760060_INSPECTIONS_20171231

Division of Water Resources
Division of Soil and Water Conservation
Other Agency
Facility Number: 760060 Facility Status: Active Permit: AWC760060 Denied Access
Inpsectlon Type: Compliance Inspection Inactive Or Closed Date:
Reason for Visit: Routine County: Randolph Reglon: Winston-Salem
Date of Visit: 09/26/2017 Entry Time: 01:00 pm Exit Time: 3:35 pm Incident 0
Farm Name: Koopman Dairies Inc
Owner: Koopman Dairies Inc
Mailing Address: 204 Lloyd Rd
Physical Address, 4105 Meredall Farm Rd
Facility Statua•
Owner Email:
Phone: [phone]
Statesville NC 28626
Liberty NC 27298
❑ Compliant Not Compliant Integrator.
Location of Farm: Latitude: 35° 51' 22" Longitude: 79' 38' 27"
Farm address: 4718 Ramseur- Julian Road, Liberty, NCUS Hwy 421 south from GSO. Right onto Old Liberty Rd. Right onto
Ramseur -Julian Rd. Farm is on right. ..,,
Question Areas:
Dischrge & Stream Impacts Waste Col, Stor, & Treat Waste Application
Records and Documents Other Issues
Certified Operator: Ard Koopman Operator Certification Number: 997080
Secondary OIC(s):
On -Sine Representative(s): Name Title Phone
24 hour contact name Ard Koopman Phone : [phone]
On -site representative Ard Koopman Phone : [phone]
Primary Inspector:
Inspector Signature:
Secondary Inspector(s):
Inspection Summary:
334. 77(0 , q(oR9
Phone:
Date: -* ig `7
page: 1

Permit: AWC760060 Owner - Facility: Koopman Dairies Inc Facility Number: 760060
Inspection -Date: - 09/26/17 - .. • Inppection Type: Compliance Inspection Reason for Visit:-- Routine
3. No water quality concerns noted below freshwater pond.
7. Location of future WSP #5 on Slarmount Road looks to be ok as long as it meets setback requirements (wells, houses,
streams, etc.).
7. Please try to establish additional permanent vegetation on dams of waste ponds 1 and 3.
8, Marker in 92 WSP (lower) has not yet been re -set (see 2016 inspection). Engineer, Sam Bingham, to come in two weeks to
survey amd re -set. `*'Upon completion, can change inspection to "compliant."
21. Soil tests that are due in 2017 have not yet been completed. Check next visit.
21. Please use usable acres when completing PAN balance forms (i.e. SLUR-2, Solid-2, etc.).
21. T-11402 F-1 was recorded on PAN balance form but not listed in waste plan. Typo in records?
24. All calibrations (solid, slurry, and dragline) completed in 2017. Required again in 2019.`
32. New land has been added to waste plan. Suggest also listing new tractslfields in narrative part of waste plan.
32. "Cover crop" received waste Fall 2016 but could not locate this "crop" and the allowable PAN (30 lbs. Nlacre) in waste plan.
Please add. May include in narrative,
32. Sorghum silage received waste in the summer of 2016 and 2017 but this crop is not listed as a receiving crop in the most
recent waste plan (September 2017). Tract/Fields receiving waste on a crop not listed in the waste plan include: T-3624; T-4427
F-1&2; T-4457 F-1&2; T-4543 F-1; T-5458; T-9532: T-11136 F-1; T-12033; T-12058 F-1&2; T-12573; T-1001541; T-1001542. Mr.
Koopman used the PAN for small grain to complete his records. No overapplication of nitrogen expected. Please contact technical
specialist to have this crop added to waste plan. Will update inspection report once this task is completed.
"Any animal waste management issues pertaining to the April 6, 2017 complaint investigation have already been addressed in
DV-2017-0035 and are not included in this report.
page: 2

i
i
•
Permit: AWC760060 Owner - Facility: Koopman Dairies Inc Facility Number: 760060
Inspection Date: 09/26/17 Inpsection Type: " Compliance Inspection Reason fof Visit: Routine
Regulated Operations Design Capacity Current promotions
Cattle
Cattle - Milk Cow 5,000 1,830
Total Design Capacity: 5,000
Total SSLW: 7,000,000
Waste Structures
Disignated Observed
Type Identifier Closed Date Start Date Freeboard Freeboard
Waste Pond
04
18.00
120.00
Waste Pond
LARGE WSP #3
38.00
Waste Pond
LOWER STAGE #2
48.00
Waste Pond
UPPER STAGE #1
28.00
page 3

IF
10 •
Permit: AWC760060 Owner - Facility : Koopman Dairies Inc Facility Number: 760060
Inspection Date:•-•09/26117 Inppection 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?
❑
M ❑
❑
Discharge originated at:
Structure
❑
Application Field
❑
Other
❑
a. Was conveyance man-made?
❑
■ ❑
❑
b. Did discharge reach Waters of the State? (if yes, notify DWQ)
❑
M ❑
❑
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)
❑
M ❑
❑
2. Is there evidence of a past discharge from any part of the operation?
❑
0 ❑
❑
3. Were there any observable adverse impacts or potential adverse impacts to Waters of the
❑
0 ❑
❑
State other than from a discharge?
Waste Collection, Storage & Treatment
Yee No Na Ns
4. Is storage capacity less than adequate?
❑
M ❑
❑
If yes, is waste level into structural freeboard?
❑
5. Are there any immediate threats to the integrity of any of the structures observed (Le./ large
❑
0 ❑
❑
trees, severe erosion, seepage, etc.)?
6. Are there structures on -site that are not properly addressed and/or managed through a
❑
0 ❑
❑
waste management or closure plan?
7. Do any of the structures need maintenance or improvement?
M
❑ ❑
❑
B. Do any of the structures lack adequate markers as required by the permit? (Not applicable
0
1111
❑
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?
Waste Application
Yea No Na No
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ M ❑ ❑
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?
❑
Is PAN > 100ro/10 lbs.?
❑
Total Phosphorus?
❑
Failure to incorporate manure/sludge into bare soil?
❑
Outside of acceptable crop window?
❑
Evidence of wind drift?
❑
Application outside of application area?
❑
page: 4

Permit: AWC760060 Owner - Facility : Koopman Dairies Inc Facility Number: 760060
inspection Date:- � 09/26/17 Inspection Type: Compliance Inspection Reason'foir' Visit: Routine
Waste Application
Yes
No Na No
Crop Type 1
Com (Silage)
Crop Type 2
Small Grain Cover
Crop Type 3
Sorghum,
Sudex (Silage)
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
0
❑ ❑
❑
Management Plan(CAWMP)?
15. Does the receiving crop and/or land application site need improvement?
❑
E ❑
❑
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre
❑
❑ 0
❑
determination?
17. Does the facility lack adequate acreage for land application?
❑
0 ❑
❑
18. Is there a lack of properly operating waste application equipment?
❑
MCI
❑
Records and Documents
Yes
No Na No
19. Did the facility fail to have Certificate of Coverage and Permit readily available?
❑
E ❑
❑
20. Does the facility fail to have all components of the CAWMP readily available?
❑
❑
❑
If yes, check the appropriate box below.
WUP?
❑
Checklists?
❑
Design?
❑
Maps?
❑
Lease Agreements?
❑
Other?
❑
If Other, please specify
21. Does record keeping need improvement?
❑
❑
❑
If yes, check the appropriate box below.
Waste Application?
❑
Weekly Freeboard?
❑
Waste Analysis?
❑
Soil analysis?
❑
Waste Transfers?
❑
Weather code?
❑
Rainfall?
❑
Stocking?
❑
page: 5

Permit: AWC760060 Owner - Facility : Koopman Dairies Inc Facility Number:
760060
Inspection Date: •09126/17 Inppection Type: Compliance Inspection Reason for Visit: •-
Routine
Records and Documents
Yes
No Na No
Crop yields?
❑
120 Minute inspections?
❑
Monthly and 1" Rainfall Inspections
❑
Sludge Survey
❑
22. Did the facility fail to install and maintain a rain gauge?
❑
0 ❑
❑
23. If selected, did the facility fail to install and maintain a rainbreaker on irrigation equipment
❑
0 ❑
❑
(NPDES only)?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑
❑
❑
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check the
❑
❑ 0
❑
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?
❑
01111
27. Did the f3cility fail to secure a phosphorous loss assessment (PLAT) certification?
❑
❑
❑
Otherlssues
Yes
No Na No
2B. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑
m ❑
❑
and report mortality rates that exceed normal rates?
29. At the time of the inspection did the facility pose an odor or air quality concern? If yes,
❑
E0
❑
contact a regional Air Quality representative immediately.
30. Did the facility fail to notify regional DWQ of emergency situations as required by Permit?
❑
E ❑
❑
(i.e., discharge, freeboard problems, over -application)
31. Do'subsurfaoe tile drains exist at the facility?
❑
❑
❑
If yes, check the appropriate box below.
Application Field
❑
Lagoon / Storage Pond
❑
Other
❑
If Other, please specify
32. Were any additional problems noted which cause non-compliance of the Permit or
0
❑ ❑
❑
CAWMP?
33. Did the Reviewer/inspector fail to discuss reviewhnspection with on -site representative?
0000
34. Does the facility require a follow-up visit by same agency?
❑
0 ❑
❑
page: 6

L' %J
'ivis"•ion of Water Resources I
Facility Number - ©Division of Soil and Water Creation. - d�P
0 Other Agency
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
r
Date of Visit: 17 Arrival Time: p M Departure Time: County: ROLrOljo h Region: W5RZ
Farm Name: �466p man_ I)_a_ i C&,5 n G -
Owner Name: Ar4t COD¢M A-V1
Mailing Address: oZ d `1 Lloyd Rd, 5-16A -5
Physical Address:
Owner Email:
Phone:
i tle _ Mc, 7.-7 z9
Facility Contact: /� rd k_oap (n a1'1 Title:
Onsite Representative:
Certified Operator: Back-up Operator: �, rIL _ Ts & 4/
n f;r.,hn• 'd y''/ 11 / t I nnrtit �.ln• -% a O :2
Location of Farm:
N9 C' 02- 7 ,1-1„X
Phon�Q 9oZ9 - al�s�
Integrator:
Certification Number:
Certification Number:
05 [ uq a1S old 6 i be..,-j 2d,! ®R-
Ian
Design
Current
Design
Current
Design Current
Swine Capacity
Pop.
Wet Poultry
Capacity
Pop.
Cattle
Capacity Pop.
Wean [o Finish
La er
DairyCow
Q
Wean to Feeder
Non -La er
Dairy Calf
Feeder to Finish
1.
Dairy Heifer
Farrow to Wean
Design
B
Current
Dry Cow
Farrow to Feeder
Drr P4oultr,.
Ca aci
P,o P.
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -La ers
l
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
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 jo No [] NA_._0 NE
[] Yes
❑ No
❑ NA
❑ NE
❑ Yes
0 No
❑ NA
❑ NE
❑ Yes ❑ No
❑ Yes o
❑ Yes No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 21412015 Continued

Facili Number: - Date of Inspection:
24. Did the facility fail to calibrate waste applicaaion equipment as required by the permit? ❑ Yes ,N'KIo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑ No tSj"KA ❑ 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 XNo ❑ NA ❑ NE
❑ Yes { k( No
❑ Yes (�J`No
❑ Yes Ao
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. ❑ Yes C�`No ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? Yes ❑ No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes No ❑ NA [] NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes [1Vo ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers andlor any additional recommendations or any other comments. -
Us swings of facility to better explain situations (use additiongo4es as necessary).
0 Z C to t,a ter, Itri ar k� r�-- 5 �-Ir 5 at�w+ fi l e �roM � Z -�,r 5 L v 2rejcZ
+e-S- S d v Z. 6 (7. N of � e+ t✓o 41e-f� i G V e_c- 1L A e-?,-+ \1 L S i
b r &_ o n o P 5o 1 i 5 P r-e�4-v' y- ok r-a ) i n C u e_ a o (`(� Co l
N� t,v l a.n dl dd J is w u P 2 A60 � N c�-eve T- Nod 3z- F= I, z 3
i
�� T io-r3�f F- � � 2►3
en+ � ra55 on �j` 1D�3 �t F- I 2
�' t ►-' C:t�-tirt� -�2sh kl� �or� , t t° 3 z3
� VA T- Ica 1 3 j 1�'t,I*
3 4 1
�57 F2_ IN T144 -Z7 -2----
7- 11E34 F I -r 1Z051 F- 4- 2-T ' i,zo 3 3 - 7- 4S3Z ? T- l0015-Z.
I T-12S--73ath
o� er P � � �A 0--�JL� �q.,x, d CAA bp t rt n �' ra � v
5P use vsa-b le a.G SSA
-*I, . *rq, �O r5 430,W.?2- PMV
+o d a�/ r&V .r i Y' 4-0 0LC_-1 1 +-1 a
Reviewer/I Spector Name:
Reviewer/Inspector Signature:
Pa` 3 T- I I q6 z r - l
Phone:.3�" -alp—%9 1
Date: q17
2/4/Z015
— 1� r vu-, i �� d\/ P o?
Sail In 5nrj
+i! me-, J

Facilit Number: J 7,j- Date of Inspection:
40
Waste Collection & Treatment L`ti,e
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 Structure 5 Structure 6
Identifier: !! )n u_ie ` L4, LL> $ P Wa o w5P
Spillway?: t 'L
(fir
Designed Freeboard (in): 2 $ 11
t�
Observed Freeboard (in): � rc D " 7 iryk xx_ _ O
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes EXo ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement?
9Yes [:]No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
(�Yes ❑ No
T
❑ 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 O-No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground
❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑
Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift
❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? Yes WNo
No ❑ NA ❑ NE15. Does the receiving crop and/or land application site need improvement? Yes ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes ❑ No ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application? ❑ Yes RlGo ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes ❑ NA ❑ NE
Required Records & Documents �jKNo
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 5? o ❑ NA ❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
2 . Does record keeping need i provement? e ❑ Yes No DA ❑ NE
[aste Appiicat' n ekly Freeboard Waste Analysis Soil Analysis �n-'i` "----`---eather Code
Rainfall Stocking Crop Yield !20 Minute Inspections [Monthly and 1" Rainfall Inspections �srvey
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 -PR:NA ❑ NE
Page 2 of 3 21412015 Continued

P
Type of Visit: 9R Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance FI
Reason for Visit: Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access 1J
Date of Visit: Arrival Time: Departure Time: County: l 0 hRegion: \&LSM
Farm Name: rn 0-Ali .1 Y' 4 e5 Xn c Owner Email:
Owner Name: A rat lL oO P m zLn Phone: fto4) -1 Q 9
Mailing Address: , Z Q N lk Vd 12d... Sf—A +;to,5 V I r r te._AJ Wir6 AS
Physical Address:
Facility Contact:
MIT u ' . �, 01_f
Onsite Representat
Certified Operator
Back-up Operator:
Location of Farm:
NC, 9-7 ;Lq e
Phony'? 0� U
Integrator:
(Certification Number:
7 / Certification Number:
! f b , 1
rl
Latitude:.15 S ! 10 1rLongitude:'7931x7
0093� OP
u 5 vjy �! S R. 4 L� r,l-c,� Pd-
TT
I
�
t
IS
■
--
'
■
--
e ■
1 1 1 4
--
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 9 No ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes ❑ No
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes [ No ❑ NA ❑ NE
❑ Yes No . ❑ NA ❑ NE
Page I of 3 21412015 Continued

Facility Number: - jDate of Inspection:
— 46 W
Waste Collection & 'Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 0 No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes ❑ No ❑ NA ❑ NE
Structure I 5tri�t u r c Structure 3 aStructure 4 Structure 5 Structure 6
Identifier: P- Wx WSQ
�illway?:1 t ]Tp�
I)A
D
Designed Fretin : tJfV� © ""�Z� � �0 Vr
Observed Freeboard (in): i k 9�B1�0
5. Are there any immediate threats to the integrity of any of the structures observed? + ❑ Yes 5� No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes �(No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes E4No ❑ 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 �io ❑ 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? 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
O
12. Crop Type(s): ob, g.�j
13. Soil Type(s):
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 ❑ Yes No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application'? ❑ Yes .Eno ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes P4 No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes �rNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes Wol�o ❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
VVWaste
es record keeping need i rovement? ess.eizee ❑Yes J, r ❑ NA [] NE
Application ekly Freeb;��
aste Analysis it Analysis Bather Code
ainfaII Stocks op Yield Minute Inspections onthly and 1" Rainfall Inspections
22. Did the d 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 21412015 Continued

Facility Number: "1 - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? if yes, check ❑ Yes 1111���❑"'' No �. A ❑ 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 Y5 No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ` NZNo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
3 I. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:'
❑ Yes p t' No
❑ Yes KNo
❑ Yes �No
❑ Yes A No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAW MP? ❑ Yes No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes No ❑ NA ❑ NE
Comments (refer to question #): Explain any YES.answers and/or any additional recommendations or any other comments.
U a drawings of facility to better explain situations (use additional pages as necessary).
re- - 5 e-+ ? a." Lf- o rn Z +6r 5 L
�i 5ol a.d 17.
Cal'c br iarL &C*A fle,+dA j'olr Sol id .5p r-eaAes' +- 1n
�e 7
J �
i a1 iz Ja 0 15
Reviewerllnspector Name:
Reviewer/Inspector Signatuw
Page 3 of 3
t, 5D 9- 1 tyl-tDo" 1i 6 :-- C2 i S & ) ��; rj /-rm
C,,'5 04 1 bs - Wjoco RJ ,
Phone
Date: �
,2141201 S
R

