760005_INSPECTIONS_20171231

Division of Water Resource
Facility Number ®- D Division of Soil and L�'atcr l_.. servation r*� n
Q Other Agency ►'-t
1'►'pe of Visit: Compliance Inspection 0 Operation Review Q Structure Evaluation p Technical Assistance
Reason fur Visit: �6 Routine Q Complaint Q Follow-up 0 Referral Q Entergency Q Other Q Denied Access
Date of Visit: t1 f Arrival Time: Departure Time:UT= County: t) }j Region: ij SP-b
Farm Nante: +LL<i 'A- w 1ne Farm O►vner Frnail:
Owner Name: _ 1LI nn 62nIr V t n Phone:
Mailing Address: PO rlD l- 1� 3 U . Lr 11P�� �� iN� ••2 7 2- q
111-tvsical Address- Cl ;OL
Facilky Contact: {t {rye rI £��-� 'Title: Phone:
Onsite Representative: Integrator:
Certified Operator: Certification Nurnher:
Back-up Operator: Certification Nuinher:
Location oLocation of [,arm-.`,
Latitude: j T p ,3 LLongitude:c g
uS Aj,,21 J0L7f-h to NC 14 wy Y9 "Z' P Shack ►� �fol �� go
Design Current Design Current
Sw'' b —VQ0 Capacity Pop. Wet Poullry Capacity Pop.
Wean to FinishI Layer
Wcan to Feeder Non —Layer
Feeder to Finish
Farrow to Wean
Z Q
Farrowto Feeder
Farrow to Finish
Gilts
li[lars
Other
Other
Design Current
Dr►• Poultr►' Capacity Pon.
La sirs
Nsm-La ers
Pullcls
'Curke s
Turkey POLllts
Other
Discharues and Stream Impacts
1. 1s any discharge observed from any part of the operation?
Discharge originated at: ❑ Slrucltire ❑ Application Field ❑ (.)lhcr:
a. Was the conveyance man-rnade?
h. Did the discharge reach ►F•aters of the State'? (I f yes. notify D W R)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste tnanagernent system? (If yes. notify DWR)
2. is there evidence of a past discharge trorn any part of the operation?
3. Were there any observahlc adverse impacts or polcnIial adverse impacts to the watcrs
❑I'the State other than from a discharge?
Design Current
Cattle Capacity Pop.
Dairy Cow
[Jain, Calf
Dairy Ileifcr
DryCow
.Non -Dairy
Beef Stocker
Beet' Feeder
Beef Brood Cow
ElYes MIN ❑ NA ❑ Nl:
❑ Yes ❑ No ❑ NIA ❑ NE,
❑ Yes ❑Ito ❑ NA ❑ N I:
❑ Yes ❑ No
❑ Yes �9(No
❑ Yeti x No
❑NA ❑N'1:
❑NA ❑N'F
[] NA ❑ NE
Page 1 (PO 3 21412015 Continmerl

hacilih- ,Number: - Date ur ins ection: OSII�—WDOij
Wattle Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes XNo ❑ NA ❑ NEE
a. It yes, is waste feveI into the structural frechoard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Smicture 4 Structure 5 Structure G
Identifier: L pp()
Spillway?: kZt r
Designed Freeboard (in): �� [In 0* wa_y)
Observed Freeboard (in): 4.3
5. Are there any immediate threats to the integrity of any of the Structures observed? ❑ Yes No ❑ NA ❑ NE
(i,e., large tree~, severe erosion. seepage, etc.)
C, Are [here structures on -site which are not properly addressed and/or managed through a ❑ Yes No ❑ NA ❑ NE
waste management or closure plan'?
If any ufqueStion%4-fi ►►ere answered yes, and the situation poses an immediate public health ur environmen IaI threat, notify MVR
7. Du any of the strucltn'es need maintenance or improvement? Yes ❑ No ❑ NA 0 NF
S. Do any of the structures lack adequate markers as required by the permit? ❑ Yes I ;jrNo ❑ NA ❑ NL
(not applicable to roofed pits, dry stacks, andlor wet stacks) ��``
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement's
14'astc Application
10. Are there any required buffers. setbacks, or compliance alternatives that need ❑ YesXNo ❑ ti'A ❑;tie:
maintenance or improvement?
11. is there cvi[lcnce cif incorrect land application'? If'yes, check the appropriate box below. ❑ Yes �'a ❑ NA ❑ NI:
❑ Excessive Ponding ❑ IIydrauIic Overload ❑ Frozen (;round ❑ heavy Metals (Cu, In, 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 0 Application Outside of Approve[] Area
12. Crop Type(s): r**—
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CA'4 N1P? ❑ Yes 0No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes g.lo ❑ NA ❑ NE
16. Did the facility flail to secure and/or operate per the irrigation design or wettable ❑ Yes Wwo ❑ NA ❑ iNE
acres determination?
17. Does the facility lack adequate acreage for [anti application'?
❑ Yes rNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipmcnc., N6 jsan S 40
Ix Yes ❑ No
❑ NA
❑ NlE
Required Records & Documents
ic). Did the i'aciIity fail to leave the Certificate of Coverage & Permit readily available:' ❑ Yes -(] No ❑ NA ❑ NEE
20. Does the facility fail to have all components of the CAW M11 readily available? If yes. check ❑ Yes I No ❑ NA ❑ Ni;
(lie appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements El ( -)[her:
21 Does record keeping need in provcntcnt? [ryes, the • t riate box below. Yes ❑ No ❑ NA ❑ NE
dvzvz
ste Applicati n '~1'cckly Freeboard 14'a�Anal)— Soil Analysis 0* �:' • •t' -- 'Feather Code
nftll Stacking ❑Crop Yield ❑ 12i1 Minute Inspections onlltly' and 1" ltainiijl! Inspecli[�ns sludge Survey
22. Did the litcilily flail to install and maintain a rain gauge? 0Yes ❑ No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No J�t<.A ❑ NE
Page 2 uf'3 21412015 Continued

I•acilit • Nutnher: - hate of ins tection:Q$ 'gyp
24. Uid the facility fail to calibrate waste app nation equipment as required by the permit? ❑ Yes NNo ❑ NA ❑ NE
25. is the facility out oFcomp] iance with permit conditions related to sludge'? If yes, check XYes ❑ No ❑ NA ❑ NEi
the appropriate box(es) below.
❑ Failure to complete annual sludge sun•ey ❑ 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 documenlation ol'an actively certified operator in charge'?
❑ Yes
IN"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
[XNo
❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time ofthe inspection did the facility pose an odor or air quality concern?
❑ Yes
YNo
❑ NA
❑ NE
If yes, contact a regional Air Quaiity representative immediately.
30, Did the facility tail to notify the Regional 0I'lice of emergency situations as required by the
❑ Yes
�Vo
[] NA
❑ NE
permit'? (i.e.. discharge, Freeboard problems, over -application)
31. Do subsurface tile drains exist at the tacility'? If yes, check the appropriate box below.
❑ Yes
�' o
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted .which cause non-compliance of the permit or CAWMP'?
❑ Yes
N•No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative'!
❑ Yes
C'No
[] NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
�o
❑ NA
❑ N1;
Cominents (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Us
gAra►vings of facility to better explain situations (use additional pages as necessary).
7 F,nt_6 r► n v- vA e r� on ? P6&se. Co n b n ue. ' r r 4 5❑ R erv�.IDa�V-�►n. net'
u -I- u nS I rl to C a i r � 0 add � o+ y\P�d � \&x_ 1r; 'n
s of b rip
a Call lorek_+ oln � ue_ ► n ao tl o(\P1 5R t ab
r s 20l6 -- aot7 5fuA�e 5urveVs o" (t° t,e8 ? -No .
• a ❑ 1-7 5 o t l Not j eA , (h e_C V_ Y, e)6 t-- \J, \ 5 t .
a a. P t erase i n st-d, 0 ro-- a Ole, u. -, rl
a-p p ('t c0*1Vjs d j A ►n crt LoaLst eC,4(� a_t � s E 5
t t� irk & C> ACLp S S Mon-k4^ 5. No -P_y Kr-te A A 1-
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l W Clt 7 te— P Ili Q,0_ -i 01'j j—e—G G �( J� CD le- p D cd
I r
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9V
Naeea c� p y d 90 w tA-P Jjr w .
CAnee__k- 445 4, wzQn to jr►Vx-% h 4
:5n' c e A a o[ .
Reviewer/Inspector Name:
Reviewer/Inspector Signatur
Page 3 of 3
Phone: Jlo --7-7 9� 9
Date: D 9 p 7— a i
21,120! _4

I!
Division of Water Resource
Facility Number © - n Division of Soil and Water Conservation j044 n(
p Other Agency f V ri
i'vpe of Visit: Compliance Inspection 0 Operation Review Q Structure Evaluation (:)Technical Assistance
Reason for Visit: outine Q Complaint O Follow-up ❑ Referral ❑ en ► Other Q Denied Access
I
Date of Visit: Arrival Time:® Departure 'Time: County: Id f hegion:
Farm Name: LS LAj�{Iyj 't. Owner Email:
Owner Name: 'f-{>,tn Phone:
Mailing Address:
Physical Address: `7j4/ -_ J,It7t�l
Facility Contact: (L I LIB LII61 1
Onsite Representative:
Certified Operator:
Title: Phone: A3 tp 31 4-/ -
Integrator: I CC
Certification Number:
Back-up Operator: Certification Number:
Location of Farm: Lat1tude:3S q S14 _3_ 7 14)
us are
Swine
xC)+V_.>y qqe,
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
Layer
Non -La er
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Oilier
Design Current
Dry Pauliry Canacity Pon -
Layers
Non -Layers
FUliet5
TUrkc s
Turkey Poults
Other
Resign Current
Cattle Capacity Pop.
Daia Cow
Dairy Calf
Dairy Heifer
Dry Cow
.Non -Dairy
Beef Stocker
Serf Feeder
Sect' Brood Crow
Discharges and Stream Impacts
1. is any discharge observed from any part of the operation? ❑ Yes No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the Conveyance man-made? ❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes. notify 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 ❑ No
❑ Yes No
❑ Yes No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3
21412014 Continued

F:rcilit►' Number: + - [late of Inspection:
Waste Collection & Treatment
4, Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes W o
a. 11'yes, is waste level into the structural freeboard? ❑ Yes ❑ No
Structure 1 Structure 2
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
❑NA ❑NI:
❑NA ❑NH
Structure 3 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 anchor managed through a
waste management or closure plan?
❑ Yes No ❑ NA ❑ NI:
El Yes �4No ❑NA ❑N1:
if an►• of questions 4-6 we re an.s eyed `es, and the situation poses an immediate public health ur en►•ironmen IaI threat, notif►• MVR
7. Do any ofthe structures need maintenance or improvement') ❑ Yes �4 No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes 5941N
No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet slacks)
9. Does any part cif the waste management system other than (lie waste structures require [] Yeso ❑ NA ❑ NE
maintenance or improvement?
Waste application
10. Are there any required buffers. setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NI:
maintenance or improvement?
1 I . Is there evidence of incorrect land application? I I'yes, check the appropriate box below, ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ 1-1cavy Mcials {CU. Zo. 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 Approved Area
12. Crop Type(s): Z U rj
13. Soil Type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes N No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes �N'o ❑ NA ❑ N1:
16. Did the taCility fail to secure anchor operate per (lie irrigation design or wettable ❑ Yes �No ❑ NA ❑ NE
acres determination?
17. Does the Virility lack adequate acreage for land application'? ❑ Yes �dNo ❑ NIA ❑ N1:
18. is there a lack of properly operating waste application equipnicnt? ❑ Yes Oj4o ❑ NA ❑ NE
Required Records & Doeuments
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NIA ❑ N'E
20. Does the facility fa'sl to have all components of the CAWMP readily available? If yes. check ❑ Yes M No ❑ NIA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping neY�Ieekly
nprovement'? If'yes. cliec irate box belo Yes ❑ Nlo r% ❑ NE
❑ Waste Application Frcebal20
d Wlaste AnaIysi. Soif Analysis s Feather Code
['Rainfall QStocking ❑ Crup Yield Minute [nspecttons Monthly and l" Rainfall Inspections 95ludge Sur-ey
22. Did the facility fail to install and maintain a rain gauge? El Yes .io ❑ NA ❑ NE
23. If'sclected, diet the facility fail to install and maintain rainbreakers on irrigation equipment'? ❑ Yes ❑ No 2g�NA ❑ NI:
Page 2 of.? 21412015 Crr►rti►irred

Facilitv Number: - Date of Inspection;
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes kNo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes 1>(No ❑ NA ❑ NE
the appropriate box(cs) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a 1'DA fi)r 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, aid 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
[XNo
❑ NA
❑ NI:
If yes, contact a regional Air Quality representative immediately.
30. 1)id the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
tdNo
❑ 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
D�No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
DNo
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative'? ❑ Yes No ❑ NA ❑ NI:
34. Does the facility require a follow-up visit by the same agency? ❑ Yes d No ❑ NA ❑ NE
Comments (refer to question 4): Explain any YES answers and/or any additional recommendations or arty other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
?: $ w �s&f " S 2 Kut.1�
X-C, [-7
5. S e-
s ��di q 'tom S J !" Lj V rt�n -� �drr`�2.�n S [ o fl
V•
Soo I fey, c� L' a-c 7,
i Pu rp� ? Y , dn� � rots hoke_'m pi pe -- bZi vj re i ra�
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�
Reviewer/[nspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
phone: 1
ql�Date:
21412014

Ta Division of Witter ResourctIM
Facility Number ®- t7 0 Division of Soil and Water Conservation I 1 4 N
D Other Ageney
Type of Visit:
Compliance Inspection 0
Operation Review 0 Structure Evaluation O'I'echnical Assistance
Reason for Visit: Routine Q Complaint
Q Follow-up Q Referral Q Emergency 0 Other ❑ Denied Access
bate of Visit:
[ Arrival Time: 11 00Departure Time: .S-$-' County:
Region:
Farm Name:
L Q
Owner Email:
Owner Name:
� j ['� � y' L 1l'�L n
Phone:
Mailing Address:
6 Ox
Physical Address: -To--
Facility Contact: [ M V- Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
NCI V_ 7 3 55
r
Phone: — $ "[.7
V Ct? d
Integrator: 0jx0 (V
Certification Number:
Certification Number:
Location of Farm: ].attitude: 135- q1 t(3 Longitude: '7 9 3 7
us saw -4o Ne-, tf wY q s . 2&LV4 G-eet'�- , UL 511-
�b�� RAO
Swine
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
Layer
Non -La er
Wean to Finish
Wean to Feeder
Feeder to finish
Farrow to Wean
D
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
0thcr
You
Pullets
Turkey Poults
Other
Design Current
Discharges and Stream impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b, Did the discharge: reach waters of the State'! (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -pair
Beef Stocker
Beef Feeder
Beef' Brood Cow
❑ Yes [A No [DNA ❑ NE
[]Yes ❑No ❑NA ❑NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes No
❑ Yes No
❑ NA ❑ NE
❑NA ONE
❑ NA ❑ NE
Page 1 nf'3
21412014 Continued

Facilit Number: - Date of Inspection: � U1
Waste Collection & 'Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [No
a• If yes, is waste level into the structural freeboard? ❑ Yes ❑ No
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
Structure 1 Structure 2
'3D
❑NA ❑N1:
❑ NA ❑ NF"s
Structure 3 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 ❑ Nli
❑ Yes yNo ❑ NA ❑ NEI
if any of (Iuestions 4-6 were answered ves, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? } Yes [:]No ❑ NA ❑ NE
K. Do any of the structures lack adequate markers as required by the permit? 7❑� Yes No ❑ NA ❑ NE:
(not applicable to roofed pits, dry stack%, 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 A No ❑ NA ❑ NF:
maintenance or improvement?
1 1. Is there evidence of incorrect land application'' If yes, check the appropriate box below. ❑ Yes ONo ❑ NA ❑ NF?
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground 0 Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lhs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Hare Sail
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop 7'ype(s):
13. Soil Typc(s):
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
(A No
❑ NA
❑ NL
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
lb.
Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
No
❑ NA
ON 1
acres determination?
17.
Does the facility lack adequate acreage for land application?
❑ Yes
XNo
❑ NA
❑ NE
18.
1s there a lack of properly operating waste application equipment?
0Yes
❑ No
❑ NA
❑ NE
Required
19.
Records & Documents
Did (lie facility fail to have the Certificate of Coverage & Permit readily available'?
D. Yes
X,No
❑ NA
❑ NE:
20.
Does the tacility tail to have all components of the CAWMP readily available? If yes, check
[] Yes
RNo
❑ NA
❑ NI ---
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21 )oes record keeping nee91provernent? ❑ Yes DNo ❑ N ❑ NEastc Applicatio eekly Freeboard ��W a�tl [S'til Analysis te- riu r+r Wcather Code
WRairfall locking ❑Crop Yield ❑ 12U Minute Inspections ❑I<rtCmthly and I" Rainfall In ❑Vdge Sunny
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes 6 No NA ❑ NE
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No NA ❑ NE
]'age 2 of 3 21412014 Continued

[Facility Number: 7 - ❑ S � Date of Inspection: Q IS
24. [)id the facility fail to calibrate waste application equipment as required by the permit? 0 Yes MNo
25. is the facility out ❑fcomp] iance with permit conditions related to sludge? If yes, check ❑ Yes �No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
[] NA ❑ NE
❑ NA ❑ NE
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes gNo ❑ 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
]jJ No
❑ NA
❑ NE
and report mortality rates that were higher than normal?
T
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ 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.
Pd Yes
❑ No
❑ NA
❑ NI-
❑ Application Field ❑ Lagoon/storage Pond Other: t0U.] &re&
be-�o rr)
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
9No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency`' ❑ Yes [B No ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
; drawings of facility to better explain situations (use additional pages as necessary).
no
�orf�a-�S ❑��adl Q �01S
r
- m�x+ vis
� aor?
t4 - -'
aLAJ d
nYb-)d►.�. .. sue-Q c�0, �." �r� n��
d �
a
Reviewer/Inspector Name:
Reviewer/]nspector Signature;
1VIA Iry M 40
4 off
1"Lf✓L L�j �5+��'raG Phone: 36 169 1
Date:
Page 3 uf3 z{4/2014

Division of Water Quali>�
Facility Number '`S (� - 0 Division of Soil and Wate pnservation /Qhm
Q Other Agency
Type of Visit: Compliance Inspection 0 Operation Review a Structure Evaluation Q Technical Assistance
Reason for Visit: O'Routine Q Complaint Q Follow-up Q Refcrral a Emergencv Q Other Q Denied Access
Date of Visit: f Arrival Time: Departure Time: County: /?A* C rloh legion: [A_�5AJ3
Fartn Name: 1,- L.5 Sty i n e— Owner Email:
Owner Name: l�l1y� �p 1 {;'t Phone:
Mailing Address: PQ O g( 130 L1,.b?:::K L4 t,� G �L7
Physical Address: 5 .3 q Sh a -AA , Ao i to in 12..c1. cS JZOe._, a 7.3 S '.-"
Facility Contact:1 q , Title: Phone:
- �S9
Onsite Representative: Integrator: e6xo if nQ IQax-4
Certified Operator: Certification Number:
Back-up Operator:
Certification Number:
Location of Farm: Latitude: 35 qg q 3 Longitude: 11 3 7 3!?
V sb:7 1 -ta NA!_, qWy q1 5, Ga-hC } 6no—e—te— UL 5aA/,/ 1`CtvL,
Design Current
Swine Capacity Pop.
Wean to Finish
Wean to Feeder
Feeder to Finish
TK
Farrow to Wean
C:O
1 1 710
Farrow to Feeder
Farrow to Finish
D,Il t
Gilts
Boars
Other
Other
Design Current
Wet Poultry Capacity Pop.
La er
Non -La er
Fak�'$VCfA; Design Current
Dry Poultry Capacity Pop.
L
ay ers
Non -Layers
Pullets
Turkeys
I urkeX Poults
Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes. notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
Ilesign Current
Cattle Capacity Pop.
Dairy Cow
Dairy Call'
Dairy Heifer
Dry Cow
.Non -Dairy
Beef Stocker
Becf' Feedcr
Beef Brood Cow
C] Yes �<No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
(I. Does the discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes ❑ No ❑ NA ❑ NE,
2. Is there evidence of a past discharge from any part of the operation'? ❑ Yes o ❑ NA ❑ NI:
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes tNo ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

Facilit y Number: - 0 c7dj& 1 Date of Inspection: q IWO
Waste Collection & 'Treatment qV
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
Oyes
❑ No
❑ NA
[] NE
a. If yes, is Haste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure l Structure 2 Stnreture 3 Structure 4
Structure 5
Structure 6
Identifier: AQCY'rj
Spillwuy'?: ��
Designed Freeboard (in):
Observed Freeboard (in): rZ —7
5. Are there any irnmcdiate threats to the integrity of any of the structures observed'?
❑ Yes
CdNo
[] 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
PfNo
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, And the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? X Yes ❑ No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require 10s No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need [] Yes �5 No D NA ❑ NE
maintenance or improvement?
i 1. Is there evidence of incorrect land application? If yes, check the appropriate box below. Yes ❑ No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ I [eavy 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 'I'ype(s):
14. Do the receiving craps differ from those designated in the CAWMP?
❑ Yes
D�No
❑ NA
[] NE
15. Does the receiving crop and/or land application site need improvement?
D4'Ycs
0 No
❑ NA
❑ NE
16, Did the facility fail to secure and/or operate per the irrigation design or wettable
[] Yes
No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
�IrNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
5$No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
4�fNo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
WNo
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21, Does record keeping need i provement?
��il
❑YesNa}
❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard � Waste Analysis Analysis
S Viest- Transfers
❑ Weather Code
Q Rainfall Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
[Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
Wo
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[P'No
❑ NA ❑ NE
Page 2 of 3
21412011 Continued

]Facility Number: - slate of Inspection: j r
24. Did the Facility tail to calibrate waste application cquipincnt 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 X
No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26, Did the facility fail to provide documentation of an actively certified operator in charge?
[] Yes
[� No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
No
❑ NA
❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
�] No
❑ NA
❑ NE
and report mortality rates that were higher than normal?
I�
29. At the tirne of the inspection did the facility pose an odor or air quality concern?
❑ Yes
6dNo
❑ 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
O/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: Lo vJ &-re4 ark A 0.5 fu
r9_
32. Were any additional problems noted which cause non-cornpliunce of the permit or CAWMP?
❑ Yes
gNo
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
JM'No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
P�No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
XA3 C&(LbrQj�a) cm e CL5 or-Q, bare. w' Loj i
, �• da3 Sluci 'oe. � r7 �7
'jar II 1 C ��{j 5 �U C�Q�.� S, fv�L L'OI, ot- • (� i'11C�
3 [ r C who_ n 5bu
CC Corr `ze-t-e_J W 512 o re. q ra.r a t n l h t 4 h 4�Qe_(aoxl-& M a t n ''`} ; �N 6
ji 76 fb5.N/t000TDp
�1s as 37 q 55_
Reviewcrllnspector Name:
r
Reviewcrllnspector Signature:
Page 3 of 3 0 b—) 2 it rj 7r C -!AItt) L bAkk l 10-A
Phonc: 7 -7 5,- Sol
Date: q
21412011
ezvpI!a Y) C P,

a
Division of Water Quality
Facility number 1� - Division of Soil and Water
0 other Agency
10AM
Type of Visit: Compiiance Inspection operation Review Q Structure Evaluation p Technical Assistance
Reason for Visit: 4 Routine 0 Complaint Q Follow-up o Referral o Emergency Q Other o Denied Access
Date of Visit: Q Arrival Time: Departure Time: County: P..ZXtNdO P} Region: W 5)2.0
Farm Name: lC L 5 S w t In q- owner Email: } +
Owner Name:! t` t C twin - — -- Phone:
I
Mailing Address: P Q ROY, 2 0 G j hper- 'V-14 � r✓ � 7
Physical Address: 5 Z39 5InoA!q 146_cvj � j`a u mCi �L 7•3-S-S-
Facility Contact: 1 t I Title: Phone:
Onsite Representative: I Integrator: G&-r o l [ ho, H 6wa_rd
Certified operator: W Certification Number -
Back -up Operator:
Certification Dumber:
Location of Farm: Latitude:. .S ` 9 q -3 longitude: -7 R .3 -7 3 r
u 5 ► S to +- LL C"' ey- P-
S 0,1(o0
Swine
Design Current Resign Current
Capacity Pop. Wet Poultry Capacity Pap.
Layer
Non -La er
Wean to Finish
Wean to Feeder
}'ceder to Finish
Farrow to Wean
Z
s
Farrow to Feeder
3100
Farrow to Finish
le.
GiIts
Boars
Other
Other
Sow 5
Dry Poultry
ES Layers
Non -Layers
Pullets
Turkeys
Turkev Poults
Design Current
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? (Ifyes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system'? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes ®"No ❑ NA ❑ NE
❑Yes ❑No ❑NA ❑NE
❑Yes ❑No ❑NA ❑NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
ErNo
❑ NA
❑ NE
❑ Yes
Ea'No
❑ NA
❑ NE
Page 1 of 3 21412011 Continued

Facility dumber: - ❑ Date of Inspection:
Waste Collection & 'Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes WNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: L& Don
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Arc 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 (here 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 ar environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? �d Yes [—]No ❑ NA ❑ NE
S. Do any of the structures lack adequate markers as required by the permit? ❑ Yes C�fNo ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks) �J
9. Does any part of the waste management system other than the waste structures require ❑ Yes { }i No ❑ NA ❑ NE
maintenance or improvement? '7"`
_Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes X
No❑ NA ❑ NE
maintenance or improvement'?
11. Is there evidence of incorrect land application? if yes, check the appropriate box below. 0 Yes��o
❑ NA ❑ NE
❑ Excessive Pending ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > l0% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil s
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s): v
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes t4 No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes OdNo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes ONo ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application? ❑ Yes [S� No ❑ NA ❑ NE
I S. Is there a luck of properly operating waste application equipment'? Yes ❑ No ❑ NA ❑ NE
Required Records & Documents TT
19. Did the f rcility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes � No ❑ NA ❑ NE
20. Does the facility fail so have all components of the CAWMP readily available? If yes, check ❑ Yes j�'No ❑ NA ❑ N1's
the appropriate box. T�
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements []Other:
21 Joes record keeping ne�1)
nprnvement`? [f'y-mod ❑Yes ] No ❑ A ❑ NE
Waste A lie tioneekl Freebear V+'aste Anal sis Soil Anal sis ' Weather Code
pPY Y Y
Rainfall [Stocking rop Yield [2D Minute Inspections Monthly and l" Rainfall inspections lodge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes JRNo ❑ NA ❑ Nf;
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No IX NA ❑ NE
Page 2 of-3 21412011 Continued

Facility Number: Date of Inspection: a
24. Did the facility mail to calibrate waste appli
CR. equipment as required by the permit? ❑ Yes No ❑ NA ❑ Nf:
25, Is the facility out of compliance with permit conditions related to sludge'' if yes, check ❑ Yes ❑ No [] NA N'NE
the appropriate box(cs) below.
[] Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structurc(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an activeIy certified operator in charger ❑ Yes XN1 o 0 NA ❑ NE
27. Did the Facility fail to secure a phosphorus loss assessments (PLAT) certification'! ❑ Yes M1 No N NA ON 11
Other Issues
29. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes >rNo ❑ 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
ONo
❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the faacility fail to notify the Regional Officc ofcmergency situations as required by the
[:]Yes
P(No
0 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,
�cs
❑ No
❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond � Other: L p i,.5 ��4 r v,,
QQ5 +L-) re.
32. Were any additional problems noted which cause non-compliance oFthe permit or CAWMP?
❑ Yes
[x No
❑ NA ❑ NIE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
C%No
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Ycs
�Q 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).
ease Can $-i h U e.-
a0 L3S. v ZOt3 K0i-
` Y ��, ' ' f - UJ U 7 N o„
�. ❑an 1 e,v�� �boY e. IY10.yL d��'�,� ��CC?SS t Ve- Uoun y
m ►ivy ems- . N o
y
L,4 u aarId,
Reviewer/Inspector Name:
Reviewerdnspeclor Signature:
Page 3 eif'3
73.
taL* IPO/
o[a o
Q � a � 13
1.30
Phonc:
ICJ Date: q_/ g /go o
21412011

U Division of Water Quality
Facilit►° Number ®- D Division of Soil and Waterl-Psen•ation
p Other Agency
Type of Visit: Compliance Inspection 0 Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: (VRoutine Q Complaint ❑ Follow-up Q Referral Q Emergency (:)Other a Denied Access
Date of Visit: ❑ rrival Time: Departure Time:�,�:ounty: egion:
Farm Name: ILLS StUj ner Owner Email:
r A
Owner Name: ]r I Eau— _ _ _ _ Phone: (e Sq� Lw)
Mailing Address: PO PjL&. 0 U h-erlU _PC- a 7 Xq g�
Physical Address: c�•944 �75 �J
Farilit► Contact: A & E&4� Title: Phone:0.
❑nsite Representative:! yj� , Integrator:��j
Certified Operator: Certification Number: �
C Iri +1 ne.. .
Back-up Operator: Certification Number:
Location of Farm:
us 4 a I S.
1-0 113C. 1
Le f + 6 S
Design Current
Swine Capacity Pup.
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Latitude:
qq S � gi sin ri
Design Current
Wet Poultry Capacity Pop.
La er
Non -La er
Design Current
Dry Poultry Canacitv Pon.
Layers
Non -Layers
Pullets
Turkeys
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field [] Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (Ifyes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge frorn 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?
Longitude:
hf o W
Design Current
Cattle Capacity Pop.
Dairy Cow
Daia Calf
Dairy Heifer
Dry Cow
Non-Dai
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yeso ❑ NA ❑ NI:
❑Yes No ❑NA ❑Nl;
❑Yes No ❑NA ❑Nl:
❑Yes
❑No
❑NA
❑NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
Page I of 3 21412011 Cwrri►rued

Facility Number. - Date of Inspection: ;)Q
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes j�'y� No ❑ NA ❑ NE
a. if yes, is waste level into the structural freeboard`? ❑ Yes TT❑''�� No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier;
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): -�
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes t%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 XNo ❑ NA ❑ NE
waste management or closure plan`'
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notifv DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes )<No ❑ NA ❑ NE
9. 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 PNo D NA ❑ NE
maintenance or improvement?
Waste Anntication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes Wo ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? if yes, check the appropriate box below, ❑ Yes X"No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN a 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure. to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidcnce of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): r j r Z s
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the f icility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18, is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available'? If yes, check
the appropriate box.
❑ Yes
C& o
❑ NA
❑ NE
"Yes
❑ No
❑ NA
❑ NE
[]Yes
N"
❑NA
❑NE
❑ Yes XNo
❑ Yes '&J'$40
❑ Yes Dj�`No
Yes DVo
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE:
❑ W UP [:]Checklists ❑ Design , ❑ Maps ❑ Lease Agreements ❑Other;
2 , Does record keeping need i rovement? ❑Yes oYM,
A ❑ NE
Waste Applic• ion"ekly Frcebo ?d Waste Analysis Soil Analysis seather Code
Vainf ll [Stocking Crop Yield I2Q Minute Inspections 004onthiy and l" Rainfall Inspectionsc Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes >(Na ❑ NA ❑ NE
23. If selected, did the facility foil to install and maintain rainbreakcrs on irrigation equipment? ❑ Yes fNo ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: - Date of Inspection; p
24. Did the facility fail to calibrate w"apption equipment as required by the permit? ❑ Yes No ❑ NA ❑ NI's
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 ch;srge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the tirne 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.
0 Application Field Cl Lagoon/Storage Pond ❑ Other:
❑ Yes
d No
❑ NA
❑ NE
❑ Yes
[g No
❑ NA
❑ NE
❑ Yes
5�No
❑ NA
❑ NE
❑ Yes oNo ❑ NA ❑ NE
❑ Yes [XNo ❑ NA ❑ NE
Oyes ❑ No ❑ NA ❑ NE:
32. Were any additional problerns noted which cause non-compliance of the permit or CAWM1'? 1$ Yes
❑ No
❑ NA
❑ N1:
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes
;< No
D NA
❑ NE
34. Does the facility require a l'ollow-up visit by the same agency? ❑ Yes
VNo
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Usejdkawings of facility to better explain situations (use additional pages as necessary).
Fl e_I d ! a�.+re_' I�oo it ---*?qu
o41 cld rest ucior l
a/131a-oU = ASS I.io lb-s./V/(Ooo�O-Q-
n 0
U Q`
..., � -a Ukd*-- -t"A.a..ao -two
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3of3
QO
Phone: Y — I
Date: 'A d l
214120!

CA. t n.5 j2e"Oij3.23 a
Division of Water Quality
Facility Number - 0 Division of Soil and Water 0-servation
Q Other Agency
I'ype of Visit: P
Compliance Inspection 0
Operation Re►•ie►v Q Structure Evaluation
Q Technical Assistance
Reason for Visit:
Routine Q Complaint
Q Follow-up n Referral Q Emergency
Q Other 0 Denied Access
Date of Visit: Arrival Time:'= —� Departure Time: County: Region: It—ASP-0
Farm Name: ]L LS 5 it;� h � Owner Email:
Owner Name: ' . Phone:' 4%q
Mailing Address: P 0 py-
Physical Address: � a3 q S h &AV Hof ktj tzd
a
Facility Contact: KI �1 f'itle:
f, .
Onsite Representative: �I�:-� ri L t- II _ -
Certified Operator: _ �L�UR60 r I � �; yt
[lack -up ❑perator-
+a l.eq A)C ,-L73 s 5-
Phone: L-n 9 L(qL
Integrator:
Certification Number:
Certification Number:
Location of Farm: Latitude:- 3 5� iq� , q 3 Longitude: - _1 ► 3 -1 , 3
US 4 � 1 S . r o fv w qq S , try r>~� rid h+�-f � �'►� j�-+rl
O e_ta 1L- U&Vt a i\+o 611a. 146110cJ .
Swine
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
Layer
Non -La er
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Design Current
Dry Poultry Capacit► Pon.
Laye rs
Non -Layers
Pullets
Turkeys
Turkey Pol1Its
Other
Discharges and Stream Impacts
1. Is any discharge observed froth any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of she State other than from a discharge?
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy IIeifer
Dry COW
.Non -Dairy
Beef Stocker
Beef Feeder
Beef [hood Cow
❑ Yes �'Vo ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes [] No
❑ Yes ❑ No
❑ Yes No
❑ Yes j No
❑NA ❑N1;
❑NA ❑NE
❑ NA ❑ N1;
❑ NA ❑ NE
❑ NA ❑ NI:
Page I of 3 21412011 Continued

Facility Number: 10 - Date of Inspection:
Waste Collection & 'Treatment
4. Is storage capacity (structural plus storm Storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural f'rccboard?
Identifier:
Spillway?:
Designed Freeboard (in):
Structure l Structure 2
r
Structure 3 Structure 4
❑ Yes
Structure 5
U-'No ❑ NA ❑ NE
❑ No ❑ NA ❑ NE
Structure b
Observed Freeboard (in): 3 A
5. Arc 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.)
G. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes MNo ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify ❑WQ
7. Do any of the structures need maintenance or improvement?
wYcs ❑ No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes �No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures
require ❑ Yes"`'
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes JoNo
❑ NA
❑ NE
maintenance or improvement?
11, Is there evidence of incorrect land application? if yes, check the appropriate box below. ❑ Yes PNo
❑ NA
❑ NI:
❑ Excessive Pending ❑ l lydraulic Overload ❑ Frozen Ground
❑ 1lcavy Metals (Cu. Zn, etc.))''��LL
❑ 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, ❑o the receiving crops differ from those designated in the CAWMP`! ❑ Yes No ❑ NA ❑ NE
15. hoes the receiving crop and/or land application site need improvement? ❑ Yes WNo ❑ NA ❑ NE
16, [lid the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes DjrNo ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application'!
❑ Yes
C6 No
❑ NA
❑ NE
18. 1s there a lack of properly operating waste application equipment?
❑ Yes
7R(No
❑ NA
❑ NE
Required Records & Documents
lq. Did the facility Fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
b(No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWM1' readily available? If yes, check
❑ Yes
�eo
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑C:hccklists 0 Design ❑ Maps ❑ Lease Agreements ❑Other:
21. )oes record keeping neVWeckly
provement? ❑ Yes No }CIA ❑ NE
'ante Applica in Freeboard ❑Waste Analysis oil Analysis Weather Code
waste
Stocking WropYicld ❑ 120 Minute Inspections Monthly and 1" >Zainfitll Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes W No �'NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No [Z NA ❑ NE
1'age 2 of 3 21412011 Continued

Facility :Number: - Date of Inspection:
24. Did the facility fail to calibrate waste a4pnrpation equipment as required by the permit? ❑ Yes ] No [] NA ❑ NI:
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 Elie iIity fait provide documentation of an actively certified operator in charge'? ❑ Yes gNo ❑ NA ❑ NI's
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [� No ❑ NA ❑ NEi
Other Issues
2& Did the facility f sil to properly dispose of dead animals with 24 hours and/or document [:]Yes KNo ❑ 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 ❑ NI:
Il'yes, contact a regional Air Quality representative immediately.
30. Did the facility I'd] to notify the Regional Office of cinergency situations as required by the ❑ Yes "'''�No ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application) TTT
31. Do subsurface tiic drains exist at the facility? If yes, check the appropriate box below. ❑ Yes ;RrNo ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ® Other: nn i
32. Were any additional problems noted which cause non-compliance of'th'e era t w4m,
P? ❑ Yes XNo ❑ NA ❑ NE
33. Did the Revicwcr/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes C� No ❑ NA ❑ NE's
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).
711 ?d�— Ibl�
,�� •�-1 i b C'r�.� ors �] � �. � � �� � � . ��� � .
t.3
�{�rxt 3'x ►�lI ����d�y�
tA
PLA�)
Name:
Reviewer/Inspector Signature:
Page 3 of 3 F_
mi d i.CJ
■� ��I..��L. .� . Lam_ , �J
� M
gate: 11 I
2 �U1I

gDivision of Water Quality
Facility Number Division of Soil and Water Conservation
Q Other Agency : Z to_.:7"'�
Type of Visit
Compliance Inspection
Q Operation Review Q Structure Evaluation
O Technical Assistance
Reason for Visit
Routine Q Complaint
I
Q Follow up Q Referral Q Emergency
Q Other ❑ Denied Access
Date of Visit- f Arrival Time: ® Departure Time: County: QkrJdjQ Region; L.�I�
Farm Name: ILLS 5.iu w % Owner Email:
/� t ❑ �w C)wncr Namc: _l�l j[j� l �J r1��is�l3 ll,w, A Phone: ._�fJ�
Mailing Address: T O boy_"13_01 1 Jl f Vl� a 7 a
Physical Address: t] t ILu ' ► �� { �-1 r� vZ ��
Facility Contact: — _Kum 1:11 ��_ Title. Phone No: i cJ
Onsite Representative: l I�1 ` & ri i-7 Integrator: xc i.- flnuiq=c_
�I�, 1` t P
Certified Operator: _ 1 ['r5 ri Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
�
Location of Farm: Latitude: o �--d Longitude: o
S �} al So h -}m �� • y `� ` d- fuf-n +ri q h f . Q� h�- olnta
�J
� - f uc , Le_�i ov0 -6 S p� old o tJ .
Swine
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ l.avcr �
{ ❑ Nan -La er I I I
❑
Wean to Finish
❑
Wean to Feeder
❑
Feeder to Finish
[-arrow to Wean
Farrow to Feeder
❑
Farrow to Finish
❑
Gilts
❑
Boars
Other, .
❑ Other I
Dry Poultry
❑ Lavers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkcx 11oults
❑ Other
I)ischarzes & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at. ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
.Design
Cattle '' Capacit
❑ Daily Cow
❑ Dairy Calf
❑ Dai ycifci
❑ Dry Cow
❑ Non -Dal
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
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?
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ N IE'
❑ Yes
❑ No
❑ NA
❑ NE
❑Yes
P.Na
❑NA
❑NE
3. Were there any adverse impacts or potential adverse impacts to (lie Waters of the State
other than from a discharge?
❑ Yes No Cl NA ❑ NE
12128104 Continued

Facility tiunahcr: — Q 16 hate of Inspection 13
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate'?
Yes ❑ No
❑ NA
❑ NI:
a. If ycs, is waste level into the structural freeboard?
Yes ❑ No
❑ NA
❑ N I;
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Stncture
b
Identifier: LoLamn
Ij
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Ycs No
ElNA
❑ NE
(ic/ large trees, severe erosion, seepage, etc.)
b. Are there structures on -site which are not properly :addressed and/or managed
Yes ❑ No
❑ NA
❑ NI;
through a waste management or closure plan?
I
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? )� Yes ❑ No ❑ NA ❑ NI
K. Do ;any of the stuctures lack adequate markers as required by the permit? XYeZjNo ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. hoes any part of the waste management system other than the waste structures require ❑ Yes ❑ No ❑ NA ❑ N13
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance altematives that need ❑ Yes No ❑ NA ❑ NEi
maintenancch mprover rent?
11. Is there evidence of 'incorrect application? If yes, check the appropriate box below. ❑ Ycs No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN 7 I01V%, or 10 lhs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence rof Wind Drift ❑ Application Outside of Area
12. Crop type(s) r421,
13. Soil type(s)
14• Do the receiving crops differ from those designated in the CAWMP?
XYes
❑ No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre
determination?❑ Yes
No
❑ NA
❑ NE
17. Does the faciiity lack adequate acreage f'or land application?
❑ Yes
Oo
❑ NA
❑ NE
1 X. is there a lack of properly operating waste application equipment?
❑Yes
No
❑ NA
ElNE
Comments (refer tip question #): Explain any VES answers and/or any recommendations or any other comments.
Use dr2wings of facility to better explain situations. (use additional pages as necessary):
. G kL m� ?
� Cu-* � .Q,o}
A,t!a�i-
a
r.R co r�-P. S �,Oh+ kiA te-c� spe( ►a�
Reviewer/[nspector Name
(' Phone: � —
Reviewer/inspector Signature:
Dale:
rati
I " - - 12/28/04 Co►rti►aued

Facility Number: — 6 0 of Inspection
Required Records & ❑ocuments.
19. 1)id the facility flail to have Certificate of Coverage be Pemiit readily availahle? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAG' IMP readily available? If yes, check [] Yes No ❑ NA ❑ N I
the appropriate box. ,
ElW UE El Checklists El Design ❑ ,daps ❑ Other
21. Does ecord keeping need i provement? 1 ❑ Yes No ❑ NA ❑ NP
ante Applicat' rn Zee ly Freeboard Waste Analysis Soil A lysis 'Vaste Transfers
Rainfall Stocking L� Crop Yield 12i] Ivlitiute [nspcctiotis Monthly attd l" Rani Inspections G'v'catlicr Cnde
22. Did the facility fail to install and maintain a rain gauge?
23. 1f selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24, Did the facility fail to calibrate waste application equipment as require(] 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 ccrtificd operator in charge'?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Offier [%sues
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 1 . Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (iel discharge, freeboard problems, over application)
32. Did Reviewerllnspector fail to discuss revicwlinspection tivith an on -site representative?
33. Does facility require a follow-up visit by same agency'?
Comments andlo:• Drawings:
❑ Yes *5No
❑ Yes X No
❑ Yes PfNo
❑ Yes No
❑ Yes No
❑ Yes YNO
❑ NA ❑ Nl:
❑ NA ❑ N E"s
❑ NA ❑ Nl:
❑ NA ❑ ,Nli
El NA ❑Nl:
El NA ❑NE
0 Yes ❑ No ElNA [I NE
El Yes 6No ❑NA ❑NE:
❑ Yes ® No ❑ NA ❑ NEI
❑ Yes 9 No ❑ NA ❑ N E
❑ Yes N(No ❑ NA ❑ Nl:
❑ Yes M Na ❑ NA ❑ Nei
a�. C-OL roj�o
a.0 0� So � j �-e5-- res u k+S � � �-�-
S-- Conk LP-�ed �o U- a 609 y e S• o�- u e- 0.q �X - rA u n �-1 a o �3 Q
NUA -1-� CLA
�14/ to , . a i �5. N Mo
Page 3 uy'3 121128104

0
•
�F VJATFRpG Incident Report
fl
(`} Y
J �
-a
Report Number: 201001658 if\
rb � J �,�` 0� PC C)S- Qo
Incident Type: Nan -Compliance Reporting
On -Site Contact:
Category: APS -Animal
First/Mid/Last Name.
Incident'S6a ted� 0112512010
Company Name:
County: Randolph
Phone:
City: Staley
PagerlMobile Phone:
1
Farm #: 076-0005
Responsible Party:
Reported Sy:
Owner:
First/Mid/Last Name:
GPermit:;+j AWS760005
Company Name:
Facility: KLS Swine Farm
Address:
First Name: Kim
Middle Name:
City/State/Zip:
Last Name: Griffen
Phone:
Address PO Box 130
Pager/Mobile Phone:
I
City/State/Zip: Liberty NC 2729801
Phone:
Material Category: Estimated Qty: UOM
Chemical Name
Reportable C1ty. lbs. Reportable C1ty. kgs.
DD:MM:SS Decimal
Latitude:
Longitude:
Location of Incident: Shady Ilollow Road
Address:
City/State/Zip
Position Method:
Position Accuracy:
Position Datum:
Report Created 05114/10 01:25 PM Page I

r
s
Cause/Observation:
Action Taken:
Incident Questions:
Did the Material reach the Surface Water? Unknown
Surface Water Name?
Did the Spill result in a Fish Kill? Unknown
If the Spill was from a storage tank indicate type.
Containment? Unknown
Cleanup Complete? Unknown
Water Supply Wells within 1500ft
Access to Farm
Structure Questions
Unknown
Directions:
Comments:
Animal Population
Conveyance-.
Estimated Number of fish?
(Above Ground or Under Ground)
Groundwater Impacted : Unknown
0 Spray Availability
Report Created 05/14/10 01:25 PM Page 2

0 •
Access to Farm
Farm accessible from the main road? ❑ Yes ❑ No ❑ NA ❑ NE
Animal Population
Confined?
❑ Yes ❑ No ❑ NA ❑ NE
❑epop?
❑ Yes ❑ No ❑ NA ❑ NE
Feed Available? ❑ Yes ❑ No ❑ NA ❑ NE
Mortality? ❑ Yes ❑ No ❑ NA ❑ NE
Spray Availability
Pumping equipment?
❑ Yes ❑ No ❑ NA ❑ NE
Available Fields?
❑ Yes ❑ No ❑ NA ❑ NE
Structure Questions
Breached?
Inundated?
Overtopped?
Water an outside wall?
Poor dike conditions?
Waste Structure Type Waste Structure Identi inches Plan Due Date
Lagoon LAGOON 16A0
Event Type Event Date Due Date
Incident closed
Requested Additional Information
Report Received
Referred to Regional Office - Primary Contact
Report Entered 2010-05-11 01:26:11
Incident Start 2010-01-25 08:00:00
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ N❑ ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Plan Recieved Date Level OK Date
Comment
Report Created 05/14/10 01:25 PM Page 3

Standard Agencies Notified:
Agency Name Phone First Name M.I. Last Name Contact Date
Other Agencies Notified:
Agency Name Phone First Name M.I. Last Name Contact Date
DWQ Information:
Report Taken By: Report Entered By: Regional Contact:
Melissa Rosebrock
Phone:
DatelTime: 2010-05-11 01:25:11 PM
Referred Via:
Did ❑W❑ request an additional written report?
If yes, What additional information is needed?
Report Created 05/14/10 01:25 PM Page 4

m
TDi►'ision of Water Quality '
Facility' °(�e 9
umber Division of Soil and Water Conservation
Q Other Agency
lType of Visit C mpliance Inspection ❑ Operation Review ❑ Structure Evaluation ❑Technical Assistance
ReasonforVisit WRoutine ❑ Complaint ❑ Follow up ❑ Referral Q Emergency Q Other ❑ Denied Access
Date of Visit:
Arri►�al'l'ime: '
Departare'f'irne: County:2fi
Region: --LL?
Farm Name: �L�.�
1 [ ► nPr
_ Owner Email:
Owner Name: _ �t, I nUL_
�n I"�, i" ��
Phone: 2
v►�
Mailing Address: P0 t `y0-
Physical Address: r r I
Facilitv Contact: 1/ „nA G It [ t-F ' ( __ 'l'itle:
Onsite Representative:
Certified Operator: k YvxQ-�
Back-up Operator:
Integrator* xe, ■6 up s t:a.
Operator Certification Number:
Back-up Certification Number:
Location tit' harm: _ ° t-3 `�
[,altitude: [�onl,itude:
on +n Sanr t_. (b P. P Y-- • ( _e 4 n n fo 5h bAw. Ho
Swine
Design Current Design Current
Capacity Population Wet Poultry Capacit►' Population
❑ l,a cr
❑ Non -laver I EE1
❑
Wcan to Finish
❑
Wean to Feeder
Ez,eder to Finish
Farrow to Wean
Farrow to Feeder
❑
Darrow to Finish
❑
oilts
❑
Boars
Other
❑ Other
Dry Poultry
ElLayers
El
Non -Lavers
El
Pullets
❑
Turkeys
El
Turkey Poults
❑
Other
❑ischar�es & Streain Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: El Structure El Application Field El Other
a. Was the conveyance man-made'?
Design Current
Cattle Capacity Population
El
Dairy Cow
ElDairy
Calf
ElDai
IIeifer
El
Dry Cow
❑
Non -Dairy
❑
Beef Stocker
El
BeefFeeder
El
Beef Brood Cow
h. Did the discharge. reach waters orthe State'? ([ryes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)'?
Number of Structures:
d. Does discharge bypass the waste management system`? (Ifyes. 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 ;x No ❑ NA ❑ NE
❑Yes
❑No
❑NA
ONE
❑ Yes
❑ No
❑ NA
*0 NI:
❑ NA
❑ NE
❑ Yes
❑ o
❑ Yes
o
❑ NA
❑ N E
❑ Yes
No
❑ NA
[I NE
12128104 Continued

Facility Number: -1—() Date of inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. I1'yes, is waste leveI into the structural freeboard?
Structure l Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any imnicdiate threats to (lie integrity of any of tlic structures observed?
(iel large trees. severe erosion, seepage, etc.)
G. Are there stntctures cm -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes �N. ❑ NA ❑ NE
[]Yes ❑ No ❑ NA ❑ NE3
Structure 5 Structure b
❑ Yeti �fNo ❑ NA ❑ NF
�cs
❑ No ❑ NA ❑ NE
If any of questions 4-6 were ans►►ered yes, and the situation poses an immediate public health or environmental threat, notify ❑WQ
7. Do any of the structures need maintenance or improvement? ayes ❑ No ❑ NA ❑ NL
K. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yeti F°k <) ❑ NA ❑ NI:
(Not applicable to roofed pits, dry stacks anchor wet stacks)
9. Does any part of the waste management system other than the waste structureS require ❑yes No ❑ NA ❑ NI;
rnaintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes p4o ❑ NA ❑ NE
maintenaticelimprovement?
11. is there evidence of incorrect application? Ef yes, cheek the appropriate box below. ❑ Yeti 5 No ❑ NA ❑ NI
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate ManurelSludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ F. idence of'Wind tariff ❑ Application Outside of Arca
12. Crop type(s)
13. Soil type(s)
14, Do the receiving crops differ from those designated in the CAWMP? ❑ Yes 16vo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination? ❑ Yes
17. Does the facility lack adequate acreage for land application? ❑Yes
18. Is there a lack of properly operating waste application equipment?
❑ Yes
"No ElNA El
No ❑ NA ❑ NF
❑ El NA ❑NE
Na ❑NA ❑NE:
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings (if facility to better explain situations. (use additional pages as necessary):
1 �' ■+ j ff I �� 1�
Reviener/Inspector ,Name 1 Phone: i1 ! 1 —,5 �T
i�cvienerllnspect❑r tiil;naturc: fl/I®' 1 � 0 k A7 Date: in ),-:so i t)g

Facility Number: — Date of inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes E , Nq ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available'? If yes, check ElYes No ❑ NA ❑ NE
the appropriate box. ,
❑ V+ UP El Checklists ❑ Design El Maps ❑ Daher
21. Does cord keeping need7impee,ement? I}+es-o#te �es ❑No ❑NA ❑NE
W ste Applic ion
Freeboard Waste Analysi oil Analysis rs
1�ainfall [! Stacking Yield 120 Minute Inspections onthly and I Rain Inspections 'rather Cock
22. Did the facility flail to install and maintain a rain gauge? ❑ Yes �No ❑ NA ❑ NE:
.23. 1f selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No �(NA ❑ NI
24. Did the facility fail to calibrate waste application equipment as required by the permit? Cl Yes o ❑ NA ElNf?
25. Did the facility fail to conduct a sludge survey as required by the permit? ElYes `o ❑ NA ❑ NI;
26. Did the facility fail to have an actively certified operator in charge? ❑ Yes XNo ❑ NA El NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? El Yes VNo ❑ NA ❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CA WIMP? qiJ Yes ❑ No ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document ❑ Yes b�<o ❑ NA ❑ NE
and report the moriality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes a ❑ NA ElNF
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 �Mo ❑ NA ❑ N1;
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/inspector fail to discuss review/inspection with -.in on -site representative? ❑ Yes C�No ❑ NA ❑ NE?
33, Docs facility require a follow-up visit by same agency? ❑ Yes �Wo ❑ NA ❑ Nl"s
Additional Comment% and/or Drawings:
pit ip u t ld � n � �3 tm � u p 1 ` e+ �c.S� 5 �eci al 15 _
] aom O-L Sot -hest ce.b o RS .�
ado
`-
i :�

'el A , '! 4
g Division of Water Quality
Facility Number Division of Soil and Water Conservation
Q Other Agency
Type of Visit Compliance Inspection Q Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit 4 Routine Q Complaint Q Follow up Q Referral Q Emergency Q Other ❑ Denied Access
Date of Visit: Arrkal lime: = Departure County:
Region: 05020
Farm Name:
Owner dame: ��
L
Owner F:mail:
Phone:
1 Oje lftrr
e o_
Mailing Address:
FO Boy- t 3Q U
Physical Address: n J'-[�
Facility Contact: it
Onsite Representative: IL'A DA A1-11
Certified Operator: ) 411" 0 r I GO—,
Back-up Operator:
Location of Farm:
r;, 1
b-"4 .
Swine
Title:
9-ne,
No: e,
a
lnte � ator:
Opera Cer�fic • n� mher:
Back-up Certification Number:
Latitude: F7� M
Design Current Design Current
Capacity Population Wct Poultry Capacity Population
❑ Laver
❑ Non -La er
❑
Wcan to Finish
❑
Wean to Feeder
❑
Feeder to Finish
Farrow to Wean
JiD
Er
Farrow to Feeder
❑
Farrow to Finish
'
❑
Gilts
❑
Boars
Other
❑ Other
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
Ulurkey Poults
❑ Other
Dischtirp_es & 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?
' `7aKFAWKIN
Design Current
Cattle Capacity Population
❑
Dairy Cow
❑
Dairy Calf
❑
Dairy Ileifer
❑
Dry Cow
❑
Non -Dairy
❑
Beef Stocker
❑
Beef Feeder
❑
Beef Brood Cowl
I
Number of Structures: EI]
b. Did the discharge reach waters of the State'' (Il'yes, notify DWQ)
c. What is the estimated volume that reached waters ol'the State (gallons)?
d. Does discharge bypass the waste management system? (11'yes, notit'y DWQ)
2. Is there evidence oi'a past discharge from any pan of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page 1 of-3
❑ Yes
>No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
n
'❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
J_P�t o
❑ NA
❑ NE
❑ YesNo
❑ NA
❑ NE
12128104 Continued

Facility Number: — wsl Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes �No
❑ NA
❑ NE.
a. If yes, is waste level into the structural freeboard?
❑ Yes ❑ No
❑ NA
❑ NI:
tructure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 30
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes %No
❑ NA
❑ NE
(ie/ large trees, severe erosion. seepage, etc.)
6. Are there structures (in -site which are not properly addressed and/or managed
❑ Yes )<No
❑ NA
❑ N1;
through a waste management or closure plan'!
If any of questions 4-6 were answered ves, and the situation pnses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? Yes ❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit" ❑ Yes No ❑ NA ❑ NE;
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement'?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance/improvement'?
It. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ❑ NE
❑) xcessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn. etc.)
❑ PAN ❑ PAN > 10% or l0 lbs ❑ Total Phosphorus ❑ Failure to incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s) v
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
YNo ❑ NA
❑ NE
15. Does the receiving crop anti/or land application site need improvement?
W Yes
C] No ❑ NA
❑ NI:
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
0 No ❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application'?
❑ Yes
WNo ❑ NA
❑ NE
18. Is there a lack of properly operating; waste application equipment?
❑ Yes
4No ❑ NA
❑ NE"s
Comments (refer to question #): Explain an)' YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pal;cs as necessary):
/t �v Y-A-e -
Reviewer/Inspector NameF - ---- _- - - --- - -- ----- ---- --- -� Phone:
WV
Reviewer/Inspector Signature: Date: d
Page 2 of 3 12 8104 Continued

4-
Facility Number: q — (j Date of Inspection
Re wired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ yes ONo ❑ NA ❑ NE
20. Does the facility fail to have all components oFthe CAWMP readily available? I1'yes, check [] yes �No ❑ NA ❑ NF
the appropriate box.
Cl WUP ❑Checklists El Design ❑Maps ❑ Other
21. Does record keeping need iimprovement`. a�iat�-k� ❑ Yes )?"No ❑ NA ❑ NI:
VsteApplicati n L11�C'eekly kreeboard ❑Waste Analysis oil Analysis �ii n .� r ,.nfall Mocking rop Yield ❑ 120 Minute Inspections onthly and 1" Rain Inspections Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Ycs KNo ❑ NA ❑ NIi
23. 1fselected, did the facility tail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No tNA ❑ Nl:
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. [aid the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
❑ Yes
�(No
❑ NA
❑ Nl:
❑ Yes
%No
❑ NA
❑ NE
❑ Yes
W,o
❑ NA
❑ NE
❑ Yes
WNo
❑ 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`?
Il'yes, contact a regional Air Quality representative immediately
31. Did the t'acility Fail to notify the regional office of emergency situations as required by
General Pen -nit? (iel discharge, freeboard problems, over application)
32, Did Reviewer/Inspector titil to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency'?
El Yes X.
❑ Yes 660
❑ Yes XNo
❑ Yes [ o
❑ Yes XNb
❑ Yes 1XNo
❑NA ❑NE
El NA El NE
❑ NA ❑ NE
El NA El NE
❑ NA ❑ NE
El NA El NE
A nal Comments and/or Drawings:
a s 00-7 a- aOb 'K
�•t t b d 7t�_ U-) ? �� mot. C.�.�-e�� 4UA/J_Aft4_1Lfe
r
' ROD-7
D
Page 3 of 3
12128104

' Facility Number
%) Division of Water Quality j
Q Division of Soil and Water
Q Other Agency
�nservation
, _�Or
tqGP.x_Pt/,
Type of Visit P Compliance Inspection Q Operation Review Q Structure Evaluation Q Technical Assistance
Lj.Q Reason for Visit Routine Q Complaint Q Follow up Q Referral 0 Emergency Q Other ❑ Denied Access
Date of visit: ArrivalTime: Departure Time: County': CIP� Region: (A)SP-0
Farm Name: �4L �ix3l ii� _ _ _ Owner Email:
Owner Name: J 71�,2 r- 1 t ��j n l Phone:
Mailing Address: Q G i "� 7 ,aq�
Physical Address: y�` 11 P. 73
Facility Contact: aE Title: Phone No: 3
Onsite Representative: Integrator: D ��
Certified Operator: Operator Certification Number: _Q 3 a
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: [0o Longitude: s
Pq PE , '21 Sa L0 H-wy qq
Design Current Design Current
Swine Capacity Population ►Vet Poultry Capacity Population
❑ Wean to Finish ❑ I.aVer
❑ Wean to Feeder 1 ❑ Non-Lavet
❑ Feeder to Finish
Farrow to Wean lool Incri Dry Poultry
❑ Farrow to l ceder
❑ Farrow to Finish
❑ Gilts
n Boars
Other
❑ Other
❑ Layers
❑ Non -Lavers
❑ Poets
❑ Turkeys
❑ Turkey Poults
❑ Other
lava �,.
Discharges & , ream i ,nacis too
1. Is any discharge observed from any =on?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance roan -made?
b. Did the discharge reach waters of the State? (If yes, notify ❑WQ)
Design Current
Cattle Capacity Population
❑ Dar Coxv
❑ ❑airy Calf
❑ Dairy Ilei fei
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stockct
❑ Beef Feeder
❑ Beef Brood Cow
c. What is the estimated volume that reached waters of the State (gallons)"
Number of Structures: FLI
d, Does discharge bypass the waste manaacment syste=n? (If yes, notify DWQ)
Z, Is there evidence of past discharge from any part ofthe operation"
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than froth a discharge."
❑ Yes
�No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ N1:
❑ Yes
❑ No
❑ NA
❑ NE;
El Yes
El No
❑NA
El NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
12128104
Lo►Illnued

} aeility Number: —Lwl 40 bate of Inspection b
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NH
a. If ycs, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: Lammo
�k Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(ic/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed Yes ❑ No ❑ NA ❑ NE
through a waste management or closure plan?
If a of questions 4-6 were answered ves, and the situation poses an immediate public h lth r�elvironmental threat, notify DNN'Q
Is7. o any of the structures need maintenance or improvement? r bo �_ Jn Yes X No ❑ NA ❑ NE
no any of the stuctures lack adequate markers as required by the permit? ❑ Yes VNo ❑ 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 K No ❑ NA ❑ NE
mai ntenance/improvement"
11. Is there evidence of incorrect application? if yes, check the appropriate box below. ❑ Yes No ❑ NA El NE
El Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground El Heavy Metals (Cu, Ln, etc.)
❑ PAN ❑ PAN ] 10% or M Ihs ❑ Tatni Phosphoms ❑ 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)
Ue
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
1 No ❑ NA ❑ NE
No ❑ NA ❑ NE
No ❑ NA ❑ NE
�(No ❑ NA ❑ NE
tdNo ❑ 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):
• llC'.t,---) v l 5 \Qkon 5Ir-A i�r 100 buI t.� L40v
�►.D
a �+tca*�o ,� aid one Ltdze_
h a� S �'[T�-d� 0o +f`�}- ► c , 4A�D 0 Q a t rJ`r ry\ 0-
Reviewer/Insfrector Name `Phone: 7 3 1 - 5 p-L
ReviewerAnspector Signature\ i un It', A i 1 11 L Ar Date: 'q I.; 10-1
V v C J " ` `� 12128104' Continued
�10 fl\�r Alb-i 11 U � �f SihQ�. Svq �es1 hertA5 aroUrj e 1�

1I
Facility Number: '1— Ocsl 9te of Inspection moo
Required Records & Documents
19. Did the facility fail to ]cave Certificate of Coverage & Permit readily available'? ❑ Yes 0 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available`? if yes, check El Ncz El NA ❑ Nf's
the appropirate box.
❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21.
Does record keeping need improvement? If c to appr w. ❑Yes
❑ No
Cl NA
❑ NE
❑Waste Applicat' n Wee ly Freeboard Waste Analysis S,o.,illAnalysis [� Waste Transfers
❑
Rainfall Stocking rop field ❑ 120 Minute Inspections Monthly and 1 " Rain Inspections
El
Weather
Code
22.
Did the facility fail to install and maintain a rain gauge? ❑ Yes
[(No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment`? ❑ Yes
❑ No
NA
ElNE
24.
Did the facility fail to calibrate waste application equipment as required by the permit'? dQOS' ElYes A. No9NA
El NE
25.
Did the facility fail to conduct a sludge survey as required by the permit? ADO 1 ❑ ►- +r�ve5+-❑ Yes
f �No
❑ NA
❑ NE
26,
Did the facility fail to have an actively certified operator in charge'' ❑ Yes
XNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ❑ Yes
❑ No
0
NA
❑ NE
Other Issues
2&
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 ot•dead animals within 24 hours and/or document
r❑ Yes
No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
ref
30.
At the time of the inspection did the facility pose an ador or air quality concern'?
❑ Yes
[No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
I
31,
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
o
❑ NA
❑ NE
General Permit? (ic/ 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
Adjj4ajQa1 Comments and/or Drawings:
12128104

4.
r'I
Type of Visit ❑ Compliance Inspection Cr-E7peration Review ❑ Structure Evaluation ❑ Technical Assistance
Reason far Visit Q&outine ❑ Complaint ' ❑ Follow up ❑ Referral ❑ Emergency Q Other ❑ Denied Access
r: a
007
C I ` rwyw,'dl e+..C7
[late of Visit: Arrival Time: Departure ]'line- County:.��: ��-___-• Region:
Farm Name: y,+ Owner Email:
Owner NamX
e: + ---C J1_Cl4k_'�-..-•_--- Phone:
,Mailing Address: .
Phvsical Address: O•t16�-fwY_.___ _____ w_ ____ ..__�_._ ___ __ _ _-___--•--•.._ __ .. _�
Facility Contact: I` _ ' ,�^- �w _ _ Title: __.. _ _ ._.,.._.__.. _._ Phonc No:
OnsiteRepresentati►•e: lute= �_ l_l►'!I`_-? .._-.____._._ ._..__ �_.._.__.._.____. razor:.----_..__.___..__.__�_.-__��_�__ _
�• - g
Certified Operator: ' 1F �.,_.-•..__._w. Operator Certification Number:
13ack-up Operator:
Location of Farm:
Back-up Certification Number:
o � Lungilude: �o
Latitude: 3S - �7
Design Current' _ Design' Current
'Cipacity. Popu[ittintt �'t'et F'ut�l#ry .r; Capacity' 1'upulation Cattle-
-
.t;:
A
u%
;V
�i
F
❑
Wean to Finish
❑
Wean to Feeder
❑
Fecder to Finish
Farrow to Wean
JIM1�Qt3
❑
Farrow to Feeder
❑
Farrow to Finish
❑
Gilts
❑
Boars
Otltir{`'
❑ Other
❑ haver
❑Nnn-l�a et
•Ilti"y !'oultry •.:.•- . .'•
Non-1..
Pullets
Other
Points
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at, ❑ Structure ❑ Application Ficid ❑ Other
a. Was the conveyance man-made?
Design Current
Capacity Population'_
❑
Dairy Cow
❑
Dairy Call
❑
Daia IIeifez
❑
Dry Cow
❑
Non-Dai
ElBeef
Stocker
❑
Beef I eeder
❑
Bcef 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 managcmezrl 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
ether than from a discharge'?
❑ Ycs D-<i ❑ NA ❑ NE
❑ Yes
❑ No
❑-NA
❑ NE
❑ Yes
❑ No
[D-NA
❑ NE
DNA
❑ NE
❑ Yes
❑ No
❑ Yes
M—Ko
❑ NA
❑ NI's
❑ Yes
o
❑ NA
j] NE
12128104 Continued

Facility Number: qu— Date of Inspection M�
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): it`{``
lio-
5. Are there any immediate threats to tite integrity of any of the structures observed'!
('se/ 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 ErNo ❑ NA ❑ NE
❑ Yes [R<o ❑ NA ❑ NE
Stricture 5 Structure 6
❑ Yes E14 ❑ NA ❑ NE
❑ Yes l44c, ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? [`},es ❑ No ❑ NA ❑ NE
S. ❑o any of the stuctures lack adequate markers as required by the pen -nit? ❑ Yes EKo ❑ 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 ETZ ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance a;ternatives that need ❑ Yes r No ❑ NA ❑ NE
maintenance/improvement?
11. is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes E5<0 ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ heavy Metals (Cu, Zn, etc,)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) L
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
E]"No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
ErNn
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑
Yes
U'No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
El NA
❑ NE
IR. Is there a lack of properly operating waste application equipment?
[I Yes
,[�__,,'��lcr
['No
❑ NA
❑ NE
't)C44L
d
dl V V" SCA W bZULA,
X- V— w ,-nbti to "- e <_ .
cdt4
L) � tV3 .1A���� 4LtGLt^
�'1Gt�� - we �U ►rC� J►�
1L AMP€ . ..:� .li .t e `rwf:t tiY`i��RSE I I
Reviewer/Inspector22�I MIX.
�.
1•

tl
Facility 1Vumhcr: — .j Se of Inspection
Required Records & Documents ,,.._,,�
19. Did the facility fail to have Certificate of Coverage & Permit readily available? El Yes @ o ❑ NA ❑ NE
20.
Does the facility fail to have all components of the CAWMP readily available? ]fyes, check
❑ Yes
d tiro
❑ NA
❑ NE:
the appropirate box. ,
❑ WL1I ❑ Checklists ❑ I]esign ❑ Maps ❑ ether
21.
Does record keeping need improvement?
❑ Yes
E_ 6
❑ NA
❑ N1's
Freeboard [Waste Analysis Soil Analysis
Waste Application ❑ W��
rs
[�Annuai
Certification
ek�eekly
❑ Rainfall �tocking 13 rop Yield ❑ 120 Minute Inspections ❑ Monthly and 1"
Rain Inspections ( -Weather
Code
22,
Did the facility fail to install and maintain a rain gauge?
❑ Yes
9 No
❑ NA.
❑ NE_
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
ET�No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
0-1�qo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ NA.
ElNE
26.
Did the facility fail to have an actively certified operator in charge?
ElYes
,[3<o
d !vo
❑ NA
❑ Nf?
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
2<o
❑ NA
❑ NIT,
Other Issues
28. Wcrc any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes i❑ 5o ❑ NA ❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
E No
[:1 NA
❑ N1:
and report the mortality rates that were higher than normal?
30.
At the time oi'the inspection did the facility pose an odor or air quality concern?
❑ Yes
EfNo
❑ 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
El Yes
CJ No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/]nspector fail to discuss review/inspection with an on -site representative?
❑ Yes
6o
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
E j N❑
❑ NA
❑ NE
Y !yN :,E'."r";C'7'ld,'."Y.LSSr y^ ` "' R: 4 'x° k �4°N•",
.:� fit, adaC .i�,u�rroie� �nr�llr�►viutg�:.� � �.. '. �'�
12128104
12128104

r
Facility Number: qJ4— (}'} Date of Inspection
Technirai Assistance
Needed
34. Waste Plan Revision or Amendment
35, Waste Plan Conditional Amendment
❑
36, Review or Evaluate Waste Plan w/producer
❑
37, Forms Need (list in comment section)
❑
38, Missing Components (Iist in comments)
❑
is
Provided
❑ YL�t?t►1� �„,�� cad �>t
11
El
El
39, 2H.0200 rc-certification
❑
❑
40, Five & Thirty day Plans of Action (PoA)
❑
❑
41. Irrigation record keeping assistance
❑
❑
42, Organize/computerization of records
❑
❑
43. Sludge Evaluation
❑
❑
44. Sludge or Closure Plan
❑
❑
45, Sludge removal/closurc procedures
❑
❑
46. Waste Structure Evaluation
Cl
❑
47. Structure, Needs Improvement
❑
❑
48, Operation &c Maintenance Improvements
❑
❑
49. Marker check/caiibrat ion
❑
❑
50, Site evaluation
❑
❑
51, Irrigation Calibration
❑
❑
52. Irrigation system designtinstallation
❑
❑
53. Secure irrigation information (maps, etc.)
❑
❑
54.Operating improvements (pull signs, etc.)
❑
❑
55, Wettable Acre Determination
❑
❑
56. Evaluate WAD certification/recbecks
❑
❑
57. Crop evaluation/recommendations
❑
❑
58. Drainage work/evaluation
❑
❑
59, Land shaping, subsoiling, aeration, etc.
0
❑
60. Runoff control, stormwater diversion, etc,
❑
❑
61. Buffer improvements
❑
❑
62. Field measumments(GPS, surveying, etc.)
❑
❑
63. Mortality 13MPs
❑
❑
64. Waste operator education
❑
❑
65.Operation & maintenance education
❑
❑
66. Record keeping education
❑
❑
67. Crop/forage management education
❑
❑
68. Soil and/or waste sampling education
❑
❑
69. PLAT
❑
❑
70. Other
❑
❑
List Improvements Made by Operation:
-- l 4
2. S.
3. 6. 1212&04

c+
Division of Water Quality
❑ Division of Soil and Water Conservation
❑ Other Agency
Facility Number: 760005 Facility Status: Active Permit: AWS760005 ❑ Denied Access
Inspection Type: ComolianceInactive or Closed Date:
Reason for Visit: Routing _ County: Rpndoloh Region: Winston-Salem
Date of Visit: 05/22/2006_ Entry Time:10:15 AM_ _ Exit Time: 12:00 PM Incident #:
Farm Name: KLS SwineFarm
Owner Email:
Owner: Kim Griffen _
Phone: [phone]
Mailing Address: PO Box 130
Liberty NC 272980130 _
Physical Address:
Facility Status: ❑ Compliant ❑ Not Compliant Integrator:
Location of Farm: Latitude:
35'48'43" Longitude: 79*37-38"
Farm Location: SR 2543 - Shady Hollow Road. From GSO, take US Hwy 421 south to Old Liberty Rd. and take right. Take left onto
Brower Meadow Rd. Left onto Sandy Creek Rd., right ontoShady Hallow Rd.
Question Areas:
Discharges & Stream Impacts Waste Collection & Treatment
Waste Application
Records and Documents Other Issues
Certified Operator: Kimberly S. Griffin
Operator Certification Number: 23281
Secondary OIC(s):
On -Site Representative(s): Name
Title Phone
On -site representative Kim Griffen
Phone: [phone]
24 hour contact name Kim Griffen
Phone: [phone]
Primary Inspector: Melissa Rosebrock
Phone:
Inspector Signature:
Date:
Secondary Inspector(s):
Inspection Summary:
7. Much better! Continue efforts.
15. Try to re -seed in Fall to revegetate bare spots.
21. Don't forget to pull sail samples for 2006.
25. Sludge survey was conducted July.2005 per operator. Need written documentation
5116106=1.8 lbs. N11000 gal.
Page: 1

•
Permit: AWS760005 Owner - Facility: Kim Griffen
Inspection Date: 05/22/2006 Inspection Type: Compliance Inspection
Facility Number: 760005
Reason for Visit: Routine
Regulated Operations Design Capacity Current Population
Swine
Swine - Farrow to Wean 1, 200 1,050
Total Design Capacity: 1,200
Total SSLW: 519,600
Waste Structures
Type Identlfler Closed Date Start Date Designed Freeboard Observed Freeboard
koon LAGOON 42.00
Page: 2

•
•
Permit: AWS760005 Owner - Facility: Kim 0riffen Facility Number: 760005
Inspection Date: 05/22/2006 Inspection Typo: Compliance Inspection Reason for Visit: Routine
Discharges & Stream Impacts Yea No NA NE
1. Is any discharge observed from any part of the operation? ❑ ■ ❑ ❑
Discharge originated at
Structure ❑
Application Field ❑
Other ❑
a. Was conveyance man-made? ❑ ■ ❑ ❑
b. Did discharge reach Waters of the State? (if yes, notify DWQ) ❑ ■ ❑ ❑
c. Estimated volume reaching surface waters?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
❑
■
Cl
❑
2, Is there evidence of a past discharge from any part of the operation?
❑
■
❑
Cl
3. Were there any adverse impacts or potential adverse impacts to Waters of the State other than from a
❑
■
❑
❑
discharge?
Waste Collection, Storage & Treatment
Yea
No
NA
NE
4, Is storage capacity less than adequate?
❑
■
❑
❑
If yes, is waste level into structural freeboard?
❑
5, Are there any immediate threats to the integrity of any of the structures observed (LeJ large trees, severe
❑
■
❑
❑
erosion, seepage, etc.)?
6. Are there structures on -site that are not properly addressed and/or managed through a waste management
❑
■
❑
Cl
or closure plan?
7. Do any of the structures need maintenance or improvement?
■
❑
❑
❑
8. Do any of the structures lack adequate markers as required by the permit? (Not applicable to roofed pits,
❑
■
❑
❑
dry statics andtorwet stacks)
9. Does any part of the waste management system other than the waste structures require maintenance or
❑
■
❑
❑
improvement?
Waste Application
Yes
No
NA
NE
10. Are there any required buffers, setbacks, or compliance alternatives that need maintenance or
❑
■
❑
❑
improvement?
11. Is there evidence of incorrect application?
❑
■
❑
❑
If yes, check the appropriate box below
Excessive Ponding?
❑
Hydraulic Overload?
❑
Frozen Ground?
❑
Heavy metals (Cu, Zn, etc)?
❑
Page: 3

Permit: AWS760005 Owner • Facility: Kim Griffen
Inspection Date: 05/22/2006 Inspection Type: Compliance Inspection
Facility Number: 760005
Reason far Via it: Routine
Waste Application
Yes No NA
NE
PAN?
❑
Is PAN a 10%110 lbs.?
❑
Total P205?
❑
Failure to incorporate manurelsludge into bare soil?
❑
Outside of acceptable crop window?
❑
Evidence of wind drift?
❑
Application outside of application area?
❑
Crop Type 1
Bermuda Grass (Hay,
Pasture)
Crop Type 2
Fescue (Hay, Pasture)
Crop Type 3
Crop Type 4
Crop Type 5
Crop Type 6
Soil Type 1
Soil Type 2
Soil Type 3
Soil Type 4
Soil Type 5
Soil Type 6
14. Do the receiving crops differ from those designated in the Certified Animal Waste Management
❑ ■ Q
❑
Plan(CAWMP)?
15. Does the receiving crop and/or land application site need improvement?
■ ❑ ❑
❑
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination? ❑ ■ ❑
Q
17, Does the facility lack adequate acreage for land application?
❑ ■ ❑
❑
18. Is there a lack of properly operating waste application equipment?
❑ ■ Q
❑
Records and Documents
Yes No NA
NE
19. Did the facility fail to have Certificate of Coverage and Permit readily available?
❑ ■ ❑
❑
20. Does the facility fail to have all components of the CAWMP readily available?
❑ ■ ❑
❑
If yes, check the appropriate box below.
WU P?
❑
Page: 4

0
•
Permit: AWS760005
Inspection Oats: 05/22/2006
Records and Documents
Checklists?
Design?
Maps?
Other?
Owner - Facility: Kim Griffen
Inspection Type: Compliance Inspection
21. Does record keeping need improvement?
If yes. check the appropriate box below.
Waste Application?
120 Minute inspections?
Weather code?
Facility Number : 760005
Reason for Via It: Routine
P!
Weekly Freeboard?
❑
Transfers?
❑
Rainfall?
❑
Inspections after > 1 inch rainfall & monthly?
❑
Waste Analysis?
❑
Annual soil analysis?
❑
Crop yields?
❑
Stocking?
❑
Annual Certification Farm (NPDES only)?
❑
22. Did the facility fail to install and maintain a rain gauge?
❑
■
❑
❑
23. If selected, did the facility fail to install and maintain a rainbreaker on irrigation equipment (NPDES only)?
❑
■
❑
❑
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 phosphorous loss assessment (PLAT) certification?
❑
■
❑
❑
Other Issues
Yes No
NA
N
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 those
❑ ■
❑
❑
mortality rates that exceed normal rates?
30. At the time of the inspection did the facility pose an air quality concern? If yes, contact a regional Air
❑ ■
❑
❑
Quality representative immediately.
Page: 5

0 0
Permit: AWS760005 Owner - Facility: Kim Griffen Facility Number: 760005
Inspection Date: 0512WO06 Inspection Type: Compliance Inspection Reason for Visit: Routine
Other Issues Yes No NA NE
31. Did the facility fail to notify regional DWQ of emergency situations as required by Permit?
32, Did Reviewer/inspector fail to discuss review/inspection with on -site representative?
33. Does facility require a follow-up visit by same agency?
Page: 6
El

Division of Water Quality
Facility Number s Division of Soil and Water Conservation
Q Other Agency
Type of Visit 1�Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance 4
Reason for Visit Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visil: oZa �pArrival Time: a°a Departure •Time: l ❑0 County: Region: W5 010
Farm Name: K L5 t h Far M Owner Frnail:
Owner Name: _ K11M �0rr t P•V1 II -- Phone: _ �rz�_ - _L1 Y9- -
Mailing Address: P ^'� !{ �+� I 3 L- ;2-
Phvsical Address: b M C_ 5 s
` q?qV
ontaCt; r" � 0,0 (1 ,_• Facility CVie Title: Phone No: u r
Onsite Representative: � -�L � _ g i 1's r'1 � '1 Integrator: �
Certified Operator: KIryL r l � fie. Y) Operator Certification Number: d 3
Back-up Operator:
Location of Farm: 17a20 SOL)%
J�W y Y-;y ,-)o u fl
P-+phia 'S"
Swine
Back-up Certification Number:
�iwt�!l�r�r_
Ma �.r err
Design Current Design Current
Capacity Population 'Vet Poultry Capacity Population
❑ Laver
❑ Non -Laver
❑
Wean to Finish
❑
Wean to Feeder
❑
Feeder to Finish
Farrow to Wean
Farrow to I ceder
❑
Farrow to finish
❑
Gilts
❑
Boars
Other
❑ Other
Dr►• Poultry
❑
Layers
❑
Non -Lavers
❑
Pullcts
❑
Turkeys
F❑ Turkev Poults
❑
Other
Discharges & Stream Impacts
1, Is any discharge observed Irnm any part of the operation'!
❑ischarge originated at; ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters ofthe State'? (If yes, notify DWQ)
n®` De
C '
No
�.�. V.0
Cattle
Design Current
Capacity Population
] ❑airy Cow
] Dairy Calf
] Dairy Heifer
] Dry Cow
] Non-Dairy
] I3cel' Stocker
] Beef Feeder
i
] l3eefI3roodCow
Number of Structures:
❑ Yes
ko ❑ 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)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes Y'+ No ❑ NA ❑ NI:
❑ Yes �No ❑ NA ❑ NE
Page 1 of 3 12128104 Continued

Facility timber: 0 Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes W N10
❑ NA
❑ NE
a, If yes, is waste level into the structural freeboard?
❑ Yes ❑ No
❑ NA
❑ NE
Structure i Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
ldentifier: con
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes > 10
❑ NA
❑ NE
(ic/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes �(Nlo
❑ NA
❑ NE
through a waste management or closure plan'?
if any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or irnprovernent? XYes ❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes XNo ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes o ❑ NA ❑ NE
maintenance or improvement?
Waste Applicatinn_
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 ❑ Ilydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu. I.n, etc.)
❑ PAN ❑ PAN > 10% or 10 ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Hare Soil
❑ Outside of Acceptable Crop Window ❑ Evidcncc 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 71No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? Yes ❑ No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes No ElNA El NE
18. Is there a lack o€'properly operating waste application equipment? ❑ Yes 19'No ❑ NA ❑ NE
Comments (refer to question 4): 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):
' Pq
Reviewer/Inspector Name j W Phone: al
Reviewer/Inspector Signature. Date:
Page 2 of 3 12128104 Continued

Facility Number: —Jr Oe of Inspection �Z
Required Records & Documents
19. Did the the ility rail to have Certificate of Coverage & Permit readily available?
❑ Yes �Wo
❑ NA ❑ NE
20, Does the facility fail to have all components of the C:AWMP readily available'? if yes, check ❑ Ycs No
the appropriate box. ❑ WUp 0 Checklists ❑ I7esign El Maps ❑ Other
2 1, Do record keeping need improvement'.' ❑ YesNcr
❑ NA ❑ NE
El NA ❑NE
62 Waste Application CtiyL__V.__eekkl�ly Freeboard Waste Analysis Soil Ana ysis -
ainfall tocking [50( rop Yield 120 Minute Inspections Monthly and 1" Rain Inspections Weather Code
22.
Did the Facility fitil to install and maintain a rain gauge?
❑ Yes
XNo
❑ NA
ElNE
23.
Ifselected, did the facility fail to install and maintain rainbreakers on irrigation equipment'?
❑ Yes
❑ No
❑ NE
24.
[lid the facility tail to calibrate waste application equipment as required by the permit? dL
❑ Yes
No
'KNA
❑ NA
❑ NE;
25.
1
Did the facility Iail to conduct a sludge survey as required by the permit?
❑ Yes
No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge'?
❑ Yes
o
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
No
VNA
❑ NF
Other
Issues
28.
Were any additional problems noted which cause non-compliance of l�e permit or CAWMP?
❑ Yes
f
L .No
❑ NA
ElNF
29.
. N
Did the facility fail to properly dispose ofdead animals within 24 hours and/or document
❑ Yes
K41Jo
ElElNA
NIsand
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
LKNo
El NA
❑ NE
If yes, contact a regional Air Quality representative immediately[[[LLL
31.
Did the fiscility fail to notify the regional office of'emergeney situations as required by
❑ Yes
f
o
❑ NA
❑ NE
General Permit? (iel discharge, freeboard problems, over application)
I
32.
Did Reviewerd n spector 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
o
❑ NA
❑ NE
Additional Comments and/or Drawings:
s- 4- ".0 (0 7
AL
too
pn l)
Page 3 of 3 12129104

Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit *Routine 0 Complaint 0 Follow up ()Referral 0 Emergency 0 Other ❑ ❑enied Access
Date of c Arri►al Time: ia'• 2� Deparun'e'I'ime: db County:`P._ Region: �-�-
Farm Name: AS �r�.I.lY1���'!n _�. [l►►ner [mail:
Owtier Name: —�l.Y!1�'L''►��J-_1 - Phone:
Maili rig Add t-es%-
PtivsicalAddress:
Facilily Contact: R��1'L �..3_� __. 'I'itic: M�-
0iisite Representative;
Certified Operator: <
� • 1 '< rvl i
Back-up Operator:
Rack -up Certification Number:
Location of Farth: Latilude: e ® ® Longitude: FIR ° 0 `
-- kt L4 9 '-W talz( Li he . —tl Lr Sap a- C3 1�j
<�v,,,A . Vkhl1 w —U. — rr,..4,% pkJ eP —qu .
swine .h - : , i
'r:i- Capacih'. Population
❑
Wean to Finish
❑
Wean to Feeder
❑
Feeder to Finish
®
Farrow to Wean
120b
Cpl
❑
Farrow to Feeder
❑
Farrow to Finish
❑
Gilts
❑
Boars
Uthcr., ..
D other
Design Current
Wet Poultry . Capacity Population
❑ Layer `
❑ Non -Laver
Dr Potilfr►' "
❑
Lavers
❑
Non -Layers
❑
Pullets
❑
Turkeys
❑
Turkev Pouits
❑
Other
1)iseharees & Stream Iint}acts
1, is any discharge observed liom any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conve}•ance man-rnade?
Design.. - Cu rr.ent it s
Cattle Capacity -Populaticirt-
ElDairy
Cow
❑
Dairy Calf
ElDairy
Heif'ci
ElDry
Cow
ElNon-Dairy
El
Beef StockerEl
Beef Feeder
Beef Brood Cow 4
Number of Structures:
b. Did the discharge reach waters of the State`' (Ifyes, notify D%VQ)
c. What is the estimated Volume that reached waters of the State (gallons]?
d. Docs discharge bypass the waste managcrncnt system`? ([Oyes, notify DWQ]
2. Is there evidence of a past discharge front any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other titan from a discharge?
❑ Yes [XNo ❑ NA ❑ NE
❑ Yes ❑ No ZNA ❑ NE
❑ Yes
❑ No
[�NA
❑ NE
ZLNA
❑ NE
❑ Yes
❑ No
❑ Yes
EXN o
❑ NA
❑ NE
❑ Yes
qNo
❑ NA
❑ NE
12128104 Continued

Facility Number: — [late of Inspection 6
Waste Collection & Treatment
: 4. Is storage capacity (structural plus storm storage plus heavy rainfall} less than adequate? ❑ Yes '$ZrNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 ?INA
tcture 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 Vj, No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes [I No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered ves, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ,2 Yes ❑ No ❑ NA ❑ NE
S. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes W No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes [,'3oNc, ❑ NA ❑ NE
maintenance or improvement?
WasteApplication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 9 No ❑ NA ❑ NE
maintenancelimprovement?
MPI
11. is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes JW No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[--]PAN ❑ PAN > I0% 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) y
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
E�No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need :mprovement?
❑ Yes
[�No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination' ❑ Yes
EZNo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
q No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
'110fNo
❑ NA
❑ NE
in m ennat tunsi or.,, an vrotn er-, cop
�. Z 6AZU"4 Aqlaces
Reviewer/Inspector Nome E'E V
` ;M� e rd lye"
; .:
Phone: 311-31
8 -{J` qb
Revie►.-er/lnspector Signature:
KAL
Date: I
r
12128104
Continued

Facility Number: — �e of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate: of Coverage & Permit readily available? ❑ Yes [ No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWIMP readily available? If yes, check ❑ Yes [�j 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 UNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ AnnuaI Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
§0 No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
Ef NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
�1 No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
P No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
[p No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
El Yes
No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
� 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
99 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? (le/ 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
s "/f1R ... yam.... .• L _
to� [ L."h Vvc7;ril-r _ ; ✓ { y •ice r �•. -{x.
Adritttta l CoGnurntent:; andlnr.Dra►► to �s: . ra„ "' f,` 1= �.
. 1._ si, c. iF.l �.:ia, ���.� �t..� 14}:,..:•`a.. .a i.:'i•r.... ;ry.: V�.
Q-4, Swc� WA l ve vines to i nCLU& _ k-t
12128104

s
s
Facility Number:` Date of inspection
Technical Assistance Needed
Provided
34. Waste flan Revision or Amendment
❑
❑
35. Waste Plan Conditional Amendment
❑
❑
36, Review or Evaluate Waste Plan w/producer
❑
❑
37. Forms Need (list in comment section)
❑
❑
38. Missing Components (list in comments)
❑
❑
39. 2H,0200 re -certification
❑
❑
40. Five & Thirty day Plans of Action (PoA)
❑
❑
41. Irrigation record keeping assistance
❑
❑
42. Organizelcomputerization of records
❑
❑
43. Sludge Evaluation
❑
❑
44. Sludge or Closure Plan
❑
❑
45. Sludge removal/closure procedures
❑
❑
46. Waste Structure Evaluation
❑
❑
47. Structure Needs Improvement
❑
❑
48. Operation & Maintenance Improvements
❑
❑
49. Marker check/calibration
❑
❑
50, Site evaluation
❑
❑
51. Irrigation Calibration
❑
❑
52. Irrigation system design/installation
❑
❑
53. Secure irrigation information (maps, etc.)
❑
❑
54. Operating improvements (pull signs, etc.)
❑
❑
55. Wettable Acre Determination
❑
❑
56, Evaluate WAD certification/rechecks
❑
❑
57. Crop evaluation/recommendations
❑
❑
58. Drainage work/evaluation
❑
❑
59. Land shaping, subsoiling, aeration, etc.
❑
❑
60, Runoff control, stormwater diversion, etc.
❑
❑
61. Buffer improvements
❑
❑
62. Field mcasurements(GPS, surveying, etc.)
❑
❑
63. Mortality BMPs
❑
❑
64. Waste operator education
❑
❑
65. Operation & maintenance education
❑
❑
66. Record keeping education
❑
❑
67. Crop/forage management education
❑
❑
68. Soil and/or waste sampling education
❑
❑
69. PLAT
❑
70, Other
❑
❑
List Imyrove men ts Made b►' Operation:
1.
4.
2,
5.
R1
t7
VP T'KIVIIA

Division of Water Quality
❑ Division of Soil and Water Conservation
❑ Other Agency
Facility Number: 76000§ Facility Status: Active Permit: AWS760005 ❑ Denied Access
Inspection Type: Cornploance Inspection Inactive or Closed Date:
Reason for Visit: Routine County: Randolph Region: Winston-Salem
Date of Visit: 07112I2005 Entry Time: 10:00 AM Exit Time: 11:30 AM Incident #:
Farm Name: KL. Swine, Farm _ _ Owner Email:
Owner: Kim Griffen Phone:[phone]
Mailing Address: Li n y NC ZT2980130 � 3
Physical Address:
Facility Status: ❑ Compliant ❑ Not Compliant Integrator:
Location of Farm: Latitude: 35"48'43" Longitude: 79°37'38
Farm Location: SR 2543 - Shady Hollow Road. From GSO, take US Hwy 421 south to Old Liberty Rd. and take right. Take left
onto Brower Meadow Rd. Left onto Sandy Creek Rd., right ontoShady Hallow Rd.
Question Areas:
0 Discharges & Stream Impacts Waste Collection & Treatment 0 Waste Application
0 Records and Documents 0 Other Issues
Certified Operator: Kimberly S. Griffin Operator Certification Number: 23281
Secondary OIC(s):
On -Site Representative(s): Name Title Phone
On -site representative Kim Griffen Phone: [phone]
24 hour contact name Kim Griffen Phone: [phone]
Primary Inspector: M li sa M Rosebrock Phone: [phone]
Ext.383.� OS�
Inspector Signature:�4 Date:
Secondary Inspector(s):
Phone:
Phone:
Inspection Summary:
7. Most of slope has been sprayed for broadleaf weeds and the weeds have started to die. Need to complete and re -spray if
necessary. Must also cut woody vegetation by Fall.
15.Continue efforts to control broadleaf weeds in receiving crop. Looks much better this year.
18. Operator is in process of replacing original hydrants wl PVC ones.
21. 2005 soil samples were sent to Raleigh last week, Check results next visit.
21. Records look great.
4/11105 waste analysis=1.5 lbs. Nil000 gal.
Page: 1

0 0
Permit: AWS760005 Owner - Facility: Kim Griffen Facility Number: 760005
Inspection Date: 07/12/2005 Inspection Type: Compliance Inspection Reason for Visit: Routine
Regulated Operations Design Capacity Current Population
Swine
2 Swine - Farrow to Wean 1,200 1,062
Total Design Capacity: 1,200
Total SSLW: 519,600
Waste Structures
Type Identlfler Closed Date Start Date Designed Freeboard Observed Freeboard
Lagoon LAGOON 36.00
Page: 2

s
•
Permit: AWS760005 Ownor • Facility: Kim Griffen
Facility Number: 760005
Inspection Date: 07/12/2005 Inspection Type: Compliance Inspection Reason for Visit: Routine
xns No NA NF
1. Is any dischargo observed from any part of the operation? ❑ 0 ❑ ❑
Discharge originated at:
Structure
❑
Application Field
❑
Other
❑
a. Was conveyance man-made?
❑
MOO
b. Did discharge reach Waters of the State? (if yes, notify DWfl)
❑
0
❑
❑
c. Estimated volume reaching surface waters?
d. Does discharga bypass the waste management system? (if yes, notify DWO)
❑
0
❑
❑
2. Is there evidence of a past discharge from any part of the operation?
❑
M
❑
❑
3. Were there any adverse impacts or potential adverse impacts to Waters of the State other than from a discharge?
❑
Yr_s
0
No
❑
RA
❑
NF
Waste Collection_ Rtoraoe & Treatment
4. Is storage capacity less than adequate?
❑
■ ❑
❑
If yes, is waste level into structural freeboard?
5. Are there any immediate threats to the Integrity of any of the structures observed (I.e.1 large trees, severe erosion,
❑
❑
❑
seepage, etc.)?
6. Are there structures on -site that are not properly addressed and/or managed through a waste management or
Cl
❑
❑
closure plan?
7. Do any of the structures need maintenance or improvement?
■
❑
❑
❑
8. Do any of the structures lack adequate markers as required by the permit? (Not applicable to roofed pits, dry stacks
❑
0
❑
❑
and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require maintenance or
❑
❑
❑
improvement?
Yes
No
NA-
NE
Waste Apolication
10. Are there any required buff ors, setbacks, or oompi[ance altemaIives that need maintenance or improvement?
❑
E ❑
❑
11, Is there evidence of incorrect application?
❑
M
❑
Cl
If yes, check the appropriate box below.
Excessive Ponding?
❑
Hydraulic Overload?
❑
Frozen Ground?
❑
Heavy metals (Cu, Zn, etc)?
❑
PAN?
❑
Is PAN n 10%110lbs.?
❑
Total P2O5?
❑
Failure to incorporate manure/sludge into bare soil?
❑
Outside of acceptable crop window?
❑
Evidence of wind drift?
❑
Application outside of application area?
❑
Crop Type 1 Fescue (Hay)
Crop Typo 2
Crop Type 3
Crop Type 4
Crop Type 5
Page: 3

Permit: AWS760005 Owner - Facility: Kim GHtfen
Inspection Date: 07/12/2005 Inspection Type: Compliance Inspection
Facility Number: 760005
Reason for Visit: Routine
Waste Applinntmon
Crop Type 6
Yes
No
14A
NE
Soil Type 1
Soil Type 2
Soil Type 3
Soil Type 4
Soil Type 5
Soil Type 6
14. Do the receiving crops differ from those designated in the Certified Animal Waste Management Plan(CAWMP)? ❑
■
❑
❑
15, floes the receiving crop and/or land application site need improvement?
❑
0
❑
❑
16. Did the facility fait to secure and/or operate per the irrigation design or wettable acre determination?
❑
0
❑
❑
17, Does the facility lack adequate acreage for land application?
❑
N
❑
❑
18. Is there a lack of property operating waste application equipment?
❑
Yes
M
No
❑
NA
❑
NE
Rerords and Documents
19. Did the facility fail to have Certificate of Coverage and Permit readily available?
❑
0
❑
❑
20. Does the facility fail to have all components of the CAWMP readily available?
❑
0
❑
❑
If yes, check the appropriate box below
WUP?
❑
Checklists?
❑
Design?
❑
Maps?
❑
Other?
❑
21. Does record keeping need improvement?
❑
0130
If yes, check the appropriate box below.
Waste Application?
❑
120 Minute inspections?
❑
Weather code?
❑
Weekly Freeboard?
❑
Transfers?
❑
Rainfall?
❑
Inspections after a i inch rainfall & monthly?
❑
Waste Analysis?
❑
Annual soil analysis?
❑
Crop yields?
❑
Stocking?
❑
Annual Certification Form (NPDES only)?
❑
22. Did the facility fail to install and maintain a rain gauge?
❑
M
❑
❑
23. If selected, did the facility fail to install and maintain a rainbreaker on irrigation equipment INPDES only}?
❑
0
❑
❑
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑
0
❑
❑
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 phosphorous loss assessment (PLAT) certification?
❑
0
❑
❑
Page: 4

0 0
Permit: AW5760005 Owner - Facility: Kim Griffen Facility Number :
760005
Inspection Date: 07/12/2005 Inspection Type: Compliance Inspection Reason for Visit:
Routine
.�c
26. Were any additional problems noted which cause non-eompfance of the Permit or CAWMP?
Yes
❑
No
IN
NA
❑
NE
❑
29. Did the facility fail to properly dispose of dead animals within 24 hours andfor document and report those mortality
❑
0
❑
❑
rates that exceed normal rates?
30. At the time of the inspection did the facility pose an air quality concern? If yes. contact a regional Air quality
❑
M
0
❑
representative immediately.
31, Did the facility fail to notify regional DWQ of emergency situations as required by Permit?
❑
0
❑
❑
32. Did Reviewer/inspector fail to discuss reviewfnspection with on -site representative?
❑
■
❑
❑
33. Does facility require a follow-up visit by same agency?
❑ ■ ❑ ❑
Page: 5

'• tivision of ►Pater Quatih .ivision of Soil and�V4'atcr"Co r►•ation' �
Q'[liFier Agency i.. r.
R'urr�tier
Type of Visit
Type of Visit
Compliance Inspection
Q Operation Review Q Structure Evaluation
Q Technical Assistance
Reason for Visit
Routine Q complaint
❑ Follow up ❑ Referral 0 Emergency
❑ Other ❑ Denied Access
Uate of Visit. , < rkrri►'al'l'iute: OM I) ep:irture'rinwe: ' 3o County: ��o1R1'-�] Region; W��LJ
Farm ,Name: � 5�n e - - Owner Email:
(?caner Name: �] .—.L(1 UM I'hntte: 35:. 6 6 � a - 4 ?q
(LNU—
MailingAddress: _r� 60! �� �� - 0
Physical Address: �3
N� "13ss
Facility Contacc �o r � Title: Phone No:.�04
Onsite Representative: l��rn UJ�!'l t Integratsrr:
Certified Operator: � _ J � Operator Certification Number: a
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: �) M1 Longitude: [B°
r 40 e-a5�� SD, u 5 aao sbL +a b� p� 46ems-• us 6 aft U 1
49 s)q&vn C�1s+) . _ R t a4onio Sa�.4- 6ku-k fK . C� ��- o�ta Y :
Swine
Design Current Design Current
Capacity- Population Wet Poultry Capacity Population
❑ La cr
❑ Non -La yet
❑
Wean to Finish
❑
Wean to Feeder
P.Vccder
to Finish
29
Farrow to Wean
❑
Farrow to Feeder
❑
Farrow to finish
❑
Gilts
❑
Boars
Other
❑ Other
Dry Poultry
❑ Lavers
❑ Non -La yen
❑ Pullcts
❑ Turkevs
❑ Turke Poults
❑ Other
Discharges & Stream Impacts
1. is any discharge observed from any part ❑f the operation'?
Discharge originated at: ❑ structure ❑ Application Field ❑ Other
a. Was the conveyance man-made'?
h. Did the discharge reach waters cif the State" (If yes, notify DWQ)
Design Current
Cattle Capacity Population
❑
Dairv� Cow
❑
Dairy Calf
❑
Dai Ilei i'ei
❑
Dry Cow
❑
Non -Dairy
❑
Beef Stockct
❑
Beef Feeder
❑
Beef Brood Cowl
c. What is the estimated volume that reached waters of'the State (gallons)'?
Number of Structures:
d. Does discharge hypasSs the Waste management syslem? (lf Ves, notify DWQ)
2. is there evidence of a past discharge frorn 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
VNo
❑ NA
❑ NE
El Yes
❑No
❑NA
El NE
El Yes
El No
❑NA
❑NC
❑Yes
❑ No
❑ NA
❑ NE:
❑ Yes Na ❑ NA ❑ NE
❑ 1`cs No ElNA ❑ N1-
-
12/28/04 Continued

Facility Number: 1 - , hate (if Inspection
NVaste Collection & 'Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate''
❑ Yes b No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes ❑ No
❑ NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: Q.onn
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): -310
5. Are there any immediate threats to the 'integrity of any of the structures observed?
❑ Yes �No
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
❑ NA
❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of -the structures need maintenance or improvement? XYes ❑ No ❑ NA ❑ NE
8. Do any ofthe stuctures lack adequate markers as required by the permit`? ❑ Yes )KNo ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or .%ret stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
%Paste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance/intprovernent?
11, Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes )kNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu. Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑'1•otal 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 CAWMII?
❑ Yes
[� No
❑ NA
❑ NE
15, Dues the receiving crap and/or land application site need improvement'?
❑ Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination'❑
Yes
No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application'?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
r No
❑ NA
❑ NE
Coniments (refer to question #): Explain any YES answers and/or any recommendations or;any.ather comments.,. u•;o-m ` :: x
Use drawings of facility to better explain situations. (use additional pages as necessary): , M;
5 � �
v4 UA-)
01/ )0V� o
Reviewer/Inspector Name . 5�� Phone: �j b ❑
Reviewer/Inspector Signat Date: 3
12128104 Continued

Facility dumber: — Dag Inspection M1146i
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage &- Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWM11 readily available? ifyes, check ❑ Yes No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping nee;�W
ovement'? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ❑ NE
Wastc Application ekl Freeboard Waste Analysis Soil A alysis - as e !� ." __...."" z
i `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 XNo ❑ NA ❑ NE:
23. If selected, did the facility fail to install and raintain rainbrcakers on irrigation equipment:' ❑ Yes *o ❑ NA ❑ NE:
24. Did the facility fail to calibrate waste application equipment as required by the pemiit? 0& •• ❑ Yes 0 No ❑ NA ❑ N1:
25, laid the facility fail to conduct a sludge survey as required by the permit`' ❑ Yes t�No ❑ NA El NE
26, [aid the thcility fail to have an actively certified operator in charge? El Yes 1No ❑ NA ❑ NE
27. Did the facility flail to secure a phosphorus loss assessment (PLAT) certification? ❑ Yes %No ❑ NA ❑ NE
Oflier Issues
29. Were any additional problems noted which cause non-compliance of the permit or CAWMI'? ❑ Yes No ❑ NA ❑ NE
29, Did the facility fail to properly dispose of dead animals within 24 hours and/or document ❑ Yes No ElNA ElNE
and report the mortality rates that were higher than normal'?((( "`
30. At the time ol'the inspection did the facility pose an odor or air quality concern'' 0 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? (icl discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes L]9 No ❑ NA ❑ NE
33. Does facility require a follow-up visit by same agency? ❑ Yes No ❑ NA ❑ NE
Additional Comments and/or Drawings:
>% FQ
! 2128104

Assistance Site Visit
❑ Wean to Feeder
❑ Feeder to Finish
® Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gifts
❑ Boars
tzoo
iota
• ❑AWn of Soil and Water Conservation/
Q N'' aural Resources Conservation Service
0 Soil and Water Conservation District
O Other...
Facility dumber 7[j - Date: 12/16/04 Time: 1 900 1 Time On Farm: 45 WSRO
Farm Name KLS Swine Farm County Randolph Phone: [phone]
Mailing Address PO Box 130 Liberty NC 27298
Onsite
Representative Kim Griffin Integrator G1S
Type Of Visit Purpose Of Visit
® Operation Review
❑ Compliance Inspection (pilot only)
❑ Technical Assistance
❑ Confirmation for Removal
❑ No Animals -Date Last Operated:
❑ Operating below threshold
® Swine ❑ Poultry ❑ Cattle ❑ Horse
© Routine
• Response to DWQIDENR referral
O Response to DSWCISWCD referral
O Response to complaintllocal referral
Q Requested by prod ucerlintegrator
Q Follow-up
a Emergency
0 Other...
Design Current Design Current
Capacity Population Capacity Population
El
❑ Non -Layer
❑ Dairy
❑ Non -Dairy
❑ Other
GENERAL QUESTIONS:
1. Is waste discharging from any part of the operation and reaching surface waters or wetlands? ❑ yes ® no
2. Is there evidence of a past waste discharge from any part of the operation that waste reached
❑ Other
GENERAL QUESTIONS:
1. Is waste discharging from any part of the operation and reaching surface waters or wetlands? ❑ yes ® no
2. Is there evidence of a past waste discharge from any part of the operation that waste reached
❑ yes ® no
surface waters or wetlands?
3. Does any problem pose an immediate threat to the integrity of the waste structure (large trees,
❑ yes ® no
seepage, severe erosion, etc.)?
4. Is there evidence of nitrogen over application, hydraulic overloading or excessive ponding
❑ yes ® no
requiring DWQ notification?
5. Is there evidence of improper dead animal disposal that poses a threat to the environment
❑ yes ® no
and/or public health?
6. Is the waste level within the structural freeboard elevation range for any waste structure?
❑ yes ® no
Structurel Structure 2 Structure 3 Structure 4
Structure 5
Identifier 11
Level (inches) 1 +1
CROP TYPES Fescue -ha 1comman Bermuda -hay
SPRAYFIELD
SOIL TYPES Cab BaB ApB
7. What type of technical assistance does the ansite representative feel is needed? (list in comment section)
03/10/03

a
Facility Number 76 - 5 Date:
12/16/04
PARAMETER
Q No assistance provided/requested
❑ 8. Waste spill leaving site
❑ 9. Waste spill contained on site
TECHNICAL ASSISTANCE Needed
Provided
El 10. Level in structural freeboard
25. Waste Plan Revision or Amendment
El
❑
❑ 11, Level in storm storage
26. Waste Plan Conditional Amendment
❑
❑
27. Review or Evaluate Waste Plan wlproducer
❑
El
12. Waste structure integrity compromised
❑ 13. Waste structure needs maintenance
28• Forms Need (list in comment section)
❑
❑
29. Missing Components (list in comments)
❑
❑
❑ 14, Over application 3= 10% & 10 lbs.
Over application <.10% or < 10 lbs.
30. 2H.0200 re -certification
El
El
❑ 16. Hydraulic overloading
El
31. Five & Thirty day Plans of Action (PoA)
❑
❑
32. Irrigation record keeping assistance
❑
❑
❑ 17. Deficient irrigation records
❑ 18, Latelmissing waste analysis
33. Organiizelcomputerization of records
❑
❑
❑ 19. Late/missing lagoon level records
34. Sludge Evaluation
❑
❑
❑ 20. Late/missing soils analysis
❑ 21. Crop needs improvement
35. Sludge or Closure Plan
❑
❑
❑ 22. Crop inconsistent with waste plan
36. Sludge removal/closure procedures
❑
❑
37. Waste Structure Evaluation
❑
❑
❑ 23. Irrigation maintenance deficiency
❑ 24, Deficient sprayfield conditions
38. Structure Needs Improvement
❑
❑
39. Operation & Maintenance Improvements
❑
❑
40. Marker check/calibration
❑
❑
Reaulatory Referrals
41. Site evaluation
❑
❑
❑ Referred to DWQ Date:
42, Irrigation Calibration
❑
❑
❑ Referred to NCDA Date:
43. Irrigation designlinstallation
El
❑ Other...
system
Date:
44. Secure irrigation information (maps, etc.)
❑
❑
LIST IMPROVEMENTS
Operating improvements
45. ❑ eratin (pull signs, etc.)
❑
❑
MADE BY OPERATION
❑
❑
46. Wettable Acre Determination
1
47. Evaluate WAD certificationlrechecks
❑
❑
48. Crop evaluation/recommendations
❑
❑
2.
49. Drainage work/evaluation
❑
❑
50. Land shaping, subsoiling, aeration, etc.3.
51. Runoff control, stormwater diversion, etc.
❑
❑
❑
❑
52. Buffer improvements
❑
❑
53. Field measurements(GPS, surveying, etc.)
❑
❑
4.
54. Mortality 8MPs
❑
❑
55. Waste operator education (NPDES)
5'
56. Operation & maintenance education
❑
❑
57. Record keeping education
6.
58. Crop/forage management education
❑
❑
59. Soil and/or waste sampling education
❑
❑
03/10/03

Facility Number 76 - Date:
TECHNICAL SPECIALIST 113etsy K. Gerwig
SIGNATURE
Date Entered: 12/17/04
Entered By: lBetsy K. Gerwi
03/10/03

F - ''vision of Water Quality
ision of Soil and Water Conservation
OOther Agency -"
Type of Visit Q Compliance Inspection Q Operation Review 0 Lagoon Evaluation
Reason for Visit @) Routine 0 Complaint Q Follow up Q Emergency Notification Q Other ❑ Denied Access
Date of Visit: 8l1212U{}4 Time; U910
F-P
�icility ,umber 7l5 5
Q Not ❑ erational Q Below Threshold
® Permitted ® Certified O Conditionally Certified © Registered 1):itc Last Operated or Ahnve'['ltresltold: .........................
Farin Name: KLS.SytIac Earm .............................. ..... Count►•: RA;MJ.Q.1ph ......................................... !I'.SR.'o........
Owner Name: Kim .................... ...... Glrjffcx1.............
Mailing Address: .................................................
Facility Contact: KiTXl.Grifful................................................
Onsite liettrescnt:itive: ,Kim..G.rif>fclx...................
["hone No:#-�%%4_( a ................
Lj.trgxta.. N.0............................. ..
l itic:.............
................................................... Phone No: k1.3�6 6ZJ3.k6'1..................
............................ Integrator:.... ........................I.
CertifiedOPPrator:,Ki.m.bexly..S.......................... G.61AR................ .................... .......... Operator Certification Itiumher:Z32,8.1.......... ....................
Location of Farm:
Farin Location: SR 2543 - Shady Hollow Road. From CSO, take US Hwy 421 south to Old Liherty Rd. and take right. Tak A�
left onto Brower Meadow Rd. Left onto Sandy Creek lad., right ontoShady llollow Rd. �
N Swine ❑ Poultry ❑ Cattle ❑ Horse latitude 35a F-4—X-11 43 Longitude 79 37 38
Design Current
Design Current
Design Current
Swine Ca acit • Population
Poultry
Capacity Population Cattle
Capacity Population
❑ Wean to Feeder
❑ Layer
❑ Dairy
❑ Feeder to finish
❑ Non -Layer
10 Non -Dairy
N Farrow to Wean
1200
1000
El Farrow to Feeder
❑ Other
❑ Farrow to Finish
'Total Design Capacity
1,200
❑ Gilts
❑ Boars
Total SSLW
519,60
Number of Lagoons 1 S • ra Field Arctt
. ... .. 0
Disc�ha!'t'~ & Stream Impacts
1. is any discharge observed from any part of the operation? ❑ Yes N No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a• If'discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes. notify DWQ) ❑ Yes ❑ No
c. II'd ischarge is observed. what is the estimated flow in ballmin?
d. Does discharge bypass a lagoon System? (l Fyes, notify ❑1+ Q) ❑ Yes ❑ No
2, Is there evidence of past discharge from any part of the operation? ❑ Yes N No
3. Were there any adverse impacts or potential adverse impacts to the Wasters of the State other than from a discharge? ❑ Yes N No
Waste Collection & Treatment
4, Is storage capacity (freeboard plus storm storage) less than adequate? N Spillway ❑ Yes N No
Structure l Structure 2 Structure 3 Structure 4 Structure 5 Structure b
Identifier: ..........Lagoom..................................................................................... .......
Freeboard (inches): 35
12/I2103 Continued

Facility Number: 76-5 Date of Inspection 1 8/1212004
5.
Are there any immediate threats to the Integrity of any of the structures observed? (ic/ tits, severe erosion,
❑Yes'
®No'
seepage, etc.)
6.
Are there structures on -site which are not properly addressed and/or managed through a waste management or
El Yes
®No
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threa(, notify DWQ)
7.
Do any of the structures need maintenance/improvement'?
® Yes
❑ No
8,
Does any part of the waste management system other than waste structures require maintenance/improverent?
❑ Yes
® No
9.
Do any stuctures lack adequate. gauged markers with required maximum and minimum liquid level
El Yes
N No
elevation markings?
Waste Application
10.
Are there any buffers that need maintenance/improvement?
❑ Yes
N No
11.
Is there evidence of over application? 1 f yes, check the appropriate box below.
❑ Yes
N No
❑ Excessive Pnnding ❑ PAN ❑ I iydraulic Overload ElFrozen Ground ElCopper and/or Zinc
12.
Crop type Coastal Bennuda (Hay) Fescue (Hay)
13.
Do the receiving crops differ with those designated in the Certified AitimaI Waste Management flan (CA WMP)?
❑ Yes
N No
14.
a) Does the facility lack adequate acreage for land application?
❑ Yes
N No
b) Does the facility need a wettable acre determination?
❑ Yes
N Na
c)'['his facility is pended for a wettable acre determination?
❑ Yes
N No
15.
Does the receiving crop need improvement?
N Yes
❑ No
16.
Is there a lack of adequate waste application equipment?
❑ Yes
N No
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes N No
19. Is there any evidence of wind drift during land application? (i.c. residue on neighboring vegetation, asphalt, ❑ Yes N No
'roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If'yes, contact a regional ❑ Yes N No
Air Quality representative immediately.
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): FEJ Fieid Copy N Final Notes
7. Continue efforts to control vegetation. looks better this year. 'Nees have been cut t A,
15. Still need to control broadleaf weeds in bermuda fields.
15. Must take a cutting from the hay fields that received animal waste this year,
16. Some of the fields look as if the application was not uniform. Suggest re -checking spray pattern and pressure rr gun.
3. Soil samples have been sent. Check next visit.
3. Waste analysis for Spring was slightly outside the 60-day window,
123/04 waste analysis=l.6 lbs. NI1000 gal.
Reviewer/Inspector Name ;Nell sa Rosebrock
Reviewer/Inspector Signature:
1211210.3
Date: `tS1Ic
Continued

Facility Number: 76-5 1): of Inspection 8112120U4
0
Required
Records & i)ocumcnis
21.
Fail to have Certificate of Covertige & General Permit or other Permit readily available?
❑ Yes
® No
22.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
® No
23,
floes record keeping need improvement? If yes, check the appropriate box below.
® Yes
❑ No
❑ Waste Application ❑ Freeboard ® Waste Analysis ❑ Soil Sampling
24.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
® No
25.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
® No
26.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(iel discharge, freeboard problems, over application)
❑ Yes
® No
27.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
® No
29,
Does facility require: a follow-up visit by same agency?
❑ Yes
® No
29,
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
®No
NIIDES Permitted Facilities
30.
Is the facility covered under a NPDES Permit? (if no, skip questions 31-35)
❑ Yes
® No
31.
]fselected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
32.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ No
33.
Did the facility fail to conduct an annual sludge survey?
❑ Yes
❑ No
34,
Did the facility fail to calibrate waste application equipment?
❑ Yes
❑ No
35.
Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below.
❑ Yes
❑ No
❑ Stocking Form ❑ Crop Yield Form ❑ RainfalI ❑ Inspection After 1" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
p
No violations or deficiencies were noted during this visit. You ► HI reeei►•e no further correspondriwe about this visit.
Comments and/or Drawings:
A.
�I
12112103

d ti r :z .r.rr r.ti a a*•r.r i
.x* �3 7 .' r ky.,wa • P . �: ssi q.. ���..
Via:•'',: ._ , _ w •�',!
�"a)�ty
� ��•� �, �' � �:�, ��,,��,,.� ��� 'irisio�uf Snit•sndiWate�Conservativ_a�"�-� ,V� �'- '=�.�3 ���'�,��`�' 1 �.�''• 1,�'�.`'�'
V,�''�,.1^�.�; r �• ��� � ',r.� � �.F � ��_` i ■ M ' e°; ��7}� • 5 S� . •: ��,r�< �'s�"^�aY'v" �" ". ,v�ai: 'ay..:r�A.�d;"`.r�n:. x�� �� �•.� r ' !Y �
,�
+la� NSF- ya. ,�g� 'naY`� �j �; `� - -�' y-+ -t•'� . �. ..�`-: - _ i, r�
r•„a'G: ra...�.:a�. i.,...=:a�.,.._ .,E'i%.�.dlw; c.,.�'.'x7':'sT.a.i .�: .�:"a5'..k 3. :..as.a:` ..w _ :, it ..-`.ii x. R. - :A
Type of Visit Compliance Inspection a Operation Review O Lagoon Evaluation
Reason for Visit Routine D Complaint D Fallow up Q Emergency Notification p Other ❑ Denied Access
Facility Number Date of Visit: Time:
Q Not Operational Q Below Threshold
Permitted [] Certified 13 Conditionally Certified 0 Registered Date Last Operated or Above Threshold:
Farm Name: ....._ I.L L':... Con .. G_1t n }........ _....
Owner Name: . ....00-. - .Ff—P _....»......................... ....... Phone No: ,3 3� �P.-2 � � i. _�1�`�' �S
Mailing Address:.. 1 ._ �:.� _ �_.. .. ....�_._.._ _ __._._._.._...... D_9 ❑w.... -........ ..........................
Facilih• L Contact:....._ _.....l. IY1-...�1_.__� . ...._.-- --Title. Phone No:
r �
Onsite Representative- rtT Integrator. 1.
Certified Operator:..• n(]Q.... Operator Certification Number:..
Location of Farm:
U . 50 a
k� Swine [] Poultry E] Cattle
0 Morse Latitude
Yongitude
Uesiga : Curreat f ;xY = - ,, Desag�•.:Cnrrent,':Design; r ='Current
Swine •rzPaetI _ T a -� : Cattle"
Ca ci •'l elation>r� t6Y, Caj `cif :Pv tilatinn; Ca aci Pv nlataon'
❑ Wean to Feeder '; ❑ Layer '. ❑Dairy
ElFeeder to Finish s ❑Non -Layer aj❑ Non -Dairy
Farrow to Wean y,.. .... .., . L.,
�� Other
Farrow to Feeder, E-
❑ Farrow to Finish i"I` Total Des ; . ati oZ C] Q
❑ Gilts,; -.Ca .P3',
�w: • ..._•:..
❑ Boars Y :=;s'.t - _:TOW SSLW =" S��
Discharges & stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes �No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in ga.Umin?
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
I Structure I Structure 2 Structure 3 Structure 4 Structure S
Identifier:n _....
Freeboard (inches):
121I2103
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes No
❑ Yes No
❑ Yes No
Structure 6
Continued
1

Facility Number: Date of Inspection L?
5: Are there any immediate threats to the ini2�rity of any of the structures observed? (ie ee severe erosion,
epage, 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?
S. Does any part of the waste management system other than waste structures require maintenancelimprovement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation 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 [IPAN ❑ Hydraulic Overload ❑ Frozen Ground
12. Crop type
13. Do the receiving crops differ. with those designated in the Cerd
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?
❑ Copper and/or Zinc
❑ Yes KNO
❑ Yes �Nio
Yes ❑ No
❑ Yes o
❑ Yes No
❑ Yes *io
❑ Yes XNo
Animal Waste Management Plan (CAWMP)? ❑ Yes
0
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge atlor 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 No
❑ Yes [{ No
❑ Yes OV
No
-kYes ❑ No
t ❑Yes �No
❑ Yes No
❑ Yes o
❑ Yes XNO
- ---.�. _.--..-_ ___ -,,. •rl y.L-:'•. :+r _.._.. .i.,�. _..-..- __•. n- - rr- -:.- -.. ..... _...__.-•- .ors -r ��.. �,.r _. r .. .•s-•=• ,. w-- - --
Cornmeats (i�efer.to t;vrstaon #) Explain a>3y YF5 answers and/or, nay rccammeridatiotu vr.any1at6rcndrarnts.
Ue drawings of fadlity.ta bitteir rxp * sit:iiativns. (use additional pages as necessary): { Feld Copy ❑ Final Notes
S
t
,
Reviewerlinspector Name.M1...�"
Reviewer/Inspector Signature. � j Date:Vt
12112103
(Continued

Facility Number. — Da of Inspection
Ree uired Records & Document,;
21. FaiI to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
ko
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(iel WUP, checklists, design, maps, etc.)
❑ Yes
No
23. Does record keeping need improvement? yes, check the appropriate box below.
XYes
❑ No
❑ Waste Application ❑ Freeboard Waste Analysis ❑ Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
�No
25. Did the facility fail to have a actively certified operator in charge?
❑ Yes
ANO
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(iel discharge, freeboard problems, over application)
❑ Yes
o
27. Did Reviewer/Inspector fail to discuss reviewlinspection with on -site representative?
❑ Yes
o
28. Does facility require a follow-up visit by same agency?
❑ Yes
o
29. Were any ,additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
fNo
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
❑ Yes
*No
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
32. Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ No
33. Did the facility fail to conduct an annual sludge survey?
❑ Yes
❑ No
34. Did the facility fail to calibrate waste application equipment?
❑ Yes
❑ No
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below.
❑ Yes
❑ No
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After 1" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
0 No violations or deficiencies were noted during this visit- You will receive no further correspondence about this visit.
rtrona omments' aadlor, wings_ x ,
@Po,!5 -h} ct,5 r-e, - se&l e c? LO,
U e-i-, am on dc1,m ?
�Ptkr
`° - —
V
r
12112103

7 ■ 1 on of Water Quality
i Q loon of Soil and Water Conservation
Q'Othcr Agency
Type of Visit O Compliance Inspection ❑ Operation Review O Lagoon Evaluation j
for Visit 0 Routine 0 Complaint O Follow up 0 Emergency Notification O Other ❑ Denied Access
haci[it►• Number 76
4 ❑u,r ul 1'i+it; IIIUKI201}3 "i'in,e: 10{I[I
KEN: (11 C},eralional Q Belo► Threshold
Permitted M Certified 0 Conditionally Cerlif,ed [3 Rcgistered I}xic Last []peralec! or Alxt►r'I hritihnld: . __..........
;arm mine: W.Swine....... -................................... t.rratnty:RjDAg.....
()i%uer ,Name: KiruL.---.-------.---.-.- Grif[[
Mailing Address: YSl.I u..139...........................
Facilit► [:onlact:.................................................... ...111IC:............................................... Phone No. Hl ,36,b2Z.3.46I..............
Onsite Repr•esentaln'ct �iAlSi[li�flC}i- - --- - --- - --- --- - --- - -•-•- -- Inlci;ralnr:�eLS-- - --- - - - - --- - - - -- ---.-..
Certified Operator: k(1111��115. ....................... ....G i,ffm............................................... Operalur Certification Number':23,2$.j
............................
Locallon of Farrar:
Farm location: SR 2543 - Shady Hollow Road. From GSO, take US Hwy 421 south to Old liberty Rd. and take right. Tak
eft onto Brower Meadow Rd. Left onto Sandy Creek Rd., right ontoShady Hollow Rd.
® Swine ❑ Poultry []Cattle ❑ Horse Lalitude 35 48 43 I.otlgitude 79 • 37 38
Design Current
Swine C'anneity Pontrintion
❑ Wean to Feeder
❑ Feeder to Finish
® Farrow to Wean
1200
800
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Design Current Design Current
Poultry Capacity Population Cattle Capacity Population
❑ Layer ❑ Dairy
❑ Non -Layer ❑ Non -Dairy r,
❑ Other I
Total Design Capacity 1,200
Total SSLW 519,600
Number of Lagoons ❑ Subsurface Drain-, Present ❑ Lagoon Area ® Spra} Field Area rF
[folding Ponds/ Solid Traps J❑ ,No liquid Waste Managernent Svsteln
Discharges & Stream Imparts
1. Is :any discharge observed from any part of the operation? ❑ Yes ® Na
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, ►►•as the conveyance man-made? ❑ Yes ❑ No
b. if discharge is observed. did it reach Water of the State'? (lf yes. notify DWQ) ❑Yes ❑ No
c, if discharge is observed, what is the estimated flo►+• in gallmin?
d. Dues discharge bvpatis a lagoon systetn? (lfyes. 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
Wasle Colieelion & Trealntent
4. Is storage capacity (freeboard plus storm storage) less than adequate'? ❑ Spillway ❑ Yes ® No
StrUCIM-C I Structure 2 SITuclure 3 Structure 4 StruCIUre 5 Structure 6
Idenlil er: ....... Lagoon -------- ---------------------------
Fleebow'd (inches): 42
05103101 Continued

Facilitv Number. 7[,—S D11ty of lnNpection 12/08/2003
5. Are there any immediate threats to the integrity of any of the structures observed? tie/ trees; severe erosion, ❑Yes N No
seepage, etc.)
C. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? El Yes N No
(if any of questions 4-6 was answered ves, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/irnprovernent? N Yes ❑ No
8. Does any pan of the waste management system other than waste structures require maintenance/improverent'? ❑ Yes ® No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum Iiquid level
elevation markings?
❑ Yes
N No
N%'a%te Application
10.
Are there any buffers that need maintenance/improvement?
❑ Yes
N No
11.
Is there evidence of over application'? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload [
❑ Yes
N No
12.
Crop type Coastal Bermuda (}-fay) Fescue (flay)
13.
Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CA WMP)?
❑ Yes
N No
14.
a) Does the facility lack adequate acreage for land application?
❑ Yes
N No
b) Does the facility need a wettable acre determination'?
❑ Yes
N No
c) This facility is pended for a wettable acre determination?
❑ Yes
N No
15.
Does the receiving crop need improvement?
❑ Yes
N No
16.
Is there a lack of adequate waste application equipment?
❑ Yes
® No
Required
Records & Documents
IT
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
® Yes
❑ No
18.
Does the facility fail to have ail components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
N No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
N No
20.
Is facility not in cornpliance with any applicable setback criteria in effect at the time of design?
❑ Yes
N Na
21.
Did the facility fail to have a actively certified operutar in charge'?
❑ Yes
N No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
N No
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
N 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
N No
[j No violations or deficiencies were noted during this visit. You will receive no Further correspondence about this visit.
Comments {refer to question #): Explain any YES an and/or any i ecorrarnendaIions or any other cominents.
Use drawings of facility' to getter esplaio situations. [use additional pages as neces%ary): ❑ Field Copy N Fina] Notes
_ 2
7. Lagoon embankment to be cleaned -up by IA 5104. 17
15. Pastures to be re -seeded in spring.
15. Per soil analysis, four fields need to be limed this year.
17. Need to keep copy of permit with records at the farm, per permit.
19. Records look great as usual.
12/4103 waste analysis: 1.0 lbs. N/1000 gal.
r
Review er/Inspector Name Melina Rosebrock
Reviewei-Anspector Signature: Date: b
05103101 Continued

Facility Number: 76-5 1)ali ln%pcction 1ZIUK12UU3
Udor Iti�ury
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,
road~, building structure, and/or public property)
29Is the land application spray system intake not located near the liquid surface of the lagoon?
30. Were any major maintenance problems with the ventilation Can(s) noted? (i.e. broken fan belts, missing or
or broken fain 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 permanentltempOTary Cover?
❑ Yes ❑ No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
Cl Yes ® No
❑ Yes ® No
❑ Yes ® No
A[IditinnalL•nmments,,and nr�I3ra►t'ing
A,
05/D3/0 J

Di►�ision.6 ANate f�uality
Q.Divkiun `uf•Soil ind':Wnter.Conser' in on
5 Otlier'Af,
Type of Visit Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit i Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Date of Visit: Time: is D
Facility Number
Permitted E3 Certified 13 Conditionally Certified [] Registered lute Lust Operated or Ahove Threshold:
Iti:►mr: - Count►:
f)r►ncr Name: Phone No:
Mailing Address: V a ox 13 htC—
Facilhv Cunlact: 'fitle: Phone No: �'� &-1
Onsite Representali vc: ! �' Integrator:
Certified Operator: �t �rl L 1 _ Operator Certification Number:
l.ocalion of Farm:
Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude `" 0 Longitude a
Design Current
Design Current
Design Current
Swine Capacity Population
Poultry
Capacity Population Cattle
Ca acit►• Population
❑
Wean to Feeder
ID Lavcr
Dai
ED
['ceder to Finish
Non -Laver
NUtl-❑airy
Farrow, to Wean
d
❑ Other
El
Farrow to Feeder
❑
Farrow to Finish
fetal Design Capacity
2,D
❑
oits
Total SSI.W
S--f , 6
❑
Boars
Number of Lagoons __j ❑ Subsurface Drains Present ❑ I.a goon .yrea ❑ 5 pra► Field Area
Bolding Ponds / Solid'fraps 10 No U uid %Vastc ilana Intent System
Discharges &. St. _ream ln_ tpacos
i. is any discharge observed From any part of the operation'? ❑ Yes No
Discharge originated at: El Lagoon El Spray Field El Other
a. If discharge is observed, was the conveyance man-made? El Yes ❑ No
b. It'dischatrge is observed, did it reach Water of the State? (II'Yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gallmin?
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
1'4'_ oste ti _& Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate'? ❑ Spillway ❑ Yes [(No
Structure l Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard (inches):
05/03/01 Continued

FacilIq, Number: Date of Inspection
5. Are there any immediate threats to the inteerity of any of the structures observed? (ie! trees. severe erosion.
❑ �'es
No
seepage. etc.)
6. Are there structures on -site which are not properly addressed andlor managed through a waste management or
closure plan?
❑ Yes
ko
(If any of questions 4-6 ►+as answered yes, and the situation poses an
immediate public health or environmental threat, notifv DWQ)
7. Do any of the structures need maintcnancclimprovement?
Yes
❑ No
S. Does any pan of the waste management system other than waste structures require maintcnancc!improvcment?
❑ Yes
o
9. Do any stuctures lack adequate. gauged markers With required maximum and minimum liquid level
elevation markings?
❑ 1'es
]tio
%Paste Application
la. Are there anv buffers that need maintenanceiimprovement?
❑ Yes
0110
11, Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
❑ Yes
o
1
11. Crop type F0 &7 M CLU
13. Do the recci%rine crops differ with those d signated in the Certified Animal Waste Manage(It Plan (CAI;11IP)?
❑ Yes
To
]4. a) Does the facility lack adequate acreage for land application?
❑ Yeso
b) Does the facility need a vvenable acre determination?
ElYeso
c) This facility• is pended for a wettable acre determination?
ElYesNo
IN
15. Does the receiving crop need improvement?
ElYeso
16. is there a lack of adequate waste application equipment?
❑ Yeso
Required Records S Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
Yes
❑ No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(lei WUP. checklists, design, maps. etc.) ❑ 7'es r
19. Does record keeping need improvement? [ice' irrigation. freeboard, waste analysis & sample reports) ❑Yes No
20, Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes rX.No
21. Did the facility• fail to have a active],. -certified operator in charge? ❑ Y'es No
22. rail to notiffi• regional D«'Q of emergency situations as required by General Permit?
Gel discharge. freeboard problems. over application) ❑ Yes N.
5. 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 AA'MP? ❑ Yes No
0 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
-..... r M..;,a cs�, 9'^?;':aa' vy,;+.�'.x+�':�:n•^:�e "'s.w.r- x.ss&'a: i• e" :: ;: r:.^a,_e-�^,:;..r -.� ' .:Y'� ,i•,�^e -.«�..
Y—ommeots (reiwto'g6esWoa #):':EiplziK aAy,YES answeiFs and/or. any. recommendations or:a6y.vther..comments. �•:.. �: + : ~
Use drawings of facilih� to better explai.ti situ>tions. (use additional pages 'as necessary):' . Field Co r ❑ Final ;dates
J. Y-.7f�.::. ?.xx;,�.ns.a:fl=a�.'•�.;_ �.�n v.�sb`Li.'i�c�r"ar���'.".s-�rL:� ._ w "Y..+yi:iti�az: -- A�r'.t.iC
'�_7j
Nlo /A Q
)12 Z/Q3 N/ iboo A i�_5
2-2
ReviewerfIns — - „_"'�^V,,,;�r'w^.: �^ _-�--`..- .c-;y �.,�r-,,, '^'c �,: :..*ate+:-^^r^• �
pector Name i.:i:
s�f" '�`�i-s..:�s..: ,,�iiwa=a:�"°�7.::t . �i' �G. ; �::� '• � �;.a. :k
Reviewer/Inspector Signature. Date:
05103101 ` ` C'vndriued

Facility Number, fy —5 1 Elate of Inspection Z)-3
Odor Issues
26. Does the discharge pipe from the confinement building to the storage }pond or lagoon fail to discharge atinr below
liquid Icvcl of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours:'
2S. is there any cvidencc of kind drift during land application? (i.c. residue on neighboring %'egctation. 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:'
+U. «'cre any major maintenance problems with the ventilation fan(s) noted? (i.c. broken fan belts. missing or
or broken fan biade[s), inoperable shutters. etc.l
? 1. Do the animals feed storage bins fail to have appropriate coVcr?
32. Do the flush tanks lack a submerged fill pipe or a permanent+temporan, cover?
Additional Comments andlor Drawings:
14k-
r '
❑ Yes No
❑ N•cs do
El )*es �N'o
❑ 1'cs '10
❑ 1'es No
❑ ).cs No
05103101

Technical Assistance Site Visit Report
Q Div' of Soil and Water Conservation MW
* Na`ural Resources Conservation Service
Q Soil and Water Conservation District
Q Other...
Facility Number 76 - Date: 121193 Time: 1 9:05 1 Time On Farm: WSRC
Farm Name Carolina Swine Producers Inc.
Mailing Address PO Box 1247
pnsite
Representative
Type Of Visit
® Operation Review
❑ Compliance Inspection (pilot only)
❑ Technical Assistance
❑ Confirmation for Removal
I❑ No Animals -Date Last Operated:
❑ Operating below threshold
IN Swine ❑ Poultry ❑ Cattle ❑ Horse
Design Current
Capacity Population
❑ Wean to Feeder
❑ Feeder to Finish
® Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
1200
1080
county Randolph Phone: [phone]
Liberty NC 27298
Integrator inde endent
Purpose Of Visit
Q Routine
Q Response to DWQ/DENR referral
Q Response to DSWC/SWCD referral
Q Response to complaint/local referral
Q Requested by producer/integrator
p Follow-up
Q Emergency
0 Other...
Design Current
Capacity Ponulation
❑ Layer
❑ Non -Layer
❑ Dairy
❑ Non -Dairy
❑ other
GENERAL QUESTIONS:
1, Is waste discharging from any part of the operation and reaching surface waters or wetlands?
2. Is there evidence of a past waste discharge from any part of the operation that waste reached
surface waters or wetlands?
3. Does any problem pose an immediate threat to the integrity of the waste structure (large trees,
seepage, severe erosion, etc.)?
4. Is there evidence of nitrogen over application, hydraulic overloading or excessive ponding
requiring DWQ notification?
5- Is there evidence of improper dead animal disposal that poses a threat to the environment
and/or public health?
5. Is the waste level within the structural freeboard elevation range for any waste structure?
❑ yes ® no
❑ yes ® no
❑ yes ® no
❑ yes ® no
❑ yes ®no
❑ yes ® no
Structurel Structure 2 Structure 3 Structure 4 Structure 5
Identifier Lagoon
Level (Inches) $ IF
CROP TYPES Fescue -graze IFescue-hay jHybrid B.G.
eGnAyGIFI n
bVIL I Wtb
7. What type of technical assistance does the pnsite representative feel is needed? (list in comment section)
1 03/1 fl143
❑ Dairy
❑ Non -Dairy
❑ other
GENERAL QUESTIONS:
1, Is waste discharging from any part of the operation and reaching surface waters or wetlands?
2. Is there evidence of a past waste discharge from any part of the operation that waste reached
surface waters or wetlands?
3. Does any problem pose an immediate threat to the integrity of the waste structure (large trees,
seepage, severe erosion, etc.)?
4. Is there evidence of nitrogen over application, hydraulic overloading or excessive ponding
requiring DWQ notification?
5- Is there evidence of improper dead animal disposal that poses a threat to the environment
and/or public health?
5. Is the waste level within the structural freeboard elevation range for any waste structure?
❑ yes ® no
❑ yes ® no
❑ yes ® no
❑ yes ® no
❑ yes ®no
❑ yes ® no
Structurel Structure 2 Structure 3 Structure 4 Structure 5
Identifier Lagoon
Level (Inches) $ IF
CROP TYPES Fescue -graze IFescue-hay jHybrid B.G.
eGnAyGIFI n
bVIL I Wtb
7. What type of technical assistance does the pnsite representative feel is needed? (list in comment section)
1 03/1 fl143
❑ other
GENERAL QUESTIONS:
1, Is waste discharging from any part of the operation and reaching surface waters or wetlands?
2. Is there evidence of a past waste discharge from any part of the operation that waste reached
surface waters or wetlands?
3. Does any problem pose an immediate threat to the integrity of the waste structure (large trees,
seepage, severe erosion, etc.)?
4. Is there evidence of nitrogen over application, hydraulic overloading or excessive ponding
requiring DWQ notification?
5- Is there evidence of improper dead animal disposal that poses a threat to the environment
and/or public health?
5. Is the waste level within the structural freeboard elevation range for any waste structure?
❑ yes ® no
❑ yes ® no
❑ yes ® no
❑ yes ® no
❑ yes ®no
❑ yes ® no
Structurel Structure 2 Structure 3 Structure 4 Structure 5
Identifier Lagoon
Level (Inches) $ IF
CROP TYPES Fescue -graze IFescue-hay jHybrid B.G.
eGnAyGIFI n
bVIL I Wtb
7. What type of technical assistance does the pnsite representative feel is needed? (list in comment section)
1 03/1 fl143

a
Facility Number 76 - 5 Date:
4/21103
PARAMETER
Q No assistance provided/requested
❑ 8. Waste spill leaving site
[19. Waste spill contained on site
TECHNICAL ASSISTANCE Needed
Provided
10. Level in structural freeboard
25, Waste Plan Revision or Amendment
❑
El
® 11. Level in storm storage
26. Waste Plan Conditional Amendment
❑
❑
27. Review or Evaluate Waste Plan wlproducer
❑
❑
❑ 12. Waste structure integrity compromised
28. Forms Need in
El
El
El 13. Waste structure needs maintenance
(list Comment section)
29. Missing Components (list in comments)
❑
❑
❑ 14. Over application >= 10% & 10 lbs.
❑
❑
❑ 15. Over application < 10% or < 10 lbs.
30. 21-11.0200 re -certification
❑ 16, Hydraulic overloading
31. Five & Thirty day Plans of Action (PoA)
❑
❑
32. Irrigation record keeping assistance
❑
❑
❑ 1 T Deficient irrigation records
❑ 18. Late/missing waste analysis
33. Organizelcomputerization of records
❑
❑
❑ 19. Latelmissing lagoon level records
34. Sludge Evaluation
❑
❑
❑ 20. Late/missing soils analysis
® 21. Crop needs improvement
35. Sludge or Closure Plan
❑
❑
❑ 22. Crop inconsistent with waste plan
36. Sludge removallclosure procedures
❑
❑
37. Waste Structure Evaluation
❑
❑
❑ 23. Irrigation maintenance deficiency
❑ 24. Deficient sprayfield conditions
38. Structure Needs Improvement
❑
❑
39. Operation & Maintenance Improvements
❑
❑
40. Marker checklcalibration
❑
❑
Requlatory Referrals
41. Site evaluation
❑
❑
❑ Referred to ❑WQ Date:
42. Irrigation Calibration
El
El
El Referred to NC�A Date:
43. Irrigation designlinstallation
❑
❑
❑ other...
system
Date:
44. Secure irrigation information (maps, etc.)
❑
❑
LIST IMPROVEMENTS
45. Operating improvements (pull signs, etc,)
❑
❑
MADE BY OPERATION
❑
❑
46. Wettable Acre Determination
1
47. Evaluate WAD certificationlrechecks
❑
❑
48. Crop evaluationlrecommendations
2,
49. Drainage work/evaluation
❑
❑
50. Land shaping, subsoiling, aeration, etc.
51. Runoff control, stormwater diversion, etc.
❑
❑
❑
❑
3.
52. Buffer improvements
❑
❑
53. Field measurements(GPS, surveying, etc.)
❑
❑
4.
54. Mortality BMPs
❑
❑
55. Waste operator education (NPDES)
❑
❑
5.
56. Operation & maintenance education
❑
❑
57. Record keeping education
❑
❑
6.
58. Croplforage management education
❑
❑
59. Soil and/or waste sampling education
❑
❑
1114I 1711143

s
,Facility dumber 76 - U Date: 4/21/03
MMENTS:
led DWQ (Melissa Rosebrock) 2-26-03 and 3-15-03. Five day PGA on 3-21-03.
;eed pastures in Fall 2003.--
ste analysis- 3-19-03 Soil- 4-10-03
TECHNICAL SPECIALIST 113. Barton Roberson
SIGNATURE
Date Entered: 7118103 Entered By: lRocky Durham
3 03/ 10/03

• Sion of Water Quality
❑ion of Soil and Water Conservation
❑ Other Agency
]Type of Visit D Compliance Inspection Q Operation Review 0 Lagoon Evaluation
Reason for Visit D Routine n Complaint Q Fallow up Q Emergency !Notification 0 Other 0 Denied Access
Facility Number 7ti [l$ liar. ��t �'itiit: t;RlliaD2 l'i�nr: t�OU
❑ Not O erational ❑ Be1o"Threshold
® Permitted ® Certified [] Conditionally Certified 0 Registered Date bust Operated or Aho►e'I'hrtshertd: ................
Farm Name: �ktltlli a�.Si�iulf".k'1CQL1lt GCS.IgIC................................................. .... ... Count►: FAjj4,Qjpjj ......................................... ,SRp........
.......
Owner Name: W..iIiijltm..........I....................... Smith ........................................................... Phone No: {,33(�.fez-�k�i`?1.......... _._... ............ --.... ---..... ..... -
MailingAddress:EQ.0p.m.12,47 .......................................................................................... LibuU.N.0 ........... .............................. z7 28...---........
Facilih. Contact: i�i IM..Giri llBut---------------------------------------------------- Title: ... ............................................... .............. Phone No: 33.6.OZ2,14.67.......................
Onsite Representative: Kim.fa',rifAFl... ................................. ...... .................... ..... I............. Integrator: Indcp rtlflelat...........................................................
CertifiedOperator-.Kjmb.edY.S.......................... Gxifiut.............................................. Operator Certification Numher:Z3281.............................
Location of Farm:
Farm Locution: SR 2543 - Shady Hollow Road. From GSO, take US Hwy 421 south to Old Liberty Rd. and take right. Takc A
left onto Brower !Meadow Rd. Left onto Sandy Creek Rd., right ontoShady Hollow Rd.
® Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 35 48 43 Longitude F 79 37 38
Design Current
Design Current
Design Current
Swine Capacity Population
Poultry
Capacity acit Population Cattle
Capacity Population
❑ Wean to Feeder
❑ Layer
❑ Dairy
❑ Feeder to Finish
JE1 Non -Layer
I JEI Non -Dairy
® Farrow to Wean 1200
El Farrow to Feeder
❑ ether
p Farrow to Finish
Total Design Capacity
1,200
❑ Gilts
❑ Boars
Total SSI1 W
519,60
Number of Lagoons 10 Subsurface Drains Present ❑ E.agi..n Area IN Spray Field Arca
Holding Ponds 1 Solid Traps 10 No Liquid Waste Management System
DischargeK ti ream [nlc�
1. Is any discharge observed from any part of the operation? 0 Yeti ® No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Dther
a. Ii'discharee is observed. was the come}•ance m:ln-made? ❑Yes ❑ No
h. li' dischargc is ohser cd. did it reach Water of the State? t It' }'es, nitrify DWQ) ❑Yes [:]No
c. II' discharge is obsen ed. what is the estimated Ilow in Val/min'!
d. lines discharge hypcass a lagoon s}'strnY.' {il yes, nolifp [7WQ] ❑ 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
Wa!at Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ® Spillway ❑ Yes ® No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure h
Identifier: Lagoun.............................................. ......................... ..... ...... ................ ................... ......................................................................
Freeboard (inches): 31
05103101 Continued

Facility Number: 76-05 1* 1),.kIv +it' 1 iispvctirii1 812112D02 0
5. Are there any immediate threats to the integrity of any of the structures observed'? (ie/ trees, severe erosion,
seepage, etc.)
5. 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 pan 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?
11'aste .1P1 I) ic-atinn
10, Are there any buffers that need maintenance/improvement'?
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
12. Crop type Coastal Bermuda (Hay) Fescue (Hay)
❑ Yes
® No
❑ Yes
® No
® Yes
❑ No
❑ Yes
® No
❑ Yes
® No
❑ Yes
® No
❑ Yes
® No
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)'? ❑ Yes ® No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes ® No
b) Does the facility need a wettable acre determination? ❑ Yes ® No
c) This facility is pended for a wettable acre determination? ❑ Yes ® No
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
R a"ired_Record5 & Documents
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?
(ic/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ic/ 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'?
Oe/ discharge, Freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection 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 ® No
❑ Yes ® No
❑ Yes OR No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
[:]Yes ® No
❑ Yes ® No
0 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Eomments (refer to question #): >xplain any YF.S answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. {use additional pages as nee sssary); ❑Field Copy ®Final Notes
7. Woody vegetation on dam needs to be sprayed as soon as possible. If not controled, will be an NOV next visit.
_
15. Continue efforts to control broadleaf weeds in Bermuda with 2A-DD.
19. Per operator, 2002 soil samples were sent off this week and results are not available yet.
25. Operator needs written documentation for her records that extended spray months is ok. Need to see Randolph SWCD.
25. Per operator, Randolph SWCD is to add a 60 acre (approx.) farm to CAWMP for pump and haul application onto pasture.
Waste analysis 6114/02 = 1.7 1bs.11000 gal.
Reviewerllnspector Name Melissa Rosebrock .�
Reviewer/Inspector Signature: �Jl r� I- ld/ L LI h 1t:? 1 Date:
05103101 Continued

Facility Number: 76-05 1 Da011spection $121I2[1(lZ 0
[ i 1n +sucti
26, Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge atlor below
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours?
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid Surface of the lagoon'?
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
31, Do the animals feed storage bins fail to have appropriate cover?
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover'?
❑ Yes ❑ No
❑ Yes ® No
❑ Yes ® No
[:]Yes []No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
'Additional ommenls and/or
w..1. g :.r.'s�ak, >.''�i "'•:z5,;f; : �' Salo �;.:Yc_ ,s,.11��:. ' asr_: �:�., .: r';h .:'s,
0510 3101

IM
Division of Water Quality
Division of Soil and Water Conservation
0 Other Agency
Type of Visit Compliance Inspection O Operation Review Q Lagoon Evaluation
Reason for Visit )A Routine ❑ Complaint Q Follow up 0 Emergency Notificatlon a Other ❑ Denied Access
Date 01 Visit:
Facilir% Number
Permitted.. Certified 0 Conditionally Certified 0 Registered
Farm Name: Q y 'l Ucf-:,r
Owner Name: „ r�►����uLTY� J�1 �],�__
Mailing Address: PO�
Facility Contact: — —1 JYl _I /I f t Z ► I 1 i Title:
Onsite Representati►—
Certified Operator: r `I�
Location of harm:
US HwY t U . C13 -. V- rr)
■ intC: a
Not D erational Q Belaw Threshold
Date Last Operat or Ab ►e Threshold:
County
Phone No: 3U/, A z L. ►
- Phone No: _. 3 ' 22 03467
Integrator•
Operator Certification Dumber: a3 9g
9Swine El Poultry El Cattle El Horse Latitude �' � �» Longitude �'
Design Current
Design Current
Design Current
Swine Ca aciry Population
Poultr►'
Capacity Pa elation Cattle
Ca acity Po elation
El Wean to Feeder
W
❑ Laver
I
I
❑ Dairy
Feeder to Finish
❑ Non -haver
❑ Nan -Dais,
Farrow to wean
12-00
❑ D:her
Farrow to Feeder
❑ Farrow to Finish
Total Design Capacity
r
❑ Gilts
Total SSLW
❑ Boars
Number -of Lagoons 1E _l Subsurface Drains Present_JILJ Lagoon Area JLJ Spray Field Area
Holding Ponds / Solid "Traps E❑ No Li uid Li'aste liana ement S►'stem
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑yes o
Discharge originated at: ❑ Lagoon ❑ Spra►• Field ❑ Other
a. Ifdischarge is observed, was the con►eyance man-made? ❑ Yes ❑ No
b. if discharge is observed, did it reach Water of the State`' (If yes, notify DIKQ) ❑ Yes ❑ No
c. if discharge is obsen ed. 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 .B'No
3. Were there any adverse impacts or potential adverse impacts to the waters of the State other than from a discharge? ❑ Yes �o
Water Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? Spillw•a►• ❑ Yes ''►I0
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure b
Identifier;
Freeboard (inches):
05103101 Continued

Facility Number-, — Dare of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees. severe erosion, ❑ }'es No
seepage, etc.)
G. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ YesI�o
(If anyof questions 4-6was answered ►•es, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7, Do any of the structures need maintenancelimprovement? )RrYcs ❑ No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes XN10
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid Ievel
elevation markings? ❑ Yes o
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes y,o
11. IS there evidence of over application? ❑ Excessive Pending El PAN El Hydraulic Overload ElMes a
12. Crop type r'
i3. Do the receiving crops differ with those designa d in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes 'gNo
14. a) Does the Facility lack adequate acreage for land application? ❑ Yes No
b) Does the facilitS need a wettable acre determination? El Yes I
c) This facility is pended for a wettable acre determination? ❑ Yes No
I5. Does the receiving crop need improvement? ❑ Yes 3R1Go
15. Is there a lack of adequate waste application equipment? ❑ Yes )Kll�o
Required Records & Docuntents
17. Fail to have Certificate of CovcraQe & General Permit or other Permit readily available? ❑ Yes 5 No
18. Does the facility fail to have all components of th7"1
ified Animal Waste Management Plan readily available?
(ie/ WUP, checklists. design, maps, etc.) j ❑ Yes $.tie
19. Does record keeping need improvement? (ie/ irrigation, freeboard. waste analysis & soil sample reports) ❑ Yes X No
20. is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes Nc
21. Did the facility fail to have a actively certified operator in charge? ❑ Yes )%-;N o
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 AWNIP? ❑ Yes 'N�N❑
[] No violations or deficiencies were noted during this visit. You will receive no further correspondence about this Visit.
Comments (refer to question. #), Explain any VES answers and/or any recommendations or any Cher comments.
Use drawings of facility to better explain situations. (use additional pages as necessary): -Field Cnnv ❑ Final Notes
Reviewer/Inspector Name
roY Farr .
Date: O7
Reviewer/Inspector Signature:
05/03/01 Continued

Facility Number: 7L — Dare of lnspec6m
( dor 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 am• 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 iocated near the liquid surface of the lagoon?
30. Wcrc any major maintenance problems with the ventilation fan(s) noted? fi.c. broken fan belts, missing or
or broken J'an hladc(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?
Additional C:ontrnent+ and/or l)ra►.irz~s:
4
❑ I'cs 1\o
❑ I'es Nz`lo
❑
❑ N'estio
❑ Yes N114
05103101

FZ 11
isron of Water Quality
ision of Soil and Water Conservation
Q Other Agency
(Type of Visit Q Compliance Inspection ❑ Operation Review ❑ Lagoon Evaluation
IReason for Visit @ Routine Q Complaint Q Follow up D Emergency Notification ❑ Other ❑ Denied Access
1}:itr. ril' 1'itiit: 111'.ip12[ll}1 'I'inri�: U85{}
Facility' Number 7fi IIS
Not Operational Q Below-'I'hreshold
® Permitted ® Certified [3 Conditionally Certified [3 Registered Date Last Operated or AboveThreshold;
Farm Name: Cats}lino.S.n'irt .>Prod.u�r,era.Imc.............................................................. County: RatntdulptX......................................... tYSFi. ........
Owner Name: y�!i>Anna...................................smittt.................................................... Phone No:Q,3.61.622,4$9..1.k,mx>ut}..........................
Mailing; Address:V..Q.B.V,x..1Z4T................. ......................................................................... Libert}:.tti.C........... ............ ........ .. .. 2729.8..............
Facility Contact: Kitt -Griff"m.................... ................................ .l'itke:..........
Phone No:
Onsite Representative: KiStx,GCiffllj................................................................................. Integralor: J d!pcxjdcja1............................................................
Certified 0perator:,Ki nb-v.rly..S,......................... Q%iflrA.............................................. Operator Certification Number:2,12&I.............................
Location of Farm:
Harm Location: SR 2543 - Shady Hollow Road. From CSO, take US Hwy 421 south to Old Liberty Rd. and take right. Tak
left onto Brower Meadow Rd. Left onto Sandy Creek Rd., right ontoShady Hollow Rd.
® Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 35 • Ott 43 Longitude 79 • 37 38
Design Current
Swine Canarity Pnnulatian
❑ Wcan to Fcedcr
❑ Feeder to finish
® Farrow to Wean
1200
1 100
❑ Farrow to Feeder
❑ Farrow to finish
❑ Gilts
❑ Boars
Design Current Design Current
Poultry Capacity Population Cattle Cat)acitv Population
❑ Layer BNon-Dairyj
Dairy
❑ Non -Layer
❑ Other
,rotal Design Capacity 1,200
Total SSLW 519,600
Number of Lagoons 1 ❑ Subsurface Drains Present 110 1,apsNrn Area IN Spray Field Area
Holding Ponds 1 Solid Traps 0 ❑ No liquid Waste Management System
12ischargcs Kim, Imparts
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. It' discharge is observed, did it reach Water of the State? ( It' yeti, 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 DWO)
2. Is there evidence of past discharge from any part of the operation?
❑ Yes ® No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ 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
Wassle Collection & Treatment
4. Is storage capacity (freeboard plus Storm storage) less than adequate? ❑ Spillway ❑ Yes ® No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure h
Identifier: ..........Lagoon..........................................................................................................................................................................................
Freeboard (inches): 42
051031111 rr7 r- y Continued

Facility Number: 76—If5 0 Date nl' In•pectiirn l 1/30/2001
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 environntental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part cif the waste management system other than waste structures require rttaintenancelimprovement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimurn liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improverent?
Is there evidence of over application? ❑ Excessive Pending ❑ PAN ❑ Hydraulic Overload
12. Crop type Coastal Bermuda (Hay) Fescue (Hay)
❑ Yes
® No
® Yes
❑ No
❑ Yes
® No
❑ Yes
® No
❑ Yes
® No
❑ Yes
® No
❑ Yes
®No
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ® Yes ❑ No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes ® No
b) Does the facility need a wettable acre determination? ❑ Yes ® No
c) This facility is pended for a wettable acre determination? ❑ Yes ® No
15. Does the receiving crop need improvement'? IN Yes ❑ No
16. Is there a lack of adequate waste application equipment'? ❑ Yes ® No
Rf.'[luired Recortis & ❑o ntcnts
17. Hail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes ® No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
Ge/ WUP, checklists, design, maps, etc.) ❑ Yes ® No
19.
Dees record keeping need improvement? (iel irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
® No
20.
Is Facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
® No
21.
Did the facility fail to have a actively certified operator in charge'?
❑ Yes
® No
22.
Fail to notify regional DWQ of emergency situations :is required by General Permit?
(ic/ discharge, freeboard problems, over application]
❑ Yes
® No
23,
Did Reviewer/inspector fail to discuss reviewlinspection with on -site representative?
❑ Yes
® No
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 ® No
❑ Yes ® No
0 No violations or deficiencies were noted during this Visit. You will receive no further correspondence about this visit.
Comments (refer to question o): Explain any YES answers and/or any recommendations nr any other comments.
use drawings of facility to Netter explain situations. {use additional pages as necessary'): ❑ Field Copy ® Final Notes
7. Need to remove woody vegetation from lagoon dam :is soon as possible. This was noted during 2000 DWQ inspection also. Operator
A.
plans to have this done by Jan. 1, 2002.
13. Some hydrants may be spraying onto bermucla a but CAWMP lists the crop as fescue. May want to have this revised.
15. Need to control weeds in berm uda. Operator plans to apply 2.4-D next Spring.
25. Operator wants to add fields to CAWMP so that lagoon sludge can be sampled, removed , and land applied.
27. One dead sow to be picked -up by Esteridge Animal Removal.
Reviewer/Inspector Name NJ li sa Rosebrock 4
Reviewer/Inspector Signature: Date: j
05/03/01 Cimlinued

I%
1. Facility Number: 76-05 I)9f Insprrtiron 1113{}120f}1
Odor Istincs
26.
Does the discharge pipe from the contitic ment building to the storage pond or lagoon fail to discharge at/or below
❑ Yes
[:]No
liquid level of lagoon or storage pond with no agitation'!
27.
Are there any dead animals not disposed of properly within 24 hours?
❑ Yes
® 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?
❑ Yes
❑ No
Additional omments and/orDrawings: '
AL
05/031111

U
�. •:, .: �: ;.' f'tWater,Coc►ito=Oprto°Re�iApon
d,:[3 DMon'of SWater.Conervdon - ComplianreIsDivision of Sand
. �..
Division of Water Quality' - Cotiipliance Inspection ' :; , y :u.: r ,. `, • i,y h. �7
, �'.". r�.Y `. i��. Other Agency - O eration Review �Tr _ °� + : "•ld:. ? i!,^.� . a,�nk ww
1111111koutid ❑ Complaint Q Follow-up of DWQ inspection Q Follow-up of DSLVC review Q Other
Facility Number Date of Inspection 30/
11.111- �
�( Time of Inspection ❑ 24 hr. (hh:mm)
® Permitted A Certified 0 Conditionally Certified 0 Registered 0 Not O erational Date Last Operated:
Farm Name: .... .Q.l�. ...... ]l .lr].fw,,..... i�L+� .r�. Crtunty:...... 1 .0.1. h........................................
II {� 4 f
Owner Name:.....�Ui.1�.. .... }................................................................. Phone No: ............^.......... ......... q17
.................................................................
rr (r� '�Zz- 7f`I' i
Facility Contact: . �.A.. .r�. r..it.n............................. I'itle:....... .............................. ............... ............ ^Phone No:..........................................6. 7ta
Mailing Address: P ice] b..!.....�.....�..�.J"]... #..1. �'�.......................... 1.......1...................... .......................... -
°........... ........? !! �.....a
Onsite Representative: ,......!!-1i.+.i.;..G. ,.E.. o........................................................ Integrator: '�'� l�t�+-.
Certified Operator:,..............arl.—M.h.................................................... Operator Certification Number:...... �.�.........................
Location,of Farm:
Latitude Longitude Eille j
Swine
❑ Wean to Feeder
❑ Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
❑ Gilts
11 Boars
Design Current' Design Current
;a acit Population Poultry Ca acit Po utation
❑ Layer
❑ Non -Layer
2
❑ Other
Design ° Current
Cattle Capacity - Population
❑ Dairy �.
❑ Non -Dairy
Total Design Capacity.
Total SSLW• ,6
le zoo)
Number of Lagoons ❑ Subsurface Drains Present ❑ Lagoon Area 10 Spray Field Area y
Holding Ponds 1 Solid Traps ❑ No Liquid Waste Management System .
Discharge & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes XNn
Discharge originated at: []Lagoon ❑ Spray Field ❑ Other
a. It' discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge: is observed, did it reach Water of the State? (If ycs, notify DWQ) ❑Ycs ❑ No
c. If discharge is observed, what is the estimated flow in gal/min'!
d. Does discharge bypass a lagoon systcin? (If ycs, notil•y DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes XNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the Slate other than from a discharge? ❑ Yes �No
Waste Collection & 'I'reatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes x No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure b
ldentilicr: tqq con
Freeboard(inches): 7................................................ .............. ........... ..... .... ..................... ........... ..............................
......
5. Are there any immediate threats to the integrity of any of the structures observed? (iel trees, severe erosion, ❑ Yes
secp:ige, etc.)
3/23/99 Continued onI

)i'acility Number: — Oof Inspection
6. Are: there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
Do any of the structures need maintenance/improvement? X Yes wo
8. Does any part of the waste management system other than waste structures require maintenancelimprovement? ❑ Yes XNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
NNo
Waste Application
10. Are there any buffers that need tnaintenance/improvement?
❑ Yes
XNO
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN
❑ Yes
N40
12. Crop type All Aij)
Tj
13. Do the receiving crops differ with those designated in a Certified Animal Waste Mnnagement Plan (CAWMP)?
XYes
❑ No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
S�No
b) Does the facility need a wettable acre determination?
❑ Yes
4No
c) This facility is pended for a wettable acre determination?
❑ Yes
4NO
15. Does the receiving crop need improvement?
AYes
❑ No
16. Is there a lack of adequate waste application equipment?
❑ Yes
�No
Required Records & Documents
IT. Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
XNO
18, Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(iel WUP, checklists, design, maps, etc.)
❑ Yes
j No
0
19, Does record keeping need improvement? (ic/ irri ation, freeboard, waste analysis & s8il sample reports)
❑ Yes
No
20, Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
No
21. Did the facility fail to have a actively certified operator in charge?
❑ Yes
No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
No
23. Did Reviewer/inspector fail to discuss reviewlinspection 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
,PrNO
Nd. i0p p.k }ris.o; 0. Vi iencies were np#ea O(Wirig #;hlsy. s. l You wi�eceiye o #'ut-# ter -
.correspo den" motif: this visit :::::::::::: :: .
Comments (refer to question#); Explain any YES answers and/or,any recammendations or:anyother;comrkients+•r ` ' i .
Use drawings `of facility to better explain situations: {use additional pages as necessary).
r r
J
�� � � � i.. � ■ . � .._,t � .ice _i � %E• � - �'.. I
Reviewer/Inspector Name
Reviewer/Inspector SignaturV_/111n A I A A A_ lid R.I n /L d-i P2 J Date:

Facility Number: — 1)0' ItIspretion Printud on: 7/21/2000
Odor Issues
26. Does (lie discharge pipe: from the confinement building to (he Storage pond or lagoon fail to discharge .Wor below o
liquid level of lagoon or storage pond with no agitation?
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 (in neighboring vegetation, asphalt, ❑ Yes WN o
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon'? ate.0
30. Were any major maintenance problems with the ventilation fan(s) noted'? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes �No
31. Do the animals feed storage bins fail to have appropriate cover'? B *es o
32. ❑o the flush tanks lack a submerged fill pipe or a perntanent/ternporary cover?
Additional Comments and/or Drawings:
�/}xe�c/im.�, .? U� e+�-dam?�
? s41s�bZ�lo3�-b7�ugv�Lf&.�.,PA&4tb 4
v
6AiP
1-3
I S i)P.o�`i$ CA�o-�GUee�9 /ri✓ /�yicu�l f • t�� �'
SAM

il,isiol of Water Quality, `' .. �
�` : �, •;
� _ rr
^'fir
171soWConser►'ationE o
'•' �' ', '+ '•` }� `'
• * '
..y..
,F'� !'. •Y
A
. �WS.�
'; Y.
O�Other) gency. rN•. •.�..: f...
F
/!!
,
rv�w. A
Type of Visit Q Compliance Inspection &'operation Review ❑ Lagoon Evaluation
Reason for Visit Routine ❑ Complaint ❑ Fallow up ❑ Emergency Notification Q Other ❑ Denied Access
= Dale of vi"it: /=s-a',' 'I`irree:, o❑ 1� • Prinleat on: 10/26/2000
L- - hacilih, Number
- .,-1 yr Hirt (.] rratisaual Q fia lo�� 'I'hreshold
�. r-,
'remitted ©Crr'tificd ©Con[fitinrtaily Ccrtilied agi f P (JXMZ ri-AMPerated or Ahove Threshold: .-....... -......... -
Farm Name: �A!QD..L..I.N.g..............S 1 N L............. ... [.:mint►':..... ....4��4........................................-......
0 �.... R
Owner Name: ,.....(fir .............. �.lM...I.TH............. ...Vy;j•ffgf... ...... I'hrrnc No.
..............................
Facility Contact:...t�iM............�%'/..�I�l�................... ['i��j�•�•����i� ................ Phone No:
Mailing Address. ...Po ..... A.?.]-.�........ f.247... .........�C�W'f�y. ....��......... .,�r1cx��.�......................................................... ..........................
Onsile Representative:....... .................................................... In(egrator:....... �.N.s���5'r^�¢ e..Id/........ .....................
e[]ILratnr:..........�I.a
..... . .....................[ler:t<rCrttific:tiontiumhcr:..a.a.8.�.............CertifLL.................................
Location of'Farrn:
61f 6xk57- 7b &tox 49 or e 1-er7-o --J •5f1 G
r rfe bur G cnr='r S
wine D Poultry • ❑ Cattle ❑ Horse l,:atitude IN 4�BJ' L, 1 I longitude 1 7 9 J• 1 3 7 I` 2� .5 "
Design Current
Swine Caoacitv . Population
❑ Wean to Feeder
❑ Feeder to finish
❑ Farrow to Wean
1 p
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Design Current r„
Poultry Capacity Population
❑ L,1yer .
❑ Non-l-ay"
❑ other
Design Current
Cattle Capacity Po >'ulati6n
❑ Dairy
❑ Non -Dairy
Total Resign Capacity pp
Total SSLW
Number of l,agnnns ❑ Suhsurface Drains Present ❑ I.:a};+1nn Area ❑ Spray Field Area
Holding fonds 1 Solid Traps ❑ No Uquid ii';astc �lanagemrnt Sy:titern
Discharges & Stream Impactti
1. Is any discharge observed frorn any Part of• 1he operation? ❑ Yes © No
Discharge origin iod at: ❑ lagoon ❑ Spray field ❑ other
a. if discharge is observed, was the conNrCyance man-made? Yes ❑ No
h. If discharge is ohserN•ed, dud it reach Watcr of the State? (Ifyes, notify DWQ) ❑Yes ❑ No
c. II discharge iti trhscr�ed. what is the estimated no t• in gallmirt•'
Lt. Does discharge bypass a lagoon syslent:' (II'yes, nlltify DWQ] ❑ Yes ❑ No
2. is there evidence of Past discharge frorn any part of the operation? ❑ Yes
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Ycs Q-90
i nsle Uallection 'Treatment
4. ds !,I,::age capacity (freeboard iglus storm storage) less than ade(loalr..
51ucturc I till LiCtU10 2 s,.,'..uuc 3
Identifier: Pr6,111"kCR
...............................................................................-
Freckoul 1 (111che%): --)0
S�llll
1 l Spi I I way
Structure 4
1
❑ Yes [� No
SIILICIMC S S[ILictul,c 0
Continued on hack

I:aeility Number: G — S Date of lrrsptr'tion Prirrterl on: 1 ❑/26/2000
5. Are there any immediate threats to thcl'R[egrity of any of the structures observed'? Oe/ trees, severe erosion, ❑ Yes CG4�o
seepage, etc.)
G. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan'? ❑ Yes ED4o
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or envirnrrntental threat, notify DWQ)
7. Do any of the structures need maintenance/improvetnent? ❑ Yes 2- o
S, Does any part of the waste management system other than waste structures require rnaintenance,/improvement'? ❑ Yes [Kn
I. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes n
Waste Applicatirrn
10, Are there any buffers that need maintenance/irnprovetrtent? ❑ Yes 9-110
11. Is there evidence of over application'? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overlord ❑ Yes FNo
12. Crop type r u M k.. C1
13. Do the receiving crops differ with those designated in the Certifiers Animal Waste Management Plan (CAWMP)?
14• a) Does the facility lack adequate acreage for land application?
h) 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 applicalion equipment?
Required Records & Documents
17. Bail to have Certificate of Coverage & General Permit readily available?
19. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
Oc/ WUP, checklists, design, maps, etc.)
19. Does record keeping treed irnpro vement? (icl irrigatitrn, fh'cboard, 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'?
(ic/ discharge, freeboard problems, over application)
23, Did Reviewer/Inspector fail to discuss review/inspection 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?
Z Io.vib'latiOris'o1� dci'iciencies -w�rc hated. diWirig this"visit: �nai� :rll rectriye rio lfu> thgr ;
.................
% • corresnoridence.albautithis .visit • . -. • . •.' . .' . -. -.-.. • .
❑ Yes EUK(r
❑ Yes [>'10
❑ Yes L:><o
❑ Yes Q4
❑ Yes QrNo
❑ Yes [211�o
❑ Yes [21�o
❑ Yes 12'90
Lj Yes allo
❑ Yes O'Vo
❑ Yes ja-No
❑ Yes E Na
❑ Yes Q Nr)
[ Yes M-90
❑ Yes [;WO
Comments (refer to iiuestinn #) Ea' lair any YES answers and/or any rkomnte'ndations or any 6 her; ctnents. ',~ r + `' ? a
Usedrawin of facility to better explain situations. (use additional pages as necessary):
&s. Y p pg. }-
,'� �. C� = y `� �i 1 j t r ti 1 • A.
: nJ e yC �e.. �F nJ • f'CU % r�
r� I t*
rS ,���n� fMArNArNr. rf �� tJ�'Ce ZLe�
Reviewer/Inspector, N erne« Al
Reviewer/Ir:=;,,!etor Signature: Date: 5/oo

Facility Number: — S �;,te 4it' IIIspeeIiorl 1'riuted on: 10/26/2000
0
Odor
Issues
26,
Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
[ "Yes
❑ No
liquid level of lagoon or storage pond with no ,tgitadon?
27.
Are there any dead animals not disposed of properly within 24 hours'?
❑ Yes
�10
28,
Is titere :rny evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
o
•
roads, building structure, and/or public property)
29.
Is the land dpplication spray system intake not located near the liquid surface of the lagoon?
❑ Yes
❑c-f-
30,
Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
/
or broken fan hlade(s), inoperable shutters, etc.)
ElE Yes
No
31,
❑o the animals feed storage bins fail to have appropriate cover'?
❑ Yes
o
32.
[)o the flush tanks lack a submerged fill pipe or a permanent/temporary cover? 1V'A-
❑ Yes
❑ No
Additional Comments andlor'Drawings: ;
J
ROO

(r ision of Water Quality
vision of Soil and Water Conservation
0 Other Agency
[Type of Visit Q Compliance Inspection Q Operation Review O Lagoon Evaluation
(Reason for Visit D Routine O Complaint O Follow up O Emergency Notification O 0ther ❑ Denied Access
Il:atr ni' N"kh: 11r.H121111{I 1'imc; 113f1 Nrintral (on-.11/28/2000
Facilit► Number 7C� S
F Not Operational O Below "threshold
® Permitled ® Certified [] Condilionally Certified 13 Registered Date Last Operated or Ahove 'Threshold: .......................
Farm Narne: .............................................................. County: RZaildOIRIA......... ......................... ....... WSRQ........
Owner Name:'111i;Jltlgl.................................. r 1tlRi�t............................ Phone No: (23..t1.62::�1.�f`94.............................I....
Facility Contact: RIt.SCAfft............................................... .... 7'itle:............ ....... ............................................ Phone Nu• . .......................
MailingAddress- P..0-13rQ.N..1Z.4T.......................................................................................... Littejrts..NG........ �T.,'.`�.�f ..................................................... ..............
Onsite Representative:. im.Q..60111 ................................................................................. Integrator: .............................. ............. ............................ ............. ..
Certified Operator: JK4jx.QrIl ux...................................................................... ... operator Certification Numher:ZRM..............................
Location of Farm:
Farm Location. SR 2543 - Shady Hollow Road, Rt. 1, Staley, NC.
® Swine ❑ Poultry ❑ Cattle ❑ Norse latitude 35 • 38 d31. Longitude 79 • 37 38
Design Current
Swine Caoucity Pouulation Poultry
❑ Wean to Feeder
❑ Feeder to Finish
® Farrow to Wean
1200
1000
❑ furrow to Feeder
❑ Barrow to Finish
❑ Gilts
❑ Soars
Design Current Design Current
Capacity Population Cattle Capacity Population
F
Dairy Non -Dairy
❑ Layer
❑ Non -Layer
❑ Other
Total Design Capacity 1,200
Total SSLW 1 519,E(
Number of Lagoons 10 Subsurface Drains Present ❑ Lagoon Area IN Spray Fi.(17, ra.a
bolding Ponds/Solid "Traps E= JQNo Liquid Waste ,Management System
❑ischurees & Stream ' ct
1. is any discharge observed frorn any part of the operation? ❑ Yes ® No
Disch-,wge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance nrin-made? [I Yes [3 No
h. If discharge is observed, did it reach Water of lire Sl,atc? [ If yes, nolity DWQ) ❑ Yes ❑ No
c. It'dischartc is observed, what is the estimaled flow in gal/min?
d. Does discharge bypass a lagoon system? Of yes. notify DWQ] ❑ Yeti ❑ 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) iess than adequate? ❑ Spillway ❑ Yes ® No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ...... .... Laguou.......... .................................... ........................ ........ ................................ :...... .......... .......................... ....................................
Frecb,o and [inches]: 36
Slflfl , � 47Q q f,'rinlitaucrl on hack

Facility Number: 76-5 hate of I[is pec•lion 11/28/2000 Printed on: 11/28/2000
5.
Are there any immediate threats to the *ity of any of the structures observed`? (ic/ trel'Oevere erosion.
❑Yes
No
seepage, etc.)
6.
Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
❑ Yeti
® No
(if any of questions 4-6 was answered yes, and the situation polies an
immediate public health or environmental threat, notify D%VQ)
7.
❑o any of the structures need mairite nancc/irprovement?
® Yes
❑ No
H.
i7oes any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
® No
9,
Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
® Yes
❑ No
Waste Application
10.
Are there any buffers that need maintenance/improve men1?
❑ Yes
® No
11.
Is there evidence of over application'? ❑ Excessive Pending ❑ PAN ❑ Hydraulic Overload
❑ Yes
® No
12. Crop type Fescue (Hay) Coastal Bermuda (Hay)
13. Uo the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ® Yes ❑ No
14. a] Does the facility lack adequate acreage for land application'? ❑ Yes ® No
b] Does the facility need a wettable acre determination? ❑ Yes ® No
c]'Fhis facility is pended tier a wettable acre determination? ❑ Yes ® No
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
R ni A Records & Docurnynts
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 irnprovemenr? (ic/ 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?
(ic/ discharge, freeboard problems, over application)
23. 1)id Reviewer/Inspector fail to discuss review/inspection with on -site representative'?
24. Dues facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP•?
0; N6 ii)'1a'[ r deficiencies were l receive,n,o,further.
crirreso otidehc' e. abaitt: this '.visit.`
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yeti ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
.ysv��w.•rv� �sp��.A�• we'-n. rp .w vw��i�e•—a�e•e �^::A
—.-, .. .... .,
Cmm��ents'{refer to questann.#]: Ifxpl:��n any I;S�answ n 1/or any recamtnenclations'or any other comme:its. . _..
yr rf� s.
Userawings�uf�facility to�tter,explaan,situations. [use_additinnal pase5 asp n�ecsarr.): y� _:�`'- ,
7, Need to cut vegetation on dam and establish some grass. +
J. Per permit, need to clearly :mirk maximum and minimum waste levels and lowest point on dam on marker.
13. Hydrants 54,57. 62. 63 and 67 have berntuda on them. WUP lists tescue hay. WUP should be revised to reflect actual crop.
1W
Reviewer/Inspector Name 14lelissa Ro sebrock
Reviewer/Inspector Signatu [41AN — V19w, 1,41 Date: iI 5loo

Facilitv.Number: 76-5 D61' Lispertion 111281200{t
Printed on: 11/28/2000
26.
Dues the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or
below ❑ Yes
❑ No
liquid level of lagoon or storage pond with no agitation?
27.
Are there any dead animals not disposed of properly within 24 hours?
❑ Yes
® No
28.
is there any evidence of wines 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 Iagoon?
❑ 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 cs submerged till pipe or a permanent/temporary cover?
❑ Yes
❑ No
Additional Comments and/orDrawings:
5/00

0, PM
rvision of Water Quality
Division of Soil and Water Conservation
a Other Agency
Type of Visit * Compliance inspection ❑ Operation Review Q Lagoon Evaluation
Reason for Visit *Routine O Complaint Q Follow up ❑ Emergency Notification D Other ❑ Denied Access
Facility Number Dale of Visit: irnc: M2D Printed on. 7/21/2000
Not O peratianai D Below Thrcwhold
Permitted ACertified © Conditionally Certified 13 Registered Date Last Operated or. lbove'Threshold:
Farm Name:-'rD�.l...! ll�.�.i..r�. .... r ..! rr ..xj']�' , County: ............. Y...�R.L�.1... �1.j......... .....................
..
�.......
(Inner N:ime:...M.I.�.i..�e►.}'Y1........JJ[�....l.►.l......................................................... I'hune Nor: .. .: ail'..:.. ..°.�...�..U.r.._............................... —7
Facility Contact: ...F— .. �. r i`i �.......... Title: .............................................. Phone No: 3.-..a-..�-..� 1
.................�.. ++..II.. '
Mailing Address: ............ ..` t...��r � t..N.,::�..............Ir"5...7... P...... .-.............. ......
Onsitc Representative: ... .Z1..1.....Y1.L.t'..................................... Integrator: .............
................................................................
Certified Operator: ...... l�.j..1'}!]...... i.!�....................................................... Operator Certification Number:...... a?-,R.) ..........
Location -of Farm:
JDZ) on to
05
Swine ❑ poultry ❑ Cattle ❑ horse Latitude
af I-J/Y- 1j,6r9 4O �4 Eld� C re-e, e I U rei, �
e ° ®•' Longitude• ®®«
- '1" Design Current
)Design Current
Design Current
Swlne Capacity Population
Poultry
CapacitV Population Cattle
Capacity Population
Wean to Feeder
❑ Layer
❑ Dairy
Feeder to Finish
❑ Non -Layer
❑ Non -Dairy
`
arrow to Wean
❑�
Farrow to Feeder
❑Other
Farrow to Finish
Total Design Capacity
a
"
Gilts
Boars
Total SSL W
o
Number of Lagoons ❑ Subsurface Drains Present ❑ Lagnan Area JE3 Spray Field Area
Holding]Ponds 1 Solid Traps
p ❑ lvo Liquid Waste Management System
Discharges & Stream Imi2acts
1. Is any discharge observed from any part of the operation? ❑ Yes po
Discharge originated at: [I Lagoon ❑ Spray Field ❑ Other //��
a. It'dischargc is observed, was the conveyance man-madr:' ❑Yes El No
b. If discharge is observed. did it reach Water of [lie Stale:' (lf yes, notify DWQ) ❑ Yes ❑ No
c. if discharge is observed. what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (it• y'es, 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 & 1'realment
4. Is storage capacity (freeboard plus storm storage) less than adequate'? ❑ Spillway
. trueturc I Structure 2 Structure 3 Structure 4 Structure 5
[r!e nti fie r: .................. 0..... ......... ........................... .... ................ :.............. ........... ......................... ............. ................
Freehnard (inches):
fl
SIOII
❑ Yes ❑ No
❑ Yes *o
❑ Yes k 0
❑ Yes A No
Structure C
Continued un back

Facility Number: —7 — 0_61 0 hate of lnspection I I 1 /019 0 printed on: 712112000
5. Are there any immediate threats to the integrity of any of the structures observed? (iel trees, severe erosion, ❑ Yes )6N❑
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
Closure plan? ❑ Yes IgN❑
(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 maintenancelimprovement?
S. Does any part of the waste management system other than waste structures require maintenancelimprovement?
9. Do any stuctures lack adequate, gauged markers with required maximum and m'snitnum liquid level
elevation markings?
«'ante Application
10. Are there any buffers that need maintenancelimprovement'?
11. Is there evidency f over application'? ❑ ],xcessive Ponding ❑ PAN ❑ Hydraulic Overload
fly I i
12. Crop type
0
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) Phis 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'?
l K Does the facility fail to have all components of (lie Certified Animal Waste Management Plan readily available`?
(ie/ WUP, checklists, design, Wraps, etc.)
19. Does record keeping need improvement'? (ic/ irrigation, freeboard, waste analysis & soil sample reports)
20, Is facility not in compliance with any applicable setback cntcria 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 require a Follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
' Nd., iMhfi0s:oi , &ficjerndes -i►Aere noted d0firig 4his:visit; - yoit wiil-i-eeeiye trio furthor
' Cor'reso6 iden6e:ab"fthisuisit: . .....I ..............................
kYes ❑ No
❑ Yes XNo
XYes ❑ No
❑ YesrNo
❑ Yes >'No
Ayes ❑ No
❑ Yes 1"'' No
❑ Yes No
❑ Yes o
❑ Yes XNo
❑ Yes �5No
❑ Yes VNo
❑ Yes No
❑ Yes No
❑ Yes No
❑ Yes No
❑ Yes No
❑ Yes No
ElYes No
❑ Yes 'VNo
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):
7. N� 4 kA veje4a oP) on 6taaM f+ es_b6�-1.5
R pty-tm I f , neM -6 (2, l eax-
jo� s D" tea CM rv�x-r K�r
Reviewer/]nspector Name p, i 11j - f� _Pff}0 h r,0
Reviewer/Inspector Signature flJ f r'A Jf�fA ls. /), A f Date: 11 I a18 / 00 5100

Facility Number: — 1184 Inspection 41 prinird on: 7/21/2000
Odor Issue~
26. Does the discharge pipe from the confinement building to the storage pond a3�n or lagoon fail to discharge at/or below r
liquid level of lagoon OT storage pond with no agitation? OM 1 IT I a6W.
2T Are there any dead animals not disposed of properly within 24 hours? ❑ Yes [ No
29. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes VNo
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 I 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 YNO
31. Do the animals iced storage bins fail to have appropriate corer? ❑ Yes X No
32. Do the flush tanks lack a submerged fill pipe or a permarnent/temporary cover'? p M IT, ZAG , jYcs. -No
A.
R PPI►ea�ha-7 reear0l,-5 V &)v/10 re-Vlsed /J S116LJ
1S3 yt -do 'b t ,ee.JL
� 7 r
g9
N5tw bes" n
OVA- e,M W%V) q 5
Uje,k�
l3 . dram ��+ S71( 31S �-6 7 ha..Y.e_ be'rMlJ�
On *hem 1+'5b Fscue h . k P SlIWO %erexiseJ 4 FJ1 Lc4 I :�,r, p
-
5100

k�.DFVISIDnYp( S �t and Wate�.Co"riservation Operatii in e�ir � t
v�,.� ,.�•p Y,,w�..-, �,, _�,.. ;,.. •.-�;s.:x..a�.�,,;�ya �;..--�°�a�rr •-•-•..T s �
Y �. 4 a,� '.ti , [a Division of . nd;Wal er,Conservatiou -Compliance I1L
T' .' iri•. �, �• jry fi S. �..,.,.. c ih I ii F ,,� i•7 r� `;.�,_±� µ. ti.f.� : ?r,.; !, k !� S
-�, - ivision of �� er unlit Conn fiance Ins ection 'fir +,• t.: ; �x �..� �r # Y,
�,, .s;,.' . [1�j3...• s.i c F1'.:3&.-�I':.r-p
then on 'ik s
,r Agency — .P�` ..a �?x._.Cs•_._ �.�. _�_... ,w• �Le y.•�t I
Q Routine n Cum laint Q Follow-up of D"'Q inspection Q Follow-up of DS1VC review Q Other
Facility Number
Permitted GdCertified [3 Conditionally Ceitft.
Farm Nante.
J
Date of Inspection
!" f Inspection o,f 24 hr. (hh:mm)
N'ot O erational Date bast Operated: .............
Count}• ......rl..i.� �1...........................
Owner• Narne:... . , .... czi 'hone No: ..
Facility Contact:.pp.I..CY1..:.r..,.:,..Y1....................L>7t•l"�`•A..=. Phone No: ...................................................
Mailing Address: „L, ;d.' .. .�.I.. 1.. t-- °� �..r7 ..........................
Onsite Representative:......'.. ...C. ���t`1..................................................... Integrator:........................................................................
Certified U}aerator:.. ,.5.x l `.. ,^'.!............'..Y1........................................................... Operator Certification Number:,,..2..­-�..?_j.............
Location of Farrn:
Al
t-'-' e .� ; r ...........
1' �'... .. G.Y..-�.......... ..�:�'s.�.. .. ......1`.'4...'� ............ Y
Latitude Longitude �• ©' ®c` �� �`'# x.�'��Cu s • T
Design Current
Swine Caaacity Ponulation
0 Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
1,200
f (>00
❑ Farrow to Feeder
Farrow to Finish
❑ Gilts
❑ Boars
Design Current `;;:Design Current
Poultry Capacity Population Cattle Xapacity Population
❑ Layer ❑ Dairy
❑ Non -Laver I JE1 Non -Dairy
❑ Other
Total Design,• Capaciiy-�-
Totat,SSL.W r
IYumher ❑f I;a oons, r ❑ Subsurface Drains Present ❑ lagoon Arer ❑ Spray Field Arer
Holding I'mids 1 Solid•Traps ' ❑ No Liquid Waste Management System
Discharges & Stream Intuacts
1. Is any discharge observed from any part of the operation? [3 Yes 0 No
Dischar-c origintated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. if discharge is observed, was the conveyance inan-made? ❑ Yes ❑ No
b. If' discharge is observed, did it reach Water of the State? (Il' yes, notify DWQ) El Yes ❑ No
c. If discharge is observed, what is the estimated flow in gallrnin•?
d. Does discharge hypass a lagoon system" (II•yes, nastily 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 [A No
Waste Collection & Treatment
4. is storage capacity (freeboard plus storm storage) less than adequate'? ❑ Spillway ❑ Yes eNo
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure b
IdC1111fier•:
Freeboardt i nchc,,t:................. .................. .................................... ................................... .................................... ................................ ...
5. Arc there any iinmediate threats to the inteSri ty of any of the structures ol)scrved•? (iel trees, severe erosion, ❑ Yes d No
seepage, etc.)
3/23199 Continued on back

F:ic v Nurnf)er
6. Arc (here ,tructures On -site which arc n Operlyaddrcsscd :utdlc r managed through a e in or
M
closure Flan?
❑Yes
No
(Ifa ny of questions -I-ti was answered yes, and the situation poses an
immediate public health or environ rental threat, notify DNVQ)
7. D❑ any of the structures need maintenance/improvement?
❑ Yes
12 N0
S. Does any part of the waste management system other than waste structures require inaintenance/improvemen0
❑ Yeti
LYJ No
9. Do any stuctures lack adequate, gauged markers with required rnaximurn and minimum liquid level
elevation markings?
Tf Yes
❑ No
Waste Applicatin�i
Id, Are there any buffers that need maintenance/improvement?
❑ Yes
No
11. Is there evidence of' over application? ❑ Excessive Ponding ❑ PAN
❑ Yes
06 No
12. Crop type �-' Z'�G- --?— I 9_ r
13, Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
INo
14. a) Does the Facility lack adequate acreage For Iand application'?
❑ Yes
5� No
b) Does the Facility need a wettable acre determination?
❑ Yes
❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes
❑ No
15. Does the receiving crop need improvement'?
❑ Yes
No
16. Is there a lack of adequate waste application equipment?
❑ Yes
No
Rettaaired Records & Documents
17, Fail to have Certificate of Coverage & GeneraI Permit readily available'?
❑ Yes
No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ic/ WUP, checklists, design, maps, etc.) ❑ Yes 56 No
19. Does record keeping need improvement? (ic/ irrigation, freeboard, waste analysis & soil sample reports) ❑f Yes ❑ No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes Rf No
21. Did the facility fait to have a actively certified operator in charge'? ❑ Yes [dNo
22. Fail to notify regional DWQ of emergency situations as required by General Permit'?
Ocl discharge, freeboard problems, over application) ❑ Yes R] No
23. Did Reviewer/Inspector fail to discuss reviewlinspection with on -site representative'? ❑ Yes [0 No
24. Does facility require a follow-up visit by same agency? ❑ Yes 62�Na
25. Were any additional problems netted which cause noncompliance of the Certified AWMP? ❑ Yes d]NO
i'L'�i r i �lati�iris •car i3eticicrtcies ►yet a noted dtrrint; his visit: Ynit "will ree6*(e ri further .
co resparidepee abi►ut. thi_5 .r isit- • . '
Comments {refer to question #}:. Explain any YI:S answer's andlor.any recommendations or.atiy,ofher�cnmments:"' la "• •'' �'
., r -
Use drawings of faeility to better explain situa iions.. (use additional pcages as necessary}:^i-
h rt U 1a e n do nArU� d � ��no 4v . �,� 5 U ; rL r� t•V car #
Revie►tierlInspector Name ;R `ae � �5'�s'� 1 _ '' - :.: ' .„r•: ._ - _.,
Reviewer/Inspector signature: �aT,z�yY Date: _
_--
3123199

�1 aliiity Number:' (D-- S ❑• of hispeetion
Odor Issues
26, spe rom t e ron o the stnra a and or ]a "i 1Qw ❑ Yes ❑ No
_4Kpmd4cveLof_lag ❑n or stora nd_wiih no agi�tie � j (�
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes Qf No
28. Is there any evidence of wind drift during land application'! (i.e. residue on neighboring vegetation, asphalt, ❑ Yes [F Na
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 [2No
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 �lo
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes [" No
32. N 1\ ❑ Yes ❑ No
ddltiona1 Uomments and/or _q awln 1T
$s ..
_.... .- . � .._. _._.s.-...-.._-. _.. � Yjx,.:r�ra. Y, &, �-�• � �:i}i .:-?r .. ... ...._ .. .;Ji...- .. +. m:.....tir`�ir:�N.,e. .1 l��i• �7?E'.t�
Al

0 Division of nd Water Conservation - Operation Revie
13 Division of Ond Water Conservation - Corn nce pliaInsOn
Division of Water Quality - Compliance Inspection
Q Other Agency - Operation Review
10 Routine 0 Complaint Q Follow-up of DWQ inspection O Follow-up of DSWC review Q Other
Facility Number 7(i US [late of Inspection 9129199
Tinte of Inspection l3:!}0 24 hr. Oh:mm)
Permitted ® Certified 0 Conditionally Certified 13 Registered JE3 Not O erational Date Last Operated:
Farm Name: ........................ .... County. :ala 9 it .................................. ... NMR0........
Owner Name: Wjllitam.................................. MMith....... ........ ..................................... ..... Phone No: [, M1.622. �,N91............
..
Facility Contact: Kim-Griffm................. ..... t ee...................... .. Phone No: Mfj-621 -:. .
.............. ................. Title: 1l1t►.u�a ..................... �1.......................
MailingAddress: 1',CJ3.q%.1a47......................................................................................... I..jbkx.tr..:,X(.............................................................. 27.2�8 ..............
OnsiteRepresentative: jm..(;.rjj .IFt................................................................................. Integrator: ...................................................... ........................ ........
Certified OAerator:ysinx......................................... k'ixiffA................. ............................. Operator Certification Number: ;Z5,1.... ........ ........ .......
..
Location of Farm:
............................................................................................................................................................................................... A�
k:ttxua.l.utc�tiata:...Sli.xS�.-.S.h.tt HnIIa:.l�ctact�.l�t...1..S.t►ale,.................................................................................................... .......................
Latitude 35 ' 48 , 42 44 Longitude 79 • 37 311
Design Current
Swine Capacity Poriulation
❑ Wean to Feeder
❑ Feeder to Finish
® Farrow to Wean
12M
950
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Ctilts
❑ Boars
Design Current Design Current
Poullry Capacity Population Cattle Capacity Population
❑ Layer ❑ Dairy
❑ Non-LLyer JE1 Non -Dairy
❑ Other
Total Design Capacity 1,200
Total SSLNV 519,E{iti
Number of Lagoons L�.,r l ❑ Subsurface Drains Present 110 Lagoon Area ® Spray Field ,Irca
Holding Ponds/ Solid Traps jE1,No liquid Waste Management Sy.stern
Uischar= & Stryam ImWact
1. Is any discharge observed from any part of the operation? ❑ Yes ® No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
it. 11 discharge is observed. was the conveyance man-made? ❑ Yeti ® No
b. 11' discharge is observed, slid it reach Water of the State'? (If yes. notify DWQ) ❑ Yes ® No
c. ]f discharge is observed, what is the estimated flow in gal/min?
d. Does discharge hypass a lagoon systent'? (If yeti, notily DWQ) ❑ Yes ® No
2. Is there evidence of past discharge frorn any part of the operation? ❑ Yes ® No
3. Were there any adverse impacts or potential adverse imparts to the Waters of the State other than from a discharge'? ❑ Yes ® No
Waste Collection I. 'Treatment
4. Is storage capacity (freeboard plus storm steerage) less than adequate? ❑ Spillway ❑ Yes ® No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure b
Identifier:
Freeboard(inches): ...............24................ .... ................. ....... ........ ...... ............................. .............. ....... ............. ................. ............. ........ .... ............... ........ .........
5. Are there any immediate threats to the integrity of any of the Structures observed? (iel trees, severe erasion, ❑ Yeti ® No
seepage, etc.)
3/23/99 Continued on buck

Facility Number: 76-05 U f ]nspection
6. Are there structures on site which are not iperly addressed and/or managed through a w 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 ofthe structures need Mai ntenancehinprovement?
S. 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 rnaxiimun and nainimuna liquid level
elevation markings?
1Waste Aon i •r iun
10, Are there any buffer that need rnaintenancelimprovement•?
11. is there evidence of over application? ❑ Excessive Ponding ❑ PAN
12. Crop type Coastal Bermuda (Hay) Fescue (Hay)
9129199
❑ Yes
® No
❑ Yes
® No
❑ Yes
® No
❑ Yes
® No
❑ Yes
® No
❑ Yes
® No
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (C:AWMP)? ❑ Yes ® No
14. a) Does the facility lack adequate acreage for land application'? ❑ Yes ® No
b) Does the facility need a wettable acre determination'? ❑ Yes ® No
c) This facility is pended for a wettable acre determination? ❑ Yes ® No
15, Does the receiving crap need improvement'?
16. Is there a lack ofadequate waste application equipment?
Ryunircd Recorder& Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
Ili. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available'!
Oct WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (icl 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?
iel discharge. freeboard problems, over application)
23, Did Reviewer/Inspector fail to discuss revicwlinspection 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?
riblati6' or deficiencies'►''ere"noted"during;-this visit. ;Y' f'4 will recei►•e-ho-ftirther-:'-,
currespimdencc abitui this .visit. .
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
[:]Yes ® No
[:]Yes ❑ No
❑ Yes ® No
[:]Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
acility in excellent shape. No problems noted.
19 - ORC will talk to SWCDINRCS to determine best manner to keep irrigation records. May need to section off fields to keep
5cords accurate.
Reviewer/Inspector Name ;W. Corey Basinger
Reviewer/Inspector Signature: Date:

r j] Division of ` nd Water Consei vation - Operation Revi
1.. Division of S and Water Conservation,- Compliance In on u
Division of Water Quality - Compliance Imspectiori
0 Other Agency - Operation Review.
Q Rnulinc Q Complaint Q Follow-up of M ins ection Q Follow-up of DSWC review Q Other
Facility Number Date of Inspection
Time of lnspeclion -QD 24 hr. (hh:mm]
Pcrntittc[ Ccr�tilhed 0 Contiitionally Certified E'Hcgistered EJ Not Operational DateLastOperated:
Farm Narne: T/�irt. .... ir2 P� icLT County:... F'rt�lfd��.�r N .......
....
r
OwnerName: ................ ..:.l... ....................j........................................................................ I'hune No:
....... ..-��. .. Z dS'..........................
.
Facility' Contact: .........../<-, ..........C'-V'- t5►.'......... ....•ritle 04Q► 4dP�.... Phone No:
Mailing Address: ....................... .:........ a?x...... 7.. `I. ......... . . ..../Kc..............I.......I......... ....Z..%�r�
...............
Onsile Representative: .... ... L �%� 6r........................................... Integrator: ................................................. ........ .................. ...........
Certified Operator :........ !!1................................. ����� ,:........... Operator Certification Number:.... J�.............................
Location or Farm:
.......................................................................................................................................................................................................................... ....... ?'
Latitude ®' � g � Longitude ©• 3% � 3d �
Design Current
Swine Canacitv PnDlrlation
❑ Wean to Feeder
❑ Feeder to Finish
WT-arrow to Wean
/Zpd
❑ Farrow to Feeder
❑ Harrow to Finish
❑ Gilts,
❑ Boars
Design Current Design Current
Poultry Capacity Population Cattle Capacity Population
❑ [_ayer ❑ Dairy -_
❑ Non -Layer ❑ Non -Dairy
❑ Other
Total Design Capacity f Z 0 to
Total SS1.W �J9 fvDO
}Number of Lagoons ❑ Subsurface Drains Present 110 Lagoon Area lrr:lp Field Area
Holding Ponds 1 Solid Traps 10 No Liquid Waste Management System
Mscharges Air Stream Impact
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. [I'discharge is observed, was the conveyance man-made''
b. [f discharge is ohscrved, did it reach Water of the State? (If yes, notify DWQ)
c. II' discharge is observed• what is chc estimated flow in galltnin?
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 ? Structure 3
Identifier: 1114
Freeboard(inches): ........ .......................................................................................
❑ Yes M No
❑ Yes RNo
❑ Yes NrNo
❑ Yes CKNo
❑ Yes VNo
❑ Yes E'No
❑ Yes IN -No
Structure 4 Sts-ueture ] Structure 6
S. Are there any immediate threats to the integrity of any of the structures observed? (icl trees, severe erosion,
seepage, etc.)
3/23/99
...................................
❑ Yes j No
Continued nit buck

Facility rtiiutniter: — py� Irrl' ltttipr'c'tinn
b. Are there structures un-site which are not properly addressed and/or managed through a waste management or �--'
closure plan'! ❑ Yes VNo
(If any of questions 4.6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Dn any of the structures need maintenance/improvement? ❑ Yes �fNo
S. Does any part of the waste management system other than waste structures require tttaintcnttnce/improv'ement'! ❑ Yes P No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes 9No
Waste Application
10. Are there any buffers that need main ten anceliinprove mcnt? ❑ Yes �Po
11, Is there evidence of over application'? ❑ Excessive Pending ❑ PAN ❑ Yes 9No
12. Crop type _ Cws-Fr ! + ray ud ez - f-05;6-" L
13. Do the receiving craps differ with those designated in the Certified Aitiinal Wattle ianagement Plan (CAW MP)? ❑ Yes �'No
14. a) Does the facility lack adcqualc acreage for land application? ❑ Yes RNo
b) Does the facility need a wettable acre determination? ❑ Yes ONo
c)'1'his facility is pended for a wettable acre determination? ❑ Yes -1Net
15. Does the receiving crop need improvement? ❑ Yes 1@ No
16. is there a lack of adequate waste application equipment'? ❑ Yes t1`No
Required Records & Documents
17, bail to have Certificate of Coverage k General Permit readily available? ❑ Yes ® No
19. Does the facility fail to have all components of the Certified Animal Wastc Mamibenient plan readily available?
Oe/ WUP, checklists, design, maps, ctc.) le�e- oak- beje�Q ❑ Yes [�No
19. Does record keeping need improvement? 'e/ irrigati , freeboard, waste analysis & soil sample reports) ❑ Yes No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes No
21. Did the facility fail to have a actively certified operator in charge? ❑ Yes E�'No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ic/ discharge, frceboard problems, over application) ❑ Yes fiErNo
23. Did Reviewer/Inspector fail to discuss review/inspection with oti-site representative? ❑ Yes RiNo
24. Does facility require a f6how-up visit by same agency`? ❑ Yes E�No
25. Werc any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes 'Eallo
iti riirlatintis;or eficiencies -Wer.e nirt'eyc .I.g . s.visj1,. YOi1'Wi1... ecip6 tigfuethgr'
ctirres orideitct : a�aut: this :visit. ::::
Comments (refer to question #): Explain any YES answers andlor any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
�a�� �•�u.If 5�x. Ivy wl -a,,ts
ZLIL
St6tzCv+ tc -(Le-[45 4-0 P l�Ge7fei5 cC+x Q- "
Reviewer/Inspector Name r el—
Rev'iew'er/Inspector Signature: rdDate:
3123/99

Facility Number: 7& — 6S" 00,
Inspection _9 r
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes ,KNo
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes E'No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes t5rNo
roads, buiNing structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes Pj�IVo
30, Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blades}, inoperable shutters, etc.) ❑ Yes )�Q No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes ;K—Nu
32. Do the flush tanks lack a sub=rscrged fill pipe or a permanent/lemporary cover? ❑ Yes '� "I'
wings:
3/23/99

p Division of Soil an
fter Conser►�ation - Operation Revie►►•
p Division of Soil ant rter Conservation - Compliance Inspection
Division of Water Qititlity - Coin piiance Inspection
i p Other Agency - Operation Review
16 r[ourlue 0 t_nnlplaknt 0 PnkJro►►-up nr D Y inspection 0 r•(.
Faeilily Ninnihcr
E Registered p Certified p Applied for Permit p Permitted
MV-ol] Ur 1l"'�►1't_ 1,t'►•10%, c t.lrnek' I
Il:,lk• oI' Inspec titm
I iIII e of Inslx rIi€rn © 24 hr. (hh:mm)
in [Nut Oper:rtinua I1;l1e Last Operaled:
F;Ir'ro Mloc: C:lx0l,inn,a..SWiuc.Y1od.................... ..... County: Randolph WSRO
......................................................... .
[1►►tier N:imt: Mu ........................................... Slidth...
Pli one Nip: 336.!.622.-2505............. ..... ......... I ........... I .... ....... .......
F:[cilit►' Cilr[tavl: Kitn.GriffiD................ ..........Vick:: Mauager.................. ...... .................. .. I'llorkv Nro: 33Ct-.622-.4S9.1..... ....... ............
Mailing Address: 11' ...... I.belrty-NC.............................................................
Ilktsite ileprc.suncati►e: Kim -Griffin, ....................... ............ - ....................... .... - ............ Intcgl"Itror:.......... ................................. .................................
...........
i;k•I•lified Operator: ............................... ............ .............................................................. Operator Certification Number:.........................................
Location of har'rtl:
I.�111t1i[1f.' ©•®• ©•• I,[IiltikrllflL' ®� ©• ®••
Swine Capacity Population
p can to Feeder
❑ Feeder to FInks
® Farrow to Wean
1000
p Farrow to Feeder
p Farrow to Finis
❑ Gilts
❑ Boars
Poultry Capacity Population Cattle Capacity Population
13 Layer
p Non -Laver
p Other
Total Desigini Capacity 1,20
'fatal SSLW 519,600
Number of Lagoons 1 Hold ing Ponds p . u stir ace Drains Present p ngoukr rent IM Spray
❑ ❑ Liquid Waste Management System
Gvncr•kI
1. Are there any buffers that need maintenance/improvement? p Yes ® No
2. is any discharge observed from any part of the operation? p Yes ® No
Gischary originated at: p Lagoon ❑ Spray Field p Other
a. II'disch:lrge is obser►k d. was the conveyance roan-madc'? p Yes IN No
h. II dischharge is observed, did it reach SurliteC fttel',' t If i.cs, nirtifi• Life') ❑Yes ®No
C. II disclull-C' is observed. ►chat Is tllc estinrlted 110W in Uallmiil'?
d. Does discharge bypass a In"oun s►slem'? {Il'yes. nolify IM,Q) Yes ®Na
3. is there evidence of past discharge f'rorrh any part of the operation? p Yes ® No
A. Were there any adverse impacts to the waters of the State other than front a discharge? p Yes 0 No
5. Does any part of the waste management system (other than lagoons/holding ponds) require []Yes ® No
nh ai me nan celi m provenierlt`?
G. Is Facility not in compliance with any applicable setback criteria in effect at the t'ktne of design? p Yes ® No
7. laid the facility fail to have :t certified operator in responsible charge? ❑ Yes p No
7/25/97

act li ty um ter: 76_05 Datrh;.ectim)
8. Are there lagoons or storage ponds on site which need to be properly closed? p Yes ® No
tilr'nctures lolding Ponds. Flash NIS. c(c.1
1). Is storage capacity (freeboard plus storm storage) less than adequate? p Yes ® No
Structure 1 structure 2 Stricture .i Structure 4 structure Structure 6
Identifier:
I-rec1)oiird ( ll 1: ................ 4'.-1......I...................................................................................................................... I.—...................... .... 10. Is seepage observed from any of the structures? p Yes ® No
11. is erosion, or any other threats to (lie integrity of any of the structures observed? p Yes ® No
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?
IVaste Application
14. Is there physical evidence of over application?
(]fin excess of WMP, or runoff entering waters ofthe State, notify [7WQ)
15. Crop type ..... Caastaal.Rer TiudALGrass...... ............... ....... Eescue......... .................
..................... ...................................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMI')?
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need irnprovernent?
19, Is there a lack of available waste application equiprttent?
20. Does facility require a t'oIlow-up visit by same agency?
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site. representative?
22, Does record keeping need improvement?
F4Ir (A. rt i fil L-d nr PCrInitIed Facilities ( )niy
23. Does the facility taiI 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?
. wo.viaiattons.or rteutcrenetes.►vere.nmen .nunng tnis visa., . Y tau. vvyi xetceive no, iuriner
..... ....... ....
t;Hj�reg0 nkile( dWt>.f.tliisYiSi}:.•.•:•:.:•. .................. ......
p Yes M No
p Yes M No
p Yes ® No
p Yes ® No
p Yes ®No
p Yes ® No
p Yes ® No
p Yes ®No
C] Yes ®No
p Yes ®No
[] Yes Na
p Yes p No
p Yes 0 No
C:oinincnts (refer to question u?): Explain any Y14 S itnswers and/or arty recomrnendsttious or any outer comments.
Use drawings of Facility to better explain situations. (use additional pages as necessary):
7. FORMER OPERATOR, MARVIN BRIDGES, PASSED AWAY DURING SUMMER. MS. GRIFFIN TOOK OVER AL
AT THAT TIME. SHE HAS TAKEN COURSE AND INTENDS •I.O TAKE TEST IN 1)ECEMBER, 1998.
ONCERNS ADDRESSED BY SWC❑ INSPECTOR WILL BE TAKEN CARE OF AS SOON AS POSSIBLE.
1-1ANGES TO IRRIGATION SYSTEM TO BE COMPLETED BY CERTIFICATION DEADLINE.
Reviewer/Inspector Nante �W• C&tr N Basinger
Reviewer/inspector Signature: Date:

❑ Division of SAM Water Conservation ❑ Utlter Mtcy
Division of Water [duality
RUutine D Complaint O Follow-up or I}WO inspection Q follow-uU or DSWC review ❑ Other
Date ofIuspection 2Z 9d
Facility Number Time of Inspection �� 24 hr. (hh:nun)
*Registered. © Certified © Applied for Permit 13 Permitted 113 Not () erational Date Last Operated:
F arrtt Narne: ...... 'LLY o YIGL..... Sw 1 Yl6 ................................... County:.............. kd P' f.................... ..
Owner Name: � : `"c" S ' ` Phone No: .......33C... (0 2 Z Z ...................SC� �
Facility Contact: Gizi ep,'j Title: 2 1 hone No: :.................................................& 8 f
I! { H� Q 33f [a
.................. I ........... .........................----....... ....... I ........................
Mailing Address: r 24 j tA...................................-2 Zct 8
.............................................................. .... .....
Onsite Representative:... . �+-�.............. �,R l Fr-i 1 ntcgrator:...................... ............................................. ....... ............
Certified Operator:..Vt
.....1�["1.............................. •- Operator Certification Nurttber;...-.............
Uwation or Farm:
s� z5 .3.. 5 ...... � IL ) f f.....�..... e �..................... .....
....................i...................... ....
Latitude 3 S • ®6 [} Z « Longitude • 1 3C7 «
Design Current Design Current
Swine Capacity Population Poultry Capacity Population
❑ Wean to Feeder
❑ Feeder to Finish
Farrow to Wean
f 7,w
QQQ
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gifts
❑ Boars
❑ Layer
❑ Non -Layer
Cattle Capacity Population
❑ DairyI I El
❑ Non -Dairy
❑ Other
Total Design Capacity
Total SSLW
Number of Lagoons / Holding Ponds ❑ Subsurface Drains Present ❑ Lagoon Area
❑ No Liquid Waste Management System
General
1. Are there any buffers that need maintenance/improverncrit'?
2. Is any discharge observed from any part of the operation?
Discharge originated at: [ILagoon ❑ Spray Field ElOther
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 gallmin?
d. Does discharge bypass a lagoon system? (if yes, notify DWQ)
3. Is there evidence of past discharge from any p:ul 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
ntai rite rtancelintpro vemc=it?
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
// zeo
5-1 9 Goo
❑ Spray Field Area
❑ Yes l tvn
❑ Yes aLNo
❑ Yeti .B No
❑ Yes EINTc,
❑ Yes E[No
❑ Yes ErNo
❑ Yes ,Q-No
❑ Yes No
❑ Yes W No
❑ Yes ❑ No

Facility Number: _ — ()( 9
8. Are there lagoons or storage ponds on site which need to be properly closed?
r Structures (Lay-onns,liolding-Ynnds. Flush Pits etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier:
........
11
Freeboard(ft)................ `f..... ........... . ............................ I ......
10. Is seepage observed from any of the structures?
❑ Yeti )�TNo
❑ Yes Z No
Structure 5 Structure 6
❑ Yes • fZNo
11. is erosion, or any other threats to the integrity of any of the structures observed? ❑ Yes NNo
12. Do any of the structures need maintertancelimprovement? ❑ Yes VNo
(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)
15. Cropt D • f ►tu R WSG&c e.
y�..............................................................................................................
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 Perinitted 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?
11
No'violatinns•or deficiencies were noted. during this:visit..You:will receive no further
• c¢rrespandeit+ce about this: visit:• : - .:. � ... . - . � . � . � : . � . - � . .. � ... .. .. ...:: ...
❑ Yes P-No
❑ Yes ® No
❑ Yes tl-No
❑ Yes qNo
❑ Yes allo
❑ Yes JR No
❑ Yes 12 No
❑ Yes 0 No
❑ Yes R1 No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
Comments (refer tin'queslton # F�tplain `any.Y'ES aiisrye"rs aindlor ai>y ec©iiasii�endations or txny other carruneritsi' ` "'
Us'e`drawings of facility to better explain situations: {use additional pages as necessary):
�" J,�1L �9nc'I�t- i , � r►''.� i,1yt d r cS5tCIt "V" dAcLA�
Pt 5 . (� r i (T V. r -}eAr.- ctJ -k c-f -}z2_&­c-#-_
-ca_ C_
h-e- 4—lu" �e t C'
cL-C -Iu- 7/25N7
cveewcr Inslrcctor anre
ReviewerllnspectorSignature: Date: „70l d�1

t.
16 Routine p Complaint p o ❑w-up of DWQ inspection p a ow -up of review p Other
[late of Inspection
Facility Number _
Time of Inspection 24 fir. [hh:nlrn]
© registered p Certified p Applied for Perrnit 0 Permitted 13 Not Oper;atiorl:i Date Last Operated:
Farm Name: Ctrs-cilii>a.Saxiue.Yr.[ld.................................................................................. County: Randolph WSRO
Owner Name: Ma-r,Yin................................... Bridges ....................................................... Phone No: U2-.9R(U...................... ...... ......... ............ ...... .............
Facility Contact: Marui.n-Hr:idges.........
Title.
Mailing Address:.f'Q..fox..1.2:4.7.........................................................................
Phone No:
L.faze:rly.NC......................... 2729h ..............
Onsite Representalive: Mar.mi>a.131-it M........................................................................ Integrator:
Certified Opera tor:lYiarx.W.li ............................ Rridj m ............................................. Opera for Certification Nu inber: 188Q .............................
Location of Farm:
Latitude ►®� ©� Longilude ©■ © ®«
Swine Capacity Population
p Wean to -ceder
p 1-ceder to inls l
® arrow to Call
I] arrow to Feeder
p Farrow to Finish
p Gilts
p Boars U
esign urren esign urren
Poultry Capacity Population Cattle Capacity Population
p Layer p Datry
p Non -Layer p En -Dairy
p tier
Total Design Capacity 1,2
Total SSLW a 1 9,6=
Ntnnber of Lagoons 1 Holding Ponds ��
p
u asur ace
Drains
Present IFET,al;non
� rea JE3
Spray re < < tea
❑
No Liquid Waste
Management
System
General
1,
Are there any bufi'ers that need maintenancelirnprovement?
0 Yes
® No
2.
Is any discharge observed from any part of the operation?
p Yes
M No
Discharge originated at: p Lagoon p Spray field p Other
a. Vdischarge: is observed, was the conveyance man-made?
❑ Yes
® No
b. if discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
❑ Yes
® No
c. If discharge is observed, what is the estimated flow in gallmin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
❑ Yes
® No
3.
is there evidence of past discharge from any part of the operation?
[]Yes
M No
4,
Were there any adverse impacts to the waters of the State other than from a discharge?
p Yes
M No
5.
Does any part of the waste management system (other than lagoons/holding ponds) require
p Yes
® No
maintenancelimprovem en t?
G.
is facility not in compliance with any applicable setback criteria in effect at the time of design?
p Yes
M No
7.
Did the facility fail to have a certified operator in responsible charge?
p Yes
M No
7125/97

act ity Number: 70-05 1 0
8.
Are there lagoons or storage ponds on si elhich need to be properly closed?
p Yes
® No
L
Structures (LaLoonsjfolding Ponds, Flush Pits,-ete.y_
9.
Is storage capacity (Freeboard plus storm storage) less than adequate?
p Yes
® No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Structure
6
Identifier:
Freeboard (ft): ..........3 t.Lta.......... ...................... .....................
10,
Is seepage observed from any of the structures?
❑ Yes
tj No
11,
Is erosion, or any other threats to the integrity of aziy of the structures observed?
p Yes
® No
12.
Do any of the structures need nt;tinte»artcelintprovertiezit?
❑ Yes
® No
(If a» y of questions 9-12 was answered yes, and the situation poses au
immediate public health or environmental threat, notify DWQ)
13.
Do any of the structures lack adequate minimum or maximum liquid level markers?
® Yes
❑ No
Waste Application
14.
is there physical evidence of over application?
❑ Yes
M No
(If in excess of WMP, or runoff entering waters of the State, notify DWa)
15.
Crop type ................ E.c.scum... ................... ...... Coastal.Sexrrauda.Grass.......................................... ....................... ...............................................
16.
❑o the receiving crops differ with those designated in the Animal Waste Management flan (AWMP)?
p Yes
p No
17.
Does the facility have a lack of adequate acreage for land a,)pIication?
❑ Yes
M No
18.
Does the receiving crop need improvement?
p Yes
® No
19.
Is there a lack of available waste application equipment?
p Yes
® No
20.
Does facility require a follow-up visit by same agency?
p Yes
M No
21.
Did Reviewerllnspector fail to discuss rev iewliitspection with on -site representative?
p Yes
® No
22.
Does record keeping need improvement?
p Yes
® No
For Certifier! or Permitted Facilities Only
23.
Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
© Yes
❑ No
24.
Were any additional problems noted which cause noncompliance of the Certified A'W,MP?
❑ Yes
❑ No
25.
Were any additional problerns noted which cause noncompliance of the Permit?
❑ Yes
p No
. .:o.vi(t •tttt)tis.t►r.t L jcrencies.were.ntrtc uring t its visit:. ttrt. Zvi .receive no: urt cr I.
40l"[ etitj[}ii[l�rlef ii tltr tf115'1`. . . .
Co tit tit ents (refer to question #!): EAplaiit any YE'S a nswers anttlor any recommendations or any other continents.
Use drawings:of facility to leper explain situations. (use additional pages as necessary):
umber ol'animals - 1,200 sows, 40 boars, 1,000 piglets (less than 3 weeks old)
13 - Waiting on MRCS to set levels for start/stop pumping markers.
16 --No plan yet. NRCS working on -it.
23=25. - Not certified yet. Dn•NRCS list to get certified plan,
Bridges has already begun keeping records as would,be required under a -certified plan.
lity is in excellent condition.
7/25197 —
Reviewerllnspector Name Corey Basinger
Rev iewerllnspector Signature: Date:

+❑ USWC AnJM Feedlot Operation Review '
E,[DWQ Animal Feedlot Operation Site Inspection
q
Routine ❑ com >laint Q F,rllo►►'-u 1 ul' f3LL't itts xclism Q 1' [1I141H'-Ir ] ,lf IitiLL'C. I4�'liH' Q 0ther
late of inspection
F-F acilit►' Number
`l'i me of 1 ntiltecl itltl : OD 24 hr. (hh:m[n}
D Registered ©Certified ©Applied for Permit 0 Permitted 113,Not O erati►mat Date Last Operated:...
Farm ,Name GA,I?aG►At.4 Sk1►,j a Count►-; �Ax-Pr1: & . ilt�o
.................................................................................................. ........... .......... ......I................
Owner Name: a E+i2t1� 6P-, :)&aS ....., I'Iulrie tics: ....... ....6.................g9...................................
.................. .
Facility Contact:
Mailing Address: r pyy ! `O/ /2¢�
Onslte Representative:,,....r`���"`-I Bvnorza~3
Certified Operator,..E !Aiz!/"`-1 13t? ID 6tt;s
Location of Farm:
I'illc:.................................................. .............. Phone No:......----•........................................
'�iY.�..�L'............. 2�q8
........................ Intel;ratm.............. .................... ......................................................
..................................... Opvr•ator i'crtificati,lrt `timlls r;...�.8. .....................
...2 ....3.. .. N .... u! s ..JCS b........ ,...4......................................................................................................................... +
---. ...-- .... ............................. ............................. ............................... ..... ......................................................... ................... ...................... I T
Latitude -1 4$ 4-2. Longitude �• �� `
Design Current
Swine CupacitF Population
❑ Wean us Feedcr
❑ Feeder to Finish
al'arrow to Wean
I Zad
/2 p p
❑ Farrow to Fs:edL:r
❑ Farrow to Finish
❑ [Tilts
❑ Boars
Design Current Design Current
Poultry Capacity Population Cattle Capacity Population
❑ Layer ❑ Dairy
❑ ,Non -Laver I I ❑ Non -Dairy
❑ Other
`fatal Design Capacity
Total SSLW
Number of Lagoons / Holding Ponds © ❑ Suhsurf:rce Drains Present lip Lagoon Area ❑ Spray field Area
❑ No Liquid LL'arte �1sn:r�ctnrnt ti►titct11
General
1. Are there :any buffers that need
❑ Yes
,'R 'o
2. Is any discharge observed from any part of the operation?
❑ Yes
A�No
I]isclt:lr rL UfI�I11atL'd JI' ❑ I,:tgoon ❑ Spray Fidd ❑ Dther
a. [I'discharge is observed, was the conveyaricr man -trade'.'
❑ Yes
);�1'n
h. [fditichar�e is nhscry ed, dill it rcuclt Surf -Ace LL';i[cr'' nerd#r [7%'O}
❑Yeti
1RI`IQe,
c. It discharge is observed. what is the estimated flow in gal/min''
d! Does diswharge bypass a lagt3on sytitc111? (If yes, n(ptiI DWQ)
❑Yes
Na:j�o
3. Is there evidence of past discharge f'om any part of ths: operation?
❑ Yes
RtNo
4. Were there any adverse impacts to the waters of the State other than from a discharge?
❑ Yes
,'rNo
5. Does any part of the waste nmmagenlem system (other than lagoons/holding Bonds) require
❑ Yeti
ONo
maintenance/i nil)rovenu n t?
G. Is facility not in compliance with any applicable setback criteria in effect at the time of design:'
❑ Yeti
fKrNo
7. ❑id the facility fail to haves certified operator in responsible charge?
❑ Yes
�'o
7/25/97
Co►rfin ued on back

Facility Nutnher:.I&— p5
age ponds on site which need to he properly closed? $. Are there lagoons or stor
Structures (l.a�orms,lfoldiny I'rFnds,- Flush fits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate'?
Structure l Structure 2 structure 3 Structure 4
Identifier:
............................................................................................................................................. ....
Freeboard O't 1: �f}
.'�............................................................................................ ...............................
10. Is seepage observed from any of the structures?
11. Is erosion, or any other threats to the integrity of any of the structures observed?
12, Da any of the structures need m,tiiuen,tttcelimprovemem'?
(If :any (or questions 9-12 was answered yes. and the situation louses
an immediate public health or environmental threat, notify D%VQ)
13. Do any of the structures lack adequate ntsnimunt or maximum liquid level markers?
Waste Aiw ication
14. is there physical evidence of over application:'
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
❑ Yes XNo
❑ Yeti 15rNo
StraCtnru 5 Structure 0
15. Crop type $ CuQ- ....,.
16. ❑o the receiving crops differ with those designated in the Anintal Waste Manage:ntent Plan (A11` N-11')'?
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 Sarre agency?
21. Did Reviewerllnspector fail to discuss rev icwlinspection with on - site representative?
22. Does record keeping neck] improvement?
For Certitied tor Permitted Facilities Only
23. Does the facility fail to have a copy of the Anintal Waste Management Plan readily available?
24. Were any additional problems noted which cause noncompliance of the Certified AW,MP?
25. Were any additional prohiemS noted which cause noncompliance of the Permit?
Na.viol Jttions' ter deliciencies were noted during; thiS'Visit.- Xcou.will receive no further
• . • Ct?CCE:sI}OtldenCe about this, visit. .
❑ Yes 14 No
❑ Yes fg'No
❑ Yes W'o
f.Yes ❑ No
❑ Yes WNo
❑ Yeti ❑ No
❑ Yeti XNo
❑ Yes [R`o
❑ Yes :"No
❑ Yes '10No
❑ Yes ,KNo
❑ Yes Wo
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
Comments (refer to question #): F,xplain any YFS answers and/or any recommendations or any other comments.
Use drawings of facility to hotter explain situations. Luse additional pages as necessary):
'V-6F Rn�r►+4!_r— /?.00 Saw ¢o h�"aRrs � /odd t� P; &3ssy)
A,
+ o-, NRL`8 fit. �Y 144Q0 ice.. s
1` nla pfa+j Yet, xites 4&arlr4.� C�k r-f.
t 3 -z5 -- ► 07-- C"T7 R eV V O T: as ogle usr 7a Ce-r A447J. w
PICC4 s a r W6w[d fw ! ids
Mrs. 1"rj AO 44U4 4w APA'� rd
J
71251k)7
Reviewer/Inspector Name
Reviewerllnspector Signature: — Date: �--�4