090146_NOV-2021-DV-0483 Enforcement Package_20220505

ROY COOPER
Governor
ELIZABETH S. BISER
Secretory
S. DANIEL SMITH
Director
NORTH CAROLINA
Environmental Quality
December 6, 2021
CERTIFIED MAIL
RETURN RECEIPT REQUESTED 7020 0090 0001 7206 2949
Mr. Chad Hazelwood
11474 Old Mintz Hwy
Garland NC 28441
Subject: NOTICE OF VIOLATIONINOTICE OF INTENT
Administrative Code 15A NCAC 2T .1304
NOV-2021-DV-0483
Hazelwood Family Farm Facility Number 09-146
Permit AWS090146
Bladen County
Dear Mr. Hazelwood:
On September 10, 2021, staff of the NC Department of Environmental Quality (DEQ) Division
of Water Resources (DWR), Water Quality Regional Operations Section (WQROS) inspected
the Hazelwood Family Farm and the permitted waste disposal system. The reason for the
inspection was a compliant. We wish to thank Mr. Brisson for his assistance during the
inspection.
As a result of this inspection, you are hereby notified that, having been permitted to have a non -
discharge permit for the subject animal waste disposal system pursuant to 15A NCAC 2T .1304,
you have been found to be in violation of your permit as follows:
Violation 1:
Failure to prevent discharge of waste to surface waters or wetlands. N.C.G.S. 143-215.10C - (Permit No.
AWG 100000 Section Conditions I 1).
On September 10, 2021, DWR received a complaint about your farm. The compliant was about waste
flowing from hog houses, lagoons flowing over, and dead hogs in the barns. DWR staff documented
waste flowing from both houses from the back doors. Water samples taken on September 13, 2021
indicated that waste had reached ditches around your farm.
IE
North Carolina Department of Environmental Quality Division of Water Resources
Fayetteville Regional Office ! 225 Green Street, Suite 714 Fayetteville. North Carolina 28301
910.433.3300

Page 2
Chad Hazelwood
December 6, 2021
At house # 1, DWR staff documented the waste after leaving the house went into a field and ponded with
evidence of waste going into the ditch and confirmed with water samples. DWR staff inspected house #2
(two) and found a high volume of waste flowing from under the back door on to the ground behind the
house. Waste continued to collect in a large area inside the wooded area next to the house. Some waste
flowed into a ditch leading from behind the house and confirmed by water samples. The lift stations were
full and needed the waste transferred to the lagoons, and by the pits being full, waste was forced to flow
out of the house. Mr. Garett Brisson was pumping waste from house 2 to lagoon 2 to try and stop the flow
of waste out of the barn.
Required Corrective Action for Violation 1:
Stop the flow of waste from the houses and contain waste that has flowed out as discussed the day of the
inspection with Mr. Brisson and with you on later inspections. The waste must be cleaned up around both
houses, and take all necessary steps prevent this from happening again.
Violation 2:
The Permittee shall report by telephone to the appropriate Division Regional Office as soon as
possible, but in no case more than twenty-four (24) hours following first knowledge of the
occurrence of any of the following events:
e. Failure of any component of the animal waste management system resulting in a
discharge to ditches, surface waters, or wetlands. (Permit AWG No.100000 Condition III
17 a).
Your permit specifically requires notification by telephone within 24 hours and a written report
within 5 calendar days following first knowledge of the occurrence of a reportable permit
condition. DWR has no record of receiving the 24-hour notification and the 5-day written report.
The DWR has no record of you reporting non -compliant lagoon levels prior to September 10,
2021. The DWR was made aware of the farm condition from a compliant about your farm on
September 10, 2021.
�E
caa. rvn
UapeMmn a[mtmpnwput gwity\ ..
North Carolina Department of Environmental Quality ! Division of Water Resources
Fayetteville Regional Office 1225 Green Street, Suite 714 < Fayetteville. North Carolina 28301
910.433.3300