Type of Visit: Com liance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: ARoutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: 4 ( J
Arrival Time:
Departure Time:iounty:y���
Farm Name: K ODPfY\o n -N-i 6 cs
Owner Email -
h Region: _LL-) LC
Owner Name: 1L6ofay)0_-\ bi V-i P-5 =h C Phone: r�C�' I R a 9 "' b� Cam' [ f
Mailing Address: o2 0 q L 6 V J P-d 5 t-0_+,0_5 'J [ t l e. C a 8 ��
Physical Address: �� a S� fAW10_C P_ rcLr` ryl 2 6L . L i Wt1+"j:j j • N L 77 7 9- 9 23
Facility Contact: Ar-A K6Qp ma-n Title: Phone: U S76 — 1 q09
Onsite Representative: Integrator:
Certified Operator: Certification Number:
Back-up Operator:
Certification Number:
Location of Farm: Latitude: 3S-' .S 1 " 16 11 Longitude: 7 J ° 3 $ 1 a q "
US w� 4,24 SJ11 u. beriij RA PDAIUL Stu✓
Design Current Design Current
Swine Capacity Pop. Wet Poultry Capacity Pop.
Wean to Finish I JLayer
Design
Cattle C►apacity
Dairy Cow (j0
Dairy Calf
C►urrent
Pop.
Wean to Feeder I INon-Layer
I
Feeder to Finish
Dairy Heifer 60
Farrow to Wean Design Current
Farrow to Feeder D , P,o_ultr. Ca aei l;op.
Dry Cow
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layer
Beef Feeder
Boars
Pullets
113eef Brood Cow
Qther
Other
Turke s
Turke Points
Other
Discharges and Stream Imuacts
1. Is any discharge observed from any part of the operation?
❑ Yes
N 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
E(No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes [d No ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 21412014 Continued

Facilit Number: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the steal freeb ard? � ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1-Ptructure 2 Structure 3 *tructure 4 Structure 5 Structure 6
Identifier: 1, 4' t,o t.u-'e� 1�i5 g,1,tJ
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): �' ) a- s
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 4No ❑ 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 {"f 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 Dq No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? Yes jo 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 a]tematives that need ❑ Yes QNo ❑ 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 l0 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
Yes
[:]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
Reauired 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 CAWjAadil v 3k yes, check Yes 7— No ❑ NA ❑ NE
the appropriate box. !,�nMaps
'�t
❑WUP ❑Checklists * ❑ Lease Agreements ❑Other:
2l . es record keeping need i ovement? TTTTTT����'' ❑ Yes �J No ❑ NA ❑ NE
ste Applicaf nE91ekiy Freeboard Waste Analysis oil Analysis 111---Fen ❑ Weather Code
Rainfall Stocking Crop Yield ❑ 120 Minute Inspections onthly 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 TTT❑No IS�NA ❑ NE
Page 2 of 3 21412014 Continued

Facility Number: - L Q , 1 Date of Inspection: I 111 qS
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑ No NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes 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
P9 No
❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
% No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes]
No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
Yes
❑ No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No
X
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
E No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any.additional recommendations or any other comments.
UV,dKwmgs of facility to better explain situations (use additional pages a essary).
rr- I af16 i'1 2s r1 oh
6 i �I i Ipv o �-ib n Go 1e,4io ni br
rx PA QA)+5 MC w eA ? �(�s.1hau.l�-S . 5 ''P e n e Q 1
o It -1 •� . -} n Y* P n e��
1i P�%` Qi4N aC L i� i�C� U P ? 1 F1� a S+�@- �-�C�1 5 P GG it Ls k-
3 Tr&_L+s iP ? NoA- le'k-- S ee'
ao�-70
u P w nti A re, v i sect t-o (Xc.cou n-}- �6 V_ to s S cs� e o.t�e d U e--
P i +n �u L i # v� : No - Sew fps h sW -JAsi
I 2b I� Darn yie_16�s .5or4hurvL ylado,
err a. V -
Ig -ion mk' t��s+e. 1�0.s nod
S New �o n.ds Sorg
uvr� toT-�oot3 F-�F l
Powns r o- - ne!4A . 11" saAuzIe, J�om 1 0 Z on Iv Srono, w asloe i
Reviewer/Inspector Name: S r t� Phone: '�f — Q 42 q�
Reviewer/Inspector Sign lure: Date: I j f ';1-6 J-5
Page 3 of 3 �t 1� n r mar
�� V • n 0 �J 2/4/2014
Pi � 5 t� v YLX�'y 1c.�Q,�' � j' I, L► A

Type of Visit: C mpliance Inspection U Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: I Im Departure Time: ® County: �h Region: V &a
Farm Name: &onimoa i Dair 4a 5 Owner Email:
Owner Name: K ao p rn o-n Z 0!j r %e-:5 � Y'/VC• � Phone: _70 j 4 ;Lq — 0 &.S-9
Mailing Address:
Physical Address:
Facility Contact: Arj 001Q MQMTitle:
Onsite Representative: Ard 60-N
Certified Operator:
Back-up Operator:
Phone: g %(%0�/}$7lp — �f`l a9
Integrator:
Certification Number: V/
Certification Number:
Location of Farm: Latitude: J_i -61 f (D Longitude: _7q 3 $ oz
u5;ao 51 U5 Ft" 421 S� f r2+. onto 04 L1 er411 _A •) Uk, one
R&M,Seur - Xu i io-n R
Design Current Design Current Design
Swine Capacity Pop. Wet Poultry Capacity Pop. Cattle Capacity
Current
Fop.
Wean to Finish
La er
Dai Cow
.S
Wcan to Feeder
Non -La er Dai Calf
DairyHeifer
Design Current D Cow
Q
Feeder to Finish
06
Farrow to Wean
Farrow to Feeder
Dr, P,oultr, C*.a acl P,o P. Non -Dal
Layers Beef Stocker
Farrow to Finish
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turkeys
Turkey Puults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ,
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Ye's XNo ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes []No
[:]Yes ❑ No
❑ Yes YNo
❑ Yes ONO
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3 21412014 Continued

Facility Number: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ONo ❑ 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: L4Q.k15P P.t�
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):.---
5. Are there any immediate threats to the integrity of any of the structures observed? D 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 [N'% ❑ 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? 9yes ❑ 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 XNo ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes )?r,No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s): V
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes rNo
o ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑Yes -❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ YesVo ❑ NA ❑ NE
acres determination? J�
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑ Yes No
❑ Yes ('�f No
❑ Yes ANo
❑ Yes Zo
❑ Other:
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
21. oes record keeping need i provement?-if-y+ee; e ❑ Yes �No ❑ N// ❑ NE
W to Applicat' n eekly Freeboar Waste AnalysisFonthly
Analysis ['Weather Code
ainfaII tocking Crop Yield 1120 Minute Inspections and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? 0 Yes ;eNo D NA ❑ NE
23. If selected, did acility fail to install and maintain ra�in,bre�ak{ers, on irrigation equipment? ❑ Yes No ❑ NA ❑ NE
Page 2 of 3 21412074 Continued
,P

Facility Number: Date of Inspection:TO 7,261
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑ No CA NA ❑ NE
the appropriate boxes) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes 25—No
❑ Yes 0;'No
❑NA ❑NE
❑ NA ❑ NE
❑ Yes
YNo
❑ NA
❑ NE
❑ Yes
O(No
❑ NA
❑ NE
❑ Yes
DgrNo
❑ NA
❑ NE
❑ Yes
�No
❑ NA
❑ NE
❑ Yes CR No ❑ NA ❑ NE
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes [ 6o ❑ NA ❑ NE
n or any other comments.
swings of facility to better explain situations (use additional pages as necessa ). I UP
3 11 ,a ? MO No Iq
.�le
t
ents (refer to
n any vt s answers antvor any
I I _Aji-CAP '_�
LA.-, 01 3 110 a0 f S� &ZL, S +10
7J S"A.P" _dAr-1
C L) 4- z. n 7
J0 N ?6!" -bn> W U Pa
al.Lew to w U P ? [004L� e -
a0L 31 Lr_- ao 14. �e
64 jqA�-� UU.• PU
LAD
v
is t� as 3 c,sL)U _je.
Reviewer/Inspector Name: p�SSGI, 0 ,�jn roC.� Phone:
Reviewer/Inspector Signature:
Page 3 of 3�'-
Date:

15,t- �nJ-ew
U

Type of Visit: Compliance Inspection n 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: to Arrival Time: Departure Time: County: 010 Region:
Farm Name: KoDmA h rle 5 _ Owner Email:
Owner Name:ppn� n=h Qi rig-5 C c Phone: 8P-11
Mailing Address: -o`t L:b44 R' 1a �Lle_, N
Physical Address: "1I 6.5 U0,l p_d p_lZ f'.! o"Z 7
Facility Contact: r m Title: Phone: 0 7 9
a9
Onsite Representative: r & K06IQImQ,ys Integrator:
k
Certified Operator: I>�-r�ptman Certification Number:
Back-up Operator:
Certification Number:
Location of Farm: Latitude: 34" 5-1 r to Longitude: _7_'�_1 A y
Design,
U6!14gent.
Design Current
Design Current
Swine
Gaparlty
°Pop.,
i'Vet Poultr,;y , .
Capacity P.op.
Cattle`
Capacity
Pop.
t
�&`
t
Wean to Finish
La er'Dairy
Cow
p
Wean to Feeder
Non -La er
Dairy Calf
OQ
Feeder to Finish
USIDairy
Heifer
OD
Farrow to Wean
Design. Current
Dry Cow
Farrow to Feeder
D.r, P,oultr,
Ca aci P,a .
Non -Dairy
Farrow to Finish
La era
A
Beef Stocker
i
Gilts
Non -Layers
Beef Feeder
L
Boars
Pullets
Beef Brood Cow
Turke s
©.theeMill
Turkey Poults
Other
Other
Discharges and Stream Impacts
I. Is any discharge observed from any part of the operation? ❑ Yes C�No ❑ NA ❑ NE
Discharge originated at; ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) ❑ Yes ❑ No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) [] 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 1 of 21412011 Continued

Facili Number: - &Q Date of Ins ection: I 0
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes P No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: L on
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes [XNo ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.) 77��``
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes gNo ❑ 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 WNo ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes ONo ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes 0No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes X(No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ` [:]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 W``indoeew__--❑ Evidence of Wind Drift ❑ Application Outside of Approved Area L
12. Crop Type(s): ['A lit J .�..0 � � ■ �� &..&J-0 _ 4"IA'e
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes gNo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes WNo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable Yes M No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application? ❑ Yes KNo ❑ 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 ❑ 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 i rovement? Yes ❑ No ❑ NA ❑ NE
V
aste Application Weekly Freeboard ❑ Waste Analysis Soil Anal sis Waste Transfers ❑ Weather Code
infall �*D
Crop Yield ❑ 120 Minute Inspections Monthly and 1" Rainfall Inspections Sludge supyey.
22. Did the facility fail to install and maintain a rain gauge? []Yes No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: - Date of Ins ectlon:
24, Did the facility fail to calibrate waste appli*n 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
CgfNo
❑ NA
❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/ordocument
00 1
❑ Yes
No
0
❑ NA
❑ NE
and report mortality rates that were higher than normal? % ,3 *Ro I
29, At the time of the inspection did the facility pose an odor or air quality concern, W ��-0
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
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 O� No ❑ NA ❑ NE
❑ Yes 4 No ❑ NA ❑ NE
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? ❑ Yes51No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes XNo ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or^any additional recommendations or any=other comments., 777,
Use drawings of facility to better explain situations (use additional pages as necessary).
Oil
/ , 1
1 =,
Reviewer/Inspector Name:
Al (d&PAL� ) App��d
_SaS
Phone: ��7 �
Date: f -^!3
A2/4/2011

M-A X-6 H 44 l 3
NCDABCS Agronomic Division Phone: [phone]
Website: www.neagr.gov/ngronornil
Report No. FY13-WO06694
Chris Cass
Page 3 of 5
Sample Information
Nutrient and Other Measurements
Nitrogen (N) (ppm)
P (DDm)
K (ppm) Ca (ppm) Mq (ppm)
S (ppm) Fe (ppm) Mn (ppm)
Zn (Gpm) CU (Pon)) B (pDm) Na 1ppm)
C (Dpm)
Sample !D: i(4
Total N
212
1110 729 275
142 134 9.59
8.18 2.53 5.33 377
Waste Code: LSD
Description:
Total Kjeldahl N 1320
-------------
..................
.....................
--------- ..-- ---- ...............--..
Dairy L'+q. Slurry
pH
DM (%) SS (10-5S/cm)
EC (mSlcm)
GCE (90) ALE(1000 gal.)
C:N
inorganic N
NH4-N
6.71
Comments:
NO3-N
Organic N
Ni Win)
Cd (ppm) Pb (porn) Al (ppm)
Se (ppm) Li (porn) As
(DDm) Cr (ppm) Co (ppm) Cl (ppm)
Mo (ppm)
Ursa
Estimate of Nutrients Available for First Crop (lb 11000 gal.)
Other Elements (lb 1 1000 gal.)
Application Method
N P205 K20
Ca Mg
S Fe Mn Zn
CU a Mo
Cl Na Ni Cd Pb Al
Se Li
Broadcast 1
4.75 2.84 8.87
4.25 1.61
0.63 0.78 0.06 0.05
0.02 0.03
3.14
Sample Information
Nutrient and Other Measurements
Nitrogen (N) (ppm)
P (ppm)
K (ppm) Ca (ppm) Mq (ppm)
S (Dpm) Fe (ppm) Mn eaum)
Zn ftm) Cu (ppm) 6 (r?pm) No (ppm)
C (PP-)
Sample KS
Total N
141
737 459 180
88.7 84.7 5.84
5.19 1.65 1.04 231
Waste Code: LSO
Description.
Total KJeldahl N 760
:------- ............
•---------------------------
. ........ ----------............
----------------------- --------------------
Dairy Liq. Slurry
pH
DM (Y.) SS (10-5S/crn)
EC (mS/cnI)
CCE (%) ALE(1000 gal.)
C:N
Inorganic N
NH4-N
6.70
Comments:
NO3-N
--------------------
----------•----------------.
Organic N
Ni (porn)
Cd (ppm) Pb (ppm) Al (ppm)
Se (Dpm) Li (ppm) As
(ppm) Cr (ppm) Co (ppm) C) (ppm)
pm)
Urea
Estimate of Nutrients Available for First Crop (Ib 1 1000 gal.)
Other Elements (lb 1 1000 gal.)
Application Method
N P206 K20
Ca Mg
S Fe Mn Zn
CU B Mo
Cl Na Ni Cd Pb AI
Se Li
Broadcast
2.73 1.89 5.90
2.68 1.05
0.52 0.49 0.03 0-03
0.01 0.01
1.93

(Type of Visit: 9 Colnpliance Inspection U Operation Review U Structure Evaluation U Technical Assistance I
Reason for Visit: Routine 0 Complaint O Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: "1 o?S jlrrival Time: Departure Time: I I a ounty: ICGU G10 I )jRegion: 165RO
Farm Name: k6opli') CLy\ i r i Q Owner Email;
Owner Name: 14 ov R DA W-N J)CAl i` I P S L Il C_ . Phone:
Mailing Address: a o q Loy u (z6 , S fLl�e V ! I !
Physical Address
Facility Contact:
q 105 iM axed ej 1 ,From... PA. I
Arat 1,me lAtle:
Onsite Representative: r16 UX'S.D
Certified Operator: A rd Y woma'l
aS
,i b r4-u
Phone: d L fp' 9lIC
Integrator: _I
Certification Number:
Back-up Operator: Certification Number: +/
Location of Farm: Latitude: 3 S 51 I 10 Longitude:
Design
Current Design Current Design C►urgent
ltryapacity Pop. Cattie Capacla
to Finish
La er
Dai Cow O
to Feeder
Non -La er Dai Calf
Dai Heiferw
r to Finish
to Wean
tFarrowto Feeder
w to Finish
Design Current D Cow
Dr� P.oultr. Ca aci l;o Non -Dairy
La ers Beef Stocker
Non -La ers Beef Feeder
Pullets
Beef Brood Cow
Othe ITurkey
Other
Turkeys
Poults
10thor
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
C. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
,\2. Is there evidence of a past discharge from any part of the operation?
\Were there any observable adverse impacts or potential adverse impacts to the waters
Nf the State other than from a discharge?
\lZe 1 of 3
❑ Yes iNo
[] Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes No
Yes No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
[DNA ❑ NE
❑ NA ❑ NE
21412011 Continued

Facility Number: -tn ID Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: t) 13 049_ Low-er VStC1Z
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes WO
❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes ONo ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ES1 INNS ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
VNo ❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
tR<O ❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
WIN o ❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
N ❑ 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. D s record keeping neFi vement? If yes, check 'appropriate box below. ❑Yes No NA,/ ❑ NE
�ste Appli�nly Freeboard Waste Analysis Soil Analysis [�iV7sstenmsi�F� L(v weather Code
ainfall tockingYield 20 Minute Inspections Monthly and V Rainfall Inspections 24wdg"wvuy
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes iNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes XNo ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

FacilityNumber: jDate of Inspection:
24. Did the facility fail to calibrate waste apOication. equipment as required by the permit? ❑ Yes J� 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 boxes) 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 WO'No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes jSeNo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
NNo
❑ 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
[26o
❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
o
❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
���'''''''''ttt
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
N/No
❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
Y
,�,/es � 0
❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
PCWo
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
Wo
❑ 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):,
1
rLW
� I
v'tri r0.C+ I0-7 30
1 rpigQ�Co�
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
dD
0
y i ►
. r �, 4� � 1 E• . �! y fl> S
o� Pal*
/�oal3. F-1 PWQOQ
zi
I'M, MxvAl' I Mum I Date: -7 JA P-C) I
r.

