760059_INSPECTIONS_20171231

Type of Visit: Compliance inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: &Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: County:
Farm Name: Co 14-rq h b en r Owner Email:
Owner Name: rl�Y)SCi}'� C +- Ol r) Phone:
P.
Region:S I2 6
Mailing Address: r won MarillI1 Piensan+ [CArden NG 7-
Physical Address: �} �l� 1�+t:11 Vi. F't QG1 �i1i i�'jGl'G� 2Yl I V % o`i7`7, j 3 1
Facility Contact:�/ j p� [ n + #`j�C3 }�} ei Title: Phone: — SJ !
Onsite Representative: Integrator:
b nr5 nQ�d f
Certified Operator: ✓ Certification N u m be r:
i
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Discharses and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes P� No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA
❑ Yes ❑ No ❑ NA
❑ Yes 1 ❑ No
❑ Yes No
❑ Yes No
❑ NE
❑ NE
[]NA ❑NE
❑ NA ❑ NE
❑NA ❑NE
Page 1 of 3 21412015 Continuer!

Facility Number: - • Date of Inspection: k1
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate'? [:]Yes 0 No ❑ NA ❑ NE
a. I f 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: llPp�.�2 WWF_2 Ro�f'S
Spillway?:
Designed Freeboard (in): —
Observed Freeboard (in): t L 61
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes Wplj 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 N No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[;g No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[ No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes]
No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.}
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application
Outside of Approved
Area
12. Crop Type(s): L OM { 66 j �a�kj 1`5l b
U J
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
'] No
[] NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[� No
❑ NA
❑ NE
18. Is there a lack of properly operating waste'application equipment?
❑ Yes
No
❑ NA
❑ NE
Re wired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below
❑ Yes
No
❑ NA
❑ NE
MLI pl
Waste Application �] Weekly Freeboard Waste Analysis
1A
7si
Weather Code
?V11
Rainfall oStocking Crop Yield A120 Minute Inspections CS Monthly and I" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
M No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
NA
❑ NE
Page 2 of 3
21412015 Continued

Facility Number: - 6 cl jDate of Inspection: 1 1
24. Did the facility fail to calibrate waste appion equipment as required by the permit? [] Yes VX No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes 0 No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
❑ Yes No ❑ NA ❑ NE
❑ Yes VM No NA ❑ NE
❑ YesL?vl N No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes `� No ❑ NA ❑ NE
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. ❑ Yes z No
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes EZ No
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes No
34. Does the facility require a follow-up visit by the same agency? ❑ Yes No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer;to question #): Explain any YES answers and/or any additional recornr6endations or any other, comments.:
Use drawings of facility to better explain situations (use additional pages as necessary},'
?, ChtGK Sl 106 clr� (NON 10-1- �`�� o� �dY1.i-L iNY10f 6.,(ar �i16 jouj rx
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Cal; pra_11( 6n due -
T0.IL eWiL F 1prfe d r U� fZo- "pad
Reviewer/Inspector
Reviewer/Inspector
Page 3 of 3
uCy4 s
ol*3.4
tU M10 3.$,kc,r
le:
IL21 I '�a
21412015

Type of Visit: Z Compliance Inspection Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: VRoutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: =00 Departure Time: =4 County: ' UIL&Rp Region: WW
Farm Name: (�o La'Rmc Owner Email:
Owner Name: r�►JSp•1J C9 amxe Phone:
Mailing Address: I �.�n %RAM.5 fl /AwL RP L6,J1i'SA'K 1 GmmG'W [
Physical Address: `-9 4 LUNSa,LW WOW, MC �7 313
Facility Contact: rim \Q Co LIVAR & Title: Phone: d�`5 ' 7 4S
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Integrator: qq
Certification Number:
1*0
Certification Number:
Longitude:
Design Current
Design
C*urrent
Design Current
Swine
C*apacity Pup.
Wet Poultry
Capacity.
Pop.
Cattle
Capacity
Pop.
Wean to Finish
La er
Pn�Dai Cow
pa 0
Wean to Feeder
Non -La er
ai Calf
O
Feeder to Finish
Dai Heifer
0%
Farrow to Wean
Design
Current
D Cow
Q Q
Farrow to Feeder
Dr, P■oultr,
Ca peit
P■a ,
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
I
Gilts
]Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
Turkey Poults
Other
Other
Discharees 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)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
[] Yes
k No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
6No
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412015 Continued

Facility Number: 16 - 60k I Date of Inspection -
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
K 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: U to V- C
Spillway?:
Designed Freeboard (in):
l9U
Observed Freeboard (in): l�
5. Are there any immediate threats to the integrity of any of the structures observed?
0 Yes
jCsI 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
tKNo
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat,
notify DWR
7. Do any of the structures need maintenance or improvement'?
❑ Yes
K No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
JK 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
[X'No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
rZfNo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes 9No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): CrJRN S1t-AU , Wk\C,1
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
Zf No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
® No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
❑ No
D NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
gNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
�No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
�{
LZ! No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
]ZfNo
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
gNo
❑ NA
❑ NE
❑ Waste Application eekly Frce —Q Mlaate- nVysis
❑ Weather
Code
,fifall ❑Stocking ❑ Crop Yield ❑ 120 Minute Inspections
ispcuuunS
u ge
ury
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
® No
NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑Yes
❑ No
NA
❑ NE
Page 2 of 3 21412015 Continued

[Facility Number: - Date of Ins ection:
24. Did the facility fail to calibrate waste apoon equipment as required by the permit? ❑ Yes n No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑ No [KNA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance':
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes [�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 NJ 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 FWNo ❑ 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 C] 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 fait to discuss review/inspection with an on -site representative? ❑ Yes EKNo ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes E2" No ❑ NA ❑ NE
Comments (refer to question #)-Explain any:YES'answers and/or any additions[ reeo► inendations or any other comments.
Use drawings of facility to better explain'situ'ations (use additional pages as necess ry); e
—v20\�o CAi_�$R1�Z1o>a? \Its Co LG-`�E f0-��-I{o�X'� rjat_ SN_.pIL- O�)c a0k9
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Cow LSTUoN6
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ck 11i17'115 L5 () = N - .A lob) (.' �L
�r 6 _� l t-� \4000 6AL GaCC �
G U L5q tki�ks 1b two 6AL
1000 om_ L5�
5 19((6 ��� 15 l� 3GAL
Reviewer/inspector Name:
Reviewer/Inspector Signatui
Page 3 of 3
Phone: '55 INO • LkQa 3
Date:
21412015

Type of Visit: 0 Compliance Inspection Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 0 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: ; 35 County: )&ntJ6J� kegion:
q,
Farm Name: �p �-�Q j1� Frw, Owner Email: T'
Owner Name: ra nson Cb i h—Q n 2. Phone:
Mailing Address: 7 x3 ! Bra_n sa'? M I It Ne- 4Za.Y [O "jo . N C a 731. ?L.-_
Physical Address: 1 Z S ! silt d—M pet ' ��I�S�YI � _LJ ax-j e*j . IV C- ,.,--2
- 7 3 1 3
Facility Contact: T 1d__6o1*"cd Title: Phone: 21 — -7 �S
Al Go -6346
Onsite Representative: Integrator:
Certified Operator: Certification Number:
Back-up Operator:
Certification Number:
Location of Farm: Latitude: 3-T 5_3 55 Longitude: '79 S 4 3
US 2 20 5 '!-o L�l CrOSS v. Z- o vi fo 6 ra_41 Sar) on fo
Design Current
Swine Capacity OF.
Wean to Finish
Wet Poultry
Layer
Design
Capacity
Current
Pop.
C►attle
Dairy Cow
Design
C►apacity
O60
C►urgent
Pop.
9
Wean to Feeder
I
INon-Layer
I
Dairy Calf
O
0
Feeder to Finish
Design Current
Dairy Heifer O
3
Farrow to Wean
Dry Cow 100
0
Farrow to Feeder
Dr, P.oultr, Ca Aci P.o P.
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
(�ltber
Turkeys
Turkey Poults
Other LjOther
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?
❑ Yes '�4 No ❑ NA ❑ NE
[]Yes ❑ No
[:]Yes [—]No
❑ Yes ❑ No
❑ Yes C�No
Yes [:]No
❑ NA ❑ NE
❑NA ❑NE
❑NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
Page I of 3 21412014 Continued

a7
Facility Number: i - Date of Inspection: 0
Waste Collection & Treatment wr
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 19 No ❑ NA ❑ NE
l a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
n �U 1 )'' Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
�j� ldent�fier: (J OWe-C
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): S c
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ❑ No ❑ NA '�r_A4 NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a Yes ❑ No ❑ NA ❑ NE
waste management or closure plan? EA
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[� No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require]
Yes
pt
❑ No
❑ NA
❑ NE
maintenance or improvement?
Waste Apolication
10. Are there any required buffers, setbacks, or compliance alternatives that need
[] Yes
j No
❑ NA
[] NE
maintenance or improvement?
T�
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift [] Application Outside of Approved
Area
12. Crop Type(s): 1AD') 4 � j% l_) P_J Q 5 +L.r�
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
rVNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ No
❑ NA
NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
CyNo
❑ NA
❑` NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
6 No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
JNo
�
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
Wo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
Q<o
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21/Does record keeping need i ovement? ❑Yes No ❑ NA ❑ NE
W ste Applicati Weekly Freeboard Waste Analysis V Soil Analysis ❑ ❑ Weather Code
Rainfall locking [Crop Yield ❑ 120 Minute Inspections [Monthly and 1° Rainfall Inspections
22. Did the facility fail to ►nstall and maintain a rain gauge? ❑ Yes allo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No 5rNA ❑ NE
Page 2 of 3 21412014 Continued

;Ll
Facili Number: "j - Date of Ins ection: Z O
24. Did the facility fail to calibrate waste appetion equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge. If yes, check ❑Yes ❑ No Z�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 CR'go ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes CR-IQo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document [] Yes] No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
1;�No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
V 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
ONo
❑ NA
❑ NE
33. Did the Reviewcdlnspector fail to discuss review/inspection with an on -site representative?
❑ Yes
�No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
N2 No
❑ NA
❑ NE
x a y . d/or any additional retoni.niendati6i s or any; other -comments �
1�,omrnents: (refer o��es one � xp am�any_�. answcrs�an �_�
iJ�drawinga of�facility;to better ezpla►n�sifuatioris, (use additlonal pages'as;necessary) , ;=w tip- _ 9s : , ; _�
on U p pa,c W S P re --se- t- ? v 6 S - o- iz_L .
3a N�w� d Cq�►�� o c eA -6 wuP? N 04 e,�°
4 2 o{ N t b rq� o r, ? 4- ao I (o v 3e.+ n 9 ti w�,Ia er a
. 7 OIL- 20[90 ate• Cu�Z
2 1 a§r
ed�
40
GA
s Q y01Ut0
� /U��SU� �� �.Za�S
1 1r4CIap I i r r
L,,2,5 ;2-- u1 t2-�
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: rQ
Date: ; oa 01-
2014

H.
Type of Visit: (g 7Routine
pliance Inspection Q Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: E3 Arrival Time: Departure Time: County: �� Region: WJ►�[J
r
Farm Name: Owner Email;
Owner Name: Lli2± $y % f �-}��-e Phone:
Mailing Address: �'2 3� IJY►-�Sv� I , �1[�S--t
,J- .,jc. 2131
Physical Address: 1 (� NA'vz
Facility Contact: bld o Title: Phone: zi s,-,, 7qr
Onsite Representative: t� ri Integrator:
Certified Operator:
I It
Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
4U6 Z1311
t
Design Current
Design Current
Swine=QignMWjrcn
apacity
Pop.
Wet Poultry Capacity Pop.
Cattle Capacity Pop.
Wean to Finish
Layer
DairyCow 5D
Wean to Feeder
Non -La er
Dairy Calf Z
Feeder to Finish
DairyHeifer 600WOR
3
Farrow to Wean
Design Current
D Cow j vr�
Farrow to Feeder
Dr, P,oulte, Ca aci P.o
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
Other
Turke Poults
Other
�Y��
PH
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
A
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DW R)
❑ Yes
❑ No
VNA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (if yes, notify DWR)
❑ Yes
[] o
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
[] Yes
rN
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412014 Continued

Facility Number: - Date of Inspection:
Waste Collection & Treatment
4 FW
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? [—]Yes EdNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No FD/NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 90
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes [v]No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environments neat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ es No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? [Yes ❑ No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes [' No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need [:]Yes YNo ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [:]Yes Ea�No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12, Crop Type(s): Avj i C.Y✓l , k-,
13, Soil Type(s): evw + V
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [V(No ❑ NA ❑ NE
t6. 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
EfNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[v]/No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
[:]Yes
�No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
Q/No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 6A ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ffNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes jNo ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: jDate of Inspection: Of
24. Did the facility fail to calibrate waste app ication equipment as required by the permit? ❑ Yes ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? [—]Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? []Yes BNo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes dNo ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
3 I. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes EJ�No ❑ NA ❑ NE
[:]Yes dNo ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes dNo ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes dNo ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes WNo ❑ 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).
4111- I, .�� - ekkiw -y-e,,� [Ar -46".'YPH
" 1 j"�( 1
� l./Lw Q JGy7K W / M" Cad bj 4"
G-0 mo,k,, w/ i 'Oft rt&4 cpe L
o(" we c.l 4 )
yak I 0AAF- II I40 6C
� �s
V FP"VY-j "}ram
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: J ' i�I' Roo
Date: I
1, J)q
214,1011

Type of Visit: Compliance Inspection Q Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency Q Other 0 Denied Access
Date of Visit: l k Arrival Time: Departure Time: County: cr,n� Region: W-5f, a
Farm Name: C-6 Ea rm Owner Email: W 17'',tccL r yt�q, I • c t.:�
Owner Name: Q ( a.AsOn 6> 1 Lrti,l.L Phone:
Mailing Address: -7-2_3� jjYtMn S,,, MA 1 �I tis + C, r,��..� N L 2 13
Physical Address:
Facility Contact: bu % d �ll'G�n/IQ� _ Title: Phone: Wt 21 • ��+5
Onsite Representative: �Gn1 i Integrator:
it /IW ij ivk�s b y Zwt�
Certified Operator: Certification Number: 2, 311
Back-up Operator:
Location of Farm;
Certification Number:
Latitude: 3 5 S 3 SS
us t7+a 5 - s t c .tl G..s �1 (� (3 ��- Su.. M M2 i - { .. n.r►+ ,.
Longitude:
-4-9 Ltw 3Z
Design Current Design Current
Swine Capacity Pop. Wet Poultry Capacity Pop.
Wean to Finish La er
Design C►urrent
Cattle Capacity Pop.
iry Cow 1000 YSS
Wean to Feeder
Non -La er
iry Calf
[ 34
Feeder to Finish
Dairy Heifer
5pp
Farrow to Wean
Farrow to Feeder
Design Current
D . P,oultt. Ca aci P,o
Dry Cow
Non -Dairy
lop
Farrow to Finish
Layers
Beef Stocker
Ll
Gilts
Non -Layers
Pullets
Beef Feeder
Boars
Beef Brood Cow
Qther=M=M=M==MMjj
Other
Turkeys
17urk;yPoults
Other
Discharges and Stream Impacts �(
1. Is any discharge observed from any part of the operation? ❑ Yes E No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
E�No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
[t/� No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
No
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

Facifi Number: Date of Inspection: li
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [Z No [DNA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No 0 NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: UQP15TZ Lc--�warR- Caw
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): ��� �v j012
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes [�rNo ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a []Yes [ No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes 2 No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? [dyes []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 2 No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [�No ❑ NA ❑ NE
maintenance or improvement?
l I. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [ (No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
D
13. Soil Type(s): Ng t J
14. Do the receiving crops differ from those designated in the CAWMP? []Yes [�No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes []�No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes d No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
0 No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[� No
C] NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[g"]�o
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
dNo
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
[]Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
E� No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections (]Monthly and I" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
Q No
E;�NA
❑ NE
Page 2 of 3
21412011 Continued

FacilityI I A,
FZ/
Number: - 5Date of Inspection: It+24. Did the facility fail to calibrate waste application equipment as required by the permit? [Yes ❑ No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes FRINo ❑ 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 [Z 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?
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 the drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes []No ❑ NA ❑ NE
❑ Yes [dNo ❑ NA ❑ NE
❑ Yes Er No ❑ NA ❑ NE
❑ Yes © No
❑ Yes El No
❑ Yes allo
❑ NA ❑ NE
❑ NA ❑ NE
❑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 explaiwsituations (use additional-' age's as necessary:). � � rg;:�i • , : i.
� 22j,, S"As rby `�JJ gp''I1 .5 I-�} I; ^� � ju,�,c: �ki
V C�.li �ri.t10+C ol3� a.T(, rtj5
lfrtLl, J j) Zol l i Peal c wi • r, 2G.�
—Yla CA 1, 6vz," 3
VA M
em of LDi3
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
F,cij}faZj/off
Sit- 7I> o► ,;
-ro
U�.Kc.I , W1,cq� �+�. �+.te►.
Iles ►1Y(kj,0-
Yl�^�
lawv?
ri4vvr,s
113 - 6 -I z►,vt.d
S5-� —0-6 Vk-6
Phone: 951 •7:F '5zg$
Date: 113113
21412011

Dlvision ofWater Quality 1 I
Facility Number ®- @igG�606iil and WQther Age, n�cy
Type of Visit: Compliance Inspection 0 Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: (Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: I 1 / Arrival Timer Departure Time: County Region: Ws 126
r Kando P h
Farm Name: &01 Tr-Gi`.n e. Far Owner Email:
Owner Name: r o-n 5 0n Cy l man .e. Phone -
Mailing /j 1 j %� HP_aS
�jrd- 7 3Mailing Address: � � 3 q ►J I'Qy] Sf]►'] I ter, i 1I! L-d' 1 Q..17� (1JG�c-I�GL!!°i'1 ,
Physical Address: ] ;2'
Facility Contact: 'Dew l [ Ca +r-" IL Title:
Onsite Representative:
Certified Operator: 4
Back-up Operator:
a7 31.3
14 to 7 q_._ C
Phone:
Integrator:
Certification Number:
Certification Number:
Location of Farm: Latitude: J S ET-3 5.�Longitude: -7 j
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)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
[]Yes �(No ❑ NA ❑ NE
[]Yes ❑ No
❑ Yes [-]No
❑ Yes ❑ No
❑ Yes o
❑ Yes No
❑ NA ❑ NE
❑ NA FINE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 21412011 Continued

Facili Number: - Date of Inspection: _7 3
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ;�J'No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
1 Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
�(p Identifier; i) p (,6 W e-.r—
Spillway?:
Designed Freeboard (in): ' :1=)
Observed Freeboard (in): �91,
5. Are there any immediate threats to the integrity of any of the structures observed? [—]Yes No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a Yes ❑ No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? Yes ❑ No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? 5 Yes ❑ No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks) (V -e-'t L)
9. Does any part of the waste management system other than the waste structures require ❑ Yes P(No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes UNo ❑ NA ❑ NE
maintenance or improvement? Wo
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 101bs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): t
13. Soil Type(s): �.
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes ONo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes XNo ❑ 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 INNo ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes Na<o ❑ NA ❑ NE
Required Records & Documents 7�
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes rNo ❑ NA ❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21 oes record keeping need'provement? I Yes No �A ❑ NE
Waste Applic tion Weekly Freeboard Waste Analysis Soil Analysis Waste Transfers Weather Code
Rainfall Stocking [Crop Yield ❑ 120 Minute Inspections Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [:]No CSj-'1qA ❑ NE
Page 2 of 3 21412011 Continued

Facili Number: - Date of inspection: (a
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes tENo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [:]Yes ❑ No [KNA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? if yes, check the appropriate box below
❑ Application Field ❑ Lagoon/storage Pond ❑ Other:
❑ Yes
CjfNo
❑ NA
❑ NE
[:]Yes
� o
❑ NA
❑ NE
[:]Yes
J�fNo
❑ NA
❑ NE
❑ Yes b�No ❑ NA ❑ NE
❑ Yes VNo ❑ NA ❑ NE
❑ Yes ` rNo ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes MNo ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes to
o ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? [:]Yes ❑ NA ❑ NE
Comments (refer to question ##): Explain any YES answers and/or any.additional recommendations or any other comments..,
Use drawings of facility to better explain sit s (use additional pages asnecessa Y)•
�i. C Ulf Sal I t �C��a ?�--
C e4 I t yc-
rep 4-i o �D� u _ 013 L6
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e
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6, o 0 12 > 1 .2
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C 6_0 N 1 z
II f �4%1►
e_6L ull = q- 7
dauP 11 = 0-5-7
=
9.1 ;oil
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: '?'7 1— e-a S q
Date: -713 1 ,9_01 s--
2/4/2011

"kRalKboW Fatts-
Type of Visit: IR
Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit:D j jA►rrival Time: Departure Time: 0 ounty: Region:
Farm (Same: Crj 7r LLY1 P _ ;�1Q{_�. Y' 1L Z Owner Email:
Owner Name: �jr_ �� 11 '�"iC1 T— Phone:
Mailing Address: �] a �� C1 R i 'FGt JIi Sn n AA j I 1 iU , Plta! (&A — Aand e, , , 2 % 3 / 3
Physical Address: 1 t3,.1C1± 4 �—
! f074 -03yp
Facility Contact: d i I V I (,� �D h� Title: Phone:-
,.� �p l
Onsite Representative: Integrator: a -
Certified Operator: Certification Number:��.'L.��J
Back-up Operator:
Certification Number:
Location of Farm: Latitude:,D ss' Longitude: o-
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation? []Yes NfNo ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes [] No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) [:]Yes ❑ No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes ❑ No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes M No ❑ NA ❑ NE
3, Were there any observable adverse impacts or potential adverse impacts to the waters WjrYes j'No ❑ NA ❑ NE
of the St ther than from a discharge?