Page 3
Chad Hazelwood
December 6, 2021
Required Corrective action for Violation 2:
In the future, report any issues at your farm as stated in Condition III 17.
Violation 3:
The collection, treatment, and storage facilities, and the land application equipment and fields shall be
properly operated and maintained at all times. - [15A NCAC 02T .1304(b)] (Permit No. AWG100000
Section II 1).
On September 10, 2021 during the compliant inspection, it was documented that you had not
corrected the issues you had in January 2021. In addition to waste coming from house #2 it was
coming from house #1 also. During follow-up inspections, it was determined that you were not
flushing your pits as often as necessary to prevent the waste from becoming too thick to be
pumped to the lagoons.
On January 4, 2021 during the structural evaluation inspection, waste was observed coming from
house #2, caused by waste backed up in the house due to waste in the lift station not being
pumped to the lagoon. During your October 2020 Routine Compliance inspection, it was noted
that the lift stations at both housed showed signs of past discharges of waste on the ground next
to them. You were advised to maintain the lift stations as designed and stop this from happening
again.
Required Corrective Action for Violation 3:
You need to flush the waste in your houses as often as necessary to allow the pumps you put in to transfer
the waste to the lagoon.
Violation 4:
Disposal of dead animals shall be done in accordance with the facility's CAWMP and the North
Carolina Department of Agriculture and Consumer Services (NCDA&CS) Veterinary Division
Statutes and regulations.
Disposal of dead animals must occur within twenty-four (24) hours after knowledge of the death
in a manner approved by the State Veterinarian Proposed methods for disposal of mortality that
extend beyond twenty- four (24) hours must be approved by the state Veterinarian. [G.S. 143-
215.10C (e) (3) and 106-403] (Permit AWG No. 100000 Condition II 10)
vC57 o• CA,C1.
M{Iul4ront Of Emvm,mm Ui @W.ly
North Carolina Department of Environmental Quality Division of Water Resources
Fayetteville Regional Office 1225 Green Street. Suite 714 Fayetteville. North Carolina 28301
910.433.3300

Page 4
Chad Hazelwood
December 6, 2021
On September 10, 2021, DWR staff documented that hundreds of hog were in a disposal
container that was picked up by Valley Protein to be taken away for rendering. Documented
evidence in the hog houses confirmed that hogs were not removed within 24 hours after their
death. In addition, you admitted no one had been to the farm for at least two weeks to care for the
hogs that you were aware of.
Required Corrective Action for Violation 4:
In the future, remove dead hogs as required by your permit.
Violation 5:
The Permittee shall designate a certified animal waste management system operator with a valid
certification to be in charge of the animal waste management system. The waste management
system shall be operated by the Operator in Charge (OIC) or a person under the OIC's
supervision. - [G.S. 90A-47.2] II 16 (Permit AWG 100000 Condition II 16).
On September 13, 2021 during the inspection to review the farm records with your OIC Brandon
Norris, it was documented that Mr. Norris had not been to your farm after the middle July 2021.
For the estimated two -week period you stated that you did not go to the farm and the OIC was
not at the farm, this farm had no one operating the waste management system.
Required Corrective Action for Violation 5:
In the future, this farm must have a designated OIC and someone under their supervision to
operate the waste management system. You had a designated OIC, but it requires this person to
visit the farm as often as necessary to prevent discharges.
Violation 6:
Failure of the Operator in Charge (OIC) or a person under the supervision of an OIC to inspect the waste
collection, treatment, and storage structures, and runoff control measures shall be conducted and
documented at a frequency to insure proper operation but at least monthly and after all storm events of
greater than one (1) inch in 24 hours. For example, lagoons/storage ponds, and other structures should be
inspected for evidence of erosion, leakage, damage by animals or discharge. Inspection shall also include
visual observation of subsurface drain outlets, ditches, and drainage ways for any discharge of waste.
[15A NCAC 02T .1304 (b)] Permit No. AWG 100000 Section III 1).
On September 10, 2021 neither you nor your OIC were present at the farm and had not been for
at least two weeks. The only person on site trying to prevent the continuing discharge of waste
was a friend that heard about the farm condition and did what he could.
.rtE
Department a Emtpmnmtlt qW i
North Carolina Department of Environmental Quality Division of Water Resources
Fayetteville Regional Office 225 Green Street. Suite 714 ' Fayetteville. North Carolina 28301
Q1o.433.3300

Page 5
Chad Hazelwood
December 6, 2021
Required Corrective Action for Violation 6:
In the future, have your OIC on site every day or someone under their supervision to prevent
discharges from your waste containment system.
Violation 7:
Monitoring and recording freeboard levels, the waste level in each lagoon with a waste level
gauge shall be monitored and recorded weekly on forms supplied by or approved by the
Division- [15A NCACO2T.0108 (c)] (Permit AWG 100000 Condition III 2).
On September 13, 2021 during record review with Brandon Norris your OIC, it was documented
that no freeboard levels were recorded after July 25, 2021.
Required Corrective action for Violation 7:
In the future, record weekly freeboard levels as required by your Permit.
Violation 8:
Monitoring and Recording Precipitation Events, a rain gauge must be installed at a site that is
representative of the weather conditions at the farm's land application site(s). Daily records of
precipitation type and amount must be recorded for all precipitation events and maintained on
site for review by the Department of Environmental Quality(Department). Daily records do not
need to be maintained for those days without precipitation events. [15A NCAC 02T.0108(c)
(Permit AWG 100000 Condition III 3).
On September 13, 2021, it was documented that no rainfall events were recorded after July 19,
2021.
Required Corrective action for Violation 8:
In the future, record rainfall events as required by your Permit.
�ID_E
pepst9mM M Emvaxnmfat
North Carolina Department of Environmental Quality i Division of Water Resources
Fayetteville Regional Office 1225 Green Street. Suite 714 Fayetteville. North Carolina 28301
910.433.3300

Page 6
Chad Hazelwood
December 6, 2021
The Division of Water Resources requests that, in addition to the specified corrective action
above, please submit the following items on or before (30 days after receipt of this letter):
1. An explanation from the OIC during this incident (Brandon Norris) for this farm
regarding how these violations occurred.
2. A list from the OIC during this incident (Mr. Brandon Norris) concerning the steps that
will be taken to prevent these violations from occurring in the future.
3. An explanation from Mr. Chad Hazelwood regarding how these violations occurred.
4. A list from Mr. Chad Hazelwood concerning the steps that will be taken to prevent these
violations from occurring in the future.
5. Provide a copy of your lagoon levels with rainfall for 2021 up to present date.
6. Provide a copy of your IRR 1 and IRR 2 forms for 2021 up to present date.
You are required to take any necessary action to correct the above violations on or before
any hogs are placed on this farm and to provide a written response to this Notice within 30
days from receipt of this letter. Please include in your response all corrective actions already
taken and a schedule for completion of any corrective actions not addressed.
As a result of the violations in this Notice, this office is considering a recommendation for a civil
penalty assessment to the Director of the Division. If you wish to present an explanation for the
violations cited, or if you believe there are other factors, which should be considered. please send
such information to me in writing within ten (10) days following receipt of this letter. Your
response will be reviewed, and, if an enforcement action is still deemed appropriate, it will be
forwarded to the Director and included for consideration.
Failure to comply with conditions in a permit may result in a recommendation of enforcement
action, to the Director of the Division of Water Quality who may issue a civil penalty assessment
of not more that twenty-five thousand ($25,000) dollars against any "person" who violates or
fails to act in accordance with the terms, conditions, or requirements of a permit under authority
of G.S. 143-215.6A.
If you have any questions concerning this Notice, please contact Steve Guyton or me at (910)
433-3336.
D_E
' OfTV. C.V CI..rvn
DeRerO+wt of Nrv4amnenNl
North Carolina Department of Environmental Quality Division of Water Resources
Fayetteville Regional Office 225 Green Street, Suite 714 `:. Fayetteville. North Carolina 28301
950.433.3300

Page 7
Chad Hazelwood
December 6, 2021
Sincerely,
DocuSigned'by:
'N,eAk.gn
IJ�aU(P.n
5189C2D3005C42B...
J. Trent Allen
Regional Supervisor
Water Quality Regional Operations Section
Division of Water Resources
cc: DWR - WQROS - CAFO Unit — Central Office
FRO Compliance Animal Files-Laserfiche
gomrhrwnt of E.ranmanut UW iM
North Carolina Department of Environmental Quality Division of Water Resources
Fayetteville Regional Office 1225 Green Street, Suite 714 Fayetteville. North Carolina 28301
P10.433.3300

Facility Number
1
alTivision of Water Resources
0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit: 3-compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 0 Routine 0 Complaint O'"low-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: ' 9 / 3_ ;k' Arrival Time:
Farm Name:
Owner Name:
Departure Time:
Mailing Address:
5
Owner Email:
Phone:
County:
Region:
Physical Address:
Facility Contact: , „r
Onsite Representative:
f
•
Title:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Integrator:
Phone:
Certification Number: ,
it.
Certification Number: /''cif..
Longitude:
Swine
Design Current
Capacity Pop.
Wean to Finish
Wean to Feeder
';;- '. f
-•-k)"-"
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Design Current
Wet Poultry Capacity Pop.
Layer
Non -Layer
Design Current
Dry Poultr Ca i aci Po
Cattle
Design Current
Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
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?
0Yes El No ❑NA ❑NE
Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑No ❑NA ❑NE
❑ Yes ❑No El NA ❑NE
Yes ❑No El NA NE
❑ Yes ❑'No ❑ NA ❑ NE
Page lo 3
2/4/2015 Continued

Facility Number:
Date of Inspection: /;
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
Structure I Structure 2
❑ Yes
❑ Yes
Structure 3 Structure 4 Structure 5
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes 0/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
0/No ❑ NA ❑ NE
❑ No ❑ NA ❑ NE
Structure 6
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 Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
maintenance or improvement?
I I . Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes 0 NA ❑ NE
0-Yes ❑ No ❑ NA ❑ NE
❑ Yes -[]No ❑NA ❑NE
[Yes ❑No ❑NA ❑NE
❑ Yes ❑No ❑ NA E
❑ Yes aIClo ❑ NA 414
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
n 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):
fa I, .7,- 5
150
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes to ❑ NA ❑ NE
the appropriate box.
❑WUP ['Checklists ❑Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
Waste Application ❑'Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
12'1 ainfall ❑ Stocking ❑ Crop Yield ' 120 Minute inspections ❑ Monthly and I" R
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?
Page 2 of 3
❑ Yes [ No ❑ NA ❑ NE
❑ Yes QNo ❑ NA ❑ NE
❑ Yes Ei'o ❑ NA ❑ NE
❑ Yes Q'o 0 NA ❑ NE
❑ Yes Q"1lo ❑ NA n NE
❑ Yes ["No ❑ NA ( I NE
ainfall Inspections
❑ Yes
❑ Yes
[`des ❑ No ❑ NA ❑ NE
Waste Transfers 0-Weather Code
❑ Sludge Survey
No ❑ NA ❑ NE
RNo ❑ NA ❑ NE
5/12/2020 Continued

Facility Number:
- qL
!Date of Inspection: 7 / 3 / Y
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
25. is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes
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:
2.<0
❑ NA
❑ NA
❑ NE
❑ NE
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes Q No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes 12rNo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document 12-"res ❑ 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 [t]"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 Er/es ❑ No ❑ NA ❑ NE
permit? (Le., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? if yes, check the appropriate box below. ❑ Yes 1.--"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? ❑ YesNo ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? DNes ❑ No ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
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Reviewer/Inspector Name:
Reviewer/inspector Signature:
Page 3 of'3
Phone: `rli� -V 1 !
Date:
5/12/2020

a)
Facility Number
6L
ivision of Water Resources
0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit: Cmpliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 0 Routine erro7Pplaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit:
Farm Name:
Owner Name:
/e 4rrival Time: ,7` .
/:61-ZCAUOD) G447r ly
ytL ///a- -A000 di
Mailing Address:
Physical Address:
Facility Contact:
Departure Time:
Owner Email:
Phone:
County:L i. Region:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Title:
Latitude:
Integrator:
Certification Number:
Certification Number:
Longitude:
Phone:
� r
/Oo/3 !
Swine
Design Current
Capacity Pop.
W an to Finish
�d'Wean to Feeder
Feeder to Finish
oo
-0-
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Design Current
Wet Poultry Capacity Pop.
Layer
Non -Layer
Dr v Poultr
Design Current
Capacity Pop.
Layers
Non -Layers
Pullets
Turkeys
Turkey Poults
Other
Cattle
Design Current
Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field
a.
b.
c.
d.
Other:
Was the conveyance man-made?
Did the discharge reach waters of the State? (If yes, notify DWR)
What is the estimated volume that reached waters of the State (gallons)?
s ❑No ❑NA ❑NE
34;11-fr 14: Lkvti
'es No ❑ NA
'es ❑ No ❑
NA
❑ NE
❑ NE
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?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑' Yes ❑ No ❑ NA ❑ NE
❑Yes [Io ❑NA ❑NE
of the State other than from a discharge?
Page 1 of 3
5/12/2020 Continued

Facility Number:
Date of Inspection: /p—P--7
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes ❑ No ❑ NA []1VG
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑ No ❑ NA]E
the appropriate box(es) below.
n Failure to complete annual sludge survey n Failure to develop a POA for sludge levels
n 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? ❑ Ycs ❑ No ❑ NA ®``NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Ycs ❑ No ❑ NA ICJ
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document tYes ❑ 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 IE--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 Etles ❑ 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
n Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? 'es ❑ No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes iNo ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? EY s ❑ No ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
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Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date:
q/0Y-/5(
2/4/2015

Facility Number: cy -/yam
Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
❑ Yes
❑ Yes
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
2 Li
El o ❑NA El NE
❑No ❑NA El NE
Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed? D Yes 1 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 E Ycs FNo ❑ 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?
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 Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
Yes ❑ No ❑ NA ❑ NE
❑ Yes I i o ❑ NA ❑ NE
es ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA I NE
❑ Yes ❑ No ❑ NA [EIE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. n Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window n 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 thc CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? n Yes ❑ No ❑ NA IfNE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check n Ycs ❑ No ❑ NA ❑ NE
the appropriate box.
❑ W UP ❑ Checklists El Design El Maps ❑ Lease Agreements
21. Does record keeping need improvement? If ycs, check thc appropriate box below.
El Waste Application n Weekly Freeboard n Waste Analysis ❑ Soil Analysis
n Rainfall ❑ Stocking El Crop Yield n 120 Minute Inspections n Monthly and l"
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did thc facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Ycs ❑ No ❑ NA EiE
❑ Ycs ❑ No ❑ NA ❑'NE
❑ Yes ❑ No ❑ NA
n Yes ❑ No ❑ NA �E
n Yes ❑ No ❑ NAIE
['Other:
D Yes ❑ No ❑ NA zNE
D Waste Transfers n Weather Code
Rainfall Inspections ❑ Sludge Survey
❑ Yes n No ❑ NA IE'NE
❑ Ycs n No ❑ NA [] Iqf
Page 2 of 3 2/4/2015 Continued

Facility Number
1
alTivision of Water Resources
0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit: 3-compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 0 Routine 0 Complaint O'"low-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: ' 9 / 3_ ;k' Arrival Time:
Farm Name:
Owner Name:
Departure Time:
Mailing Address:
5
Owner Email:
Phone:
County:
Region:
Physical Address:
Facility Contact: , „r
Onsite Representative:
f
•
Title:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Integrator:
Phone:
Certification Number: ,
it.
Certification Number: /''cif..
Longitude:
Swine
Design Current
Capacity Pop.
Wean to Finish
Wean to Feeder
';;- '. f
-•-k)"-"
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Design Current
Wet Poultry Capacity Pop.
Layer
Non -Layer
Design Current
Dry Poultr Ca i aci Po
Cattle
Design Current
Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
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?
0Yes El No ❑NA ❑NE
Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑No ❑NA ❑NE
❑ Yes ❑No El NA ❑NE
Yes ❑No El NA NE
❑ Yes ❑'No ❑ NA ❑ NE
Page lo 3
2/4/2015 Continued

Facility Number:
Date of Inspection: /;
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
Structure I Structure 2
❑ Yes
❑ Yes
Structure 3 Structure 4 Structure 5
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes 0/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
0/No ❑ NA ❑ NE
❑ No ❑ NA ❑ NE
Structure 6
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 Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
maintenance or improvement?
I I . Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes 0 NA ❑ NE
0-Yes ❑ No ❑ NA ❑ NE
❑ Yes -[]No ❑NA ❑NE
[Yes ❑No ❑NA ❑NE
❑ Yes ❑No ❑ NA E
❑ Yes aIClo ❑ NA 414
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
n 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):
fa I, .7,- 5
150
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes to ❑ NA ❑ NE
the appropriate box.
❑WUP ['Checklists ❑Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
Waste Application ❑'Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
12'1 ainfall ❑ Stocking ❑ Crop Yield ' 120 Minute inspections ❑ Monthly and I" R
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?
Page 2 of 3
❑ Yes [ No ❑ NA ❑ NE
❑ Yes QNo ❑ NA ❑ NE
❑ Yes Ei'o ❑ NA ❑ NE
❑ Yes Q'o 0 NA ❑ NE
❑ Yes Q"1lo ❑ NA n NE
❑ Yes ["No ❑ NA ( I NE
ainfall Inspections
❑ Yes
❑ Yes
[`des ❑ No ❑ NA ❑ NE
Waste Transfers 0-Weather Code
❑ Sludge Survey
No ❑ NA ❑ NE
RNo ❑ NA ❑ NE
5/12/2020 Continued

Facility Number:
- qL
!Date of Inspection: 7 / 3 / Y
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
25. is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes
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:
2.<0
❑ NA
❑ NA
❑ NE
❑ NE
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes Q No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes 12rNo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document 12-"res ❑ 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 [t]"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 Er/es ❑ No ❑ NA ❑ NE
permit? (Le., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? if yes, check the appropriate box below. ❑ Yes 1.--"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? ❑ YesNo ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? DNes ❑ No ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
7-/ o- r Mom- 467794
+' L'�j�(;Je� v Wax5 7—SFr U- r3Fmf'
J�
10
-Zrr---1`"
- DI`f r5 �' T C �
0.\d-er- re--E).0-007464,
171e,4tro OPF34,,,f74. P•ex-iet kelaitc,He„,_ zpo
F /itch o a), a rroc.13 # a � I
j�'a Pf iS dam-:� ere) z- � � 4 PITretir6-4-N--_ 4-16 Oz--L-_ 7'1 .--�- �`� C � r ��� � � �f
Gi��� �^'U/J� /—r i ! r iLG�^ - s �P / g�tJ'h'
O!i C�V
Reviewer/Inspector Name:
Reviewer/inspector Signature:
Page 3 of'3
Phone: `rli� -V 1 !
Date:
5/12/2020

a)
Facility Number
6L
ivision of Water Resources
0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit: Cmpliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 0 Routine erro7Pplaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit:
Farm Name:
Owner Name:
/e 4rrival Time: ,7` .
/:61-ZCAUOD) G447r ly
ytL ///a- -A000 di
Mailing Address:
Physical Address:
Facility Contact:
Departure Time:
Owner Email:
Phone:
County:L i. Region:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Title:
Latitude:
Integrator:
Certification Number:
Certification Number:
Longitude:
Phone:
� r
/Oo/3 !
Swine
Design Current
Capacity Pop.
W an to Finish
�d'Wean to Feeder
Feeder to Finish
oo
-0-
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Design Current
Wet Poultry Capacity Pop.
Layer
Non -Layer
Dr v Poultr
Design Current
Capacity Pop.
Layers
Non -Layers
Pullets
Turkeys
Turkey Poults
Other
Cattle
Design Current
Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field
a.
b.
c.
d.
Other:
Was the conveyance man-made?
Did the discharge reach waters of the State? (If yes, notify DWR)
What is the estimated volume that reached waters of the State (gallons)?
s ❑No ❑NA ❑NE
34;11-fr 14: Lkvti
'es No ❑ NA
'es ❑ No ❑
NA
❑ NE
❑ NE
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?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑' Yes ❑ No ❑ NA ❑ NE
❑Yes [Io ❑NA ❑NE
of the State other than from a discharge?
Page 1 of 3
5/12/2020 Continued

Facility Number:
Date of Inspection: /p—P--7
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes ❑ No ❑ NA []1VG
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑ No ❑ NA]E
the appropriate box(es) below.
n Failure to complete annual sludge survey n Failure to develop a POA for sludge levels
n 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? ❑ Ycs ❑ No ❑ NA ®``NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Ycs ❑ No ❑ NA ICJ
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document tYes ❑ 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 IE--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 Etles ❑ 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
n Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? 'es ❑ No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes iNo ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? EY s ❑ No ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
0- o rci-o 7), or- Pv-,5-ti- FiOLAJ>—
t f7-AA) S •e3 Lo `J "`- Bv�✓ FL D Ga;__ 61—v6 � Dt5 I eft- --1_ �' I
{{ 4-00-5 e""GC);'"` aYl�c
61415i`l fitJvS T �e� -/gr- h US `f Doti lac Yoh t- as 7,e a�Y �r e�
�1' �cc�- 1� �r�d' �i / J� 7 /la� M ,PDT, �/ l " yn�jtiT J
5T:1 l .^- % H_ ti- was )0c- u
/ytart s
/'•PI /1 ( boa) e 1,of lO�itru>�✓ ��"-r___Cd4
APre9 tQ- /uooei u Zol 71-w49y�1 a ? lth
Aflp �%Ofis of ' I,c� 10 D r'.,►- A-rkic -c tuns I-00k- A} -Fr✓-
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date:
q/0Y-/5(
2/4/2015

Facility Number: cy -/yam
Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
❑ Yes
❑ Yes
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
2 Li
El o ❑NA El NE
❑No ❑NA El NE
Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed? D Yes 1 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 E Ycs FNo ❑ 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?
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 Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
Yes ❑ No ❑ NA ❑ NE
❑ Yes I i o ❑ NA ❑ NE
es ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA I NE
❑ Yes ❑ No ❑ NA [EIE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. n Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window n 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 thc CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? n Yes ❑ No ❑ NA IfNE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check n Ycs ❑ No ❑ NA ❑ NE
the appropriate box.
❑ W UP ❑ Checklists El Design El Maps ❑ Lease Agreements
21. Does record keeping need improvement? If ycs, check thc appropriate box below.
El Waste Application n Weekly Freeboard n Waste Analysis ❑ Soil Analysis
n Rainfall ❑ Stocking El Crop Yield n 120 Minute Inspections n Monthly and l"
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did thc facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Ycs ❑ No ❑ NA EiE
❑ Ycs ❑ No ❑ NA ❑'NE
❑ Yes ❑ No ❑ NA
n Yes ❑ No ❑ NA �E
n Yes ❑ No ❑ NAIE
['Other:
D Yes ❑ No ❑ NA zNE
D Waste Transfers n Weather Code
Rainfall Inspections ❑ Sludge Survey
❑ Yes n No ❑ NA IE'NE
❑ Ycs n No ❑ NA [] Iqf
Page 2 of 3 2/4/2015 Continued

Environmental Chemists, Inc.
envirochem
ANALYTICAL & CONSULTING CHEMISTS
6602 Windmill Way, Wilmington, NC 28405 • 910.392.0223 Lab • 910.392.4424 Fax
710 Bowsertown Road, Manteo, NC 27954 • 252.473.5702 Lab/Fax
255-A Wilmington Highway, Jacksonville, NC 28540 • 910.347.5843 Lab/Fax
[e-mail]
NCDEQ/DWR-Fayetteville
225 Green Street
Fayetteville NC
Attention: Trent Allen
Date of Report: Sep 16, 2021
Customer PO #:
28301 Customer ID: 19020022
Report #: 2021-15885
Project ID: Chad Hazelwood 9-146
Lab ID
21-39798
Test
Sample ID:
Site: House 1 Ditch
Method
Collect Date/Time Matrix
9/13/2021 11:47 AM Water
Results
Sampled by
Steve Guyton
Date Analyzed
Fecal Coliform
SM 9222 D-2015 MF
48000 Colonies/100mL 09/13/2021
Lab ID
21-39799
Test
Sample ID:
Site: House 2 Ditch
Method
Collect Date/Time Matrix
9/13/2021 12:09 PM Water
Results
Sampled by
Steve Guyton
Date Analyzed
Fecal Coliform
SM 9222 D-2015 MF
>60000 Colonies/100mL 09/13/2021
Comment:
Reviewed by:
01Q- 0013-)
Report #:: 2021-15885
Page 1 of 1

Environmental Chemist, Inc., Wilmington, NC Lab #94
6602 Windmill Way
Wilmington, NC 28405
910.392.0223
Sample Receipt Checklist
Client: 1C ❑t..Q — F��bT]GlU.1`, Date: / /3 0Z-J Report Number: c Z i — I'S 51;?) c---
Receipt of sample: ECHEM Picku
O YES
❑ YES
O NO
❑ NO
J N/A
Client Delivery 0
UPS 0 FedEx 0 Other 0
1. Were custody seals present on the cooler?
N/A
Original temperature upon receipt 3
How temperature taken:
2. If custody seals were present, were they intact/unbroken?
°C
0 Temperature Blank iT Against Bottles
IR Gun ID: Thomas Traceable S/N 192511657 IR Gun Correction Factor °C: 0.0
0 YES
YES
YES
O NO
O NO
O NO
Corrected temperature upon receipt
3. If temperature of cooler exceeded 6°C, was Project Mgr./QA notified?
4. Were proper custody procedures (relinquished/received) followed?
5. Were sample ID's listed on the COC?
°C
YES
YES
YES
YES
YES
i YES
O YES
❑ YES
O YES
❑ YES
O YES
O YES
O NO
O NO
❑ NO
O NO
O NO
D ivv
O NO
O NO
O NO
❑ NO
0 NO
O NO
O NO
6. Were samples ID's listed on sample containers?
7. Were collection date and time listed on the COC?
8. Were tests to be performed listed on the COC?
9. Did samples arrive in proper containers for each test?
10. Did samples arrive in good condition for each test?
ii. Was duequdte sdnlple Volume avaiiaoier
12. Were samples received within proper holding time for requested tests?
13. Were acid preserved samples received at a pH of <2? *
14. Were cyanide samples received at a pH >12?
15. Were sulfide samples received at a pH >9?
16. Were NH3/TKN/Phenol received at a chlorine residual of <0.5 m/L? **
17. Were Sulfide/Cyanide received at a chlorine residual of <0.5 m/L?
18. Were orthophosphate samples filtered in the field within 15 minutes?
* TOC/Volatiles are pH checked at time of analysis and recorded on the benchsheet.
** Bacteria samples are checked for Chlorine at time of analysis and recorded on the benchsheet.
Sample Preservation:
Sample(s)
by adding (circle one):
Time of preservation:
(Must be completed for any sample(s) incorrectly preserved or with headspace)
were received incorrectly preserved and were adjusted accordingly
H2504 HNO3 HCI NaOH
If more than one preservative is needed, notate in comments below
Note: Notify customer service immediately for incorrectly preserved samples. Obtain a new sample or
notify the state lab if directed to analyzed by the customer. Who was notified, date and time:
Volatiles Sample(s) were received with headspace
COMMENTS:
DOC. QA.002 Rev 1

Analytical & Consulting Chemists
ENVIRONMENTAL CHEMISTS, INC
NCDENR: DWQ CERTIFICATION # 94 NCDHHS: DLS CERTIFICATION # 37729
COLLECTION AND CHAIN OF CUSTODY
6602 Windmill Way Wilmington, NC 28405
OFFICE: 910-392-0223 FAX [phone]
i nfo@e nv i ro n m ental c h em i sts.com
,&J J�( Ij
PROJECT NAME: C1
(
iyb
REPORT NO: Loy i - /rillS�
ADDRESS: ,���'(1- -
,5 c
7/k/
CONTACT NAME:
PO NO:
," „Ails,- �
REPORT TO: ''t-.
�/,"--
PHONE/FAX:
r - - — A / I rr\.
COPY TO:
email:
Sampled By: tle CS' SAMPLE TYPE: I = Influent, E = Effluent, W = Well, ST = Stream, 50 = Soil, 5L = Sludge, Other:
Sample Identification
f%DK-
Collection
d
E a
m P.
ti
Composite
or
Grab
Container
(P or G)
a m
L E
LAB ID
NUMBER
PRESERVATION
ANALYSIS REQUESTED
Date
Time
Temp
w
o
Z
o
o
N
_
z
=
a
Z
o
_
w
UJ
°
4e ticr / Dt
C
M
3`° /
1-
rei--
-/ I
/!;117,E
©
G
C
P
G
G
C
P
G
G
C
P
G
G
C
P
G
G
C
P
G
G
C
P
G
G
Transfer
Relinquished By:
Date/Time
Received By:
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TURNAROUND:

ENVIRONMENTAL CHEMISTS, INC
P.O. BOX 1037
WRIGHTSVILLE BEACH, NC 28480
Voice: 910-392-0223
Fax: [phone]
E-Mail: [e-mail]
Bill To:
NCDENR - DWQ - FAYETTEVILLE
225 GREEN STREET
SUITE 714
FAYETTEVILLE, NC 28301
PLEASE USE THE P.O. BOX FOR
ALL REMITTANCES. THANK YOU.
INVOICE NUMBER
187233
Invoice Date:
Sep 20, 2021
Page:
1
Customer ID
Customer PO
Payment Terms
19020022
9-146 CHAD HAZELWOOD
Net 30 Days
ENVIROCHEM'S FEDERAL ID #
Ship Date
Due Date
56-1894379
9/13/21
10/20/21
Quantity
Description
Unit Price
Amount
REPORT #2021-15885
WATER: 9-146 CHAD HAZELWOOD
DATE SAMPLED: 09/13/2021
CONTACT - TRENT ALLEN, STEVE GUYTON, KATIE FONTENOT
2.00
FECAL COLIFORM
35.00
70.00
1.00
TRAVEL/PICKUP IN SALEMBURG, NC
EMAIL INVOICE
REPORT HAS BEEN EMAILED.
75.00
75.00
PLEASE REFERENCE INVOICE NUMBER ON ALL
REMITTANCES IN ORDER TO PROPERLY APPLY TO
YOUR ACCOUNT. CALL TERESA WOLFE OR FRAN
GODLEY @ 910-392-0223 FOR QUESTIONS.
Subtotal
Payment/Credit Applied
145.00
Total Amount Due $ 145.00

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