Onsite Representative: �. Integrator:.j84&)A)'j
.......0..........O....G.........�.........�.......�......N.....�............
Certified Operator: ................?_ + �� .. C.R k Pf3G� Operator Certification Number: i �d Z (o
................. .....................................
Location of Farm:
Southruas ofrLcLA!/// 2 - a.v SauYh s o� Sit? /�a� RPP�a m� c�S
OF SYI 64
O Swine ❑ Poultry [:]Cattle ❑ Horse Latitude FWD • Longitude 0++
Design Current
Design Current
Design Current
Swine Capacity Population
Poultry
Capacity Population Cattle
Capacity Population
❑•Wean to Feeder
❑ Layer
❑ Dairy
Feeder to Finish
1,660
jrs Q
10 Non -Layer
❑ Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Other
❑ Farrow to Finish
Total Design Capacity
1 6 as
❑ Gilts
Total SSLW
I d /(o ed4
❑ Boars
Number of Lagoons ❑ Subsurrace Drains Present 101,agnonArea. JOSprayFieldAreal
Holding Ponds / Solid Traps ❑ No Liquid Waste Management System
Discharges & Stream Im actti
I. Is any discharge observed from any part of the operation? ❑ Yes (or No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance roan -made? ❑ Yes ❑ No
b. If discharge is ohserved. did it reach Water of the State'? (If yes, notify DWQ) ❑Yes ❑ No
c. If dischar«e is observed. what is the estimated How in gal/ruin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ?No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes V No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes 4 No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ❑ No
Structure I Structure 2 Structure ± Structure 4 Structure 5 Structure G
Idcntificr:..........taS..............................................................................................................................................................................................
Freeboard (inches):
5100 Continued on back

Facility Number:31 — 70,1 Date of Inspection ;s oz Printed on: 7/21/2000
5.
Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑ Yes
WNo
seepage, etc.)
6.
Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
❑ Yes
NNo
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7.
Do any of the structures need maintenance/improvement?
❑ Yes
jj�No
8.
Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
VTNo
9.
Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
No
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes
,WNo
11. Is there evidence of over application? ❑ Excessive Pondtng ❑ PAN ❑ Hydraulic Overload ❑ Yes NNo
12. Crop type &L- 5Vy,&.0
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes gNo
14, a) Does the facility lack adequate acreage for land application? ❑ Yes ❑ No
b) Does the facility need a wettable acre determination? Yes ❑ No
c) This facility is pended for a wettable acre determination? ❑ Yes ❑ No
15.
Does the receiving crop need improvement?
❑ Yes
❑ No
16.
Is there a lack of adequate waste application equipment?
❑ Yes
KNo
Ret aired Records & Documents
17.
Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
No
18,
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
VNo
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
�( No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes J�No
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative'? ❑ Yes No
24. Does facility require a follow-up visit by same agency'? ❑ Yes No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes No
Rio vigl'ati[s;o� dgfllciencies vt�ere ngtet1 d�t�ritig �his.vis. t' . ;Y:oit *ill-teceive iiq furtti&
........ ahi A: this :visit. .:..: :
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):
Ne.-V dcs", sv, f-0
Reviewer/Inspector Name Pjf r DURkGT%
Reviewer/Inspector Signature: I_YA 4444G r" Date: ��1L.1��__ 5/00

Facility' Number: 91 Date of Imspection {a GPI Printed on: 7/21/2000
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or Wow ❑ Yes kNo
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes g<No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes ZNo
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes [s' o
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes t<No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes P<No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ❑ No
'Additional: -omments'an or, Drawings: i
�qf� 5 R Q,bS SR 4$¢b
3
111140
,6
60
�k
5100

State of North Carolina
Department of Environment
and Natural Resources
Division of Water Quality
James B. Hunt, Jr., Governor
Bill Holman, Secretary
Kerr T. Stevens, Director
CERTIFIED MAIL
RETURN RECEIPT REQUESTED
Karen Thomas
Karen Thomas Farm
242 Jackson Store Road
Beulaville, NC 28518
Dear Karen Thomas:
! •
NCDENR
NORTH CAROLINA DEPARTMENT OF
ENVIRONMENT AND NATURAL RESOURCES
December 8, 1999
Subject: Conditional Approval
Animal Waste Management System
Facility Number 31-792
Duplin County
Our records indicate that your facility was conditionally certified in order to fulfill the requirements of
completion of your Certified Animal Waste Management Plan Certification. This letter is to inform you of your
unresolved conditional approval status. Any facility receiving a conditional approval must notify Division of Water
Quality (DWQ) in writing within 15 days after the date that the work needed to resolve the conditional certification
has been completed. Any failure to notify DWQ as required, subjects the owner to an enforcement action. As of
December 7, 1999, we have no record of any information from you, advising us of the status of your conditional
approval. Therefore, please fill out the attached form and have your technical specialist and landowner sign the form
in the appropriate areas.
The completed form must be submitted to this office on or before 45 days of receipt of this letter. Please be
advised that nothing in this letter should be taken as removing from you the responsibility or liability for failure to
provide DWQ with proper notification of your conditional certification status or possible failure to comply with the
requirement to develop and implement a certified animal waste management plan by December 31, 1997.
If you have any questions regarding this letter, please do not hesitate to contact me at [phone]
extension 571.
Sincerely,
,<A*T x av'Z51,J
Sonya L. Avant
Environmental Engineer
cc: Wilmington Regional Office
Duplin County. Soil and Water Conservation District
Facility File
1617 Mail Service Center, Raleigh, North Carolina 27699-1617 'Telephone [phone] Fax [phone]
An Equal Opportunity Affirmative Action Employer 50% recycled/l0% post -consumer paper

State of North Carolina
Department of Environment
and Natural Resources
Division of Water Quality
James B. Hunt, Jr., Governor
Bill Holman, Secretary
Kerr T. Stevens, Director
Karen Thomas
Karen Thomas Farm
242 Jackson Store Road
Beulaville, NC 28518
Dear Karen Thomas:
1 ZF5?F'A •
AIIA
NCDENR
NORTH CAROLINA DEPARTMENT OF
ENVIRONMENT AND NATURAL RESOURCES
December 30, 1999
Subject: Fertilizer Application Recordkeeping
Animal Waste Management System
Facility Number 31-792
Duplin County
This letter is being sent to clarify the recordkeeping requirement for Plant Available Nitrogen (PAN)
application on fields that are part of your Certified Animal Waste Management Plan.
In order to show that the agronomic loading rates for the crops being grown are not being exceeded, you
must keep records of all sources of nitrogen that are being added to these sites. This would include nitrogen
from all types of animal waste as well as municipal and industrial sludges/residuals, and commercial fertilizers.
Beginning January 1, 2000, all nitrogen sources applied to land receiving animal waste are required to
be kept on the appropriate recordkeeping forms (i.e. iRRI, IRR2, DRY], DRY2, DRY3, SLUR1, SLUR2,
SLDI, and SLD2) and maintained in the facility records for review. The Division of Water Quality (DWQ)
compliance inspectors and Division of Soil and Water operation reviewers will review all recordkeeping during
routine inspections. Facilities not documenting all sources of nitrogen application will be subject to an
appropriate enforcement action.
Please be advised that nothing in this letter should be taken as removing from you the responsibility or
liability for failure to comply with any State Rule, State Statute, Local County Ordinance, or permitting
requirement.
If you have any questions regarding this letter, please do not hesitate to contact Ms. Sonya Avant of the
DWQ staff at [phone] ext. 571.
Sincerely,
Kerr T. Stevens, Director
Division of Water Quality
cc: Wilmington Regional Office
Duplin County Soil and Water Conservation District
Facility File
1617 Mail Service Center, Raleigh, North Carolina 27699.1617 'Telephone [phone] Fax [phone]
An Equal Opportunity Affirmative Action Employer 50% recycled/10% post -consumer paper