Facility Number: - 9MM I Date of Inspection:
24. Did the facility fail to calibrate waste appmation equipment as required by the permit?
Yes
❑ No
❑ NA
❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
Yes
No
�NA
❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes
No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
[-]Yes
[:]No
MNA
❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
[] Yes
AKNo
❑ 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]
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
PjNo
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
�No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
[] Yes
No
❑ NA
[] NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
N
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
o
❑ NA
❑ NE
Ll
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other, comments J ;�.,xl,
Use drawings of facility to better explain situations (use additional pages as necessary)
{-�5+ r,� u+s ? aooqt��?
�,. of d
a ra�.,h o +n D �� e D I�
4 C - 1 _ 'U y rla
Q 00 _ 13 00
L�41
(,� U ffo
PP
l l . Aw v i' V�- - - ., ,
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3 Lo05+e_ 6uwd 7 S r S S// 81ac l
up
Phone: 72__L1—,TA S 9
Date: 1Q 101 61 _
21412011

[Facility Number: I ro - jDate of inspection: j K—f 0\1
YL sdUlC�ie,S,C4n
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus h(iavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes gNo ❑ NA ❑ NE
/ Structure 1 Structure 2 Structure Structure 4 Structure 5 Structure 6
Identifier: i )
/ f�,J � e3A)
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.) 0
6. Are there structures on -site which are not properly addressed and/or managed through a Yes ❑ No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate pgblic health or environmental threat, notify DWQ
One-7. Do any of the structures need maintenance or improvement? re - 5 E Y, [ Yes ❑ No ❑ NA ❑ NE
p �
8. Do any of the structures lack adequate markers as required b�tEie permit?l��+ Rctre� Yes ❑ No [:]NA ❑ NE
(no-t p l�icablc roofed pits, dry stacks, and/or wet stacks)a� �, p� t �e.
�19. Does any part of the waste maw n gment system other than the whsttes ruciures equb f ,ni"� Yes ❑ No ❑ NA ❑ NE
maintenance or improvement? � jup
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes �Vo ❑ NA ❑ NE
maintenance or improvement?
11. is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes )�No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
A 1 % r~ / '
12. Crop Type(s): ( jp r,
13. Soil Type(s):
-SSG u e
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ Yes 2 No
❑ Yes ,�No
❑ Yes N No
[] Yes o
❑ Yes 21� o
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
[] Yes 4No ❑ NA ❑ NE
❑ Yes 5lo ❑ NA ❑ NE
❑ WUP ❑Checklists ❑ Design Maps ❑ Lease Agreements ❑Other:
�/Woaste
es record keeping need improvement? Oyes ❑ No
Application eekly Freeboard Waste Analysis Soil An:alysij�rMste Transfers
Rainfall Mftocking �op Yield 120 Minute Inspections Oonthly and V Rainfall Inspections
NJ ❑ NE
Bather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes _O No ❑ NA ❑ NE
23. If selected, did th acilittyy fail to
install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No NA ❑ NE
Page 2 of 3 ' t� f, , �/J p tL 21412`011 Continued

N
JW Division of Water Quality
Facility Number Q Division of Soil and Water Coeservation
O Other Agency
Type of Visit P Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance I
Reason for Visits' 6(Routine O Complaint O Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: 0 Arrival Time: Departure Time: County:
Farm Name: /1 I iQ' r it L� Owner Email:
Owner Name: ,;n" t�UfT4 dl ]q e, Phone:
Mailing Address:
t
Region: IjDS .
Physical Address: "�j f acxfy o_Y�A_ H
Facility Contact: `t1 A.Yi 1 � CO1r:I Q V1 ?_iTitle: Phone No: l'-
�� 15 1 g U
Onsite Representative: ��a�-tom Integrator: ---------
Certified Operator: Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
� o
Location of Farm: Latitude: h I o S Longitude:
us 4LO y aab 500441 " a�&l C--ass r, +urn !�- c�k-� p o�rcu ,rcF�� �r� h ark •
N1 t 1 PA ' e , (r1'r a lrr 0 u a V� -WI FG0 rWI OVA
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Gilts
Boars
Other
❑ Other
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
I❑ Non -La ei
Dry Poultry
❑ La ers
❑ Non -La ers
❑ Pullets
❑ Turke s
QTurkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made'?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
Design Current
Cattle Capacity Population
Dairy Cow
1000
Dairy Calf
Dairy Heife►
Dry Cow
❑
Non -Dairy
❑
Beef Stocket
❑
Beef Feeder
❑
Beef Brood Co
c. What is the estimated volume that reached waters of the State (gallons)?
Nfmb r of Structures:
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes J No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
� No
❑ NA
❑ NE
❑ Yes
XNo
❑ NA
❑ NE
12128104 Continued

Facility Number: _1(— 15-11 . Date of Inspection O
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
Yes ❑ No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5 Structure 6
Identifier; to tt2!2--
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes No ElNA ElNE
(ie/ large trees, severe erosion, seepage, etc.)
'A
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes XNo ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes A 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 ElNA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes #No ❑ NA [INE
ElExcessive Ponding ❑ Hydraulic Overload ElFrozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drill ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
I
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
?; No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
�No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
❑ No
0 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
No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
�02 vx�� y—x� #X�w
�-
�P �
Reviewer/inspector Name
t'C3- Phone:
.T
Reviewer/Inspector Signature:
Date:
12128104 ' Continued

Facility Number: (p — S 17'i!% of Inspection
Reuuired Records & Documents
19. Did the facility fail to have 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 ❑ Yes �No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design El Maps ❑Other
21. Doe record keeping need improvement? e-be� El Yes No El NA El NE
Waste Applica ion Ly Weekly Freeboard IR Waste Analysis Soil Analysis
[R/Rainfall IJ Stocking CR Crop Yield Ef120 Minute Inspections onthly and V Rain Inspections ENV/eather Code
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes
❑ Yes
❑ Yes
❑ Yes
❑ Yes
❑ Yes
Yes
❑ Yes
tND
D
] No
❑ No
No
No
❑ No
Ka
❑ Yes WNo
❑ Yes �No
❑ Yes /No
❑ Yes A No
❑ NA ❑ NE
iN NA ❑ NE
❑ NA ❑ NE
NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
El NA El NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Cl NA ❑ NE
❑ NA ❑ NE
Addtkional Comments andLor Drawings •- � ;�;; . ,. x s �s
�s„ E:�»� #� � �,��:g�� � ,:� a $��&�;... ����.e�s������' a:�
.1 i r`Qin e o�r�r- �, r�1o�e� k� to P
S e- e- Q�-e�-Pn S�. C. � 1 S�a.at �l
re'�a_
i ra'o n d u O.0 1jqV
r]
Page 3 of 3 b
� �'7P�, 12/28/04

Type of Visit Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit ?h Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: Q d Departure Time: County:
Farm Name: 1+ (-Iris d ai rm , L (, 1�- Owner Email:
Owner Name:
Phone:
Region: LLJS)W
Mailing Address: z3 U r �S� n Mill 1 Oleaean+ i9 0� PJI� aZ ? r,,
Physical Address: _� a -'
7 03 46
Facility Contact: Lev Title: Phone No:
Onsite Representative: �y�Q� ne Integrator:
Certified Operator: �._ oA l ��" ` n Operator Certification Number:
Back-up Operator:
Location of Farm:
Back-up Certification Number:
Latitude: EEO R-31 , ®_ Longitude: ® o HE I Tx
S h t�0ut a ab Sou`1 L�e� L.V OsS� fiu rn �,�'� a+
m n �3an�! arvt PA. pajr nn dr\
•
l
Swine
Design Current Design
Capacity Population Wet Poultry Capacity
Current Design Current
Population Cattle C►►specify Population
❑ Wean to Finish
ILI Layer
I
I Dairy Cow
❑ Wean to Feeder
❑ Non -Layer
Dairy Calf 0
❑ Feeder to Finish
Dairy Heifer
❑ Farrow to Wean
Dry Poultry
Dry Cow too
Non -Dairy
❑ Beef Stocker
❑Beef Feeder a
El Beef Brood Cowl I�
i
Number of Structures: �.
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Layers
Gilts❑
poBoars
Nther
❑ Other
Non -Layers
Pullets
❑ Turkeys
❑ Tur ke y Poults
I ❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of -the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes [ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes �No ❑ NA ❑ NE
❑ Yes 0 No ❑ NA ❑ NE
12128104 Continued

Facility Number: 60 — Date of Inspection 91
Waste Collection &Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
o El NA ❑ NE
r 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: -c r l A Loeb
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes �No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes 6�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 KNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes )(No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ,Yes d No ❑ NA ❑ NE
❑ Excessive onding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13.
Soil type(s) 1
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
X 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
VNo
❑ 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
` qNo
❑ NA
❑ NE
Comments (refer to question #) Explain any YES answers and/or` any recommendatibns�oer comments ,
Use drawings of facility to better explain situations.-(usc additional pages as necessary) P-M],[g
t.4�:6, rt s„ ;. 7J aGi
our K �r i n 4 IF
owex vt]5 P
CA u3 xrn uj ram+ reA ? A C- e!Zc-b W Q
3 6-2A--- o m
Reviewer/Inspector Name Phone:
3 tf.
ReviewerAnspector Signatu Date: t7 7 t7 Kb 7-2- e-- 1 ti Qrn; 11 12128104 Continued
S

Facility Number:
Required Records & Documents
0
Date of Inspection 8i Q
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
•
❑ Yes ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes o ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps El Other
21. eainfall
epic eed im vement? beae-bcltnv Yes ❑ No ❑ NA ❑ NE
ste Applicati Wee ly freeboar Waste Analysis Soil��thly
Analysis Q-Wi'a�t�`PcanSf�' AR-1 GfftifieRkM
Stocking Crop Yield 120 Minute Inspections and 1"Rain Inspections Weather Code
22. Did the facility fail to install and maintain a rain gauge?
-23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes �No
❑ Yes ❑ No
❑ Yes No
❑ Yes No
❑ Yes No
❑ Yes VrNo
'0 Yes ❑ No
❑ Yes ,XNo
❑ Yes bK
❑ NA ❑ NE
;(NA ❑ NE
❑ NA ❑ NE
VNA ❑ NE
❑NA ❑NE
[I NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
El NA ❑NE
❑ Yes ONo ❑ NA ❑ NE
❑ Yes 9No ❑ NA ❑ NE
❑ Yes t.ai"No ❑ NA ❑ NE
aoos soil test
brecfron e.DAVIetecQ•?
iA 0 Fie rd s rece i v t �a5te i n 4 e. Lou Q n ou3?
S
a
rM
a) 10taA Aa6e44 &0_� (0/�, 3 6 =p) 9

I Facility Number 7 6 5-1 11
Division of Water Qua]
Division of Soil and Wi
O Other Agency
nervation
Type of Visit P Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 16 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: I 1 I 1 I UPI Arrival Time: Departure Time: County: �! Region: S V
Farm Name:`- U)'t QriQ bal i' LLC' Owner Email:
Owner Name: rQ h.50 n [� �Q n e- Phone: �D sa �� L 5 ��
Mailing Address: l I�d-�')non 1yL } l 1 Rd (ea5a rt tP QYd PX1 .2 7 3
Physical Address: -25a n Ion got '
.�R G -7 0 3�
Facility Contact: �%�� 0-04r" Title: Phone No: 0- at IS— 7 qs- 7
Onsite Representative: to..11 L i +n e Integrator: �~
Certified Operator: 1\ayA �o(4 rrkne-- Operator Certification Number:
Back-up Operator:
Location of Farm:
uS 4'U_=I aao $o
Design Current
Swine Capacity Population
❑ Wean to Finish
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
Boars
Other
❑ Other
Back-up Certification Number:
Latitude: ° E3 ` Longitude: ®°
C.ro 5 s * -l' U Ir n (e r g h+ o n " fa of •
Design Current
Wet Poultry Capacity Population
❑ Layer
❑ Non -Layer
Dry Poultry
❑
Layers
❑
Non -Layers
❑
Pullets
❑
Turkeys
❑
Turkey Poults
❑
Other
DesignCurrent
Cattle Capacity Population.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
D
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
4
Number of Structures
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
o
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
x No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
WN o
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
12128104
Continued

Facility Number: — Date of Inspection '-7
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Le Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes
�No ❑ NA El NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes
?(,No ❑ NA ElNE
8. Do any of the stuctures lack adequate markers as required by the permit? ElYes
No ❑ NA ElNE
(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
LX! No ❑ NA ❑ NE
maintenance or improvement?
r'
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need El Yes
,,�
M No ❑ NA ❑ NE
maintenance/improvement?
I]. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No El NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
[I Yes
IIIIII ___No ❑ NA
ElNE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
No ❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
o ❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
VNo ❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or'any recommendations or any other comments
Use drawings of facility to 4etter explain situations. (use additional pages as necessary):
C ra5s v PPA,#-
cc)araLQ e_
. Mar V-P_ r- 1r-e-- 5,e_f- 1 VI to U3 4. r
� 4%_( co� � �, a No4-
y-4 e
�n o
epa it
__
Reviewer/Inspector Name4, 1 _ r'
Phone:
Reviewer/Inspector Signatur
Date: Q
Page 2 of 3 - `- + # 12128104 Continuer!

Facility Number: — Date of Inspection "7
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps El Other
❑ Yes Lti/No
❑ NA ❑ NE
❑ Yes ❑ NA ❑ NE
X
21. Does cord keeping need ii rovement? ❑ No ❑ NA ❑ NE
17 rite Appiica 'on lyl Wee y Freeboard Waste Analysis ;Monthly
alysis Waste �Yes
Tra
Rainfall Stocking Crop Yield 120 Minute Inspections and I" Rain Inspections Weather Code
22. Did the facility fail to install and maintain a rain gauge? El Yes No VNA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑Yes ❑ No ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑Yes L4�'No ❑ NA ❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit? ❑Yes ❑ No I�,NA ❑ NE
26. Did the facility fail to have an actively certified operator in charge? El Yes XNo ❑ 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 To' D NA ❑ NE
29. Did the facility fail to property dispose of dead animals within 24 hours and/or document El Yes
No ❑ NA ❑ NE
and report the mortality rakes that were higher than normal? P�l
30. At the time of the inspection did the facility pose an odor or air quality concern? El Yes o ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately 31. Did the facility fail to notify the regionsl office of emergency situations as required by [I Yes ❑ NA ❑ NE
General Permit? (iel discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes
rrNo
o - ❑ NA ❑ NE
33. Does facility require afollow-up visit by same agency? Yes NEl A NE
Additional Comments and/or Drawings:
J
a . aoo�4-aoo� Sorl fest resol�s ? R��^
♦ 1 � � 1
C.
�lil✓QTP"0
UP, ct RP—
FI
(@_�, �.. . '0. }"did
Pageyy�
21. Does cord keeping need ii rovement? ❑ No ❑ NA ❑ NE
17 rite Appiica 'on lyl Wee y Freeboard Waste Analysis ;Monthly
alysis Waste �Yes
Tra
Rainfall Stocking Crop Yield 120 Minute Inspections and I" Rain Inspections Weather Code
22. Did the facility fail to install and maintain a rain gauge? El Yes No VNA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑Yes ❑ No ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑Yes L4�'No ❑ NA ❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit? ❑Yes ❑ No I�,NA ❑ NE
26. Did the facility fail to have an actively certified operator in charge? El Yes XNo ❑ 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 To' D NA ❑ NE
29. Did the facility fail to property dispose of dead animals within 24 hours and/or document El Yes
No ❑ NA ❑ NE
and report the mortality rakes that were higher than normal? P�l
30. At the time of the inspection did the facility pose an odor or air quality concern? El Yes o ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately 31. Did the facility fail to notify the regionsl office of emergency situations as required by [I Yes ❑ NA ❑ NE
General Permit? (iel discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes
rrNo
o - ❑ NA ❑ NE
33. Does facility require afollow-up visit by same agency? Yes NEl A NE
Additional Comments and/or Drawings:
J
a . aoo�4-aoo� Sorl fest resol�s ? R��^
♦ 1 � � 1
C.
�lil✓QTP"0
UP, ct RP—
FI
(@_�, �.. . '0. }"did
Pageyy�

Division of Water Qualit •
� y
❑ Division of Soil and Water Conservation
❑ Other Agency
Facility Number: 7gQ,Q59-_— Facility Status: Active _- Permit: AYYC7QQ059 Denied Access
Inspection Type: CgMgliance Inspection _ Inactive or Closed Date:
Reason for Visit: Complaint County: Randolph Region: ffX§ton-Salem___
Date of Visit: 05/02/2008 _ Entry Time:12:40 PM Exit Time: 02:45 PM Incident #:
Farm Name: Coltrane Dairy LLQ _ _ Owner Email:
Phone: [phone]
Physical Address: 1284 Banton Rd _ Pleasant Garden NC 27313
Facility Status: ❑ Compliant ❑ Not Compliant Integrator:
Location of Farm: Latitude: �5553'55" _ Longitude: 79"46'32"
From GSO south on Hwy. 220 to Level Cross exit. Take Branson Mill Rd. to the left. Right onto Bantam Rd. Farm will be on the right.
Farm entrance is off SR#2102 (Bantam Road)
Question Areas:
Discharges & Stream Impacts Waste Application Records and Documents
Certified Operator: Roy B Coltrane Operator Certification Number: 21312
Secondary OIC(s):
On -Site Representative(s): Name Title Phone
24 hour contact name David M Coltrane Phone: [phone]
On -site representative David M Coltrane Phone: [phone]
Primary Inspector: Melissa Rosebrock Phone:
Inspector Signature:
Secondary Inspector(s):
Date:
Page: 1

0 0
Permit: AWC760059 Owner - Facility: R Branson Coltrane Facility Number: 760059
Inspection Date: 06/02/2008 Inspection Type: Compliance Inspection Reason for Visit: Complaint
MOMROYMMis the result of a complaint received by DWQ/WSRO-9urfiace Vll.Aer staff on 6/2/08 from Don Peeler (City of
Randleman Public Works Director-336.669.2845) alleging a discharge from the Coltrane Dairy on 5/31/08. Surface water staff
immediately notified DWQIWSRO-Aquifer Protection staff upon receivin he complaint. Mr. Peeler also called WSRO-Aquifer
Protection on the morning of 6/2108, He stated that a neighbor (Ruby - 1454 Bantam Road, 336,674.7426), who lives next
door to the dairy, contacted the water plant on 5/31108 regarding what she c5alled animal waste in an intermittant stream (which flows
into an unnamed tributary to Polecat Creek) on her property coming from the application field(s) at the Coltrane Dairy. Coltrane Dairy
is located 12-14 miles upstream of the Polecat creek water intake for the City of Randleman water plant.
Per Coltrane Dairy's application records, irrigation pulls #1 and #3 in field 3F 107 were started and checked by David Coltrane
(Coltrane Dairy 01C) at 11:00am on 5131/08. David Coltrane stated to DWQ staff thal'at 11:30am his father (Branson Coltrane)
received a call from Ms. Johnson alleging "that waste was running off the application field into her creek." David Coltrane stated to
DWQ staff that he was eating lunch at 11:30am when his father notified him of the call from Ms. Johnson. David said that "he knew he
had just checked the irrigation gun just prior to coming in for lunch so he knew it was ok." David said he "waited until he had finished
eating and then checked the system at 12:30pm. Everything looked ok and no waste was running off so we kept spraying." Per the
waste irrigation design, the intermittant stream on Ms. Johnson's property is located at least 200 feet from the Coltrane Dairy waste.
application Field 3F 107 (pull #1).
5/31/08 Subsequent timeline of events:
- Mr. Peeler's notes show that the water plant called him at 12:08pm.
- At 12:16pm WSRO-Public Water Supply (PWS) staff (Michael Gendy) states that he "received call on his work cell' phone from
Raleigh DWQ of possible animal waste contamination."
- At 12:21 pm Michael Gendy called and left message for Tom Boyd (WSRO-PWS Regional Water Consultant) detailing current known
information.
- At 12:46pm PWS records state that Michael Gendy called the Randleman water plant and spoke with operator Bill Glenn (see PWS
report for details).
- Al 12:58pm water'plant ORC (Phillip Perkins) called WSRO-PWS (Michael Gendy) and stated that the town had decided to shut the
water plant down. The reported contamination was approximately 8-15 miles upstream of Polecat Creek (plant's water intake).
The farm's application records indicate that waste application on pull #3 ended at 1:30pm and pull #1 ended at 2:00 pm.
- Mr. Peeler's notes (and subsequent callstfaxes to DWQ) also indicate that the water plant went off-line at 1:50pm.
- Mr. Peeler's notes indicate that he called the DWQ emergency number (800.858.0368) at 2:26pm.
- WSRO-PWS records state that Phillip Perkins called Michael Gendy (WSRO-PWS) at 2:35pm. Mr. Perkins stated that "he was on
site and that there was a small wet weather stream bed that was not flowing water but had a very small amount of black substance in
the ditch." Phillip Perkins ask Michael Gendy who he should call and he was told "to call the WSRO-DWQ group to report."
- Mr. Peeler writes that he spoke with WSRO-Public Water Supply staff (Michael Gendy) at 2:35pm.
- Mr. Peeler denotes that he spoke with Ms. Johnson at 2:40pm. He also told WSRO-Aquifer Protection staff that he did not observe
any waste actually flowing from the Coltrane Dairy application fields since he did not go onto their property.
- Mr. Peeler's notes indicate that fecal coliform samples were taken by the Randleman staff approximately 3-4 miles downstream of
the farm at 3:05pm (250 col/100 ml). The lab's report states that this sample was collected at 3:35pm,
- At 3:35pm Mr. Peeler's notes indicate that another fecal coliform sample was taken approximately 10 miles downstream of Coltrane
Dairy (20 col/100 ml). The lab report states that the second sample was collected at 3:50pm.
- Tom Boyd (WSRO-PWS) received message from Michael Gendy (WSRO-PWS) at 5:02pm and called the Randleman water plant at
5:10pm and spoke with Tommy Thornton and then with Phillip Perkins. It was determined that public health was probably not going to
be affected and that it was ok to restart the plant (see WSRO-PWS report for details).
Page: 2

