090150_INSPECTIONS_20171231

"', ` ivi'sionl"©f Water R�ources
Facility 111 tuber 1M
°ODivis oof Soil and Water Conservation
i
I
®�Otber Ageo�cy
Type of Visit: omplian Inspection Operation Review Structure Evaluation 0 Technical Assistance
Reason for Visit: outine 0 Complaint 0 Follow-up 0 Referral 0 Emereencv 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: ' ; O County: Region:
Farm Name:Owner Email:
Owner Name: �� ; ? ; c��czt� Phone:
Mailing Address:
Physical Address:
Facility Contact: w ", I l ; i-_ T?z--,0 Title: �raJlz �'`r Phone:
Onsite Representative: S' Integrator:
Certified Operator: Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Swine
Design Currentun-
Capacity Pop.
MN0EDesign
Wet Poultry
g Ulu
Capacity
Current
Pop.
Cattle
Design Current
Capacity Pop.
Wean to Finish
La er
Dairy Cow
Wean to Feeder
Non -La er
Dairy Calf
rl
&'
Feeder to Finish
L 7
,J
E '
i !
D Pqulf
La ers
'DeS� n
Cs aci
Current
;II PO I !
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
.�
#§
l
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
-Layers
,h?
Boars
Pullets
Other
Turkeys
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
f�LNo
❑ NA
❑ NE
0 Yes
D?[No
❑ NA
❑ NE
Page 1 of 3 21412015 Continued

acili Number: - Date of Inspection: �-
fWaste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
D Yes
0 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
jEg-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
P�JNo
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental
threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
[, No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
allo
❑ 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
MNo
❑ NA
❑ NE
maintenance or improvement?
Waste Application_
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
El�_No
❑ NA
❑ NE
maintenance or improvement?
11. is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes f5Q 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 lrz�a+cc Window ❑ Evidence of Wind Drift /❑ Application Outside of Approved Area
,�j 12. Crop Type(s): r-r`, ��Sr�J1 Z%%t< /,,
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes O'No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes �No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes rKNo ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
I & Is there a lack of properly operating waste application equipment?
Reauired Records & Documents
❑ Yes gNo ❑ NA ❑ NE
❑ Yes rtm No ❑ NA ❑ NE
19_ Did the facility fail to have the Certificate of Coverage & Permit readily available?
[:]Yes
fqNo
❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
Q�No
❑ NA ❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
RNo
❑ 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
kNo
❑ NA ❑ NE
23. Ifselected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[4No
❑ NA ❑ NE
Page 2 of 3
21412015 Continued

i` 4acHity Number: - Date of Inspection: ,4Z /6
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
� No
❑ NA ❑ NE
25. is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
allo
❑ 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
R-No
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
allo
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes allo ❑ NA ❑ NE
❑ Yes M No ❑ NA ❑ NE
❑ Yes Pq No ❑ NA ❑ NE
❑Yes ®No DNA ❑NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
ENo
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? • ❑ Yes
J;q No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency? [::]Yes
EINo
❑ NA
❑ NE
Comments (refeitogestron#) Ezplam any ,Y Spa erstand/oranyratlditronal recomiteendadons or;any other oamments�
k ter r a o �
Use drawmgs,of facility to `better "plainlsituatrons (use addit�onalEpages as necessary).',•, ;�
Reviewer/Inspector Name:
Reviewer/Inspector Sipatuz
Page 3 of 3
Phone:
Date: dZ
21412015

Type of Visit: QrCompliance Inspection O Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: outine O Complaint 0 Follow-up 0 Referral O Emergency 0 Other 0 Denied Access
Date of Visit: [�j Arrival Time: Departure Time: County: Region:
Farm Name: _ / -3 raem7 Z Owner Email:
Owner Name: V ; , f j % �0 r-?y Phone:
Mailing Address:
Physical Address:
Facility Contact: i it Q ✓c�( Title: �(�cii't ✓ Phone:
Onsite Representative: Spa, Integrator:
Certified Operator: Certification Number: /4,;� zf
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current Design Current Design Current
Swine CapacityWet�Poultry Capacity Pop. Cattle --- Capacity Pop.
-T
Wean to Finish La er DairyCow
Wean to Feeder
Non -La er
DairyCalf
Feeder to Finish
Farrow to Wean
7
19D
Design Current
Dry�l?oulf , Ca acit P,o .
Layers
Non -Layers
DairyHeifer
D Cow
Farrow to Feeder
Non -Dairy
Farrow to Finish
Gilts
Beef Stocker
Beef Feeder
Boars
Pullets
Beef Brood Cow
Othe
Other
Turke s
urkey 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 DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes [21 No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
[] Yes
❑ No
❑ Yes
[&No
❑ Yes
0_No
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
Page 1 of 3 21412015 Continued

Facility Number: jDate of Inspection: f
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):`
Observed Freeboard (in): _ 2L
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
LdC51No
❑ 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
[ANo
❑ 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
allo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
K!A 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
[RNo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
W. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
ELNo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? if yes, check the appropriate box below. [:]Yes allo ❑ 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 [ 1 Application Outside of Approved Area
12. Crop Type(s): 3 /-m ala
13. Soil Type(s): Va 2Y:
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 O No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes CE No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
® No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
® No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
21 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 R No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 " Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [RNo
23. If selected. did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes C&No
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facility Number: - 10 jDate of ins ection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes g[ No
' 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 provide documentation of an actively certified operator in charge? ❑ Yes 0 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 ❑ Yes No
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 �a No
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 Rj No
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 S No
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes [M No
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes ® No
34. Does the facility require a follow-up visit by the same agency? ❑ Yes 7g.No
Reviewer/Inspector Name:
❑NA ❑NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Phone: 9J17��y3
Reviewer/Inspector Signature:
Page 3 of 3
Date: .12 7
21412015

P
•tom �,�. ,-.
ivision of Water Resources
Facili Nutnlier ®- S!J O Division of Soil and Water Conservation
© Other Age�tcy
Type of Visit: C�,ompliance Inspection Operation Review Q Structure Evaluation Q Technical Assistance
mp
Reason for Visit: �J Koutine 0 Complaint Follow-up Q Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: ,'3 (� Departure Time: County:'-- Region:
Farm Name: z! rA �. "` _ Owner Email:
Owner Name: W r— 1j y�r� _ Phone:
Mailing Address:
Physical Address:
Facility Contact: j�Ci (� i Z Ga �� • Title: _ 0-(,tJW7`-_r Phone:
Onsite Representative: _ Integrator: /&ff
Certified Operator: '',1111111- Certification Number: e '& �;z 7 /
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design Current
Design
Current
Design Current
Swine Capacity Pop.
Wet Poultry
Capacity
P.
Wp—acit-
YJEPop.
Wean to Finish
La er
Da' Cow
Wean to Feeder Non -La er
Da' Calf
Feeder to Finish D
Dai Heifer
Farrow to Wean
Dry Cow
Farrow to Feeder
D . Paul
Ca aci
P,o .
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
]Turkeys
Other
Turke Poults
Other iF
t1.,..•,.••.,�•-•v:6,iah'iYii9Rs _....:•
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
[:]Yes Cg-No [DNA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
[:]Yes [:]No
❑ Yes MNo
❑ Yes a No
❑NA ❑NE
DNA ❑NE
❑NA ❑NE
Page I of 3
21412014 Continued

r
hacili Number: 2 — Z 113ate of Inspection:
5= (�
Waste Collection & Treatment
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
D 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
JZ] 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
12 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
0 No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
fo 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
F21 No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
m No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes JR1 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): 1.3 �__' rr1 %J?Z 2 lwx
13. Soil Type(s): Pf
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes S No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes M1 No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes ® No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes [QNo ❑ NA ❑ NE
❑ Yes �No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes JZ No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [Z 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 M No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 " Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ja No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes Q5_No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412014 Continued

FaciIi Number: jDateof Inspection: `1
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes P No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes P 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?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWNP?
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 Z No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes QC No [] NA ❑ NE
❑ Yes P No [] NA ❑ NE
[:]Yes P.No ❑ NA ❑ NE
❑ Yes M No ❑ NA ❑ NE
❑ Yes No
[—]Yes ® No
[:]Yes No
❑ NA FINE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (referto uesboi4#i) Ezp zany*YES inswersand/�or;' any add�lssbolirecommeiids"Boris it an �ot6er°comments.
v s. Y
U..se.drawings:oftfacil�tyjtobettereapla�a s�tvahons„(use additional; apes as=necessa_,.
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of
Phone:
Date:
21412014

S
Type of Visit: ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 01outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: � Arrival Time: Departure Time: ' 3a County: �1. 4 Region:
Farm Name: K �/AVL-f Owner Email:
Owner Name: Ly L 1''t�. Phone:
Mailing Address:
Physical Address:
Facility Contact: fj(/`Y yl7r'aR 2t' Title:,,CJ�Y r/r� Phone:
Onsite Representative: ,S Integrator: Q�y,�✓��`
Certified Operator:-- Certification Number:
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Design Current
Swine Capacity Pup.
Wean to Finish I
Design Current Design Current
Wet Poultry Capacity Pop, Cattle Capacity Pop_
JLaycr I Dairy Cow
Wean to Feeder
I
jNon-Layer I
Dairy Calf
feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Da' Heifer
WEkEsign Dry Cow
Ca aci P,o Non -Dairy
Layers Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
keys
Turkey Poults
Beef Brood Cow
EL
Other
Other JMHOther
Discharges and Stream Impacts
I . Is any discharge observed from any part of the operation?
❑ Yes
Qff No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ .Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
E&No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
® No
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412014 Continued

Facili Number: jDate of Inspection:
Waste Collection &.-Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes W o ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): I;z kt
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes JgNo ❑ 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
g . 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
MNo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
allo
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
[:]Yes
2�-No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
KNo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [:]Yes [2No ❑ 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): 47
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 P, No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes 2,No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[�No
] NA
❑ NE
18. is there a lack of properly operating waste application equipment?
❑ Yes
Q�J-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
allo
❑ 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 CR-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 JK No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes VNo ❑ NA ❑ NE
Page 2 of 3 21412014 Continued

Facility Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? [:]Yes rIFNo
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [S 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 ❑ 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
❑ Yes
❑ No
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
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
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
❑ No
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
❑ No
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
❑ No
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
❑ No
❑ NA ❑ NE
❑ NA ❑ NE
NA ❑ NE
Ig NA ❑ NE
Lcf
NA ❑ NE
aVA ❑ NE
JP NA ❑ NE
29 NA ❑ NE
lv N_
❑ NE
NA
❑ NE
JZ,NA
❑ NE
Comments (refer to question #)• Explain anyYES_ answers,_and/or,afny additional_recommendntions or. any other comments - -
f =a;,..., _-..- d?�a'w it F.• +Ff ^5
Use drawings of.facility to better explain situations.,(use addid oBaE=pages-X necessary,):
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 1f`'-10
Date:
21412014

Type of visit: 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 0 Denied Access
Date of Visit: © Arrival Time: _1 0-13V Departure Time: p �, County:
Farm Name: _ j¢ l t�Q/rr� f Owner Email:
Owner Name: �,(J ; �� ; r 1J j'3 �� Phone:
Mailing Address:
Physical Address:
Region:
Facility Contact: ,�i(f i ��i C Title: tqe J n Yd Phone:
Onsite Representative: Integrator: fr r ✓� uJ ^--
Certified Operator: Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design. Current
Design Current
Design Current
Swine Capacity Pop.
Wet Poultry
Capacity Pop:'
Cattle Capacity Pop.
Wean to Finish
La er
Dai Cow
Wean to Feeder
Non -Layer
Da' Calf
ceder to Finish
Dairy Heifer
Farrow to Wean
Design Current
D Cow
Farrow to Feeder
D . Foul.
Ca see
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
­
Other
TurkeyPoults
Other
Other1"
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 CNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
[:]Yes
® No
❑ NA
❑ NE
❑ Yes
29 No
❑ NA
❑ NE
Page I of 3 21412011 Continued

[Facility Number: - Z. jDate of Inspection: p
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
D4 No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[;KNo
❑ 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
0 No
❑ NA
❑ NE
S. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
gjNo
❑ 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
LZ No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
Eg No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [:]Yes C&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
~!'`ml
12. Crop Type(s): 'beatte /'Wa ex_
13. Soil Type(s): - �( A
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 ❑ Yes "No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[&No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
®. No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
RNo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
® 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 E[ No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking [:]Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes Jallo
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes FM
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facili Number: - Date of Inspection: ff�t]/
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ® No ❑ NA ❑ NE
r 25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [a 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?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
❑ Yes
[-No
❑ NA
[] NE
❑ Yes
(a No
❑ NA
❑ NE
❑ Yes
U No
❑ NA
❑ NE
❑ Yes [allo ❑ NA ❑ NE
❑ Yes Ca No ❑ NA ❑ NE
31. Do subsurface tile drains exist at the facility? if yes, check the appropriate box below. ❑ Yes
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes
34. Does the facility require a follow-up visit by the same agency? ❑ Yes
;E�No ❑ NA ❑ NE
(allo ❑ NA ❑ NE
CK No ❑ NA ❑ NE
3-No ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (useadditional. pages as necessary).
Reviewer/Inspector Name: __�/rcic ��cy /-�� _ Phone: y%b
Reviewer/Inspector Signature:
Page 3 of 3
Date:
21412011

Type of Visit: d?fCompliance Inspection O Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit: 01foutine O Complaint C) Follow-up Q Referral O Emergency 0 Other O Denied Access
Date of Visit: Arrival Time: Departure Time: ; a County: % r rt.- Region:
Farm Name:
Owner Name: L ; 1 -g—_
Mailing Address:
Owner Email:
Phone:
Physical Address:
Facility Contact: %,V : r i r_— 3 Title: W r+ r•- %`f Phone:
Onsite Representative: 5:21--rIntegrator:
7
Certified Operator: �j Certification Number: / 71
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design Current- '``
`r
Deacffll
rrent:
Design Current
Swine
Ca aci Po Wet Poutt .
h' P .r3'
..
Ca PP
o
Cattle Ca aciP
P ty P-
Finish
La er
airy Cow
Feeder
Nan -La er
Dai Calf
Finish"
�3
DairyHeifer
Weank"Current
-
D Cow
Feeder
EF
tD ; P,oul
Ca aci
1?0
Non -Doi
Finish
La ers
Beef Stocker
Non -La ers
Beef Feeder
Pullets
BeefBoodCow
Turkeys
Turkey Poults
ML_Lther
Other
Dischat-tres and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
[—]Yes [&No ❑ NA ❑ NE
[—]Yes
[:]No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
[—]Yes
[:]No
[—]Yes
R No
[—]Yes
10 No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3 21412011 Continued

Facili Number: -Z jDate of Inspection:
-- 3
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
No
[] NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):130—
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
�ZL 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
fR 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
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
(0 No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [3-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): 2014&101-
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
[:]Yes
MNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
CKNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
j�:LNo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
L&No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[3:No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
EINo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
ERJ'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 Jallo
❑ 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 0 No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes U1 No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
DNA ❑NE
Page 2 of 3 21412011 Continued

_ Facility Number: - I Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes gLNo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [a No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ® No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes ELNo ❑ 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
F?�LNo
❑ 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
[0 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
2§ 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
QjNo
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
0 No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
�o
❑ NA
❑ NE
Comments (refer to question #) Explain any YES answers and/or. any. additional recommendations or any other comments-
Use drawings of.faciiity "to better explain situations (use additional`pa�es.as necessary},
Reviewer/Inspector Name:
Phone: 9—j© -A_32PC
Reviewer/Inspector Signature:
Page 3 of 3
Date:
21412011

Type of Visit: 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 0 Denied Access
Date of Visit: 2ENE2AZArrival Time: Departure Time: County:
Farm Name: 6 a r Owner Email:
Owner Name: j (r i ! r_ Phone:
Mailing Address:
Physical Address:
Facility Contact: �� f a r ,��.* Title: 6q:: {J1j fJ Phone:
Onsite Representative: Integrator: c
Certified Operator: YS��� Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Region: +��
Design Current
Design
Current
Design Current
Swine
Capacity Pop.
Wet Poultry
Capacity
Pop.
Cattle
Capacity P.
Wean to Finish
La er
DairyCow
Wean to Feeder
Non -La er
DairyCalf
t
eeder to Finish
7
p
- t,,
DairyHeifer
Farrow to Wean
Design
Current
D Cow
Farrow to Feeder
D , P,©ul
Layers
C•_a aeity
P,o
Non -Da'
Beef Stocker
Farrow to Finish
Gilts
Non -Layers
Pullets
Turkeys
Beef Feeder
Beef Brood Cow
Boars
Other
Turkey Poults
Other
10ther
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 [KNo ❑ NA ONE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑Yes No
❑ Yes No
❑ Yes ® No
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
Page 1 of 3 21412011 Continued

r .
Facility Number: jDate of Inspection:
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes JE�_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
tg 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
JR 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
XLNo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
J53-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
25 No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
N No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes 0 No ❑ NA 0 NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 tbs. ❑ 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):Cl�]GIrA
13. Soil Type(s): g &
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 R No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes fig -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?
❑ Yes g No ❑ NA ❑ NE
❑ Yes JZ[ No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? [:]Yes RNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes &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 E�[ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes 0 No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 54,No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

r .
t
Facility ,~`umber: jDate of Inspection:
- 24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
MNo
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
EE3-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
M No
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
,KNo
❑ NA ❑ NE
Other issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
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 CA WMP?
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 gNo ❑ NA ❑ NE
❑ Yes ,25,Na ❑ NA ❑ NE
❑ Yes �No ❑ NA ❑ NE
❑ Yes &No ❑ NA ❑ NE
❑ Yes jNo
❑ Yes No
❑ Yes No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question #)Explainany°YES aiis,.tiers.And/or any additional reconunendations or -any other commentsry-
Use drawings of facility to better explain "situations,:{arse additional pages as necessary} 5 •<x
r,e4QLr
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date: `�—%,j f4��� .72--
2/4/2011

a
Type of Visit Q<ornpiiance Inspection 0 Operation Review 0 Structure Evaluation O Technical Assistance
Reason for Visit &4o_utine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: �Arrival Time: t] Departure Time: ; 3 O 1 County: Region:
Farm Name: _71 1Z Owner Email:
Owner Name: W 1 Ib r L_ -B PI.rj Phone:
Mailing Address:
Physical Address:
Facility Contact: , r Title: e" Y.� Phone No:
Onsite Representative: Integrator: v
Certified Operator: Operator Certification Number: /LZZ/
Back-up Operator:
Location of Farm:
Back-up Certification Number:
Latitude: = 0 0 { Longitude: = o = I = u
Design Current
Catry
Design Current
CapactyPopul on
Design Current
Cattle Capacity Population
Finish
❑ La er
❑ Dai Cow
Feeder
7Feeder
❑Non -La er
❑ Dai Calf
Finish
❑ DairyHeifer
❑ Farrow to Wean
Dry Poultry
❑ D Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
❑ La ers
❑ Beef Stocker
Gilts
❑ Non -Layers
El Beef Feeder
EBoars
❑ Pullets
10 Beef Brood Co
.... _„._..:
❑ Turkeys
Other ,3
❑ TurkeyFoults
❑ Other
❑Other
Number o#Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
A No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Fieid ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
0,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

Facility Number: gr - 5j I) Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [%No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): a
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes UNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes ❑.No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
E9 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
RNo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
91 No
❑ NA
❑ NE
maintenance/improvement?
11.
Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
E9No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12.
Crop type(s)_
13.
Soil type(s) Q U2f
14.
Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
Q No
❑ NA ❑ NE
15.
Does the receiving crop and/or land application site need improvement? ❑ Yes
RNo
❑ NA ❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
M No
❑ NA ❑ NE
17.
Does the facility lack adequate acreage for land application? ❑ Yes
ERNo
❑ NA ❑ NE
18.
Is there a lack of properly operating waste application equipment? ❑ Yes
&No
❑ NA ❑ NE
Reviewer/Inspector Name Phone. —433-33
Reviewer/Inspector Signature: Date: — 15—
Wage -, of s IZ446Iu4 uununuea

Facility Number: — late of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes E.No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ yes I& No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 4Q No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes .1 No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 0No El NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
EkNo
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
91 No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
91 No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
®.No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
9No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
RNo
❑ 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
EgNo
❑ 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? (iel discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
RNo
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
QgNo
❑ NA
❑ NE
Page 3 of 3 12128104

� �'S�'V^'� .1` .�: �,''^��%. L•�I [j~lfl� -a 't _.:-r. y; ��Y .A
PRODUCER: Willie Beard
LOCATION: 3281 Rosindale Rd.
Clarkton, NC 28433
TELEPHONE: [phone]
TYPE OPERATION: Feeder - Finish
NUMBER OF ANIMALS: 3672
(Design Capacity)
The waste from your animal facility must be land applied at a specified rate to prevent pollution
of surface and/or groundwater. The plant nutrients in the animal waste should be used to
reduce the amount of commercial fertilizer required for the drops in the fields where the waste is
to be applied. This waste utilization plan uses nitrogen as the limiting nutrient. Waste should be
analyzed before each application cycle. Annual soil tests are strongly encouraged so that all
plant nutrients can be balanced for realistic yields of the crop to be grown.
Several factors are important in implementing your waste utilization plan in order to maximize
• the fertilizer value of the waste and to ensure that it is applied in an environmentally safe
manner. Always apply waste based on the needs of the crop to be grown and the nutrient
content of the waste. Do not apply more nitrogen than the crop can utilize. Soil types are
important as they have different infiltration rates, leaching potentials, cation exchange
capacities, and available water holding capacities. Normally waste shall not be applied to land
eroding at greater than 5 tons per acre per year. With special precautions, waste may be
applied to land eroding at up to 10 tons per year. Do not apply waste on saturated soils, when it
is raining, or when the surface is frozen. Either of these conditions may result in runoff to
surface waters which is not allowed under DEM regulations. Wind conditions should also be
considered to avoid drift and downwind odor problems. To maximize the value of nutrients for
crop production and to reduce the potential for pollution, the waste should be applied to a
growing crop or applied to bare ground not more than 30 days prior to planting. Injecting the
waste or disking will conserve nutrients and reduce odor problems.
The estimated acres needed to apply the animal waste is based on typical nutrient content for
this type of facility. Acreage requirements should - be_ based on the waste analysis report from
your waste management facility. Attached you will find information on proper sampling
techniques, preparation, and transfer of waste samples to the lab for analysis.
This waste utilization plan, if carried out, meets the requirements for compliance with 15A NCAC
21-1.0217 adopted by the Environmental Management Commission.
Page 1

.„
L
-}• +
I�_ "' 4 -= �-i_:.: -. tv v....� Z:..+•.
3,672 animals X 1 2 (tons) waste/animal/year =
Amount of Plant Available Nitrogen (PAN) Produced Per Year
3,672 animals X 2. lbs. PANlanimallyear =
Guide Std. 633)
6,977 (tons) waste/year.
8,446 lbs. PAN/year. (PAN from N.C.
Tech
Applying the above amount of waste is a big job. You should plan time and have appropriate
equipment to apply the waste in a timely manner
The following acreage will be needed for waste application based on the crop to be grown and
surface application:
Table 1: ACRES OWNED BY PRODUCER
Tract Field* Soil Crop Lbs. N Acres Lbs. N Month of
# No. Type Per Acre Utilized Application
Total I 25.151 8,923.25 i
*This N is from animal waste only. If nutrients from other sources such as commercial fertilizer are
applied, they must be accounted for. N must bit based on realistic yield expectation.
NOTE. The applicator Is cautioned that P and K may be over applied while meeting the N
requirements. Beginning in 1996 the Coastal Zone Management Act will require farmers in some
eastern counties of North Caroline to have a nutrient management plan that addresses all nutrients.
This plan only addresses Nitrogen.
Page 2

., •,y�.y^r,�_ _ - _- .sue � _ ^l��'_ ..r- ;.�-ter- _-��.::z:�.:���i"; - -'- t� �:.«
Table 2. ACRES WITH AGREEMENT OR LONG TERM LEASE
(Agreement with adjacent landowner must be attached)
(Required only if operator does not own adequate land [see
Required Specification 2])
Tract Field Soil Crop Lbs. N Acres Lbs. N Month of
# No. Type Per Acre* Utilized A
..
• - See footnote for Table 1.
•
Totals from above Tables
Acres Lbs. N
Utilized
Table 1 25.15 i
Table 2 0.00Total 25.15 Amount of N Produced Surplus or Deficit
NOTE. The Waste Utilization Plan must contain provisions for periodic land application of sludge at
agronomic rates. The sludge will be nutrient rich and will require precautionary measures to prevent over
application of nutrient or other elements.
Page 3

•
•
0
.a�a�.,,�- �r._M _ __ r�i�_. ��� tip• tll. �l— �Y � 1, - _ ,..L�,�:�;rz,:.r•;�_-'.�-;� _',..�x
_terms
See attached map showing the fields to be used for the utilization: of waste water.
Field Soil Type
No.
Application of Waste by Irrigation
Crop Application Application
Rate (INHr) Amount (In.)
1 DuA BermudaiMatua 0.4 0.75
THIS TABLE IS NOT NEEDED IF WASTE IS NOT BEING APPLIED BY IRRIGATION, HOWEVER A SIMILAR TABLE
WILL BE NEEDED FOR DRY LITTER OR SLURRY.
Your facility is designed for 1$Q days of temporary storage and the temporary storage must
be removed on the average of once every fi MONTHS. In no instance should the volume of
waste being stored in your structure exceed Elevation 'see lagoon design.
Call the local Natural Resources Conservation Service (formerly Soil Conservation Service ) or Soil
and Water Conservation District office after you receive the waste analysis report for assistance in
determining the amount per acre to apply and the proper application rate prior to applying the
waste.
Narrative of operation:
Acres shown are 'wetted' acres according to a wetted acreage determination provided by the
grower._ Grower may graze all land using a_bermuda/matua pasture. Follow guidelines provided
for managing this grass mixture.
Page 4

"'r.St.,`.....y..-v ••••. 4 - Wiz.' ! , . :-_ f i. r o� ., �g .. ..
:f�= f �.�s'�fr'�'l�il�,�.�s f:' '.�:• f�' ��-, �:�
r � r , r •
Animal waste shall not reach surface waters of the state by runoff, drift, manmade
conveyances, direct application, or direct discharge during operation or land application.
Any discharge of waste which reaches surface water is prohibited.
2 There must be documentation in the design folder that the producer either owns or has an
agreement for use of adequate land on which to properly apply the waste. If the producer
does not own adequate land to properly dispose of waste, he/she shall provide a copy of
an agreement with a landowner who is within a reasonable proximity, allowing him/her the
use of the land for waste application. It is the responsigility of the owner of the facility to
secure an update of the Waste Utilization Plan when there is a change in the operation,
increase in the number of animals, method of utilization, or available land.
3 Animal waste shall be applied to meet, but not exceed, the nitrogen needs for realistic crop
yields based on soil type, available moisture, historical data, climatic conditions, and level
of management, unless there are regulations that restrict the rate of application for other
nutrients.
• 4 Animal waste shall be applied to land eroding less than 5 tons per acre per year. Waste
may be applied to land that is eroding at 5 or more tons, but less than 10 tons per acre per
year providing grass filter strips are installed where runoff leaves the field. (See FOTG
Standard 393 - Filter Strip).
5 Odors can be reduced by injecting the waste or disking after waste application. Waste
should not be applied when there is danger of drift from the irrigation field.
6 When animal waste is to be applied on acres subject to flooding, it will be soil incorporated
on conventionally tilled cropland. When applied to conservation tilled crops or grassland,
the waste may be broadcast provided the application does not occur during a season
prone to flooding. (See "Weather and Climate in North Carolina" for guidance.)
7 Liquid waste shall be applied at rates not to exceed the soil infiltration rate such that runoff
does not occur offsite or to surface waters and in a method which does not cause drift
from the site during application. No ponding should occur in order to control odor or flies.
t3 Animal waste shall not be applied to saturated soils, during rainfall events, or when the
• surface is frozen.
Page 5

•
REQUIRED SPECIFICATIONS
(continued)
9 Animal waste shall be applied on actively growing crops in such a manner that the crop is
not covered with waste to a depth that would inhibit growth. The potential for salt damage
from animal waste should also be considered.
10 Waste nutrients shall not be applied in fall or winter for spring planted crops on soils with a
high potential for leaching. Waste nutrient loading rates on these soils should be held to a
minimum and a suitable winter cover crop planted to take up released nutrients. Waste
shall not be applied more than 30 days prior to planting of the crop or forages breaking
dormancy.
11 Any new swine facility sited on or after October 1, 1995 shall comply with the following:
The outer perimeter of the land area onto which waste is applied from a lagoon that is a
component of a swine farm shall be at least 50 feet from any residential property boundary
and from any perennial stream or river (other than an irrigation ditch or canal. Animal
waste other than swine waste from facilities sited on or after October 1, 1995). shall not be
• applied closer than 25 feet to perennial waters. (See Standard 393 - Filter Strips).
•
12 Animal waste shall not be applied closer than 100 feet to wells.
13 Animal waste shall not be applied closer than 200 feet of dwellings other than those
owned by the landowner.
14 Waste shall be applied in a manner not to reach other property and public right-of-ways.
15 Animal waste shall not be discharged into surface waters, drainageways, or wetlands by
discharge or by over -spraying. Animal waste may be applied to prior converted wetlands
provided they have been approved as a land application site by a "technical specialist'.
Animal waste shall not be applied on grassed waterways that discharge directly into water
courses, and on other grassed waterways, waste shall be applied at agronomic rates in a
manner that courses no runoff or drift from the site.
16 Domestic and industrial waste from washdown facilities, showers, toilets, sinks, etc., shall
not be discharged into the animal waste management system.
Page 6

" - — _ _F"^�' :�- - r.� � .Y.:�- - _ - .. .•-a ^.tom �.w" "�' .
yI�
.SCY2!�4i°= 1 7_ ,1� �/.1.5 L: _'�, :^�_�.tij• `=�
REQUIRED SPECIFICATIONS
(continued)
17 A protective cover of appropriate vegetation will be established on all disturbed areas
(lagoon embankments, berms, pipe runs, etc.). Areas shall be fenced as necessary to
protect the vegetation. Vegetation such as trees, shrubs, and other woody species, etc.,
are limited to areas where considered appropriate. lagoon areas should be kept mowed
and accessible. Berms and structures should be inspected regularly for evidence of
erosion, leakage or discharge.
18 If animal production at the facility is to be suspended or terminated, the owner is
responsible for obtaining and implementing a "closure plan" which will eliminate the
possibility of an illegal discharge, pollution and erosion.
19 Waste handling structures, piping pumps, reels, etc., should be inspected on a regular
basis to prevent breakdowns, leaks and spills. A regular maintenance checklist should be
kept on site.
20 Animal waste can be used in a rotation that includes vegetables and other crops for direct
0 human consumption. However, if animal waste is used on crops for direct human
consumption it should only be applied pre -plant with no further applications animal waste
during the crop season.
21 Highly visible markers shall be installed to mark the top and bottom elevations of the
temporary storage (pumping volume) of all waste treatment lagoons. Pumping shall be
managed to maintain the liquid level between the markers. A marker will be required to
mark the maximum storage volume for waste storage ponds.
22 Waste shall be tested within 60 days of utilization and soil shall be tested at least annually
at crop sites where waste products are applied. Nitrogen shall be the rate -determining
element. Zinc and copper levels in the soil shall be monitored and alternative crop sites
shall be used when these metal approach excessive levels. pH shall be adjusted for
optimum crop production and maintained. Soil and waste analysis records shall be kept
for five years. Poultry dry waste application records shall be maintained for three (3)
years. Waste application records for all other waste shall be maintained for five (5) years.
23
•
Dead animals will be disposed of in a manner that meets North Carolina regulations.
Page 7

•
Name of Farm: ABK, Inc.
Owner/ Manager Agreement
I (we) understand and will follow and implement the specifications and the operation and
maintenance procedures established in the approved animal waste utilization plan for the
farm named above. I (we) know that any expansion to the existing design capacity of the
waste treatment and storage system or construction of new facilities will require a new
certification to be submitted to the Division of Environment Management (DEM) before the
new animals are stocked. I (we) also understand that there must be no discharge of
animal waste from this system to surface waters of the state from a storm event less
severe than the 25-year, 24-hour storm. The approved plan will be filed on -site at the farm
office and at the office of the local Soil and Water Conservation District and will be
available for review by DEM upon request.
Name of Facility Owner: Willie Beard
(Please print)
Signature: L-• /� Date: )s —
Name of Manager (1f different from owner):
Signature: Date:
Name of Technical Specialist: (Please print) Kraig A. Westerbeek
Affiliation: Murphy Family Farms
Address (Agency):
Signature:
P.O. Box 759
Rose Hill. -NC 28458
Date: zo�
Page 8

s
IType of Visit O Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance I
Reason for Visit O Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: Arrival Time: ] `�' Departure Time: ! Dc� County:
T- a -1 aim Name: A 01Z K m 6 Owner Email:
Owner Name: W % L { ; r Phone: _
Mailing Address:
1
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Design Current
Swine Capacity P116111 ti:a_n
❑ Wean to Finish _
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
UWer
❑ Other
Integrator:
'L Region: Y �
Phone No:
Operator Certification Number:
-Back-up Certification Number:
Latitude: = o = c Longitude: [= ° = 4 0 Lf
esign C►urrent
WetNouftjN�Omacitvplopulaton
a
❑ Layer
❑ Non -Layer
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turke 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?
M-H
esignCurrenCattlepacity IP.opulation
❑ Dairy Cow '
❑ Dairy Calf
El Dairy Heifer
El 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 ❑ No ❑ NA E N_E
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
❑ No
❑ NA
ElYes
ElNo
[-INA
,[ENE
ETNE
Page 1 of 3 12/28/04 Continued

Date of visit: Arrival Time: y_ b Departure Time: ( DJ County:-rid`T�" Region:
Farm Name: A a1z K _F IrK S ' Owner Email:
Owner Name: LAJ, l : -- �/� Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative:
Certified Operator:
Back-up Operator:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude:[--] e ET I--] " Longitude: [� ° = s = 4f
Design Current
Design Current
Design C•arrent
Swine Capacity Population
Wet Poultry Capacity Popution
la
Cattle Capacity Population
❑ Wean to Finish
❑ Layer
El Dairy Cow
der ❑ Wean to Fee^ . ❑ Non -Layer
El Dairy Calf
❑ Feeder to Finish
El Dairy Heifer
El Farrow to Wean
Dry Poultry
El Dry Cow
El Farrow to Feeder
ElNon-Dairy
El Farrow to Finish
❑ Layers
El Beef Stocker
❑ Gilts
❑ Non -Layers I
❑ Beef Feeder
❑ Boars
❑ Pullets r
❑Beef Brood Ca
❑ Turkeys
Other
❑ Turkey Poults
❑ Other
❑ Other
Number of Structures:
Discharges & Stream Impacts
l . Is any discharge observed from any part of the operation?
r 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
1
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No'
❑ Yes
❑ No
❑ NA
3-NE
❑ Yes
❑ No
❑ NA
❑ NE
Page I of 3' 12128104 Continued

h
i
Facility Number: — f61D 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 I Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes ❑ No ❑ NA rG E
❑ Yes ❑ No ❑ NA aldg
Structure 5 Structure 6
❑ Yes ❑ No ❑ NA �Ef I
❑ Yes ❑ No ❑ NA EM
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 8-NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ❑ No ❑ NA [}ICE
(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
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ❑ No ❑ NA [?IF-
maintenance/improvement?
IL Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA El -NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
❑ No
❑ NA
❑ NE
IT 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
A� 3�5p4T A "):5 _FV -T-r&Zk gj�ktiv� r% /--_
F-ar L W 1( —
Re;,�J � a 1J DYJ
Reviewer/Inspector Name Phone: 4?-�c --t( -3
Reviewer/Inspector Signature: Date: /d
Page 2 of 3 12128104 Continued

t
Facility Number:"' — /,5D Date of Inspection
Waste Collection & Treatment
V 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
• f
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
-1
❑ Yes [:]No ❑ NA,-aNE
❑ Yes ❑ No ❑ NA El NE
Structure 5 Structure 6
{
5. Are there any immediate threats to the integrity of any, of the structures observed? ❑ Yes ❑ No ❑ NA ONE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes ❑ No ❑ NA O] 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 B'NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ❑ No ❑ NA [JNE
(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 0—RE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA EJNE
❑ 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
a
12. Crop type(s)
13. Soil type(s)
14, Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable 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
`Comments (refer to question _ Explain any YES answers, and/or any r&ommendatio o any otlier comments
. (use additional gages as necessary)•
�Jse drawm s"of facility to better ex tarn sttuahonsl� ,k�:
la .� p
AL
( �[J 1. �h}� ram✓ A ', 5 77dt"` �
rY? 4i ✓tie q ti1 a9
Reviewer/Inspector Hamer`jj`i6 �.�`
Phone:
Reviewer[Inspector Signature: Date: _
Page 2 o, f3 12128104 Continued

♦-
Facility Number: I — Date of Inspection CJ
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 ❑ No ❑ NA QRE
❑ Yes ❑ No ❑ NA ❑-N-E
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ,.❑.NE
❑ Waste Application El Weekly Freeboard El Waste Analysis El Soil Analysis El Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (iel discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes
❑ No
❑ NA
aNE
❑ Yes
❑ No
❑ NA
D-NE
❑ Yes
❑ No
❑ NA
EI-NE
❑ Yes
❑ No
❑ NA
BNE
❑ Yes
❑ No
❑ NA
B-NE
❑ Yes
❑ No
❑ NA
9-NE
❑ Yes
❑ No
❑ NA
ff RE
❑ Yes
❑ No
❑ NA
[5 NE
❑ Yes
❑ No
❑ NA
❑wE
❑ Yes
❑ No
❑ NA
[:�NE
❑ Yes
ETNo
❑ NA
❑ NE
❑ Yes ❑ No ❑ NA ❑oiK
Page 3 of 3 12128104

Facility Number: — �,�-� Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
❑ Yes ❑ No ❑ NA Q NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ❑ No ❑ NA [3-NE
the appropriate box. x
❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
❑ No
❑ NA
( —
❑ 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
0-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
❑ No
❑ NA
0-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
❑ No
❑ NA
0 E
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ NA
0-NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes ❑ No ❑ NA CANE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
❑ No
❑ NA
E iVE
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
EJ­NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
®No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
❑ No
❑ NA
❑41e
Additional Comments and/ror
.. „ ..._'r--.n.I..t.
L
7
Page 3 of 3 12128104

r
Type of Visit Q�fttmpliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit (06uttine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: ' Departure -fime: . � County: Region: FWD
Farm Name: 413 jK operill 5 Owner Entail:
Owner ,Name: r , n L=:E'nd "J Phone:
Mailing Address:
Physical Address:
Facility Contact: Ir"!'I i �P_ _'Title: �r/Jr� r� Phone No:
Onsite Representalive: Integrator: _
�R
Certified Operator: ,S - l Operator Certification Number:
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
Other
❑ Other
Back-up Certification Number:
Latitude: =o ❑ 1 = U Longitude: = o = ` = `
Design Current Design Current
Capacity Population Wet Poultry Capacity Population - Cattle
❑ Layer
I ❑ Non -Layer
C-7
Dry Poultry
❑ Layers
ElNon-Layers
❑ Pullets
ElTurk s
❑ TurkeyPouets
❑ 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
Capacity Population
- ❑ Dai Cow
❑ Dai Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures: El
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 �3No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
JZ No
❑ NA
❑ NE
❑ Yes
JRNo
❑ NA
❑ NE
12/2&W Continued

Facility Number: a — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes N No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Stnucture I Structure 2 Structure 3 Structure 4 Slructure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (iny
5. Are there any immediate threats to the integrity of any of the structures observed?
❑Yes
No
❑ NA NE ❑
Oe/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
No
❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
9Yes
RNo
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
(9 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
,Q No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 9 No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) 1Yt 4 d eta
13. Soil type(s) �Z) -44- A.
^�
14. Do the receiving crops differ from those designated in the CAW 4P? ❑ Yes RNo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [R No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination', ❑ Yes CgNo ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes ,Z No ❑ NA ❑ NE
❑ Yes jKNo ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility tobetterexplain situations. (use additional pages as necessary):
Nl c' E u sSY�f
U / /
�
Reviewer/inspector Name Phone:
Reviewer/InspectorSignature: Date:
l7/Zi3/(!4 continued

s
Facility Number: — s Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes JW No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes JZ No ❑ NA ❑ NE
the appropriate box.
❑ WUP El Checklists El Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes (A No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
[$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
® No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
R21 No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
Jj* No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
® No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
Jallo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
2� 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
KNo
❑ 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
g[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
W No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
KNo
❑ NA
❑ NE
12128104

IType of Visit 0-00-mpliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit "outine O Complaint O Follow up 0 Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: S Arrival Time: p +t� Departure Time: County: Region:
Farm Name: �� ��z 1< Owner Email:
Clwnrr Namr- WI II i G / �cpd/dl Phnne!
Mailing Address:
Physical Address:
Facility Contact: (N t �/ f GZ�� Title:
OnsiteRepresentative: ,ate—
Certified Operator:
Phon No•
Integrator:
Operator Certification Number: '�19":�P71'
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude:.o =1' 0" Longitude: =°
Design Current
Design Current
;, Design Current
Swine Capacity Population
Wet Poultry Capacity Population
Cattle, �: C►apacity Population
��
❑ Wean to Finish
❑ La er
❑ Dairy Cow
❑ Wean to Feeder
❑Non -La et
❑ DaiEy Calf
Feeder to Finish
1•::
Dai Heifer
❑ Farrow to Wean
'~"
Dry Poultry
❑ Cow
❑ Farrow to Feeder
❑ La ers
❑ Non -Dairy
❑ Farrow to Finish
❑ Beef Stocker
❑ Gilts
❑ Non -La ers
❑Beef Feeder
'., ❑ Boars
❑ Pullets
❑Beef Brood Co
R
❑ Turkeys
4Other
❑ Turkey PoultsW
❑ Other
❑ Other
Num -0 of: Structures: LQ
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
E No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
�❑
Li No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
01Go
❑ NA
❑ NE
other than from a discharge?
12128104
Continued

Facility Number:
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier:
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
Spillway?:
Designed Freeboard (in): "J'
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ® No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes [K 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 91 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 �No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes R,NO ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 0,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 Drifl ❑ Application Outside of Area
12. Crop type(s) / ���
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes (3No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes [-No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes ® No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes 0No ❑ NA ❑ NE
❑ 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 Phone: 2A2zjZ2Y: 33'DV'
Reviewer/Inspector Signature: Date: ''
V A- 12128104 Continued

Facility Number: Date of Inspection - D
• Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? El Yes
�,/
O No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes
Bl o
❑ NA
❑ NE
the appropirate box.
❑ WUP ❑Checklists El Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes
ErNo
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑
Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes
eNo
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ErNo ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
ONo
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
ErNo
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
BNo
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
DNo
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes [ o ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
Q,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
ONo
❑ 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
O 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
El'No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
EfNo
❑ NA
❑ NE
Page 3 of 3 12128104

IType of Visit (! 'tompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: f7-'y County: « Region: % a
Farm Name: +8 t< cc�� Owner Email:
Owner Name: W r lb & 3 Phone:
Mailing Address:
Physical Address:
Facilih, Contact: AP( Title:
Onsite Representative:
--�-
Certified Operator:
Back-up Operator:
Phone No:
Integrator:.
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: 0 0 E:I ' I--] Longitude: [� o = d
Design Current
=" `":Design Current
Design Current
Population
Wet Poultry;=s.°°.Capacity Population
C■attle Capacity Population
M!!rGapacih'
❑ La er
❑ Dai Cow
❑ We
❑Non-La er
❑ Dai Calf
Fee % %
z. r
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
❑ Non -Dairy
Farrow to Finish
❑ La ers
ElBeef Stocker
LEl
Gilts
❑Non -Lavers
ElBeef Feeder
Boars I
❑ Pullets
❑ Beef Brood Cow
. -
❑ Turkeys
r1he
er
❑ Turkey Poults
❑Other
Number of Structures:LLI
_-
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
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
O No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
52 No
❑ NA
❑ NE
other than from a discharge'?
Page 1 of 3
12128104
Continued

f ,
Facility Number: —11D I Date of Inspection I Z= 31>
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes �&No
❑ Yes ❑ No
Structure 5
❑ NA ❑ NE
❑ NA ❑ NE
Structure 6
❑ Yes RNo ❑ NA ❑ NE
❑ Yes JR1 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 Jallo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes M No ❑ NA El NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9_ Does any part of the waste management system other than the waste structures require ❑ Yes 17-1 No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes )& No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes C&No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
[:]Outside of Acceptable Crop /IWindow ❑ E.viiddence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes 0 No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes JX[No ❑ NA ❑ NE
16, Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination'![] Yes M No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes LZ No ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes W No ❑ NA ❑ NE
Reviewer/Inspector Name ;-,.- �7i` q Phone:D--
Reviewer/Inspector Signature: Date: Z— v"�1i7
12128104 Continued

Facility Number: — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes [9 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [9No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? if yes, check the appropriate box below. ®.Yes []No ❑ NA ❑ NE
Rf 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 )R No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes IRNo ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
DKNo
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
V No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
H No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
JR 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
[j Yes
X] 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
0 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
LKNo
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/lnspector 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
PNo
❑ NA
❑ NE
Additional Comments'.and/or Drawings:
Page 3 of 3 12/28/04

T
<ivision of Water Quality �� "
Fjaoility Number 4 (� O Division of Soil and Water Conservation
0 Other Agency
Type of Visit
' ommpliance Inspection
O Operation Review O Structure Evaluation
O Technical Assistance
Reason for Visit
( htoutine 0 Complaint
0 Follow up 0 Referral 0 Emergency
0 Other ❑ Denied Access
Date of Visit: --3o-D7 Arrival Time- r3 Departure Time: County: 4�^ Region: /�x—
Farm Name: _ __ _ Far,ns Owner Email:
Owner Name: a%; en _- i~�_ 1d Phone:
Mailing Address:
Physical Address:
Facility Contact: ; f- .] Title: Phone No:
Onsite Representative: �_� _ . Integrator:
Certified Operator: -�i Operator Certification Number: '
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: =o=,[�,, Longitude: =° u
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
r I I` ❑ Non-Layet I_ -- - --
Other
❑ Other
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turke s
❑ Turke Pouits
❑ 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 Co
Number of Structures: IZI
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes ® No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
C9 No
❑ NA
❑ NE
12128104 Continued

I
•
i s .Sx r y Y_ i• i -� Y —r—� ; 'i !. 1 1" •t_ i 1'' r i
3,672 animals X 1..9 (tons) wastelanimallyear =
Amount of Plant Available Nitrogen (PAN) Produced Per Year
3,672 animals X 2.3 lbs. PAN/animal/year =
Guide Std. 633)
6,977 (tons) wastelyear.
8,446 Ibs. PAN/year. (PAN from N.C.
Tech
Applying the above amount of waste is a big job. You should plan time and have appropriate
equipment to apply the waste in a timely manner
The following acreage will be needed for waste application based on the crop to be grown and
surface application:
Table 1: ACRES OWNED BY PRODUCER
Tract Field' Soil Crop Lbs. N Acres Lbs. N Month of
# No. Tvne Per Acre Utilized AoDlication
Total 1 25.15] 8,928.251
"This N is from animal waste only. if nutrients from other sources such as commercial fertilizer are
applied, they must be accounted for. N must be based on realistic yield expectation.
NOTE. The applicator is cautioned that P and K may be over applied while meeting the N
requirements. Beginning in 1996 the Coastal Zone Management Act will require farmers in some
eastern counties of North Caroline to have a nutrient management plan that addresses all nutrients.
This plan only addresses Nitrogen.
Page 2

0
Table 2: ACRES WITH AGREEMENT OR LONG TERM LEASE
(Agreement with adjacent landowner must be attached)
(Required only if operator does not own adequate land (see
Required Speciflcation 2])
Tract Field Soil Crop Lbs. N Acres Lbs. N Month of
Application# No. Type Per Acre Utilized
9 ` See footnote for Table 1.
•
Totals from above Tables
Acres Lbs. N
Utilized
Table 1 25.15 8,928
Table 2 0.00 -
Total 25.15 8,928
Amount of N Produced 8,446
Surplus or Deficit 483
NOTE: The Waste Utilization Plan must contain provisions for periodic land application of sludge at
agronomic rates. The sludge will be nutrient rich and will require precautionary measures to prevent over
application of nutrient or other elements.
Page 3

0
^',.- _ ! d'..1'- i �� i u , . ! • .. 1 '.i } t. ` 1 31 - `"a' vim.:-....F_.sY
See attached map showing the fields to be used for the utilization of waste water.
Application of Waste by Irrigation
Field Soil Type Crop Application Application
No. Rate Mr Amount In.
1 DuA BermudalMatua 0.4 0.75
THIS TABLE IS NOT NEEDED IF WASTE IS NOT BEING APPLIED BY IRRIGATION, HOWEVER A SIMILAR TABLE
WILL BE NEEDED FOR DRY LITTER OR SLURRY.
Your facility is designed for 1$Q days of temporary storage and the temporary storage must
be removed on the average of once every d MONTHS. In no instance should the volume of
waste being stored in your structure exceed Elevation 'see lagoon design.
Call the local Natural Resources Conservation Service (formerly Soil Conservation Service) or Soil
and Water Conservation District office after you receive the waste analysis report for assistance in
determining the amount per acre to apply and the proper application rate prior to applying the
waste.
Narrative of operation:
Acres shown are 'wetted'acres according to a wetted acreage determination provided by the
grower. Grower may graze all land using a bermuda/matua pasture. Follow guidelines provided
for managing this grass mixture.
Page 4

•
•
REQUIRED SPECIFICATIONS
Animal waste shall not reach surface. waters of the state by runoff, drift, manmade
conveyances, direct application, or direct discharge during operation or land application.
Any discharge of waste which reaches surface water is prohibited.
2 There must be documentation in the design folder that the producer either owns or has an
agreement for use of adequate land on which to property apply the waste. If the producer
does not own adequate land to properly dispose of waste, he/she shall provide a copy of
an agreement with a landowner who is within a reasonable proximity, allowing him/her the
use of the land for waste application. It is the responsi4ility of the owner of the facility to
secure an update of the Waste Utilization Plan when there is a change in the operation,
increase in the number of animals, method of utilization, or available land.
3 Animal waste shall be applied to meet, but not exceed, the nitrogen needs for realistic crop
yields based on soil type, available moisture, historical data, climatic conditions, and level
of management, unless there are regulations that restrict the rate of application for other
nutrients.
4 Animal waste shall be applied to land eroding less than 5 tons per acre per year. Waste
may be applied to land that is eroding at 5 or more tons, but less than 10 tons per acre per
year providing grass filter strips are installed where runoff leaves the field. (See FOTG
Standard 393 - Filter Strip).
5 Odors can be reduced by injecting the waste or disking after waste application. Waste
should not be applied when there is danger of drift from the irrigation field.
6 When animal waste is to be applied on acres subject to flooding, it will be soil incorporated
on conventionally tilled cropland. When applied to conservation tilled crops or grassland,
the waste may be broadcast provided the application does not occur during a season
prone to flooding. (See "Weather and Climate in North Carolina" for guidance.)
7 Liquid waste shall be applied at rates not to exceed the soil infiltration rate such that runoff
does not occur offsite or to surface waters and in a method which does not cause drift
from the site during application. No ponding should occur in order to control odor or flies.
8 Animal waste shall not be applied to saturated soils, during rainfall events, or when the
surface is frozen.
Page 5

•
REQUIRED SPECIFICATIONS
(continued)
9 Animal waste shall be applied on actively growing crops in such a manner that the crop is
not covered with waste to a depth that would inhibit growth. The potential for salt damage
from animal waste should also be considered.
10 Waste nutrients shall not be applied in fall or winter for spring planted crops on soils with a
high potential for leaching. Waste nutrient loading rates on these soils should be held to a
minimum and a suitable winter cover crop planted to take up released nutrients. Waste
shall not be applied more than 30 days prior to planting of the crop or forages breaking
dormancy.
11 Any new swine facility sited on or after October 1, 1995 shall comply with the following:
The outer perimeter of the land area onto which waste is applied from a lagoon that is a
component of a swine farm shall be at least 50 feet from any residential property boundary
and from any perennial stream or river (other than an irrigation ditch or canal. Animal
waste other than swine waste from facilities sited on or after October 1, 1995), shall not be
applied closer than 25 feet to perennial waters. (See Standard 393 - Filter Strips).
12 Animal waste shall not be applied closer than 100 feet to wells.
13 Animal waste shall not be applied closer than 200 feet of dwellings other than those
owned by the landowner.
14 Waste shall be applied in a manner not to reach other property and public right-of-ways.
15 Animal waste shall not be discharged into surface waters, drainageways, or wetlands by
discharge or by over -spraying. Animal waste may be applied to prior converted wetlands
provided they have been approved as a land application site by a "technical specialist'.
Animal waste shall not be applied on grassed waterways that discharge directly into water
courses, and on other grassed waterways, waste shall be applied at agronomic rates in a
manner that courses no runoff or drift from the site.
16 Domestic and industrial waste from washdown facilities, showers, toilets, sinks, etc., shall
not be discharged into the animal waste management system.
Page 6

•
REQUIRED SPECIFICATIONS
(continued)
17 A protective cover of appropriate vegetation will be established on all disturbed areas
(lagoon embankments, berms, pipe runs, etc.). Areas shall be fenced as necessary to
protect the vegetation. Vegetation such as trees, shrubs, and other woody species, etc.,
are limited to areas where considered appropriate. Lagoon areas should be kept mowed
and accessible. Berms and structures should be inspected regularly for evidence of
erosion, leakage or discharge.
18 If animal production at the facility is to be suspended or terminated, the owner is
responsible for obtaining and implementing a "closure plan" which will eliminate the
possibility of an illegal discharge, pollution and erosion.
19 Waste handling structures, piping pumps, reels, etc., should be inspected on a regular
basis to prevent breakdowns, leaks and spills. A regular maintenance checklist should be
kept on site.
20 Animal waste can be used in a rotation that includes vegetables and other crops for direct
human consumption. However, if animal waste is used on crops for direct human
consumption it should only be applied pre -plant with no further applications animal waste
during the crop season.
21 Highly visible markers shall be installed to mark the top and bottom elevations of the
temporary storage (pumping volume) of all waste treatment lagoons. Pumping shall be
managed to maintain the liquid level between the markers. A marker will be required to
mark the maximum storage volume for waste storage ponds.
22 Waste shall be tested within 60 days of utilization and soil shall be tested at least annually
at crop sites where waste products are applied. Nitrogen shall be the rate -determining
element. Zinc and copper levels in the soil shall be monitored and alternative crop sites
shall be used when these metal approach excessive levels. pH shall be adjusted for
optimum crop production and maintained. Soil and waste analysis records shall be kept
for five years. Poultry dry waste application records shall be maintained for three (3)
years. Waste application records for all other waste shall be maintained for five (5) years.
23
LJ
Dead animals will be disposed of in a manner that meets North Carolina regulations.
Page 7

•
s
.ram �ii._f.i. -/. •t_ _ -tf. T`'''. ..'L�„ .,t.. -
Name of Farm: ABK, Inc.
owner/ Manager Agreement
I (we) understand and will follow and implement the specifications and the operation and
maintenance procedures established in the approved animal waste utilization plan for the
farm named above. 1 (we) know that any expansion to the existing design capacity of the
waste treatment and storage system or construction of new facilities will require a new
certification to be submitted to the Division of Environment Management (DEM) before the
new animals are stocked. I (we) also understand that there must be no discharge of
animal waste from this system to surface waters of the state from a storm event less
severe than the 25-year, 24-hour storm. The approved plan will be filed on -site at the farm
office and at the office of the local Soil and Water Conservation District and will be
available for review by DEM upon request.
Name of Facility Owner:
(Please print)
Willie Beard
Signature: j,,,%,,p' I, /_IaDate: qQ_— J-5 Q)
Name of Manager (If different from owner):
Signature:
Name of Technical Specialist: (Please print)
Affiliation: Murphy Fames Farms
Address (Agency)
Signatt
P.O. Box 759
Date:
Kraig A. Westerbeek
Page 8

N
• vision of AVater Quality
iFacility Number a 0 Division of Soil aad Water serva Contion
Other Agency
Type of Visit "ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit routine 0 Complaint 0 Foltow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: �— Arrival Time: 3 0Departure Time: 0: O'� County: Region: !-- l..> 0
Farm Name: dW 7f FGt em_f Owner Email:
Owner Name: �/: %� i CCeol Phone: /
Mailing Address: 3 �/ �d. S % h rjla l C✓k 7^D /" C
Physical Address:
Facility Contact: I Y Zena Title:
Onsite Representative:
Certified Operator: ��—
Phone No:
Integrator: n
Operator Certification Number: 1 w.;2 7
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: 0 e = ' F--] « Longitude: 0 ° = ' 0 W
Design Current Design Current Design Current
Swine Capacity Population Wet PoultryCapacity Population C►attle Capacity Population
❑ Wean to Finish
❑ La er
❑ Dairy Cow
❑ Dairy Calf
❑ Wean to Feeder
I
1
Non -Layer
Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
7X
1110
3 D
Dry Poultry
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Farrow to Finish
❑ Gilts
❑ La ers
❑ Beef Stocker
❑ Non -Layers
Beef Feeder
❑El
Pullets
❑ Boars El Turkeys
Other ❑ Turkey Poults
❑ Other I ❑ Other
ElBeef Brood Co
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
KNo
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
[3tNo
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
KNo
❑ 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
[9No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
LKNo
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
[9 No
❑ NA
❑ NE
other than from a discharge?
Page I of
12128104
Continued

Facility Number: — Q Date of Inspection — b
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
(Z No
❑ NA
❑ NE
Structure l Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 71
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
KA 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
C9 No
❑ NA
❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
No
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
No
❑ NA
❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
El Yes
No
❑ NA
❑ NE
maintenance or improvement?
Waste Aoalication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ® No ❑ NA ❑ NE
maintenance/improvement? ray
11, Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Q4 Yes No ❑ NA [:]NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Croptype(s) Z.,, rrxu�la a�-�le Z2&Aa [ Y`at•
13. Soil type(s) 4-;Q (�(
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes ❑ No ❑ NA ❑ NE
15_ Does the receiving crop and/or land application site need improvement? ❑ Yes ❑ No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes ❑ No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers andlor, inyrecommendations or any other comments
Use drawings of facility to better explain situations. (use additional pages as necessary): z ,
Reviewer/inspector Name I 7pv � 1 Phone: g-JQ-y, _333 P
Reviewer/Inspector Signature: Date: % r�I—fit ap(p
Page 2 of 3 12128104 Continued

w
Facility Number: — ftj' Date of Inspection
Re uired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 0 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [RNo ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps
p ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ® No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes W No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ® No ❑ 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
J@ No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
14 No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
(R No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
IN 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
R 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
®,NO
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
V�No
❑ NA
❑ NE
t
Additional Commentskand76r Drawings: a5
i
H
Page 3 of 3 I2./28/04

Type of Visit t-Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit O Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: Qom— LYO Arrival'l'ime: ,+nO Departure Time: ,� a County: Region:
Farm Name: I 1 Owner Email:
U Owner Name: ! . Y Z � at e/ _ Phone:
Mailing Address: 73!]. S S adQ L r 7U, /` e— 4E;L��_:5
Physical Address:
Facility Contact: sa _ Title: - DLUq Phone No: ,+3e7—
Onsite Representative: Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = o = I ="
Longitude: = o = { 0 u
Swine
Wean to Finish
Wean to Feeder
feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -La er I
Other
❑ Other i
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turke s
❑ Turkey Poults
❑ Other
D_i_schar ryes & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
Cattle
Design Current:
Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifej
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
c. What is the estimated volume that reached waters of the Stale (gallons)?
Number of Structures: ®!
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
[--]Yes �d No ❑ NA ❑ NE
❑ Yes
W No
❑ NA
❑ NE
❑ Yes
[.No
❑ NA
❑ NE
❑ Yes
[&No
❑ NA
❑ NE
❑ Yes
[d No
❑ NA
❑ NE
[:]Yes
V No
❑ NA
❑ NE
12128104 Continued

Facility Number: — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes �dNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes KNo ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ® No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
V No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
CRYes
❑ No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
allo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
Ud No
❑ 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?
[4 Yes
❑ No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the pen -nit 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
191 No
El NA
El NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
® No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
No
❑ NA
❑ NE
Additional G0Inment5"an4/4r,Draw>ngs
Im1'�`aa✓d ��5 On Si7"�►"��'v`f
hav-e ©N.e done be5r r-,4 DF srr ►- '}'dr'•
12128104

Facility Number:
Date of Inspection
Waste Collection 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: I
Spillway?:
Designed Freeboard (in): �}
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes r71 No
tat
❑ Yes RNo
Structure 5
❑ NA ❑ NE
❑ NA ❑ NE
Structure 6
❑ Yes $3 No ❑ NA ❑ NE
❑ Yes §0 No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes �{ No El NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes W No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ;K No - ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes X No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? if yes, check the appropriate box below. ❑ Yes fO 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 Drifl ❑ Application Outside of Area
12. Crop type(s) Be-rmad, Aw,2-tz a
13, Soil type(s) IJUA
14, Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [XNo ❑ NA ❑ NE
15. Does the receiving crop and/or land• application site need improvement? ❑ Yes CK No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination[] Yes DqNo ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes NNo `1KI NA ❑ NE
t
18. Is there a lack of properly operating waste application equipment? ❑ Yes ;KNo ❑ NA ❑ NE
Reviewer/inspector Name
Phone:
Reviewer/Inspector Signature:
Date:
ZO ~ D--D
a fi�wVv vv....r.wcw

Type of Visa 0 Compliance Inspection O Operation Review O lagoon Evaluation
Reason for Visit • Routine O Complaint O Follow up O Emergency Notification O Other E] Denied Access
Facility Number Date n! Visit:® Tune:
/ b
- O Not Operational O Mow Threshold
E3emitted EKe—rfied 13 Conditionally Certified 13 Registered Date -Last Operated or Above Threshold:
Farm Name: ._... �6 9_ County: , . &a e CA
Owner Name: i G . &A d Phone No: - G
Niailiing Address /�,s ' _ _ _ Cl r1C��,q,,._.. NC. g8:3, ._
..... l /9 L[ e.- .... --- ..... ..........
Facility Contact: ... _ l✓,//ice ae"cd--------- Title: Phone No:,� 4!
Onsite Representative: _ �/, .`A;e._ Bo—a..f Integrator. , , &.4
Certified Operator. _ Zy^%� �r �e'2 rrz Operator Certification N/umber. 14-2f:44
Location of Farm:
♦1
_ IWi"
ine ❑ Poultry ❑ Cattle ❑ horse Latitude �• �' �" Longitude �• �` �"
Dischames & StreamImpa
1. Is any discharge observed from any part of the operation? ❑ Yes 9-4
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes B-go
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes Lallo
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes BI Tb
2. Is there evidence of past discharge from any part of the operation? ❑ Yes [. No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes RNo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes Blgo
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Ide tit. I _
nter. �...... .�,... _ ....-__._._.�._...
Freeboard (inches):
3 "
12112103 Contimwd

Facility Number: — • So Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes QKo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑ Yes U-110
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 smwtures need maintenance./improvement? ❑ Yes ❑ 11ro
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes D-N-o
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes 0'10—
elevation markings?
Waste ApEtheation
10. Are there any buffers that need maintenancehmprovement? ❑ Yes Elgo
11. Is there evidence of over application? if yes, check the appropriate box below. ❑ Yes 21%
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type ���.., v�ct 6raze�!�' &,• ..
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes ❑-db
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
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 structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional
Air Quality representative immediately.
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ONO
❑ Yes MNO
❑ Yes ❑ No
❑ Yes RNo
❑ Yes [g-No
❑ Yes 0xly
Final Notes
Reviewer/Laspe,.tO r Name
""'�" GGr d
ReviewerlI urmtor Signature: � � - - Date:
12112103 Continued

Facility Number: Date of Inspection
Required Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
c[(o
22. Does the facilito have' 1 c nents of the Certified Animal Waste Management Plan readily available?
(ie/ , chec ts, m ,etc.)
❑ Yes
RWo
23_ Does record keeping need improvement? If yes, check the appropriate box below.
[I Yes
ago
❑ ❑ ❑ w talysis ❑
&-ly P3.1 y- 8 7;> -?.3 ��� i y
24. Is facility not in compliance with any appli�le setback criteria in effect at the time of design?
❑ Yes
B-90
25_ Did the facility fail to have a actively certified operator in charge?
❑ Yes
D-ro
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(iel discharge, freeboard problems, over application)
❑ Yes
❑"No'
27. Did Reviewer/inspector fail to discuss review/inspection with on -site representative?
❑ Yes
�o
28. Does facility require a follow-up visit by same agency?
❑ Yes
PRO
29. Were any additional problems noted which cause noncompliance of the Certified AWMI??
❑ Yes
MNo
N`TPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
des
❑ No
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
9-Yes
❑ No
32. Did the facility fail to install and maintain a rain gauge?
❑ Yes
Q INb
33. Did the facility fail to conduct an annual sludge survey?
❑ Yes
®'No
34. Did the facility fail to calibrate waste application equipment?
❑ Yes
Rgo
35. Does record steeping for NPDES required forms need improvement? If yes, check the appropriate box below.
❑ Yes
❑-Aso
❑ 420 Nfinute hwpwtiens ❑
12112103

0 _. -_ -'-- r-
racuuy NuMber: 0Q--I&
Division of Environmental Management
Animal Feedlot Operations Site Visitation Rewrd
TrrnG:,, ; 0 9
General�%r�
Farm Name: � OLL �aC--ns � Cbmhr.
Chvner Name: ' W ,b& t_ &e, k -- phone
_ On Site Representative:tcgrator: �
Matiling Address: -PaRt nn 1��,
C ar ►11 C.
Physical AddresAmcatiow. 5 rz l 7ce
• . Latitude: I I Longitude: / I
Operation Description: (based on design cbaracreris ia)
Type of Swine No. of Animals Type ofpodrry No. of"Mais Type of Caarle No. ofAnihwU
O Sow D Dyer 0 Dairy
O Nagy 0 Nazi -layer 0 Beef
D Feader
Orherrvve ofLivesrne n i Nuin6erofAni ncls: 36
'7
Number of Lagoons:_ I (include m the Drawings and Observations the freeboard of each Lgoon)
Facility ImPtAom
Lagoon
Is lagoon(s) freeboard less than l�foot + 25 year 24 hour storm storage?:
Is seepage observed from the lagoon?:
Is erosion observed?:
Is any discharge observed?
0 Man -+Wade o Nor flan -MO&
Cover Crop
Does the facility aced more acreage for spraying?:
Does the cover crop need improvement?:
(list the crops whicA need in provemear)
Crop type: C.eas�- Actzage: S
Setback Criteria
Is a dwelling located within 2DO feet of waste application?
• Is a well located within 100 feet of waste application?
Is animal waste stockpiiled. within 100 feet of USGS Blue Line Stream?
'Is animal waste land appfied of spray irrigated within 25 fret of Blue Line Stream?
A01— Janear717,19%
Yes 0
No;
Yes O
Nol
Yes 0
No l
Yes ❑
Noj
Yes 0
WE
Yes 0
. No I
Yes 0 -No C
Yes 0 NO C
Yes 0 No C
Yes Cl No C

Does the facility maintenance need improvement? Yes ❑ No
Is there evidence of past discharge from any part of the operation? Yes 0 No
Does rmord keeping need improvement? Yes 0 No
+� Did the facility fail to have a copy of the Animal Waste Management Plan on dw? Yea 0 No
Explain any Yes anmm;
signature:.., _�r _ .� _ _ Date:
c= Fm iry Assessment Unit UseAna (jNeeded
Drawing or Observations:
W aS T'� �+ ► oay� YCI c-
La tom: -�.A :+t • - .-. - - -. TH'•ti•.�a•1. rl.I, •-n w`. =-• li er.�.p
'�
• •�{ir i ,• rti . !yf.:.�y..wa+ rt •a.r 'w .�.p� /�:� w:. Y�.� �.��r+w. �/aw tea•
AOI — Jan uat717.19%