!; Cj.Division Of Soil and Water�Com ' "' ' tion , -ompl a►teRlnspection €j;�;
�'' i� E E' ; 3 Division of Water, uali Cott;t liaiiee Ins ectl6ri l af s ,'., �`, , ; „ , ; "1 € ill;
Q^, �E " �it�V 11 ' ,q % �i3� ���. � ��' �2 SI Elp
O'OtllerAgency.-Uperzid' RCVIeW '4t
10 Routine O'Complaint 0 Follow-up of DWQ inspection 0 Follow-ruE of DSWC review 0 Other
Facility Number Date of Inspection l l q.C.
Time of Inspectiou ® 24 hr. (hh:mm)
© Permitted XCertified © Conditionally Certified (3 Registered 10 Not Operational 1 Date Last Operated:
Farm Name: .V ,^k.n........ As....... ........ County: n.5.�.n�--.l..k1..........................t-1.1�L...�
Owner Name:..- . �' �............................... Phone No:...... �.....Z3.ig.a... �..............
........ Title: �:?.!\r1 . ..i'�..................... S'A 2� t
Facility Contact: .r.�.....M... �:�....................................... Phone No: ....
Mailing Address:....�,.�.�....�'e��1�S �L�......r�T..�?.�,.� .....�,-�L�.......�3 �.1.1.C1�V..l.I�.L � ...r...�Ll �....
r
Onsite Representative:. r— ................................... Litci;rator: „QLg �....
.................................
Certified Operator:..),r-C
.;.Y.............t°��1,tn..h.�3..4..�,C ................ Operator Certiticatian Nmnber....t...�}.2............
Location of Farm:
t...(........Q 4..Y...k..k..S.......i...Y..i..... Q .... 5.....1•.. .. ........t......k...... 4'
l� .�,......� .Y..4ta....k. ........................................ .................... ....... ............... .......... !
Latitude Longitude ©r FA ®«
Design Current
Swine : ;- Canacitv Population
f
1
Number of Lagoons .
Holdtng'Ponds / Solid Traps
❑ Wean to Feeder
I~eeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Design ' Current Design Current
Poultry Capacity. Population .: Cattle ' Capacity Population '
El Layer ❑ Dairyi'j'
❑ Non -Layer d ❑ Non -Dairy '+I'
❑ Other
Total Design 'Capacity
Total SSL W
_j s
' ' '❑ x' Subsurface Drains Present ❑ Lagoon Area ❑ Spray Field Area
❑ No Liquid Waste Management System
Discharges & Stream Impacts
I. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made'?
b. If discharge is observed, did it reach Water of the State'? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/tnin'?
d. Does discharge bypass a lagoon system'? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? 0 Spillway
El Yes N'No
El Yes Wo
❑ Yes qNo
❑ Y s �WNo
El Yes �No
❑ Yes �o
El Yes 1KNo
Structure I Structure 2 Slructure 3 Structure 4 Structure S Structure 6
Identifier:
Freeboard(inches): ......:3. Z..� ............................................................................................................................. I.......................... ...................................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes J 'No
seepage, etc.)
3/23/99 Continued on back

Facility Number: — Date of Inspection q
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan'? ❑ Yes gNo
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any ol'the structures need maintenance/improvement?
❑ Yes
o
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
TNO
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
ONO
\
Waste Application
10, Are there any buffers that need maintenance/improvement?
❑ Yes
N�No
If. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN
❑ Yes
KNo
12. Crop type 5-_�f .rD---%AA ( 1 f n\j T'y" h
_
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
o
14. a) Does the facility lack adequate acreage for land application?
El Yesa
jNo
b) Does the facility need a wettable acre determination?
El Yes
c) This facility is pended for a wettable acre determination?
❑ Yes
KNO
15. Does the receiving crop need improvement?
❑ Yes
5'No
16. Is there a lack of adequate waste application equipment?
❑ Yes
X�No
Required Records & Documents
17.
Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
R110
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
RNo
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
ONo
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
No
21.
Did the facility rail to have a actively certified operator in charge?
❑ Yes
o
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ic/ discharge, freeboard problems, over application)
❑ Yes
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
RNo
24.
Does facility require a follow-up visit by same agency?
❑ Yes
ul�o
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
N'
•viola(i0ijs:ot- '!skier 6 ' 4 ' ' 'noted-ditritig 4:his:visit:- ;Y;oit will tee0iye do fuftht e
6 res�orideuce. about thisyiset_ ... .
Comments {refer to question #): Explain any. YES answers and/or any. recommendations otr any oth'ePtominents j
Use drawings of facility to'better.ex lain situations use addrtionai a es as necessa ' V.
7= l '
S t?' P p.g r3)•
f.
" —�,� ",T"' s-!mi"ai"t4 € •{' •"' _ t �77fj Ik r i "Sf
Reviewer/Inspector Name t I3� ���-r tF• 3 a i ,
-��`}t�:Y.� — �. Sv�i E5 ._•t 1r4� .1� =
Reviewer/Inspector Signature �'�� l(� , A _Q A � � � �, Date: L L , _ R �y
3/23/99

Paci4ity 1Vumber: --Z Date of inspection
Oder Issues
26, 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?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes ` rNo
28.
Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
• ❑ Yes
�o
roads, building structure, and/or public property)
29,
Is the land application spray system intake not Incited near the liquid surface of the lagoon?
❑ Yes
KN 0
30,
Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
❑ Yes
VNo
31,
Do the animals feed storage bins fail to have appropriate cover?
❑ Yes
J;�No
32.
Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ''lam %
❑ Yes
❑ No
Additional Comments And/or Drawings;
C5C 'T' t'uT
3/23/99

❑ DSNN, C Animal Feedlot Operation Review
DWQ Animal Feedlot Operation Site Inspection
O 10utinc C(im ]dint O Follow•-u of DNN ins t.•ction O Follow-u of DSWC review O Other
Date of Inspection L lLL)1_'-z
Facility Number 3 ?S
Time of Inspection 11-:4&i 24hr. (hh:mm)
0 Registered M Certified 0 Applied for Permit 13 Permitted 113 Not Operational I Date Last Operated:
Farm Name: .....AarrA&....-J�L.rp...................... _... Count`:..... .. .................._......._...... c1.........,....
Owner Name: Phone No:
___...1!._...... eL........ _ ... _ . OC..d� .� :....�._.....Y...................................
Facility Contact: .............................................................................. Title. ....... Phc►ne Igo:
Mailing, Address: .--....2q.a, ...�ik4�-.TM........................................... ........ �Au�l..#_..... ...... .......... ..... .........
OiK,ite Representative: ........... . . . . .. ,e...... ln"ZAS......................... ........ ........ .............
__ Operator Certification Number; _........,,__ ....
Certified Operator:._...:. ... ..... _ .. _...._ .........._..... p
Location of Farm:
Latitude • 1 44 Longitude • 4 61
:Design Current : Design Current '_:Z:Des.R
:Capacity.. Population Poultry Gapai ity :Population ; Cattle ":;Cape
❑ Wean to Feeder
Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Number or LagoonsJHoldtng Ponds : ❑ Subsurface Drains Present ❑ Lagoon Area 10 Spray Field Area Hw
... No Liquid Waste,hbna�!ement Svstem ,
General
+ I. Are there any buffers that need maintenance/improvement? ❑ Yes to No
2. Is any discharge observed from any part of the operation? ❑Yes j No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes No
b. If dischargm is observed, dies it reach Surface Water? (If yes. notity DWQ) ❑ Yes No
c. If discharge is observed, what is the estimated flow in cal/min? hi)p
d. Dees dischare.ge bypass a lagoon system? (If yes, notify DWQ I ❑Yes q No
3. Is there evidence of past discharge from any pan of the operation? ❑ Yes to No
4. Were there any adverse impacts to the waters of the State other than from a discharge? ❑ Yes . [P No
5. Does any pan of the waste management system (other than lagoons/holding ponds) require ❑ Yes �Q No
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes No
7. Did the facility fail to have a certified operator in responsible charge? ❑ Yes No
7/25/97 Continued on back

Facility Number:
8. Are there lagoans or storage ponds on site which need to be properly closed? ❑ )'es [A No
Structures_(La; oans,Holding Ponds, FluSh Piss. etc.l
9. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes 1XNo
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure G
Identifier.
Freeboard(ft): ..._ �_ �t — ._— ................. » ....._.....__......_...._........................................ .... .......... .... _.............. ... _.._ .... ...... ....
10. Is seepage observed from any of the structures? ❑ Yes No
11. 1s erosion, or any other threats to the integrity of any of the structures observed? ❑Yes No
12. Do any of the structures need maintenance/improvement? Yes ❑ No
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13.`Do any of the structures lack adequate minimum or maximum liquid level markers? ❑ Yes No
W'a.rde Application
14. is there physical evidence of over application? ❑ Yes (gj No
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type _....... ...tt .bwdfe........... —.. .1.1 t�............ ......%ULtT.............. `tt7l;aGt. L.........................................................................
15. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)? Yes ❑ No
17. Does the facility have a-lackof adequate acreage for land application? ❑ Yes 5INo
18. Does the receiving crop need improvement? Yes ❑ No
19. Is there a lack of available waste application equipment? ❑ Yes Q No
20. Does facility require a follow-up visit by same agency? ❑ Yes 9No
21. Did Reviewer/Inspector fail to discuss reviewFrnspection with on -site representative? ❑ Yes 10 No
22. Does'record keeping need improvement? Yes ❑ No
For Certified or Permitted Facilities Only
23. Does the facility fail 'to have a copy of the Animal Waste Management Platt readily available? ❑ Yes 71No
24. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes Ej No
ie 25. Were any additional problems noted which cause noncompliance of the Permit? ❑ Yes [A No
No.violations or def►ciencies.were-noted during this:visit You:vxill receive no ftirttier
correspbndence about this'. Ask,'. : ,
lZ Cor,•hr+uKve)(e �ow� c.ree.3 oh d �c.� rwt, li.y
16. wuU CS �e?� r stc,
urrl,. crop��w, Gy��C w� 1 f be ac� c �t� by W Uri.
i$. $ermt:ao� 5�oul cJ iDe cam+ . �,r + h 1aL.C�t_ f c(ck. ve (ue
(&0 on s;�t tt� �� �� i �rpcc�a� .. 1 RQ-� rpr!►�j s6J� be L104cj,
skims Shoo 6e Mto w� IrrVt ah� I)tS h S4CA. t1 �, w� {. „_ ;
rCt �Yt'ic an SyS�Cw was -�" inskhiVd , 1(th, h�o+ j8- V�cr' kaSv �h oo't t�i 125197
Reviewer/Inspector Name
Reviewer/Inspector Signature:
> cagy o 4,_ U) O 4 iiv%S• es`5h .3
.- Date: