660041_PERMIT FILE_20171231

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
December 13, 2000
CERTIFIED MAIL — -
RETURN RECEIPT REQUESTED
James Duncan Bridgers
Old Place
Rt 2 Box 324
Conway NC 27820
Farm Number: 66 - 41
Dear James Duncan Bridgers:
jir4i
f
NCDENR
NORTH CAROLINA DEPARTMENT OF
ENVIRONMENT AND NATURAL RESOURCES - -
You are hereby notified that Old Place, in accordance with G.S. 143-215.1OC, must apply for coverage under an
Animal Waste Operation General Permit. Upon receipt of this letter, your farm has sixty-(60) days to submit the attached
application and all supporting documentation. In accordance with Chapter 626 of 1995 Session Laws (Regular Session
1996), Section 19(c)(2), any owner or operator who fails to submit an application by the date specified by the
Department SHALL NOT OPERATE the animal waste system after the specified date. Your application must be
returned within sixty (60) days of receipt of this letter. Failure to submit the application as required may also subject your
facility to a civil penalty and other enforcement actions for each day the facility is operated following the due date of the
application.
The attached application has been partially completed using information listed in your Animal Waste Management
Plan Certification Form. If any of the general or operation information listed is incorrect please make corrections as noted on
the application before returning the application package. The signed original application, one copy of the signed application,
two copies of a general location map, and two copies of the Certified Animal Waste Management Plan must be returned to
complete the application package. The completed package should be sent to the following address:
North Carolina Division of Water Quality
Water Quality Section
Non -Discharge Permitting Unit
1617Mail Service Center
Raleigh, NC 27699-1617
If you have any questions concerning this letter, please call Theresa Nartea at [phone] extension 375 or John
Hunt with the Raleigh Regional Office at [phone],
Sir 6rely,
for Kerr T. Stevens
cc: Permit File (w/o encl.)
Raleigh Regional Office (w/o encl.)
1617 Mail Service Center, Raleigh, NC 27699-1617 Telephone [phone] FAX [phone]
An Equal Opportunity Affirmative Action Employer 50% recycled/ 10% 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
James Duncan Bridgers
Old Place
Rt 2 Box 324
Conway NC 27820
Dear James Duncan Bridgers:
ZF1.1WA .
NCDENR
NORTH CAROLINA DEPARTMENT OF---'
ENVIRONMENT AND NATURAL-RESOUWC.ES
December 30, 1999
Subject: Fertilizer Application Recordkeeping
Animal Waste Management System
Facility Number'6� 641
,Northampton 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. IRR1, IRR2, DRY1, DRY2, DRY3, SLUR], SLUR2,
SLD1, 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,
4 9.".. �. X
Kerr T. Stevens, Director
Division of Water Quality
cc: Raleigh Regional Office
Northampton 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

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To: Busier Tavwell
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Re: Due Rose #4
From: Laura Gregory
Pages; 7 including cover
Date: 4/17103
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9

t1r16S1l
(Type of Visit: Ql�?=ufince'
Inspection Q Operation Review O Structure Evaluation O Technical Assistance I
Reason for Visit: 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other "O'Denied Access
Date of Visit: - ". `-.1-` Arrival Time: /� )�� Departure Time: _County: Region:
Farm Name: P �fJ. f e Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Phone:
Facility Contact: Title: Phone:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Integrator:
Certification Number:
Certification Number:
Latitude: Longitude:
Design Current
Swine C►apacityWet
Wean to Finish
Design Current Design Current
Poultry C*apacity Fop. Cattle Capacity Pap.
Layer Dairy Cow
Wean to Feeder
Feeder to Finish
Farrow to Wean
Non -La er
I
Dairy Calf
Design Current
Dr, P.oultr. Ca acit P.o
Layers
Dai Heifer
Dry Cow
Farrow to Feeder
Farrow to Finish
Gilts
Non -Dairy
Beef Stocker
Non -Layers
Pullets
Beef Feeder
Boars
Beef Brood Cow
Other
Other
Turkeys
Turkey Poults
Other
0 1
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)
❑ Yes 6 No ❑ NA 0 NE
❑ Yes NA ❑ NE
❑ Yes No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)? ef
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes rNoO
NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes NA ❑ NE
of the State other than from a discharge?
21412011 Continued
Page 1 of 3

Facility Number: jDate of Inspection:
Waste Collection & Treatment
N
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes❑
VNo NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): {
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No ❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
[:]Yes
EJ'No ❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental rent, notify DWQ
7. Do any of the structures need maintenance or improvement'? ❑ Yes ❑ 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 ffNo ❑ 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): f' �'h'I�i. L�. S/h qr fi r •'r S
U. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[allo ❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[] NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
VNo❑ 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
VNA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage &Permit readily available?
❑YesTN,0
0 ❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
[:]Yes
❑ NA
❑ NE
the appropriate box.
❑WUP El Checklists ❑Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below..": ❑ Yes 16 No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

V
F'acilit Number: jDate of Inspection: / l
24. Did the facility fail to calibrate waste application equipment as required by the permit`? ❑ Yes No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [] Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge'? ❑ Yes E3No NA ❑ NE
27. Did the facility fail to secure a phosphorus foss assessments (PLAT) certification? ❑ Yes No A ❑ 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?
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 ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
DNA ❑NE
❑NA ❑NE
❑ NA ❑ NE
Comments (refer toquestion # : Ex laiin an ;YES answers ,andlor an additional r&om 0hdati6nJs,6r'afiy,6ther comments
Use drawings of facility to better explain situations (use additional pages as necessary).
S'GZ r—r 4P_ i
L/
r
Reviewer/[nspector Name:
Reviewer/Inspector Signature:
Phone: 7 /- 41Zo U
Date: I Z!1 I I I
21412011
Page 3 of 3

ia(I( ia._.
Type of Visit 6 Co ante Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Routine O Complaint O Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of visit: �j 7�f i c] Arrival Time: 00a I Departure Time: County: Region:
Farm Name: [ �� pd-o e Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: 7 Ly
Certified Operator: M 1)
Back-up Operator:
Location of Farm:
Title:
Phone:
Phone No:
Integrator: hin i S
Operator Certification Number:
Back-up Certification Number:
Latitude: c = ` Longitude:
m
IWO Design
Swine Capacity
Current
population
Design Current
Wet Poultry Capacity Population
Design Current
Cattle Capacity Population
❑ Wean to Finish
❑ La er
El Dairy Cow
❑ Wean to Feeder
on -Layer
El Daia Calf
❑ Feeder to Finish
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ D Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
❑ La ers
❑ Beef Stocker
❑ Oilts
❑Non -La ers
❑Beef Feeder
❑ Boars
❑ Pullets
❑ Beef Brood Co
❑ Turkeys
Other
❑ Other
❑ 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
�Co❑ 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
❑ NA
El NE
2. Is there evidence of a past discharge from any part of the operation?
El
ElNA
FNo
El NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
El Yes❑
NA
❑ NE
other than from a discharge?
Page I of 3
12128104 Continued

Facility Number: ETTI
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
❑ Yes ❑ NA ElNE
❑ Yes No ❑ NA ❑ NE
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 FfNSq ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental thr , 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 2No ❑ 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 FINE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No -NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) �`J I I
13. Soil type(s) /
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ Yes
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
17. Does the facility lack adequate acreage for land application? ❑ Yes
18. Is there a lack of properly operating waste application equipment? ❑ Yes
O N ❑NA
❑ NE
V1 N [I NA
[I NE
'[3 NA
El NE
IL.! o I[] NA
❑ N E
No ❑ NA
❑ NE
Comments (refer toquestion'#): Explain any Y;ES answers and/or any reco.mmendatlon.s yr any other comments.
Use drawl gs-of fheility to better explain situations: {user add bona! pages as necessary,):
Reviewer/Inspector Name; Phone:��}
Reviewer/Inspector Signature: fzlf A924 4 Date: Z
Page 2 of 3 I1/101W Lonfinued

Facility Number: Date of Inspection 11112511101
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes �No[O:INA
NA El NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps ❑Other
21. Does record keeping need improvement? If es check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
p g p Y
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspectionss El Weather Code
22. Did the facility fail to install and maintain a rain gauge? El Yes :�o
NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? El Yes NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss,assessment (PLAT) certification?
Other Issues
❑ Yes
��o ❑ NA
El NE
[:]Yes
;;N ❑ NA
❑ NE
❑ Yes
No NA
❑ NE
❑ Yes
No ❑ NA
❑ NE
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
3 L 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 El No El NA El NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Page 3 of 3 12128104

'd oaaernC,'EpIdWateriC,lliElcEe v ft, [3�mD:vsinfS Wav"6 OerationRevew.
f S4il
iCraaCd!'vsnn of Wt,
Quality �Caimphancc Inspec4or�E 3 `I sOiler Agency - Opa
i
$j
Hq
lD�utine Q Complaint 0 Follow-up of DWQ ins ection Q Fallow-ci of DSWC review Q Other
Facility Number Date of Inspection
Time of Inspection E= 24 hr. (hh:mm)
© Permitted © Certified [3 Conditionally Certified 13 Registered Not O crational Date Last Operated:
11 p
Farm N. J. tQaf;.t/(vt..4...... n f�-�. ..... County: „W�fh�....................................
.................
Owner Name:......a.�..L. "�`.`.....k?..�...�-r Phone No
•........................................................................
Facility Contact: .. . `...I....................................................Title: Phone No:
7
Mailing Address: ...........!. yt...... 3....`.-r......... ./1//..................1.7.................. ..........................
t..
Onsite Representative: 5�...t.. e
...... Integrator:............................................................
-s..................................... j S
Certified Operator:........ 13; C........................ Operator Certification Number
.ocation of Farm:
........................................................................................................................................................................................................................................................ ......... y
............................................................................... ......................... .......... ...... ................................................................ .
Latitude ' f i Longitude • ' 4'
Design Current " R
Capacity Population'
Design CurrentE Design Current
Capacity,. Po' ulatior Cattle Capacity Po `ulation .
[3)y,rt6to Feeder ❑ Layer ILI Dairy
Er
Feeder to Finish ❑Nou-Layer ❑Non -Dairy
za
❑ Farrow to Wean
,�' ❑ Farrow to Feeder ❑Other
❑ Farrow to Finish
Total Design Capacity
[]Gilts,
-• 11�� j I � I ' � t t I it
❑Boars , i E �,tE;iE ra ;Total SSL' W'
IPluinber of Lagoons ; ❑ Subsurface Drains Present ❑ Lagoon Area ❑ Spray Field Area
Holding.Ponds / SolidiTra s ❑ No Liquid Waste Management System E , _
., iE
Discharges & Stream Impacts
1. 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.'?
h. If dischargc is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in galhnin?
d. Dues discharge bypass a lagoon system? (If ycs, 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? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
[:]Yes No
❑ Yes o
❑ Yes o
❑ Yes LkKo
❑ Yes o
❑ Yes o
❑ Yes o
Structure 6
Identifier:
Freeboard (inches): ........... ...b.............................................. ................................
5. Are there any immediate threats to the integrity of any of the structures observed? (iel trees, severe erosion, ❑ Yes No
seepage, etc.)
3/23/99 Continued on back

Facility Number: — Date of Inspection
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes 121 o
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN
12. Crop type �„� ` J g " 12y Ar--
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23..Did Reviewer/Inspe�tor fail to discuss review/inspection with on -site representative?
24. Does facilityfeq"uire a follow-up visit by same agency?
25, We�(ty additional problems noted which cause noncompliance of the Certified AWMP?
. To yiolatiQris or dg#iciencfes 4....r.e pgtea• dt;�•rhig •this: visit' • Y04 :will•teoeiye iio: further, • . .
:.correspondence: about this visit.. • :.... • ....: I I ................::...
:: ;
Comments {i
Use drawing':
Reviewer/Inspector Name
❑ Yes.0
❑ Yes o
❑ Yes o
❑ Yes Z
ElYes EZNo
❑ Yes No
❑ Yes o
❑ Yes o
❑ Yes o
❑ Yes o
❑ Yes o
❑ Yes No
❑ Yes No
❑ Yes o
❑ Yes
❑ Yes No
❑ Yes N
❑ Yes N
❑ Yes No
❑ Yes ❑
I&
Reviewer/Inspector Signature:
Date:
3/23/99

Facility Number• Date of Inspection
Odor Issues
26.
Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge actor 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
6No
28.
Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
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
30.
Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
io
or broken fan blade(s), inoperable shutters, etc.)
❑ Yes
31.
Do the animals feed storage bins fail to have appropriate cover?
El Yes
32.
Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes
/ No
Addona omnnents an of rawings :.. . e x i; Y i,rah 't- ...�i}k �i,' '' lad, #. °' ,ai «,1 ]' G °
!tt1<':3
A.
3/23/99

..aT
IDtvts ion of Soil and Wafer Conser� horn, 'Operation Review{'"_t'
11,g
',DEytstoii Water Cotn
F
of Sotl and Conservation fiance Inspectton> { >>,
�W[P-.w1 .:G ;w 3
(]:Drvls�on of Water Quaiu37, Compliance InspecfYon�
? .; •
- OtlierA ei�c w `"l? erattor� Revtew���...'w). :;-:.��`�; s,�;,;°''
D...c ..._,g y._ p.....,. �. A
Routine 0 Complaint 0 Follow-up of DWQ inspection 0 Follow -tip of DSWC review 0 Other
Facility Number Date of Inspection
Tinto of Inspection 24 hr. (hh:mm)
13 Permitted © Certified Q Conditionally Certified © Registered 113 Not O erational Date Last Operated:
FarmName: .............................................................................................. ................... County:.............................:.......................................................
OwnerName: ................................................... .................................................................. Phone No:.....
FacilityContact.................................................................:............. Title:................................................................ Phone No: ...................................................
MailingAddress: ............................................................................. . ...................................... ...................... .......................n....................................I.. .... I.....................
Onsite Representative:... (!' ?r ....... . Itztcfrator: l"(�hL..............Q.. .....1/.. .........
Certified Operator;,,,,,,,,,,,,,, .... Operator Certification Number....,.,,.....,.....
Location of Farm:
�i
....................................................... .... ........................ ..................... .......... .
Latitude o 4 •6 Longitude • ° 6
Design Current Design Current Design: r, Current
Swine Capacity Population -Poultry Capacity Population Cattle <'Ca aci Poliulation
❑ Wean to Feeder JC3 Layer ❑ Dairy
eeder to Finish ❑ Non -Layer ❑ Non -Dairy
❑ arrow to Wean
ElFarrow to Feeder ❑ Other
[]Furrow to Finish Total Design Capacity--
❑ Gilts
❑ Boars Total SSLW
Number of Lagoons :- ❑ Subsurface Drains Present ❑ Lagoon Area I0 Spray Field Area
-'UPI f;Y fjCI
Holding Ponds / Solid,Trapsi; ❑ No Liquid Waste Management System A`40.
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation'? ❑ Yes dNo
Discharge originated aL []Lagoon ❑ Spray Field ❑ Other f
a. If discharge is observed, was the conveyance man-made'? �❑ Yes No
b. If discharge is observed, did it reach Water of the Slate? (If yes, notify DWQ) C Yes i�io
c. 1f 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
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes'. No
Structure I Structure ? Structure 3 Sh'ucture 4 Structure 5 Structure 6
Identifier: ''�� '
Freeboard(inches): ..--. �, _d............................................................................................................................................................... ...................................
5. Are there any immediate threais to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes/ ❑ No
seepage, etc.) YYYY
3/23/99 Continued on back

i I
:06cility Number: — Date of Inspection
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
iNo
closure plan?
❑ Yes
(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
eNo
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
{yYes
❑ No
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
No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN
❑ Yes No
12. Crop type LQ 65 T- rl-(—_... tC
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?
ElYe
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
�N0
16. Is there a lack of adequate waste application equipment?
❑ Yes
No
Re uired Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
,ZNo
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
ff No
19. Does record keeping �j lnpro �ntl(i� i tion, freebo waste anal i soil sample reports)
w1 HtL,T CE-I&
❑ Yes
�VNO
�N
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
17 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
o
J
fq yI I qs'o� dtrft< ngpe -Wgrp Xiotgo. d>irrthg this'visit; - ;Y;oji w06 fuith f .
COrrespondence: abi this visit. ................................. .
h�15 CUc'a a ver Mass
�p
iReviewer/Inspector Name gllf to i w 1 y -- « �Y � l` _ai �." M, rL r HW is w=
Reviewer/Inspector$ignature:ZV,&�Date:
3/23/99

f i'Facility Number: — G� Date of Inspection
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge atlor 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 . �No
28, Is there any evidence of wind drift during land application? (Le. residue on neighboring vegetation, asphalt, ❑ Yes 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 No
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 �No
31. Do the animals feed storage bins fail to have appropriate cover? ElYes No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes �IVo
0
3/23/99

SWC Animal Feedlot Operation Review
y DWQ Animal Feedlot Operation Site Inspection s
3 .ss._i
Routine O Complaint O Follow-up of 1AVQ inspection OFollow-up of I)SNVC review O Other
Date of inspection' 3
Facility Number
Time of Inspection 24 hr. (hh:mm)
Total Titne (in fraction of (lours
Farm Status: [3 Registered ❑ Applied for Permit (ex,1.2-1; for I hr 15 rnin)) Spent on Review 0
[] Certified ❑ Permitted or Inspection (includes travel and processing)
NotOperational Date Last Operated....................................................................................................................................................
Farm Name:...tr.�?` .............�'.'l.�r.................................................................... Cuunt)" .... //ri,l✓..,.........,........,.
OwnerName: ................................................... ....................................,,........,...... ......... Phone No .................
Facility Contact: ..............
....................................1,,......,1................. I illt::.....................................................,.......... Phone No: ...................................................
�4ailing: (!(lie l:.......................................................................... .................................. ......... ..................................................................................... ..........................
Onsite Representative:.... l.M/??..y............/�LI,I�G C�Z. ............... Integrator*....., �.��' S ......................................
Certified Operator: .................................................. .............................................................. Operator Certification Number...............
Location of Farm:
Latitude Longitude
Type of Operation Design Current Design : Current Design Current
Swale Capacity `Population °Poultry , Capacity Population Cattle Capacity, Population '.
❑ Wean to Feeder
Feeder to Finish
(JQ
Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Other
Number o-
of Lagoons /'Holding Ponds ❑Subsurface Urains Present ❑ Lagoon r\re ❑ Spray Field Area
General
1. Are there any buffers that need maintenance/improvement? ❑ Yes ;No
2. Is any discharge observed front any part of the operation? ❑ Yes No
Dischar-e ori_inated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. [i discharge is observed, was the conveyance man-made? ❑ Yes No
b. If discharge is observed, (lid it reach Surface Water'? (If yes, notify DWQ) ❑ Yes VNo
c. if discharge is observed, what is the estimated flow in eal/min"
d. Dues discharge byl�uss a lagoon system'? (I f yes, notify I7WCi) ❑ Yes O'No
3, Is there evidence of past discharge from any part of the operation? ❑ Yes ?�INo
4. Were there any adverse impacts to the waters of the State other than from a discharge'? ❑ Yes No
5. Does any part of the waste managenient system (other than lagoons/holding ponds) require Cl Yes No
maintenance/improvement'.>
413 t 1197
Cnntirrtied on back

I
Facility Number: —
8. Are there lagoons or storage ponds on site which need to be properly closed'?
❑ Yes (dNo
Structures (Lagoons.11oldine Ponds, Flush Pits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure 1 Structure 2 Structure 3
Identifier:
....r..�.................................................................................
Freeboard(ft):.... ..05....A...... i....................................... ..........................
10. Is seepage observed from any of the structures?
Structure 4 Structure 5
........................................................................ ...
11. Is erosion, or any other threats to the integrity of any of the structures observed?
12. Do any of the structures need maintenance/improvement?
(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?
Waste Application
14. Is there physical evidence of over application?
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
❑ Yes No
Structure 6
.......................................................................
❑ Yes [4 No
❑ Yes dNo
15. Crop type%.. it............................................................................................................................................................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21, Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
22. Does record keeping need improvement?
For Certified or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
25. Were any additional problems noted which cause noncompliance of the Permit?
0 No.violations or deficiencies.werenoted-during this.visit::You;will ire'ceive no further-
correspondence about this visit.
9/- El No
❑ Yes �j No
El Yes i[I No
...............................
❑ Yes X,No
❑ Yes �No
❑ Yes ,fNo
❑ Yes ANo
❑ Yes gfNo
❑ Yes j No
❑ Yes �o
❑ Yes No
❑ Yes No
❑ Yes Po
!,� ltx-rx'r CL.i r T?
Z GL�
f � R�.c� � iti ��E���ro�
t J-1�'�T �Q�,�i✓ r3e.�#r5 i195L!-`A. � � � `� 1 �� (— j .G-• C s�� �iL � c � � r! d}�'7 G (ri1 �J ��'S
7/25/97
Reviewer/Inspector Name
Reviewer/Inspector Signature:K�G Date: 3

State of North Carolina
Department of Environment,
Health and Natural Resources •
Raleigh Regional Office
James B. Hunt, Jr., Governor
Wayne McDevitt, Secretary IDEEHNF;Z
DIVISION OF WATER QUALITY
August 29, 1997
Mr .James D. Bridgers
Old Place Swine Farm.
Route 2, Box 324
Conway, North Carolina 27820
Subject: Compliance Evaluation Inspection
Facility # 66-41
Old Place Swine Fm7rr
Northampton County
Dear Mr. Bridgers:
On August 21, 1997, Mr. Buster Towell from the Raleigh Regional Office conducted a compliance inspection of the subject
animal facility. This inspection is part of the Division's of%rtS to determine compliance with the State's animal waste
nondischarge rules.
The inspection determined that your animal operation was not discharging Nvastcwpter into waters of the State and that the
waste lagoon had the required amount of freeboard. As a result of the inspection the facility was found to be in compliance
with the State's animal nondischarge regulations.
This office would also like to take this oppoitunity to remind you that you are required to have an approved animal waste
management Ipaa r by DecLinbci- 31, 1997. This plan must be Certified by a designated technical specialist or a professional
engineer. For a listing of certified technical specialists or assistance with your waste management plan you should contact
your local Soil and Water Conservation District office.
The Raleigh Regional Office appreciates your cooperation in this matter. If you have any questions regarding this inspection
please call Mr. Buster Towel] at [phone].
Sincerely,
9�,� ��
,lu y Garrett
Water Quality Section Supervisor
cc: Northampton County Health Department
Mr. Tony Short, Northampton Soil and Water Conservation District
Ms. Margaret O'Keefe, DSWC---I R0
DWQ Compliance Croup
RRO Files
38M Barrett Drive, Suite 101, f• Nto
FAX [phone]
Raleigh, North Carolina 27609 Cr C An Equal Opportunity Affirmative Action Employer
Voice 919-571-4700 50°k recycied/l(r/. post -consumer paper

Facility Number Date of Inspection
Time aInspection rj 24 hr. (hh:mm)
Total Tirne (in fraclion o#•hours
Farm Status: Registered ❑ Applied for Permit (ex: I.2S for l hr 15 min)) Spent on review . -7
Q Cer Tied ❑ Permitted or Inspection (includes travel and processing;)
Not O eratianal Date Last O }erated• jq �-3~
Farm Name:1^.. ... Gl✓.. �.n �. �.��''� County: �,r1.!....''.? .................................
{
OwnerNanrc:..t:.l. 'S.4r, ...,... ........... P. !. (--j ........................ eZ..:. .................. Phone No:......................................................................................
Facility Contact: . ..�` , 4—,y........j6r.!..c ..tr5,....... Tii�tlle: Phone No
i19atltnh A(#(#rcSti:..... ...2.......,.,. ... .. .zC%...........L.Q`k�''S4 ........ /.! �r L�....�;.� ............................... ..........................
Onsite Representative. ,P,,,! 4.8.................................................... Integrator:....... '1 O,�C..S........ ..................... ...............
Certified Operator-.... j............. m.7..G .. p � .`.. nY.'.................................................... Operator Certification Number:..................., .......,.
Location of farm: T j 0
.............. ... .................. ................... .............................. .............. .......................
Latitude • 6 « Longitude • 4 "
Type of Operation .. Design Current' '• Design Current
Swine. Capacity Population Poultry "" Capacity Population Cottle C
❑ Wean to Feeder
Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Other
❑ Layer I I Dairy
❑ Non -Layer ❑Non -Dairy
Total Design Capacity
Totai SSLW
Current
,v Population
1» ... .. .., AField Area
Number at'; a a s / Holdtn Ponds ' �
❑ Subsurface Drains Present l.a oon rea ❑Spray ❑
General
1. Are there any buffers that need maintenance/improvement?
2. 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, slid it reach Surface Water? (If yes, notify DWQ)
c. It dischafa-le is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system'? (If yes, notify DWQ)
3. Is there evidence of past discharge from any part of the operation?
4, Were there any adverse impacts to the waters of the State other than from a discharge?
S. Does any part of the waste management system (other than lagoons/holding ponds) require
maintenance/improvement?
4/30/97
❑ Yes No
El Yes No
ClYes o
❑ Yes No
❑ Yes N
❑ Yes
❑ Yes 7N9
ElYes No
Conlin ued on back

�L
Facility Number: —
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
7. Did the facility fail to have a certified operator in responsible charge?
8. Are there lagoons or storage ponds on site which need to be properly closed'?
❑ Yes lid 0
❑ Yes 2
❑ Yes 2'No
Structures (Lagoons and/or Holding fonds,)
9. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes C '
Freeboard (ft): Structure 1 Structure 2 Structure 3 Structure 4 Structure i Structure 6
............�...1. ....................................................................................................................................................................................11........ .....
10. is seepage observed from any of the structures? ❑ Yes No
11. Is 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 ;
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify D"'Q)
13. Do any of the structures lack adequate minimum or maximum liquid level markers'?
Waste Application
14. Is there physical evidence of over application?
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type !.�...,,..h..S.........
16. Do the receiving crops differ with those designated irk the Anim Waste Management Plan (AWMP)?
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewerllnspector fail to discuss review/inspection with on -site representative?
For Certified Facilities Only
22. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
23. Were any additional problems noted which cause noncompliance of the Certified AWMP?
es ❑ No
❑ Yes o
................................................
❑ Yes
❑ No
❑ Yes
❑ Yes
❑'1Vo
❑ Yes
❑ Yes
No
No r
❑ Yes
No
❑ Yes �. i`T "
❑ Yes �, T
24. Does record keeping need improvement? ❑ Yes r.� No
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Date:
cc: Division of Water Quality, Water Quality Section, Facility Assessment Unit 4/30/97

1
DSWC Animal Feedlot Operation Review
DWQ Animal Feedlot Operation Site Inspection
Routine O Com laint O Foil ow -up of DW Q inspection Q F olfow-u of DS`vC review Q Other
Date of Inspection
Facility Number
Titne ot'Inspection r Cf ZP24 hr. (hh:mm)
ToUl Time fin fraction of hours
Farm Status: C] Registered ❑ Applied for Permit (ex: 1.25 for 1 hr 15 min)) Spent on Review
12rCertifted ❑ Permitted or Inspection (includes travel and processing)
113 Not O erational Date Last Operated: ............................................................ ;...— .......... I .......................................... .......................
FarmName:.' ..f-, ..... :....... County: .............................................................. .......................
OwnerName: ................................................... ........................................................................ Phone No:..............,......,.................,.......,.......................................
FacilityContact:.............................................................................. Title.:..........,. Phone No: ...................................................
MailingAddress: ..........,.....,.,....................................................... .......
Onsite Representative ..........................................+........,...........................................,................... ..,.......,,.........,....
Integrator: ......................................................................
Certified Operator:................................................................................................................ Operator Certification \lumber:...............
Location of harm:
Latitucfe_ • ` '` Longitude. r��0 ` �u
Getleral
1. Are there any buffers that need maintenance/improvement? ❑ Yes. No
2. Is any discharge observed from any part of the operation? ❑ Yes No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. if dischar�,e is observed, was the conveyance than -made? ❑ Yes x J No
b. It'discharge is observed, did it reach Surface Water? (if yes, notify DWVQ) ❑ Yes Zj No
c. If dischar�,e is observed, what is the eStitllatell flow to gailnitn?
d. Does discharge bypass a lag*oon. system? (1f yes, notify DWQ)
❑ Yes No
3. is there evidence of past discharge froth any part of the operation? ❑Yes No
4. Were there any adverse impacts to the waters of the State other than from a discharge? ❑ Yes No
5. Does any part of the waste management system (other than lagoons/holding ponds) require ❑ Yes No
maintenanMimprovement?
4/i(}197
Continued on back

Facility Number:
6. Is facility not in complian e with any applicable setback criteria in effect at the time of design?
7. Did the facility fail to have a certified operator in responsible charge?
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (Lagoons and/or1loldin Ponds)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Freeboard (ft): Struct4re l Structure 2 Structure 3 Structure 4
❑ Yes No
❑ Yes No
❑ Yes l._yNo
❑ Yes 0No
Structure j Structure 6
10. Is seepage observed from any of the structures? ❑ Yes Vj No
11.
Is 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'?
9,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
/2j No
Waste
Application
14,
Is there physical evidence of over application'?
[],Yes
PTNo
(if in excess of WM.P, or runoff entering waters of the State, notify DWQ)
15.
Crop type .� !l. .e.........ev&............................................................................ ...........................
.....................
16.
Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
❑ Yes
�No
17.
Does the facility have a lack of adequate acreage for land application?
❑ Yes
dNo
18. Does the receiving crop need improvement? 5�Yes ❑ No
19. Is there a lack of available waste application equipment? ❑ YesNo
20. Does facility require a follow-up visit by same agency? ❑ Yes O'No
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes 2No
For Certified Facilities Oniv
22. Does the facility fail to have a copy of the Animal Waste Management Plan readily available? ❑ Yes FfNo
23. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes ffNo
24, Does record keeping need improvement? ❑ Yes dNo
1 � . 6 a R-rn r�� S Et ,�t � T4ls 5 POR//0 c6*a
C d o E-2r¢� C
1 TIfbA U E_Ge�_ —/*77v10 ��t1 3#It6`4761ZA PIA F-W4y F7,4krrA
Reviewer/Inspector dame
Reviewer/Inspector Signature
Date: 1 C
cc: Division of VVater Quality, Water Quadity Section, Facility Assessment Unit 4/30/97

-7lti
Div; ; n of Soil and Water Conservation 0 Other Agency
[36i-vision of Water Quality
Routine O Cum laint O Follow-up of DWQ inspection O Follow-up (if DSWC review O Other
Facility Number Date of Inspection
Time of Inspection 24 hr. (hh:mm)
© Registered Certified E/ Applied for Permit © Permitted JE3 Not O erational Date Last Operated: ..........................
Farm Name: .. .. ......./../ r.. ..... f%!/. n..''�..... /?. .......... County: ,l!✓D.. .���g!''�� ...............................
Owner Name: �.✓ �� ... Phone No: Z ��
Facility Contact: .......... �! `. ....................................... Title: Phone No
MailingAddress:..... ...�........ ..+�...z�...........z .1............... 1. ✓!-7..................f ,.Cr..... .. .................... ..........................
Onsiite Representative:........ '""' `" ;1 g / .......... .. t:.....`�^'`r.................... Into rator:.................
Certified Operator;..................s�%:-... .. Operator Certification Number ..........................................
Location of Farm: S ]C/ 5-1 0
Latitude • ' " Longitude ' 6 "
W�to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
"I Current
'Capacity: Population- Cattle
i•
LJ Non-
y ❑ Other
Total Design CapacityC
Total~SSLW.
:
Subsurface Drains Present 11❑ Lagoon Area I❑ Spray Field Area
❑ No Liquid Waste
General
1. Are there any buffers that need maintenance/improvement?
2. 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 Surface Water? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system'? (If yes, notify DWQ)
3. Is there evidence of past discharge from any part of the operation?
4. Were there any adverse impacts to the waters of the State other than from a discharge?
5. Does any part of the waste management system (other than lagoons/holding ponds) require .
maintenancelimprovement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
7. Did the facility fail to have a certified operator in responsible charge?
7/25/97
❑ Yes No
❑ Yes o '
❑ Yes No
❑ Yes o
❑ Yes
❑ Yes N
❑ Yes
❑ Yes N
❑ Yes
❑ Yes ❑ No

it
I: acllity Number•
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (Lagonns-Howi,i18tits etc.).
9. Is storage capacity (freehoard plus storm storage) less than adequate?
Structure I Structure: 2 Structure 3 Structurc 4
❑ Yes No
❑Yes
Structure 5 - Structure 6
Identifier:
Freeboard (ft)........... ..:............. .......
............................. ..... .............................. ................ ........ ......... ...............................................................
El10, Is seepage observed from any of the structures? Yes oo
11. Is erosion, or any other threats to the integrity of any of the structures observed? ❑ Yes ILf Np
12. Do any of the structures need maintenance/improvement? ❑ Yes o
(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 o
Waste A lication
14. Is there physical evidence of over application? ❑Yes o
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)? ❑ Yes Ll'iVo
17. Does the facility have a lack of adequate acreage for land application? ElYes o
18. Does the receiving crop need improvement? [I Yes N
19. Is there a lack of available waste application equipment? ❑ Yes No
20. Does facility require a follow-up visit by same agency? ❑ Yes N
1�
21. Did Reviewer/Inspector fail to discuss review/ins ction with on -site representative? ❑ Yes' :N
22. Does record keeping need improvement? ❑ Yes o
For Certified or Permitted Faq e—s }nly
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available? El Yes:�N/
24. Wzeanny
dditional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes N
25. Wdditional problems noted which cause noncompliance of the Permit? ❑ Yes No
No violatio'ns-or deficiencies'were'-i ated-during this,' Visit.' You.rvill rece'i've,no,furiher-:
:: • "correspQlialdegce t�b:out this:visit:• :: :: .. : � :: - ::: . : ::: :: . : ' ::: :. .
7/25/97
ReviewertInspector Name
i Reviewer/Inspector Signature:
\j
Date:

.Z(q ( / a
Type of Visit Q�otxrpfiance 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: Z 2 01 j Arrival Time: Departure Time: County:
7 �
Farm Name: i 1 k c' V�t7 S E L� _ Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator: _M!ndj- -4.1 i
Back-up Operator:
Location of Farm:
Title:
Phone:
Phone No:
Integrator•
Operator Certification Number:
Back-up Certification Number:
Region:
Latitude: = c = I Longitude: 0 o = , = «
REA,
DesignC•urreut
Design
Cuulation
Wet Poultry Capaeity Population
C►attle Capacity
Population
❑ Wean to Finish
❑ La er
❑ Dairy Cow
❑ Wean to Feeder
I ❑ Non -La er
❑ Dairy Calf
❑ Feeder to Finish
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
❑ La ers
❑ Beef Stocker
❑ Gilts
❑ Non -La ers
El Pullets
El8eef Feeder
❑ Beef Brood Cow
❑ Boars
❑ Turke s
Othe
❑ Other
IE]Turkev Pou Its
❑ Other I I
umber 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'?
❑ Yes No ❑ NA ❑ NE
❑ Yes No NA El NE
El Yes No ❑ NA ❑ NE
❑ Yes o NA ❑ NE
❑ Yes N NA ❑ NE
❑ Ye No ❑ NA ❑ NE
12128104 Continued

Facility Number: — Date of Inspection 11(22120 I
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
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): Z._7
Structure 2 Structure 3 Structure 4
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 No NA ❑ NE
❑Yes o ❑NA ❑NE
Structure 5 Structure 6
❑ Yes ;No
o 1VA ❑ NE
❑ Yes ❑ NA ❑ NE
, notify DWQ
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmenta2o,
7. Do any of the structures need maintenance or improvement?
❑ YesNA
El NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
No A
❑ 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
El NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
o NA
ElNE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
o ❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
o�❑NA
❑ NE
15. Does the receiving crop and/or land application site need improvement`?
❑ Yes
,�,
1-2 0 I NA
❑ NE
16, Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
IQ��N�NA
❑ NE
17. Does the facility lack adequate acreage for land application'?
❑ Yes
No NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
o ❑ NA
❑ NE
yYE'Sw. :and./'o: se.; an: v Arge-icom^m-:n.�s�so.�r,,a�#n�oh�ir commentsAll
y Comments (refer to question Explain'a nao
y
i)se.drawirigs'of facility to better, ezplam.situation's (use additional pages�as necessary); 3 t 1 i. li ,p ; ti
_ ; . a�,� Alt , t , ,, :; �. s �i!' °"�` 11111! �S i , :,°`s. $ �. '3 c�.:�� � � a ?'.�,...P� ,". �.�x sl;
ReviewerA nsp ecto r Name '' } `' `' r
i .' Phone: %�� G%2a c7
Reviewer/Inspector Signature: Ge. ` Date: IZ
12128104 Continued

Facility Number: ::q Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
❑ Yes !.d'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
U<o ❑ 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
o A
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes/[:]
NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
NE
Other lssues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes ❑ No ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
❑ No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
❑ No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
❑ No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
❑ No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
❑ No
❑ NA
❑ NE
Additional�Comm"ents and/or Dr'awmgs k ;^
rr
12/28/04

-4(- if
Type of Visit: s0 Com ance Inspection U Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: ^ 2 — Arrival Time: Departure Time: County:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Onsite Representative: gli 9 ] 'F H1 ti Lei Integrator:
Certified Operator:
Back-up Operator:
Phone:
Certification Number:
Certification Number:
Location of Farm: Latitude: Longitude:
Region:
Design
Swine Capacity
Current
Pop.
Design Current
Wet Pnultr,.y Capacity Pnp.
Cattle
Design Current
Capacity Pop.
Wean to Finish
I
ILayer
I Dairy Cow
Wean to Feeder
I
INon-LaXer
I
Dairy Calf
Dairy Heifer
Feeder to Finish
Farrow to Wean
Design Current
Dry Cow
Farrow to Feeder
Dr P,oultr Ca aci Pao P.
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
113eef Feeder
Gilts
Non -Layers
Boars
Pullets
I Beef Brood Cow
Turke s
Other
Turkey Puults
Other 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 ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) ❑ Yes No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (if yes, notify DWQ) ❑ Yes o ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ YesrNo ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yeso ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 2/4aOII Continued

71, :. 1
Facili Number: - Date of Inspection: Z
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes N NA ❑ NE
a. if yes, is waste level into the structural freeboard? ❑ Yes No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No 2rNA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental eat, notify DWQ
7. Do any of the structures need maintenance or improvement? ElYes ❑ 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 Flo
❑ 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): t'7k j J) / Oq
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes N
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes N
❑ 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?
❑ Yes 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? 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. ❑ YesFf No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers [] Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall InspectirNo
Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes❑ NA ❑ NE
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facilit Number: 6119- Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ZI <No13 NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes VNo ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes No NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes o ❑ 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?
24. 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
❑ No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
❑ No
❑ NA
❑ NE
❑ 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
❑ No
❑ NA
❑ NE
Comments (refer to question`#): Explain any YES answers and/or any'additional recommendations'or any. .other comments �.',
Use `drawings of facility to better explain situations (use additional pages as necessary)'.
�I0lit SlArVC
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone
IL Date:
f
t-z1-rs
21412011

I - 2?-- 13
IType of Visit: 10 CompWance Inspection U Operation Review U Structure Evaluation U Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: County:
Farm Name: Q_ Po 5i2� i _ Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Phone:
Facility Contact: Title: Phone:
Onsite Representative: /� ,' ({ .J Integrator:
Certified Operator: Certification Number:
Back-up Operator:
Certification Number:
Location of Farm: Latitude: Longitude:
Region:
Design Current
Deslgn
Current
Design Current
Swine
Capacity Pop.
Wet Poultry
Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
Layer
DairyCow
Wean to Feeder
Non -La er
DairyCalf
Feeder to Finish
DairyHeifer
Farrow to Wean
Design
Current
D Cow
Farrow to Feeder
Dr. Poultry
Ca aci
P.o
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Nan -La ers
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
No ❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
Wo ❑ NA
9
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
]Yes
No ❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
[] Yes
o ❑ 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 .21412011 Continued

F'acili Number: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ❑ NA ❑ NE
a. if yes, is waste level into the structural freeboard? ❑ Yes No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):,
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes XNXOE] NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environment hreat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ YesVNo ❑ 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 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): A .� ,�h �� .J 6 rvt [.:, t A—t vi
13. Soil Type(s):
t4. Do'the receiving crops differ from those designated in the CAWMP? ❑ Yes ❑ 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 N ❑ 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
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes o ❑ 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 6 No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Trans ers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspectio ❑ 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: - C Date of Inspection: / I'!
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑Yes , �No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yesg❑ 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 ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes [:]No
❑ Yes ❑ No
[:]Yes [:]No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any, addition aLrecom. mendations4or;any other,cornments
Use_drarvings of facility to better explain situationsy(use additional"pages as necessary,) I t�
074
ip "-, V , C) L' I
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 717 f -1 % Z U o
Date: %H L7l 13
21412011

714
.,1 -V .
5'
Type of Visit �omp . ce Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: 1 Arrival Time: -- o r Departure Time: County:
Farm Name: _ — _ __ Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator: �✓
Phone:
Phone No:
t
Integrator: 3
Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm:
Region
Latitude: ❑ c ❑ 4 ❑ Longitude: = o = . ❑
Design Current
Design Current Design Current
Swine Capacity Population Wet Poultry
C«apacity Population Cattle Capacity Population
❑ Dairy Cow
I ❑ Dairy Calf
❑ Wean to Finish 10
Layer
❑ Wean to Feeder 10 Non -Layer I
❑ Feeder to Finish
❑ Dairy Heifer
❑ Farrow to Wean Dry Poultry
❑ Dry Cory
❑ Farrow to Feeder
ElNon-Dairy
❑ Farrow to Finish ❑ Layers
❑ Bcet'Stocker
❑ Gilts ❑ Non -Layers
❑Beef Feeder
❑ Beef Brood Cow
❑ Boars
❑ Pullets
El Turkeys
Other
❑ Turkey Pou Its
❑ Other1
❑ Other
Number of Structures:
Discharecs & 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
ZNo ❑ NA
❑ NE
❑ Yes
No - NA
❑ NE
❑ Yes
No [l NA
❑ NE
❑ Yes
No NA
❑ NE
❑ Yes
o ❑ NA
FINE
❑ Yes
No ❑ NA
❑ NE
12128104 Continued

Facility Number: &—[� Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
❑ Yes No A ❑ NE
❑ Yes o ❑ NA ❑ NE
Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No A ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed [IYes 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 thre , notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes o A ❑ 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 ADDlication
7
10. Are there any required buffers, setbacks, or compliance alternatives that need
maintenance/improvement? ❑Yes No A El 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 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) ✓i�t --Y►�l—d •z -� .. ...
13. Soil type(s)
t4. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes N NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes;FNN:�
N NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes ❑ NA ElNE
17. Does the facility lack adequate acreage for land application? ElYes ElNA ElNE
18. Is there a lack of properly operating waste application equipment? ElYes❑ NA ❑ NE
Comments (refer to question ft 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):
AL
Reviewer/Inspector Name Phone: — Y 2 0 (i
Reviewer/inspector Signature: L Date: (/
12128104 Continued

t.
Facility Number: � — Date of Inspection D,
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ONo ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes o ❑ N ❑ NE
the appropriate box. El ElChecklists
❑ Design ❑Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections �No'�NA
er Code
22. Did the facility fail to install and maintain a rain gauge? ❑ YesFN
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit? ❑ Yes ❑ NE
26. Did the facility fail to have an actively certified operator in charge? ❑ Yes ❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ❑ Yes ❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes ❑ No ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
❑ No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
❑ No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
3 I. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
❑ No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
❑ No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
❑ No
❑ NA
❑ NE
Additional Ctiinments and/or Drawings
Page 3 of 3 12128104
Page 3 of 3 12128104

Type of Visit: oQ Co nce Inspection Q Operation Review O Structure Evaluation Q Technical Assistance
Reason for Visit: Routine Q Complaint Q Follow-up Q Referral Q Emergency Q Other Q Denied Access
Date of Visit: / i -A rival Time: i r� =1 J V l Departure Time: 0© County: Region:
Farm Name: ��j h- lJGLLAe . 7 Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
t
Onsite Representative: f —S Integrator:
Certified Operator:
Phone:
Certification Number:
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Design Current
Designs Current
Design Current
Swine Capacity Pop.
Wet Poultry Capacity Pop.
Cattle Capacity Pop.
Wean to Finish
La er
Dai Cow
Wean to Feeder
Non -La er
Dai Calf
Feeder to Finish
Dai Hcifer
Farrow to Wean
Design Current
Dry Cow
Farrow to Feeder
Dr P,outtr, Ca aci P,o
La ers
Non -Dairy
Farrow to Finish
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turke s
Qther
Turkey Poults
Other
Other
m
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes ONo ❑ 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) ❑ Yes o 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 y No ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

[Facility Number: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
1<0-- NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
o ❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
o ❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
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
t t, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
>_-EINA
7
❑ 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
Z rNo❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
ZNo ❑ 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): l /+'l CI!►� t
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
o ❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
n 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?
❑ YesE-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? If yes, check
❑ Yes❑
rNNA
❑ 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 PJNo ❑ 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 udge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes NA ❑ NE
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yese[3
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

[Facility 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 o ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes No A ❑ NE
27..Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes2 o ❑ 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 ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
Comments (refer to question #):.Explain any YES.answers and/or any additionMl recommendations,or any other comments _;
Use'drawings offacilityto better explain situations (use additional pages'' as necessary).
.5"(h �p_ st, r✓Q
0 = I - '7 a'
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
3 1 -- r -L__
Phone: 07!�/— ` 2- U
Date:. Z2 7 / �Z.---
2/4/2011

if
Michael F. Easley, Governor
William G. Ross Jr., Secretary
North Carolina Department of Environment and Natural Resources
Alan W. Klimek, P.E., Director
Division of Water Quality
October 23, 2002
Blue Rose, Inc.
Blue Rose 4
704 Andrew Hale Road
Littleton NC 27850
Attn: Jack Keane
Subject: Certificate of Coverage No. AWS660041
Blue Rose 4
Swine Waste Collection, Treatment,
Storage and Application System
Northampton County
Dear Mr. Keane:
In accordance with your Notification of Change of Ownership request received on January 9, 2001, we
are forwarding this Certificate of Coverage (COC) issued to Blue Rose, Inc., 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 Blue Rose 4, located in Northampton County,
with an animal capacity of no greater than 600 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 AWS660041 dated March 9, 2001. 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 Unit
1617 Mail Service Center, Raleigh, NC 27699-1617
DENR Customer Service Center
An Equal opportunity Action Employer
Intemet httpJ/h2o.enr.nc.state.us/ndpu
Telephone [phone] Fax [phone]
Telephone 1 B00 623-7748
50% recycled/10% post -consumer paper
�EN1R

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 an
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 Raleigh 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,
1
—Alan W. Klimek, P.E.
cc: (Certificate of Coverage only for all cc's)
Northampton County Health Department
Raleigh Regional Office, Water Quality Section
Northampton 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 15A 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 Waste Management Facility. 'Finis form must be
submitted to DWQ no later than 60 days following the transfer of ownership.
General Information:
Name of Farm: L-- L&
� 0 S E Facility No. `G
Previous Owner(s) Name: ✓ 1,0&f,, /4 el'y L� _ Phone No:
New Owner(s) Name: 10C , Phone No:
Mailing Address:�g 0-
Farm Location: Latitude and Longitude: T��/ 77 16 Z-/ County,
Please attach a copy of a county road map with-jocatiou identified and describe below (Be specific: road names, directions,
milepost, etc.): 'C'
operation Description:
Tape of Swine No. of Animals
El Wean to Feeder
dFeeder to Finish+-
0 Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
C Gilts
r Boars
Type of Poultry
❑ Laver
❑ Pullets
No. of Animals
Other Type of Livestock:.
T_vpe of Cattle . No. of Animals
❑ Dairy
C Beef
Mumber of Animals:
c eage available for Application: Required Acreage:
Number of Lagoon / Storage Ponds ; Total Capacity: 3 Cubic Feet (ft')
Owner / s''{{: naaer 3,reement
I (%ve) verify that all the above information is correct and will be updated upon charging. I (we) understand the operation
and maintenance procedures established in the approved animal waste management plan for the farm named above and will
implement these procedures. I (we) ]glow that any expansion to the existing design capacity of the waste treatment and
storage system or construction of new facilities will require a new certification to be submitted to the Division of Water
Quality (DWQ) before the new animals are stocked. I (we) understand that there must be no discharge of animal waste
from the storage or application system to surface waters of the state either directly through a man-made conveyance or from
a storm event less se'Vere than the 25-year, 2T-hour storm and there must not be run-off from the application of animal
waste. I (we) understand that run-off of pollutants from Iounging and bear use areas must be minimized using technical
standards developed by the Natural Resources Conservation Service. The approved plan will be filed at the farm and at the
office of the local Soil and Water Conservation District I (we) know that any modification must be approved by a
technical specialist and submitted to the Soil and Water Conservation District prior to implementation. A change in Iand
ownership requires written notification to DWQ or a new certification (if the approved plant is changed) within 60 days of a
title transfer.
Name of New Land Owner:
Signature: ���_r -- Date: 1J �r_7l L
Name of -Manager(if different from owner):
Signa Date:
• i]
PI ase-sign a� T for to: `. C. Division of Water Quality
Non -Discharge Compliance / Enforcement unit �f
Raleigh, NC 27�35
z76 Tf-A61 7AuauSL 19, 1997
1401rt-DISCHARGE PERMITTING

Type of Visit 9 Com lance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit outine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: ' Arrival Time: ® Departure Time: County:
Farm Name: Akl_ .(1o_z //_4/ Owner Email:
Owner Name: b �� t �� Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: //
Certified Operator: tlQA[ T�A-C lei✓
Back-up Operator:
Title:
Region:
Phone No:
Integrator:ll')urO�i�, — l3r'rrL✓� S �_
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: = e = S 0td Longitude: = ° = 1 =
De
CurrentPIP
DesignCurreYut �' , '' +Deng ' Current l R
Swine Capaci"ty
Population
Wet Poultry
Cpp�ac Pnp ian
Cattle Cp. ty Populatron
❑ Wean to Finish
❑ La er
❑Dai Cow
❑ W alto Feeder
❑Non -La er
, ❑Dai Calf
eeder to Finish
p
i;
❑ Daia Heifei
❑ Farrow to Wean
`
Dry Poultry _
❑ Dry Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
El Layers
❑ Beef Stocker
❑ Gilts
❑Non -La Non -Layers
❑Beef Feeder
❑ Boars
❑ Pullets
❑ Beef Brood Cowl
I
❑ Turkeys
Other
❑ TurkeyPoults
El Other r
❑ Other
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
ElYes
eNo ❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
' El NA
El NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
El Yes
VN❑ 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
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
❑ 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?
12128104 Continued

-Xi . ,y
Facility Number: — Date of Inspection: ru i
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No '❑ NA [I NE
a. If yes, is waste level into the structural freeboard`? El Yes No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not property addressed and/or managed ❑ Yes eNo ❑ 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 thr , notify DWQ
7. Do any of the structures need maintenance or improvement? ❑Yes Z ❑ NA El NE
8. Do any of the stuctures lack adequate markers as required by the permit? El Yes��Noo ❑ 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 El Yes No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 2&o ❑ 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 Drill ❑ Application Outside of Area
12. Crop type(s) _ ✓� �� C44 /4i17
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 Noo❑ NA [I NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination,❑ Yes L2"No ❑ NA ❑ NE
i
17. Does the facility lack adequate acreage for land application? El ro[03
NA El NE,
18. Is there a lack of properly'operating waste application equipment? El Yes NA ❑ NE
JYO 16W GJ a"I I.J{E�C 1 J1/ c�'�'1 �1 F, a f a rl Lrp tl I;r, —17�G '1
Reviewer/Inspector Namew.'�':: ' s Phone:
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
o NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 2No ❑ 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'?
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
❑ No ❑ NA
❑ NE
❑ Yes
❑ No ❑ NA,
❑ NE
❑ Yes
❑ No NA
❑ NE
❑ Yes
❑ No = NA
❑ NE
❑ Yes
No ❑ NA
❑ NE
❑ Yes
❑ No NA
❑ NE
❑ Yes L/J No ❑ NA ❑ NE
❑ Yes 2<o ❑ NA ❑ NE
❑ Yes No NA ❑ NE
❑ Yes No NA ❑ NE
❑ Yes N NA ❑ NE
❑ Yes No ❑ NA ❑ NE
A"ddiharialConitnents;and/or-Drawings:
'1
12128104

lType of Visit com ce Inspection O Operation Review O Structure Evaluation O Technical Assistance
ReasonforVisit CerRoutine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: County:
7- L
Farm Name: -t' 12yJ-r- Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Phone:
Facility Contact: Title: Phone No:
Onsite Representative: !1 ( "',� �f�L" Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Region:
Location of Farm: Latitude: = e = 4 = « Longitude: = ° = d = iE
Design Current
Design Current
"DefflingnE Current
Swine C►apacity Population
Wet Pauitty Capacity Population
Cattle
Capacity Population
❑ Wean to Finish
❑ Layer
❑ Dairy Cow
❑ an to Feeder
❑ Non -Layer
❑ Dairy Calf
Feeder to Finish
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
ElNon-Dairy
❑ Farrow to Finish
❑ Layers
❑ Beef Stocker
❑ Gilts
❑Non -La Non -Layers
ElBeef Feeder
ElBoars
❑ Pullets
El Beef Beef Brood C
❑ Turke s
Other
❑ Turkey Pouets
L=�O er
mom
I JEI Other
Number of Structures:
Discharges & Stream Impacts
l
1. Is any discharge observed from any part of the operation?
❑ Yes
VNo ❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
/N//'EEINA'
a. Was the conveyance man-made?
❑ Yes
❑ 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
0 NA
[3 NE
2. Is there evidence of a past discharge from any part of the operation'?
ElYesEl
NA
FNo
[3 NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
El Yes❑
NA
❑ NE
other than from a discharge?
Page l of 3
12128104 Continued

i.
Facility Number: — Date of Inspection bo f-1 ED
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): ]��l
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 No NA ❑ NE
El Yes No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes No ❑ NA ❑ NE
❑ Yes 2 No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental thr t, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes VNo
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑Yes❑ 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 C41NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes :/No
o NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. El Yes ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ 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?
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'/NE1
❑ NA ❑ NE
o NA ❑ NE
l.� ❑ NA ❑ NE
No NA ❑ NE
o ❑NA El NE
Comments refer -to uestion # : Explain an YES'answers and/or` ' recommendations or an other comments
q. ).. P Y Y Y t
'lase drawings of facility to better explain situations: (use additional pages as necessary).;.
� OR,
AL
Reviewer/Inspector Name
Phone:
Reviewer/Inspector Signature:
1� .c I Date:
1
Page 2 of 12128104 Continued

Facility Number: — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 2 o ❑ NA [I 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 El Checklists El Design El Maps ❑Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
No ❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 "
Rain Inspections eather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
No [:I] NA
El NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
El Yes
Ld N ❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
El Yes
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
N ❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
No E A
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
El Yes
No ❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
[] Yes
[:]No ❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes ❑ No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes ❑ No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes ❑ No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes ❑ No
❑ NA
❑ NE
Additional Comments and/or Drawings:
Page 3 of 3 12128104

' ivision of Water Quality U -D7''
Facility Number Q Division of Soil and Water Conservation
Q Other Agency
E
of Visit Com 'ante Inspection Operation Review O Structure Evaluation 0 Technical Assistance
on for Vis' Routine 0 Complaint 0 Follow up Q Referral 0 Emergency 0 Other ❑Denied Access
Date of Visit: Z jD Arrival Time: / Departure Time: County: Region:
Farm Name: _(�! SQ7 Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: l /C/Y-[✓ Integrator:
Certified Operator: wQ4� t 1 �Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Latitude: e ` = `1 Longitude: = ° "
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
I❑ Nan -La er
Dry Poultry
❑ La ers
❑ Non -La ers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made`?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ D iry Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stockei
❑ Beef Feeder
❑ Beef Brood Cow
Number of Structures
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes o ❑ NA ❑ NE
❑ Yes N NA ❑ NE
❑ Yes No �] NA ❑ NE
❑ YesrNo
A ❑ NE
❑ YesNA ❑ NE
❑ YesNA ❑ NE
12128104 Continued

Facility Numbcr: —
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes NA El NE
a. If yes, is waste level into the structural freeboard? El Yes��NoC NA ❑ NE
Structure 1 Structure 2' Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes o NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environment=ONA
tify DWQ
7. Do any of the structures need maintenance or improvement`? ❑ Yes ❑ 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 o ❑ NA ❑ NE
maintenance or improvement`?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes eNo-NA El NE
maintenance/improvement?
11. Is there evidence of incorrect application'? If yes, check the appropriate box below. El Yes :`No�[] NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drill ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
r4 5�
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 ..0No/❑ NA ❑ NE
❑ 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?
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ Yes
Vo[01
A El NE
A ❑ NE
A ❑ NE
A ❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/inspector Name J G Phone:( �Ll Zcl� T
Reviewer/Inspector Signature: Date: 111Z d
12/28104 Continued
M

' 1
Facility Number: --Gf Date of Inspection Z D
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes No A ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check Cl Yes No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ONo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No [I NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes NV ElNA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes El ❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit? ❑ Yes N El NE
26. Did the facility fail to have an actively certified operator in charge? ❑ Yes A ❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ❑ Yes!No NA ❑ NE
OtherIssues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yeso ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document [] Yes ❑ No ❑ NA ❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes ❑ No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by ❑ Yes ❑ No ❑ NA ❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes ❑ No ❑ NA ❑ NE
33. Does facility require a follow-up visit by same agency? ❑ Yes ❑ No ❑ NA ❑ NE
Additional Comments and/or Drawings:
12128104
12128104

Division of Water Quality��
Facility 'Number - Q Division of Soil and Water Conservation
u:
0. Other Agency
t_,. a ..: ........�,. .0 a..
L
Visit (r'Cum nce Inspection 0 Operation ltaieva 0 Structure 1-waluation 0 Technical Assistance
for Visit lZouRne 0 Complaint 0 FolloW up 0 Referral 0 Emergencl 0 Other ❑ Denied Access
Date of Visit: Arrival Time: d Departure Time: County:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator: fA rrl'1 ! 2 �
Title:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm:
Swine
Region:
Latitude: = c = = Longitude: = ° ❑
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non-Layet
❑
Wean to Finish
❑
Wean to Feeder
❑
Feeder to Finish
❑
Farrow to Wean
❑
Farrow to Feeder
❑
Farrow to Finish
❑
Gilts
❑
Boars
Other
❑ Other
Discharges & Stream Impacts
Dry Poultry
❑ Layers
❑ Non -La ers
❑ Pullets
❑ Turkeys
❑ Turkey Pouets
❑ Other
i
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifei
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stockei
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures: F1
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 ell
No ❑ NA ❑ NE
❑ Yes � ❑ NA [I NE
El YesVNNo❑NA El
❑ Yes "❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
12128104 Continued

Facility Number: —
Date of Inspection LI%�TJ1
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): S 7 11
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 No -NA ❑ NE
El Yes o ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes A El NE
❑ Yes;N�oo ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threa notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ;No
o NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit'? ❑ Yes 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 [I NE
maintenance or improvement`?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes J2 �o[]
NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes NNA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window El Evidence of Wind Drib ❑ Application Outside of Area
12. Crop type(s) 1n/9 `] , r ►� C
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes 14�0 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 N 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):
i
Reviewer/Inspector Name F bk,5 2— lPhone: '7 f/_e_�XCXS
ReviewerAnspector Signature: Date: Z D
12128104 Continued

Facility Number: — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes o A [INE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes o ❑ NA ❑ NE
the appropirate box. ❑ WUp ❑ Checkiists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ,W ivy' ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes Vo ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fait 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?
Comments and/or Drawings:
❑ Yes L2 NA ❑ NE
❑ Yes No ❑ NA ❑ NE
El Yes No NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
12128104

3 E i �__�JI Y1,11VII Ul_�7Ull d[!(I .YY FLLCi!l.Ull'GI Yi1UV1l. yWk7C...3...... 1�CYlC W4 'f 1} fE EFrU ' 1
e v
©'D n of Soil and Water Conservation t` pCompliance Irispeetton'tit ,t'�
s of li E3 Er�t it9 } I} A pEq
` ivision of Water Quality :Compliance InspectioiiE +t �a` >
s �I ' t t
lx .. 13'Other,Agency; °EOperatlon,Rey>ew'�, w Est. t, .
101zoutine Q Complaint Q Follow-up of DWQ insEection Q Follow-up of DSWC review Q Other ]
Facility Number Date of Inspection p
Time of Inspeel ion � ?A hr. (hh:mm)
© Permitted [3 Certified © Conditionally Certified [3 Registered rot Operational Date Last Operated:
Farm Name: ....... ...0.... L:.. .....1' 1 .•C.I............................................... ....................... County:.....................................................................................
...
r
Owner Name ............. . ..! M hr� r..t.. ..... Phone No:
..............�.............................................I......
FacilityContact: ...... Title: ................................................................ Phone No:...................................................
MailingAddress: ................................................................
Onsite Representative:................................................ ....... Integrator: �rt.�.!'Y...�...J.. ...............
Certified Operator:......., -!' !t .y.... (3 1 5 Operator Certification Number.
4 ... p
Location of Farm:
...........................................................................................................................................................................................................•.................................................... • .
Latitude 0 • �_�` �•° Longitude �� • �° �
Design Current ,_ ` urrenegn t
Swine. Poulte;Caaci P"lation ry ulation CateCaacPo
❑ We Feeder ❑Layer ❑ Dairy
EE�Fceder to Finish 0 JE1 Non -Layer I ElNon-Dairy
❑ Farrow to Wean
,u
❑ Farrow to Feeder ❑ Other
❑Farrow to Finish Total Design Capacity
❑ Gilts
.M�
❑Boars Total SSLW=`
Discharge originated at: [:]Lagoon ❑ Spray Field [-]Other
a. If discharge is observed, was the conveyance than -made?
b. If discharge is observed, did it reach Witter of the State'? (If ycs, notify DWQ)
c. if discharge is observed, what is the estimated flow in gal/ruin?
d. Does discharge bypass a lagoon system? (II'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? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
❑ Yes No
❑ Yes wo
❑ YesZI
❑ Yes ��NyNo
❑ Yes
❑ Yes o
Structure
Identifier:
t';
Freeboard (inches): ............ ..........'..I.... ..........................................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes No
seepage, etc.)
3/23/99 Continued on back

Facility Number: - Date of Inspection
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
or 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?
Waste A lication
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN
12. Crop type�r rYc �? 5�►- S, iu� ,'r, -S
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facilitywcfg'lre a follow-up visit by same agency?
25. Wer ny additional problems noted which cause noncompliance of the Certified AWMP?
'No.* iolpk(iois'or dg#jciencies were poled• during this:visit; Yoiit wiil receive Rio �ui•thgr
• corresnondeirce: abvuf this visit: :. ::: .............
se;`drawtngs of facihty tobetter explain
r;
[]Yes No
❑ Yes
❑ Yes PO
❑ Yes 4zo
❑ Yes N
❑ Yes No
❑ Yes (IN
❑ Yes No
❑ Yes
❑ Yes No
❑ Yes lU l�
El Yes No
❑ Yes No
❑ YesnINN
❑ Yes
❑ Yes VNO
❑ Yes
❑ Yes No
❑ Yes
❑ Yes N
❑ Yes No
Reviewer/Inspector Name V,,r'
Reviewer/Inspector Signature:
Date:
3/23/99

acilily Number: — Date of Inspection p U
Odor Issues
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 o
❑ Yes
❑ Yes o
❑ Yes No
Additionaomments, an or rawtn s
i a �F , �� _ �. r� _
E' ; 3 eta
i

F ty Number t Date of Visit: 'rime: Printed on: 10/26/2000
Q Not Operational Q Below Threshold
©Permitted © Certified I3 Conditionally Certified 13Registered Date Last Operated or Above Threshold: .........................
FarmName: .. ... County:...............................................................
OwnerName: ................................................... ........................................................................ Phone No:.......................................................................................
FacilityContact: ...............................................................................Title:................................................................ Phone No:...................................................
]Mailing Address: ........................
OnsiteRepresentative:........................................................................................................... Integrator:......................................................................................
r
Certified Operator:..... �. l!^'^ ....p/ r . „� Operator Certification ation Number: .........................................
7 �.................................................. of c r:
Location of Farm: `
F■
7
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude �• �` �_�" Longitude �• ��
Design Current Design Current Design Current
Swine Capacity Population Poultry Capacity Population Cattle Capacity Population
❑ We to Feeder ❑ Layer ❑ Dairy
P,Feeder to Finish ❑ Non -Layer 10 Non -Dairy.
❑ Farrow to Wean
❑ Farrow to Feeder Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ Boars Total SSLW
Number of Lagoons
Holding Ponds / Solid Traps
Subsurface Drains Present II❑ Lagoon Area I❑ Spray Field Area
No Liquid Waste
Discharges & Stream Impact~
1. Is any discharge observed from any part of the operation'?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was (lie conveyance man-made?
b� If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. II'discharge is observed, what is the estimated flow in gal/ruin?
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? ❑ Spillway
StrUClnrC 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier. I? .. :..........................................................................................
❑ Yes�;N/o
❑ Yes To
❑ Yes o ,
[]Yes'
❑ Yes ZN
;
❑ Yes o
❑ Yes No
Structure 6
Freeboard (inches):
5100 Continued on back

Faciiiliy Number: — Date of inspection Printed on: 10/26/2000
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
12. Crop typedo­-- 1,
13. Do the receiving Irops d'ffer with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination'?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available'?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. 'Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility rcqt6re a follow-up visit by same agency?
25. Werfe,aRfy additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes • o
❑ Yes o
❑ Yes
El Ye��No
❑ Yes No
❑ Yes No
❑ Yes o
❑ Yes PIS
❑ Yes o
El Yes o
❑ Yes ��No
o
❑ Yes
❑ Yes
❑ Yes+
❑ Yes
❑ Yes o
❑ Yes
❑ Yes PO
❑ Yes 70 - _o
El Yes Ld"No
❑ Yes o
❑ Yes ~
�•yiolatigris.oi- deficiencies -were ngted. ftririg -this:visit= • yob will-r, eceiye trio #'u>1•tltier : .
comes' oridence: about" this visit.J
q )r
Comments refer to ueshon # Explain any YES answers and/or any recommendations or any other commients ` = i °i
U'drwexplain-situations. (use additional pages as necessa eas F ' i
a4 f T
Reviewer/Inspector Name 44 � �`/
Reviewer/Inspector Signature- /j �j� Date: + 12
5/00

Facility Numher: -,[ Date of Inspection nl( 1 LS/0% Printed on: 10/26/2000
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below zYes❑ 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 No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes 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 No
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 No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Ye No
5100

Facility Number Date of visit: t) Time: P 3
Not O erational Q Below Threshold
Permitted E3 Ceftified n[3 Conditionally Certified [] Registered Date Last Operated or Above Threshold:
Farm Name: 1 j/ + �'t7� County:
Owner Name:
Mailing Address:
Phone No:
Facility Contact: Title: ,Phone No:
Onsite Representative: ILI 1 l ` Integrator: lJ 0 C
Certified Operator: 14v n •C 4 I � h� � z/�- Operator Certification Number:
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' 04 " Longitude 00 1
ZDesign Current Design Current`= Design Current
Poltr CSttle, Capacity Population Capacity Population
can to Feeder ❑ Laver I ❑ Dai
Feeder to Finish ILI Non -layer I JEJ Non -Dairy
❑ Farrow to Wean
❑ Other
ElFarrow to Feeder
!
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ Boars Total SSLW
„ LJ No Lin uid Waste
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation'?
Discharge originated at: ❑ Lagoon ❑ Sprav 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/min?
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? ❑ Spillway
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
identifier:
Freeboard (inches): Z �!
05103101
Field
❑ Yes
❑ Yes No
❑ Yes
❑ Yes No
❑ Yes Nc
❑ Yes o
❑ Yes No
Structure 6
Continued

Facility Number: — Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(if any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Auolication
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
12. Crop type i5 h-7,9 r4�4L'�q f . 8,e r — I q—
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Reguired RScords & DgEuments
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21, Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/inspector fail to discuss reviewhrispection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes o
❑ Yes
❑ Yes J2rNo
❑ Yes .J.vo
❑ Yes No
❑ Yes ldNo
Cl Yes l_7No
❑ Yes No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes
❑ Yes E_- o
❑ Yes o
es ❑ No
❑ Yes
❑ Yes No
❑ Yes �`No
❑ Yes
❑ Yes
❑ Yes do
10 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
o question #} Explain any YES answers andl0 any, r..,ecommeoaations:or angother"comet nts ; k
Ctitiiments4(refer:.. ' ft 'il
e ;drawings,Udacility4o better ezplaln sltustitins. (use additional pages as necessary) Field Covv ❑ Final Notes
.$ F
/a& s S / - / q f
21I _s�^" � 1 1 � �+ / w �ilUv �-i'L C V ^'-%�J�' L: fj�'�
i_�t'1�t , S IV LJ� S� v
4,j sag
Reviewer/Inspector Name s� t,a =.. Gt: t �1✓�' / .s'*
Reviewer/inspector Signature: Date:
05103101
Continued

Facility Number: Date of Inspection
9dor Ensues
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
❑ Yes 7
El Yes 51 o
❑ Yes IdNo
❑ Yes No
❑ Yes 0
❑ Yes No
Additional Comments and/or°Drawings:;;•
A,
05103101

Facility Number Date of Visit: G I 4 I 'time:
Not O erational 0 Below Threshold
Permitted 0 Certified 3 Conditionally Certified © Registered Date Last Operated or Above Threshold:
Farm Name: f� �` Y �—/�C_ " County:
Owner Name: Phone No:
Mailing Address:
Facility Contact: Title: Phone No:
Onsite Representative: Integrator: my a A y l afe—'-yam
Certified Operator: �i ��n 7,4 h /`af Operator Certification Number:
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ horse Latitude 0• 4 96 Longitude • ` «
Design
Swine Ca aci
❑ Wpar6to Feeder
eeder to Finish vo
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
7, Number of Lagoons
Holding Ponds/ Solid 'Craps;.......
,.
Current Design Current Design Current
a elation PoultryCH acit Po elation Cattle Ca aci Po ulation
❑ Layer I ELINon-Dairy
Dairy
❑ Non -Layer
❑ Other
Total Design Capacity
Total SSLW
Subsurface Drains Present IILJ Lagoon
No Liquid W
Discharges & Stream I_ mIjacts
1. 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/min?
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? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Freeboard (inches):
05103101
❑ Yes io
❑ Yes 9/0";
El Yes 12 No
❑ Yes tN
❑ Yes
❑ Yes I I N
❑ Yes No
Structure 6
Continued

Facility, Number: —
Date of Inspection 22f)
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? If yes, check the appropriate box below.
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type
Mw
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
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 at/or 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 2_1g10 '
❑ Yes e2r<0
❑ Yes ad lac
❑ Yes Wo
❑ Yes
❑ Yes 12V
❑ Yes
❑ Yes [` No
❑ Yes jrNo
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ��o
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Field Copy ❑ Final Notes
_ j� l �kHh (n -'"%mj
Reviewer/Ins1t ector Name 1 1€
Ct9stn : v._
Reviewer/Inspector Signature: Date:
12112103 Continued

Facility Number: — Date of Inspection Z /�
ReguiredRecords & 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?
Oe/ WUP, 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 31-35)
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?
❑ Yes
❑ Yes No
❑ Yes o
❑ Yes No
❑ Yes jNo
❑ Yes RZo
El Yes l
❑ Yes ❑'!VO
❑ Yes
❑ Yes o
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
34. Did the facility fail to calibrate waste application equipment? ❑ Yes ❑ No
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After I " Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
12112103

1.
WASTE UTILIZATION PLAN 66-41
Producer: BLUE ROSE, INC.
Location: Old PLACE, located on NORTH side of Jenkins Mill Rd.
704 ANDREW HALE RD., LITTLETON NC
Telephone: [phone]
Type Operation: Topping
Number of Animal Units: 600
The waste from your animal facility must be land applied at a specified rate to
prevent pollution of surface and/or ground water. The plant nutrients in the
animal waste should be used to reduce the amount of commercial fertilizer
required for the crops on the fields where the waste is to be applied. This
waste utilization plan uses nitrogen as the limiting nutrient_ Waste should be
analyzed before each application cycle. Annual soil tests are strongly
encouraged so that all plant nutrients can be balanced for realistic yields of
the crop to be grown.
Several factors are important in implementing your waste utilization plan in
order to maximize the fertilizer value of the waste and to ensure that it is
applied in an environmentally safe manner. Always apply waste based on the
needs of the crop to be grown and the nutrient content of the waste. Do not
apply more nitrogen than the crop can utilize. Soil types are important as they
have different infiltration rates, leaching potentials, cation exchange
capacities, and available water holding capacities. Normally waste shall not be
applied to land eroding at greater than 5 tons per acre per year_ With special
precautions, waste may be applied to land eroding at up to 10 tons per acre per
year. Do not apply waste on saturated soils or on land when the surface is
frozen. Either of these conditions may result in runoff to surface waters.
Either of these conditions may result in runoff to surface waters which is not
allowed under DWQ regulations. Wind conditions should also be considered to
avoid drift and downwind odor problems. To maximize the value of nutrients for
crop production and to reduce the potential for pollution, the waste should be
applied to a growing crop or applied to bare ground not more than 30 days prior
to planting. Injecting the waste or disking will conserve nutrients and reduce
odor problems.
The estimated acres needed to apply the animal waste is based on typical
nutrient content for this type of facility. Acreage requirements should be
based on the waste analysis report from your waste management facility.
Attached you will find information on proper sampling techniques, preparation,
and transfer of waste samples to the lab for analysis.
This waste utilization plan, if carried out, meets the requirements for
compliance with 15A NCAC 2H.0217 adopted by the Environmental Management
Commission.
RECEIVED / DENR I DWQ
AqulfPr PrntPf�fl()n gedon
MAR 3 0 2009

Amount of Waste Produced Per Year(gallons, tons,etc.)
600 animals X 751 gal. waste/animal/year = 450,600 gals. waste/year.
Amount of Plant Available Nitrogen (PAN) Produced Per Year
600 animals X 2.3 lbs. FAN/animal/year = 1380 lbs. PAN/year. (PAN from N. C.
Tech. Guide Std. 633)
Applying the above amount of waste is a big job. You should plan time and have
appropriate equipment to apply the waste in a timely manner.
The following acreage will be needed for waste application based -on the crop to
be grown and surface application:
ACRES DKKW BY PRRGDUCBR
Tract
Field
Soil
Type
crop
Real
Yld./Ac
Lbs. N
per
acre
Acres
Lbs.N
Used
Months
Applied
239
1
NoA
Coastal
Hay
6.1
50
4
1220
Mar 1
Sept 30
1
GoA
Coastal
Hay
6.5
50
3
975
Mar 1
Sept 30
1
NoA
Rye
50
4
200
Sept 1
-Mar 31
1
GoA
Rye
50
3
150
Sept 1
-Mar 31
Total Table 7 2545
Amount of N Produced = 1380*
Surplus or Deficit = -1165 Lbs. N
* This N is from animal waste only. I£ nutrients from other sources such as
commercial fertilizer are applied, they must be accounted for.. N must be based
on realistic yield expectation.
NOTE: The applicator is cautioned that P and K may be over applied while
meeting the N requirements. This plan only addresses Nitrogen.
NOTE: The Waste Utilization Plan must contain provisions for periodic land
application of sludge at agronomic rates. The sludge will be nutrient rich and
will require precautionary measures to prevent over application of nutrients or
other elements.

See attached map showing the fields to be used for the utilization of
wastewater.
Application of Waste by Irrigation
Field Soil Type Crop Application Application
No. Rate(In/Hr) Amount(In.)
1
Norfolk
Coastal/Hay
0.5
1.0
1
Goldsboro
Coastal/Hay
0.5
1.0
1
Norfolk
Rye
0.5
1.0
1
Norfolk
Rye
0.5
1.0
This table is not needed if waste is not being applied by irrigation, however a
similar table will be needed for dry litter or sludge.
Your facility is designed for 180 days of temporary storage and the temporary
storage must be removed on the average of once every 5 months.
In no instance should the volume of waste being stored in your structure exceed
Elevation 98.7.
Call the local Natural Resources Conservation Service (252-534-2591) office
after you receive the waste analysis report for assistance in determining the
amount per acre to apply and the proper application rate prior to applying the
waste.
Narrative of operation:
Waste will be applied to coastal bermuda hay and small grain in the fall.

-."111 Not
P"M
Ica
UF'
ir,
0-i I--
;gl
aw
.............
rr
loop
51 woo
-on Q.-
-

RZQU1RED SPECIFICATICUS
1. Animal waste shall not reach surface waters of the state by runoff,
drift, manmade conveyances, direct application, or direct discharge
during operation or land application. Any discharge of waste which
reaches surface water is prohibited.
2. There must be documentation in the design folder that the
producer either owns or has a notarized agreement for use of adequate.
land on which to properly apply the waste. If the producer does not
own adequate land to properly dispose of waste, he/she shall provide a
copy of a notarized agreement with a landowner who is within a
reasonable proximity, allowing him/her the use of the land for waste
application. It is the responsibility of the owner of the facility to
secure an update of the Waste Utilization Plan when there is a change
in the operation, increase in the number of animals, method of
utilization, or available land.
3. Animal waste shall be applied to meet but not exceed, the Nitrogen
needs For realistic crop yields based on soil type, available moisture,
historical data, climate conditions, and level of management, unless
there are regulations that restrict the rate of application for other
nutrients. Actual yields may be used in lieu of realistic yield tables
at the discretion of the planner.
4. Animal waste shall be applied on land eroding less than 5 ton per
acre per year. Waste may be applied to land that is eroding at more
than 5 tons but less than 10 tons per acre per year providing grass
filter strips are installed where runoff leaves the field. {See FOTG
Standard 393-Filter Strips}
5. Odors can be reduced by injecting the waste or disking after waste
application. Waste should not be applied when there is danger of drift
from the irrigation field.
6. when animal waste is to be applied on acres subject to flooding, it
will be soil incorporated on conventionally tilled cropland. When
applied to conservation tilled crops or grassland, the waste may be
broadcast provided the application does not occur during a season
prone to flooding.
7. Liquid Waste shall be applied at rates not to exceed the soil
infiltration rate such that runoff does not occur off site or to
surface waters and in a method which does not cause drift from the site
during application. No ponding should occur in order to control
odor and flies.
8. Animal waste shall not be applied to saturated soils, during rainfall
events, or when the surface is frozen.

9. Animal waste shall be applied on actively growing crops in such a
manner that the crop is not covered with waste to depth that would
prohibit growth. The potential for salt damage from animal waste
should also be considered.
10. Waste nutrients shall not be applied in fall or winter for spring
planted crops on soils with a high potential for leaching. Waste
nutrient loading rates on these soils should be held to a minimum and
a suitable winter cover crop planted to take up released nutrients.
Waste shall not be applied more than 30 days prior to planting of a
crop or forages breaking dormancy.
11. Any new swine facility sited on or after October 1, 1995 shall comply
with the following: The outer perimeter of the land area onto which
waste is applied from a lagoon that is a component of a swine farm
shall be at least 50 feet from any residential property boundary and
any perennial stream or river other than an irrigation ditch or canal.
Animal waste other than swine waste from facilities sited on or after
October 1, 1995, shall not be applied closer than 25 feet to surface
water. This distance may be reduced for waters that are not perennial
provided adequate vegetative filter strips are present.
12. Animal waste shall not be applied closer than 100 feet from
wells.
13. Animal waste shall not be applied closer than 200 feet of dwellings
other than those owned by the landowner.
14. Waste shall be applied in a manner not to reach other property and
public right-of-ways.
15. Animal waste shall not be discharged into surface waters, drainageways
or wetlands by a discharge or by overspraying. Animal waste may be
applied to prior converted cropland provided it has been approved
as a land applications site by a "technical specialist". Animal waste
applied on grassed waterways shall be at agronomic rates and in a
manner that causes no runoff or drift from the site.
16. Domestic and industrial waste from washdown facilities, showers,
toilets, sinks, etc., shall not be discharged into the animal waste
management system.
17. A protective cover of appropriate vegetation will be established on
all disturbed areas (lagoon embankments, berms, pipe runs, etc.). Areas
shall be fenced, as necessary, to protect the vegetation. Vegetation
such as trees, shrubs, and other woody species, etc. are limited to
areas where considered appropriate. Lagoon areas should be kept mowed
and accessible. Lagoon berms and structures should be inspected
regularly for evidence of erosion, leakage, or discharge.
18. If animal production at the facility is to be or terminated,
the owner is responsible for obtaining and implementing a "closure
plan" which will eliminate the possibility of an illegal discharge,
pollution and erosion.

19. Waste handling structures, piping, pumps, reels, etc., should be
inspected on a regular basis to prevent breakdowns, leaks, and spills,
A regular maintenance checklist should be kept on site.
20. Animal waste can be used in a rotation that includes vegetables and
other crops for direct human consumption. However, if animal waste is
used on crops for direct human consumption it should only be applied
preplant with no further applications of animal waste during the crop
season.
21. Highly visible permanent markers shall be installed to mark the top and
bottom elevations of the temporary storage (pumping volume) of all
waste treatment lagoons. Pumping shall be managed to maintain the
liquid level between the markers. A marker will be required to mark
the maximum storage volume for waste storage ponds.
22. Soil tests shall be made every two years and a liquid waste analysis
be taken at least twice each year consistent with waste utilization
plan. Poultry litter shall be tested prior to application. Soil
and waste analysis records shall be kept for five years.
23. Dead animals will be disposed of in a manner that meets N.C. regulations.

WASTE UTILIZATION PLAN AGREEMENT
Name of Farm: Old Place, BLUE ROSE INC.
Owner/Manager Agreement
I (we) understand and will follow and implement the specification and the
operation and maintenance procedures established in the approved animal waste
utilization plan for the farm named above. 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 certification to be submitted
to the Division of Water Quality (DWQ) before the new animals are stocked. I
(we) also understand that there must be no discharge of animal waste from this
system to surface waters of the state from a storm event less severe than the
25-year, 24-hour storm. The approved plan will be filed on -site at the farm
office and at the office of the local Soil and Water Conservation District and
will be available for review by DWQ upon request.
Name of Facility Owner: BLUE ROSE INC.
Signature:_&J W .pl,C � Date: 0'r
Technical Representative: Tony Short
Affiliation: Natural Resources Conservation Service
Address Agency: P.O. Box 218
Jackson N.C. 27845
Phone: -534- 91
Signature: Date:

[Type of Visit: I4.Co ante Inspection V Operation Review O Structure Evaluation 0 Technical Assistance I
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: 1 T Departure Time: d County:
Farm Name: �(� gose(- t -_ Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone:
Phone:
Integrator:
Certification Number:
Certification Number:
Latitude: Longitude:
Region:
Design Current
Design
Current
Design Current
Swine
Capacity Pop.
Wet Poultry
Capacity
Pop.
C►attie Cap city Pop.
Wean to Finish
Layer
I INon-Layer_
Dairy Cow
Dairy Calf
Dairy Heifer
Wean to Feeder
Feeder to Finish
Farrow to Wean
ighn
Dry Cow
Farrow to Feeder
Dt. P.ouitr.
Ca Veit
P,o
Non -Dairy
Farrow to Finish
I Layers
Beef Stocker
Gilts
Non -La ers
I Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
<NoEE:] NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ 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
o ❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ YesgN/o
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
❑ No ❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412015 Continued

Facili ,Number: - I Date of Inspection: r
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑Yes VNo
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey [:]Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes N ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes N ' ❑ 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
❑ No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
❑ No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
❑ No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
[] No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
0 Yes
❑ No
❑ NA
❑ NE
Comments (refer to;question=#): Explain anytYES.answers _and/or any additionalrecommendations or any other, comments :b� t
Use drawings of facility to better explain situations (use additional pages as necessary). °.
Reviewer/Inspector Name:
Phone: III- Ll wb
Reviewer/Inspector Signature: �� S L. (&Lf (�( C Date:
Page 3 of 3
21412015

fFacility.Number: jDate of Inspection:_
Waste Collection & 'Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate'? ❑ Yes N�6 NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes N❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): t(
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental reat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes N ❑ 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 Al2plication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No - ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application'? If yes, check the appropriate box below. ❑ Yes No [DNA ❑ 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 a ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes E6 y
❑ 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 o ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes No ❑ NA ❑ NE
Reguired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes o ❑ 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 6 No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspection El 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 21412015 Continued

Type of Visit: c0 Cydpliance Inspection V Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit: 6 Routine O Complaint O Follow-up O Referral O Emergency O Other p Denied Access
Date of Visit: I Arrival Time: + Q Departure Time: --1 County: Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Owner Email:
Phone:
Title: Phone:
Onsite Representative: %'', rTw'-, ; l Q S Integrator:
Certified Operator:
Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude: Longitude:
jest 9419,WUrrent Design Current
Capacity Pap. Wet Poultry Capacity Pop.
nish La er
7Eeeder
Cattle
DairyCow
Design
Capacity
Current
Pop.
eder
Non -La er
DairyCalf
inish
Design Current
Dry, P.oult ry Ca aci P.o ..
Layers
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Non -Layers
Beef Feeder
L_j0thcr
Boars
Pullets
Beef Brood Cow
Other.
Turke s
Turke Poults
Other
Discharges and Stream Impact
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 DWR)
❑ Yes
rNo❑ 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
N ❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
❑ 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 21412014 Continued

Facili. Number: jDate of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes No ❑ NA ❑ NE
Structure 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?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
❑ Yes No NA ❑ NE
❑ Yes No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental t eat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes I No NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes ONo ❑ 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 2rNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): 6er it d ��'` h I_66_�_
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[JNo ❑ 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
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?
❑ Yes
�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? 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 No ❑ NA ❑ NE
❑ Waste Application ❑Weekly Freeboard ❑Waste Analysis ❑Soil Analysis ❑Waste Transfers ❑Weather Code
❑ Rainfall D Stocking [:]Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall InspectieNo
Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes❑ NA ❑ NE
Page 2 of 3 21412014 Continued

acili Number: jDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes 6"�❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes 0 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 �Noo
NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ 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
❑ No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
[] No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
❑ No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
[] No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
[] No
❑ NA
❑ NE
Comments (refer to question ft Explain any-.YE&artswers and/or. any additional-'recommendati6nsiorzany other coo' ments
Use drawings of facility to better explain situations use additional pages as.necessa {'
( p g �y)•: f
5 ('J'k 7 9 -15---15'
Reviewer/Inspector Name:
Reviewer/Inspector Signature: C.�, S` ^�. 7d LJ
Page 3 of 3
Phone: 71/- �'ZdQ
Date: ; :1 9 —/ ,.
2/4/2014

Type of Visit: rO Corn ce Inspection V Operation Review U Structure Evaluation U Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit:zi- Arrival Time: Departure Time: County: Region:
I
Farm Name: / in c 4os e- V Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: iYir .f Integrator:
Phone:
Certified Operator: Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Iti
€
Design Current
Design
Current
Design
Current
Swine
Capacity Pop
Wet Poultry
Capacity
Pyop..
Cattle
Capacity
Pop:.
A
IWir""I Pit[c llElld�u�it
ilYi4 (ll it�AK&1l[{f l
�€i€:#; kt[IE16(�YN n. l
il€Yi9i 11
t�l�lill{Itli3f
.0 . a �
ItlYVIIpw tlPNiHEf6 !
7i�IkL M d
Wean to Finish
La er
DairyCow
Wean to Feeder
Non -Layer
DairyCalf
Feeder to Finish
DairyHeifer
Farrow to Wean
Deslgn
Cbrrent�
D Cow
Farrow
Farrow to Feeder
D ,
P,oult
Cana `1
Po .
-Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
Turkey Poults
Other
uwwlwlDMW4WM•NfTn��
�MbfRlwHl�o�tr`[xwur,uiTW�l1l�iLaefRpula+nfwrawWMM11H1L'Wru
Other
€
Dischar es and Stream Impacts
I. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes V /No ❑ NA ❑ NE
❑Yes o ❑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)
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 ❑ NA ❑ NE
❑ Yes o ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Page I of 21412015 Continued

E'acili `Number: op - Date of I ns ection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes No ❑ NA ❑ NE
Structure I Structure 2 Structure 3
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): d
Structure 4 Structure 5 Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
❑ Yes No NA ❑ NE
❑ Yes No ❑ NA ❑ ONE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environment threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes rNo'
❑ NA ❑ NE-
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes ❑ NA D 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 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 `1'ype(s)= d
1� a t in U k 1� g q- '�__ I ':'V
r �
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
Z ❑ 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
No ❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ NA
jNo
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
o ❑ 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 No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ ! 20 Minute Inspections ❑Monthly and ]" Rainfall Inspections ❑Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? [] Yes o ❑ 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 21412015 Continued

' Facility 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 ❑ No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes [] No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No ❑ NA ❑ NE
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
ON E
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
❑ No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
❑ No
❑ NA
❑ NE
❑ 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
❑ No
❑ NA
❑ NE
c kr A 0h lJ-CK2—t CV450n (6 0kC'.
�rL�r I0-r _t =.j7- /!
51t1j51
0 t. j
f,., �_.0q
7-l-.-�0)'7
Reviewer/Inspector Name:
Reviewer/Inspector Signature:�j S � U
Page 3 of 3
;_0 I
Phone: —% � 11,,, L/ So D
Date: 3--0— t-3
21412015

Type of Visit .0 Com ' nce Inspection 0 Operation Review 0 Lagoon Evaluation
Reason for VI, Routine 0 Complaint 0 Follow up 0 Emergency Notification 0 Other ❑ Denied Access
F 1ityNumber Date of Visit.
Not O erational Below Threshold
Permitted DCertifieO 0 Conditionally�-C-e�rtified D Registered Date Last Operated or Above Threshold:
Farm Name: -�L 1'7T —.' l� z/I-- ___ County:
Owner Name:
Mailing Address:
Facility Contact:
Onsite Representative:
Certified Operator:
Location of Farm:
Title:
Phone No:
Phone No:
Integrator:
Operator Certification Number:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' 06 « Longitude 0' 06 Lf
Design
Current' Design Current ad
Design ," Current` '
Swine Capacitv
Population P ultry Capacity Population : Cattle" Capacity Population
❑ Wean to Feeder
10 La er ❑ Dai
❑ Feeder to Finish
JE1 Non -La er x ❑ Non -Dairy
Farrow to Wean
- - . ... _................ ..........
❑ Farrow to Feeder
❑ Other
❑ Farrow to Finish
Total Design" Capacity
` ❑ Gilts
- n
.
' ❑ Boars
,� Total SSLW
Number of Lag Dons
❑ Subsurface Drains Present ❑ Lagoon Area
❑ Spray Field Area
;Holdm Ponds I;Sohd Tra s
g": p
❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. 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/min'?
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?
a t Collectign & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillwav
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Freeboard (inches):�j 't
05103101
❑ YesZ No
❑ Yes VNo
o
El Yes
❑ YesjNo
N
❑ Yes
❑ Yeso
El Yes
Structure b
Continued
e

Facility Number: — Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes o
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes o
(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 N
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ElYesjNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ YesVNo
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes
11. Is there evidence of over application? El Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes
12. Crop type
n
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
❑ Yes
❑ Yes
❑ Yes
❑ Yes
❑ Yes
No
❑ No
❑ No
N
16. is there a lack of adequate waste application equipment?
❑ Yes
No
Reauired
Records & Documents
ZNo
17.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Y
No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
Yes
❑
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
rMo
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
N
23.
Did Reviewer/Inspector fail to discuss reviewlinspection with on -site representative?
❑ Yes
24.
Does facility require a follow-up visit by same agency?
❑ Yes25.
FNo
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
10
No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Contrnents (refer to';gitestion_#) Explain anyYES answchs and/or any recommendations or any tither coinments:
a"drawings of facility tobett ir'explain situations:;(ust additionalpages as -nee"' y) r.
[] Field Copy ❑ Final Not
Ms'
✓� .�-,; �l - Sze - z r� G s p I� y l)M s, s
Reviewer/Inspector Name `"
Reviewer/Inspector Signature: _7 11.16--.1' Date: 3 / / l / 1?
05103101 Continued

Facility Number:6 Date of Inspection L 7
Odor Issues
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 dNo
El;Z
Yes
❑ Yes<No
❑ Yes
❑ Yes
❑ Yes No
❑ Yes o
Additional Comments and/or Drawings:
AL
05103101