"� "I.� t.YM� `A�:f`•w�' YI�.Fy` \ z'f :C,�� - � Y I .�"V' -
+ k'
i4lil' It.
� .:Zz
. - o � � � St � �h•+!''t�{'_a,.t�fi�..3�jy'4` � ��•yytt.��4 ��; 1 �f, �
aLl i
•�' - f � ���� wok �'` ti.�lif �, ,'r.l ��; � - _. �.
ti

Division of Water Quality
❑ Division of Soll and Water Conservation
❑ Other Agency
Facility Number: 760060 Facility Status: Active Permit: 6WC7600QQ ❑ Denied Access
Inspection Type: Compliance Inspection Inactive or Closed Date:
Reason for Visit: Complaint I County: Region: Winston-Salem
Date of Visit: gZ/08/2012 Entry Time: 10:00 AM Exit Time: 10:45 AM Incident #:
Farm Name: Owner Email:
Owner: Phone: 704fmB76-4909
Malling Address: 204 Lloyd Rd Statesville NC 28625
Physical Address: 4105 Meredall Farm Rd Liberty NC 27298
Facility Status: E Compliant ❑ Not Compliant Integrator:
Location of Farm: Latitude: 35°51'22" Longitude: 79°38'27"
Farm address: 4718 Ramseur- Julian Road, Liberty, NCUS Hwy 421 south from GSO. Right onto Old Liberty Rd. Right onto
Ramseur -Julian Rd. Farm is on right.
Question Areas:
11 Dischrge i£ Stream Impacts Waste Application
Certified Operator: Christopher Cass Operator Certification Number: 985502
Secondary OIC(s):
On -Site Representative(s): Name Title Phone
24 hour contact name Ard Koopman Phone: [phone]
Primary Inspector: Melissa Rosebrock Phone: 11 - S aS 9
Inspector Signature: I c-v-- o Date:
Secondary Inspector(s):
Page: 1

Permit: AWC760060 Owner - Facility: Koopman Dairies Inc Facility Number : 760060
Inspection Date: 02/08/2012 Inspection Type: Compliance Inspection Reason for Visit: Complaint
Inspection Summary:
Todays visit to several of the application fields located on Ramseur -Julian Rd. and Randolph Church Rd. were in response to two
complaints received 2/7/2012 from neighbors. We also received a call from the Ranolph Co. Health Dept. who forwarded a complaint
they received.
We noted tracks in the fields left by the application equipment. We also documented remnants of mud on the road near the
entrance/exit to some of the fields. No manure was observed on the road. No evidence of overapplication, channeling, or dead
vegetation in the fields, either.
DWQ contacted both Mr. Ard Koopman and Mr. Chris Cass to tell of our findings. We also instructed the appplicators to begin
spreading waste "away from the entrance to the field" so as to not track any waste from the field back out onto the road. Both were
also instructed to apply waste when soils were dryer to avoid tracking mud from the field. Both seemed receptive and agreeable to
these suggestions. Mr. Cass was also ask to submit completed SLUR-1 and SLUR-2 forms for waste application that occurred on
February 1-2, 2012.
After visiting the fields, DWQ also contacted the two complaintants who thanked us for our efforts and seemed pleased that we
understood their complaint and investigated.
Page; 2

Permit: AWC760060 Owner • Facility: Koopman Dairles Inc
Inspection Date: 02/08/2012 Inspection Type: Compliance Inspection
Waste Structures
Tvue Identifier
Facility Number : 760060
Reason for Visit: Complaint
Devigned Observed
Closed Date Start Date Freeboard Freeboard
Neste Pond
LARGE WSP #3
Neste Pond
LOWER STAGE #2
aste Pond
UPPER STAGE #1
Page: 3

•
0
Permit: AWC760060 Owner - Facility: Koopman Dalrles Inc Facility Number: 76006D
Inspection Date: 02/06/2012 Inspection Type: Compliance Inspection Reason for Visit: Complaint
Discharges SL 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. 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? ❑ 0 ❑ ❑
3. Were there any observable 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?
❑
Is PAN > 10%/10 lbs.?
❑
Total Phosphors?
❑
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 Small Grain (Wheat,
Barley, Oats)
Crop Type 2 Fescue (Hay, Pasture)
Page: 4

i •
Permit: AWC760060 Owner • Facility: Koopman Dairies Inc Facility Number. 760060
Inspection Date: 02/08/2012 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? [loom
17. Does the facility lack adequate acreage for land application? ❑ ■ ❑ ❑
16. Is there a lack of properly operating waste application equipment? ❑ ❑ ❑ 0
Page: 5

Type of Visit OrCompliance inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit ARoutine O Complaint O Follow up 0 Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: t73 ,j Arrival Time: LIB Departure Time: �� County: Pint r1140 11 Region: 03 RQ
130+ke PcOr y En-#crptj kr,�b
Farm Name: Owner Email:
ti
T1
Owner Name: I/ R ii, o I �,, jt G � ri, En �r3r�1, �i1G Phone:
Mailing Address: i I0'r I"'Pre- 11 f iI-M _ L f7er G 2r72—(1
Physical Address:
Facility Contact: I h ) � tiJ T r l� Title: Phone No "C) 7G 0 „
Onsite Representative: Grp �f s Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator: G�� frj r "'` ya�-1 osBack-up Certification Number:
Location of Farm: Latitude: 35 ©�� ® Longitude: ° 38
k+w� 27-0s,�4-o 44wy Lf2_I5,r Kh ti Oil L.b�r P�11 lrt�o�-%� Ra^S-eur-J;1faA
Design Current Design Current Design
Current
Swine Capacity Population Wet Poultry Capacity Population Cattle Capi eI[S
.Population
❑ Wean to Finish ❑ Layer MaiCow D
007
❑ Wean to Feeder
10 Non -Layer
DaiLy Calf
❑ Feeder to Finish
Dairy Heifer 400
1.570
❑ Farrow to Wean
Dry Poultry
D Cow
El Farrow to Feeder
ElNon-Dairy
❑ Farrow to Finish
❑ Layers
❑ Beef Stocker
❑ Gilts
❑ Non -Layers
❑ Beef Feeder
Broad Cow
❑ Boars
❑ Pullets
❑❑Beef
Turkeys
Other
❑ Turkey Poults
❑ Other
❑ Other
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (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?
1 Page 1 of 3
❑ Yes ),<No ❑ NA ❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
❑ Yes ❑.No
❑ NA
❑ NE
❑ Yes .9No
El NA
El NE
ElYes X`��` No
❑ NA
❑ NE
12128104
Continued

,f
r
Facility Number: 174 — &0 • Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes XNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: U i L'o W" 07- L arL� t g
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3 f b �� '3
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes VNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes PNo ❑ 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 VNo ❑ 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) XNo
9. Does any part of the waste management system other than the waste structures require ElYes ❑ 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 XNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[]PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12, Crop type(s) Corn
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes XNo
❑ 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 acre determination ?
❑ Yes No
❑ NA
El 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
El NA
❑ NE
ad. :. ,`' t,..' y',,
Comments {refer to question #) . Expla►n,ariy:YES;answ.ers and/or anyrecomni!endations or any other,comments,�:;�
Usetd fn s 6f facilit �to better cz lain situations: use`addittonal� a es as necessar
g y P ( P g Y) �; 1
Ildf OA6
�
7� -tr �� �- j
/ , s 11 � p
Reviewer/Inspector Name a-iY
'. 'i '��a i,
€ Phone: 3(a 271 � Z S
, , �ti �ffi, T�t.aR �9,
�.
Reviewer/Inspector Signature:
Date: Q3 15 2D
Page 2 of 3 12128104 Continued

-Facility Number: 176— G *of Inspection 03 �
Required
Records & Documents
19.
Did the facility fail to have Certificate of Coverage & Permit readily available?
❑ Yes 'VNo
❑ NA ❑ NE
20.
Does the facility fail to have all components of the CAWMP readily available? If yes, check
El Yes No
❑ NA El NE
the appropriate box. ❑ WUp ❑ Checklists ❑ Design ❑ Maps ❑ Other
21.
Does record keeping need improvement?
❑ Yes MNo
❑ NA ❑ NE
Waste Application Weekly Freeboard aste Analysis Soil Analysis rite Transfers 0 Annu"er
riisztion
Rainfall Stocking (Crop Yield 120 Minute Inspections Monthly and I"
Rain Inspections Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes XNo
❑ NA ❑ NE
23,
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes ❑ No
h�NA ❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes No
❑ NA ❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes ❑ No
gNA ❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes )� No
❑ NA ❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes gN o
❑ NA ❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes No
❑ NA ❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes XNo
❑ NA ❑ NE
and report the mortality rates that were higher than normal?
30,
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes No
[INA ❑ NE
If yes, contact a regional Air Quality representative immediately
' `
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes No
[INA ElNE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes X No
❑ NA ❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes )VNo
❑ NA ❑ NE
omment" and/or Drawn s .4 ' Addittonal;C � .2 . g * ��t� ' � ``a' .� ,� t a" � �, ;� � �^�'��'
S b 2; .i " LY i
27, �1�17�y772�
f
eO►n'�l�!
j
M�tftz`� 214,(Trr,9kn)� +T4 2.a1b
lnl&5,re APA06V
2..5 D
7,
0
`C 3,9' (-�3
at 3 S'u� 2.Z
z , a I, 7
Page 3 of 3 12128104

EF I . ..
Division of Water Quality
Facility Number 9Divisiou of Soil and Water Conservation 36j
0 Other Agency
f
Type of Visit C mpliance Inspection 0 Operation Review
0 Structure Evaluation
0 Technical Assistance
Reason for Visit Routine 0 Complaint 0 Follow up 0 Referral
0 Emergency
0 Other ❑ Denied Access
Date of Visit: Arrival Time:
0 Departure'I'ime: County:
Region: I Ae. 10
Farm Name
Owner Email:
Ow er Name:
L
Phone:
Z.7
Mailing Add re 1b :
o
rM
� �j
�,, . e-t" M(�, ,a 7z C.�_
Physical Address:
c
Facility Contact:
11
Title:
Phone 46 6 - 9 q
N. 3.
, 1)L
Onsite
Certified Operator:
Integrator•
Operator Certification Number:
Back-up Operator: UVISBack-up
/ Certification Number:
1(0 �� I -2`fJ p�
Location of Farm: � + Latitude: [�o w � Longitude: o®d
us bG from 656 6o 05 � qal l ont6 0 [derf •
�d • � (zl h�~ a n� �xvts�,u r -- s� Ian
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -Layer
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Dischart=_es & Stream Impacts
I. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
Cows
Calf
F
Heifer
Cow
❑
Non -Dairy
❑
Beef StockeE
❑
Beef Feeder
❑
Beef Brood Cowl
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 [ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
�No
❑ NA
❑ NE
❑ Yes � No ❑ NA ❑ NE
12128104 Continued

Facility Number, 3 ro -- (� O
• Date of Inspection IIu I •
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: GOwyer 4 IJ
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes kNo El NA El NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes �dNo ❑ 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?
0 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 Ai mlication
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes ❑ No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[:]PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
oElNA
ElNE
15. Does the receiving crop and/or land application site need improvement?
[IYes
tNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination'?0
Yes
❑ No
❑ NA
❑ NE
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
A 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):
(?o fa ► v'< S o �U
•
Reviewer/Inspector Name 10Q `
Phone:
Reviewer/Inspector Signature:
Date: oT a d
0
tv
' t 12128104 Continued

C, �
Facility Humber: oe of Inspection •
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ YesVNo
❑ NA ❑ NE
20. Does the facility fail to ha�4wl
compone is of the CA P rea 'ly a ailable? If es, check ❑ Yes❑ NA ❑ NE
the appropriate box. Checklists tl)esign�maps Other
21. Does ecord keeping need im rovement? I ❑ Yes o ❑ NA ❑ NE
aste Applicat'on Wee y Freeboard Waste Analysis �Soillysis �ste Transfers tirnr
Rainfall Stocking Crop Yield 120 Minute Inspections Ianthly and 1" Rain Inspections Weather Code
�qZ
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? ❑ es ❑ No *A ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit? ,`Yes ❑ No ❑ NA ❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit? ❑ Yes ❑ No JXNA ❑ NE
26. Did the facility fail to have an actively certified operator in charge? ❑ Yes %No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ❑ Yes 0 No ❑ NA ❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ YesNo ❑ NA ❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
Yes
0
❑ No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
&No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
flqN
❑ 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
0No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
El�Yes
No
❑ NA
❑ NE
Additional, i i 1
-
�RAI
o
F .,.•mot•, �� � -
i � � / � (1 -
� � �
Page 3 of 3
12128104

Type of Visit'. P �Compliance Inspection 0 Operation Review 0 Structure Evaluation . 0 Technical Assistance
Reason for Visit y4l Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: County: r)aC 1 10h Region: CA5
Farm Name: L�Lj�(,S i�l I t Owner Email:
Owner Name: V i d A ` Phone: o� MailingAddress: `'t'� �� Ni.Pare_dlel� L LIY�VL 1�.0\ • i �, o� %
Physical Address:
Facility Contact: 1��1 P �ilfr�, Title: Phone No:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Operator Certification Number:
Back-up Certification Number:
Longitude: ° ®` "
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population
Design Current
C►►attic Capacity Population
❑ Wean to Finish
❑ Layer I
I
Dairy Cow 1600 1100
❑ Wean to Feeder
10 Non -Layer I
I
Dairy Calf
❑ Feeder to Finish
IN Dairy Heifer 406
❑ Farrow to Wean
❑ Farrow to Feeder
Dry Poultry
❑ Dry Cow
ElNon-Dairy
El Farrow to Finish
❑ Gilts
❑ Layers
❑ Non -Layers
❑ Beef Stocker
El Beef Feeder
❑ Boars
❑ Pullets
❑ Beef Brood Cow
❑ Turkeys
Other
❑ Other
Number of Structures:
❑ Turkey Poults
❑ Other
Discharp_es & Stream impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
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 XNo ❑ NA ❑ NE
El Yes
❑No
❑NA
El NE
❑Yes
❑No
❑NA
❑NE
El Yes
El No
❑NA
El NE
❑ Yes �40 ❑ NA ❑ NE
❑ Yes *No ❑ NA ❑ NE
12128104 Continued

Facility Number: rpr . Date of Inspection •
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes bio ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
p Structure 1 Structure 2 11Struct 3 Structure 4 Structure 5 Structure 6
Identifier: Lbws l.. O
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes VNo
El NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.) X
6. Are there structures on -site which are not properly addressed and/or managed El Yes ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ,01 El NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes io ❑ 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 ❑NE
maintenance or improvement?
Waste ADplication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes INo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes �No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Out�bf,Areaa
12. Crop type(s) C&A
13. Soil type(s) U -,rk-W q /
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
Yes
❑ Yes
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
17. Does the facility lack adequate acreage for land application? ❑ Yes
18. Is there a lack of properly operating waste application equipment? ❑ Yes
❑ No ❑ NA ❑ NE
V10 ❑ NA ❑ NE
No ❑ NA ❑ NE
o [I NA El NE
No ❑ NA ❑ NE
C
Comments (refer to question #): Ezplain'any YES answer°s and/or any.recommendations�6r.anytother cYomments� � ,
Use drawings of facility to better explain situations. (usekadditional pages as Decessary):°.`
P4
LoUP.
Reviewer/Ins ector Name '
�' . L Phone:
p
Reviewer/Inspector Signature: Date: 1 I in i n'9
12128104 Continued

T'
Facility Number: *of Inspection
Reauired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ,
❑ Yes
jym
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check
El Yes
�(No
❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps El Other
21. Do s record keeping need im ro ement. ❑Yes L� No ❑ NA ❑ NE
P g P �'
Zainfall
e Applicat' n „L,y, W/ kly Freeboard Waste Analysis Soil lysis Waste Transfers
Locking j Crop Yield 120 Minute Inspections Monthly and 1" Rain Inspections Weather Code
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
29. 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/lnspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes No ❑ NA ❑ NE
❑ Yes ❑ No V.
El NE
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes ❑ No gNA ❑ NE
❑ Yes )eNo ❑ NA ❑ NE
❑ Yes [ No ❑ NA ❑ NE
❑ Yes �(No
❑ NA ❑ NE
❑ Yes No ElNA ❑ NE
❑ Yes WNo ❑ NA ❑ NE
❑ Yes �No ❑ NA ❑ NE
❑ Yes No ❑ NA [INE
❑ Yes ;No ❑ NA ❑ NE
Additional Commentsandlor'Drawin s x` :�` 1 , �� •` _ �_
a oZbb � dz6q S o to o r fs . •
on +'� S o, d 5 r -d e.a i b ra o n
a'ap C4
12128104

Type of Visit 1PCompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit �6 Routine 0 Complaint 0 Follow up 0 Referral -0 Emergency 0 Other ❑ Denied Access
Date of Visit: I 1 Arrival Time: Departure Time: County: f`�` � 1 p h Region: S
Farm Name: & hR mill i) f , 1 C Owner Email:
�LI d u- p I t r h
Owner Name: 2 V d f Phone:
Mailing Address: IpS 1'1'1�'e d e l 1 f Car1rY1 [�1 L 110 �!- jI
Physical Address:rn P_
Facility Contact:
Onsite Representai
Certified Operatoi
Back-up Operator.
Title: Phone No:
be-
R" Integrator:
e^ Mec- 911333
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: � e ©� ®�� Longitude:
u.S dad S. f-'rom (oSd Ljo E, to us d ,5otH-h , 0. onfo o14
P'- antb R_ams-eur
Design Current Design C«urgent
Design C►urgent
Swine Capacity Population Wet Poultry Capacity Population
Cattle C►apacity Population
❑ Wean to Finish
JEI Layer I
I
Dairy Cow
A 66
1 ,j
❑ Wean to Feeder
JE1 Non -Layer I
E[Dairy Calf
❑ Feeder to Finish
0 Dairy Heifer
Q
❑ Farrow to Wean Dry Poultry
Dry Cow
❑ farrow to Feeder
❑ Nan-Dai
❑ Farrow to Finish ❑ Layers
ElBeef Stocker
❑ Gilts El Non -Layers
El Beef Feeder
❑ Boars El Pullets
❑Beef Brood Cow
❑ Turkeys
Other ❑ Turkey Poults
❑ Other ❑ Other
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes 4No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made? ❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) `,
❑ Yes ❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes ❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes No
ElNA
ElNE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
El No
El NA
[I NE
other than from a discharge?
Page I of 3
12128104
Continued

Facility Number: — ! Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes No ❑ NA ❑ NE
Structure l S1tru_cture 2 Structur Structure 4 Structure 5 Structure 6
Identifier: - V � P`� w W'P•tr✓ �!'�d
Spillway?:
Designed Freeboard (in): f
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 4No ❑ NA ❑ NE
(ic/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes No ElNA [INE
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 t reat, 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 VNo ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes X
No ❑ NA El NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need Dyes>�No ❑ NA El NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. Yes ❑ No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu. Zn, etc.)
❑ PAN PAN > 10% or l0 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
..e-5 - Z _ _ . a -1 1 , 1 .. .
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
o ❑ NA
El NE
15. Does the receiving crop and/or land application site need improvement?
El Yes
No ❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
No ❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
No ❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
qNo ❑ 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):
1 H - U
-6 to U . S
a F- y
Reviewer/Inspector Name F
Phone:
Reviewer/Inspector Signature:
Date: d
Page 2 of 3
12128104 Continued

Facility Number: b — a ate of Inspection 0
•
Required Records & Documents �� �ln�1101jCt" . 1iJY�tu ^`apC�o
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 appropriate box. ❑ WUP ❑ Checklists ❑ Design El Maps El Other
21. Doe ed im ovemen u -`—`
Yes eNo ❑ NA ❑ NE
aste Applica ' n ce y Freeboard aste Analysi Soil A lysis W Waste Transfers ❑
Rainfall Stocking Evrop Yield 2 spections Monthly and 1" Rain Inspections 7eather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
%No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
T�(NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by thepe it? 'D
��
El YesA
No
El NA
El NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
El Yes
❑
VNA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
No
❑ NA
❑ NE
Other issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
Cl Yes
.hNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
[ 6o
❑ 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
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
XNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
>No
❑ NA
❑ NE
Additional Comments and/or Drawinns:
1
Page 3 of 3
12128104

Division of Water Qualio.
Facilit00
y Number O9 Division of Soil and Water Conservation f
Other Agency 2 [ A 67
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 ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: - 0 unty: Region:
Farm Name: 01 1 Owner Email: `, C.
Owner Name: L Pho1ne:I_3-3 UAL Q'
Mailing Address: 4 QS ��.�{'� � %� i1�i � ' l L1 K;,l�� I I X
4 !�?��l i O • L� ber � a ?_. �9�
Physics! Address: 1 ��Y rV1 _ _
Facility Contact: Title. Phone No:
Onsite Representati
Certified Operator:
Back-up Operator:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: MO
[� N Longitude: [NO
M[Old
t)5 aao s F-rbm 50 1 o � . vs y J_l4 S U� 2+-
o y o b l� t er Qd • Pj.
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Boars
Other
❑ Other
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -La et
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharp,es & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
Cattle
. Design Current
Capacity Populafi
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Q
❑ Non-DaiCL
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures: ©'
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes
�No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
R No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
12128104
Continued

Facility Number: ] Q Dale of Inspection
Waste Collection &Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ko ❑ NA ❑ NE
V a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
�4 Structure I Structure 2 aStrucStructure 4 Structure 5 Structure 6
( Identifier: LL7[1.� L tur 0 nA
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 VNo ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes [ (No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes V 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 J9No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes XNo [I NA El NE
❑ Excessive Ponding El Hydraulic Overload El Frozen Ground El 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 CgNo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes /M No
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[:] Yes WNo
17. Does the facility lack adequate acreage for land application? ❑ Yes V No
18. Is there a lack of properly operating waste application equipment? ❑ Yes �No
❑NA El NE
El NA [I NE
❑NA ❑NE
❑ NA El 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):
W" 1314 �_��. u�/ o
F-4. at..)F-��
Reviewer/Inspector Name r Phone: _
Reviewer/Inspector Signatur Date: S 3 Q
V,- It v
I2128104 Continued

d
Facility Number: 77of Inspection QM •
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps ❑Other
21. Does record keeping need improvement'? ❑ Yes No ❑ NA El NE
Waste Applic W ekly Freeboard 06 Waste Analysis Soil Analysis Waste Transfers nnual Certification
Rainfall Stocki Crop Yield 120 Minute Inspections Monthly and I 'Rain Inspections Weather Code
22. Did the facility faA�mstan aintain a rain gauge? ❑ Yes No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No X NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit? a200(pf's 'Yes gNo ❑ NA ❑ NE
90az'2
25. Did the facility fail to conduct a sludge survey as required by the permit? ❑ Yes ❑ No XNA ❑ NE
26. Did the facility fail to have an actively certified operator in charge? ❑ Yes XNo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ❑ Yes XNo ❑ NA ❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? Yes ElNo [INA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document Xo Yes o ❑ NA ❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by ❑ Yes X No ❑ NA ❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes No ❑ NA ❑ NE
33. Does facility require a follow-up visit by same agency? ❑ Yes No ❑ NA ❑ NE
Additional Comments and/or Drawings:
QL
?
a . e,4j
� � o
f a? f o7
4 6`3
r 4 lD
tc nt4.,6A4"0fjA"' -g Pj

M
76
Type of Visit Q Compliance Inspection Operation Review O Structure Evaluation O Technical Assistance]31em
1007
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral O Emergency 0 Other ❑ Denied Acces
t.rr�
-� Regional Offico
Date of visit: 1G(1 AAfrrival Time; Itt377 Departure Time: . S v_ County: _ _ fjRegion:
Farm Name: Owner Email:
Owner Name: . _jDACIC _ _ ._ .w _ _ ---.__ Phone:
Mailing Address: __ Diu? __.iLc._CiI�M-.L .. _.�..`___ ,_. v_.r.�_._..�_.,._.....__ •_.._ w._...._ _ •. _ _._�
Physical Address:
Facility Contact: P�t�e._...v _.__..:Title: _ ._ _ .__ . .w ...... — — Phone No:�0•..�._TVy —_
.x
Onsite Representative: -- -- - - _ _ _ _ ..__ _ �� ----- Integrator:
Certified Operator:._ _.______._ _ •,__ ,,,._..,,._ _ _„�,_ _,_. _ -� Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: RT o [0' ©" Longitude:
G E P6 bay J/1 .leiroW #j, Alta ix�r ri'af, tv bha- l ►SF -��t
,lam% % e,J 1% T A?ac f M SEt;10w ar eLa wary .rol f*� .
¢ Design Current ` Design Current
Design - Current >
1
a � s
Awine , R� Capacity 'I'opuladoii `, ' `Wet Poultry Capacity PopuEat�on
Catfile Capacity; Population _.,
.t
_
F ❑ Wean to Finish
11.10 Layer
' ❑Wean to Feeder
❑ Non La er
❑ Feeder to Finish
4:
�y[
❑ Farrow to Wean
Y
Dry Poultry
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Layers
' ❑ Gilts
❑ Non -La ers
,.
❑ Boars
' ❑Pullets
❑Turke s
OtherN ��❑Turke Poults
w ❑ Other ❑ Other
f
Number o Structures
s
❑ Dai Cow
1
d
O
❑ Dairy Calf
❑ Dairy Heifer
❑ D cow
�
3
❑ Non -Dal
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes 4 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 (gaIlons)?
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
N No
❑ NA ❑ NE
3-W-ere eil� re any adverse imps or poten to a verse impacfs'to fhee Waters o-ftfie State
0 es No
8NA ❑NE. .
other than from a discharge?
2/28/04 Continued

r Facility Number: Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes DQ 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:d-M *L i a,xfa
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 5] 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 [I Yes 5RNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes $4 No ❑ NA ❑ NE
maintenance/improvement?
11. is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes $ZNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10%.or 10 lbs [:]Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Sail
❑ Outside ofAcceptableCrop Window
�❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)iCyF
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
. No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination i ❑ Yes
�] No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
P No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment!
❑ Yes
91 No
❑ NA
❑ NE
6"VS 4*,f&%r6D - 5/3�/, a - 57/LFlo�
- - -
------------
y - /x
Reviewer/Inspector Signature: _J
Continued

Facility Number: — ate of Inspection S
Reauired Records & Documents
19.. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20; Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes P�No ❑ NA ❑ NE
the appropirate box. ❑ WUp [] Checklists ❑ Design
g El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes RNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis T ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute'lnspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22, Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facilitypose 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?
El Yes
OpNo❑NA.
El NE
❑ Yes
k No
❑ NA
❑ NE
❑ Yes
RNo
❑ NA
❑ NE
❑ Yes
❑ No
4 NA.
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
QqNo
❑ NA
❑ NE
❑ Yes
N No
❑ NA
❑ NE
❑ Yes
RNo
❑ NA
❑ NE
❑ Yes
W No
❑ NA
❑ NE
❑ Yes X No
❑ Yes No
❑ Yes No
El NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
,12%28%04

Facility Number: - Date of Inspection
Technical Assistance
Needed
Provided
34, Waste Plan Revision or Amendment
❑
❑
35, Waste PIan 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.Organize/computerization of records
❑
❑
43. Sludge Evaluation
❑
❑
44, Sludge or Closure Plan
❑
❑
45, Sludge removal/closure procedures
❑
❑
46. Waste Structure Evaluation
❑
❑
47. Structure Needs Improvement
❑
❑
48, Operation & Maintenance Improvements
❑
❑
49. Marker check/calibration
❑
❑
50. Site evaluation
❑
❑
51, Irrigation Calibration
❑
❑
52, Irrigation system design/installation
❑
❑
53. Secure irrigation information (maps, etc.)
❑
❑
54, Operating improvements (pull signs, etc.)
❑
❑
55. Wettable Acre Determination
❑
❑
56. Evaluate WAD certification/rechecks
❑
❑
57. Crop evaluation/recommendations
❑
❑
58. Drainage work/evaluation
❑
❑
59. Land shaping, subsoiling, aeration, etc.
❑
❑
60. Runoff control, stormwater diversion, etc.
❑
❑
61. Buffer improvements
❑
❑
62. Field 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 Improvements Made by Operation:
1. 4. _ . .......--__......_...-...__._.... _...
2. 5.
-- 6. - - 12/2lS - -

Division of Water Quality
❑ Division of Soil and Water Conservation
❑ Other Agency
Facility Number: 760060 Facility Status: Active Permit: NCA376060 ❑ Denied Access
Inspection Type: Inactive or Closed Date:
Reason for Visit: County: Randolph Region: Wi1i;jQ0-SaI2m
Date of Visit: Q5f2512006 Entry Time:09:30 AM____ Exit Time: Q:00 PM Incident #:
Farm Name: Meredell Owner Email:
Owner. Arlin_Buttke Phone: 336-495=1393
Mailing Address: 5796 Walker -Mill Rd 13andleman NC 273177319
Physical Address:
Facility Status: ❑ Compliant ❑ Not Compliant Integrator:
Location of Farm:
Latitude:35°51'16" Longitude:79°38'24"
Farm address: 4718 Ramseur- Julian Road, Liberty, NCUS Hwy 421 south from GSO. Right onto Old Liberty Rd. Right onto
Ramseur -Julian Rd. Farm is on right.
Question Areas:
Discharges & Stream Impacts
Records and Documents
Certified Operator: Everett P Wright
Secondary OIC(s):
Waste Collection & Treatment Waste Application
Other Issues
Operator Certification Number: 21333
On -Site Representative(s): Name Title Phone
On -site representative Phillip Wright Phone:
24 hour contact name Phillip Wright Phone:
Primary Inspector: Melissa Rosebrock Phone:
Inspector Signature: Date:
Secondary Inspector(s):
Inspection Summary:
*7. & 28. Upper WSP embankment was cut into the lower overflow pipe. Must get engineer to certify structural stability. Schedule
within a week.
18. 2005 calibration ok for dry spreader. No irrigation of waste occurred in 2005. Don't forget to calibrate for irrigation in 2006.
21. Don't forget to do 2006 soil samples. In 2005, copper was averaging 1000.
21. Don't forget to record monthly stocking average, 120 minute waste irrigation checks and weather on day of application.
27. Need to keep copy of PLAT on farm, See tech specialist for copy.
28. SWCDINRCS has been requested to write WUP for 1600 milkers and 400 dry for a total of 2000. Additional land is to be added
according to Mr. Wright. I
Page: 1

•
•
Permit: NCA376060 Owner - Facility: Arlin Buttke Facility Number: 760060
Inspection Data: 05/25/2006 Inspection Type: Compliance Inspection Reason for Melt: Routine
Regulated Operations Design Capacity Current Population
Cattle
O Cattle -Dry Cow
90
Q Cattle -Milk Cow
1,500 1 850
Total Design Capacity: 1,500
Total SSLW: 2,100,000
Waste Structures
Type Identifier Closed Date Start Date Designed Freeboard Observed Freeboard
Neste Pond
LARGE WSP 93
72.00
aste Pond
LOWER STAGE #2
36.00
aste Pond
UPPER STAGE #1
12.00
Page: 2

•
Permit: NCA376060 Owner - Facility: Arlin Buttke Facility Number: 760060
Inspection Date: 05/25/2006 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)
❑ ■
❑ ❑
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 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,
❑ ■
❑ ❑
dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require maintenance or
❑ ■
❑ ❑
improvement?
Waste App ication
Yes No
NA NE
10. Are there any required buffers, setbacks, or compliance alternatives that need maintenanceor
❑ ■
❑ ❑
improvement?
11. Is there evidence of incorrect application?
❑ ■
❑ ❑
If yes, check the appropriate box below.
Excessive Ponding? ❑
Hydraulic Overload? ❑
Frozen Ground? ❑
Heavy metals (Cu, Zn, etc)? ❑
Page: 3

Permit: NCA376060 Owner- Facility: Arlin Buttke
Facility Number: 760060
Inspection Date: 05/25/2006 Inspection Type: Compliance Inspection
Reason for Via It: Routine
Waste Application
Yes No NA NE
PAN?
❑
Is PAN > 10%110 lbs.?
❑
Total P2057
❑
Failure to incorporate manure/sludge into bare soil?
❑
Outside of acceptable crop window?
❑
Evidence of wind drift?
❑
Application outside of application area?
❑
Crop Type 1
Fescue (Hay)
Crop Type 2 Corn (Silage)
Crop Type 3 Soybeans
Crop Type 4 Small Grain (Wheat,
Barley, Oats)
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 Cl ■ ❑ ❑
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?
❑
■
❑ ❑
1 B. 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?
❑
■
❑
❑
20. Does the facility fail to have all components of the CAWMP readily available?
❑
❑
❑
If yes, check the appropriate box below.
WUP?
❑
Page: 4

• •
Permit: NCA376060 Owner -Facility: Arlin Buttke Facility Number: 760060
Inspection Date: 05/25/2006 Inspection Type: Compliance Inspection Reason for Visit: Routine
Records and Documents Yes No NA NE
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 > 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 oertified 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 ❑ ■ ❑ ❑
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

C�
•
Permit; NCA376060 Owner • Faclllt : Alain Bake Faclllt Number: 760060
Inspection Date: 05/25/2006 Inspection Type: Compliance Inspection
Reason for Visit: Routine
Other Issues
Yes
No NA
NE
31. Did the facility fail to notify regional DWQ of emergency situations as required by Permit?
❑
■ ❑
❑
32, Did ReviewerAnspector fail to discuss review/inspection with on -site representative?
❑
■ ❑
❑
33. Does facility require a follow-up visit by same agency?
❑
■ ❑
❑
Page: 6

Division of Water Quality
Facility Number 9Division of Soil and: Water Ponservati
- -- Q Other,Agency
Type of Visit Q�ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit _ Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: S �noZ�S Arrival Time: Z=Departure Time: County: Region:
Farm Name: 1 Y 1 �[�P_ 1Y N +EVL dfi SQowner Email:
Owner Name: `�� V, (],] Phone: Iq S--
Mailing Ad ess:
Physical"Mdress: U r da 0
Facility Contact: ri Title: Phone No: !z 6 ?i
e o 0
Onsite Representative: 4JIntegrator:
`I 2
Certified Operator: Phi ll L'� Operator Certification Number: 133,3
P,vkqlasi3�erator: Back-up Certification Number:
Location of Farm: Latitude: ° ©� Longitude:
tY lUms-e u ]r,Tv i ck n . 1 U1 jt-tl n U5 41A.3 O so L) Fro M
u 1 u 5 a M se u r Suli"
Design Current Design . Current Design Current'
Swine Capacity Population ,We(voultry . Capacity Population tyattle Capacity Population
❑ Wean to Finish
❑ Wean to Feeder
❑ Feeder to Finish I
❑ Farrow to Wean
❑ Farrow to Feeder
E
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
❑ Layer
❑ Non -Layer
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
I. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
GS,Dairy Cow
❑ Dairy Calf
EI_Dairy Heifer
❑ Da Cow
9 d
❑ 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?
Page I of 3
❑ Yes Xo ❑ NA ❑ NE
ElYes
ElNo
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
�o
❑ NA
❑ NE
❑ Yes VNo ❑ NA ❑ NE
12128104 Continued

ill
Facility Number: l — D • Date of Inspection ao*
Waste Collection & Treatment
4. Is stprage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structur(e�3 Structure 4
Identifier. f.t�i�t�r- Y
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): Z.
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 JNO
❑ Yes ❑ No
Structure 5
❑NA El NE
❑ NA ❑ NE
Structure 6
Dyes 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 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 )6No ❑ 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 )& ❑ 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 o ❑ 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 Dxift ❑ Application Outside of Area
12. Crop type(s)
v
13. Soil type(s)
14. Do the receiving crops differ fr4 those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ Yes
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
17. Does the facility lack adequate acreage for land application? ❑ Yes
18. Is there a lack of properly operating waste application equipment? ❑ Yes
No ❑ NA ❑ NE
No ❑ NA ❑ NE
iiNo El NA [I NE
No ❑ NA [I NE
o El NA [I NE
Comments (refer to question ft Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
'oZ005 fi o lti ?
�J
�Izoo
�a
`
l
t'
Reviewer/Inspector Name
Phone:
Reviewer/Inspector Signature:
Date:
Page 2 of 3 v • L " 12/28/04 Continued

a
Facility Number: -7 — Oteofinspection
Required Records & Documents
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 No El NA ❑ NE
the appropriate box. ElWUp El Checklists ❑ Design ❑Maps El Other
21. Doe record keeping need i provement? es, c ec the appropriate ox ow. Kyes ❑ No ,❑ NA ❑ NE
Waste Appl' n Wee y Freeboard is Soil alysis VWaste Transfers An Certification
Rainfall Stocking Crop Yield ❑ 120 Minute Inspections �Q Monthly and I" Rain Inspections Weather Cod
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ,KNo ❑ NA ❑ NE
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No 1XNA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ?No ❑ NA ❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit? ❑ Yes ❑ No LIKA ❑ NE
26. Did the facility fail to have an actively certified operator in charge? ❑ Yes No ElNA ElNE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ❑ Yes VNo ❑ NA ❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?KYes ❑ No ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document ❑ Yes ])!(No ❑ NA ❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by ❑ Yes N/1; 0 ❑ 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 X No ❑ NA ❑ NE
33. Does facility require a follow-up visit by same agency? ❑ Yes WN ❑ NA ❑ NE
Additional Comments and/or Drawings:
7u oc�l . moos �-°�- AL
�S
1 (0 oo
lao�ii�
a� 3Paq/e&P
;z _ Nil I Coo t 1 _-�a 6 ` 0,1
Page 3 of 3 12128104

}
L.r
�
//!
1
,�
i
��
;'
..

Division of Water Quality
❑ Division of Soil and Water Conservation
❑ Other Agency
Facility Number: 760060 Facility Status: Active Permit: NCA376060 ❑ Denied Access
Inspection Type: Compliancg_(fspection Inactive or Closed Date:
Reason for Visit: Routine County: Randolph Region: Winston-Salem _ T
Date of Visit: Q711812005 Entry Time: 01705 PM Exit Time: 03:00 PM Incident #:
Farm Name: Meredell Owner Email:
Owner: Arlin Buttke- Phone: [phone]
• - -7Fgpl1murmx :FR{fTfi TitA►I+1E'�kSirtkS�
Physical Address:
Facility Status: ❑ Compliant ❑ Not Compliant Integrator:
Location of Farm: Latitude: 35°51'16" Longitude: 79°38'24"
Farm address: 4718 Ramseur- Julian Road, Liberty, NCUS Hwy 421 south from GSO. Right onto Old Liberty Rd. Right onto
Ramseur -Julian Rd. Farm Is on right.
Question Areas:
Discharges & Stream Impacts Waste Collection & Treatment Waste Application
Records and Documents Other Issues
Certified Operator: Everett P Wright Operator Certification Number: 21333
Secondary OIC(s):
On -Site Representative(s): Name Title Phone
On -site representative Phillip Wright Phone:
24 hour contact name Phillip Wright Phone:
Primary Inspector: Melissa M Rosebrock Phone:
336-771-4600
Ext.383
Inspector Signature:
Date:
Secondary Inspector(s):
Phone:
Phone:
Inspection Summary:
7. MUST remove solids from upper WSP #1 and install freshwater diversion ditches around all WSps prior to cattle being stocked.
21. No application of animal waste in 2004 so no calibration records required for 2004. Must complete calibration of 3000 gal honey
wagon by 12/31/2005.
21. Soil test results required for those fields that receive animal waste this year.
21. Only need to record freeboard when there is a rain event until cattle are stocked (possibly Oct. 2005).
27. PLAT certification is due October 1, 2005,
28. Need to completely revise calculations for CAWMP due to new construction, change in concrete surface areas, hand sinks,
washing machine, etc. Operator states that CAWMP needs to be for 1400 milk cows and 200 dry cows.
213105 waste analysis=0.02 lbs. N11000 gal.
Page: 1

Penult: NCA376060 Owner - Facility: Arlin Butlke Facility Number: 760060
Inspection Date: 07118/2005 Inspection Type: Compliance Inspection Reason for Visit: Routine
Regulated Operations Design Capacity Current Population
Cattle
Cattle -Milk Cow 1,500 0
Total Design Capacity: 1,500
Total SSLW: 2,100,000
Waste Structures
Tvoe Identifler Closed Date Start Date Desioned Freeboard Observed Freeboard
Waste Pond
LARGE WSP #3
84.00
Waste Pond
LOWER STAGE #2
48.00
Waste Pond
UPPER STAGE #1
24.00
Page: 2

0 0
Permit: NCA376060 Owner -Facility: Arlin Bunke Facility Number. 760060
Inspection Date: 07/18/2005 Inspection Type: Compliance Inspection Reason for Visit: Routlne
Discharges & Stream Impacts Xas Ng NA NP
1. Is any discharge observed from any part of the operation? ❑ 0 ❑ ❑
Discharge originated at:
Structu re
❑
Application Field
❑
Other
❑
a. Was conveyance man-made?
❑
0 ❑
❑
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)
❑
0 Cl
❑
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
4. Is storage capacity less than adequate?
❑
M ❑
❑
If yes, Is waste level into structural freeboard?
❑
5. Are there any Immediate threats to the integrity of any of the structures observed (I.a.l 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?
0
❑ ❑
❑
8. Do any of the structures lack adequate markers as required by the permit? (Not applicable to roofed pits, dry stacks
❑
M ❑
❑
and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require maintenance or
❑
❑
❑
improvement?
Yes
ig NA
NE
Waste Application
10, Are there any required buffers, setbacks, or compliance alternatives that need maintenance or improvement?
❑
■ ❑
❑
11. Is there evidence of incorrect application?
❑
M ❑
❑
If yes, check the appropriate box below.
Excessive Ponding?
❑
Hydraulic Overload?
❑
Frozen Ground?
❑
Heavy metals (Cu, Zn, etc)?
❑
PAN?
❑
Is PAN > 10%l10 lbs.?
❑
Total P2O57
Cl
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
Crop Type 3
Crop Type 4
Crop Type 5
Page: 3

Permit: NCA376060 Owner- Facility: Arlin Buttke
Inspection Date: 07/18/2005 Inspection Type: Compliance Inspection
Facility Number: 760060
Reason for Visit: Routine
Waste Aonlicatmon
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 naceiving crops differ from those designated in the Certified Animal Waste Management Plan(CAWMP)? ❑
s ❑ ❑
15. Does the receiving crop and/or land application site need improvement?
❑
0 ❑ ❑
16. Did the facility fail to secure and/or operate per the Irrigation design or wettable acre determination?
❑
E ❑ ❑
17. Does the facility lack adequate acreage for land application?
❑
0 ❑ ❑
18. Is there a lack of properly operating waste application equipment?
❑
Yes
0 ❑ ❑
No NA NE
Records and documents
19. Did the facility fail to have Certificate of Coverage and Permit readily available?
❑
M ❑ ❑
20. Does the facility fail to have all components of the CAWMP readily available?
❑
M ❑ ❑
If yes, check the appropriate box below
WUP?
❑
Checklists?
❑
Design?
❑
Maps?
❑
Other?
❑
21. Does record keeping need improvement?
❑
■ ❑
Cl
If yes, check the appropriate box below.
Waste Application?
❑
120 Minute inspections?
❑
Weather code?
❑
Weekly Freeboard?
❑
Transfers?
❑
Rainfall?
Cl
Inspections after > 1 inch rainfall & monthly?
❑
Waste Analysis?
❑
Annual soil analysis?
❑
Crop yields?
❑
Stocking?
❑
Annual Certification Form (NPDES only)?
❑
22. Did the facility fall to install and maintain a rain gauge?
❑
N ❑
❑
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?
❑
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?
❑
E ❑
❑
Page: 4

• •
Permit: NCA376060 Owner -Facility: Arlin Suttke Facility Number: 760060
Inspection Date: 0711812005 Inspection Type: Compliance Inspection Reason for Vlslt: Routine
28, Were any additional problems noted which cause non-compliance of the Permit or CAWMP? 0 ❑ ❑ ❑
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document and report those mortality ❑
rates that exceed normal rates?
30. At the time of the inspection did the facility pose an air quality concern? If yes, contact a regional Air Quality ❑ ❑ ❑
representative immediately.
31. Did the facility fail to notify regional DWQ of emergency situations as required by Permit? ❑ moo
32, Did Reviewer/Inspector fall to discuss review/inspection with on -site representative? ❑ moo
33. Does facility require a follow-up visit by same agency? ❑ moo
Page: 5

Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: L—Qtj J 6 Arrival Time: s eparture Time: County: Region:
Farm Name: r l-'Q / e- l arm Owner Email:
Owner Name: �r 1h by� Ynit Phone:
Mailing Address: s� jin V\12_ 1yp_� Ir i L 1W
Physical Address: N kA
�L
Facility Contact: p W r Title: Pone No:�
Onsite Representative: 11 fit' W Integrator:
Certified Operator: +11�,p_ _ W_'t Operator Certification Number: 3 33
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: ®o U ®` � " Longitude:
Design CurrentsmDe.signCurrerit
-~ D�ntion
Wet PoultryopulationCattle
Capacity
Papnlatfon
❑ Wean to Finish
❑ Layer
Dai Cow
❑ Wean to Feeder
❑ Non -Layer
Dairy Calf
❑ Feeder to Finish
❑ Dairy Heifej
❑ Farrow to Wean
Dry Foultry
❑ Da Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
❑ La ers
❑Beef Stocker
❑ Gilts
❑Non -La ers
❑ Beef Feeder
❑ Boars
❑ Pullets
❑ Beef Brood Cow
❑ Turkeys
e
vallOther
❑ Turkey Poults
❑ Other I
❑ Other I
res:
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
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
No
❑ NA
❑ NE
12128104
Continued

Facility Number: — Date of Inspection `i-�'�- ! •
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes �No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
` Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
( Identifier: 1.6u3-t r
Spillway?:
Designed Freeboard (tn).
1<7
Observed Freeboard (in): dN
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
o ❑ 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 envir mental
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 El NA El NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes
�No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
*No El NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground [I 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 Dritl ❑ Application Outside of Area
12. Crop type(s)
v
13, Soil type(s)
14, Do the receiving crops differ from those designated in the CAWMP7
❑ Yes
ElNA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
INo
ElYeso
❑ NA
ElNE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination%❑
Yeso
❑ NA
ElNE
17. Does the facility lack adequate acreage for land application?
ElYeso
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes &No
❑ NA
❑ NE
-� M u� 3000 .
/0,T-
. r
Reviewer/Inspector Name E ��' s Phone: 1-38
Reviewer/Inspector Signatur : j � Pji;A Date:
12128104 Continued

Facility Number: — Dlef Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available'? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps ❑Other
21. Doe record keeping neeVimovement? If yes, chee the appropriate,b�,oxx below. ❑ Yes qNo ❑ NA ❑ NE
aste Applicatione ]y Freeboard aste Analysis L1dSoil A al is r — [�nnuai Certification
D►' Rainfall Stocking Cro Yield 220 Minute Inspections Monthly and 1" Rain Inspections Bather Code
22. Did the faF,llity fail to install and maintain a rain gauge? ❑ Yes 240 ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes o ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by'the permit? t.431105 ❑ Yes No ❑ NA ❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
❑ Yes
❑ No
INA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal'?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
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 X No
❑ Yes I*
❑ Yes �N0
❑NA El NE
El NA ❑NE
El NA ❑NE
El NA ❑NE
El NA ❑NE
❑ NA ❑ NE
and/orAdditional Comments Drawings:
•� r
4
IMF � ems/ � � � J►i `'+.
+� , >• ► ! .
1
12128104

, _..; .. -
;� 1' !I va i i., 3F! 1 'E'. -� 1 „Iti:::i �., ,tEe.k f r lri FZI 1 f f. 1..+i.. j,, $ r '.'•,i 1 1' fl j. !
1 , f � ! , E ', E , R, . E oaf Water (�ualit ; � ;' r a 7 I
, i ! F �Il� -ai€ il!77! `� !. , !II 7 I I c ENf llQ P � r 1lii
� ' F �, .E,! d .sl', � f , ,d� € �Ir� f�, , f i ii e, :dE; dal i 1 { �. Iy 3 ri , f q4 . �
� 1't �1, t _!� f„ ,1af i3 k. iltal 3i €F� �i,li sj! fr.
, ivislon of Soy!°and,Water�ConserVation ' ,'� 9, r'"r'
{! .5;
! a
enC tl!€ ,
� y 1 €'! .,II!'
EVl `!1 1 !.r ¢ ! F:,
, r H 3�- �! � EE �
E
f Visit O+ Compliance Inspection O Operation Review O Lagoon Evaluation
n for Visit OO Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number 76 60 Date of Visit. 9/1/2004 Time: 1305
Not O erational O Below Threshold
® Permitted ® Certified © Conditionally Certified 0 Registered Date Last Operated or Above Threshold: ............
FarmName: IY.I.exl:detl........................................................................................................... County: FkaAd.QjAUx......................................... W. .SRA........
OwnerName:,j'Jku........................................ d3ta tS......................................................... Phone No: 336r.49S-d.49.8..........................................................
Mailing Address: .72.4c.''a.I1jeX.JYJiJ>,.d........................................................................ RAAd1cMf n..N.C............................... .... Z.7.317...............
Facility Contact: Airlin.B.at1kc................................................... Title:................................................................ Phone No: 332,99� .(eelJ)..........
Onsite Representative., Ohllljp.W.l:lgbt....................................................................... . Integrator: ..........................................................
Certified Operator:.EXelCett..P.......:...................... Wright.............................................. Operator Certification Number:Zl3.3a.............
Location of Farm:
Farm address: 4718 Ramseur- Julian Road, Liberty, NC +
US Hwy 421 south from GSO. Right onto Old Liberty Rd. Right onto Ramseur -Julian Rd. Farm is on right.
[I Swine [3 Poultry ® Cattle
[I Horse Latitude 35 • 51
16 �� Longitude 79 • 3$ 24 «
'Design
Current' Design
Current
Design. Current
Swine Capacity
Population Poultry Capacity
Population Cattle
Cavacitv Population
❑ Wean to Feeder
❑ Layer
® Dairy
1500 0
❑ Feeder to Finish
❑ Non -Layer
❑Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder
❑Other
❑ Farrow to Finish
Total Design Capacity
1,500
❑ Gilts
❑ Boars
Total SSLW
2,100,000
Number of Lagoons 0 j 1 Spray Field Area
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? ❑ Spillway ❑ Yes ❑ No
Structure I Structure 2 Structure 3 .Structure 4 Structure 5 Structure 6
Identif er: ...... pper.stage.............. Lo.=02 ........ ............... #3 ................ ................................... ........................
Freeboard (inches): 12 42 38 _
12112103 Continued

Facility Number: 76-64 • Date of Inspection 9/1/2004 • 0 -
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 r] 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 Small Grain Overseed Corn (Silage & Grain)
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 ❑ 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.
Comments (refer to question #)` 6plain any YES answers and/or any, recbmmenEdatctons or: any, othencomments',
Use'drawings'of facility to € better``explaiif sitdidons: (use additional 'pages as necessary) Field Copy ®Final Notes=77
.,.
t E �i _ 1
7. Need to cap/rernove unused pipes in waste ponds before this weekend to keep excess freshwater out of waste ponds.
+
7. Need to fill in low areas on dam of #3.
7. Need to clean out vegetation/solids from #1 prior to use.
16. Suggest purchasing reel for use at this farm only.
3. Don't forget to record commercial fertilizer if a field also receives animal waste.
3. No animal waste has been applied since the last DWQ inspection. No waste or soil samples required for today's inspection.
t operator's request, DWQ to send list of operator classes and certif cation form.
r
Reviewer/Inspector Name Meli a Rosekirock
Reviewer/inspector Signature: 0,1 L Aq JA,Date:
12112103 . VT - 1 V - - ` - v— I r Continued

Facility.Iumber: 76 -60 i of Inspection 9/1/2004 .
N
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?
(ic/ discharge, freeboard problems, over application)
❑ Yes
®No
27.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
®No
2$.
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
IN 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 V Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
12112103

(Type of Visit 0 Compliance Inspection O Operation Review O Lagoon Evaluation �
for Visit ID Routine Q Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Date of Visit: I Q y Time:
Nat Operational 0 Below Threshold
XPermitted ©ryCertt f`ied © Conditionally Certified 13 Registered Date Last Operated or Above Threshold:
Farm Name fn................................ County:... �1 �..� ........».....'..._ _ __......_.
Owner Name: »..! !» 1.�. n........... .,.v��:e........ .....»...._._...._._........_..... 'Phone No:...f:..» f• »..1 �....___.� �. .
Mailing Address: ..S.-.3 .0......WAL..t ux- -__-----{ I .I_...
Facility Contact: Title:._»..»».».... .. » » ..___ Phone No:
Onsite Representative: P- �[I-�. .0 ` ___..... ..... Integrator. �.... ».»__.»» _ ...._._.___ . _» .»» .»..
Certified Operator:._—L.vp T .. _ l� �.� .._. Operator Certification Number:
Location of Farm: r
zXaW--11 M K291rl W
Seer--7u
=C�: c�
❑ Swine ❑Poultry Cattle ❑Horse Latitude" Longitude ', �«
Swine C
Wean to Feeder
?^'
Feeder to Finish
ELayer
Non -Layer
Farrow to Wean
Farrow to Feeder
� Other
Farrow to Finish
16W—DeM
Gilts
Boars
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
I
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?
❑ Yes "KNo
❑ Yes '❑ No
❑ Yes ❑ No
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 XNo
Structure ._ Str> m m 2 Structurg�3 Structure 4 Structure 5 Structure 6
Identifier: r� ___'ZI _. __. ...__.__._._._........__.. .._._._..__ . __.._.»... .._ .» ... » .
Freeboard (inches): O�
12112103 Continued

Facility Number: (� Date of Inspection
5. Are there any immediate threats to the ii'1llgrity of any of the structures observed? (ie/ tre ,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?
(i£ any of questions 4.6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? Yes fNo
8. Does any part of the waste management system other than waste structures require maintenan�mprnvement? GG❑-Yes
9. Do any stuctures lack adequate, ganged markers with required maximum and minimum liquid level ❑Yes
elevation markings?
Waste AavIicatian
10. Are there any buffers that need maintenanceJimprovement? ❑Yes No
11. Is there evidence of over application? If yes, check the appropriate box below. ❑Yes o
❑ Excessive Ponding ❑PAN ❑Hydraulic Overload ❑Frozen Ground ❑Copper and/or Zinc
12. Crop
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 fNo
o
b) Does the facility need a wettable acre determination? - ❑Yes o
c) This facility is pended for a wettable acre determination? ❑Yes
15. Does the receiving crop need improvement? ❑Yes �10
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 attar below —j3-y4
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑Yes 1
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.
\ Re viewer/Inspector Name
Reviewer/inspector Signa
\12112103
Field Copy ❑ Final Notes
Date:
Continued

IFacility Number: — D of Inspection
Required Records & Documents 'X
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/ , checklists, design, maps, etc.) \ ❑ Yes No
23. Doe Ord keeping need im vement? If y ", check the appropri box below. ❑ Yes No
Waste Application meboard to Analysis tl 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 cm,— 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) XYes ❑ No
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ONO
32. Did the facility fail to install and maintain a rain gauge? ❑ Yes XO
33. Did the facility fail to conduct an annual sludge survey? L4�doh5 O •$ o�$xe�
34. Did the facility fail to calibrate waste application equipment? v Q � 'N Yes [I No
35. Does record keeping for NPDES required fornI nL vement? If yes, check the appropriate box below. - Yes ❑ No
tJi4 [I Stocking Form M) Yiel Form j Rainfall Inspection After 1" Rain
7�
0 Ilk] 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.
4
{ J
lJ n-e.¢el tu
43.
U
ariv
I
AL
�>> i
12112103

vlsion of Water Quality . P
ision of Soil and Water Conservation
O Other Agency
Type of Visit © Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit O Routine O Complaint O Follow up O Emergency Notification O Other 0 Denied Access
Date of Visit: 12JD912o03 Time: 1530
F-1 acililV Number 76 60
Q Not O perational 0 13c7tv "I'Itreshold
N Permitted ® Certified 0 Conditionally Certified © Registered Date Last Operated or Above Threshold: RV-0/209.1.
Farm Name: Meredlizil.F.Aral,ing................................................................ County: NAdQjpk ............................... Wjj&0.....
O►yner Name: ArJfU.ButUse------------ Meceiditb_.___._------------_-_--- Phone No: 331fi:445:J4Q$.-------------_._.._--------
Mailing Address: 5.79A.NV.a1kex.Mali.RQAd................................................................... Rand iman,AC................................................... MIT
Facility Contact: Ar U.8jkRkc.......................................URIC:............................................... Phone No: 3$2,9Q34.P.hil1iR..q&......
Onsite Representative: Phillip �LCIghL_._._._.----------------------_-_---lntegratgr:-_-_-___•_-_______-_•--_----------
Certified Operator:
Location of Farm:
Operator Certification Number: ZI.JJ3..................
4arm address: 4718 Ramseur- Julian Road, Liberty, NC f
.JS Hwy 421 south from GSO. Right onto Old Liberty Rd. Right onto Ramseur -Julian Rd. Farm is on right.
I-
0 Swine ❑ Poultry ® Cattle ❑ Horse Latitude 35 • 51 { 16 44 Longitude 79 • 38 24
Design Current
Swine ranneity Ponnlntinn
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Soars
Design Current Design Current
Poultry Capacity Population Cattle Capacity Population
❑ Layer 119 Dairy 2000 0
❑ Non -Layer ❑ Non -Dairy
❑ Other
Total Design Capacity 2,000
Total SSLW 2,800,000
Number of Lagoons ® ❑ Subsurface Drains Present ❑ Lagoon Area IN Spray Field Area
Holding Ponds 1 Solid Traps 3 ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
N
❑ Yes ® No
❑ 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 6
Identifier:__._llpReestage..... ...... Lawer.#2...... ........... #1........... ............................ ........................... ...........................
Freeboard (inches): 24 42 48
t75/03/01 �, �/O � ��Continued

Facility Number; 76-60 Date of 111spedion 1210912003
Are there an immediate threats to the in e rit of an of the structures observed? ie/ kreesevere erasion
5 Y g Y Y ( ❑Yes No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? Yes ®No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes ® No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes ® No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes ® No
Waste Application
10. Are there any buffiers that need maintenance/improvement? ❑ Yes ® No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload [ ❑ Yes ® No
12. Crop type Corn (Silage & Grain) Small Grain Overseed Small Grain (Wheat, Barley, Fescue (Hay)
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 sail 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
El 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
13 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
❑ Field Copy ® Final Notes
to change owners name on permit. Form cent to Arlin Buttke on 1112104.
9. Records look good for 2003.
9. Don't forget to calibrate waste application equipment, send in rainbreaker form now and the annual certification farm by March 1 st,
nd record rainfall per the NPDES permit. Call DWQ if you have questions regarding any of the permit requirements.
Reviewerllnspector Name Mell%sa Rosebrock
Reviewer/inspector Signature:
Date:
O5103101 Continued

facility Number: 7b-60 [ a of Inspection—569/2UU3
� i
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
05103101

Type of Visit O Compliance Inspection 0 Operation Review Q Lagoon Evaluation .
Reason for Visit © Routine Q Complaint Q Follow up 4 Emergency Notification 0 Other ❑ Denied Access
Facility Number 76 b0 Dale (1t' Visit: 9/10/20Q2 Time: Q92Q
I, Not Operational O Below Threshold
Permitted E Certified 0 Conditionally Certified 0 Registered Date Last Operated or Above Threshold:.. .......................
Farm Name: KtwWIPH.kAM-JuC. ................................ County: IZ,atnitlalllbt....:.................................... !..SRO........ ........ f
OwnerName: MAW ...................................... Mmedkb.................................................... Phone No: ��':A ............................................
MailingAddress: FURq 9.4.4.......................................................................................... Mim.ty.N.0 ............................................................. Z.7.29.8 .............
Facility Contact: P.hil P..Wright...............................................Title:................................................................ Phone N 1-33.638,2,9034........................
Onsite Representative: jPhAlllp..W.>:i8ht................................................................... .... Integrator:
................................................................
Certified Operator: Y.lr1Ct~ t. �............................. 1' rigiit.............................................. Operator Certification Number:ZI3.33 .............................
Location of Farm:
)avid'd address and farm address: 4718 Ramseur- Julian Road, Liberty, NC +
JS Hwy 421 south from GSO. Right onto Old Liberty Rd. Right onto Ramseur -Julian Rd. Farm is on Right.
❑ Swine ❑ Poultry IN Cattle ❑ Horse Latitude 35 • 51 16 Longitude 79 • 38 24 46
{ i` a y 'arse tr;;� �.W
i3;ay., -� i Design Current IDesign nt Design ur'Poultr. Cattle Y Ca acit P.o ultion� Y Ca acit ,tion Cs actt - Po ulatron
Wean to Feeder <y � ❑ ❑Layer ®Dairy zaoo 800
❑ Feeder to Finish ❑Non -Layer ❑Non -Dairy
`' ❑ Farrow to Wean
. r K
❑ Farrow to Feeder ❑Other
❑ Farrow to Finish Total Des>Ign Capacity 2,000
❑ Gilts ;
❑ Boars; ;. "; :, t Total SSLW 2,800,000
Number of Lagoons © ❑Subsurface Drains Present ❑ Lagoon Area ®Spray Field Area
Holding Ponds I Soled Traps 0 ❑ No Liquid Waste Management System
Discharges X Stregin Impacts
I. 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? 0i' 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 R Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ® Spillway ❑ Yes ® No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ...... 1'V.asle.P.tand..... ...... Uppet.stage........... .Lawat.sta,ge...............................................................................................................
Freeboard (inches): 53 24 36
05103101 Continued

Facility Number: 76—bd Date of Inspection 9/10/2002
5. Are there any immediate threats to the inigrity of any of the structures observed? (ie/ tree0evere 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) Rye cover
e
❑ Yes ® No
❑ Yes ® No
® Yes ❑ No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes ® No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes ® No
b) Does the facility need a wettable acre determination? ❑ Yes ® No
c) This facility is pended for a wettable acre determination? ❑ Yes ® No
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Ryquired 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 ® No
13 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
•om ents refer to q tin :Explain any YES ans a and/or any recommendations or any other comments.
t se drawings of facilit t better explain situations. ,use additional pages as nee ssary : El Field Copy ®Final Notes
7. Continue efforts to repair groundhog holes around load -out pipe on waste pond.
17. Neither of the state or NPDES permits or COC has been issued yet.
t9. A couple of the fields are high for Cu, Zn, or P but do not appear to be increasing year to year.
19. Solid waste was applied on Tract 4466, Field 2/3 (wheat) on 3/t 1/02. CAWMP was written for wheat application during the months
of Aug. -Nov. or for application on corn silage Mar. -May. Due to drought, wheat was planted in Nov. 2001 and was much smaller than
normal in Mar. 2002. This is not a typical scenerio. No need to revise CAWMP yet.
19. Need to take waste sample from the specific waste storage structure that is being applied.
Reviewer/Inspector Name Melis Ro ebro k n.
Reviewer/Inspector Signature: Date: U
05103101 1 Continued

Facility ]Number: 76_.60 D
ot' Inspection 9/10/2002
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?
/Questions that were left blank are not applicable to this facility at this time.
❑ Yes ❑ No
❑ Yes ® No
❑ Yes ® No
❑ Yes ❑ No
❑ Yes ® No
❑ Yes ® No
❑ Yes ❑ No
J
05103101

V
a:30 A�
Ot'�WSCIQtlalit'}''`�PP� €� nr'.'##j¢ Da j,:E Eta `4Ei: i cal rt,gijbE y3 s�ltta€i#4`E �i lEureati I d€r!
€
�, ', , i„ Division of Soillttnd Wster Conservation
>#f
'C?tll
er �►RcY r € aaa€ r, € °
,
:
Type of Visit Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit ,6 Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Date of Visit: 0 'l-ime:
j 10 Not Operational Below Threshold
© Permitted Certified 0 Conditionally Certified [3 Registered Date Last Operated or Above Threshold:
p r f ! E
Farm Name: v� �+ r Fiacm '1 n C • County: _ Rand o !p h `
Owner Name:.. v iy E
Mailing A Tess:eis:
Facility Contact:
Onsite Representative:
Certified Operator:
Location of Farm:
m qalseu ra
[:]Swine ❑ Poultry
Swine
Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
e_d l`qo
Phone No: 3� 6 g_ a r.2- 4 ';� L f2,
a rn nque-Jo a 7 a S'
r Title:
Phone No: • ��
r
Integrator: t
Operator Certtifi�tion Number:
1•0• Li
a7 xq;5
-FTram 654• c aoto
60 ti V - h+- on �-o
r j
-
Cattle ❑ Horse Latitude
ongitude'
'Design �•�;: „
tgti Current ' . Design. 'Current ;Destgn" Current „f.`=''
2a scity population Layer � ,�CapacitvE:,
Po ulation� a,° C DIlea _" �• ` Ca! aciti>, "Pa ulla ion
O a o
r❑ Non -Laver I
I Non -Dairy
❑ Other
@
Total .Design Capaclt3 000 E .
.,
Total SSLW a g 0 0 0 a0
bei aof Lagoons ❑Subsurface Drains Present ❑ Lagoon oon Area ❑ S ray Feld
Holding Ponds / Soitd'.Traps i ❑ No Liquid Waste Manage ent System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? Spillway
Structure Structure 2 Structure 3 Structure 4 Structure 5
Identifier; I Q U
❑ Yes *o
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes -ViNo
❑ Yes . -No
❑ Yes V0
Structure 6
Freeboard (inches):
05103101 Continued

Facility Number: —lb—Z;d Date of Inspection 0
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes XNo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? El 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? A 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 "NtNo
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes . No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes No
12. Crop type Q
13. Do the receiving crops differ wi those desi nated 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 Rec rds & Documents
❑ Yes X No
❑ Yes 04 No
❑ Yes �VNO
o
❑ Yes
❑ Yes �No
❑ Yes XNo
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?
❑ Yes
06No
(ie/ WUP, checklists, design, maps, etc.) 1/
19.
Does record keeping need improvement? (ie/ irrigation, fre)board, 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
XNo
21,
Did the facility fail to have a actively certified operator in charge?
❑ Yes
Wo
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes
*0
(ie/ discharge, freeboard problems, over application)
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
AQo
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
ANo
©
No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
t 1 " 1 4. FV °;. a -r; - Lt.d ttr < sa 8 3.
Comm€ents {refer to:questiop3#) Expialn anylYES ansaersaand/orEany recommendations or any er•1comments.
v... i.� ,r M33 .�I' € <,'3 ri.«..w,:a..,�...9e....,.r:,.t,.:.,,.L„ at,.,«t..... ...M ,. �a..,...-.� �F
p dtfitioital,page�as necessary) c t (use & Field Cory ❑ Final Notes " r3
Ilse drawin s of fa illty to better ex lam'sttuatiohis p � �R y � MV - µ Ty N 0.
a- S r N P 1) us �. Jh�,c n o+ 155 ueGt
7 Carrtn ue. f8naA r halms round h S
locid o�+ o� U�a6 -e- p t A�-
P P�
Reviewer/Inspector Name
Reviewer/Inspector Signature: A7 Date: o�--

r k
Facility Number: — 01 4ate of Inspection
dov 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 XNo
❑ Yes x No
r �'INo
❑ Yes No
❑ Yes / Vo
o
Additional M''�i
S r a- I r) ad e. �rom Sfocv-pi k I usea SQhd be4dlh ?
1q, pecoras lCe#b �� ui e2 �R .
as In6ne-r"a4z)r added ? �.
,6-i,tetv %&c "
L--x*W- 3111 J %-4 1
00 YVO
e'J-Z'�
Ut
too
AJO
..
05103101

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 60 Date of Visit: 11/30/2001 Time: 1030
0 Not Operational 0 Below Threshold
{� Permitted E Certified [3 Conditionally Certified 0 Registered Date Last Operated or Above Threshold:
Farm Name: lY avdell.FarmIng.................................................................................... County: RtTLdQlRh......................................... W�RA........
Owner Name: David ....................................... Meredith ................................................... Phone No:Q3,6)..622,-Z4Z$ ........................................................
MailingAddress: PO. QU0.4.4 ......................................................................................... LibrjOYNC ............................................................. 2.7.290 .............
Facility Contact: PWRIpMrAgAL ...............................................Title:......................... Phone No:
Onsite Representative: PhillipMight........................................................................... Integrator:
Certified Operator: EKirlCcU .............................. Wright.............................................. Operator Certification Number: 213.33 .............................
Location of Farm:
4718 Ramseur- Julian Road, Liberty, NC •
❑ Swine ❑ Poultry ® Cattle ❑ Horse Latitude F 35 • Longitude 79 •
-w.t.,st s � � t� -+tis. i � '9:,a�+.rQc: u
Design Current r''T Design Current Destgn; Current.
Swine. - fCa acit , 1?0 'ulat on ,: Poultr.Y Ca acit tr P.o ulation �. Cattle Ca acit iH Po$ a lion
❑ Wean to Feeder ❑Layer ®Dairy 2000 700
'`. ❑ Feeder to Finish ❑ Non -Layer ❑Non -Dairy
❑ Farrow to WeanT
Farrow to Feeder ❑ Other "
❑ Farrow to Finish , TotalDesignCapactty,; 2,000
.F. ❑ Gilts
❑ Boars "`�" : " M �TotaiSSLW? 2,800,000
Number of Lagoons ❑Subsurface Drains Present ❑Lagoon Area ® Spray Field Areaa
Holding Ponds /Solid Traps 0 ❑ No Liquid Waste Management System' 4-
Discharges 8� 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. li'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 6
Identifier: ...... Wasie.Fand..... ............ pper........... ...........Lower............ .........................................................................................................
Freeboard (inches): 24 54 46
05103101 Continued
77�7��

Facility Number: 76-60 Date of Inspection 11 330/2001
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or 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 ® No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes ® No
12, Crop type Small Grain Overseed Corn (Silage & Grain)
13. Do the receivinj; 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
Rye
uired 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?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
® No
19.
Does record keeping need improvement? (iel irrigation, freeboard, waste analysis & soil sample reports)
® Yes
❑ No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
® No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
® No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(iel 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
11 mments refer t estion # : Expla[n an an a and/or an recommendations o an other commen
drawings of fa li o better explain situation . us additional pages as ne essary 'a ❑ Field Copy ® Fina!Not!es
8. Some drainage is coming off of bedding pile. Waste has not left property. Operator plans to concrete and berm this area as soon as
_
possible.
13. Operator is applying waste to oats (hay) and fescue (hay) that is harvested from field number six. This crop needs to be added to
CAWMP.
14. Irrigation design was by Ronnie Wall of Gra-Mak and signed 9/25/00'. Was done on wetted acres.
19. Need to keep irrigated waste application by "pulls" and wetted acres (page 46 in CAWMP). Solid waste applications may use the
acres for the entire field.
19. Need to use the PAN from the CAWMP in calculations (page 46 for irrigation and 2age 50 for solid).
Reviewer/Inspector Name imelis Rosebrock
Reviewer/Inspector Signature: Date: Q
05103101 1 / Continued

Facility Num�.er: 76-6U 1) f Inspection 0
11/30/2001
.r
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?
next time plan is revised, suggest adding incinerator as animal disposal method.
❑ Yes ❑ No
❑ Yes ® No
❑ Yes ® No
❑ Yes ❑ No
❑ Yes ® No
❑ Yes ❑ No
❑ Yes ❑ No
I
05103101

outi Q Com taint Q Follow-up of DWQ inspection Q Follow-up of DSWC review Q Other
I ` 1acility)Nurnber Date of Inspection
Time of Inspection 24 hr. (hh:mm)
t .
+ Q Perritted ® Certified 13 Conditionally Certified [3Registered JE3 Not O erational Date Last Operated: ..........................
Farm.Names ..... ed� �.....Farm.,XnlC..'................. I.................. County:.... rd-1 ph .........................................
,Ow er Narne:.!1,..1.�i,%1.......!•'..•p✓t•.�..1. ►.1.. Phone No: ...'!.'iP Z Z— �+{a
�,. ...................
,I `_
Fpa�ci 'ty Con t:....P �..1.J.P.....0 ).Q. Il ............Title: ................................................................ Phone No:...................................................
fv r�� ii � T �. / 1 � 7 p�
Malinqddr s .. ..�L. ... .�4�.%. :..11.C1�.1.L .%1.....................r i.r.... ....... ...................... 9.11'....................
Onsite Repres iative:..... 1.11 Lit Integrator:
........................................................................................................................................................
,,r� �I.t �11 j`- i� f l
Certified Operator:,C... P...... .........P.J[.� i��.........11 ...... ............... Operator Certification Number:.,rot,1.3..13..............
Location of Farm: , , , a ,- , JI
zn.:..a..... u.r..- �..11ar�..... .......... r...m.....r......n......r.. .............. I............. I.. .......
Latitude ®• Longitude, �' ®'
E214
"
t'
,
Uischarees & Stream Impacts
I. 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 [I No
b, If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) [I Yes ❑ No
c, If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon systern? (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 No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? �Spillway
❑ Yes VN
Structure Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
0 Identifier: W 011 U nDr
Freeboard(inches): ................................ .....:............ .................. ....................................
..............................................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, El Yes ye(
No seepage, etc.)
3/23/99 1 Continued on back

Facility Number: — I) if Inspection
r
6. Are there structures on -site which are not properly addressed and/or managed tlrough a waste rnanageniclit or
closure plan? [:]Yes XNo
(If any of questions 4-6 was answered yes, and the sittiation pose's an
immediate public health or environmental threat, notify DWQ) y
IlIo any of the structures need maintenance/improvement? .0 Yes JKNo
S. Doesrany part of the waste management system other than waste structures requira ilainteraucVlimprovement? ! Yes ❑ No
9. Do any stuctures lack adequate,' gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes ;K No
i
?Waste Application
r 10. Are there any buffers that need maintenance/improvement? - ❑ Yes OXNo
11. Is there evidence of over application? []Excessive Ponding ❑ PAN ❑ Yes o
12. Crop type A11(P (
13. Do the receiving crjs differ with those designated in the Certified Rhitual Waste Mana. Ament Plan (CAWMP)?
Ayes
❑ No
14. a) Does the facility lack. -adequate acreage for land application?
❑ Yes
DINob
b) Does the facility need a wettable acre determination?
-.
❑ Yes
Wo
c) This facility is pended for a wettable acre determination?
❑ Yes
No
15. Does the receiving crop reed improvement?
❑ Yes
No
16. Is there'a lack of adequ to waste application equipment?
❑ Yes
No
Required Records & DocLntents
IT. Fail to have CertificdU, of Coverage & General Permit readily available?
18. 'Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
�No
(ic/ WUP, checklists, design, maps, etc.)
❑ Yes
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
WYes
❑ No
20-- Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
XNo
21. Did the facility fail to have a actively certified operator in charge?
❑ Yes22.
�<No'
Fail to notify regional DWQ of emergency situations as required by General Permit?1!
(ie/ discharge, freeboard problems, over application)
❑ Yes
o
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
XNo
24. Does facility require a follow-up visit by same agency?
❑ Yes
VNo
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
XNo
i'Yo yiola(iols *or of rlcj ncio$ •►.'re A4feo- O(Wi6g tbis'vjsjt; • Y:oo ;wiii•teetiye ijo fu4•' r • . .
comes ori�ence. a otit this visit.
j9' } I - 3 •'�>t3r.3} 'd i41C4"�;P =il9 3 , 13 1,' y)' f I ! [ea ... P. '.'-i E, j i' �.�ft:§...§ s ! .$j%d£{£jf .•, �{: E3: 3tf3V".:"l;i >11 .. I.I1.Nollil Bi#i dia8 iT"°'i dz.PPfs9t9�f945;1¢A67�@f yi -S� 9 i1R kjSsfj4'ti:534'3iFSIYY£"Cf
CommentsE(rke%rfto questionany;YlES ans{{wars and/or3anytrecomm`endiaptri�ns orany othercomments.PE.
¢6�{ r! .1.,$1.:f �., 11�1 �ii x°<f�.i
wings tacility46 better expim situations (use additibiiW pages a }necessary)
.. 4R. - .y31. r 1 =i:, S , vt Wz# Mib;q,>.4 ..i.. I ea r-
&x*,4 OAW -,AU
Reviewer/Ins l rs ,jl b.+ .�..533 .. r, is�r
��I�
Reviewer/Inspector Name
p ,.,
Reviewer/Inspector Signatur I.I.M. Air I I k .b, b/ Date:

Facility Number: 16 — O aof Inspection a Printed on: 7/21/2000
Oder Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or br-low
liquid level of lagoon or storage pond with no agitation?
0 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)
24. 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?
� � ► I i ►1 ►�,! � ' � f �' ' �'� 'fir'`
4�9.-f-4
14
❑ Yes NNo
❑ Yes '(No
❑ Yes X No
1
5100

Type of Visit Q Compliance Inspection' O Operation Review Q Lagoon Evaluation
Reason for Visit 4 Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number 76 60 Date of Visit: 12/1/2004 Time: 0925 Printed on: 12/4/2000
Q Not Operational O Below Threshold
® Permitted ® Certified 0 Conditionally Certified 0 Registered Date Last Operated or Above Threshold:... ......................
Farm Name: rdervt0fatrmIn-c.................................. ................. County: Readalpha......................................... W.5RQ........
Owner Name: A:axxsl....................................... 1.!'cir.edial.................................................... Phone No: 013.61622-MM.................. ......................................
Facility Contact: ...................... Title: Phone No:
MailingAddress: .......................................................... Ubgrty..K ............................................................. 2.7.29.$ .............
Onsite Representative: f,1hUjl1?..W.rigilt ........................... ........... Integrator: ........................................................................
Certified Operator: Eyrxv. t................................... Wright......................... ................. Operator Certification Number:2ja��
Location of Farm:
1718 Ramseur- Julian Road, Liberty, NC A
❑ Swine ❑ Poultry ® Cattle ❑ Horse Latitude 35 • 51 16 Longitude 79 • 383 24 66
:A l7esigu Current Design Current Design 'CCurrent
Swine Ca acit Po elation Poultry Ca acit P,o elation Cattle,, Ca acit Po elation
❑ Wean to Feeder ❑Layer ®Dairy 2000 850
❑ Feeder to Finish ❑Non -Layer ❑Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder ❑Other
❑ Farrow to Finish Total Deslgn>;Capaclty 2,000
❑ Gilts d
r,w ❑ Boars TotaIF, Isil 2,800,000
Number of Lagoons 1 0 ❑ Subsurface Drains Present ❑ Lagoon Area IN Spray Field Area
Holding Ponds / Solid Traps F3 ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State'? (Ii' 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
® Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
® Yes ❑ No
❑ Yes ® No
4. Is storage capacity (freeboard plus storm storage) less than adequate? ® Spillway ❑ Yes ® No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:......Waste.2and...... ...... Uppea.stage...... ..... Ljawex.stagt~.................................................................................................................
Freeboard (inches): 94 12 36
5100 ��� Continued on back

Facility Number: 76-60 Date of Inspection 12/1/2000 Printed on: 12/4/2000
5. Are there any immediate threats to the into rity of any of the structures observed? (iel tree*vere 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 maintenancelimprovement'? ❑ Yes ® No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ® Yes ❑ No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ® Yes ❑ No
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes ® No
11. Is there evidence of over application? ❑ Excessive Ponding []PAN ❑ Hydraulic Overload ❑ Yes IN No
12. Crop type Rye Oats
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?
18. 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? (iel 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?
0: No'violatiolis:oT def cieneies were :noted d, iithtg•this: visit.• :You' 'WAIl ireeeive i�o ftirthei�- : • :
correspondence: about this' i it .....: :::::::: :::::::: • : • :: :::::::
1,2, &8. Discharge from sandtrap overflows to main pond. Operator will have it contained by end of month.
9. Need to have spillway marked on main pond marker and need a marker for lower stage waste pond.
13. fescue field will be in corn in the Spring. To be followed by rye in the Fall. Mostly bermuda now.
15. Rye has not come up well yet. Has started, though.
19. Need to keep freeboard on lower stage waste pond.
Reviewer/Inspector Name "Melissa Rosebrock - -- __-_-- - - - --
® Yes ❑ No
❑ Yes ® No
[3 Yes ® No
❑ Yes ® No
® Yes ❑ No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
Reviewer/Inspector Signature: V1 V] 1 JA Q & &f U j f y ,R Date: /,).1'yffid 5100

Facility Number: 76-60 D9lnspcction 12/1/200U Printed on: 12/4/2000
Odor Issues 0
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 till pipe or a permanent/temporary cover? ❑ Yes ❑ No
thong comments an or rawrn�sr - Y� �, �*
a.
5100

ivision of Water Quality
,]vision of Soil and Water Conservation
,O'OtheCA enC
,y;
i
Type of Visit Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit `6Routine O Complaint O Fallow up O Emergency Notification O Other ❑ Denied Access
Facility Number Date of Visit: Qb 'Time: Printed on: 7/21/2000
0 Not Operational O Below Threshold
Permitted 13 Certified ❑ Conditionally Certified [] Registered Date Last Operated or Above Threshold:
Farm Name: ...... ride]].. Farm X n K. ...... County:......i»S7!�.............. ...............................
I_ Q'
Owner Name:... Q.Lfid......... .: .� 1.............................................. I... Phone No:. 334.r...%l. ..r..a. i?......................,
,,��,�jj�� ��.... i r!... Facility Contact: .... e. .... n!.....� �. i1 --r.� U4L....................................................:........ Phone No....................................................
Mailing Address: ........T...7..1.�c�........ e.u. .. i �..1.1.a.t�.....Td.:} ... �.. ....................... a.. �.-'........ NL
Onsite Representative:....Pb-111l:401 .....WVi, Integrator:......................................................
Certified Operator• e„1r�i„ ►1 Operator Certification Number:......: ...................................
Location of Farm:
!From H6hrz oro,+V_e---Hwy qq Niq Ta Ike �e'f onfa mSeur emu[
Tarim is on rI p h+ a f P_ r 61d Lfbgn-.l
❑ Swine ❑ Poultry aCattle ❑ Horse Latitude ©•Lyl 4 '1 Longitude �• �� ���
Design Current
Design Current
Design Current
Swine Capacity Population
Poultry
Capacity Population Cattle
Capacity Popplation
❑ Wean to Feeder
❑ Layer
Dairy
❑ Feeder to Finish
JE3 Non -Layer
I
Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Other
❑ Farrow to Finish
Total Design Capacity
❑ Gilts
❑ Boars
Total SSLW
Number of Lagoons ❑ Subsurface Drains Present ❑ Lagnnn Area ❑ Spray Field Area
Holding Ponds 1 Solid Traps ❑ No Liquid Waste Management System
Discharges & Stream Impacts
I. 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
h. If discharge is observed. did it reach Water of tiie State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed. what is the estimated flow in gal/min?
cf. 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? x Yes ❑ No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑Yes j(No
Waste Collection & 'Treatment IKNO
_
4. Is storage capacity (freeboard plus storm storage) less than adequate? Spillway ❑ Yes
Su•ucturc Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Icicntifier: .)�-�I,{��t� .. t7I'1' .......�„�.. �r ?.to-�C... ..................................................................................
Freeboard (inches): q 4 3 Y0 ,
5100 Continued on back
0

Facility Number: — D* Inspection I I,;GI 1 1(N1s 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 atfor below
liquid level of lagoon or storage pond with no agitation? OM 11`j a[XQO,
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 VNo
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes INO
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? Q m j Ti 157600 des--�
Additional Comments and/orDrawings:
A,
Pory
I?. ned 4 4UPe�
5100

Facility Number: %— 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 No
seepage, etc.) IV
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes ArNo
(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 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 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?
o-yi0NWris;o- dtficje;n0b9 * re)io e$• (i;l•t 1Ag 4jk4s;vjsjtf • Yo> :wii� I"ee�iye too; fu> t�gr
corres�6fidence: about. this visit. ... .
Yes No
),Yes No
Yes ❑ No
❑ Yes No
❑ Yes No
Yes ❑ No
❑ Yes *0
ElYes No
❑ Yes No
XYes ❑ No
❑ Yes KNo
❑ Yes ,)!fNo
❑ Yes XNo
Yes ❑ No
❑ Yes to
o
ElYes
❑ Yes No
❑ Yes No
❑ Yes o
❑ Yes No
Comments (refer to question ft Explain any YES answers and/or any recommendations or�any oilier co'ininents 5.,
Use drawings of facilityatii to better situons." (use: addidonal oases as ine'cessarv)..
3 , Vesoo yeti w� I I It. c.orh I vt Spr1h - �-otloweJ 6y e�i K F t
Mos fit*-Ml-4 h6W-0 , a�
a , gQ -�rDm Sa l ova-�1 �- ivy rid �A�~�L
'.. C °,EIr Reviewer/Inspector Name r l ale
Reviewer/Inspector Signatur : Date: L111 Z 160 S/pQ

l
Facility Number i.)att of Ir►sln:ctinta
!-ime of Inspeclion ® 24 hr. (hh:mm)
M Permitted 0 Certified p Conditionally Certified o Registered 0 Not Operattona Date Last Operated:
arin Nance: MerAde1l..Farm4.1nc..................................................................................... County: Randolph WSRO
Owner Name: David ...................................... Meredith............p.0 $off.Phuue No: 3.1b.)..622.2428.......................................................
..Io..4 L t b
c•ilitr' Contact: phulip...Wright................... g �
Fa ... Phone No -.
............................. I'iue: manager . 33br bJ.2-.2428.......................
Mailing Address: 47..1.8Ramseur-. ulian..l oad.....
1.,ibe 1y..lN............................
011siteRepresentative: RWUip....r1ghL........................................................................... Intel;ratur:.......................................................................................
Certified Operator: E.Y.erett4.P.............................. Wrigbi .............................................. Operalor Certification Number:21,333 ............................
Locative of Farm:
A
7IR.1�aigtstux-.Ililiaa;Rsad.,Lib.crt,y.G:::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::M:NU:::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::m::::::::::::::::::::: —
:
T �
Latitude ©0 Longitude
Design Current
Swine Capacity Population Poultry
[3 Wean to Feeder
[3 Feeder to Finish
[3 Farrow to can
13 Parrow to Feeder
p Farrow to Finis
13 Gilts
p Boars
p Layer
p Non -Layer
Design Current Design Current
Capacity Population Cattle Capacity Population
rairy
on- airy
p other
Total Design Capacity 2,000
Total SSLW 2,800,000
Number of Lagoons I t Ip au4surtace urarns rresent [3 Lagoon Area IN spray r►era Area
g
lioldin fonds l Solid'Traps f7 o rqur as a Management System
Discharges & Sireant Impacts
1. Is any discharge observed from any part of the operation? p Yes ® No
Discharge originated at: ❑ Lagoon p Spray Field p Other
a. II'dischargc Is observed. was the conveyance man-made? p Yes p No
b. II'discharge is observed, did it reach Wsler ol'the Slate? (]f yes, niftily DWQ) ❑ Yes p No
c. If discharge is observed. what is Ilse estimated flow In L'all Ain?
cl. Does discharge bypass a lagoon system`? (If ycs, notify DWQ) 13 Yes p No
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? 13 Yes ® No
Waste Collecti►►n & 'I'r•eatnlent
4. Is storage capacity (freeboard plus storm storage) less than adequate? 13 Spillway p Yes ® No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Slrticturc h
Identifier:...............................................................................................................................................................................
Freeboard(inches): ................. a ................. .................................... ................................... .................................... .................................... ....................................
5. Are there any immediate threats to the integrity of any of the structures observed? (iel trees, severe erosion, 17 Yes ® No
seepage, etc.)
3/23/99 Continued on hack

Facility Number: 76_60 • 1'16
1, 111specdo,l
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 M No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? p Yes ® No
1' asty Application
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 Fescue (Hay) Rye Corn (Silage & Grain)
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? p Yes M No
14, a) Does the facility lack adequate acreage for land application? p Yes ® No
b) Does the facility need a wettable acre determination? p Yes ® No
c) Does this facility lack adequate documentation to make a determination of adequate acreage?
15. Does the receiving crop need improvement? p Yes ® No
16. Is there a lack of adequate waste application equipment?
Requircd Records & Docunienis
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
� ' 1Vo.violationa,,inr• denciencies.were:naoted •during: this visit. • Ynur will -receive no further. :
.......... ....... ......................
....
Ondence: aboW this:visit
p Yes ® No
p Yes ® No
p Yes ® No
p Yes N No
p Yes M No
p Yes M No
p Yes ® No
p Yes ® No
p Yes ® No
p Yes ® No
c ommlelnts:(reterftoiquestton,n)pxptain eanyji Y,Lb.i answers, annror�anyrecommenaanons or. anyotner corn ments;
' 3.ai:4iAi�f.,j{IPI € E. f�EgE..fP..:i< EvEE.J E I €aEEi !>: �. ,.. EE... �. ��.. @ E , . ;�<.y: _..:E9_@I. E E . E. -E.:s E
Use drawtn s`of;facilit to.=.bettereex lat'n:situations: us% add�tional;E a es as'necessar,
y P P y)
Letter from Hof and Environmental stating that system was not functioning as originally de
signed. Facility nee a additional land �
o irrigate on. An additional 200 acres is currently being used.
BionTechnologies is currently designing new system. Should be complete by end of April.
w
Reviewer/Ins ector Name 1 __Basi'-ng_er. _
P iW Corey
Reviewerllnspector Signature. Date:

❑ Division of Solid Water Conservation ❑ Other
J'Division of Water Quality
19(Routine O Complaint O Follow-up of I)WQinspection O Follow-u� of DSWC review O Other �
_ - r.nrrr ■ mn urrirri nnrrrr u.rrrr
Date of Inspection 3 31 99
Facility Number 1 LO Time of Inspection !EZ`z�-7�� 24 hr. (hh:mm)
0 Registered �ertified 0 Applied for Permit fiPermitted 0 Not Operational LDate Last .Olperated:
Farm Name:....... / ier [ l...... "�..�..... I Nc..:. ..... County;..... L............................. t,JS.
OwnerName: ....... D'c4!P.............................�e`�.-1ti+........................................... Phone No:........................................... .....................................
FacilityContact: ...... Title: .........
%�ili.��(P.........Wt'!. .f............ / rl +s� ........................ PhoneNo:. �r ...........................ZZ-Z4 e
MailingAddress:.... .......:..... ....... ..................... .. r�........... I......`L ..................................
Onsite Representative:......f . J. J ... �' Integrator:
........................................ .....................
Certified Operator;....&��- ....P............... o!. e a.L!'.................................. Operator Certification Number;.- Z1 .3 3
Location of Farm:
Latitude Longitude FED
l7estgn Current
;,: -.Design Current ; :: ;; Design Current
Swine Capacity�Population
Poultry
Capacity Population Catfle E Capacity Population
❑ Wean to Feeder
❑ Layer
WDairy
yaa o1 &e,
El Feeder to Finish
❑ Non -Layer
❑Non -Dairy
4,
❑ Farrow to Wean
❑Other
�
❑ Farrow to Feeder
❑ Farrow to Finish
Total Design Capacity
Z o coo
CI Gilts
.,.,
;•
otal S W
Total
7.
Number of Lagoons I Holding Ponds', ❑ Subsurface Drains Present
©Lagoon Area
Spray Field Area
"^>
❑ No Liquid Waste Management System,
General
1. Arc there any buffers that need maintenance/improvement? ❑ Yes FNo
2. Is any discharge observed from any part of the operation? ❑ Yes P"No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes tNo
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ) ❑ Yes R 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
C�No
3. Is there evidence of past discharge from any part of the operation?
❑ Yes
ONo
4. Were there any adverse impacts to the waters of the State other than from a discharge?
❑ Yes
RNo
5. Does any part of the waste management system (other than lagoons/holding ponds) require
❑ Yes
Jt5No
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
PRNo
7/25/97

r � .
i
Facility Number: —
8. Are there lagoons or storage ponds on site which need to be properly closed? ❑ Yes AINo
Structures (Lagoons.Holding Ponds. -Flush Pits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes VNo
Structure 1 Stnicture 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
...................................................................................................................................................................................................................
8�
FreeboardV*.......................................................................................................................................................................................................................
10. Is seepage observed from any of the structures? ❑ Yes O'No
11. Is erosion, or any other threats to the integrity of any of the structures observed? ❑ Yes Q'No
12.
Do any of the structures need maintenancelimprovement?
❑ Yes
S'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
A"No
Waste Application
14.
Is there physical evidence of over application?
❑ Yes
JgNo
(If in excess of WNW, or runoff entering waters of the State, notify DWQ)
I5.
Crop e F?��cu........................................ .....................................................................................................................................................
P h'P �
16.
Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
❑ Yes
[SrNo
17.
Does the facility have a lack of adequate acreage for land application?
❑ Yes
�fNo
18.
Does the receiving crop need improvement?
❑ Yes
JWNo
19.
Is there a lack of available waste application equipment?
❑ Yes
UNo
20.
Does facility require a follow-up visit by same agency?
❑ Yes
UrNo
21.
Did Reviewer/inspector fail to discuss review/inspection with on -site representative?
❑ Yes
WNo
22.
Does record keeping need improvement?
❑ Yes
Plo
For Certified or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available? ❑ Yes KNo
24. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes O"I'No
25. Were any additional problems noted which cause noncompliance of the Permit? ❑ Yes J`No
No.vialations'or de'rcieilcies:were'noted-during this:visit.•.Y.ou,wiII re'ceive•nolt rth'er .
"s
� �.
7125197
Reviewer/Inspector Nameffl',
Reviewer/inspector Signature: Date: 3