! •
Permit: AWC760059 Owner - Facility: R Branson Coltrane ' Facility Number: 760059
Inspection Date: 06/02/2008 Inspection Type: Compliance Inspection Reason for Visit: Complaint
- Mr. Peeler's notes show that he took photos of the intermittant stream in question at 5:30pm and contacted WSRO/Public Water
Supply staff (Tom Boyd) at 6:02pm. The water plant was back on line at 6:30pm,
6/2108 Events:
Please note that DWQ/WSRO staff was not aware of and was not contacted regarding this incident until 612/08. Both Surface Water
and Aquifer Protection personnel visited the Coltrane Dairy on 6/2/08:
Questions 2. & 18.
On 612/08 DWQ staff observed a small amount of animal waste that had flowed 20-30 feet from a 3/4" to 1" in -line cut off valve located
in Field 3F 111 (see waste irrigation design). The cut off valve is located approximately 100 feet from Ms. Johnson's property line and
200 feet from the intermittant stream where she alleges animal waste was observed. The area between the cut-off valve and property
line/stream is heavily wooded and vegetated. Ms. Johnson's house is not visible from any of the spray fields used by Coltrane Dairy.
David Coltrane confirmed that the waste irrigation system was first started -up and checked at 2:00pm on Friday May 30, 2008. The
cut-off valve had been left open for winterization and he had forgotten to close it. The leak was discovered as he drove around to
check the system and was closed between 2:05pm and 2:10pm on May 30th. DWO staff did NOT observe evidence of any waste
extending further than 20-30 feet from the valve.
Saturday's (5/31/08) land application site (and several additional fields) were checked for evidence of waste run off by DWQ staff on
6/2108 and none was discovered (no odor in the stream or buffer areas, no dark coated or "washed -over" vegetation in the buffers or
application fields, no sludge worms or dead fish in the stream, and no excessive algal growth).
Two locations upstream of the alleged discharge were sampled on 612108 for fecal coliform (site #1=280 and site #2=420 col/100 ml).
A location on Polecat Creek, prior to any waste application fields, was also sampled (site #3=640 col/100 ml). Sample site #4 was
downstream of the confluence of sample site #3 with the perennial stream (unnamed tributtary to Polecat Creek) passing nearest the
irrigation fields (site #4=440 col/100 ml). Ms. Johnson's residence was not visible from any of the sampling locations.
Page: 3

• - . 0
Permit: AWC760059 Owner - Facility: R Branson Coltrane Facility Number: 760059
Inspection Date: 06/02/2008 Inspection Type: Compliance Inspection Reason for Visit: Complaint
Waste Structures
Type Identifier Closed Date Start Date Designed Freeboard Observed Freeboard
Waste Pond LOWER
Waste Pond UPPER
Page: 4

0 .
Permit: AWC760059 Owner -Facility: R Branson Coltrane Facility Number: 760059
Inspection Date: 06/02/2008 Inspection Type: Compliance Inspection Reason for Visit: Complaint
Discharges & Stream Impacts Yes 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)
❑
■
❑
❑
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 Waters of the State other than from a
❑
■
❑
❑
discharge?
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)?
❑
PAN?
Cl
Is PAN > 10%110 lbs.?
❑
Total P205?
❑
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
Corn
(Silage)
Crop Type 2
Corn
(Grain)
Page: 5

Permit: AWC760059 Owner - Facility: R Branson Coltrane
Facility Number:
760059
Inspection Date: 06/02/2008 Inspection Type: Compliance Inspection
Reason for Visit: Complaint
Waste Application
Yes
No
NA
NE
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
❑
■
❑
❑
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? ❑
■
❑
❑
17. Does the facility lack adequate acreage for land application?
❑
❑
❑
18. Is there a lack of properly operating waste application equipment?
❑
❑
❑
Records and Documents
Yes
No
NA
NE
19. Did the facility fail to have Certificate of Coverage and Permit readily available?
Q
❑
❑
■
20. Does the facility fail to have all components of the CAWMP readily available?
❑
■
❑
❑
If yes, check the appropriate box below.
WU P?
❑
Checklists?
❑
Design?
❑
Maps?
❑
Other?
❑
21. Does record keeping need improvement?
❑ ■ ❑ ❑
If yes, check the appropriate box below.
Waste Application?
❑
120 Minute inspections?
❑
Weather code?
❑
Page: 6

0
Permit: AWC760059 Owner - Facility: R Branson Coltrane Facility Number. 760059
Inspection Date: 06/02/2008 Inspection Type: Compliance Inspection Reason for Visit: Complaint
Records and Documents Yes No NA NE
Weekly Freeboard? ❑
Transfers? ❑
Rainfall? ❑
Inspections after > 1 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? ❑ ■ ❑ ❑
23, If selected, did the facility fail to install and maintain a rainbreaker on irrigation equipment (NPDES only)? ❑ Cl ■ ❑
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑
■
❑
❑
25. Did the facility fall to conduct a sludge survey as required by the permit?
❑
❑
0
❑
26. Did the facility fail to have an actively certified operator in charge?
❑
0
❑
❑
27. Did the facility fail to secure a phosphorous loss assessment (PLAT) certification?
❑
❑
❑
■
Page: 7

fozr-p.p- .
Division of Water QualitAp
Facility Number 9Division of Soil and Water Conservation J. �w
0 Other Agency / ' +'I'j
L
f Visit Compliance Inspection O Operation Review Q Structure Evaluation 0 Technical Assistance
n for Visit Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: IqIIL M
rival Time: F0 b Departure Time: County: P4 YV1810 Region:f�
Farm Name: Mal L L � Owner Email:
Owner Name: _ .� ' 4-�ira1 50i An 1 4-rn „n a Phone: 1 S dZ O _ fir
Mailing Address: T a 3 �fan �� �� tl FF. , p
Physical Address: 1 m 4 1'1Tlf�i1� r (i ir4- ! v C 1 j 3 ol73 13
Facility Contact:y 1 Lam?, L1 Title: Phone No: WN 0
3 *p
`_'Q 1'
Onsite Representative: 1. 3 ` td ! �7 Ct h �. Integrator:
Certified Operator: ���- Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: Longitude:
US ;tab So 3* -6 L tit? 1 era sS -maxi+ +urn h1L
WA-0 ". Fawvn e)n r`
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Other
❑ Other
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
_ ❑ Non -La er
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ ke s
Eurkey
❑ Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation`?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
Dq Dairy Cow
%Dairy Calf
0
90
Dairy Heifer
QQ
D Cow
too
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes IC} No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
o
tNo
ElNA
ElNE
❑ Yes
❑ NA
❑ NE
12128104 Continued

F,
Facility Number: • Date of Inspection
Waste Collection & Treatment XNo
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ElNA [INE
a. If yes, is waste level into the structural freeboard? ❑Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier;
Spillway?: o—
Designed Freeboard (in):
Observed Freeboard (in): I
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ElNE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes �No ❑-NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? 9Yes ❑ 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 ElNA ElNE
maintenance or improvement? [ - 9
Waste Application ma—
Waste
Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes XNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes XNo ElNA ElNE
❑ Excessive Pending ElHydraulic Overload ❑ Frozen Ground ElHeavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or ] 0 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drifl [:]Application Outside of Area
12. Crop type(s) I A �l � � A C4, l*
� . _1 k)-V
. ',
I]A
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
ElYes
XNo
El NA
El NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
XNo
ElNA
ElNE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
❑ No
X 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
tgVo
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
9 aal Aud ggeL4&
2� - tAv a-4L0,5
Reviewer/Inspector Name4%Phone:
,Z
Reviewer/[nspector Signatur
Date:
12128104 Continued

Facility Number: — *ate of Inspection 1 - 1 1 9
Reauired Records & Documents /
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 7No
o ❑ NA ❑ NE
20. Does the facility fail to have all co onentss of the C WM—P�rea ply av ilable? If yes, check ❑ Yes ❑ NA ❑ NE
the appropirate box. ❑ WUPJ❑ CheL'k isYsN LJ De�Ign �aps ❑ Other
21. D es record keeping need i ` provement?}e , �epprepristc� J w ❑ Yes KNo ❑ NA ❑ NE
Waste Application oard Waste Analysis Soil n sis 2 Waste Transfers
Pp�� Y Y ��"`
Rainfall l�'Stocking Crop Yield s Monthly and 1" Rain Inspections Weather Code
0 WC
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes jNo ❑NA El NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
sc� .
24. Did the facility fail to calibrate waste application equipment as required by the permit? acol
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge'?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes ❑ No %NA ❑ NE
❑ Yes V No ❑ NA ❑ NE
❑ Yes ❑ No XNA ❑ NE
❑ Yes "S�No ❑ NA ❑ NE
❑ Yes ❑ No XNA ❑ NE
❑ Yes
�No
❑ NA
❑ NE
❑ Yes
O(No
❑ NA
❑ NE
❑ Yes
)�No
❑ NA
❑ NE
❑ Yes
qNo
❑ NA
❑ NE
❑ Yes
4No
❑ NA
❑ NE
❑ Yes
kg4o
❑ NA
❑ NE
Additional Comments and/or Drawings:
01006 Sal
a
L�PT=5 ( L_35wn
L
12128104

F/14
Type of Visit 0 Compliance Inspection Operation Review 0 Structure Evaluation 0 Technical Asslstar!.6e4M 0 � 2C
Type
for Visit ID Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 other 0 Denied Access
•MiMan-1 Z*
'�Mjtll ,
Date of Visit: Arrival Time: Departure Tinje: County:...... - Reglonr:
Farm Name- .Lice --.-_-.- Owner Email:
Owner Name: Phone: J—. 3
Mailing Address: /-0/
Physical Address:
Facility Contact: Title: Phone NOJX__.��_7A�Ao_
Onsite Integrator:
Certified Operator: ----------- ____ Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm; Latitude: F53] 0 Longitude: 5#1 OrO�'
L___L_j Uit-i
#Q 21-,P - _<0A66# fb 45iWIL C49,5ROO *W Aj4t // fo &4ff 9W 400%4W
VAm 04
Pit
W esign L Current .ti Design Current
.......
it
Cattley
D Wean to Finish Laver Dairy Cow
El Wean to Feeder -][01- Non -La xe I El Dairy Calf
❑Feeder to Finish Dairy Heifer I , � "'.
. . . . . . . . . .
❑ Farrow to WeanDry DEY Cow
Y El Non -Dairy
❑ Farrow to Feeder
❑El Layers D Beef Stocket
Farrow to Finish
❑ Non -Layers
❑Gilts Beef
El Pullets
—Boars Beef Brood Cow
.,% -.. 4. Turkeys
:rtK"O
->Z Lj Turkey Poults
❑ 0 0 Other ffier Number of Structures d
AIA
Feeder
Discharges & Stream Impact
1. Is any discharge observed from any part of the operation? [I Yes 00 No El NA 0 NE
Discharge originated at: 0 Structure El Application Field 0 Other
a. Was the conveyance man-made? 0 Yes D No IKI NA D NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) 0 Yes 0 No 5Q NA El NE.
What is the estimated volume that reached waters of the State
.... ..... . . ......
d, Does discharge bypass the waste management system? (If yes, notify DWQ) El Yes 11 No M NA ❑ NE
2.., Is there evidence of a past discharge from any part of the operation? 0 Yes 0 No KI NA ❑ NE
_.Were t ere any adverse impacts iir—poFe-nt-i-aT—adv-iFi-FeFimp—ac-fs—to-thi-Wit-er-s—of'tWe--S-fite- NO

Facility Number: 7G — • Date of Inspection Z
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ❑ No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: uP
Spillway?:
Designed Freeboard (in): jV
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(ie/ large trees, severe erosion, scepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental 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 W No ❑ NA ❑ NE
maintenance/improvement7
It. Is there evidence of incorrect application? 1f yes, check the appropriate box below. ❑ Yes ,P No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑. Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ FAN ❑ PAN> 10%.or i0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drifl ❑ Application Outside of Area
12. Crop type(s) uY' "44e K �.L��--
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes V No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination%❑ Yes rV 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 2 No ❑ NA ❑ NE
�� �� /IcirXv Ii'FG
.... _........
.___.._._..____
4r,e&.eRG
- - --- --------- ------- ------- _-. -----
- -
Reviewer/Inspector Signature: Date:
12/ "4
Continued

Facility Number: -- *ate of Inspection
Required Records $c Documents
19.. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20, Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes (� No ❑ NA ❑ NE
the approprrate box. ❑ WUp ❑ Checklists ❑ Design
g El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspection's' ❑ Monthly and I" stain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
❑ No
jO NA
❑ NE
❑ Yes
4 No
❑ NA
❑ NE
❑ Yes D(No ❑ NA ❑ NE
❑ Yes k No ❑ NA ❑ NE
[]Yes 1?1 No ❑ NA ❑ NE
[:]Yes 09No ❑ NA ❑ NE
❑ Yes E4 No ❑ NA ❑ NE
❑ Yes
N No
❑ NA
❑ NE
❑ Yes
- OQNo '
❑ NA
❑ NE
12129104

Facility Number: - Date ol'Inspection
Technical Assistance
Needed
Provide
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 (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, Irigation 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/rechecks
❑
❑
57. Crop evaluation/recommendations
❑
❑
58. Drainage worklevaluation
❑
❑
59. Land shaping, subsoiling, aeration, etc.
❑
❑
60. Runoff control, stormwater diversion, etc.
❑
❑
61. Buffer improvements
❑
❑
62. Field measurements(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 ImarovemenjA Made _pv t 1peration:
----------
4.
2. - _ 5.
--

1j,
Division of Water Quality
❑ Division of Soil and Water Conservation
❑ Other Agency
Facility Number: 7QO059 Facility Status: Active Permit: AWCZ60059 ❑ Denied Access
Inspection Type: Compliance Inspection— Inactive or Closed Date:
Reason for Visit: Routine _ _� County. Bandoloh Region:Winston-Salem
Date of Visit: 07/27/2006 Entry Time:10720 AM Exit Time: 12:30 PM Incident #:
Farm Name: Coltrane Dairy. LLC Owner Emali:
Owner: R Branson Coltrane Phone: [phone]
Mailing Address: 7239 Branson Mill Rd
Physical Address:
Facility Status: ❑ Compliant ❑ Not Compliant Integrator:
Location of Farm: Latitude: 35°53'55" Longitude: 79*46'32" _
From GSO south on Hwy. 220 to Level Cross exit. Take Branson Mill Rd. to the left. Right onto Bantam Rd. Farm will be on the right.
Question Areas:
Discharges & Stream Impacts
Records and Documents
Certified Operator: David M Coltrane
Secondary OIC(s):
Waste Collection & Treatment Waste Application
Other Issues
Operator Certification Number. 21311
On -Site Representative(s): Name Title Phone
On -site representative David M Coltrane Phone: [phone]
24 hour contact name David M Coltrane
Phone: [phone]
Primary Inspector: M i sa Rosebrock Phone:
Inspector Signature: Date:
Secondary Inspector(s):
Inspection Summary:
Tech specialist is revising WUP at this time. Manure is managedthandled for heifers and dry cows also, Operator wants to include
1000 milk cows, 800 heifers, and 150 calves in the new WUP.
21. Three fields report zinc values greater than 1000 units. Don't forget to obtain samples for 2006.
24. Honey wagon and spreader were calibrated June 2006.
21. Records are excellent!
7/24/06 waste analyses:
upper=1.0 and 0.96 lbs. N/1000 gal.
Lower=6.8 lbs. N/1000 gal.
solids=5.9 lbs. Nlton
Page: 1

•
0
Permit: AWC760059
Inspection Date: 07/27/2006
Owner - Facility: R Branson Coltrane
Inspection Type: Compliance Inspection
Facility Number: 760059
Reason for Visit: Routine
Regulated Operations Design Capacity Current Population
Cattle
O Cattle - Dairy Calf
20
Cattle - Dairy Heifer
400
Q Cattle - Dry Cow
50
O Cattle -Milk Cow
500
433
Total Design Capacity: 500
Total 5SLW: 700,000
Type Identifier Closed Date Start Date Designed Freeboard Observed Freeboard
aste Pond LOWER 42.00
aste Pond UPPER 66.00
Page: 2

•
•
Permit: AWC760059 Owner - Facility: R Branson Coltrane Facility Number: 760059
Inspection Date: 07/27/2006 Inspection Type: Compliance Inspection Reason for Visit: Routine
Discharges & Stream Impacts Yes 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) 1101311
c. Estimated volume reaching surface waters?
d. Does discharge bypass the waste management system? (if yes, notify DWQ) Cl ■ Cl ❑
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 Waters of the State other than from a ❑ ■ ❑ ❑
discharge?
Waste Collection, Storage &_Treatment
Yes
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 (I.e./ 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 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,
❑
01111
dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require maintenance or
❑
■
❑
Cl
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

•
0
Permit: AWC760059 Owner- Facility: R Branson Coltrane Facility Number: 760059
Inspection Date: 07/27/2006 Inspection Type: Compliance Inspection Reason for Visit: Routine
Waste Application Yes No NA NE
PAN? ❑
Is PAN > 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
Crop Type 2
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
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?
17. Does the facility lack adequate acreage for land application?
18, Is there a lack of properly operating waste application equipment?
Records and Documents
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.
WUP?
Small Grain (Wheat,
Barley, Oats)
Fescue (Pasture)
Corn (Silage)
❑ ■ ❑ ❑
Cl ■ ❑ ❑
❑ ■ ❑ ❑
Cl ■ ❑ Cl
❑ ■ ❑ Cl
Yes No NA NE
❑ ■ ❑ ❑
❑ ■ ❑ ❑
1❑
Page: 4

Permit: AWC760059 owner- Facility: R Branson Coltrane Facility Number: 760059
Inspection Date: 07/27/2006 Inspection Type: Compliance Inspection Reason for Visit: Routine
Records and Documents Yes No NA NB
Checklists? ❑
Design? ❑
Maps? ❑
Other? ❑
21. Does record keeping need improvement? ❑ ■ ❑ ❑
If yes, check the appropriate box below.
Waste Application?
❑
120 Minute inspections?
❑
Weather code?
❑
Weekly Freeboard?
❑
Transfers?
❑
Rainfall?
❑
Inspections after a 1 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?
❑
■
❑
❑
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
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 those Q ■ Q ❑
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

Permit: AWC760059 Owner- Facility: R Branson Coltrane Facility Number: 760059
Inspection Date: 07/27/2006 inspection Type: Compliance Inspection Reason for Visit: Routine
Otherl'ssues Yes No NA NE
31. Did the facility fail to notify regional DWO of emergency situations as required by Permit? ❑ m ❑ ❑
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

Erm" MAI-
'I
Type of Visit (�Cornpliance Inspection Q Operation Review Q Structure Evaluation 0 Technical Assistance
Reason for Visit l Routine 0 Complaint O Fallow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: !- 1�Lf rrival Time: ?. Departure Time:
!�County: Region: 4)5 F= 6
Farm Name: _A 1 T%e- _Nil t' 4 �-(-�- Owner Email: i iLMare be, i+rd+-p
Owner Name: f�-' �lf`Q�3�C311 Co I +an t-- ra � Phone: ' � � % 3
Mailing Address: `7 131 � V-�15on Mill R . Ka%ttl
Physical Address: oL� l Q 1[Uo._
Facility Contact: 112L&I . "0 t 4 h e- Title: Phone No .�
Onsite Representative:
Certified Operator:
Integrator: -
Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm:
Discharges & Stream Impacts
t. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes xo ❑ NA ❑ NE
❑Yes
El No
❑NA
❑NE
❑Yes
El No
El NA
[I NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
o
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
Page 1 of 3 12128104 Continued

Facility Number: • Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
.J
�A Structure I Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes No
❑ Yes III❑ No
Structure 5
El NA El NE
❑ NA ❑ NE
Structure 6
❑ Yes No ❑ NA ❑ NE
❑ Yes *No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental great, notify DWQ
7. Do any of the structures need maintenance or improvement? El Yes [�( o ❑ NA ❑ NE
$. 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 IR<o ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes >lo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes Vo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l O lbs [:]Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence ofWind Drift ❑ Application Outside of Area
12. Crop type(s) �D[`h 5`( ���, c nAn 114 a x—a'i 11, EnC2 )P_ D28fo T-e-
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ NA
El NE
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 ?
El Yes
❑ Yes
,�o
L�9
No
❑ NA
❑ NA
❑ NE
❑ 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
No
❑ NA
❑ NE
Comments (refer to question ##): Explain any,YES answers and/or any recommendations or any.:. other.comments.
Use drawings of facility to better explain situations.. (use'additional pages as necessary):'
Reviewer/Inspector Name I r Phone:
Reviewer/Inspector Signat i h Date:
Page 2 of 3 if " 12128104 Continued

Facility Number: '"') — ate of inspection 0
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes J�'No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check ❑ Yes , Rio ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design El Maps ❑Other
21. Des record keeping need improvement, ertpprcprmte-,b0* ialew- El Yes �No [I NA El NE
Waste Application WWeeky Freeboard Waste Analysis lb{ Soil Analysis ] Waste Transfers �n
Rainfall Stockinop Yield 120 Minute InspectionsX
Month/ and 1" Rain Inspections
Ly Weather Code
g P Y P
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 maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No NA ❑ NE
24. Did the facility fait to calibrate waste application equipment as required by the permit? W. DLL ❑ Yes 0 No ❑ NA ❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit? ❑ Yes ❑ No I(NA ❑ NE
26. Did the facility fail to have an actively certified operator in charge? ❑ Yes kNo [I NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ❑ Yes ❑ No KNA ❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes o [INA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document ElYes 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 XNo ElNA ❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by ❑ Yes 0N0 ❑ NA ❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes No ❑ NA ❑ NE
33. Does facility require a follow-up visit by same agency? ❑ Yes XNo ❑ NA ❑ NE
Add' ' al Comments and/or Drawings:
a q ng�te"Luz_ ? -
.e > 1 ooa zc, PZO S6-1-P .
4-o, 9b
I
s oce-&QA '
a

Division of Water Quality
[] Division of Sol! and Water Conservation
❑ Other Agency__
Facility Number: 760059 Facility Status: Active Permit: AWC760059 ❑ Denied Access
Inspection Type: Compliance Inspection _ Inactive or Closed Date:
Reason for Visit: Routine County: Randolph Region: Winston-Salem
Date of Visit: 07/26/2005 Entry Time: 08:55 AM Exit Time: 11:00 AM Incident #:
Farm Name: Coltrane Dairy. LLC _ Owner Email:
Owner: R Branson Coltrane
Phone: [phone]_
Mailing Address: 7239 Branson Mill Rd _ _ Pleasant Garden NC 273139870
Physical Address:
Facility Status: ❑ Compliant ❑ Not Compliant Integrator:
Location of Farm: Latitude: 35153'55" Longitude: 79°46'32"
From GSO south on Hwy. 220 to Level Cross exit. Take Branson Mill Rd, to the left. Right onto Bantam Rd. Farm will be on the right,
Question Areas:
Discharges & Stream Impacts
Records and Documents
Certified Operator: Roy B Coltrane
Secondary OIC(s):
0 Waste Collection & Treatment Waste Application
Other Issues
Operator Certification Number: 21312
On -Site Representative(s): Name Title Phone
On -site representative David M Coltrane Phone: [phone]
24 hour contact name David M Coltrane Phone: [phone]
Primary Inspector: Melissa M Rosebrock Phone: [phone]
Ext.383
Inspector Signature:
Date:
Secondary Inspector(s):
Phone:
Phone:
Inspection Summary:
21. Went over new permit requirements with operator. Records look great.
24. Calibration has been completed for irrigation (check psi on gun, though). Still need to complete calibration for honey wagon and
spreader by October 2006.
28. Operator has contacted tech specialist about raising milk cattle number to 800.
4118/05 Waste analyses:
Lipper=l.2 lbs. N/1000 gal.
Lower=6.4 lbs. N/1000 gal.
Solids=4.6 lbs. N1lon
Page: 1

0
Permit: AWC760059 Owner - Facility; R Branson Coltrane
Inspection Date: 07/26/2005 inspection Type: Compliance Inspection
Facility Number. 760059
Reason for Visit: Routine
Regulated Operations Design Capacity Current Population
Cattle
Cattle - Milk Cow 500 435
Total Design Capacity: 500
Total SSLW: 700,000
Waste Structures
Type Identifier Closed Date Start Date Designed Freeboard Observed Freeboard
Waste Pond LOWER 60.00
Waste Pond UPPER 60.00
Page: 2

•
•
Permit: AWC760059 Owner • Facility: R Branson Coltrane
Facility Number: 760059
Inspection Date: 07/26/2005 Inspection Type: Compliance Inspection Reason for Visit: Routine
Yes_ No _ NA NE
1. Is any discharge observed from any part of the operation? ❑ 0 ❑ ❑
Discharge originated at:
Structure
❑
Application Feld
❑
Other
❑
a. Was conveyance man-made?
❑
❑ ❑
b. Did discharge reach Waters of the Stale? (if yes, notify DWQ)
❑
❑ ❑
c. Estimated volume reaching surface waters?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
❑
0 ❑ ❑
2. Is there evidence of a past discharge from any part of the operation?
❑
0 ❑ ❑
3. Were there any adverse impacts or potential adverse Impacts to Waters of the State other than from a discharge?
❑
Yes
M ❑ ❑
No NA NE
21i]Ste Collection. Storage & 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 (Led 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
❑
0 ❑ ❑
closure plan?
7. Do any of the structures need maintenance or Improvement?
❑
❑ ❑
B. Do any of the structures lack adequate markers as required by the permit? (Not applicable to roofed pits, dry stacks
❑
❑ ❑
and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require maintenance or
❑
■ ❑ ❑
improvement?
Yea,
No NA NF
Waste Annlicatlon
10. Are there any required buffers, setbacks, or compliance alternatives that need maintenance or Improvement?
❑
0 ❑ ❑
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)?
❑
PAN?
❑
Is PAN > 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
Corn (Silage)
Crop Type 2
Fescue (Hay, Pasture)
Crop Type 3
Small Grain (Wheal,
Barley, Oats)
Crop Type 4
Crop Type 5
Page: 3

Permit: AWC760059 Owner - Facility: R Branson Coltrane Facility Number: 760059
Inspection bate: 07/26/2005 Inspection Type: Compliance Inspection Reason for Visit: Routine
Waste App iration Yes --No- NA - NE
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 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?
❑
M ❑
❑
17. Does the facility lack adequate acreage for land application?
❑
N ❑
❑
16. Is there a lack of properly operating waste application equipment?
Rernrds
❑
Yes
0 ❑
NQ NA
❑
NE
and _17nr_irmentc
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?
E
❑ ❑
❑
If yes, check the appropriate box below.
Waste Application?
❑
120 Minute inspections?
Weather code?
Weekly Freeboard?
❑
Transfers?
❑
Rainfall?
❑
Inspections after > 1 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?
❑
■ ❑
❑
23. if selected, did the facility fail to Install and maintain a rainbreaker on Irrigation equipment (NPDES only)?
❑
0 ❑
❑
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑
N ❑
❑
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑
0 ❑
❑
26. Did the facility fail to have an actively certified operator in charge?
❑
M ❑
❑
27. Did the facility fall to secure a phosphorous loss assessment (PLAT) certification?
❑
0 ❑
❑
Page: 4

•
Permit: AWC760059 Owner - Facility: R Branson Coltrane Facility Number: 760059
Inspection Date: 07/26/2005 Inspection Type: Compliance Inspection Reason for Visit: Routine
Other Issues
28. Were any additional problems noted which cause non-compliance of the Permit or CAWMP?
Ygs
❑
No NA
■ ❑
NF
❑
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
❑
0 ❑
❑
representative immediately.
31. Did the facility fail to notify regional DWO of emergency situations as required by Permit?
❑
❑
❑
32. Did Reviewer/Inspector fall to discuss reviewlinspection with on -site representative?
❑
❑
❑
33. Does facility require a follow-up visit by same agency?
❑
❑
❑
Page: 5

Type of Visit Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit X Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: 0�10 Arrival Time: Departure Time: County: Region: WS RC
Farm Name: Ca �. �nx n� �K� in/f,,.,V t L- L- C- Owner Email: a
Owner Name '" I(-&y\S0r W�'l'I'QY1�.- Phone: — ��_4 - s - 0 ,
Mailing Address:
Q T� �� a -7 313
Physical Address: � ��D 0 f $eM�1(� �'�
Facility Contact: l�n.v l�J �'C'r`!al lr�� Title: Phone No: P�
Onsite Representative; % �-rLian� integrator:
Certified Operator: Ko�.4 V L-`' �-rQ nOperator Certification Number:
Back-up Operator. - .2�j kd C-O and Back-up Certification Number: a 13) I
Location of Farm:
�PSo, Sow on uS " oL dC
1Z it h+ a►ni-o v��aarvt
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Other
❑ Other
Latitude: 0 `
LeAct Cro5s
Fax-m o n r 14 h� .
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
F— 1! O Non -La et - - - - --- - -
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑
Turkeys
❑
Turkey Poults
❑ Other
Longitude: ®° N ` ["
T + rn -2
Design Current
Cattle Capacity Population
Dairy Cow
-505
Dairy Calf
.S
❑
Dairy Heifei
a
Dry Cow
Non -Dairy
❑
Beef Stocker
❑
Beef Feeder
❑
Beef Brood Cow
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes b No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made? ❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) ❑ Yes ❑ No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes ❑No [:1NA [INE
2. Is there evidence of a past discharge from any part of the operation? ElYes 1 ]io ❑ NA ❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State ❑ Yes > Vo ❑ NA ❑ NE
other than from a discharge?
12128104 Continued

Facility Number: — • Date of Inspection 50
Waste Collection & Treatment �.f
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes l.]�Vo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes I❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
/0 Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
ANo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes
No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes
No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
4. Does any part of the waste management system other than the waste structures require ❑ Yes
XNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
53"No ❑ NA ❑ NE
❑ Excessive 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)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
VNo
❑ 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 determinations❑ yes
10 No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
ONo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
kNo
❑ NA
❑ NE
V res5 uN re- ��v- on to n ? a� ,✓
adb s Sat 1 { - re , I+S 7 Corn rnearcIaA ��i I I z e-c ? V jet
Reviewer/Inspector Name r a Phone: 11�Q_
Reviewer/Inspector Signatur doDate:
12128104 Continued

Facility Number: f Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes NWNo
o ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check El Yes ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design El Maps El Other
21. Doe record keeping need im ovement? if es chec the appropriate box Blow. L�J Yes ❑ No ❑ NA ❑ NE
P g � yes,
WRainfall
aste Applic lion Wee ly Freeboard a to Analysis Soil Analysis ❑ Waste Transfers
Stocking pd Crop Yield 120 Minute Inspections Monthly and 1 "Rain inspection Weather Code
22. Did the facility fail to install and maintain a rain gauge? []Yes XNNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment'? ❑ Yes ❑ No VNA ElNE
24. Did the facility fail to calibrate waste application equipment as required by the permit? ®0ElYes P<No ❑NA ❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit? ❑ Yes XN
❑No 0NAElNE
26. Did the facility fail to have an actively certified operator in charge? ❑ Yes o El NA ElNE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ❑ Yes❑No l.� NA ❑ NE
Other Issues I
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
V
ElNA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
19
ElNA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
`10
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector tail to discuss rev6w/inspection with an on -site representative?
❑ Yes
)(No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
Mio
❑ NA
El NE
CommentsAdditional and/or Drawings:
~
1 I
• �' s v
�► �'� ' �t;U
r
011 1/
r
J
-7 3 1y j 121PIN

ethnical Assistance Site Visit Repo
• on of Soil and Water Conservatio
O Natural Resources Conservation Service
O Soil and Water Conservation District
O Other...
Facility Number 76 - 59 Date: 12/15/04 Time: 1 13:00 1 Time On Farm: 60 WSRO
Farm Name Coltrane Dairy, LLC County Randolph Phone: [phone]
Mailing Address 7239 Branson Mill Road Pleasant Garden NC 27313
Onsite
Representative David Coltrane Integrator
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
O Routine
O Response to DWQ/DENR referral
O Response to DSWC/SWCD referral
O Response to complaint/local referral
O Requested by producer/integrator
O Follow-up
O Emergency
O Other...
Design Current Design Current
Wean to Feeder
Capacity Population Capacity Population
❑ Feeder to Finish
❑ Layer
❑ Non -Layer
❑
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
GENERALQUESTIONS:
® Dairy
❑ Non -Dairy
GENERALQUESTIONS:
® Dairy
❑ Non -Dairy
5001
475
❑ Other
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?
6• 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 Upper Lower
Level (Inches) 1 4$ 50
CROP TYPES lCorn, Silage Fescue- raze I IFescue-haySmall grain sila e
SPRAYFIELD
SOIL TYPES
7. What type of technical assistance does the onsite representative feel is needed? (list in comment section)
03/10/03

Facility Number 76 - 59 Date:
12/15/04 '
PARAMETER
0 No assistance provided/requested
❑ 8. Waste spill leaving site
TECHNICAL ASSISTANCE Needed
Provided
❑ 9. Waste spill contained on site
❑ 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
Y8. Forms Need (list in comment section)
❑
❑
❑ 13. Waste structure needs maintenance
❑
❑
28. Missing Components (list in comments)
[114. Over application >= 10% & 10 lbs.
❑
❑
[115. Over application < 10% or < 10 lbs.
30.21♦.0200 re -certification
[116. Hydraulic overloading
31. Five & Thirty day Plans of Action (PoA)
❑
❑
32. Irrigation record keeping assistance
❑
❑
❑ 17. Deficient irrigation records
❑ 18. Late/missing waste analysis
33. Organizelcomputerization of records
❑
❑
❑ 19. Late/missing lagoon level records
34. Sludge Evaluation
❑
❑
❑ 20. Late/missing soils analysis
[121. 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
[124. Deficient sprayfield conditions
38. Structure Needs Improvement
❑
❑
39.Operation & Maintenance Improvements
❑
❑
40. Marker check/calibration
❑
❑
Reeulatory Referrals
41. Site evaluation
❑
❑
❑ Referred to DWQ Date:
42. Irrigation Calibration
®
❑
❑ Referred to NCDA Date:
El Other...
43. Irrigation system design/installation
❑
El
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 certification/rechecks
❑
❑
48. Crop evaluationtrecommendations
❑
❑
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)
❑
El
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 - 59 pate: 12/15/04 I
COMMENTS:
Facility and records appear to be well maintained.
# 42. Remember to calibrate your application equipment within two years of receiving the new permit
nd every other year thereafter.
# 57. 1 reviewed some of the new record keeping requirements with Mr. Coltrane.
* Remember to use the new record keeping forms.
The irrigation hydrants have been repaired, that were noted in the DWQ inspection.
TECHNICAL SPECIALIST lRocky Durham
SIGNATURE
Date Entered: 12/16/04
Entered By: lRocky Durham
3 03/10/03

r*"t - Ir o"ti •r R:: F.fP>i ;',II, ,. ,. - .r,j", r- tg'!11V€titi;EU"1Yi2Flif:III P€p ;IIIPIii.Ilri1II1 i7.. i f I:,. 71f t8 € i i3 t i � if I'7 i li h,:llllltil ' !� nlir � 1 � ! s lli
I G., E €Y I .f I(1 i. l I€ 1 k t�• } [ I IEr , I� I ll
Water`
11.r7;r'° IE .•#`,'., 11 III i'!K�''I,;"s; 1S.'il ,ll.aj'fl r �: alp E r. € r*'t„p'r9 €�'',i ! Idld rl.hdionlofSoflan,d'WaterI.jConservatto,r:. � , I, .i€,, I i . , .; � €€, :. ;.EII, ;litlllr�.t ".D; ;Others'• gency � i,._Irs €!�I ^I,I,,;3i f'lii�,.t! f�l,�� ^i^,rrli}i (I: ri€:,:fl: i!€ tt I aiiEl„€rti I€ ,I�E�I:� =�It l°rt I' ll� I ri",;IE'?° I l �"t,l �;kr #'� „4�i'}a rli'=If'i r Erl,n,Il€,:E ,`
1 i !
Type of Visit O Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit O Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number 76 59 hate of Visit: 8/25/2004 'Time: 0900
0 Not Operational 0 Below Threshold
0 Pern-dtted ® Certified [3 Conditionally Certified 13 Registered Date Last Operated or Above Threshold: .........................
Farm Name: 1~ails,any.l?siilX.l,]G................................................ ......... ..................... ... County: RlladRlAla......................................... WSW ........
Owner Name:&.IQxatasaia ........................... C.01trwag ..................................................... Phone No:(3161,614=5.28.3 ........................................................
Mailing Address: � �.Ilxa>asaa�. i�li ltvad................................................................. 1seasa�ax.Gaxden .I.......................................... 2.7. 1 ..............
Facility Contact: Da,.v! t.C.Q1(rAtaP.............................................. Title:................................................................ Phone No: UOA71.93.40 .......................
Onsite Representative: D.A.Y.its.CQ1t:alae.......................................................................... Integrator:..........
Certified Operator:Roy.D..................................... ultra,ne.......................................... Operator Certification Number:,ZI3,11 .............................
Location of Farm:
rom GSO south on Hwy. 220 to Level Cross exit. Take Branson Mill Rd. to the left. Right onto Bantam Rd. Farm will be on A
he right.
❑ Swine ❑ Poultry ® Cattle ❑ Horse Latitude 35 • 53 4 S5 66 Longitude 79 • 46 � 32 «
Design Current
Swine Capacity Population
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Discharges & Stream Impacts
Design Current Design Current
Poultry Capacity Population Cattle Capacity Population
❑ Layer ® Dairy 1 1025 832
❑ Non -Layer ❑ Non -Dairy
❑ Other
Total Design Capacity 1,025
Total SSLW 1,435,000
1. Is any discharge observed from any part of the operation? ❑ Yes ® No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min'?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes ® No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ® No
Waste 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 G
Identifier: ............pperc........... ...........Law=........................................................................................................................................................
Freeboard (inches): 30 48
12112103 Continued

Facility Number: 76-59 Date of Inspection 8/26/2004
5. Are there an immediate threats to the iAtegri of any of the structures observed? (ie/ trees, ere erosion, Yes No
Yh' ❑❑
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑ Yes ® No
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes ® No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ® Yes ❑ No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes ® No
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes ® No
11. Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes ® No
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type Corn (Silage & Grain) Fescue (Graze) Fescue (Hay) Small Grain (Wheat, Barley,
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes ® No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes ® No
b) Does the facility need a wettable acre determination? ❑ Yes ® No
c) This facility is pended for a wettable acre determination? ❑ Yes ® No
15. Does the receiving crop need improvement? ❑ Yes ® No
16. Is there a lack of adequate waste application equipment? ❑ Yes ®No
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes El 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 ® No
19. 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)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional ❑ Yes ® No
Air Quality representative immediately.
Coiriments il//iefer;aa iestion�# ?�Ex lam'an Y1;Sianswers and/or' an recommendations o'r an 'other comments i
1. 9 _F .- ), -.. p, , � h: , � 4 �R.1ri�wu.�iaas
Use drawings of facility to better ezplamsituations."{use addrtional pages'asFnecessary): El Field Copy ®Final Notes
7. Need to mow/spray vegetation on embankment of lower WSP. Other improvements look good.
9. Per operator, marker on lower WSP has not been re -checked yet.
16. Hydrant 103-4 has been repaired. Operator is to repair surrounding ground.
16. Need pressure gauge for one of the irrigation reels.
16. In field 107, one of the hydrants needs a new cover,
23. Operator did not obtain 2003 soil analyses. he took samples late in Dec. 2003 and stated that lab lost his samples. Results for 2004
have already been received and look ok.
23. May 2004 applications did not have waste sample taken within 60 days. August waste sample has already been received, though.
23. Don't forget to record commercial fertilizer applied to animal waste sites, also.
23. Permit issued 12/31/03 now requires freeboard to be kept weekly. Don't forget.
Facility has .375 milk cows and 50 dry cows today far a total of 425. While 457 heifers are also confined, this number does NOT count
towards the number for a federal NPDES permit. The waste produced from the heifers has been calculated into the CA WMP, though.
•
Reviewer/Ins ector Name w 1 r P 1 .', i. r ~
p �Meliss� Rosel�i•ock %'� ��;' i r� � ; � , � r i ,_� � �r, �� i �� -� . . __
Reviewer/Inspector Signatu
Date:
12112103 I IContinued

Facility Number: 76-59 D f Inspection 8/2fi120p4
Reauired Records & Documents
21. Fail to have Certificate of Coverage & 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. Does 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?
(ie/ discharge, freeboard problems, over application) ❑ Yes ® No
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes ® No
28.
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
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
C1 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
dditional.C6rnm' cats and/or Drawings: " i N �t !� i i' t' r`. :
12112103

Type of Visit IV Compliance Inspection O Operation Review '0 Lagoon Evaluation
Reason for visit (0 Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Date of visit: ime:
Not O erationnl 0 Below Threshold
Permitted [3LI.In-niL
Certified © CondidonaUy Certified II0 Registered Date Last Ope d or ba a eshold: .... ».....
Farm Name: ..1.r -�t �_ .._ County: ��----...»»
Owner Name: r 'Phone No:
Mailing Address:...f....!.it. !!.. !�L[ :..PleS f M »CDard. G a. ... 3
Facility Contact: .sl.G �. .»..lL..(J� .� �..._ Title:._.... _ ......_. _ ....__. __. Phon of 3 -1.3-t � 3.M
Onsite Representative:. G1L1C� __. �.QC� , „ .W- », ,.» , Integrator: __.
Certifiied Operator: . . ...... .........._� :». �� � ��......_......... Operator Certification
Location of Farm:
U 1 0l0
w
_P1
❑ Swine 0 Poultry Xcattle ❑ horse
Latitude �• ��
�" Longitude —•
•
;Cti1t'heiit
F , T�h
rrCnrreni Desgn "Current
r
Swine �wPo teona ci Po tioto We Ca"'aci tioa
Wean to Feeder
fPoW
❑Layer
,'Po
Dairy
Feeder to Finish
❑Non -Lay er;
Non -Dairy
4 w
Farrow to Wean
Farrow to Feeder
Other
Farrow to Finish
Gilts
Boars
r '
x ;; Tota�'SSLW M. Q
lvttttnber�af Lagoons
�Ai� ,��!C(Ly
�,
,
'�c*}
-eii�
Y-
11n1dmie Po'nd�t / Selid4Trarns
?�,«
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes WO
r o Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
5 ��b. If discharge is observed,.did it reach Water of the State? (If yes, notify DWQ) ❑ Yes El
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes o
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a di§charge? ❑ Yes No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? *pillway ❑ Yes CTo
Structure I Stricture 2 Structure 3 Structure 4 Structure 5 Structure fyTTT
IdentiFier�� �.l~:eft......».........�...Q.........».........._.._..._... ..............._.»... _..........._.�......._.w. ___...- - - - - .........»
Freeboard (inches):
12112103 Continued

Facility Number: ' — Date of Inspection
5. Are there any immediate threats to the ir�grity of any of the structures observed? (ie/ trees, severe erosion,
❑ Yes
No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
❑ Yes
No
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?
XYes
No
8. Does any part of the waste management system other than waste structures require maintenancelimprovement?
❑ Yes
No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
❑ Yes
No
elevation markings?
Waste Application.
10. Are there any buffers that need maintenance/improvement?
❑ YesNo
11. Is there evidence of over application? If yes, check the appropriate box below.
❑ Yes
)(No
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type rn &6fv LAP- VN -
13. Do the receiving crops differ with those designated in the Certified knimal Waste Management Plan (CAWNIP)?
❑ Yes
XNo
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
o
b) Does the facility need a wettable acre determination?
❑ YesINo
o
c) This facility is pended for a wettable acre determination?
❑ Yes
15. Does the receiving crop need improvement?
❑ Yeso
16. Is there a lack of adequate waste application equipment?
❑ Yes
XNo
Odor hgsues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge attor below
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes No
19. 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)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional ❑ Yes o
Air Quality representative immediately. �'``"''"
Final Notes
t4
nnewl-5 4a to P 7 Ln4_., TV, — 6t�d'� �l
m
00
r r J/
jW 441U.7 RL. Vj"WF9sc6s

Facility Number: — of Inspection
R4uired Records & Documents
21. Fail to have Certificate of Coverage & 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?
�No
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
23. D record keeping need improvement? If es, check the appro ate box below.
Waste
Ayes
❑ No
Waste Application Freeboard Analysis oil 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?
J
(ie/ discharge, freeboard problems, over application)
❑ Yes
o
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
o
28. Does facility require a follow-up visit by same agency?
❑ Yes
No
29. Were any additional l--oblems noted which cause noncompliance of the Certified AWMP?
❑ Yes
o
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
❑ Yes
_Fo
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 I" 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.
ra3 a�o3 Soy I Pests ? L (,e�f'a59�P� . o2Cbf�. i'AJ, LC &f
1x/x2103

Type of Visit O Compliance Inspection O Operation Review Q Lagoon Evaluation
Reason for Visit O Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number 76 59 Date oi' Visit: t2104/2003 Time: 1115
Not Operational Q Below Threshold
E Permitted E Certified 0 Conditionally Certified 0 Registered Date [cast Operated or Above Threshold: -___-_.
harm Name: Ggl)rxgng.11141xX,UG...................................................... County: Ass IIAbL............................... N'SRQ......
Owner Name: �.�1Ag8011-------------&9ltrane-------------------------- Phone No:(��SLl{17.4:5�8�----------------------------
Mailing Address:. 7.23.9..13xAri;.m.M.ill.Rud................................................................. riginalit-GArdeaAC ......................................... Z73.13..............
Facility Contact: JDavid.Q9J1ranc................................... Fitle:............................................... Phone No: 336,67.4,034.0..................
Onsite Representative:(Y(d_�Ql1iA0E....................... integrator:._.------_---_-_-_---_--------------------..
Certified Operator: RQ.B.................................... CR1tC#]ke........................................... Operator Certitication Number: 2U1.2.............................
Location of Farm:
From GSO south on Hwy. 220 to Level Cross exit. Take Branson Mill Rd. to the left. Right onto Bantam Rd. Farm will be o +
the right.
❑ Swine ❑ Poultry ® Cattle ❑ Horse Latitude 35 • 53 55 Longitude 79 'F 46 32 «
Design Current
Design Current Design Current
Swine Ca aei P.o ulation
Poultry Ca aei P,o ulation C►attle Ca aei P.o ulation �
❑ Wean to Feeder
❑Layer
®Dairy
❑ Farrow to Wean
❑ Farrow to Feeder
Other
❑ Farrow to Finish
Total Design Capacity 1,025 N
❑ Gilts
Total SS i,W 1,435,000
❑ Boars
Number of Lagoons 0 ❑ Subsurface Drains Present ❑ Lagoon Area ® Spray Field Area
Holding Ponds 1 Solid Traps 2 ❑ No Liquid Waste Management System 11
1025 800
❑ Feeder to Finish Non -Layer Non -Dairy
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑Lagoon ❑Spray Field [3 Other
a. If discharge is observed, was the conveyance man-made?
b, if discharge is observed, did it reach Water of the State:' {If yes, notify DWQ}
c. if discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection &Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ®Spillway
Stricture I Structure 2 Structure 3 Structure 4 Structure 5
Identifier: --------- 1.Ipp$r-........ ......... udcm........ .......................... -•--.............._._........-•--••-•--•--•--•--•--•-• -•--•
Freeboard (inches): 66 48
❑ Yes ®No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ®No
❑ Yes ®No
❑ Yes ®No
Structure {,
05
/03/01 Continued

Facility Number; 76-59 1 Date of Inspection 12/04/2003 1 •
5. Are there any immediate threats to the oinegrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload [
12. Crop type Corn (Silage & Grain) Small Grain (Wheat, Barley, Fescue (Graze) Fescue (Hay)
❑ Yes ® No
❑ Yes ® No
❑ Yes IN 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?
ReQuired Records & 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?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes ®No
❑ Yes ® No
❑ Yes ® No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes ® No
113 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
❑ Field Copy ® Final Notes
7. Owner plans to backfill a corner of the upper waste pond so that equipment is more level for pumping. Plans to install culverts to
convey surface water around waste pond. Operator also plans to widen diversion around lower waste pond and build up the road across
he dam of the lower waste pond. Instructed owner and operator to communicate with SWCD rebefore.construction.
9. markers have not been re -set yet.
19. Operator will obtain the rest of the 2003 soil samples this month. Check next visit.
19. Suggest keeping irrigation records by pulls and then add "edges" afterwards on same IRR-2 form. make sure to the acres for each
rull in completing calculations.
0/7/03 waste analvses:Lower = 1.8 (I) and 1.9 (B). Unver 0.68 (1). dry = 7.87 lbs. N/ton
Reviewer/Inspector Name iM
Reviewer/Inspector Signature:
Date:
05103101 Continued

Facility Number: 76-59 Dif Inspection 12/0412Q03 .
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 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
♦1
05103101

A- PM
Type of Visit compliance inspection O Operation Review O Lagoon Evaluation
Reason for Visit � Routine Q Complaint O Follow up 0 Emergency Notification Q Other ❑ Denied Access
Facility Number Date of Visit: ! Z y Time:
10 Not Operational Q Below Threshold
0 Permitted 0 Certified [3 Conditionally Certified [3 Registered Date Last Operated or Above Threshold:
Farm Name: LL-C. County: I
Owner Name: Y`Q ::, L a Phone No: 74, S a ?.J H
Mailing Address: --? 2- 31 B/��� Qri__ 1. t 1% � 0 7 3 13
Facility Contact: L)t2 V I j `f p i � n` _' - Title: Phone No: .33. 6 7 Y. P3q�6 (14J
Onsite Representative: ��� �I Co ( t e
Certified Operator:
Location of Farm:
Integrator.
Operator Certification N b r: t
06 RL01 Z.ZO Soy* ronj GS0 � LC� e Cu'o5� ext}.e� !QI'1Sbi1 I
`6 ll? �' � i h b Farm O n f i p
❑ Swine ❑ Poultry Cattle
❑ Horse Latitude l 3 I-
I U_S2 I° 11 Longitude L_
I f I' I `j V II 1,,jd I °
Design
Current
Design Current
Design .Current
Swine capacity
Population Poultry
Capacity Population Cattle
Capacitv Popplation
❑ Wean to Feeder
❑ Layer
Dai
0 D
❑ Feeder to Finish
10 Non -Layer
Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Other
❑ Farrow to Finish
Total Design Capacity
-
❑ Gilts
❑ Boars
Total SSLW
Q d 3O 0
Number of Lagoons,
❑ Subsurface Drains Present ❑ Lagoon Area Spray Field Area
............ _
Holdil g X. ds l`Sohd Traps
,.
0, ❑ No Liquid Waste Management S stem
.
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes kl'*N'o
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. if discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes �No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes AM
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? [jQ Spillway ❑ Yes No
Structure I Structure 2 Structure 3 ` Structure 4 Structure 5 Structure 6
Identifier: V
Freeboard (inches):
051031013 6 Continued
, r � �IP�
34.6
37
6

Facility Number: — 5 Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes �No
seepage, etc.)
6. Are there structures on site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes No
(If any of questions 4-6 was answered yes, and the situation poses an .
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes/? No
S. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes A No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes X No
VI aste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes No
11. Is there evidence of over application? ElExcessive Ponding ElPAN [I Hydraulic
,�Overload ❑ YesINO
12. Crop type o f e U� ]t i r e
13. Do the receiving crops differ with those designateAn the Certife Animal Waste Management Plan (CA P)? ❑ Yes o
14. a) Does the facility lack adequate acreage for land application? ❑ Yes ""'No
b) Does the faciliy need a wettable acre determination? ❑ Yes No
c) This facility is pended for a wettable acre determination? ❑ Yes XNo
15. Does the receiving crop need improvement? ❑ Yes XNo
16. Is there a lack of adequate waste application equipment? ❑ Yes *0
Re aired Records & Documents,' ``
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available? o
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design. maps, etc.) / ✓ ❑ Yes j9 No
19. Does record keeping need improvement? (ie/ irrigation. , as✓te analysis & soil sample reports) ❑ Yes KNo
20. is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes �tNo
o
21, Did the facility fail to have a actively certified operator in charge? ElYes
22. Fail to notify regional D'tVQ of emergency situations as required by General Permit?
0e! discharge. freeboard problems. over application) ❑ Yes XNo
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 X No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes No
© No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit. {`
C OmDlents, �CfBP toy ' nest:oii� In pan AYES ii 5iia, n"`dl r S s � 7ECV[R le]tE 8ti4 Ora _DtILL'C COflltlleltt&:
Use'drawings of factlity,to better explaw situ tioris.'(ase addlt,onal "pages as necessary) A ; .;y Field Co Final Notes �� F
itl�E"+.84 _`,-�.'i-' -- t� h'p5' ®� 4� �
wsP - W
� L d t
PIA*o ®-7�)
.. 7 F`"'�'w J
Reviewer/Inspector Name i r ,t2 a :t j. nr iP 't. 1
Re-viewer/Inspector Signature: Date:
05/03/0bj . 5 P 2V_ b4p „I e I Continued

0
Facility Number:
*ate of Inspection 170 •
Odor Issues
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?
29, 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?
17H
FF(I'A 9W) .. iiiiiii I I � i I a 11
Mffl 2
101-7 f o3 [,5 &u-,00 l, g-T- O B
�r� -7.<9 faln
CV-
OLC
S-�eS"—G-No
❑ Yes �No
❑ Yes ANo

echnical Assistance Site Visit RenoriL
Q DWon of Soil and Water Conservatio
Natural Resources Conservation Service
Q Soil and Water Conservation District
Q Other...
Facility Number 7fi -
59
Date: /17/03
Time: 10:07
Time On Farm: WSRO
Farm Name Coltrane Farm
County Randolph
Phone:. [phone]
Mailing'Address 7239 Branson Mill Road
27313
Onsite
Representative David Coltrane Integrator
Type Of Visit Purpose Of Visit
Compliance Inspection (pilot only)
Technical Assistance
Confirmation for Removal
❑ No Animals -Date Last Operated:
❑ Operating below threshold
❑ 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
Pleasant Garden NC
0 Routine
O Response to DWQ/DENR referral
O Response to DSWC/SWCD referral
O Response to complaint/local referral
0 Requested by prod ucerlintegrator.
0 Follow-up
O Emergency
O Other...
Design Current
Capacity Population
❑ Layer
❑ Non -Layer
® Dairy
❑ Non -Dairy
Pleasant Garden NC
0 Routine
O Response to DWQ/DENR referral
O Response to DSWC/SWCD referral
O Response to complaint/local referral
0 Requested by prod ucerlintegrator.
0 Follow-up
O Emergency
O Other...
Design Current
Capacity Population
❑ Layer
❑ Non -Layer
® Dairy
❑ Non -Dairy
® Dairy
❑ Non -Dairy
5001
375
❑ 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 Upper WSP Lower WSP
Level (Inches) 8 18
CROP TYPES mall grain silage 1corn, Silage orghum o beans
SPRAYFIELD
SOIL TYPES
7. What type of technical assistance does the onsite representative feel is needed? (list in comment section)
03/10/03

i
•
Facility Number 76 - 59 Date:
4/17/03
PARAMETER
Q No assistance provided/requested
❑ 8. Waste spill leaving site
TECHNICAL ASSISTANCE Needed
Provided
❑ 9. Waste spill contained on site
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 w/producer
❑
❑
❑ 12. Waste structure integrity compromised
❑ 13. Waste structure needs maintenance
28. Forms Need (list in comment section)
❑
❑
29. Missing Components (lost in comments)
❑
❑
❑ 14. Over application >= 10% & 10 lbs.
❑
❑
❑ 15. Over application < 10% or < 10 lbs.
30. 21-I.0200 re -certification
❑ 16. Hydraulic overloading
31. Five & Thirty day Plans of Action (PoA)
❑
❑
32. Irrigation record keeping assistance
❑
❑
❑ 17. Deficient irrigation records
❑ 18. Late/missing waste analysis
33. Organ izelcomputerization of records
❑
❑
❑ 19. Late/missing lagoon level records
34. Sludge Evaluation
❑
CO]
❑ 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 checklcalibration
®
❑
Regulatory Referrals
41. Site evaluation
❑
❑
❑ Referred to DWQ Date:
42. Irrigation Calibration
❑
❑
❑ Referred to NCDA Date:
43. Irrigation
❑
❑
❑ Other...
system design/installation
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
❑ .
❑
s
58. Croplforage management education
❑
❑
59. Soil and/or waste sampling education
❑
❑
03/10/03

�J
I Facility Number 76 - 59 Date: 1 4117103
COMMENTS:
Larry Graham is working on the wettable acres for the facility. The WUP is being revised to add free -stall and heifer barns +
or solid clean out, a mortality checklist, and field and crop designations updated.
NRCS to reset markers in early June.
The facility does not have a general permit yet.
TECHNICAL SPECIALIST B. Barton Roberson
SIGNATURE
Date Entered: 7/25/03
Entered By: lRocky Durham
3 03/10/03

Type of Visit O Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit O Routine O Complaint O Foliow up O Emergency Notification O Other ❑ Denied Access
Facility Number 76 Sq Date of Visit: 9/25/20U2 Time: 1300
Q Not Operational O Below Threshold
13 Permitted E Certified 0 Conditionally Certified 0 Registered Date Last Operated or Above Threshold:.. ...................
FarmName: .............................................................................................. County-. RAWt PIX......................................... WSW........
Owner Name: R..Drawoxl ........................... COUX.8he .................................................... Phone No: {33 )..fr.7.4- ��3. raasa '.a. Qtntc...................
Mailing Address: 7.Z �uln�Qtt.mill.�ioa�d.................:.......:....................................... Flgmajal.Garduk.N.0 ......................................... 2.7.313 .............
Facility Contact: DAXUG(th rtnt............................... :.............. Title: ............................................................. ... Phone No: 33.6.67.4,jQ3.4Q .......................
Onsite Representative: Ds.Y.W.CQltme............................::...:........::.............................. Integrator:.......... ........................................................................
Certified Operator: Roy.jD. ............................... C.Rlx rmc.......................................... Operator Certification Number: Z 1312................
Location of Farm:
From GSO south on Hwy. 220 to Level Cross exit. Take Branson Mill Rd. to the left. Right onto Bantam Rd. Farm will be o
the right.
❑ Swine ❑ Poultry ® Cattle ❑ Worse Latitude 35 • 53 5S Longitude 79 • 46 32 ai
�,opula
vi:w:ky� ret��t P 1 tl " Poultry C t' Ca_ tile, C' it P' "1 t';,� i-l-l";d
aaei.uaoaci
ion
•a ac �� 4o u a ton �ti�
❑Wean to Feeder
[] Layer
®Dairy
500
350 �
❑Feeder to Finish
❑Non -Layer
❑Non -Dairy
❑ Farrow to Wean
❑Farrow to Feeder
r _ ;�. '�- �h ;.•,�,'r.,
❑Other - .a c ,' `'�* �' '�
r ❑Farrow to Finish
�-:- u � <: T;otal Design Capacity 500 P
❑Gilts
7oa,00a
❑ Boars
Discharges 4s� Stream Impacts •.
1. Is any discharge observed from any part of the operation? ❑Yes ®No
Discharge originated at: [I Lagoon ❑Spray Field El 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? (]f yes, notify DWQ) ❑yes ❑ No
c. If discharge is observed, what is the estimated Clow in gal/thin?
d. Does discharge bypass a lagoon system'? (If yes, notify DWQ) ❑Yes ❑ No
2. Is there eviderice of past discharge from any part of the operation? ❑Yes No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑Yes No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ®Spillway ❑Yes ®No
Structure l Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ...... Llpger..W.. SAP...... ..... I.nw es. YV. S P...................................................................................................................................................
Freeboard (inches): 30 48
05/03/01 Continued

Facility Number: 76-59 1 • Date of Inspection I 9/25/2002 1 .
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
1 L Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
12. Crop type Corn (Silage & Grain) Small Grain (Wheat, Barley,
❑ Yes
® No
® Yes
❑ No
❑ Yes
IN 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 IN No
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
)squired Records: 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?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility 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 ❑ No
® Yes ❑ No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes IN No
193 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
omments re a to ion # : Explain an a and/o any omme dations or any other co menu.
rawings of ac o better explain situatio a additional pages as nec sary : ❑Field Copy ®Final Notes
6. Need to account for dry waste from packs in barns (new barn) in CAWMP.
_
9. How many inches from maximum waste level to the spillway? Is difficult to tell from marker.
17. permit has not been issued yet.
18. Could not locate an insect or mortaliiy checklist in the CAWMP. See technical specialist.
19. Operator has sent in his 2002 soil samples and is awaiting results.
19. Need to obtain waste analysis by I IA2/02 for Sept. 2002 applications.
[Questions left blank are not applicable to this facility at this time.
Reviewer/Inspector Name tMelRosebrock
Reviewer/Inspector Signature: Date:
05103101 4 v v Continued

I.Facility.Number: 76-59 1) lInspeclion 9/25/2002
_Qdfrr Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours?
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon?
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
31. Do the animals feed storage bins fail to have appropriate cover?
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes
❑ No
❑ Yes
® No
❑ Yes
® No
❑ Yes
❑ No
❑ Yes
® No
❑ Yes
❑ No
❑ Yes
❑ No
J
05103101

•
P
Type of Visit Compliance Inspection 0 Operation Review 0 Lagoon Evaluation
Reason for Visit Routine 0 Complaint 0 Follow up 0 Emergency Notification 0 Other ❑ Denied Access
Date of Visit: Time:
Facility Number
Not Operational 0 Below Threshold
E3 Permitted Certified 0 Conditionally Certified [3 Registered Date Last Operated orAbove
,Threshold;
Farm Name: N14,Q - Q Farm County: a n l t_ ,U/!h
Owner Name: ke • ,r Jr 0 a Poe No: 3 3 &. p 7 T' 6—a r l
Mailing Address: , i i &a5�jn`-
Facility Contact: Title: Phone No: • Q 3
qvW
Onsite Representative: n� Integrator:
Certified Operator: + n Operator Certification Number: a13 I 1
Location of Farm:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes [ 60
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste QQSmtion & Treatment P6pillway
4. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier: U
Freeboard (inches):
OSIO3101 r
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes No
❑ Yes No
❑ Yes XNo
Structure 6 `"`
Continued

Facility Number: —7rp — Date of Inspection �./
S. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes L1G No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? Yes ❑ No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7, Do any of the structures need maintenance/improvement? ❑ Yes No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes XNo
Wastg Applicati n
10. Are there any buffers that need maintenance/improvement? El Yes; No
11. Is there evidence of over application? ❑ Excessive Ponding El PAN ❑ Hydraulic Overload ❑ Yes No
12. Crop type
13. Do the receiving crops differ with those clTsignated in the CertifiA Animal Waste Management Plan (CAWMP)? ❑ Yes XNo
14. a) Does the facility lack adequate acreage for land application? ElYes XNo
b) Does the facility need a wettable acre determination? ❑ Yes No
c) This facility is pended for a wettable acre determination? ❑ Yes XNo
15. Does the receiving crop need improvement? ❑ Yes No
16. Is there a lack of adequate waste application equipment? ❑ Yes ] No
Renuired Records & Documents r
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available? o
18. Does the faciJIX fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, Gklists esign, maps, etc.) ✓ Yes ❑ No
19. Does record keeping need improvement? (ie/ irrigation, Aeebeerd, waste analysis & soil sample reports) Cl Yes ONO
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes �No
21. Did the facility fail to have a actively certified operator 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 XNo
23. Did Reviewer/inspector fail to discuss review/inspection with on -site representative? ❑ Yes No
24. Does facility require a follow-up visit by same agency? ❑ Yes No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes XNo
0 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
1€ iN.; i �.fdi= t r. 1 3 .a+, ,i `': tfif € F 7. 3� 3r a,{,t`�#�.. I E.in-i I r�,tr- r. a=' f r - .? � € f lE.€a jd��i P;: it-
).. p dations or any, other, comments:. t Comments (refer to question' Ex lain'anytYE5 a�aswers and/or. any recoramen
Use drawtn s of facli to btter explain sttiattons. use adiihona!pages)
as necessary
Final Notes
Fie Copv ❑
,
i E
........
9 GA.) WAX-0-4
a
LV
IAI�R"410
Reviewer/Inspector Name t ;'
Reviewer/Inspector Signature: A
Date:
05103101 Continued

Facility Dumber: % —S Date of Inspection
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 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, andfor 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?
al Comments anti/or Drawings: �:..
jog
0 ��O.eh.e�ta�--moo. vw aooa
it/ +a'
+ It
05103101
❑ Yes X No
❑ Yes ONO
..,
q.'r- . ..

vision, of Water Quiality
I � ��� � } r�'��¢' �I I�i f ' 9' j
� -'�-:� I E ..i• r
E, �
� � 6 {Sf _ !
=
Kision of Soil and Water ConserYat><on
t�
/tf
5 r,
i ,
....
{,
Type of Visit - O Compliance Inspection 01)peration Review Q Lagoon Evaluation
Reason for Visit GYRoutine O Complaint O Follow up O Emergency Notification Q Other ❑ Denied Access
Date of Visit.• 'I,irne: Printed on: 10/26/2000
Facility Number
0 Not Operational 0 Below Threshold
© Permitted 0-Certified 13 Conditionally Certifie Registered Date Last Operated or Above. 'Threshold:
FarmName: ..... 'u..I. ► .n'..4 .........:............................................... County:..... ] .R n'..&.)p................... .... ...... I............
Owner Name: i, r N a L�U �t' Phone No: G �t
��..................r..,j.....�.¢.-......� ................
... ...
Facility Contact:
N i Phone No:
Mailing Address, ....l.a.aa.......
l,J.
t `x rwi..... '..�........k1 o:A..CL. .......
�..c........... .' . .,. 1..
OnsiteRepresentative. ........................................................... Integrator:......................................................................................
Certified Operator:..... +............................. .i�% .....(. '..../../- rAA/Operator Certification Number:......... ....�...�.1..#...........
Location of Farm: / l
TA k-t.. AW j QL ;1 0' 1 'k Le.v C�L �i L �� �r' f 4l / !4i C} r.i �!•i'� r11 J nJ �til � R C• %F
❑ Swine ❑Poultry G3oGattie ❑Horse Latitude" �' rj' " Longitude ®0 ®'
Design Current
Swine Canacitv Ponulation
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Design Current Design Current
Poultry Capacitv Population Cattle Capacity Population
❑ Layer U41.1iry ov
❑ Non -Layer FO-Non-Dairyj
❑ Other
Total Design Capacity
Total SSL W 1 -7[� 4
Number of Lagoons I I ❑ Subsurface Drains Present-110 Lagoon Area 10 Spray Field Area
Holding Ponds / Solid Traps ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation'? ❑ Yes [(No
Discharge originated at: []Lagoon ❑ Spray Field ❑ Other f
a. If discharge is ohserved, was the conveyance man-made? ❑ Yes ❑ No
it, if discharge is observed. did it reach Water of the State? (if yes, notify DWQ) ❑ Yes ❑ No
c. if discharge is observed. what is the estimated floe' in gal/min?
d.. Does discharge bypass a lagoon system? (lf yes, notify DWQ) ❑ Yes ['No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes 1 No
3. Were there any adverse impacts or potential adverse impacts to the Watcrs of the State other than from a discharge? ❑ Yes CXNo
Waste Collection & Treatment
4. is storage capacity (fr t r lus storm st rt e) IcG;.t[:ctn adequate? El Spillway El Yes M No
5[t'ucturc Structure 3 Structure 4 Structure 5 Structure 6
identifier-:........../0-3............ .................. %..`............................................................................... .... ................................ ....................................
Freeboard (inches):
5100

Facility Number: 2 Date of' Inspection /� -14. printed on:
5. Are there any immediate threats to the grity 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 of
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 maintenancefimprovement?
10/26/2000
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
12. Crop type
13, Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19, Does record keeping need improvement'? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21, Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by'General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did ReviewerAnspector 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?
4 Yiolaiitjjis •off• 0 Ocien eN •wire �ote(1 ti�rring �his'v�s�t; Yoh will eegiye o #u1�t gr'
comes oritience. abotif this :visit... .. •
n;quesbon #). Ezplairriny YES answers and/or anyrecomiriendations or any otli
cility to /letter explain situations (useadditional pages as necessary)
❑ Yes R No
❑ Yes No
❑ Yes 17No
❑ Yes ® No
❑ Yes RNo
❑ Yes R No
❑ Yes [)Vo
❑ Yes [WNo
❑ Yes S6110
❑ Yes ❑ No
❑ Yes [53,No
❑ Yes p. No
❑ Yes R No
01�es ❑ No
❑ Yes No
❑ Yes No
❑ Yes PjNo
❑ Yes 91 No
❑ Yes R No
❑ Yes R No
❑ Yes P9 No
❑ Yes [P No
s N��J /lnAl�c.r5. � o � � . 6 fC GtJr'�N� �,Qi. r1�1 i . a n✓3 ,•���
Reviewer/Inspector Name �, / /
Oi e). r�
Reviewer/Inspector Signature: ' <
Date: /7 —
5100

Facility Number: — " �"e of Inspection „2- �-C • Printed on: 10/26/2000
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes MNo
/
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes OrNo
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.) ❑ Yes P'No
31. Do the animals feed storage bins fail to have appropriate cover? '3 9 N
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? Qxee--e-Nv
5100

of Visit O Compliance Inspection O Operation Review O Lagoon Evaluation
!Reason for Visit O Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number 7t5 gg Date or Visit: 12Jll/2001 Time: 1135
FO Not Operational 0 Below Threshold
❑ Permitted ■ Certified ❑ Conditionally Certified ❑ Registered Date Last Operated or Above Threshold: ...................
Farm Name: CQ11ttcKLA.k:UM.................................................................
Owner Name: RA.Ricatitcaia ........................... C.0hral3t~........................
Mailing Address: 7.239Ar.atasuat.,MH1..RQ.Rd....................................
Facility Contact: I2AYId..C.911rane. .............................................Title:.......
Onsite Representative: D.ayjjd..Cojtr.aj3F........................................................
Certified Operator: Ral..................................... C.QAt1C>3titt.........................
Location of Farm:
..... County: Rand. Atilt ......................................... WISRO........
Phone No:{36t)...7.4:��3.tarasQa%I1Rune........................
.............. P1PA att>t.Gairden..N.C......................................... 27.313 .............
............. ............. I ................. ......... Phone No: 33.6..b2.4,0391}.D�txAd.(1��.
..... Integrator:..
... Operator Certification Number:?.13.1Z ............................
From GSO south on Hwy. 220 to Level Cross exit. Take Branson Mill Rd. to the left. Right onto Bantam Rd. Farm will be o AL
the right.
I —
[I Swine ❑ Poultry ® Cattle ❑ Horse Latitude 3S • S3 SS Longitude 79 • 46 32 Y
F '•�' -
a!
y t-
r
"Ca
k'GIrY:
Desi n
s° g
`'a
lf�Ys' '
Current
3 r' _. `Cm.'
5 " Desi n •Current y "' Des n Currents -
fi g g
,Swine
it
P,o uiation
Paultr.Y Ca acit Po` ulation . Cattle Ca" ctt Po'"ulation
ak ❑ Wean to Feeder
..
❑Layer ®Dairy 500 353
4�'I!. ❑ Feeder to Finish
❑Non -Layer ❑Non Dairy i
❑ Farrow to Wean
❑ Farrow to Feeder
❑Other
Farrow to FinishDesignCapaCtty
Gilts
500
❑ Boars
r 4`ota1ISSM, 700,000
;Number of ]Lagoons ® ❑ Subsurface Drains Present ❑ Lagoon Area ® Spray Field Arca
i Holdi g Ponds /Solid Traps ❑ No Liquid Waste Management System
DischaMes .& Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. if discharge is observed, was the conveyance man-made?
b. if discharge is observed, did it reach Water of the State? (if yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
❑ Yes ® No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? [:]Yes ®No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ® No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ® Spillway ❑ Yes ® No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
l de n t i fi er: ............Upper........... ...........Lower............................................... .
Freeboard (inches): 102 78
05103101 Continuer!

Facility Number: 76-59 . Date of Inspection 12/11/2001
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trip, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
Waste Application
10. Are there any buffers that need maintenance/improvement? []Yes IN No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes ® No
12. Crop type Corn (Silage & Grain) Small Grain (Wheat, Barley,
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes ® No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes ❑ No
b) Does the facility need a wettable acre determination? ❑ Yes ❑ No
c) This facility is pended for a wettable acre determination? ❑ Yes ❑ No
15.
Does the receiving crop need improvement?
❑ Yes
® No
16.
Is there a lack of adequate waste application equipment?
❑ Yes
® No
Required
Records & 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?
(iel WUP, checklists, design, maps, etc.)
❑ Yes
® No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
® No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
® No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
® No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(iet discharge, freeboard problems, over application)
❑ Yes
® No
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
® No
24.
Does facility require a follow-up visit by same agency?
❑ Yes
® No
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
® No
E3 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
•o men frefe o u ion # : Explain an. >+:S a and/or an ecommendations or an other comments.
drawin of a i o better explain situatio additional pa as ecessary : ❑Field Copy ®Final Notes
5. Repairs to dam of lower waste storage pond look great!
_
9. Need to site in the spillway and maximum liquid level on lower waste storage pond marker.
14. Original irrigation design by Mid Atlantic on 3/7/97 is being revised by Larry Graham for wttable acres. Most recent CAWMP is
ated 11 /6/98.
19. Need to take samples of solid bedding/waste if applied to fields in CAWMP.
27. Some calves are being composted out in a field with at least three foot of cover on top and at least 300 feet from the creek.
Reviewer/Inspector Name iMeliss osebrock
Reviewer/Inspector Signature: Date: l� Q
05103101 Continued

I.Facility Number: 76-59 1 1)6f Inspection I2111/2001 0
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours?
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon?
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
31. Do the animals feed storage bins fail to have appropriate cover?
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
[-]Yes []No
❑ Yes ®No
[]Yes ® No
❑ Yes ❑ No
[]Yes ® No
❑ Yes ❑ No
❑ Yes ❑ No
f.. ' itiona kUrfft en Mn oi•D _r_uw�tngs:
05103101
05103101

11'.36AM
us
•,w■vulva��c■■u{rrusc��,a.�ruacaz�uuvu:u�uva�uyirnu�c�rah.wywnvu�,�r
y a � D�iv�ston of Water Q 7:1"-�Comptls nee Inspection �, , �t R r
aki Other Agency. Operation Rev�ew'� x,s�l` �■
.. .v.... 'i �� .�..
Routine O Complaint Q Follow-up of DWQ inspection Q Follow-up of DSWC review Q Other
Facility Number S Date of Inspection Q
Time of Inspection E= 24 hr. (hh:mm)
0 Permitted A6
© Conditionally Certified © Registered © Not Operational Date Last Operated:
Farm Name: ..C=�,�l.' r' .I ..F.Ul,.rm. County:....1�`'�!..'�-!.�.� �.................. I ......................
Owner Name: f r y� C n /�� Ica pe- Phon o• 3 7 �'"� o
...Q ' 'w+1 .........i,!'..4..1.'.......................................�i{ �.... �1 .... ....... ....I..................... ... ...............
' n,� � �� 3 36. G 7�• a3 spa
Facility Contact: �U.�d....C.4��.`.� an.........................Title:................................................................ Phone o.....................................
Mailing Address:.. .. ..1...... i.T tn..M.111... ..:.�.... e .. P �! ..``....vv....... ...a�.� ...��
Onsite Representative: a ✓ i tied L �Q Integrator:
p . ............ I..... ......I.............. .................,................... #, ....... ......
Certified Operator:. ..y.. :,!'! I..:...... f j'1 Q Operator Certification Number:....... �1 1..31..j............
■ __...:__ ..ram.._._-.
LGc'auorm Vl rRa■aai
......................�...................,e."..Q.............. .....
.............l....F.........�:................................................................
a-L .............
on1.......... .
Latitude 0 i Sti. �4 1 _ ]11 Longitude I '-)1' 1 If( J1 1 ---5 11
I
10
' [Design Current
wine ,
i .'� Ca aextPv iilativn ; Poultry,.
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
Farrow to Finish
❑ Gilts
❑ Boars
U I-ayer
lialry
I nou
❑ Non -Layer
❑Nan -Dairy
❑ Other
Total 6ign'Capac>tty�` S
i -��
` Total SSL' W I
€ Number_ rof,LagoonsE i ❑ Subsurface Drains Present ❑ Lagoon Area I[] Spray Field Area ; a
- s �. s, - - --- - - - - _ �.� 4 r,i
Holding Ponds / Solid Tra 's' " 'q gSystemf ► i, , p z ❑ No Liquid Waste Management y
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes 9 No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? El Yes El No
b. If discharge is observed, did it reach Water of the Stale? (If yes, notify DWQ) El Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system'? (If ycs, 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 V No
Waste Collection & Treatment
4, Is storage capacity (freeboard plus storm storage) less than adequate? Spillway ❑ Yes WNo
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: L) or Lo wer
QQ .
Freeboard(inches): �..!t..............................:.................................................................. . ...........................................................................................................
3/23/99
Continued on back

Facility Number: , — Date of Inspection I Lj •
5. Are there any immediate threats to the inty of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4.6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenancelimprovement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste A lication
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
12. Crop type VAJ
13. Do the receiving crops differ with tho designated in the Certi
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Ian readily available?
(ic/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation,#'reabom waste a 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?
!'iQigiVois.o� 00ricie)m�iej *vre PPt�c� alH`t4g �� s'vpspt! Yop ;wilt eetiiye too; fu ii0
correspo><idence. about this visit. .
❑ Yes ONo
❑ Yes A-Iqo
❑ Yes tzo
❑ Yes
❑ Yes X.
❑ Yes To
❑ Yes Irf4o
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes IR-NO
= I Ilk"IMM"
1190;
❑ Yes )�No
❑ Yes A<
❑ Yes ONo
❑ Yes XNo
❑ Yes
❑ Yes No
❑ Yes )(No
❑ Yes R190
{.rVaaaaaaiaaa.7��a cacti-ay.yueaaavu irf un+rawau wu� a a,..a aaawna.ao aaaw va raarJ ■a.�.vaaaau�.uaawaaarau va _'y vauca �vaaaaaaeaaao- e j- i
Use drawings ofifacilfty to better;ixplafn situations (use;addttianal pages as tiecessary,):�;3 } >•i ,� 4, tl;,'��� °°i;`''; `',,t �', it;;````y'�;i',€;iy
ffifdt&4_c, 3 ? q 7
S. diQ'm 4'0tu� 05 00
a
Reviewer/Inspector Name r r $ S `
♦E �L:, x S. t .,P_. n� .:15. F 4 �i' i�. ( i i--"�•,ti' ,fi
Reviewer/Inspector Signature: Date: 5/00

Facility Number: -7 — 5 I)' of Inspection j I 0 Printed on: 7/21/2000
6
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge AUor below —B Yes --E A-N
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 )j(No
❑ Yes A1110
[I Yes
~e'Ye5—`EJ-No
cAwQ zCO6�
)gPA/J 7rzRa4sL�,ea
Q�t.Q tZe at
e 17
I
1 j
5100

!,iT i! i ;••i-r.» s I h ' 7 '?, � i� ,.i ISi,ls}i=a=
t SIOn' Of Water:.(o�UIItV
E,.y• q .:a as: a` U, ... J rll oi,, 1i�i�:. l� li �i - ..i i�iJ �'`�I �ii it i •.l E 1 Ih,li i�i ��l JJu�l,ii
' I I i Sl ll I S ,i S i I'Iii • �>
Of SOIItaI1dlWater Conservation
n i a. n li iY
' I OtherAgenC- ;
y
�. ,ra5Y t.
Type of Visit O Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit O Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number
Date of Visit: 10/26/2000 'rime: 1315 Printed on: 10/27/2000
76 S9
O Not operational 0 Below Threshold
0 Permitted ® Certified 0 Conditionally Certified [3 Registered Date Last Operated or Above Threshold:.. ...............
Farm Name: QRltrAtke—Farm.............................................................................................. County: Pand.alpla......................................... W.SRQ........
Owner Name: fL,BxAnlsaxl........................... CQltriliag...
Facility Contact: VAYU.C.Q try,ne.................................
Mailing Address: 73.xaianzl.�Ylilltoad.............
................ Phone No: (.(...7.4r.S2133........................
Title: ................................................................ Phone No: 33.&67...........:............
........................................ ......................................... 2.7.31,3...... ........
Onsite Representative: RA.YW-Cf► ft.011C..................... ......... . Integrator:..............
..................................................................................
Certified Operator: DR.Y.l.M................................ C.Q1XKAu .......................................... Operator Certification Number:2.13.1,j .............................
Location of Farm:
From GSO south on Hwy. 220 to Level Cross exit. Take Branson Mill Rd. to the left. Right onto Bantam Rd. Farm will be on +
the right.
❑ Swine ❑ Poultry ® Cattle ❑ Horse Latitude 35 • 53 55 �i Longitude 79 • 46 32
Design Current
Swine Canneity Ponulation
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Design Current .. Design . Current
Poultry Capacity Population Cattle Ca6acity. Po ulafion
❑ Layer ® Dairy 500 285
❑ Non -Layer ❑ Non -Dairy
❑ Other
Total,DesignCapa'city 500
Total SSLW 700,000
Number of Lagoons 0 ❑ Subsurface Drains Present ❑ Lagoon Area ® Spray Field Area
Holding Ponds 1 Solid Traps 2 ❑ No Liquid Waste Management System '
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes ® No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c, if discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes ® No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ® No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? 0 Spillway
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier: ............ Llpptr............ ........... J awer.................................... .................
Freeboard (inches): 36 120
5100
❑ Yes 0 No
Structure 6
Continued on back

Facility Number: 76-59 1 Date of Inspection 10/26/2000 Printed on;
5. Are there any immediate threats to the Oity of any of the structures observed? (ie/ tr4evere erosion,
seepage; etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management of
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?
10/27/2000 x
❑ Yes ® No
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum.liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
12. Crop type Corn, Soybeans, Wheat Fescue (Hay)
❑ 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?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
t8. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(iel WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
NoYiolatioris:oi:deficiencies wece:noted ;dpring#his visit.• :You:will receive ilti•fti_rther; ;
correspondence about
❑ Yes ® No
❑ Yes ® No
❑ Yes ❑ No
❑ Yes ® No
® Yes ❑ No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
1Comments (refer to question #): 'Expfain any YES answers and/ory y an recommendations or an other comments.
Use dra►vings of facility to better explain situations. {use additional pages as necessary);
7. Dam of lower waste pond has several holes and washed-out areas that need to be repaired. Pond also has vegetation growing on +
9. Markers are ok now. Will need gauged markers once permitted.
19. Need to keep applications by crop on each sheet.Record PAN and Acres, too.
11. Facility was applying waste on date of inspection. Some ponding noted.
19. Operator has recorded application dates and locations. Will complete IRR2 and SLR2 after waste analysis results come back. .
Have sent off samples.
Send IRR forms to David.
Reviewer/Ins ector Name rMeli
P Rosebrock
Reviewer/Inspector Signatur „ I Date: 5100

Facility Number: 76-59 Da f Inspection 10/2ti12000 Printed on: 10/27/2006
a
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 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
J
5100

i
k vision of Water Quality 3
{ l{itRl', 1)�vlsion of Soil and Water Conservation E 3`
4 1 e : i l ,'�� Other• Agency
Type of Visit KCompliance Inspection O Operation Review O Lagoon Evaluation I
Reason for Visit jWHoutine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
[late. of Visit: o� b ime: Printed on: 7/21/2000
Facility Number
Q Not Operational Q Below Threshold
0 Permitted 4Certified © Conditionally Certified ❑ Registered Date Last Operated or Above Threshold:
1 c ........r.........................
Farm Name: ...... L,,,Q
�j .l.�r�..�. er.....4.lrr........................................... County:
......... 1 ..................
Owner Name: rn.�� ...�.... ...... Phone No. ....R..� 5..°�
�. r�..:.� ...... .....................
.....
Facility Contact:buld.....-1�l�ne/...........Title:................................................................ Phone No: �..... f�.�.�
Mailing Address: �.d.... ...... L.".E.11.1-1....... 1 .'..�.. PJea5 n. ....V. e n.r ...427,��13
Onsite Representative: ...OaiJ .Co..1-1'a�..� integrator: .................1.......................................................
'l'1i'' t'i1 �F .
Certified Operator:................Q•(,%.............................................. Operator Certification Number:............. �....)........
Location 'of .Farm:
JA,
Front. W5P0, , 5ou� or, >� `gym e*! s . T4 _ rar)5ah , 2
a Fa.m r a n /-Ihilt
❑ 5wlne ❑ Poultry Cattle ❑ Horse Latitude �� ©� ®+� Longt ode �• EM, EIZT«
Design Current Design Current Design . Current
'Capacity Po ulation Poultry _ Ca aci Po ulatioa Catt]e Ca' acr ,:. Pu ulalion
?" Wean to Feeder ❑ Layer _r. airy
..:
Feeder to Finish 10 Non -Layer 10 Non -Dairy
Farrow to Wean
❑ ' Farrow to Feeder Other
r ° Farrow to Finish
i_:;t Total Design Capacity �(jb
Gilts
' ' Boars Total SSL
11` W 100 040
'I�aaiEber oft j;�ppnq- ❑ Subsurface Drains Present ❑ Lagoon Area ❑ Spray Field Area
„ r Hoidiiog Ponds / Solid Traps'' ❑ No Liquid Waste Management System
liii
Discharges & Stream Im act5
I. Is any discharge observed from any part of the operation? ❑ Yes koNoo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed. what is the estimated now in gal/inin`?
(1, 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? A
Spillway
Structure l Structure 2 Structure 3Structure 4 Structure 5
..�.�1 Identifier: .1�, fv.......... Lowex .. .........................................................................................
Freeboard (inches): r
5100
❑ Yes ❑ No
❑ Yes
❑ Yes VNo
❑ Yes x No
Structure 6
Continued on back

Facility Number: • 7 — 5qj Date of Inspection Printed on: 7/21/2000
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes WNo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes ,KNo
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? `Yes ❑ No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes X0
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ~� Yes ❑ No
Waste Application
10, Are there any buffers that need maintenance improvement? ❑ Yes A60
11. Is there evidence ooff `over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ElYes
12. Crop type [�U1u a+ Q. S c U iz,
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 ENo
b) Does the facility need a wettable acre determination? ❑ Yes gNo
c) This facility is pended for a wettable acre determination? ❑ Yes XNo
15. Does the receiving crop need improvement? ❑ Yes WN0
16, Is there a lack of adequate waste application equipment? ❑ Yes [ o
Required Records & Documents
17, Fail to have Certificate of Coverage & General Permit readily available? f V /A
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available? ,
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes KNO
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
Yes ❑ No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes �o
21. Did the facility fail to have a actively certified operator in charge?
❑ Yes o
X11
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
No
(ie/ discharge, freeboard problems, over application)
❑ Yes
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative'
❑ Yes AVo
24. Does facility require a follow-up visit by same agency?
❑ Yes
/�'N,
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
��'N/o
❑ Yes o
/ ,
1Q Yigla(,i0ris;o� deficiencies •wiere ptgtcd• O(Wi ft •thIs'visit; • Y;oir will ttejceiW o fu�-iii
•.•.corres oricience:abalit:this:visit: '-•-''''''-•-'''•'-'
Conuiterits (refer'tn question #): Explain city -YES answers and/or any recommendations or any other coments� ;
Use drawings of facility',to better explain situations.. {use idditioel pages as necessary), ,I t! „ ' ,; ; y:'.',!.;y.l..t
Zarn J 6ux r LoxS�t° nd has S�rzra.i ho es q- u-)qs heJ
tine %6 bo- if "I re
�. m1x�5 are DV- nuo . l) Ii1 n" ao R)�ILerS` I jt4
q- erg
i1.IVonit d ,�P W_by �R- nn'o-no_k ,5h��-. ea-d PA+� ZO.
Reviewer/Inspector Name X
1 , 41.
Reviewer/Inspector Signature. Date: 5100

Facility Number: — [of Inspection Printed on: 7/21/2000
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond- with no agitation? Qrn f �` I boa
27, Are there any dead animals not disposed of properly within 24 hours? l ❑ Yes No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboringdegetation, asphalt, ❑ Yes 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? ❑ 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 IWNo
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
Additional otrtmegts and/orDrawings:
NAe-,5' Fr-wba ud record d 2
a
Ve or) an pcn4 I: rri a- oo pr66le.rns
Adul4oml ifl�'. due I'm Sept 46 JR '7o5hi .
e&11 5ue� A4m e t000d 91 T 733. Sa8,3 �e Ste,
Ls wt�
&CO' 4 well
PC>I
� 13 . to
� GCS
m�PO ri
I9- !-.s r'QCoro�� of ' p l'�-`�a 5 r{6CQ.�7on5
i Co ru-P I e4e_ T Q4- 6 t- a- p4e- - s-�e✓
n a 5 5 &re- ej 4o,5 &en 6alf io-Pr.

14% Routine O Complaint O Follow-up of DWO inspection O Follow-up of DSWC review O Other -
Facility Number
Date of Inspection Li�9�
Time of Inspection L 1; 14)cAMI 24 hr. (hh:mm)
Permitted ® Certified © Conditionally Certified Imo, Kegistertd �� Not Operational I Date Last Operated:
�i ..........................
Farm Name: ...... [ .1 - 0.C.1rY1....... `a .. :.. :.:::..:......", l._... unty:....Tl n .1.. �f1.............. .........................
Owner Name: ... %A:.4s:! ...... .. .r\.Q ..........J.U.L.....I...7 ZOOO Phone No:...�t? .-"..��..i? ....
Facility Contact:%?4.i..........0.�►4.5%....>iti��•rrrr�?.a l,e.......................... Phone No:........� �C.........
Mailing Address:..�TA.s�..
OnsiteRepresentative: ........................................................................................................... Integrator:......................................................................................
Certified Operaton:l Ga o„V „�L „ ,p c� leg, .�.. rt .f� �'� ............ Operator Certification Number:......,,p ,1. ,,,,,,,,,,,,,
Location of Farm:
A
............ ...................................................................................... ...................................................................................N. i.....................................................................
.
�tV�ti a�• c �r�, o Q1 gyros
I s-_ -�I_
Latitude I �5 J • I J.S I` 1 _5� _ J" r.ongituae I E `1 I - t `f (c, f� I b�! i`° "` •-
aS irl _ � ` Deslgil �' Curl Crlt sr 6 r� Desl "�; ° °Currents gar a < s sM N— � a
.( 811aC1tV: ' POD111Atlon. ; ' POUItr)! CapaCltV,..POgUiat10111' �;C�attle�r:..9t
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
I
❑ Layer
,Ii;e
'rDairy
❑ Non -Layer
Non -Dairy
�..
�.
` ❑ Other
Subsurface Drains Present 110 Lagoon Area
No Liquid Waste Management System
Discharges & Stream I. mpacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
y Field Area
�ht pit, `
}A
3
❑ Yes ['No
❑ Yes C04o
❑ Yes 2f,10
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If'yes, notify DWQ) ❑ Yes [3'*No
2. is there evidence of past discharge from any part of the operation? ❑ Yes [9 o
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ONO
Waste Collection & Treatment
4. is storage capacity (freeboar s storm storage) less than adequate? ❑ Spillway ❑ Yes 0140
ructur tructure 2 Structure 3 Structure 4 Structure S Structure 6
Identifier:
Freeboard inches 5.. . ........................... i/at
S. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes [!g No
seepage, etc.)
3/23199 Continued on back

'Facility Number: — �te of inspection
6. Are there structures on -site which A properly addressed and/or managed through a waste management or
closure plan? ❑Yes [No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes [►K40
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes 2"No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes ["No
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes [ErNo
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Yes dN6
12. Crop type CZr CV I iA 1Kn e.-*
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes f2rNo
14. a) Does the facility lack adequate acreage for land application? ❑ Yes ["No
b) Does the facility need a wettable acre determination? ❑ Yes dNo
c) This facility is pended for a wettable acre determination? ❑ Yes j[ No
15. Does the receiving crop need improvement? ❑ Yes dNo
16.
Is there a lack of adequate waste application equipment?
❑ Yes
Ld No
Required
Records & Documents
17.
Fail to have Certificate of Coverage & General Permit readily available?
[Yes
❑ No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
[g'&o
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
2' qo
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
n 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?
Yes
(ie/ discharge, freeboard problems, over application)
❑
[ff"No
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
Eff"No
24.
Does facility require a follow-up visit by same agency?
❑ Yes
Q No
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
�To
Io yiola�igtjs;o dg# e�e;ncies v0re �tQt;e d0.0.9 •thjs;vjtsat} Your ill tOboive 06 fufth
rorresnorit,ience: about: this visit: ...........................:. .:. , : .
.-i apz.rn °or-\ VNO.:5 r\bVVZ.-�r\ I A,
1-0, Co r- k76 m a-,, �-
oQ�.rr��-©c t�.c3S -�o o�a��►�ess �� v e��-a-y- �O+r� �ro ua;�r1� or�-bp
�-&j 0.s'te �►� •�-I�,z p C n d
lI
Reviewer/Inspector Name•; a ,,
v tt,
_ ?Ki. .try t� ,..,_�t: -. .x t : s:� . r_ , .t.;tt � <...r., • c. � !,: Sri :n:,
.Reviewer/Inspector Signature: I\ 0 Ct1_[� a Date: fr, _-3Cg -oQ

Facility Number: �te of Inspection
Odor Issues
26. tau '1 te-disehaTc-ftt�❑ Yes ❑ No
-liquid n?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes GINo
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes GKNo
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 02rNo
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 0"N' O
3 ❑ Yes ❑ No

State of North Caro
Department of Envit ment
and Natural Resources
Division of Water Quality
James B. Hunt, Jr., Governor
Bill Holman, Secretary
Kerr T. Stevens, Director
R. Branson Coltrane
Coltrane Farm
7239 Branson Mill Road
Pleasant Garden NC 27313
Dear R. Branson Coltrane:
NCDENR
NORTH CAROLINA DEPARTMENT OF
ENVIRONMENT AND NATURAL RESOURcEs
December 30, 1999 RECEIVED
N.C. Dept. of EHNR
.JAIL 0 5 2000
Winston-Salem,
Regional Off I I
Subject: Fertilizer Application Recordkeeping
Animal Waste Management System
Facility Number 76-59
Randolph County
This letter is being sent to clarify the recordkeeping requirement for Plant Available Nitrogen (PAN) '
application on fields that are part of your Certified Animal Waste Management Plan.
In order to show that the agronomic loading rates for the crops being grown are not being exceeded, you
must keep records of all sources of nitrogen that are being added to these sites. This would include nitrogen
from all types of animal waste as well as municipal and industrial sludges/residuals, and commercial fertilizers.
Beginning January 1, 2000, all nitrogen sources applied to land receiving animal waste are required to
be kept on the appropriate recordkeeping forms (i.e. IRR1, IRR2, DRY1, DRY2, DRYS, SLUR1, SLUR2,
SLD1, and SLD2) and maintained in the facility records for review. The Division of Water Quality (DWQ)
compliance inspectors and Division of Soil and Water operation reviewers will review ail recordkeeping during
routine inspections. Facilities, not documenting all sources of nitrogen application will be subject to an
appropriate enforcement action.
Please be advised that nothing in this letter should be taken as removing from you the responsibility or
liability for failure to comply with any State Rule, State Statute, Local County Ordinance, or permitting
requirement.
If you have any questions regarding this letter, please do not hesitate to contact Ms. Sonya Avant of the
DWQ staff at [phone] ext. 571.
Since ,
Kerr T. Stevens, Director
Division of Water Quality
cc: Winston-Salem Regional Office
Randolph County Soil and Water Conservation District
Facility File
1617 Mail Service Center, Raleigh, North Carolina 27699-1617 Telephone [phone] Fax [phone]
An Equal Opportunity Affirmative Action Employer 50% recycled/10% post -consumer paper

State of North Carolina
Department of Environ t
and Natural Resources
Division of Water Quality
James B. Hunt, Jr., Governor
Wayne McDevitt, Secretary
Kerr T. Stevens, Director
June 22, 1999
CERTIFIED MAIL
RETURNE P REQUESTED
R. Branson o trane
Coltrane Farm
7239 Branson Mill Road
Pleasant Garden NC 27313,
Farm Number: 76 - 59
Dear R. Branson Coltrane:
VIA Gbr`r
NCDENR
NORTH CAROLINA DEPARTMENT OF
ENVIRONMENT AND NATURAL RESOURCES
RECEIVED
M.C. Dept. of EHNF�
JUN 2 3 1M
Wjj-�-. • • �":�Pm
Rei�,Ui,ZAI Office
You are hereby notified that Coltrane Farm, in accordance with G.S. 143-215.10C, must apply
for coverage under an Animal Waste Operation General Permit. Upon receipt of this letter, your farm
has six 60 days to submit the attached application and all supporting documentation. In accordance
with Chapter 626 of 1995 Session Laws (Regular Session 1996), Section 19(c)(2), any owner or
operator who fails to submit an application by the date specified by the Department SHALL NOT
OPERATE the animal waste system after the specified date. Your application must be returned
within sixty (60) days of receipt of this letter. Failure to submit the application as required may also
subject your facility to a civil penalty and other enforcement actions for each day the facility is operated
following the due date of the application.
The attached application has been partially completed using information listed in your Animal
Waste Management Plan Certification Form. If any of the general or operation information listed is
incorrect please make corrections as noted on the application before returning the application package.
The signed original application, one copy of the signed application, two copies of a general location
map, and two copies of the Certified Animal Waste Management Plan must be returned to complete the
application package. The completed package should be sent to the following address:
North Carolina Division of Water Quality
Water Quality Section
Non -Discharge Permitting Unit
Post Office Box 29535
Raleigh, NC 27626-0535
If you have any questions concerning this letter, please call Sue Homewood at [phone]
extension 502 or Ron Linville with the Winston-Salem Regional Office at [phone].
/ incerely,
XJ
for Kerr T. Stevens
cc: Permit File (w/o encl.)
W.inston=Salem_Regional-Office.(w/o encl.)
P.O. Box 29535, Raleigh, North Carolina 27626-0535 Telephone [phone] FAX [phone]
An Equal Opportunity Affirmative Action Employer 50% recycled/ 10% post -consumer paper

S
[]Division of Sod Water Conservation ❑ Other cy'
:
g�
r
'Division of Water Quality a"<
F,
Routine Q Cum laint O Follow-up of DW ins action O Follow-up of DSWC review Q Other
Date of Inspection
Facility Number
Time of Inspection Eb2D24 hr. (hh:mm)
0 Registered O Certified © Applied for Permit [] Permitted JUNot O erational Date Last Operated:
Farm Name: 1G &44so� Qv! 'T .4' P:Q�W County, ,OAIA?a�� LJS,�U
Owner Name: ...... h:.......��R �lSa�l.....CQ T26.......................................... Phone No: .... 3G.'.. .......5....2.93 .........................
Facility Contact: ..........�..'g` 1!1.... .................. Title:................................................................ Phone No:.�' .-. �.Z-"......-.6.35V
Mailing Address: ..,..,...*Z 39 j3kA-j5a j A71 / i Qd . Z7t
...........................................................................................J���7... ' i...........1�...........1.1.........3 3
Oncite Representative: .... ✓..+.d..%atilE'............................................ Integrator:......................................................................................
Certified Operator ........................ �....E..................................... Operator Certification N€imber:..Z/3/Z
Location of Farm:
Latitude • S4- [ ®66 Longitude ®• ' "
"Design Current Design urrent:
"Capacity Population Poultry`s CapacitykaPopufaiion Cattle .
.:
❑ Wean to Feeder
........ ... .
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
_'
❑ Gilts
❑ Boars
Number of;Lagoons J Holding Pands� Z. j❑ Subsurface Drains Present ❑ Lagoon Area Spray Field Area
n --
' , qe ." ❑ No Liauid Waste Management System
General
1. Are there any buffers that need maintenance/improvement? ❑ Yes ANo
2, Is any discharge observed from any part of the operation? ❑ Yes ONO
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ONO
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ) ❑ Yes XNo
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system'? (If yes, notify DWQ) ❑ Yes XNo
3. Is there evidence of past discharge from any part of the operation? ❑ Yes ,NNo
4. Were there any adverse impacts to the waters of the State other than from a discharge? ❑ Yes EkNo
5. Does any part of the waste management system (other than lagoons/holding ponds) require ❑ Yes IFfNo
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes ,rNo
7. Did the facility fail to have a certified operator in responsible charge? ❑ Yes ;N(No
7/25/97

- Facility Number: -- •
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (Lagoons,Holding Ponds, Flush Pits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure 1 Structure 2 Structure 3
Identifier: (� we-k
....... ............ .. ..............................
Freeboard(ft):......................................................... .........................
10, Is seepage observed from any of the structures?
Structure 4
❑ Yes W No
❑ Yes ,NVNo
Structure 5 Structure 6
..............................................................
............................................................................................................
❑ Yes b(No
11.
Is erosion, or any other threats to the integrity of any of the structures observed?
❑ Yes
IV No
12.
Do any of the structures need maintenance/improvement?
❑ Yes
0 No
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13.
Do any of the structures lack adequate minimum or maximum liquid level markers?
❑ Yes
ONO
Waste Application
14.
Is there physical evidence of over application?
❑ Yes
ONO
(If in excess of WM/P,�orr runoff entering waters of the State, notify DWQ)
15.
Crop type .............. {.V..'"........................(;,1r4.7�r.. ............................... ............... ..........I....................................................................................
....................
16.
Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
❑ Yes
M No
17.
Does the facility have a lack of adequate acreage for land application?
❑ Yes
V No
18.
Does the receiving crop need improvement?
❑ Yes
0 No
I9.
Is there a lack of available waste application equipment?
❑ Yes
ANo
20.
Does facility require a follow-up visit by same agency?
❑ Yes
a No
21.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
No
tNo
22.
Does record keeping need improvement?
❑ Yes
For Certified or Permitted Facilities Only
23.
Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑ Yes
)dNo
24.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
kj No
25.
Were any additional problems noted which cause noncompliance of the Permit?
❑ Yes
❑ No
No:vioiatio'ns•or. di ft; iencies.were-n6ted-d6iik this.visit;- You:wift i-eceive.ito•ftirttier,
c0rresO06deiko about this:visit:• :..
7/25/97
Reviewer/Inspector Name ,' .. R "' i, R f: "t t ^ate ;
i .;.,
Reviewer/Inspector Signature: Date: i ~ L

• w � g , : ed, p Division of. _ " nd�Water Causer
r ,t p Drvrsran"of� nd Water€€Conner
Divisi m6f Water Quality CoWp
' pOther�Agency==0peratronfRevrew
O Routine O Complaint O Follow-up ot DWQ inspection O
I Facilit. Number I
p Permitted ■ Certified p Conditionally Certified p Registered
f __f
)n Compliance In tan
e lnsP ection .. p '
, i
ow-up of DSWC revietir• O . 1 ier
Mile of lnspeclion
Time or Inslwolioii ® 24 hr. (hh:mm)
p of peralion❑ D"Ife Last Operaled:
Farm Name: R...B,ranson-Caltraae—FaX.M..................................................................... County: Randolph WSRO
0%vncr Name: R.-Hra.nsan........................... CD]Lrwm .................................................... Phone No: fiUrSZ83 ...................................................................
hacililY Giulact: lllaviid.CaltiaIIe..............................................'I'ille: Par.tncr .............................................. Phone No: MA-0.4--0140 .......................
Mailing Address: .7.239-H>rapson.- UMd....................................................................... JPleasarit.GardenAC......................................... 27-111 ..............
OnsiteRepresentative: Duld..Caltranx......................................................................... Integralor:.......................................................................................
Certified Operator: RUY-14..................................... EDIUalle ........................................... Operator Certiticotion Numbcr:2.1.3.1.2.............................
Location of Farm:
L.alitude ©• ® ®14 Longitude ®•
Swine Capacity Population
❑ Wean to Feeder
p Feeder to Finish
❑ Farrow to Wean
❑ Farrow to ee er
❑ Farrow to Finis
[3 Gilts
❑ Boars
Design Current Design Current
Poultry Capacity Population Cattle Capacity Population
❑ Layer ,:� �= IT611111111111
p Non -Layer
❑ Other
Total Design Capacity 300
Total SSLW 420,000
Number of Lagoons (3u sur ace Drains Prcsen ❑ Lagoon Area In spray MeMCFER
Holding Ponds a Solid' Traps ❑ o LiquidWaste ManagementSystem
0
Discharges& S(reanl Impacts
I. is any discharge observed from any part of the operation? ❑ Yes g No
1)ischargc originated at: [3Lagoon [3Spray Field (3Other
a. I I'discharge is observed, was the conveyance nian-made'? ❑ Yes (3No
b. II discharge Is observed. did it reach Miter fifllie State? (ll'yrS, notify DWQ) p Yes ❑ No
c. I I discharge ii observed, whal is the estinialed I'low in gal/iniii ?
d. Rocs discharge bypass a lagoon system? (li'yes, notify DWQ) [3Yes [3No
2. Is there evidence of past discharge from any part of the operation? p Yes ® No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? [3Yes g No
Waste Coileetion IS.,Tre'ltment
4. Is storage capacity (freeboard plus storm storage) less than adequate? [3Spillway [3Yes g No
struclure I SIRICIL rc 2 Slrrucurrc 3 Sirticturc 4 Structure 5 Structure 0
Identifier:............................................................................................................................................. .............................
Freeboard(inches):.................5..................................5.....................................................................................................................
5. Are there any immediate threats to the integrity of any of the structures observed? (iel trees, severe erosion,
seepage, etc.)
3/23/99
❑ Yes g No
Continued oil back

Fcility Number. 76--59 .rrl' In,lrcctiort
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? p Yes ® No
(if any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? p Yes N No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? p Yes ® No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? p Yes ® No
Waste Apillic,11ion
10. Are there any buffers that need maintenance/improvement? p Yes M No
11. Is there evidence of over application? p Excessive Ponding p PAN p Yes ® No
12. Crop type Corn (Silage & Grain) Fescue (Hay) Small Grain (Wheat, Barley,
13. Do the receiving crops differ with those designated in the Certified Animal V13aste_lVlanagement Plan (CAWMP)? (3 Yes ®No
14. a) Does the facility lack adequate acreage for land application? p Yes N No
b) Does the facility need a wettable acre determination? (3 Yes M No
c) Does this facility lack adequate documentation to make a determination of adequate acreage?
15.
Dies the receiving crop need improvement?
p Yes
® No
16.
Is there a lack of adequate waste application equipment?
p Yes
N No
Required Records & Documents
17.
Fail to have Certificate of Coverage & General Permit readily available?
p Yes
® No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
p Yes
M No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
p Yes
®No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
p Yes
N No
21.
Did the facility fail to have a actively certified operator in charge?
p Yes
® No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit? -
(ie/ discharge, freeboard problems, over application)
p Yes
® No
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
p Yes
M No
24.
Does facility require a follow-up visit by same agency?
p Yes
®No
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
p Yes
®No
K No:viu tiaits.or.cleficiei�'cies:we e-irote'dl:during:thisvisit.:Yhu'wvill'receiveno.further- :
.............I.. ...... .................
:: icorres'pbnideki about this visit; . . .....:..... .
a lComments1refer to`yuestion #) " Explainany3YES answers and/or!any, recommendations or;any other comments
USe draWing6iOf€facility,'to� etter.explain situatlons (use additionalrpages�ASineceBSary,)'' -,� iE� 1, � ji!'sr
Facilitv'irn' excellent share. No problems noted. .i.
** DESIGNED FOR 500 HEAD. CERTIFICATION DOCUMENTS ARE ACCURATE, SYSTEM NEEDS TO BE UPDATED
'O REFLECT 500 HEAD.
IV
ReviewerAuspector Name `^ Corey Basinger , Y T,
<E>�3 I i
Reviewer/Inspector Signature. Date:

p Division of SoU."
.� p Division of Soil' an
M Division,of Water
p OttierjAgencj€€=+Q
r
0 outine'0 omp aint 0 0 ow -up
ter Conservation W'Operation Review
ter Conservation - Compliance'ln
Nahty !C,dmplla'nee Inspection
,'iI
eration`Revie'w; ; t
inspeetion 0 Pollow-up of W5WC: review 0 Other
Facility Number I):rtc of InspcC(f rn dlyis
lime of Inspeciiort ® 24 hr. (hh:mm)
0 Registered p Certified p Applied for Permit p Permitted in Not 01eratrnna Dale Last Operated:
F:irin Name: R...Rramsnn..Caltraa r—Eam..................................................................... County: Randolph WSRO
Owner Name: R..RransoR......
Facility Contact: David -Coltrane...
Caltrarite...........................
Title: Partner..........
Mailing Address: ..7239-13ra.Lima.lul.11l.Rd..........................................
Onsite Representative: Daritl.&.Rratasom-Caltratue.....................
Ccrlit•ied Operator: ..................................... coltraue ...............
Location of Farm:
Phone No: 67.4-5283..............................................
Phone No: 3.3fi4G24-0,.14A.......................
Pleasant Gardert.NC.......................................... 27.11.1 ..............
1 r►tegrator:.........................................................
OpciakarCcrtification Nuuthcr:2,h3.12.............................
LatitNdc ©0 ®" Longitude ®& ®c ®6,
Swine , Capacity Population
13 Wean to Feeder
13 Feeder to Finish
p Farrow to Wean
p Farrow to ee er
p Farrow to Finish
p Gilts
p Boars
Poultry Capacity Population Cattle Capacity Population
© Layer ,. ® Dairy
p Non -Layer [3 Non -Dairy
[3 Other
Total Design Capacity 300
Total SSLW
Nu ni c;'r`o :Lagoons /,Holriing Po`.nds,2 [3
u
sur ace
rains
Present[3
Lagoon Area
In pray FieldArea
p
o
rqui Waste
ManagementSy
em
,
fft141i1
. Are there any buffers that need maintenance/improvement?
2. Is any discharge observed from any part of the operation?
Diseharge originated at: p Lagoon 13 Spray Field p Other
a. [I•dischar-e is observed, was the conveyance man-made?
b. ll'discharge is observed, did it reach SUH'Me Water? Slfyes, notify DWQ)
c. II'discharge is observed, what is the estimated flaw in gal/►nin?
d. Does discharge bypass a lagoon system'? (If yes, notity DWQ)
3. Is there evidence of past discharge from any part of the operation?
4. Were there any adverse impacts to the waters of the State other than from a discharge?
5. Does any part of the waste management system (other than lagoons/holding ponds) require
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
7. Did the facility fait to have a certified operator in responsible charge?
7/25/97
p Yes pi No
p Yes ® No
p Yes ® No
p Yes ® No
p Yes ® No
p Yes IS No
p Yes ® No
p Yes ® No
13 Yes ® No
p Yes ® No

acr i y um er: 76_59 Dale �f:1 CIi1
6 )ll
y 8. Are there lagoons or storage ponds on ss9which need to be properly closed? • Yes No
A
Siruewres (Lal-mons.l-iokline._Ponds, Flush Pits. etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate? p Yes ® No
S11'HOLIre I Structure ? Sh•ucture i Structure 11 Structure 5 Structure 6
Identi[icr: Upper Lower
17rceboard (h):................7.................................. .5.:.................................................... ................................... ......................................................................
10. Is seepage observed from any of the structures? p Yes ® No
11. Is erosion, or any other threats to the integrity of any of the structures observed? p Yes N No
12. Do any of the structures need maintenance/improvement? p Yes ® No
(If any of questions 9-12 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers? p Yes ® No
Waste Application
14. Is there physical evidence of over application? p Yes ® No
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type ........ arn.4SUage.&.O.tain.) ....... ...................... Frsrvue...................... ....................................
Milo pats)
16. Do the receiving crops differ with those designated in the Animal Waste Management plan (AWMP)? p Yes ® No
17.
Does the facility have a lack of adequate acreage for land application?
p 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
Ig No
20.
Does facility require a follow-up visit by same agency?
p Yes
®No
21.
Did Reviewer/[nspector fail to discuss review/inspection with on -site representative?
p Yes
®No
22.
Does record keeping need improvement?
p Yes
® No
For Certified or Permitted Facililies Onh,
23.
Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
p Yes
p No
24.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
p Yes
p No
25.
Were any additional problems noted which cause noncompliance of the Permit?
p Yes
p No
R .�N.wvlalations.or cien-cres-were.noted . urrng this visit:. You
. u. will.receive no further ...
. • : �ox�esi�o�+s�erie� �>t�ttt :t�iis•vis+}:. • ......... • . • . • .
Comments (refer to,question`#) Explain any YE5 answers and/or any;recommeiiations or`any of er comments
i z .s € ' r:f ,
Use drawings of faeihty to better explaintlsit ations (use additional pages as neces
FACILITY IN EXCELLENT SHAPE.
A
WASTE APPLICATION IN PROGRESS AT TIME OF INSPECTION UTILIZING NEWLY INSTALLED IRRIGATION
SYSTEM. SYSTEM WORKS WELL.
EW FREE STALL BARN UNDER CONSTRUCTION, PLANS ARE TO INCREASE HERD TO APPROXIMATELY
500 HEAD. IRRIGATION SYSTEM DESIGNED ACCORDINGLY.
SHOULD COMPLETE CERTIFICATION REQUIREMENTS SOON.
O PROBLEMS NOTED.
n C'7!x h rz. rwX'4rp 'YEY""*g i r 1"'"r� n �'. r : irv^ i"�1 ..:.ry � :�.ry .-' 1 w'"" �{• -."� i ! 'M, , � n ��17t
Reviewer/Inspector Name �W: CoreytBasin ger� ��- �, �'� tt,�s
Reviewer/inspector Signature: Date:

Division of SoWd Water Conservation ❑ Other
Division of Water Quality
M Routine O Complaint O Follow-up of DWQ inspection O Follow-up of DSWC review O Other I
Date of Inspection
Facility Number
Time of Inspection 24 hr. (hh:mm)
, Registered 0 Certified 0 Applied for Permit [] Permitted 113 Not Opera Date Last Operated.
Farm Name; ..........g 63k- d9bti[ Ci U_1? an(L= . �.M.............. Countv.........PanIPOP! ................,......
OP�0-d Go[TI�A►ur (3��
OwnerName ...................................................................... Phone No..................................................,....................................
Facility Contact: m'4?�!E .., Title:... ...................... Phone No: e�¢ -d3�
....................................... ............................................................................I..........
Mailing Address: $24nt5D1q P I(L r c-d 112Sd4 4ir-vv 4,, AZG........... ...0;7 3, .f 3..:
........................................................................................................................................................................
OnsiteRepresentative:
....�a�rrJ......�.......�,iSD...`:I.........�...�'.�`. r... Integrator: ......................................................................................
Certified Operator ,......F y � � ...................................... ....................... Operator Certification Nnmber;... z! 3 / Z.................
Location of Farm:
.......... ..... ............. .......... ........ .. ....... ......
Latitude 3 S 0 6 46 Longitude ® • 4 L ® 64
I]estgn C.tirrent �� ` r"
i)esign = Current -
Design Gurrent� •::
Swine n
C...apacity
:Population ;, Poultr`y
CapaciEy Yopulattonq Cattle
,Capacity Populategn ,
❑ Wean to Feeder
❑ Layer
MDairy
ae
❑ Feeder to Finish
❑Non -Layer
❑Non -Dairy
'
❑ Farrow to Wean
❑Other
0� � � x,
4,
❑ Farrow to Feeder
❑ Farrow to Finish
qK
Total Design`Capacity
rA
❑ Gilts
P. .
Total SSLW
s
"
Boars
��
.a_ �
� .e v _n! Ik �.
General
1. Are there any buffers that need maintenance/improvement? ❑ Yes ONO
2. Is any discharge observed from any part of the operation? ❑ Yes XNo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ONO
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ) ❑ Yes ANo
c. If discharge is observed, what is the estimated flow in gaUmin?
d. Does discharge bypass a lagoon system'? (If yes, notify DWQ) ❑ Yes ,M No
3. Is there evidence of past discharge from any part of the operation?
❑ Yes
JR No
4. Were there any adverse impacts to the waters of the State other than from a discharge?
❑ Yes
ArNo
5. Does any part of the waste management system (other than lagoons/holding ponds) require
❑ Yes
XfNo
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of d6.sign?
❑ Yes
M No
7. Did the facility fail to have a certified operator in responsible charge?
❑ Yes
No
7/25/97

* Facility Number:
(p=-2j 0
— 8. Are there lagoons or storage ponds on . site which need to be properly closed?
Structures (Lagoons.Holding Ponds Flush Pits etc.
9. Is storage capacity (freeboard plus storm storage) less than adequate?
St cture i Structure 2 Structure 3 Structure 4
Identifier: 1Z
Freeboard(ft):..............� ................... �............... ................................... .................... I ............... .....
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, Do any of the structures need maintenance/improvement?
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
Waste Aunl►cation
Structure 5
❑ Yes 0 No
❑ Yes allo
Structure 6
❑ Yes O No
❑ Yes P1 No
❑ Yes )@'No
❑ Yes 19'No
14. Is there physical evidence of over application? ❑ Yes A No
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type ( L_.O ......................... .5Md & 6hQi (.......... ........�.:?S�...................................................................................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)? - ❑ Yes E1Vo
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 reviewlinspection with on -site representative?
22. Does record keeping need improvement?
For Certified or Permitted Facilities Onl
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?
No.vialationsar. deficiencies.were noted. during this.visiit.Aod4ill e&e' ve' m6ldrihei
cti&0000dekt about this: visit:• ' : , ... . .. .. . . .:.. .. . .
❑ Yes Ej No
❑ Yes WNo
❑ Yes RNo
❑ Yes Ej No
❑ Yes 1p No
❑ Yes O�No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
� a• pwa�`,..z.� Sid' �e•ra/. /.�v�c�L� S sue- �e�r, „e�i gc�a�H
7/25/97

9
I* Koutine p uompia:nt p ronow-up of uwd inspection p rt
Facility Number ®�
■ Registered p Certified p Applied for Permit p Permitted
Farm Name: R..Rr.amsau Craltra.nn.F.arm .............................................
Owner Name: R..Rransan ........................... cuftrarm..............................
Facility Contact: David.Coltrane ..............................................Title:...
Mailing Address: .7.239-brans:aa..lkiilJ<.Rd,...............................................
Onsite Representative: David..&.Hransan.Coltr.mina..........................
Certified Operator: Ray..H..................................... Coltrane....................
Location of Farm:
review p utner
Date of Inspection
Time of Inspection 24 hr. (hh:mm)
in Not OperationalDate Last Operated:
County: Randolph WSRO
.................... Phone No: fi74:-5Z8a ...................................................................
............................................ Phone No: 9111-AU.-.0411.........
Pleasant-Garde.a.NC.......................................... 27.3 13..............
.................... Integrator: ................................................................
Operator Certification Number:2.1.3.1.2.............................
Latitude ©•®� ®64 Longitude ®• ® ®C6
t , a ,,, . is 'r eslgn t-' urren ? a�,,.... eslgn ? urren s e esign, urren,
Swtne" Cap3ctty Population ,Poultry,. Ca acii Population Cattle , . Ca acit Po uiation., `
r..
p Y P, p y`", - p
j
❑❑ can to Feeder
Feeder to Finish
❑ arrow to Wean
❑ arrow to -Feeder
❑ Farrow to Finis
❑Gets
3 Boars
Layer
1❑M
❑yer
NutnWr}of Lagoons/ Holding Ponds ; Lp u sur ace Drains Present p Lagoon Area JE3 Spray Held Area
i ❑ o iqut as a ManagementSystem
-
i�,..
General
1. Are there any buffers that need maintenance/improvement? ❑.Yes N No
2. Is any discharge observed from any part of the operation? ❑ Yes N No
Discharge originated at: Fl Lagoon ❑ Spray Ficid ❑ Other
a. If discharge is observed, was the conveyance man-made? p 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 gal/min?
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 ®No
4. Were there any adverse impacts to the waters of the State other than from a discharge? ❑ Yes ®No
5. Does any part of the waste management system (other than lagoons/holding ponds) require p Yes ® No
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes ® No
7. Did the facility fail to have a certified operator in responsible charge? ❑ Yes ®No
7/25/97

Vacuity um er: 76_59 .
8. Are there lagoons or storage ponds on I which need to be properly closed? p Yes ® No
Structures (Lazoons,Holdine Ponds, Flush Pits, etc.)
9. is storage capacity (freeboard plus storm storage) less than adequate? p Yes N No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier.
Freeboard(ft): ..........2.fL4±( .................... S.B.4t�.......... ................ ............. .......................................... ......................................................................
10. Is seepage observed from any of the structures? p Yes N No
11. Is erosion, or any other threats to the integrity of any of the structures observed? p Yes ® No
12. Do any of the structures need maintenance/improvement? p Yes ® No
(If any of questions 9-12 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers? M Yes p No
_Waste Application
14. Is there physical evidence of over application? [3 Yes ® No
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type .......Carn..(Sj1ap.&.Grain.)....... �Sbrtall.C�rain�.(Wpkiea�t,.Barley,........................ ftscue...................... ...........................................................
16. Do the receiving crops differ with those designated in the' Animal Waste Management Plan (AWMP)? p Yes p No
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
22. Does record keeping need improvement?
For Certified or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
25. Were any additional problems noted which cause noncompliance of the Permit?
R• .•o•viaios.or 44»cretnieYs•we.r:e..noa ..n.nng is visit;You. w.Y.....v..n.o .u.r...er
ca ...::::::.......... . .....• . .
p Yes H No
p Yes ® No
p Yes ®No
p Yes ®No
p Yes ®No
p Yes ®No
p Yes p No
p Yes p No
p Yes p No
Reviewer/Inspector Name
Reviewer/Inspector Signature: , Date:

+[]DSWC Ani Feedlot Operation Review
4,
�DWQ Animal Feedlot Operation Site nspection
e I
rn.�•.,.:�..,nmme.. n.e.Twee.r.......+.r.M.�:.....u.....�.,.....�,.,.«,v..
,
f
E
Routine QCompbint O Follox^-u of l)Wl itts cction O Follow- tip of DS%VC review O Other
Facility Number
Date of Inspection JM a ej
Time of Inspection 0: DO 24 hr. (hh:mm)
Registered [3 Certified [3 Applied for Permit E3 Permitted
JE3 Not Operational Date Last Operated: ,.........................
Farm Name:........ ....15R.A-UU l[.. �LTiir.4�G.... !!?.........................
County:...RA................................................c.Pl.osko,..
. ..... .%........................................Phone
Owner Name:...K+ ...��.........� .........
52.8.3
No:.9/O„-� ........................................................
Facility Contact: ...DAV.«., �t-'rR.A�.tc , Title.
�................
Phone No: (,� 3 ......,.....
..................,........,�.....4 0
Mailing Address: 2 �Gl �2Afi[ � NI�LL �a.
�45•9,�r7— 6.44Z-PC ..�..f" 2
..... ..........3.13......
OnsiteRepresentative:......TCZDtnL.......................................................
Intel;ratnr:......................................................................................
Certified Operator;..,,, ,`f ........ ,r?...................... C..�L ^��'
......................................................
..... Operator Certification Number;........ g...... �.!.Z............
Location of Farm.
/............................................................................................................................................................................................................................................................... L
�pCITIfE��i �JrLnp2r� /,,�lQ nJc7 rr N P ,�ddl�g Cotl�f f79S Ovr 2sP�„5017 �6w " d 14N
............. ................................................................................................................................................................................................................................................I............ ,
Latitude M1• ` " Loiigitude • 4,
awme
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
u rrent
roputataon
Design Current Design Current
Poultry Capacity Population Cattle Capacity Population
❑ Layer 'Dairy 3p0 2SO
❑ Non -Layer ❑ Non -Dairy
❑ Other [
Total Design Capacity r -qo 0
Total SSLW 1 77 797
'`Number of Lagoons / Holding Ponds 10 Subsurface Drains Present ❑ Lagoon Area
ID Spray Field Area
:. ❑ No Liquid Waste 1Vlanat;etnent System
General
1. Are there any buffers that need maintenance/improvement?
❑ Yes
WNo
2. is any discharge observed from any part of the operation?
❑ Yes
WNo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made'
❑ Yes
_allo
b. If discharge is observed, did it reach Surface Water? (If ves, notify DWQ)
❑ Yes
.t'No
c. If discharge is observed, what is the estimated flow in gal/min?
d. D(:)cs discharge bypass a lagoon system?(Il' yes, notify DWQ)
❑ Yes
E `No
3. Is there evidence of past discharge from any part of the operation?
❑ Yes
.E�No
4. Were there any adverse impacts to the waters of the State other than from a discharge?
❑ Yes
allo
5. Does any part of the waste management system (other than lagoons/holding ponds) require
❑ Yes
--IffNo
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
RNo
7. Did the facility fail to have a certified operator in responsible charge?
❑ Yes
'Wo
7/25/97
Continued on back

Facility Number: qc, —
8. Are there lagoons or storage ponds on site which need to be properly closed. ❑ Yes )SP No
Structures (Latroons,11olding Ponds, Flush Pits etc.
9. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes Q No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 0
Identifier:
Freeboard(ft): .................................. .... a).,.........................,.,.............................................................,......,.,...............,.,........................,.........,..
10. Is seepage observed from any of the structures'? ❑ Yes allo
11. Is erosion, or any other threats to the integrity of any of the structures observed? ❑ Yes &No
12. Do any of the structures need maintenance/improvement? IsYes XNo
(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? A Yes ❑ No
Waste Application
14. Is there physical evidence of over application? ❑ Yes KNo
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type ........................................ `-�"``..........................,.,................................................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)? ❑ Yes ❑ No
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
22. Does record keeping need improvement'?
For Certified or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
25. Were any additional problems noted which cause noncompliance of the Permit'?
No ',violations or deficieheies.were noted during this.visit.-.You.will receive no further
coe..resOfidence ab"out this'. visit'.,."
❑ Yes la -No
❑ Yes 5�N0
❑ Yes NINO
❑ Yes O'No
❑ Yes -ffNo
❑ Yes e No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
Comments (refer to question t). Explain any YES answers and_/or any recommendations or any other con_nienls.
Use drawings of facihfy tti Better explain situations. (use additional pages as necessary)" M"
�U ,.
•, L1 1i-dt"s
f. tea e �tmee.r 0,tv ZAk6t N.`4 Pi&K Aa> i°Ig �, "�" "'r inQL (�a-1
� t s
ly�'UrYvucft6✓� �5,c.�C.� !�'�GLt !9'`7�. oSl[.p�.t%C!'� I,�—�vr �-(�-� �� '�
OGl S'L op . 11 b P t.a9't's C�wS jl_ [ j
7125/97
Reviewer/Inspector Name .. f I
Date:���%j
Reviewer/Inspector Signature: