090039_INSPECTIONS_20171231

� t �kk5 I l TJ4 I %_
Type of Visit: QXom lance Inspection Q Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: (y Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time:LA loo filDeparture Time: County:
Farm Name: krc- k G G 6)--K h& Owner Email:
Owner Name: Al 1` CA a IG S' & o Phone:
Mailing Address:
Physical Address:
Facility Contact: CU t 77`5 3C''W Title: Phone:
Onsite Representative: l t Integrator: W 13
Certified Operator: ` I`S Certification Numbe
Region:
Back-up Operator: f heit`L& b -c-� Certification Number: 7�? s 7A0
Location of Farm: Latitude: Longitude:
Design Current Design Current
Swine Capacity Pop. Wet Poultry Capacity Pop.
Wean to Finish Layer
Design Current
Cattle Capacity op.
Dairy Cow
Wean to Feeder
Non -La er
Dairy Calf
Dairy Heifer
Feeder to Finish
3q!j -1005
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Design Current
D , P,ouI -a aci P,a
Layers
D Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turkeys
Turkey Poults
Other
Discharges and Stream Impacts
I . Is any discharge observed from any part of the operation? ❑ Yes ❑t .Nd�_❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No Q.AdAA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR) [:]Yes ❑ No �A ❑ 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 LJ A ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes DNo [DNA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes E5'No ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412015 Continued

Facili Number: 2t - 3 jDate of inspection: t�
Waste Colle tion & Treatment
4. Is sorage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [DAio•❑ NA NE
a. If yes, is waste level into the structural freeboard? ❑Yes ❑ No NA ❑ NE
Identifier:
Spillway?:
Designed Freeboard (in):
Structure 1 Structure 2 Structure 3 Structure 4
,i[]J"
Observed Freeboard (in):_ 3 2-
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
Structure 5 Structure 6
❑ Yes l_ o ❑ NA ❑ NE
❑ Yes aln_ �Ej NA ❑ NE
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 [❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes MIN�00 NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes [No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window❑JEvidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): _�GYy►��c�t� )4 rF _
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes �o ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes Ua<o ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑WUP El Checklists ❑Design ❑ Maps ❑ Lease Agreements
❑ Yes
Ed >e,
❑ NA
❑ NE
❑ Yes
Ll 40
❑ NA
❑ NE
❑ Yes
D'No
❑ NA
❑ NE
❑ Yes � [DX6'_ ❑ NA ❑ NE
❑ Yes I]joVu ❑ NA ❑ NE
❑ Other.
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ©>p ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis El Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections Zo Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? [] Yes E&Iqo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes �rco❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facili Number: - Date of Inspection: mow'
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes MI? �01 NA ❑ NE
25. Is t e facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes o ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes o ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes [21-N$- ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes nNo ❑ 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
tDV-_ ❑ 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
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
I__f'r"' ❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
[0,KE] NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
❑-Ko ❑ NA
❑ NE
Comments (refertoquestioit �n anyYESaiis ,anrany addcttoinal recommendations or any other coiinments:
Lise drawings of,fac.. Itobettereaplan�sitnattons:.(use.addtho.nal pages asrnecessa , ,
tY. _ ry) z.
30&- 69 51
Reviewer/Inspector Name:
Reviewer/Inspector Signatur
Page 3 of 3
Phoneco-�3333y
Q-
Date: S vJU
21412015

Type of Visit: Q-Compliance Inspection 0 Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: O'Routine 0 Complaint Q Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit:'"'--`t�"''Y'r Arrival Time: 'C# P I Departure Time: County: t3l&.c-- j Region:
Farm Name: i „rye. d'`t' ­t f`lk f F [Le__-, `t ner Email:
Owner Name: �tcc L<' 1-1 Phone:
Mailing Address:
Physical Address:
Facility Contact: { -�r ? �� q v-Cy � (,r Title: Phone:
Onsite Representative: i { Integrator: R
Certified Operator: ��` U`�Z r� Certification Number:
Sack -up Operator:
Location of Farm:
Latitude:
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)
Certification Number:
Longitude:
❑ Yes ❑'No❑ NA ❑ NE
[]Yes
[—]No
[ A
❑ NE
❑ Yes
[]No
0'
❑ 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 past discharge from any part of the operation? ❑ Yes L3-"'U ❑ NA ❑ NE
3_ Were there any observable adverse impacts or potential adverse impacts to the waters [:]Yes to ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 21412015 Continued

IFacility Numbpr: - Date of Inspection:
6 /
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
❑a - ❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
D N-N— ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):_
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
Q oo
[] 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
[JW
❑ 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
[2,1Qo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
E3 "'o
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[D' No
❑ NA
❑ NE
maintenance or improvement?
I 1 _ Is there evidence of incorrect land application? If yes, check the appropriate box below. [] Yes [;Ko [] NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drill ❑ Application Outside of Approved Area
12. Crop Type(s): i3 6!-e phu cpL jY
13. Soil Type(s): /{�n
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [A -No ❑ NA [] NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [J No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable [] Yes [;�'90 ❑ NA ❑ NE
acres determination? '
17_ Does the facility lack adequate acreage for land application?
❑ Yes
[3-No
❑ NA
❑ NE .
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[�a`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
[ ""'
❑ 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. Cn7ycs L'" l% ❑ NA ❑ NE
Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑Stocking Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? [—]Yes Q'No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes [fo [] NA ❑ NE
Page 2 of 3 21412015 Continued

Racili Num er: - Date of Ins ection:
A
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ®slab ❑ NA ❑ NE
25. is the facility out of compliance with permit conditions related to sludge? if yes, check ❑ Yes [t-N-o ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance: j
i
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑-No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
❑'No
❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
O 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
E>o
❑ NA
❑ NE
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.
[] 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
[>o
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
[2'Flo
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
L2-go
❑ NA
❑ NE
Comments (refer to question #):,EiplaiB any ,YES answers and/or any"additional,; recommendations or.any Other coinmeots: ,
m ✓ lyuz _.a
Use, drawings of facility to better explain sifuati(tns'(dse`addltioIIal Pages�as,'neCessary).. _ -
5
gi-re5 — f
45
Nu C,,, e 'c.(ts - G'':'A
Cf To-- 3'0�r-b
Reviewer/Inspector Name: 1�[ r�+ l �lA Phone:.Jo-q333
c
Reviewer/Inspector Signature: _ Date: 1
Page 3 of 3 21412015

1
Environmental
Quality
RECEIVED
DEQIDWR
JUL 10 2917
oden WQROS July 7, 2017
Nick Gooden Far
Nicholas en Farm # 3 FAYETTEVILLE REGIONAL OFFICE
448 Soup Haire Road
Elizabethtown, NC 28337
Dear Nicholas Gooden:
ROY COOPER
Governor
MICHAEL S. REGAN
Secretary
S. JAY ZIMMERMAN
Director
Subject: Certificate of Coverage No. AWS090039
Nick Gooden Farm # 3
Swine Waste Collection, Treatment,
Storage and Application System
Bladen County
In accordance with your June 19, 2017 Notification of Change of Ownership, we are hereby forwarding to
you this Certificate of Coverage (COC) issued to Nicholas Gooden, authorizing the operation of the subject
animal waste management system in accordance with General Permit AWG100000.
This approval shall consist of the operation of this system including, but not limited to, the management
and land application of animal waste as specified in the facility's Certified Animal Waste Management Plan
(CAWMP) for the Nick Gooden Farm # 3, located in Bladen County, with a swine animal capacity of no
greater than the following annual averages:
Wean to Finish: Feeder to Finish: 7,344 Boar/Stud:
Wean to Feeder: Farrow to Wean: Gilts:
Farrow to Finish: Farrow to Feeder: Other:
If this is a Farrow to Wean. or Farrow to Feeder operation, there may be one boar for each 15 sows. Where
boars are unnecessary, they may be replaced by an equivalent number of sows. Any of the sows may be
replaced by gilts at a rate of 4 gilts for every 3 sows.
The COC shall be effective from the date of issuance until September 30, 2014, and shall hereby void
Certificate of Coverage Number AWS090039 dated October 1, 2014. Pursuant to this COC, you are
authorized and required to operate the system in conformity with the conditions and limitations as specified
in the General Permit, the facility's CAWMP, and this COC. An adequate system for collecting and
maintaining the required monitoring data and operational information must be established for this facility.
Any increase in waste production greater than the certified design capacity or increase in number of animals
authorized by this COC (as provided above) will require a modification to the CAWMP and this COC and
must be completed prior to actual increase in either wastewater flow or number of animals.
Please carefully read this COC and the enclosed State General Permit. PIease pgy careful attention to the
record keeping and monitoring conditions in this permit. Record keeping forms are unchanged with this
General_ Permit. Please continue to use the same record keeping forms.
If your Waste Utilization Plan (WUP) has been developed based on site -specific information, careful
evaluation of future samples is necessary. Should your records show that the current WUP is inaccurate
you will need to have a new WUP developed.
N[sl ping Compares'-----.
state of North Carolina I Environmental Quality I Division of Water Resources
Water Quality Regional operations Section
1636 Mail Service Center I Raleigh, North Carolina 27699-1636
919-707-9129

The issuance of this COC does not excuse the Permittee from the obligation to comply with all applicable
laws, rules, standards, and ordinances (local, state, and federal), nor does issuance of a COC to operate
under this permit convey any property rights in either real or personal property.
Per 15A NCAC 2T .0105(h) a compliance boundary is provided for the facility and no new water supply
wells shall be constructed within the compliance boundary. Per NRCS standards a 100-foot separation
shall be maintained between water supply wells and any lagoon, storage pond, or any wetted area of a spray
field.
Please be advised that any violation of the terms and conditions specified in this COC, the General Permit
or the CAWMP may result in the revocation of this COC, or penalties in accordance with NCGS 143-
215.6A through 143-215.6C including civil penalties, criminal penalties, and injunctive relief.
If you wish to continue the activity permitted under the General Permit after the expiration date of the
General Permit, then an application for renewal must be filed at least 180 days prior to expiration.
This COC is not automatically transferable. A name/ownership change application must be submitted to
the Division prior to a name change or change in ownership.
If any parts, requirements, or limitations contained in this COC are unacceptable, you have the right to
apply for an individual permit by contacting the Animal Feeding Operations Unit for information on this
process. Unless such a request is made within 30 days, this COC shall be final and binding.
In accordance with Condition II.22 of the General Permit, waste application shall cease within four (4)
hours of the time that the National Weather Service issues a Hurricane Warning, Tropical Storm Warning,
or a Flood Watch associated with a tropical system for the county in which the facility is located. You may
find detailed watch/warning information for your county by calling the Wilmington, NC National Weather
Service office at [phone], or by visiting their website at: hqp://www.weathff gov/iInV
This facility is located in a county covered by our Fayetteville Regional Office. The Regional Office staff
may be reached at 910-433-3300. If you need additional information concerning this COC or the General
Permit, please contact the Animal Feeding Operations Program staff at [phone].
Sincerely,
f
rl
for S. Jay Zimmerman, P.G.
Director, Division of Water Resources
Enclosure (General Permit AWG100000)
cc: (Certificate of Coverage only for all ccs)
Fayetteville Regional Office, Water Quality Regional Operations Section
Bladen County Health Department
Bladen County Soil and Water Conservation District
WQROS Central Files (Permit No. AWS090039)

r�! 1*5 a q�- t& tSD
Type of Visit: 0 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
of
Date of Visit:Arrival Time• Departure Time: County: (3fey& Region:
Farm Name: MS Dc. 22, Owner Email:
Owner Name: IX1E 12 *-tom A�LO_"( I Phone:
Mailing Address:
Physical Address:
Facility Contact:
rsol Title:
Oasite Representative: �l
Certified Operator: vvrtc j
Phone:
Integrator; S
Certification Number:
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
!h<<&4 7_dS OZa3q fiODzmtb-PC- 61?0'
Design Current
Design
Current
Design Current
Swine
Capacity Pop.
Wet Poultry
Capacity
Pop.
Cattle Capacity Fop.
Wean to Finish
[Layer
DairyCow
Wean to Feeder
Non -Layer
DairyCalf
Feeder to Finish
t{
Dai Heifer
Farrow to Wean
Design
Current
Cow
Farrow to Feeder
Dry P.oul
Ca aci
l'o
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
NJ
Boars
I
I
Pullets
Beef Brood Cow
Turke s
11
Other
Turke Pouets
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 DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes D-Ko— ❑ NA [] NE
❑ Yes [:]No [DNA ❑ NE
❑ Yes [:]No [31NA ❑ NE
❑ Yes
[:]No
[2rNA
❑ NE .
❑ Yes
[✓"No
❑ NA
❑ NE
[:]Yes
KNo
❑ NA
❑ NE
Page I of 3 21412011 Continued

FaciQ Number: jDate of Inspection: jt
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes C[�No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes [—]No E3-M ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): qq,,,,
Observed Freeboard (in): °``
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes Q Ko ❑ 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 2-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
©'1Cio
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
[:]Yes
[!jNo
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
/O 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 El 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): 1D _
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [�3`No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes Q,No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable [—]Yes Q'No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Reuuired Records & Documents
❑ Yes Q'No ❑ NA ❑ NE
❑ Yes Q'No ❑ NA ❑ NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes [244o ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [D'1Vo ❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? if yes, check the appropriate box below. ❑ Yes [2,No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? [:]Yes C!fNo ❑ NA ❑ NE
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes C 'rNo ❑ NA ❑ NE
Page 2 of 3 21412014 Continued

Facili Number: jDate of Inspection: ' 'l
2,f Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ❑'90
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes Ea.hlo
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 (Z"No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [—]Yes [2rNo
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 the drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ Yes Q,Po ❑ NA ❑ NE
❑ Yes Q o ❑ NA ❑ NE
❑ Yes �No ❑ NA ❑ NE
[]Yes �o ❑ NA ❑ NE
❑ Yes
Feno
❑ NA
❑ NE
[:]Yes
0'No
❑ NA
❑ NE
❑ Yes
�No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other .comments.
Use drawings offacillity to better explain situations use additional pages as necessary).-
G4'i r O ', r wt ;L o (I
2, 17
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: ' , JW
Date:
21412011

Type of Visit: UCompfiance Inspection U Operation Review U Structure Evaluation U Technical Assistance
Reason for Visit: (Routine 0 Complaint Q Follow-up Q Referral O Emergency 0 Other O Denied Access
Date of Visit: Arrival Time: of Departure Time: 'UU County: Region: r-00
Farm Name; Ptd tkV4C cyyc`i r z, Owner Email:
Owner Name: cc Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative: A (
Certified Operator:{ yt N)WI 1
Integrator:
K
Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
MO
Design
Current
Design
Current
Design Current
Swine Capacity
Pop.
Wet Poultry
Capacity
Pop.
Cattle Capacity Pvp.
Wean to Finish
I_a er
Dairy Cow
Wean to Feeder
Non -La er
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Dry Cow
Farrow to Feeder
I) . P,v.ult >
Ca aci
P,o
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turke s
Othe
iTurkey Poults
Other
10ther
Discharnes and Stream lmoacts
1. Is any discharge observed from any part of the operation?
[:]Yes
c o
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
[—]No
ETNA
❑ 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
❑'Flo
❑ NA
❑ NE
1 Is there, evidence of a past discharge from any part of the operation?
❑ Yes
ETNo
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
[:]Yes
�o
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412014 Continued

Facili Number: ff Date of inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
ayes
0 No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
[Z�No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): g�
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
❑fiio
❑ 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
[B'1 o
❑ 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
❑.3Go
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
[] Yes
[ ,45'
❑ 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
[3"N'o
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
<o
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes Ee o ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN [] PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑LLE__vidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):�"t'Iriti f'7 �i� yT `s- (4 0
13. Soil Type(s): �% n
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes �l�Vo ❑ 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 e'1Go ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of property operating waste application equipment?
Required Records & Documents
❑ Yes [a'1�o ❑ NA ❑ NE
❑ Yes [2'llo ❑ NA ❑ NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
[:]Yes
[R o
❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[; o
❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
[nNo
❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall [:]Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
[:]Yes
[fNo
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [7rNo ❑ NA ❑ NE
Page 2 of 3 21412014 Continued

Farilfty Dumber: 17 -
24.'Did the facility fail to calibrate waste application equipment as required by the permit? [-]Yes [RNo
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes E No
the appropriate box(es) below.
[] Failure to complete annual sludge survey [:]Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes �fNo
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes Mo
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?
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
[:]Yes ❑'No ❑ NA ❑ NE
❑ Yes [3"-No ❑ NA ❑ NE
❑ Yes ®'No ❑ NA ❑ NE
❑ Yes [�No ❑ NA ❑ NE
❑ Yes [J-1Go
[:]Yes ZINO
[:]Yes [fNo
(DNA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
Comments (refer to question ft 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).
z�� a• Dc 5
C Ocj 4 7Fre x ,j 0,
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Page 3 of 3
-, ki L-� �Jvkv
Cf 02 r) f I P. QM
Phone: `3S
Date: _ t S Ds 1,5
21412014

7
(Type of Visit: ®'Compliance Inspection U Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: (jKoutine O Complaint Q Follow-up O Referral () Emergency O Other O Denied Access .
Date of Visit: Arrival Time: Departure Time: County: 9D�- Region:
Farm Name:��-f( A d✓ i7 12L�Z. Owner Email:
Owner Name: t� Phone:
Mailing Address:,
Physical Address:
Facility Contact: 1'(19 Title:
Onsite Representative: Integrator:
Phone:
V113
Certified Operator: kc`le•iG & rVi'/tj Certification Number: 16 G ( o
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current
Design
Current
Design Current
Swine Capacity Pop.
we Poultry
Capacity
P©p.
Cattle Capacity Pap.
Wean to Finish
La er
Dairy Cow
Wean to Feeder
I
jNon-Layer
I
Dairy Calf
Feeder to Finish JJW
Dairy Heifer
Farrow to Wean
Design
Dry Cow
Farrow to Feeder
D , RouI
Ca aci-
P,o
Non-Datry
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
I Beef Brood Cow
Turkeys
Other
Turke Poults
Other
Other
Discharses and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes [ ::D� NA ❑ NE
❑ Yes ❑ No Eg-NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
[:]Yes
[-]No
D-Nk
❑ 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
❑ 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
[ o
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412014 Continued

F,acili Number: 17 - 3 T I
I Date of Inspection: iff, ps)v
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
q— 21 Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
Q-No ❑ NA ❑ NE
❑ No [a,AFA ❑ NE
Structure 6
❑ Yes E No ❑ NA ❑ NE
❑ Yes [;LNo ❑ NA ❑ NE
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?
Inot 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?
❑ Yes Rallo ❑ NA ❑ NE
[:]Yes ❑-No [DNA ❑ NE
[3 Yes [ Fo []NA ❑NE
❑ Yes [D"No ❑ NA ❑ NE
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes nA'o ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): . &ryu_cA *4 SG
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[ !I'll
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[]3,No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
Q�o
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[:;Po
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[ do
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[�o
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
❑.Ado
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists []Design [:]Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes I� "" ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis [—]Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections [:]Monthly and 1 " Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ZNo ❑ 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 21412014 Continued

Fatili Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [ .No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [� - o
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 [trl�o
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes L.1 A10
❑ NA ❑ NE
❑NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes C!I<o
❑ 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 [5'&lo
❑ 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 [!]'1Io
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes [D Ko
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes [j],No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes [ BIN o
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes E�,Vo
❑ NA
❑ NE
Comments (refer to question#):.:EzplaWany YES answers and/or any additional recommendations or any other commentspi ,
Use drawings of facility to better explain: situations (use additional pages as necessary).
c
C f� J I.0 -ej r
S(u.df e scol-In
Reviewer/Inspector Name:
knA- tz* t 3
Reviewer/Inspector Signature: r
Page 3 of 3
Phone: t�' �33
Date: IqAowq
21412014

rw.r:.iw A
NCDENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Beverly Eaves Perdue Charles Wakild, P. E.
Governor Director
January 3, 2013
CERTIFIIED MAIL 70101870 0003 4774 8034
RETURN RECEIPT REQUESTED
Mr. Mitchell W Norris
494 Coley Rd.
Elizabethtown, North Carolina 28337
SUBJECT: Request for Information
Mitchell Norris #1 & ##2
09-039
A WS090039
Dear Mr. Norris:
On January 3, 2013 you or your representative reported a high freeboard at your upper lagoon.
As specified in your permit, the Division of Water Quality requests that you submit a copy of the
following records to the Fayetteville Regional Office.
1. All lagoon levels, rainfall records for 2012 to present.
2. Irrigation events (IRR2) from March 1, 2012 to present.
3. A copy of your WUP.
You may mail or fax the requested information to the address listed below. Information must be
received within fifteen (15) working days of receiving this request see section 1I1 12 of your
permit. Your records and any records submitted to this office are open to the public unless they
constitute confidential information under NC GS. 132-1. 2, if you have any questions please
contact me at 910-303-0151.
NC DENR
DWQ-AP Section
225 Green St., Ste. 714
Fayetteville, NC 28301
Fax No.: 910-486-0707
Dee Freeman
Secretary
Sincerely,
Steve Guyton
AQUIFER PROTECTION SECTION
Environmental Specialist
225 Green St., Ste. 714
Fayetteville, North Carolina 28301
One
Phone: [phone] FAX: [phone]T Customer Service: 1-877-4523.674s NorthGarolina
Internet: t+wyw.h20.enrstate.nc.us
���� ����
An Equal Opportunity , AfTrma6ve Action Employer

Type of Visit: 'Compliance Inspection O Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint ello-How-up 0 Referral 0 Emergency _0 Other 0 Denied Access
Date of Visit: Arrival Time: i) Departure Time: ;'p p County: may` Region:
�lc 1 � per,
Farm Name: �i.S ��`� Owner Email:
Owner Name: 1W. 'f a,4 L0 o rTiS Phone:
Mailing Address:
Physical Address:
Facility Contact: /%% la C /% 0o n"rS Title:
Onsite Representative: _$.5� Integrator:
Phone:
Certified Operator: � d-z-A-r Certification Number:
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
11MC-opacl.Pop.
esign Current Design Current
VVet Poultry Capacity Pap. Cattle capacity Pop.
La er Da' Cow
Wean to Finish
Wean to Feeder
on -Layer
Design
D P,oultr. Ca aci
Layers
Current
P,o
airy Calf
Feeder to Finish
Farrow to Wean
Farrow to Feeder
D Heifer
Cow
Non-D '
Farrow to Finish
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Turke s
Turkex Poults
Other
LLOther
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?
❑ Yes ❑ No ❑ NA [aNE
❑ 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
Z, NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

Facili Number: 17- Date of Inspection: f
24. Did the facility fail to calibrate waste application equipment as required by the permit? [—]Yes [:]No ❑ NA 0_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 aNE
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?
24. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes ❑ No ❑ NA NE
❑ Yes ❑ No ❑ NA [S,NE
❑ Yes ❑ No ❑ NA ELNE
[] Yes ❑ No ❑ NA JZ] NE
❑ Yes ❑ No
❑ Yes No
,Ea1'es ❑ No
❑ NA [gNE
[DNA ❑NE
❑ NA ❑ NE
Comments (refer to question:#): Explain any YES answers and/or -any additional recommendations or any otbervommen&- -
Use drawings of facility to better explain situations` (use additional. psges as -necessary).,
74
14-7 `1 wc) fl
/ u ry
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: i/D:!iQa 33 c3c�
Date: AE 9 ✓7tf ;701
21412011

!Facility Number: - I Date of Inspection -
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ❑ No ❑ NA r711 NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA [:I NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ❑ No
[DNA
aNE
(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
KNE
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
[AINE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes ❑ No
❑ NA
j� 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
[3NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ❑ No
❑ NA
INE
maintenance or improvement?
11. Is there evidence of incorrect land application? If.yes, check the appropriate box below. ❑ Yes ❑ No
❑ NA
MNE
❑ 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 CA WMP? ❑ Yes ❑ No ❑ NA ®. NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ❑ No ❑ NA MNE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes ❑ No ❑ NA aNE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA
E!�NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
[] NA
[3,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
L&NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design [:]maps [:]Lease Agreements
❑Other:
21 _ Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
❑ No
D NA
M NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ No
❑ NA
MNE
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
❑ NA
[ZI.NE
Page 2 of 3
21412011 Continued

Type of Visit:mplipce Inspection 0 Operation Review 0 Structure Evaluation Q Technical Assistance
Reason for Visit: utine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: rrival Time: �� Departure Time: ' c7 County: Region:
Farm Name: /%�; y. f r" i j ��(f ` Owner Email:
Owner Name: N rrs' Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
i
Certified Operator: hfz� 11
Back-up Operator:
Title: C. Phone:
.41
"1r- A /--/`r s Integrator:
Ir
Certification Number:
Certification Number:
Location of Farm: Latitude: Longitude:
Design Current Design Current
Swine Capacity Pop. Vet Poultry Capacity _ Pop.
Cattle
Design Current
Capacity Pop.
Wean to Finish
La er
Dairy Cow
Wean to Feeder
Non -La er
Dairy Calf
Feeder to Finish 7
Farrow to Wean
Design Current
©. P,oult . Ca aci l'o P.
Layers
Dairy Heifer
Dry Cow
Farrow to Feeder
Farrow to Finish
Non -Dairy
Beef Stocker
Gilts
Boars
Non -Layers
Pullets
Beef Feeder
Beef Brood Cow
Other M9Turke
Other
Turke s
Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes L& No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
C] NA
❑ NE
❑ Yes
1951 No
❑ NA
❑ NE
❑ Yes
to No
❑ NA
❑ NE
Page l of 3 21412011 Continued

Facility Numher: - 377 jDate of Inspection:
Waste Collection & Treatment
i
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes R!,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:
Spillway?:
Designed Freeboard (in):_ %
Observed Freeboard (in):_
5- Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes [Z No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes [$ No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ® No
[] NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ 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 [a Yes ® No
❑ NA
❑ NE
maintenance or improvement?
Application
_Waste
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 gLNo
❑ 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
1❑
12. Crop Type(s):�11�r�Z1T-
. %
13. Soil Type(s): _ /v uf
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 ZLNo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes [R No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. 1s there a lack of properly operating waste application equipment?
❑ Yes QNo ❑ NA ❑ NE
❑ Yes [a No [D 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? Ifyes, check ❑ Yes [ No ❑ NA ❑ NE
the appropriate box.
❑ WUP []Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes j� No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall [] Stocking []Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge'? ❑ Yes RNo
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes Wo
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: - Date of Inspection: '7 �-
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes Eg No ❑ NA ❑ NE
f 25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes Dq 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 0 No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
I 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
Callo
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
RNo
❑ NA
❑ NE
33. Did the ReviewerAnspector fail to discuss review/inspection with an on -site representative?
❑ Yes
MNo
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
gLNo
❑ NA
❑ NE
Comments (refer to question:#) Explain any YES answers:and/or:any i ddiiibnal recommendations�or�any�ot> er'comFnents. "
z n g '
Use drawings of facility to beEter captain sitnattons (use.additional"0-i-g- as pecessa 'y
-16
RrGi�r7� fW/�� l� v � rcci�a♦�,
fr/'i �� /"c✓� fuJ f rGDrr�.f 7 D Lfloi` . Fa i"y� ll1 p U D/fd
o
�J 3 r i arm U
ja
0 V,
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: �fj�� .M11
� r
Date: 7 -�
21412011

Type of Visit: 7ZFF05moopliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: County:irl. Region:
Farm Name:- /yJ; f %� `{/ �� rr 5 d Owner Email:
Owner Name: rn,��—� ,.11 IJ n / t i S Phone:
Mailing Address:
Physical Address:
Facility Contact: L Title:
Onsite Representative: w7',-V—N0ftFs
Certified Operator: %f %J'' f �/ �Da/y 5•
Phone:
Integrator:
Certification Number:
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
cm,
Design Current
Design
Current
Design Current
Swine Capacity Pop.
Wet Poultry
Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
Layer
Dai Cow
Wean to Feeder
U
Non -Layer
Dai Calf
Feeder to Finish
Z
DaiyHeifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turke s
Other
TurkeyPoults
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 DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
E] Yes M No ❑ NA ❑ NE
❑ Yes
W No
❑ NA
E] NE
❑ Yes
[:]No
❑ NA
❑ NE
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 l of 3 21412011 Continued

Facili Number: - Date of Inspection:
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
D No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): 19t /9
Observed Freeboard (in): .r 97
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
§4 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
[R No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental
threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
a 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
No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes P 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): _AZQZ,._//5-r - —
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes allo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes �'No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes CEI-No ❑ NA ❑ NE
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
❑ Yes Qq No ❑ NA ❑ NE
❑ Yes (&No ❑ NA ❑ NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes 2] No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes � No ❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ® Yes 6ff No ❑ NA ❑ NE
5D Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes RjNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [allo ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: jDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No
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 L 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?
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes "No ❑ NA ❑ NE
❑ Yes J4
No ❑ NA ❑ NE
❑ Yes Q No ❑ NA ❑ NE
❑ Yes W1 No
❑ Yes V, No
❑ Yes Wh No
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question # ). Explain any .YES answers and/or any additional recommendations or any. other commentt�— �k
Use drawings of facility to better explaimsituations (use additional:. pages as aecessary). x .a«. ;
-er- your 5�-R a IOnpls
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:-`�/o-'.�-33�
Date: ff'En:;1 f
2/4/201I

3
$ -11- Zo/o
Type of Visit G�-C—ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit outine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: /.��p Departure Time: .3. 3T County: %6 Region: FieD
y Farm Name: i -1CZ. 4z ``m� % � Z _ Owner Email:/'I
Owner Name: z A c it /Lfpr�i Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: Akj;[a' /��=✓�'is
Certified Operator: AICYf`S
Integrator: X[ - W!.
Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm:
Latitude: = o= t 0 IX Longitude: = 0 0 i=
Design
Current Design
Current Design Current
Swine Capacity
Population Wet Poultry Capacity
Population Cattle Capacity Population
Finish
❑ La er
❑Dai Cow
❑Dai Calfr
❑ Dai Heifer
to Feeder
❑ Non -La er
to Finish
73
to Wean
ry Poultry
La ers
❑ D Cow
❑Non-Daiw
❑ Beef Stocker
to Feeder
Fto
to Finish
Non -La ers
Beef Feeder
Puilets❑
❑ Beef Brood Cowl I
Turke s
❑ Turke Poults ❑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?
❑ Yes No ❑ NA ❑ NE
❑ Yes
[:]No
NA
❑ NE
❑ Yes
❑ No
,CI
21 A
❑ NE
[- 'A
❑ NE
❑ Yes
❑ No
❑ Yes
No NA
❑ NE
❑ Yes
o
❑ NA
❑ NE
Page 1 of 3
12128104 Continued

Facility Number: — Date of Inspection 749Z-/0
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
L, o
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: fps%
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): z7eo
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
O 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
B<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 environmental) threat, notify DWQ
I�hr
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks) _ ,
9. Does any part of the waste management system other than the waste structures require El Yes GR o ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [R o ❑ 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 Outside of Area
12_ Crop type(s) ,�eYJrsu �a_ l rotes L i Z"01K a"'oy C 0' s.J
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
L'7 No ❑ NA
❑ NE
l5. Does the receiving crop and/or land application site need improvement?
❑ Yes
E No ElNA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
"NoNo ❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
ffNo ❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
ffNo ❑ NA
❑ NE
Comments (refer to question #) Explain any S answers and/or any recommendstibns or any other comments:
Use deawin s of facility to better explain. situations. (use additional pages as n6e6ssa )
Reviewer/Inspector Name Phone: 9�O•-33.��0�
Reviewer/Inspector Signature: Date: 8 —4 2 ` Zd/O
12128104 t.ontrnuerr

r
Facility Number: Q q —3 Date of Inspection
Required Records & Documents �
19. Did the facility fail to have Certificate of Coverage & Permit readily available? [I Yes 3 o ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes LJ 1vo ❑ NA ❑ NE
the appropriate box. ❑ W­Up ❑ Checklists ❑ Desig
n ❑Maps ❑Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
ErN. ❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1"
Rain Inspections ❑Weather
Code
22.
Did the facility fail to install and maintain a rain gauge?
El Yes
0 ❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
0'lqo- ❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
<oo ❑ NA
El NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
El Yes
�©
E3<oo ❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
EN"o ❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
ff ❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
B<_0 NA
ElNE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
giq ❑ 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
�,�
QNo ❑ 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
El�t
, _,
"No L7 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
,�,
a<0 ❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
Digo ❑ NA
❑ NE
12128104

BT-M& ►C•-• Z S 2 of 1'
Type of Visit compliance Inspection 0 operation Review 0 Structure Evaluation O Technical Assistance
Reason for Visit outine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: /b /9"C `) Arrival Time: UD r.ti Departure Time: County:
Farm Name: /"prt't s Z Owner Email:
Owner Name: . �fOYYt'S Phone:
Mailing Address:
Physical Address:
Facility Contact: r&f a D't SIq •✓ -Title: -{-e--f Phone No:
Onsite Representative:
eI Integrator:
Certified Operator: &, W ��_ ,yyY� S Operator Certification Number: 40# 16 9�0
Region: `�
Back-up Operator -
B
ack -up Certification Number:
Location of Farm: Latitude: = o Q g = H Longitude: ❑ ° ❑ 6 =
Swine
Design Current
Capacity Population
Wet Poultry
Design Current Design Current
Capacity Population Cattle Capacity Population
❑ can to Finish
❑ Layer
❑ Non -Layer I
❑ Dairy Cow
❑ Wean to Feeder
eeder to Finish
I
❑ Dairy Calf
I
Dry Poultry
ElLa Layers
❑ Dairy Heifer
❑ Dry Cow
ElNon-Dairy
❑ Beef Stocker
❑ Farrow to Wean
❑ Farrow to Feeder
El Farrow to Finish
❑ Gilts
❑ Boars
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Beef Feeder
❑ Beef Brood Cowl
Other
❑ Other
Number of Structures:
❑ Other
I I
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)
Z. 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 E NA ❑ NE
❑ Yes ❑ No NA ❑ NE
l [I No ' NA ❑ NE
❑ Yes
❑ Yes No'0
NA ElNE
[IYes ONo ❑ NA ❑ NE
12128104 Continued

w
Facility Number: Oq— 3 9 Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 3 N�o ❑ NA ❑ NE
a. if yes, is waste level into the structural freeboard? ❑ Yes Pr o ❑ NA ❑ NE
Structur I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: Xl'
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes o ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes EfrNo ❑ 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 [:IN E
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application /
10. Are there any required buffers, setbacks, or compliance alternatives that need El Yes BI o ❑ 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 [--IPAN > 10% or ] O 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) d a- [ ,�1�` S t�T/ liay__;)t./ L/O . S .
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
❑ Yes ENo ❑ NA ❑ NE
❑ Yes
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
17. Does the facility lack adequate acreage for land application? ❑ Yes
18. is there a lack of properly operating waste application equipment? ❑ Yes
Ir1No ❑NA El NE
�[3'-No ❑ NA ❑ NE
1_�No ❑ NA ❑ NE
2<o El NA ❑NE
�'...
Comments (refer to question"#) Explain aay YES. answers anillor any recommendationstor�any other comments. II
"�.._
Use drawings °of facility to better explain:situahons (use additional pages as necessary) & "
zoo j .60: �4s ,Pyou,- s
Reviewer/Inspector Name Phone: 91Os �.3.330D
Reviewerlinspector Signature: _ Date: /4-Ir9,- o91
12178104 Continued

Facility Number: p — Date of Inspection
Re uired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box. ❑ WUp ❑ Checklists ❑ Design ❑ Maps ❑ Other
❑ Yes ffNo ❑ NA ❑ NE
❑ Yes Io ❑ NA ❑ NE
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
o
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1"
Rain Inspections ❑ Weather
Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
No
❑ 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?
❑ Yes
No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
No
ElNA
[INE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
"a
[]'10
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
Vo
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
O'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?
El Yes
����
,BNo
❑ 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
Q'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
0'No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
0-11o�E] NA
❑ NE
12128104

E�c/�eved 6- y R'Q 7- Z v- D 7
9
W Division of Water Quality
Facility Number Q� ,jp 0 Division of Soil and Water Conservation
Other Agency
Type of Visit 0 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: (p � d] Arrival Time: 1,00 Departure Time: County: / +� Region: /-20
Farm Name: „/Tl/I^AadL61 Aloplbis I % Z Owner Email:
Owner Name: %� A10siP21 Phone:
Mailing Address:
Physical Address:
Facility Contact: "aa�, � � d,� Title: ��e✓4. S rL . _ Phone No:
Onsite Representative: &2&;p busGw/ Integrator: AfkiLPQ 44 'Ef'2l"42
Certified Operator: Operator Certification Number:
Back-up Operator -
B
ack -up Certification Number:
Location of Farm: Latitude: ❑ e =' =" Longitude: ❑ ° = I =
Swine
Design Current Design Current
Capacity Population Wet Poultry. Capacity Population
❑ La er
' ❑Non -La er
❑ Wean to Finish
❑ Wean to Feeder
Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current.:.
Cattle Capacity. Populationgr
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
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 P No ❑ NA ❑ NE
❑ Yes
T No
❑ NA
❑ NE
❑ Yes
1�1 No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
[Z No
❑ Yes
M No
❑ NA
❑ NE
❑ Yes
W No
❑ NA
❑ NE
12128104 Continued

` Facility Number: Q — 3
Date of Inspection
Waste Collection & Treatment
' 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes PfNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes JZ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
identifier: tS
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3-7
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
V 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
Z 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
V No
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
r--'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
M No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[� No
ElNA
[I NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes P 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
i
12. Crop type(s) -RP Vr04 u �o. f�G ra y G i4f C� :w/ (. �..5 •
13. Soil type(s) Alo,4 r
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [p No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination? ❑ Yes 0 No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes V9 No ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes % No ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/Inspector Name L*11` Ra✓&ts Phone: q/Z7 4133, 3300
Reviewer/Inspector Signature: 9 u� Date: (_,/ P ZOD 7
121251Q4 Continued

Facility Number: Q 9 Date of Inspection 6 2w O
" Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes W No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ yes V3 No ❑ NA ❑ NE
the appropiate box. ❑ VVTJP ❑ Checklists ❑ Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes F No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and l" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
)D No
❑ NA
❑ NE
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
� No
El NA
El NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
P0 No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
ZI No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
[2(No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
[;9 No
❑ NA ❑ NE
Other issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
5d No
❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
No
❑ NA ❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
[ No
❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
No
❑ NA ❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
[I Yes
,,.,,,�qq
JL No
❑ NA ❑ NE
12128104

I
_z� /2 /t/if//zvn 6;
Type of Visit ® Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit * Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: /L-l�3e-O� Arrival Time: Departure Time: County: ���� Region: /E67
JV Farm Name: /y/ ���G�1 �erYrS £ Z Owner Email:
Owner Name: /%'`i&4ell �arr/S Phone:
Mailing Address:
Physical Address:
Facility Contact: u �! Title: 5e_e r _ �_ jJ Phone No:
yy
Onsite Representative: I`a44 a 'b Le Sin/ Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: 0 D 0 ' u Longitude: ❑ ° ❑ I = "
Design Current
Design Current
Design Current
Swine C►opacity Population
Wet Pou.Ftry' @specify Population
Cattle Capacity Population
❑ Wean to Finish I I❑
La erI I
❑Dai Cow
❑ Wean to Feeder
❑Non -La er
❑Dai Calf
Feeder to Finish
`yam 'r.•'El
Dairy Heifer
Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder'
El Non -Dairy
El Farrow to Finish
❑ Layers
❑ Beef Stocker
El Gifts
El Non -Layers
❑ Beef Feeder
❑ Boars
El Pullets
❑ Beef Brood Co
❑ Turke s
Other
❑ Other
❑ Turkey Poults
JE1 Other
Number of Structures:
Discharges & Stream impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
%No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made'?
❑ Yes
DU No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
�ffNo
❑ 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
,,-��qq
Ili No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation'?
❑ Yes
M No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
M No
❑ NA
❑ NE
other than from a discharge'?
Page 1 of 3
12128104
Continued

� x
Facility Number: Q g — 3 Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier: to S / ` /,a !✓
Spillway?: AID /VO
Designed Freeboard (in): / 2 117
Observed Freeboard (in): - / 7 C L 3
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 property addressed and/or managed
through a waste management or closure plan?
❑ Yes [$b No
❑ NA ❑ NE
❑ Yes 10 No
❑ NA ❑ NE
Structure 5
Structure 6
❑ NA ❑ NE
❑ Yes 0 No
❑ Yes O 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 �dNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes [29 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 Wo ❑ NA ❑ NE
maintenance or.improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 10 No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. El Yes �No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence ofWind Drift El Application Outside of Area
12. Crop type(s) t�[. A>!n< ri i ry `1 } Sfyl ki! G Y,ifN_ as
13. Soil type(s) eS i,—, f '
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
EA 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
No
❑ NA
❑ NE
Note . O /
ZGL5aanv tc VCJ hats[.
Reviewer/inspector Name j �K Q V�S Phone: �1� $,*Y3-
Reviewer/Inspector Signature: Date: /Z - / — Z Oo (p
Page 2 of 3 12128104 Continued

Jlk
Facility Number: Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Desig
n ❑Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ t20 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
r� No
❑ NA
❑ NE
23. If selected, did the facility fill to install and maintain rainbreakers on irrigation equipment?
❑ Yes
® No
/�
❑ 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 ❑ NA ❑ NE
26. Did the facility fail to have an actively certified operator in charge? ❑ Yes V No ❑ NA ❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
[;9 No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
P No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
n No
LM
❑ 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
W 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
X No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
RjNo
❑ NA
❑ NE
Page 3 of 3 12128104

® Division of Water Quality
IMEacility Number 4 3 `r 0 Division of Soil and V4fater @onservation
Outer Agency
Type of Visit WCompliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit 0 Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: / Arrival Time: Departure Time: County: ey� Region: FRO
Farm Name: M + rl r Marr_5t 4 � � Owner Email:
Owner Name: Nt% W - IJnarf-ris Phone:
r
Mailing Address: L [ Y Co[I.—la�`ii,�
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Phone No:
Integrator: A4y r—a is v r �--c3,c,.=
Operator Certification Number: (o in
Back-up Certification Number:
Latitude: = 0 0 i =" Longitude: El 0 0'=
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
`� ❑ Layer
II Q Non -La et
Other
❑Other--W_Y— —_
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets I
❑ Turkeys
❑ Turkey Pouets i
❑ Other
Discharees & Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
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)?
Number of Structures: 1 7 E
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 [9 No ❑ NA ❑ NE
❑ Yes
❑ No
ERNA
❑ NE
❑ Yes
❑ No
NNA
❑ NE
RNA
❑ NE
❑ Yes
❑ No
❑ Yes
[KNo
❑ NA
❑ NE
❑ Yes
KNo
❑ NA
❑ NE
12128104 Continued

Facility Number: — 3
Date of Inspection tLlql
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
[,3No
❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
® NA ❑ NE
Structure 1 ZITS Structure 2 Zy2b Structure 3 Structure 4
Structure
5
Structure 6
Identifier: 5'f [ KleS.T_LAr
Spillway?: tle
Designed Freeboard (in): _ lot R.
Observed Freeboard (in): ��� �Z
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
29 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
2No
❑ 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
J.No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
® No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
91 No
❑ NA ❑ NE
maintenance or improvement?
Waste_-Apolication
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
P9 No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
LKNo
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground [I Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or ] 0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift Application j utstde
(t5d) c3COXz?s CSe
of Area
p _+ `
12. Crop type(s)
- IYt't 4C�YLAA!
13. Soil type(s)
No V
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
ANo
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
KNo
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination'! ❑ Yes
KNo
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
XNo
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
RNo
❑ NA ❑ NE
11 ('n11MA iirpiPr to netQctinn�i!] W.F.�nlitin RV M; C a�ntw rtdAnrl� a rvrnmmanri9tinnc nr onv nfhpr. rnmtnantc
Reviewer/Inspector Name I__r 4 Phone: g — �/S
Reviewer/Inspector Signature: Date:
12128104 Continued

Facility Number: — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes (4 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- ❑ Checkiistr ❑ Desigtr ❑ Mays El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. Yes ❑ No ❑ NA ❑ NE
❑ Waste Application/ ❑ Weekly Freeboard"❑ Waste Analysie ❑ Soil Analysis/ ❑ Waste Transfers ❑ Annual Certification.-*
❑ Rainfall ❑ Stockings ❑ Crop Yield ❑ 120 Minute Inspections.- ® Monthly and V Rain Inspections ❑ Weather Coda-
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
14 No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
® No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
KNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
KNo
❑ NA
❑ 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
EN No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
® No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
® No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
® 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
[H 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
O No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
® No
❑ NA
❑ NE
Additional `Commentsartdlor:Drawings y =� , ; 5"�'
44
zq . r K v�ecA jaje Av'w &I ee- l b r a4i"ox 4D cn' [; 41 c�
cc' I"" .
Z ! . Q ke'cL s e s ; yL 0f-f ev-, rg cc v- -u -re_ C-04 s
o t- wa.s�P_ rv�annu��..�e,,,,� S V s` e~ .
I2128✓04

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
Date of Visit: // /i Tuue: /� /S
Facility Number 4
rONotO perational 0 Below Threshold
al Permitted ® Certified Q Conditionally Certified 0 Registered Date -Last Operated or Above Threshold:
Farm Name: .7�c��-�� /Via rr; _f # ev2 County ... dloofeN RD
Owner Name: _ !! r e*4�4: i...---- e --1 - o r r : Phone No: ,
Mailing Address:
Facilitv Contact: Title:
Onsite Representative: /(Ay"/v 40u i6262
Certified Operator: %j'% / �� �� NO r r i
Location of Farm:
Phone No:
Integrator: .uu,52 . ,.
Operator Certification Number:
()3 Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • 4 && Longitude �• �Du
Design Cur
Swine Po `�
Wean to Feeder
Feeder to Finish 73qq
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
N�iber ol<i.agaons
n Desega Curregi - ":? Design Curresrt
'flY' Caacity "P4zsnlatiion. Cattle:. : , CanC�iy:.Pvvul:att:on
T jis;rb *pes & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes No
Discharge originated at: 0 Lagoon ❑ Spray Feld ❑ Other
a. If discharge is observed, was the conveyance mart -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? N j A
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 W No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes [] No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ___ _ _ I ____
Freeboard (inches): r v�
12112103 Cont&tued

Tacility Number: 9— 3
Date of Inspection / d
5. Are there any immediate threats to the integrity of any of the structures observed? Cie/ 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 maintenancelrmprovement?
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 maintenancelimprovement?
I I . Is there evidence of over application? If yes, check the appropriate box below.
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
❑ Yes P.No
❑ Yes ® No
❑ Yes P9 No
❑ Yes No
❑ Yes No
❑ Yes ® No
❑ Yes ® No
12. Crop type r u c ra e
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes 51 No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes EP No
b) Does the facility need a wettable acre determination? ❑ Yes ® No
c) 7bis facility is pended for a wettable acre determination?
I5. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours?
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building sut cture, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional
Air Quality representative immediately.
❑ Yes 19 No
® Yes ❑ No
❑ Yes P No
❑ Yes I1 No
❑ Yes EJ No
❑ Yes P No
❑ Yes P No

4�aciiity'Number: — 3 `] Date of Inspection
Required Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WIT, checklists, design, maps, etc.)
23. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
25. Did the facility fail to have a actively certified operator in charge?
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
27. Did Reviewer/inspector fail to discuss reviewimspection with on -site representative?
29. Does facility require a follow-up visit by same agency?
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
NI MES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
3I. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
32. Did the facility fail to install and maintain a rain gauge?
33. Did the facility fail to conduct an annual sludge survey?
❑ Yes ® No
❑ Yes ® No
91fes 09 No.
�a.01
W Yes Q No
❑ Yes Ip No
❑ Yes Ej No
❑ Yes] No
[:]Yes [ No
❑ Yes ® No
PO Yes ❑ No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
34_ Did the facility fail to calibrate waste application equipment? ❑ Yes ® No
35. Does record keeping for NPDFS required forms need improvement? If yes, check the appropriate box below. ® Yes ❑ No
❑ Stocking Form ❑ Crop Yield Form ® Rainfall m Inspection After 1" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
12112103

General,
Zll
Facd�tyNUmber DQ 39
County
IBladen
Owner
IMitchell �orris
Manager
Address
194 Coley Rd
Elizabethtown NC 128337
Location
Certified
Farm Name
I Mitchell Norris #1 & #2
Phone Number
1910-645-6036
Manager Phone
Lessee L-
FARO 0 MRO 0 WARO 0 WSRO
(00 FRO 0 RRO 0 WIRO L_ 6
1 169, - - I I I I I . . I . , r . . . , . . . r . . _ I . I . , , . - I . I , , - . . r . , . . I . I . . . . , I . .
... ....... ......
....... ........... ............... ............
.............. . ........... ......
................. — .......... 1�7
Certified Operator in Charge I IMitchell W. - Eorris -- I
Backup Certified Operator
originally certified as 2 separate facilities (09-207 deleted) per one WUP per Sonya Johnson
............. ......
0 .......
O'Ft-.❑ ied Date inactivated Liio�;Ii Cl or closed
Type of Operation
9 Swine 0 Poultry 0 Cattle 0 Sheep 0 Mrses [3 Goats [3 None
Design Capacity
0.1 Layer
er
Non -Layer
Total 7,344 IF Swine
SSLW 991,440 Feeder to Finish
Mitchell Norris #1 & #2 Murphy Family Farms

Date of Virit:
Facility Number
--- - ---1P Not 0 erational Below Threshold
91 Permitted V Certified 13 Conditionally Certified 0 Registered Date Last Operated or
Above Threshold:
Farm Name:/TU7C�� 4/rim '{ a County:
Owner Name: _ /-?,2/ i // /Vorri s Phone No:
flailing Address: �
FacilitV Contact: _ z;U,!n!n4e & A10.1zL Title: Phone No:
Onsite Representative: Xa 4je &e jaw integrator: /n.V-4214je
Certified Operator: %��G G N�rr: s Operator Certification Number:
Location of Farm:
Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude a ` OF Longitude • 01
Design Current Design Current Design Current
Swine Capacity Population Poultry Ca achy Po ulation Cattle Capacity Population
❑ Wean to Feeder ❑ Laver I I 1 10 Dairy
Feeder to Finish ❑ Non -Laver I ILI Non -Dairy
El Farrow to wean
❑ Farrow to Feeder Other
❑ Farrow to Finish Total Design Capacity
❑ Gifts
❑ Boars Total SSLW
Number of Lagoons I J0 Subsurface Drains Present JLJ Laeoon Area ]❑ Spray Field Area �
Holding Ponds / Solid Traps ILI 1\o Liquid Waste Management Svstem
Discharges 8 Stream Impacts
1. Is any discharge observed from an-, pan of the operation?
- El Yes � No
Discharge originated at: ❑ Lazoon ❑ 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? &Z2 �
d. Does discharge bypass a lagoon system? (If ves, notify DWQ) El Yes [3No
2. Is there evidence of past discharge from any part of the operation? El Yes 12 No
3. Were there and• adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑Yes M No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ® No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 5
Identifier: a
Freeboard (inches): .2f n
05103101 Continued

Facility Number: —
Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctwes lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes No
❑ Yes [ No
❑ Yes lh No
❑ Yes [� No
❑ Yes No
Waste Application
10. Are there any buffers that need maintenance/improvement? -
❑ Yes
-W No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
❑ Yes
W No
i
12. Crop type r Q y r GtQ c2ZZ ra f /a
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
W No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
Efi No
b) Does the facility need a wettable acre determination?
❑ Yes
W No
c) This facility is pended for a wettable acre determination?
❑ Yes
N1 No
15. Does the receiving crop need improvement?
❑ Yes
[jj No
W Is there a lack of adequate waste application equipment?
❑ Yes
® No
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
[,� No
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
[51No
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
[4] No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes
W No
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
A No
24_ Does facility require a follow-up visit by same agency?
❑ Yes
7Q No
25, Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
P No
No violations or deficiencies were noted daring this visit. You will receive no further correspondence about this visit.
_ w
Comments (refer3#o'questronf# Explain'`atty YESranswe�'s"antl/oranynrecamm�ieRdattous of aay other cunmenoxn ts
��: �sf ,
Usedra
$� wingsAoftifacibtygto�be#terdexpla:n sihrahorrs: (use a_ddrh�onyai_pagesyy�as�nesary): Field Cop-; ❑Final Notes
f. ''_'�e'ia. v
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l iD[45__5 a'' G -C'f'+ - o f 47DaN Ie ve J.
! Al e ibfs a ract/+or® fi yoQrp,�fls "y �o . YY]d n, �or
,
anc� tr�f a.s rretdQcdZ,
r _
Reviewer/Inspector Name } .- __:. '; '
Reviewer/Inspector Signature: Date: ce -- /0 -a?
05103101 Continued

Facility Number- 1 — Hate of Inspection �i �/o—•'r
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharue atlor below
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours?
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
29. Is the land application spray systcm intake not located near the liquid surface of the lagoon?
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.c. 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?
Comments
❑ Yes ❑ No
❑ Yes E'No
❑ Yes QFNo
❑ Yes 0 No
❑ Yes [INo
❑ Yes XNo
❑ Yes ❑ No
05103101