3
acilitr hillnlllL'1 D;i(v nl' hlspeclion
Vince of Insp"tiori ® 24 hr. (hh:mm)
M Registered M Certified M Applied for Permit 0 Permitted in Nol 0peratumlr Dale Last Operated:
Farm Mine: MeredrIL.E.arin.,.Inc..................................................................................... County: Randolph WSRO
Owner Name: David ...................................... MAredith.................................................... I'lione No: 33ft-,.622,-3A02 ...............................................
Facility Contact: P.ttillip.Mxight................................... .............. l'ide: Mamager ........................................... Phone No: 3,3fii-b21-.2428.......................
Mailing Address: 42,1.8.Ratnseutr,-,d.ulian.Ralad.......................................................... l.ierty,NC............................................................. 27298 ..............
Onsile Represent:itive: Qhillip-1!!'.rtiat......................
irtegralor:......................................................................................
Certified Operator: Exerett.t'.— .......................... 1i4'.right.............................................. Operator Certification Number:21.333 .............................
Location of Farm:
noseuRaa
C-...!...:.......r:....!.....x..:.......:::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::
Latitude ©*©® Longitude
Swine Capacity Population
❑ Wean to Feeder
[3 Feeder to tars
❑ Farrow to Wean
❑ Farrow to ee er
❑ Farrow to Finish
M Gilts
❑ Boars
Poultry Capacity Population Cattle Capacity Population
❑ Layer Is Dairy
p Non -Layer 10 Non -Dairy
❑ Other
Total Design Capacity ,
Total SSLW
Number,of.Lagoons / Holding Ponds ❑ u sur ace Drains Present 1113 Lagoon AM IS Spray Field Area
0
nagement aystem
General
1. Are there any buffers that need maintenance/improvement? p Yes M No
2. Is any discharge observed from any part of the operation? ❑ Yes M No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. I I'd ischa rge is observed, was the conveyance man-made? ❑ Yes M No
b. II'discharee is observed, did it reach Surface Water'? (Ifycs, notify DWQ) ❑Yes ®No
c. li'discharac is observed, what is the cstirnaled Ilow in ual/min?
d. Does discharge bypass a lagoon system? (/Eyes, notify DWQ) ❑ Yes M No
3. Is there evidence of past discharge from any part of the operation? ❑ Yes M No
4, Were there any adverse impacts to the waters of the State other than from a discharge? ❑ Yes M No
5. Does any part of the waste management system (other than lagoons/holding ponds) require ❑ Yes M No
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time pf design? ❑ Yes M No
7. Did the facility fail to have a certified operator in responsible charge? ❑ Yes M No
7/25/97

act t y um er: 76_60 1)ole r0;lrectirrri
0
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures I L.aeoons,Lfolding fonds, i"lush Pits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
tiu iic�iire I Structure 2 Structure 3 Structure 11 Structure 5
Idenlilier:
I-rceboard (ft): ...............................................................................................................
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 Application
14. Is there physical evidence of over application?
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type ....................... F..escuf....................... ...................................................................................................................... ..................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19, is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
22. Does record keeping need improvement?
For Certified or Permitted I`avilities Uoly
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?
it ..:o:vio ions.or itciencres-were.nn e . , unng . rs v1s>I :. au. w� .retcetve no ur. er . ` .
'00606n000 a4oI .this•visit::
p Yes M No
p Yes N No
Structure 6
p Yes ® No
p Yes ® No
p Yes M No
Yes
® No
p Yes
N No
p Yes
M No
p Yes
® No
p Yes
® No
p Yes N No
p Yes ® No
p Yes N No
Yes ® No
p Yes ® No
E3 Yes ® No
p Yes ® No
�Camments {rc er to question'#) �IliEzplain�any, S7enswers an /or,any,Irecommen ationsior€a.ny.ot ertcomments
�o, ,
Use drawings facility to:'better ezplaiwsitu`ations (us e'additional pages as necessary): "
PUMP TO BE RELOCATED SOON. AFTER COMPLETED, IRRIGATION SYSTEM CAN BE USED.
FACILITY IN EXCELLENT SHAPE.
O PROBLEMS NOTED.
Reviewer/Inspector Name IW Corey Basinger ; -
Reviewer/Inspector Signature: Date:

Division of Soillp Water Conservation ❑ Other
13 Division of Water Quality
JQ Routine O Complaint O Follow-up of DWQ inspection O Follow-up of DSWC review O Other
Date of Inspection
Facility Number b �
Time of Inspec;tion �.J 24 hr. (hh:mm)
Registered ,M Certified ,E Applied for Permit 19VPermitted 113Not O erational Date Last Operated
Farm Name: . .
.....
.............`.................. ...1..../.......................................... County:......... tccfd��..!..........................t,-S�s.�4,,,
Owner Name: .....................................`' ' Phone No ez — 330 z
............................................................---••---•...... ............................... ...............
.....................................
may,, . '
Facility Contact: ... el..: .... rPpp..... L� j e�7.......... Title: �t`t. a... ep Phone No:... G.�.2......Z: 4. �...............
Mailing Address: .. iG t, <c C'lf3E....................G.................... �..
.....................I................................................................ ................. ....
VjR1G,�T
Onsite Representative!................................................................................................. ... Integrator:...............
Certified Operator; ................................� lt �lc ' �{� p Z 333 ..............
........................................................ Operator Certification Number:...........................
Location of Farm:
.......... .. ....................... ........ ........................................................................... J
� .$......./ <L.c.tCa-&—....�.............................
... ..... .............. .. ..... ......... .
Latitude Longitude =• 4 t6
Design w Current..
Design Current.
Design Y Current
Somme ` V
Capaclty�Pcspulation
Poultry:
Capacity Poputandn Cattle `:
Capacity Population '
❑Wean to Feeder
❑ Layer
Dairy
R <
❑Feeder to Finish
ElNon-Layer
10
Nan -Dairy
❑ Farrow to Wean
❑ Other
K ,.
❑ Farrow to Feeder
[] Farrow to FinishF,
•s: Tbttll D@Sigh Capacity''
❑ Gilts
M r
p
.,
❑ Boars
w�
zlJ, Of O
....
a
Number of.Lago4ops / Holding Ponds
/Q
. ❑ Subsurface Drains Present
❑ Lagoon Area
❑ Spray Field Area
'
; ❑ No Liquid Waste Management System<
*
General
1. Are there any buffers that need maintenance/improvement? ❑ Yes M No
2. Is any discharge observed from any part of the operation? ❑ Yes IM No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ErNo
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ) ❑ Yes Ef 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 ffNo
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
KNo
5. Does any part of the waste management system (other than lagoons/holding ponds) require
❑ Yes
N No
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
$l No
7. Did the facility fail to have a certified operator in responsible charge?
❑ Yes
PTNo
7/25/97

Facility Number: — t4 0j 0
8. Are there lagoons or storage ponds on site which need to be properly closed?
' Structures (LagoonsMolding Ponds, Mush Pits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
❑ Yes 14 No
❑ Yes [5 No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 - Structure 6
Identifier:
...................................................................................................................................................................................................................
Freeboard(tt): ............../........... .................................... .............. ..................... .................................... .................................... ....................................
10. Is seepage observed from any of the structures? ❑ Yes O No
11. Is erosion, or any other threats to the integrity of any of the structures observed?
12. Do any of the structures need maintenance/improvement?
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
Waste, Application
14. Is there physical evidence of over application?
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type ............... 9�%fif.e............. .................................................................. ............................................................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
22. Does record keeping need improvement?
For Certified or Permitted Faciliti&s 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.vio'Wiohso4 defciencies4ere•notid-during this:visit.• You.will r&ei ive•nti•further :
ct)rrespondehce about lhis:yisit
Alllkk- ce" - Vic- uvj "
Alf
jo
IN WI •
❑ Yes 0 No
❑ Yes 19 No
❑ Yes ®'No
.........................................
❑ Yes IffNo
❑ Yes ETNo
Cl Yes UNo
❑ Yes ®'No
❑ Yes i$ No
❑ Yes ®'No
❑ Yes UY No
❑ Yes CYNo
❑ Yes [�(No
❑ Yes )Z No
7/25/97
n
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Date: 4-Ld QC7—" /Q 9Y

® hairy
p Non-uairy
p Division of Soil ateer Conservation p Other Ageli .
Division of Water Quality
r
19 Routine p Complaint O Follow-up of DWQ inspection p Follow-up of DSWC review p Other
Date of Inspection
Facility Number
Time of Inspection 24 hr. (hh:mm)
0 Registered p Certified ■ Applied for Permit p Permitted IgI Not 0 Date Last Operated:
Farm Name: Merjtd,ell..EaxjaJnc...................................................................................... County: Randolph WSRO
OwnerName: Ix:ia........................................... Meredith .................... I ..... I ....... I ..... I ..... I.... Phone No: 622-242& ...................................................................
Facility Contact: Phillip..!'I<'xight................................................Title:............................................................... Phone No:....................................................
MailingAddress: 47 &.Ram%eur.4uliars..R.aad............................................................ liherty...N.0 ............................................................ 27Z9.8 ..............
Onsite Representative: PhiRip..W.right,.Dlavitl.Meredith....................................... Integrator:.......................................................................................
Certified Operator: )aver.cUT .............................. 1i1'right.............................................. Operator Certification Number:21333 ............................
Location of Farm:
Latitude 20 Longitude ®• ®� ®°°
1
-: esin vgn esln.;:..urrez u reDesign urren -
Swine . Capacity Population Poultry Capacity o opuration Cattle Capacity Population
p Wean to Feeder
p Layer
13 FeedertoFEET—,
p Non -La er
p Farrow to ears
i
p ter
13 arrow to ee er
Total�,Desi,
3.
13Farrow to Finis
p Gilts
p Boars
1. Are there any buffers that need maintenance/improvement? p Yes ® No
2. Is any discharge observed from any part of the operation? p Yes ® No
Discharge originated at: p Lagoon p Spray Field p 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) p Yes N 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) p Yes N No
3. is there evidence of past discharge from any part of the operation? p Yes ®No
4. Were there any adverse impacts to the waters of the State other than from a discharge? p 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? p Yes ®No
7. Did the facility fail to have a certified operator in responsible charge? p Yes ® No
7/25/97

Facility um er: 7 _1
8. Are there lagoons or storage ponds on sitich need to be properly closed?
'. g g p P P Y
Structures (Lagoons,Holding Ponds Flush Pits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure I Structure 2 Structure 3 Structure 4
Identifier:
Freeboard (ft): ..........5.L4.0...............................................
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 Application
14, Is there physical evidence of over application?
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
p Yes N No
p Yes ®No
Structure 5 Structure 6
C] Yes
® No
p Yes
® No
p Yes
® No
® Yes
p No
Yes
IN No
15. Crop type ..................
..... .......................................................................................................................................................................................................
16, Do the receiving crops differ with those designated in the Animal Waste Management Plan (A WMP)? 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?
11. . 'o'Vl� Ions. Or 1de41eies'We>re -noted io7 g Is visit;, , ou Wi .receive nv,further' .
p Yes ® No
p Yes ® No
p Yes ® No
E3 Yes ®No
p Yes ®No
p Yes ®No
p Yes p No
p Yes p No
p Yes p No
Comments (tefcr,to;questibh',#) •, Explain -any, YES answers andl6r any,recommendatious€or any other'eommcnts -- €"•'"
i': ... r:F," ° -, �r, .. - �': €� !} I'a�:� E :" E,
e. °a::. Al
it1'?41i�'1�I11+a{ 1.
f `[Ise:drawings of facility ,ta betker.ex liiin situstlans . , additional a es as necissar i tiro ,i3. `
( p ,:: y) 1€, €,€
13 - Floffland Environmental will install markers during installation of new system, for which an individual .permit application
has, been received.
16 - No plan yet. Currently 5th on SWC/NRCS to list.
23-25 - No plan -yet. Currently 5th on SWC/NRCS to list.
lndividual.permit application has been received and is currently being'reviewed by Central Office.
Facility was in good shape at time of inspection
7/25/97
Reviewer/Inspector Name ',,ore �ya$risinger'
•a r ❑ -`�' €r ip u.�r F ,�.,, � .� -tip € .�a€ I �€ x-. i! � lip 1.
Reviewer/Inspector Signature: Date:

1
.. «� ... .... , .. ..__ .... _.. ...... .... y
' ❑ DSWC Ani Fe l M ,#
ed of Operation Review
F�0 DWQ Animal Feedlot Operation Site Inspection
Routine O Comnlaint O Follow-up of DWO inSDeCtion O Follow-un of DSIVC review O Other
Facility lumber
Date of Inspection d i
�-tv { -
Time of Inspection 24 hr. (hh:mFn)
Registered © Certified.)CApplied for Permit © Permitted 113 Not Operational
Date Last Operated: .
Farm ]dame RE•Dc ��t';..�.......'`!C'... County:....1C�lqOt.PL4- ............................. .�?fl.......
...............``...E...............�.'-�-..................,... ...........................
Owner Name:........1.2.! S. M fir✓ D� Phone i\o:. ... LO,.. to Z 2 — Z¢ 7�$
................................. .............................................. .................. (}.............,.........,................................,..,...........
Facility Contact: Z iWIO -w
........................�Ctl�iz/.:G....... Fri tle:......................
IMailingAddress: 44-t8 1?-, NSeuP— j.Ju4 ps-
.......................... .................................................................
Onsite Representative: .............. ryrf / f� 01P-4. �T
P......'.....�' ..............................................................
Certified Operator ;..✓� P,` apFlT
..........................................................................................
Location of Farm:
. Phone No :..................
Integrator: ......................................................................................
Operator Certification Number;......��.f..���J�J
l
4 r�: 6- s W26T o P C. Wk r1/. Yj oi",I e. 40:774 0'T jjWe(5eul dNl ,F Dfd lam . a ku s v2 ,
.............................................................................. ............I..........
Latitude Longitude ®• .�B 3�
Design Current
Swine Capacity Population
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finisli
❑ Gilts
❑ Boars
Design Current Design Current
Poultry Capacity Population Cattle Capacity Population
❑ Layer Dairy 1 800
❑ Non -Layer I X Non -Dairy
❑ Other
Total Design Capacity Sal
Total SSLW Gam; Dbo
Number of Lagoons / Holding Ponds 10 Subsurface Drains Present ❑ Lagoon Area JEJ Spray field Area
❑ No Liquid Waste Management System
General
1.
Are there any buffers that need maintenzuice/improvement'?
❑ Yes
%No
2.
Is any discharge observed from any part of the operation'?
❑ Yes
%No
Discharge originated A: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
❑ Yes
'WNo
b, If discharge is observed, did it reach Surface Water'? (Il' yes, notify DWQ)
❑ Yes
RNo
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yec, notify DWQ)
❑ Yes
5�No
3.
Is there evidence of past discharge from any part of the operation?
❑ Yes
,RNo
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
Savo
alai ntenance/improvement?
&
Is facility not in compliance with any applicable setback criteria in effect at the time of design'?
❑ Yes
TstTio
7.
Did the facility fail to have a certified operator in responsible charge?
❑ Yes
fi�CNo
7/25/97 Continued on back

a
Facility Number:.8. Are there lagoons or storage ponds on site which need to be properly closed? ❑ Yes 9No
Structures (Laeoons,tlolding Ponds, Flush Pits, etc.).
9. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes A No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
...................................................................................................................................................................................................................
00,
Freeboard (ft):...........$7.................. .......... I ....... ............
10. Is seepage observed from any of the structures? ❑ Yes ANo
11. is erosion, or any other threats to the integrity of any of the structures observed'? ❑ Yes CR�No
12. Do any of the structures need maintenance/improvement'? ❑ Yes 9No
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers? ' „yes ❑ No
Waste Application
14. Is there physical evidence of over application'? ❑ Yes 5(No
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type ......... �S:�E.........................
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.vioiations or deficiencie's.were-noted during this.visit.:Yo'U"Will receive no' further
correspondence ahout this. visit'..'.
13.
}n€s (refer to question #): Explain any YES answer`s' and/or ahy'recornmend'attnns or.:an
twtngs,of facility to better explain situations (use additional lages as necessary)
9W?1AdP r.. Ad- ..ti. F
P6rft4a-riw1 a t< Nt'LW S tLsm-i .
U _Z5
qtQ O a.w Lve , 51,4- 0 % c.ou *1 1 � 0..
❑ Yes WNo
❑ Yes W No
❑ Yes Ig No
❑ Yes �WNo
❑ Yes RNo
❑ Yes DR No
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
ents z
7125/97
Reviewer/inspector Name
Reviewer/Inspector Signature: t Date: 1z Ozecle /99�L