820037_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental Qual

aIVl f :3 rA&r17lb
Type of Visit: 0 Compliance Inspection O Operation Review p Structure Evaluation p Technical Assistance I
Reason for Visit: Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: Departure Time: [Mlh County: J `vC Region
Farm Name: _V�d'wop*�
Owner Name:
Mailing Address:
Physical Address:
Owner Email:
Phone:
Facility Contact: Title: Phone:
�3Onsite Representative: I n Integrator:
Certified Operator: Certification Number: 100,7—a. vq
Sack -up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Swore
Desi n Current
g
Capacity Pop.
Designer C►urrent '"`Desi n Current
„' g
W.et Poultry Capacit3 Pop. Cattle Capacity Pop.
t6
Wean to Finish
jDairy Cow
Wean to Feeder
Dairy Calf
Feeder to Finish
_ Desi n 'C•urrent '. �
sg
DrPloultr Ca 'achy_ P,o
Dairy Keifer
-
Farrow to Wean
Farrow to Feeder
Dry Cow
Non -Dairy
Farrow to Finish
Lavers
Beef Stocker
Gilts
Non -Layers
Beef feeder
Boars
Pullets
h
Beef Brood Co-,
Other
Turkeys
Turke Pouets
t"
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 o ❑ NA ❑ NE
❑ Yes
❑ No
Eg:NA
❑ NE
❑ Yes
❑ No
�A
❑ NE
0 Yes
❑ No
ETNA
❑ NE
❑ Yes
[�i o
❑ NA
❑ NE
❑ Yes
dNo
❑ NA
❑ NE
Page 1 of 3 21412015 Continued

[Facility Number: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Spillway?:
Designed Freeboard (in): _
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
E3--Mo` ❑ NA ❑ NE
❑ No Q_NA ❑ NE
Structure 6
❑ Yes C;;.Ko' ❑ NA ❑ NE
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
©.?�o
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat, notify DWR
7. Do any of the structures need maintenance or improvement?
0 Yes
Eg,<o
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
2"N'o
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
KfNo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
[:]Yes
CTNo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
//
[L/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 ❑ EvidenceofWind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): ('4 .Soy{� j 'U SC' U
-
!
13. Soil Type(s): �3L �� 6"a, e bCG tYjl��
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[�o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
®'No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
[;3 No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[]f 'No
[] NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[6-No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage 8 Permit readily available?
❑ Yes
[�o
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[]'TVo
❑ 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. 0 Yes ❑i'No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall [:]Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [EfrNo
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes dNo
[]NA ONE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑NA ❑NE
Page 2 of 3 21412015 Continued

Facili Number: Date of Ins ection: %
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [D-Nlo ❑ NA ❑ NE
25. is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
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?
24. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes
L[ to
❑ NA
❑ NE
❑ Yes
�o
❑ NA
❑ NE
❑ Yes C2,<o ❑ NA ❑ NE
❑ Yes [?'No ❑ NA ❑ NE
❑ Yes Io ❑ NA ❑ NE
❑ Yes [3N' o ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes EfrNo
33. Did the Reviewer/Inspector fail to discuss reviewh spection with an on -site representative? ❑ Yes ff No
34. Does the facility require a follow-up visit by the same agency? ❑ Yes [] No
❑NA ❑NE
❑ NA ❑ NE
[] NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
C11 6 04,'e 1., � "-gam-14
(;L4-.e_ — o_-'zo 4(o , 6> 4(,- 7 P f, 7.7
ct-_� `rCo _`. -- 6 Ysr
Reviewer/Inspector Name: LJ A 1 0 0 _ Phone: 6tJ �3 r3,_B 1(
c r_
Reviewer/Inspector Signature: _ _ _ Date: W `
Page 3 of 3 21112015

(Type of Visit: OTCompliance Inspection V Operation Review O Structure Evaluation Q Technical Assistance
Reason for Visit: Routine O Complaint O Follow-up O Referral Q Emergency O Other O Denied Access
Date of Visit: Arrival Time: L7�LQLJ Departure Time: County: S4-N
Farm Name: O F. vt'� Owner Email:
Owner Name: � L AA-AWO'-W Phone:
Mailing Address:
Physical Address:
Facility Contact: G([� S 1304w1 Ci< < Title:
Onsite Representative: rtj
Certified Operator: We eAr-t-C
Back-up Operator: �v rbt'x Ut [J Jfl
Location of Farm:
Latitude:
Region:
Phonei
Integrator: -W T
Certification Number: _
Certification Number: /0, Z,7,/^9
Longitude:
F ' Design Current Design Current
Swtne " Ca act f - p ty, Pop. Wet Poultry Capacity Pop.
Wean to Finish La er
Design Current
Cattle Gapaci#y Pap.
DairyCow
Wean to Feeder
d
Non -La er
Da Calf
Feeder to Finish
Da' Heifer
D Cow
Farrow to Wean
Farrow to Feeder
Design Current
D . P,oult�, Ca aci P,o .
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Other �__ „.-w "s, _
Other
Pullets
Beef Brood Cow
Turke s
Turkey Poults
Other
Discharges and Stream lmoacts
I. Is any discharge observed from any part of the operation?
❑ Yes
L.Ld No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
[3 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
ffrNA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
Eal�o
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
F3 No
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412015 Continued

Fificili Number: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? [:]Yes 52' [DNA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No F5 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? 0 Yes 211L o
❑ 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 ffrNo
❑ 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 �o
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes [Erl�o
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes [P o
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No
❑ NA
❑ NE
maintenance or improvement?
11. is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus [] Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
t7 1�" - ' ° `t . e r.� 1 a /. Lt,.ra ,fn 6 Pi � •rn Cam/
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes
RD"Ro
❑ NA
❑ NE
[]Yes
R No
❑ NA
❑ NE
❑ Yes
�No
❑ NA
❑ NE
[:]Yes
eNo
❑ NA
❑ NE
❑ Yes
ENo
❑ NA
❑ NE
Renuired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes �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 01140
❑ 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 o
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes gNo
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
[DNA ❑ NE
❑ 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 25>o ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes �o ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes EEKo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ;"o ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document [:]Yes [;)Xo" ❑ 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 Io ❑ 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 2<o ❑ 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
[3<o ❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No ❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
VN ❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
c tir� 4,v+
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: q31-233Y
Date: h-la-v
21412011

Type of Visit: C3eCompliance Inspection U Operation Review Q Structure Evaluation p Technical Assistance
Reason for Visit: outinc O Complaint Q Follow-up O Referral O Emergency Q Other O Denied Access
Date of Visit: I P19::' Arrival Time: pD I Departure Time: r [7 County Region: ^f
Farm Name: r /l; -4y �Qi�s/+'�� Owner Email:
Owner Name: �� y C(�� I �y jT� -rrT Phone:
Mailing Address:
Physical Address:
Facility Contact: C ��' r'r-r �L7!>/'z� Title:
Phone:
Onsite Representative:
Integrator: WIeF,
Certified Operator:
zLel�__12:z
Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design Current
Design , Current
Design Current
Swide
Capacity Pop.
Wet Poultry
Capacity°'Pup._
Cattle Capacity Pop.
Wean to Finish
Layer
DairyCow
can to Feeder
c)L
Non -La er
DairyCalf
Feeder to Finish
�' A
DairyHeifer
Farrow to Wean
D Cow
Farrow to Feeder
D . Paul
jsig�Currerit
C'aci P,o
Non -Da'iry
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
... ... . , ;
,,
Turkeys
Other-
Turkey Poults
-
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes 29 No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
[:]No
❑ NA
❑ NE
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 fallo ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes MNo ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 21412014 Continued

Facili Number: - Date orinspection: —/O
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 2!�­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
0,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
fi�]_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
SMNo
❑ 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
X�JNo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
® No
❑ NA
❑ NE
maintenance or improvement?
11 _ Is there evidence of incorrect Iand application? If yes, check the appropriate box below. ❑ Yes LNo ❑ NA D 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): e19 "P7 /W/?_� /sue%✓r�P»� ��/'d `Z �p !�G�s ���rtx�e� lfi �'SS�'�'-d
13. Soil Type(s): ` 'R ­ Get- �
/r_
14. Do the receiving crops differ from those designated in the CAWMP?
EfYes
Callo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
N No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
JS No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
allo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
P&No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
PR No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
L&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 JR'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 A No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ffi No ❑ NA ❑ NE
Page 2 of 3 21412014 Continued

Facili Number: --3 jDate of Ins ection-
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes LigNo ❑ 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 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
❑ Yes
RNo
❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
[allo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
PqNo
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
M No
❑ NA
❑ NE
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
B� No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
ELNo
❑ NA
❑ NE
Comments (refer to question #f). Explain any YES answers and/or any additional recommendations or any other comments.
Use drawinL-s of facility to better exoWn situations (use additional oaaes as necessarv).
/ v2
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:'-J-�-3�
Date: / /— CDC
21412014

--1 k( .sty -
Type of Visit: Q-CVimplince Inspection Q Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit: ne 0 Complaint 0 Follow-up 0 Referral 0 Emer2ency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: ,'q t] County: S s,.# �
� ' Farm Name ar rf3 deftittn",— Owner Email: "-�
Owner Name: ?asM--5 Uje-1.1 Phone:
Mailing Address:
Physical Address:
Facility Contact: / 'r A400%- _Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Phone:
Region: F�
Integrator: U..,;A, zrt'...:.
l
Certification Number:
Certification Number:
Location of Farm: Latitude: Longitude:
TV, DEei:ij0t!V,1CM_U1P1Fiet
esign Current
Design Current
CaPoultry
Capacity Pop.
Cattle CapaciPoFinish
r
Da' Cow
Feeder
(�
p
Dairy Calf
Dairy Heifer
Feeder to Finish
Farrow to Wean
Desiga Current
Dry l;oult ;Ca deity $o
Dry Cow
Farrow to Feeder
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Soars
Pullets
Beef Brood Cow
Turkeys
OtherI
ITurkeyPoults
Other
Other
Discharnes and Stream Impacts
1. Is any discharge observed from any part of the operation?
[:)Yes
[g No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a- Was the conveyance man-made?
❑ Yes
[]No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
[]No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
[:]No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
[]Yes
® No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
® No
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

Facility Number: - 3 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): + 1
Observed Freeboard (in): oil-
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
® No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes
NJ 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
E. 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
IR No
❑ 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 ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from
grated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes
2 No
❑ Yes
® No
❑ Yes
No
❑ Yes
® No
[:]Yes
® No
❑ NA
❑ NE
❑ NA
❑ NE
❑ NA
❑ NE
❑NA
❑NE
❑ 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 [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 ® 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 ® No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes EZ No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑ NA ❑ NE
"age 2 of 3
21412011 Continued

Facility Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ® 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 CZ No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below,
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ NA ❑ NE
❑ NA ❑ NE
[3 NA [3 NE
❑ NA ❑ NE
❑ Yes M No ❑ NA ❑ NE
❑ Yes ®No ❑ NA ❑ NE
❑ Yes R No ❑ NA ❑ NE
❑ Yes f. No ❑ NA ❑ NE
❑ Yes [2 No
❑ Yes to No
❑ Yes E[ No
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
ReviewerAnspector Name:
Phone: wo- 33-s3ao
Reviewer/Inspector Signature: Dater—i�
Page 3 of 3 21412011

w
Type of Visit: ompli nce Inspection 0 Operation Review 0 Structure Evaluation O Technical Assistance
Reason for Visit: outine 0 Complaint O Follow-up O Referral 0 Emergency Q Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: t i] County: ca. Region: rWV
Farm Name: ��mzcq ���/1garm. Owner Email:
Owner Name: LLrjrS �,{%� S% ��t;� Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude.
Phone:
Integrator:
Certification Number: 4%4'� &'
Certification Number:
Longitude:
..yDesign Current
Swine `.''Capacity Pop.
Wean to Finish
Wet Poultry
Layer
:Design.
Capacity
Current
Pop.
_ Design Gnrrent
Cattle ..= Capacity Pop.
Dairy Cow
Wean to Feeder
1 INon-Layer
I
airy Calf
Feeder to FinishDairy
Heifer
Farrow to Wean
Design.
Gurrent
Dry Cow
Farrow to Feeder
D . P,oult ,Cpa
i
P,o
Non-Dai
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
jBeef Brood Cow
Turkeys
Other
Turkey Poults
-
Other
Other
- - -
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes. notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes ZNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA [] NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes � No
[—]Yes [KNo
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3 21412011 Continued

Facility Number: jDate of Inspection:
-J
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
�No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure l Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): T
}
Observed Freeboard (in): 1 I
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
ELNo
❑ 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
E3 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
S. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
jq No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes RLNo ❑ NA
❑ 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 Wind/ow /❑ Evidence of Wind /Drif`t ❑ Application Outside of Approved Area
12. Crop Type(s):/r1 /T ��55t s. L�rfn�c�•� / BCirr3yr„✓l �/�2:L��T
❑ NE
13. Soil Type(s):
14. Do the receiving crops differ from those designated in t e CAWM ?
❑ Yes
M No
0 NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
JZ] No
❑ NA
❑ NE
16_ Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
IM 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
M No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
,nNo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
JqNo
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ®No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yieid ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ENo
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No
❑ NA [] NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑NA ❑NE
Page 2 of 3 21412011 Continued

Facility Number: - Date of Ins ection: —/
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes � No
25. is the facility out of compliance with permit conditions related to sludge? If yes, check [:]Yes ® No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail 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
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑NA ❑NE
❑ Yes ®No ❑ NA ❑ NE
❑Yes ®No ❑NA ❑NE
❑ Yes O No ❑ NA ONE
❑ Yes ®No ❑ NA ❑ NE
❑ Yes ® No
[:]Yes No
❑ Yes ® No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Phone: 9-/0:Y:3L36A t;; I
Reviewer/Inspector Signature:
Page 3 of 3
pate: 9-- e�:2`�13
21412011

SSG'
Type of Visit: (.)-Compliance Inspection U Operation Review U Structure Evaluation U Technical Assistance I
Reason for Visit: C`9-ifo%utine Q Complaint 0 Follow-up 0 Referral Q Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: ' t}'f] County: Region: �R
Farm Name: im.�ti �>f f ;-� i2 /�� Owner Email:
01
Owner Name: ETA" L Jry �-sy �c1'f Phone:
Mailing Address:
Physical Address:
Facility Contact: ���� /Yl0 Dy`� Title: G, Phone:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Integrator:
Certification Number:
Certification Number:
Longitude:
Design Current
RDestgu
Current
1 Design Current
Swine
ePult
Camp' act
o
a P•
Wean to Finish
La er
Non -Layer
Dai Cow
Dairy Calf
Wean to Feeder
l�
fi
Feeder to Finish
' ""
-
Dairy Heifer
Farrow to Wean
.•Design
Current
D Cow
Farrow to Feeder
D . P,oult .
fT 1. ,
Ca aci
P■o
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turke s
_..
Wither
Turke Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
®No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
No
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

Facili Number: Y7 - 3 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): 3C
5. Are there any immediate threats to the integrity of any of the structures observed?
[:]Yes
® No
❑ NA
❑ NE
(i.e.. large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
5�[ 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 anv 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
M 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
C,No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
(4 No
❑ NA
❑ NE
maintenance 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 ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes 14 No C] NA
❑ Yes N No ❑ NA
❑ Yes O' No ❑ NA
O Yes N No ❑ NA
[:]Yes N No ❑ NA
❑ NE
❑ NE
❑ NE
❑ NE
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes g 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 allo
❑ 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 D3,No
21 if selected. did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ;A No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

liacili Number: 3 Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
5ZNo
❑ NA 0 NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
[S 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
K, 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
allo
❑ 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 concem?
❑ Yes
[,No
❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
54 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
MNo
❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
® No
❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
KNo
❑ NA ❑ NE
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Date: g _1_;WL
2/4/2011

I
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: ! 0 Departure Time: /fir' D County: �sr�y�. Region
Farm Name: yyL� y �/�; noL �Grlr�-.� Owner Email: �'�T
Owner Name: "Ea?ne_t, � sf�y ���'�,�1� Phone:
Mailing Address:
Physical Address:
Facility Contact: 4 -'./ ^Lf�py`ye Title: /;G , r Phone:
Onsite Representative: !/ma,,_ Integrator: /%���•,
Certified Operator: rTG� ; " .. Certification Number: 773
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Dp ig Gurpntr
Crpnt
D esigu
Current
Swme f
4'r ry}'Capacty
Ca aci Po Wet Poutt o
9�
Cattle Eapacity
Pop.
iry Cow
Wean to Finish
Wean to Feeder
Non -La er
iEy Calf
Feeder to Finish-
_ : _ °
Dairy Heifer
Farrow to Wean
rDesign"Current
Dry Cow
Farrow to Feeder
I) .1P,oult 6 L Ca aci 1'0
Non -Dairy
Farrow to Finish
ILayers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
BoarsI I
Pullets
rl
Beef Brood Cow
Turkeys
Other
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
[�No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
f. No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
No
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3
21412011 Continued

Facility Number: - Date of Inspection: -
D!
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
®. No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure l 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
0 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
MNo
❑ 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
[�rNo
❑ 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
J§ 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
MNo
❑ 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): �r7✓/'L /����-� :-.�s �z��rr��/��/�
13. Soil Type(s): (J Gyres,,, .� 4Ls `• �-y
i
14. Do the receiving crops differ from those esignated in the CAWMP?
❑ Yes
g 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
No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
ES -No
❑ NA
❑ NE
the appropriate box.
❑ W UP ❑Checklists [:]Design ❑ Maps [:]Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes gLNo
❑ 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 ,® No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes CR No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑NA ❑NE
Page 2 of 3 21412011 Continued

Facili Number: jDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ®No ❑ NA ❑ NE
25. is the facility out of compliance with permit conditions related to sludge? 1f yes, check ❑ Yes J, 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 2'No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [:]Yes Fa No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes ® No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
® No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
SM No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
❑ No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
® No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
0 No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
E[ No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers andlor any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional vases as necessarv).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Phone:
Date:
21412011
Page 3 of 3

'.lAfs 2-6'y-Z0i19
Type of Visit &CS-mpliance Inspection O Operation Review O Structure Evaluation 0 Technical Assistance
Reason for Visit outine 0 Complaint 0 Follow up O Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: -0/�r/LO Arrival Time: Departure Time: 3:34 County: Region:
Farm Name:a e- Owner Email:
Owner Name: �"" c tr trt��S Phone:
Mailing Address:
Physical Address:
Cu r�5 Facility Contact: Contact: A(",-g Title: ��� e-<-- • Phone No:
Onsite Representative: Integrator: CDA0 A?'�'*" s _
Certified Operator:
Back-up Operator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: [� o =' = Longitude: 0 ° 0 I =
DesignMR.
rrent
Design Current
Design Current
Swine Capacity Population
Wet Poultry Capacity Population
Cattle Capacity Population
❑ Wean to Finish
❑ Layer
❑ Dairy Cow
Wean to Feeder
I J90 bO
1 2 / 00
110 Non -Layer
I
I
Dairy Calf
❑ Feeder to Finish
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
❑ Non -Dairy
El Farrow to Finish
❑ Layers
❑ Beef Stocker
❑ Gilts
❑ Non -Layers
El Beef Feeder
❑ Boars
❑ Pullets
❑ Beef Brood Cowl
❑ Turkeys
Other
❑ Other
❑ Turkey Poults
❑ Other INumber
o#Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation`?
❑ Yes
No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
C31<4A
❑ 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
l NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
El NA
El NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
W0j
❑ NA
❑ NE
other than from a discharge?
12128104
Conhinued

Facility Number: 2 —37
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): 2T
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 El
❑ Yes " No ❑ NA ❑ NE
Structure 5 Structure 6
Cl Yes ,.,No❑NA El NE
❑ Yes L;'N'o ❑ 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 04o' ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes 3 o ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks) �
9. Does any part of the waste management system other than the waste structures require ElYes 2< ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 0No ❑ NA ❑ NE
maintenance/improvement? �
11. Is there evidence of incorrect application? If yes, check the appropriate box below. El Yes B No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑\Evidence of Wind Drift ❑ Application Outside of Area `
12. Crop type(s) Bu'r�q,d/- t�C, L }!�!vr�,',�/ (O, 5.�. �' �,v-�/� 5ry�S . Ca#N
13. Soil type(s) 48, z", , cAl le_
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ Yes
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
17. Does the facility lack adequate acreage for land application'? ❑ Yes
18. Is there a lack of properly operating waste application equipment? ❑ Yes
®ErNo NA El NE
No NA ❑ NE
No ❑ NA ❑ NE
Io❑ NA ElNE
D<on❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use draFvings of facility to better explain situations. (use additional pages as necessary):
Reviewerllnspector ]Name Rj, �e y � Phone: _%0, V 33. 33 60
Reviewer/Inspector Signature: Date: Z —0/ — ZO/a
12128104 Continued

Facility Number: 82 —3 7 Date of Inspection
Required Records & Documents ,-,
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ElM Yes o ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [g-Ko— ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Desig
n El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 0'7 ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crap 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? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/inspector fail to discuss review inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes
E?qo
❑ NA
❑ NE
❑ Yes
❑L N-6
❑ NA
❑ NE
❑ Yes
[;-No
❑ NA
❑ NE
❑ Yes
❑-Ko—
❑ NA
❑ NE
❑ Yes
B-55-
❑ NA
❑ NE
❑ Yes
D'%57
❑ NA
❑ NE
❑ Yes
B iq-o— ❑ NA
❑ NE
❑ Yes
Q'mo— ❑ NA
❑ NE
❑ Yes
❑ o ❑ NA
❑ NE
❑ Yes
B-No ❑ NA
❑ NE
❑ Yes
[3-1�0 ❑ NA
❑ NE
❑ Yes
0'"Iqo— ❑ NA
❑ NE
Addrteonal�,Comments,�and/or„�Dravt7ngs
A.
12/28/04

Type of Visit & Compliance Inspection U Operation Review U Structure Evaluation U Technical Assistance
Reason for Visit &I routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: t'-J 'O q Arrival Time: Departure Time: Z: zs~;,, County: Region: ~�D
Farm Name: A6 -ryes Sl c t' Owner Email:
Owner Name: J G 04 c. S ki-i, i Aly Phone:
Mailing Address:
Physical Address:
Facility Contact. �Qrg e e AACCI --g. Title: Phone No:
Onsite Representative:
Integrator: Co G� a r �' L RI V-ou $
Certified Operator: Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: 0 n 0 i 0 is Longitude: = o = . =
di
Swine
Design
Capacity
C+urreut Design
Population Wet Poultry Capacity
Current Design Current
Population Cattle Capacity Population
❑ Wean to Finish
❑ Layer
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowi
Number of Structures:
can to Feeder
1608D
1
10 Non -Layer I
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
Dry Poultry
El Farrow to Finish
El Layers
❑ Gilts
❑Non -La Non -Layers
❑ Boars
❑ Pullets
Other
❑ Turkeys
❑ Turkey Poults
❑ Other
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes ElNo ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
8 iVA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
E10A
❑ 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
['1A
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
D1`'f> -
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
❑'N'o
❑ NA
❑ NE
other than from a discharge?
12128104
Continued

Facilitv Number: 82 -3 ] Date of inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 23
❑ Yes r❑- -Ko- ❑ NA ❑ NE
❑ Yes B- o ❑ NA ❑ NE
Structure 5 Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes [}ice ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes Bl�a ❑ 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? ElYes [31qea❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
Eltvc ❑ 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
D-NU- ❑ 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
0-?To ❑ 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) z rw.� c4I�._(Cr-: {.e-) ... �: (f c ,r--" ,4 (0. � ,)
s'� �i' .� - [.J�+ci Co i�
11.
13. Soil type(s) Ll %i rCc L
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
L��-3vo ❑ NA
El NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
-
IJ jTo ❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
�o ❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
U]`1 0� ❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment'?
❑ Yes
D44T ❑ 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):
i
r
�
Reviewer/Inspector Name �' 1G �h 11�f? J�IS Phone: //n 4`3-3. 333y
Reviewer/Inspector Signature: f fS i� _ Date: ?- 6 ` y
11118104 Conffnued

Facility Number: 82 — 3 `] Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes P"No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [ go ❑ 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
❑ 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
El NA
❑ NE
23.
if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
,9—o.
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
,L�_7,,g�o
L7No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
91 o
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
B<o
ElNA
ElNE
27_
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
M o
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32_
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
BINo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
2<.
❑ NA
❑ NE
12128104

BMS eN4cs.ec/ 11-17-ZDOS l22
�DIV1Slon of Water Quality
===acility
umber S 2 .T Division of Soil and Water Conservation
- ----_- �— Q Other Agency
Type of Visit
Compliance Inspection
0 Operation Review 0 Structure Evaluation
0 Technical Assistance
Reason for Visit
routine 0 Complaint
0 Follow up 0 Referral 0 Emergency
0 Other ❑ Denied Access
Date of Visit: Arrival Time: L].�a Departure Time: County: SG I✓ Region:
Farm Name: al � SMV r_rt` F0.v-1&0._ Owner Email:
Owner Name: 'Taytle.5 Re-trrifrsy Phone:
Mailing Address:
Physical Address:
Facility Contact: GrLG&4_ MOCI P19 - Title: S Phone No:
Onsite Representative: , 6;.YLt-r Mhh y-C _ Integrator: Pry �`^ +tea • - � ��
J
Certified Operator:
Back-up Operator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: [� o [� f = Longitude: 0 ° [= 4 = fl
Design Current
a ,Design Current
Design Current
Swine
Capacity Popolahon
=;;.
Wet Poultryr Ytapacity Population
❑ La er
Cattle Capacity Population
❑ Dairy Cow
❑ Wean to Finish
a er
❑ Dairy Calf
can to Feeder
_
Dai Heifer
Feeder to Finish
El Farrow to Wean
Dry Poultry n '
El D Caw
❑ Farrow to Feeder
Non-DaiTy
❑ Farrow to Finish
❑ La ers
❑ Beef Stocker
r,
❑ Non -La ers
❑ Pullets
❑ Turkeys
❑Beef Feeder
❑ Beef Brood Co
❑ Gilts
❑ Boars
Other
❑ Other
❑ Turkey Poults
❑ Other
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
[--]Yes
No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
ElLI Yes
�
N�o
❑ 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)
El Yes
��
L7 No
❑ NA
❑ NE
2. 1s 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
ETNoo
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12128104
Continued

Facility Number:
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. if yes, is waste level into the structural freeboard?
Structure I Structure 2
Identifier:
Spillway?: AL4
Designed Freeboard (in): 7
Observed Freeboard (in): .Z
Structure 3 Structure 4
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 O NNo ElNA ❑ NE
El,
Yes �No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes Q No ❑ NA ❑ NE
❑ Yes 3<0 ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmentaU 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 E3 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 eNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need []Yes ENo ❑ NA ❑ NE
maintenance/improvement?
11.
Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
Eg 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) i>Vjy¢y tr G"_ SO4 Vzat
+aJ (, D.S. . 6
,s'Cc^o'Y
13.
Soil type(s) l jp�_s KL L,Lt- is 1G 4
14.
Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
ErNo
❑ NA ❑ NE
15.
Does the receiving crop and/or land application site need improvement? ❑ Yes
L7 No
❑ NA ❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination? El Yes
❑ NA [I NE
17.
Does the facility lack adequate acreage for land application? El Yes
,rNo
'L{' No
❑ NA ❑ NE
18_
Is there a lack of properly operating waste application equipment? ❑ Yes
2<o
❑ NA ❑ NE
Comments (refer to question ft Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
f
1W
Reviewer/Inspector Name �e— v js Phone:
Reviewer/Inspector Signature: Date: 9 8
Page 2 of 3 12128104 Continued

Facility Number: 8L Date of Inspection y"l(o-DB
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ETNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available'? If yes, check ❑ Yes LJI No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design El Maps El Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
Bio
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste
Transfers
❑ Annual
Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and l " Rain
Inspections ❑ Weather
Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
ETNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
NNo
❑ NA
ElNE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
ElE, Yes
NNoo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
,I_�.,
oo
El NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
El Yes
�L',
[ NNoo
❑ 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
ETNo
❑ 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
ErNo
❑ 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
El Yes
,.,�
3No
❑ 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
Now❑
NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
El Yes
2No
❑ NA
❑ NE
Additional Comments and/or
Page 3 of 3 12128104

I�
Division of Water Quality
Facility Number y D�j�] PoDivision of Soil and Water Conservation [:
0 Other Agency I ���.
Type of Visit P Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit )i� Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit:
Farm Name:
Owner Name
Mailing Address:
Physical Address: �}
Facility Contact: tCXr -Title-'I 2rC
Onsite Representative:
--
Certified Operator:�
Back-up Operator:
Location of Farm:
Swine
CounRegion:
Dwner Email:
Phone:
C1
Integrator:
Phone No:
Operator Certification Number:
Back-up Certification Number:
Latitude: [�:]' =' = Longitude: =o =' = «
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
Z1i 0 ❑ Non -La er
❑ Wean to Finish
Wean to Feeder
El Feeder to Finish
El Farrow to Wean
El Farrow to Feeder
El Farrow to Finish
El Gilts
El Boars
Other
❑ Other
Dry Poultry
El1_a ers
ElNon-Layers
El Pullets
ElTurkeys
El Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation`?
Discharge originated at: El Structure ❑ Application Field El Other
a. Was the conveyance man-made?
Design Current I
Cattle Capacity Population
El Dairy Cow
El Dairy Calf
El Dairy Heifer
El Dry Cow
ElNon-Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
b. Did the discharge reach waters of the State'? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures: m
d. Does discharge bypass the waste management system? (]f 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
❑ No JaNA
❑ NE
❑ Yes
❑ Yes
No ❑ NA
❑ NE
❑ Yes
o ❑ NA
❑ NE
12128104 Continued

Facility Number:' _— 3 Date of Inspection IZ
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes Pj'40 ElNA ❑ NE
a. If yes, is waste level into the structural freeboard? ElYes kj�,No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: 1
Spillway?:
Designed Freeboard (in): �' 1
Observed Freeboard (in): !/
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ANo ❑ NA ❑ NE
(le/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes )SdjNo ❑ 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? V Yes ❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes R-No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ,[%No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑Yes %No [I NA El NE
maintenance/improvement?
11. Is there evidence of incorrect 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 ] O lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
13. Soil type(s)
14. Do the receiving crops differ from th se designated in the CA MP?
❑ Yes
Nj,-)Jo
❑ NA
[j NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
]KINo
❑ 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
6No
❑ 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 INC KT7fl Phone: �Ilc
Reviewer/Inspector Signature: Date: R
l �(./LV/VY 4VliiiVNGM

Facility Number - Date of Inspection f L
ReQuired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes NNo ❑ 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
Et;'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
ji� No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
J] 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 No ❑ 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
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
�RNo
❑ 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
�9 No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
[XNo
❑ NA
❑ NE
Additional Comments and/or Drawings:
mac Cd"
m u-`t�— b
�)y t
12128104

Facility No. �Time In Time Out
Farm Name �1L�-� _ Integrator
Owner Site Rep
Operator _ _—�C�,�,r�i��_� _ No.
Back-up No. -
COC Circle. Gene or NPDES
Date
Design
Current
Design
Current
Wean - Feed
Farrow — Feed
Wean — Finish
Farrow — Finish
Feed, Finish
Gilts / Boars
Farrow —Wean
Others
FREEBOARD: Design !/
y
ow` u c .,.�w JE �
Crop Yield
Rain Gauge
Soil Test c... PLAT
Weekly Freeboard Y Daily Rainfall
Spray/Freeboard Drop �' ° �� f 1t'__o.
Weather Codes
Waste Analysis:
120 mii'i Inspections
Date Nitrogen (N)
Z� i -
1
Observed v
Calibraticn!GPM
Waste Transfers ~�
Rain Breaker
Wettable Acres
1-in Inspections
Date
Nitrogen (N)
Pull/Field Soil Crop Pan Window
y
w
l�
0

.V'
Type of Visit Com nce Inspection O Operation Review O Structure Evaluation 0 Technical Assistance
Reason for Visit outine Q Complaint O Follow up O Referral Q Emergency Q Other ❑ Denied Access
Date of Visit: q p(o Arrival
jTime-
r4q o�� Departure Time- County:
Farm Name: 3 cj m2s Y�IP.� f I'" I=bLfm Owner Email:
_��,P�
Clwner NantP- ¢-.:��1 ► 1� �PY'l � t�.PJ Phone'
Mailing Address:
Physical Address:
Region PGO
T
Facility Contact: V �- t�l�- Title: t L? C h Phone No:
Onsite Representative amw (IniQ VC.) _ Integrator: `t"[ e-o
Certified Operator. Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = 0 0 i 0 Longitude: E__1 ° = I
�.Q
esign Current
Design C*urren[
Desigrt Current
Swine
Capacity P pulat*on
Wet Poultry
Capacity Population
Cattle Capacity Population
❑ Wean to Finish
❑ La er
airy Cow
Wean to Feeder
QM Q
❑ Non -Layer
airy Calf
❑ Feeder to Finish
Dry Poultry
„.i= "`
`3
❑ DairyHeifer
❑ D Cow
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Layers
❑ Non -Dairy
El Beef Stocker
❑ Farrow to Finish
❑ Gilts
❑ Non -La ers
❑ Beef Feeder
❑ Boars
�
❑ Pullets
❑ Turkeys
ID Turkey Points
❑ Beef Brood Co
Number of Structures:
Other
❑ Other1110Other
Discharges & Stream impacts
l . Is any discharge observed from any part of the operation? ❑ YesffNo ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made? ❑ Yes ❑ No XNA El NE
b. Did the discharge reach waters of the State? (if yes, notify DWQ) ❑ Yes ❑ No A ❑ 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 '�TVA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes o ❑ NA ❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State ❑ Yes tNo ❑ NA ❑ NE
other than from a discharge?
Page I of 3 12128104 Continued

Facility Number: �k_— 3'1 Date of Inspection U�o
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes o ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No �IA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: f
Spillway?:
r
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes O(No ❑ NA ClNE
(ie/ large trees, severe erosion, seepage, etc.) CCCCCC
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes No ElNA ElNE
through a waste management or closure plan?
If any of questions 4-6 were answered ves, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? (((((( es ❑ No ❑ NA ElNE
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 El YeNo ❑ NA El NE
maintenance or improvement?
Waste Aaolication
10. Are there any required buffers, setbacks, or compliance alternatives that need
maintenance/improvement`?
❑ Yes N ❑ NA ❑ NE
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes'N No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or ]albs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drill ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
Q_Qv n - ras
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
/ Fa
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
7 No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
lNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
Wo
❑ NA
❑ NE
Comments (refer to question ft. Explain any YES answers and/or any recommendations or any other comments.
Use drawings o(f�f�ae lity to better explain situations. (use additional pages as necessary):
Lo -v ' "x S �'1 e*-YLIAt't 1[�n Q�� • �J C� ) S>e_eC�
/
A;- a-6� . G z4- sc- -P
AL
o,o +a a`�4ia�ipn'-Cove r
cQ+_ MU45#',6Zt. Z.Z.
l'�p 71 S[v C
dam- U
T
Reviewer/Inspector Name
Phone: Ci !O U 3 3 300
Reviewer/Inspector Signature:
Date:
Page 2 of 3 12128104 Continued

.IF acility+Number: Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes �No
❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes Io ❑ NA ❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑Design El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes )4 No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ AnnuaI 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 )To
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
El Yes No
N4NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes ❑ No
'KNA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes ❑ No
)ILNA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes JUNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes ❑ No
)kNA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
1
❑ 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'�Vo
❑ 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
Page 3 of 3 12128104

4 , -/
Facility -No._ �— 3� _ Time In �a Time Out Date 9 0(,
Farm Name Integrator
Owner Site Rep
Operator
m
Back-up No. -
COC Circle: Gener or NPDES
Desi n
Current
Design
Current
Wean — Feed
CQ9252
Farrow — Feed
Wean — Finish
Farrow — Finish
Feed — Finish
Gilts / Boars
Farrow — Wean
Others
FREEBOARD: Design Observed � -�
Sludge Survey or; — ►" �� Calibration/GPM /
Crop Yield
Rain Gauge
Waste Transfers
Rain Breaker V
Soil Test Ll� PLAT Wettable Acres
Weekly Freeboard Daily Rainfall 1-in Inspections
Spray/Freeboard Drop (Y)C�_V 7vYti2 _��} L
Weather Codes 120 min Inspections
Waste Analysis:
Date Nitrogen (N)
(o
all1 -9
Date Nitrogen (N)
.
..
: '
..
iI
[..• Mel
MP
e /
�®
•
31

2 H 37
Type of Visit # Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit ® Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: 1 2'f• ID Arrival Time: �� ' /S Departure Time: T S County: Region: Flo
Farm Name: W eger,ri L.. ��5�y Owner Email:
Owner Name: Phone:
Mailing Address: K 14 gr�� c l � vn. �'*� MSC'- — -- Z8 3 ZS
Physical Address:
Facility Contact: `` Title: �_ Phone No:
Onsite Representative: W �� Ems! R e. rri !"' Integrator:
�s F
Certified Operator: , �f� ?_ Operator Certification number:
Back-up Operator:
Location of Farm:
Back-up Certification Number:
Latitude: F—I o a= Longitude: 0 0=;
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population Cattle
❑ Wean to Finish
Wean to Feeder &0 8 O
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
❑ Layer
❑ Non -Layer
Dry Poultry
Non-L
Pullets
U Turkey Puults
❑ 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
❑
Dairy Cow
❑
Dairy Calf
❑
Dairy Heifer
❑
DEy Cow
❑
Non -Dairy
❑
Beef Stocket
❑
Beef Feeder
❑
Beef Brood Cow
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system'? (If yes, notify DWQ)
2. Is there evidence of a past discharge tom 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 KNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
4 No
❑ NA
❑ NE
❑ Yes
2! No
❑ NA
❑ NE
12128104 Continued

Facility Number: $y- Date of Inspection uaiO
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
[9No ❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
64 No ❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5 Structure 6
Identifier: If
Spillway?: No
Designed Freeboard (in): •7-D. If
Observed Freeboard (in): Zs
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
�No El NA
El NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
J9 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
150 No
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
5d 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
5?No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[� No
❑ NA
El
maintenance/improvement?
`_
11. Is there evidence of incorrect application? If yes, check the appropriate box below_
❑ Yes
VNo
❑ 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
11v1,wL Sb
Out ide of Area
��l.1tS,�e�6,
G�
12. Crop type(s) s WVO)a
Co Ga
045' abo e•Yo
13. Soil type(s) gjAe, ,
o, �S
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[KNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
M;No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination.,[]
Yes
KNo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
0°No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
kg�No
❑ NA
❑ NE
64-.,+ ` 1-13. 3 ' s
4. " �.ro� �C�,,.� #o vr-r J=- + ve cw-� o.,.- 6100 -
ti �r _��....., .
Reviewer/inspector Name a kr> , i ' Phone: Ito - Yiob —ls-q
Reviewer/Inspector Signature: Date: u D S'
12128104 Continued

Facility Number: fi —?i�' Date of Inspection Z ZI
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes �XNo ❑ NA ❑ NE
the appropirate box. El WUPv ❑�❑ Maps
Checklists./'❑ Desig p `T:1 Other
21. Does record keeping need improvement? ifyes, check the appropriate box below. ❑ Yes &No ❑ NA ❑ NE
❑ Waste Applicatior40❑ Weekly FreeboareO Waste Analysi*,"❑ Soil Analysis✓❑ Waste Transfers ❑ Annual Certification
❑ Rainfak( ❑ Stockinw/❑ Crop Yiel(V ❑ 120 Minute Inspection*/ ❑ Monthly and 1 " Rain Inspection-' ❑ Weather Codgv
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
E�No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers (in irrigation equipment'?
❑ Yes
❑ No
25 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 pen -nit?
❑ Yes
0!�No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
NNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphonis loss assessment (PLAT) certification?
❑ Yes
5.No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
SNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
El Yes
15 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 duality concern?
❑ Yes
ZZNo
❑ 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
5� No
ElNA
ElNE
General Permit'? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/inspector fail to discuss review/inspection with an on -site representative'?
❑ Yes
,QNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
9No
❑ NA
❑ NE
Additional. Comments and/or Drawings:
Z�t.jos
D.`tY Z/!ct /0�
12128104

Type of Visit gCommpliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit Gr/Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Elate of Visit: Q o C q_ Tune: : d D
Facility Number
NNot Operational Q Below Threshold
Permitted eCertilsed [3 Conditionally }Certified Q Registered Date Last Operated or Above Threshold: ----- ...____�.__.
Farm Name: ......N5.._.......... C+'!.... _. --- .... _ ...... County:
Owner Name: s [.lYl`++ PhoneNo: 9� - !(• aq
- - e..v.......................... j............
.....
....
......
..........�.....--�............. _.. ..................-._..._................... ... _.......
0.1
Mailing Address: F!. -
Facility Contact: .......Wal .ln� —Tile: Phone No•
_.. ..__�...._._ ......... -- - - -..W .. W_W yy
Onsite Representative: -• r! Integrator: ?Mr";Ur �d
Certified OperaWr:-�, ,.,►! Operator Certification Number.
Location of Farm:
i
Ti
Urwine ❑ Poultry ❑ Cattle ❑ Horse Latitude �• �� ��� Longitude �• �� 0..
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes 240
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) [:]Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes RTo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes 940-
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Identifier:
Freeboard (inches):
12112103
Structure I Structure 2
r
......... _.a�............. ..... I ................ -.....
Structure 3 Structure 4
❑ Yes [94q*b__
Structure 5 Structure 6
Continued

• Facility Number: ,% — 37 1 Date of Inspection o a
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑ Yes
Q'No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
❑ Yes
[Q'No
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
❑ Yes
[rNo
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
[]'No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
❑ Yes
[2"No
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes
[ErNo
11. Is there evidence of over application? If yes, check the appropriate box below.
❑ Yes
[rNo
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type gere' rrt6,11
13. Do the receiving crops differ with those d signated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
No
14, a) Does the facility lack adequate acreage for land application?
❑ Yes
&14o
b) Does the facility need a wettable acre determination?
❑ Yes
["No
c) This facility is pended for a wettable acre determination?
❑ Yes
[5No
15. Does the receiving crop need improvement?
❑ Yes
® No
16. is there a lack of adequate waste application equipment?
❑ Yes
[✓rNo
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
❑ Yes
0.1f0
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours?
❑ Yes
[► fqo
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
[I'No
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional
❑ Yes
jj�No
Air Quality representative immediately.

Facility Number: W — Date of Inspection
Reuuired Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes 63 No
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.) ❑ Yes [Y"No
23. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ®`No
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
24.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
&"No
25.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
[v No
26.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
OT4o
27.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
Bfio
28.
Does facility require a follow-up visit by same agency?
❑ Yes
OKO
29.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
YNo
N\'PDES Permitted Facilities
30.
Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
❑ Yes
[ONO
31.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
32.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ No
33.
Did the facility fail to conduct an annual sludge survey?
❑ Yes
❑ No
34. Did the facility fail to calibrate waste application equipment? ❑ Yes ❑ No
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After 1" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
113 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
12112103

ct,r.Se r L/
Site Requires Immediate Attention:
Facility. No. -*gP'
DMSION OF ENVIRONMENTAL MANAGEMENT 92-3 %
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: ? 11 , 1995
Time: Z : 3r3 PA-9
Farm Name/Owner- Pr e s4,,P_ Fq • -,s ) w . t4e,, -,,, S- b - `�- (Lu" ice, )
Mailing Address: -
County:
Integrator: '_ P.�.� gg Phone:
On Site Representative Phone:
Physical Address/Location: AQ
Type of Operation: Swine -Z Poultry Cattle
Design Capacity: J. ,"a c t e Number of Animals on Site: 4W Z o
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: Longitude: a "
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches) es r No Actual Freeboard: 2 Ft. 6 Inches
Was any seepage observed from the lagoon(s)? Yes orQ Was any erosion observed? Yes oro
Is adequate land available for spray? ( or No Is the cover crop adequate? Yes or No
Crop(s) being utilized: C / �^,.1.,g�j
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings? Yes r No
100 Feet from Wells? <giNr No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or(W
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line: Yes or<IR6
Is animal waste discharged into water of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes or(P If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop) Ye or No
Additional Comments: _L. G p Mt w � 11,--d _ N -ew � � F' � � ��_�
liaf/PS h l rjre� yr
Inspector Name
cc: Facility Assessment Unit
jtj &-7
Signature
Use Attachments if Needed.

NORTH CAROLIAA DHPARTNMgT OF ENVnWMCMriT, H$AT-M A KATM41, PJSOW S
DIVISION OF ENMONNIMAL MANAGEMEM
Fayetteville Regional Office
Animal Operation Compliance Inspection Fora
x HIIl��i
n4SPzCTI0N ,IATXFARI�L;
AcEn i ',..i L.1+EPY biro nUf'L�aLl
fit- � ��I � e Cl+n�vn Z83Za
(q��i 5qa- 1�Z�1
All questiotas answered negatively will be discussed in sufficient detail in
the -Comments Section to enable the deemed Permittee to perform the appropriate
corrections:
5EMON r
Animal Op_*rstion TvFe:
Horses, cattle, swine
SECTION II
NvfserLf
poultry, or sheep
Y I N I COKKENTS
1. Does the number and type of animal meet or exceed
the (.0217) criteria? [Cattle (100 head),
horses (75), swine (250), sheep (1,000), and
poultry (30,000 birds with ligt:id waste
system)]
2. Does this facility meet criteria for
Animal Operation REGISTRATION'?
3. Are animals confined fed or maintained
in this facility for a 12-month period?
4. Does this facility have a CF�tTIPFEO ANI3il1L
WASTE IO►riPiGEMIM PLAN'?
5. Does this facility maintain waste management
records (Volumes of manure, land applied,
spray irrigated on specific acreage with
specific cover crop)?
6. Does this facility meet the SCS minimum
setback criteria for neighboring houses,
wells, etc?

sE_CT IdN III
Field Site Management
I. Is animal waste stockpiled or lagoon
construction within 100 ft_ of a USGS
May Blue Line Stream?
2. is animal waste land applied or spray
irrigated within 25 ft. of a USGS kap
Blue Lino Stream?
3. Does this facility have adequate acreage
on which to apply the waste?
4. Does the laud application'site have a
cover crop in accordance with the
CER%MCATION FLAN?
5. Is animal waste discharged into waters of
the state by man-made ditch, flushing system,
or other similar man-made devices?
6. noes the animal waste management at this
farm adhere to Best Management Practices
(BMP ) of the approved g RTIFICAT:L ?
7- Does animal waste lagoon have sufficient
freeboard? How much? (Approximately
8. Is the general condition of this CAFO facility,
including management and operation,
satisfactory?
SECTION IV
Comments

ry at
it 46 �
R �
.y
1� �^ � •� ,, � ��• fit. � � 1
a` • � r � n �R \ � / � 4 e
'� • .� =ill . rsI oeAilY
. r
4 (j) N
41 k O ,{
N ab� a ,
.-i r, th w h, \ r % T 9
In r41 b :�:
rd b
tw Lit 0 0 I '� .Tr °� •. , ^+ q w �'

?AS';`S PLAN ?OR MM CA Z=A=w ?2==TS
?=ease rw4zu. = the e[=:PZetad foe to the Division of at
tie adsasa on the revasaa aide of t14a fan.
,name of fa--= (Please print) : WESL4ER jJ R1a
Ad : ess . R T l t3o1c 14 13
riTon .;48 ?hone No.:'�lo n92-- I(oZ9
County: A M
'a----ocacio racic,de. and Langitude:�W - aa• 12r Ae M' irei,:z=pd} . A1s0,
please actac a copy or a councy =cad map with location identified.
re of operation (sw_ne, layer, dairy, et-.) sI W In E
yes_-=;,2ac_zy of ani-tals) r7bSC3 W�-_An -FEP?.3
yvac3se size of cperatiaa' (12 mO..CL, =c;.u_3C_Cn ays.) �8o WEAn FEED
Avera..C�e acraage needed for land appl-cacion of waste (ac=%s)
s asassassasasasassa�ssssslsslsasssas=ssslss sis�assssalsssas aassar�ys=ass asaaa sane
'�'sc�.-1 cal s�aeiaiist ca�_3tisatioa
,s a c;c:.n (cal spec-; aj-; z designated ry the. Nor~h Carclina Sail and Waca_
C:rse�:aCion Ccirnission ;,u-rsuanc to ?SA NCAC 67 .0005, I certify t-hac the new or
,a __a.ded am;--! waste =azmgeme-_t system as installed for the fa-r3 named above
In an an —I wasca management plan that. meets t:e design, censt:sc,ion.
=eracibrt and s=anda-d-w and SpeCwf4cat;ar.S of the Dirls,on of
..Y-- -.=e.^.tal ui.^.agemen= and the uSCA-SO_z Conservat,on Se= lz_ce 3-.dior =L a Nc—
Car7ii_.a Soil and dater Cbrse_r7acion Cc=-; ssicn pursuant ,o iSA NC X Z . 0217 and
NC;,C 5s .0001-.000S. Mze following a eme-MM3 and tzei= c:r=ssmonding
�itar_a-% er'�een _ye-ri_ied by me or other designated technical specialists and
are included. is the plan as applicable: mini=,- separations (bu=,e•-s) ; liners or
etlivalent. --cr lagoons a= waste s=o=aset ponds;_waste storage capacity; adequate
q�antit_r and a=cuac of laud for waste utilisation (or use of th�-_­d party) ; access
c- ow-narsRip az.: proper oast&,.application equipment; - schedule for ti=inq of
applzc__ions;_-apalicatzon ratemr loadi=q rates; and tI' control of the discha,ye
of pollutamr-.1 ;zzo==watar runoff av+ants less-savere than-tbm Z5-year.- 24-hour - - -
staza_-_
3Tamr of , 2 �c�t� s�c�i a a� . {P� w��, �prisrtl - G: •G{.�'rrr� • �Ct r�Tar� z'z
-
Ae-:ress (Age -^icy) : !-a. Box, *38CLrr7r47ti NC_ _ -, P*.laas 577/
szs-..at•�.e: :Q`��Lla.r C�GC•+-- _ _ _ Data: -_ B f T-42g-
iasasal;lisaliiasaal;;=7!!!!allsls!!lesis Als!!!S!!llaisassls�=ss�s!!;! -
Z (we) understand the operation, and maintenance procedures established in the
anp=7ved animal waste =k nagemen= plan for the fa+= famed above and will" imrlemeant:
tl�:ese Procedures. z fwe) know that any additional exgan ion to the e-xistin4
desiy= capacity of the waste t=ea=ent and storage system or corst--uction of new
facilities will require a new ca-=ificatyon co be to the Div-isiea of
F-v=ror.-enLal :+,aaagQment before the new an orals are stocked. - (we) also
erstard ghat t. ere must be no dischasye of ani✓.a? .taste f_om this syste= tm
surface-wacars of t2he staca th-cugz a man-made conveyance or t..rcugh
-_noif _norm a scar= event less severe than the 2S-_year, 24-Pour storm. The
acprcved plans will be z_yec at the fa.= a_z:d ac the office of the iccal Soil and
Wa_er Corse=vatioa Distri . ,
Ya :. a f LA=d owrtar (Please Prime) :
Date -
yaae ad WM :agar, if di=recent f�24_m Owner (P eaaeLt)r-t)
S_g__ac•.z.=e - Date:
-Tote: A c:.ange in land Ownership requizes nocizication or a new certizwcation.
(if the acmroved plan is changed) to be submitted to ::he Division oz
Fhv_z.a=e^tal Ma.^.agement wj_=hi.^. 50 days of a title trar_szeZ.
Oe - USE

:r. =
l �.C..;f Ukii +L1 '
DePc+ II ent of Environment,
Health cnd Ncturd Resources ;
Division ct Envircrtmentcl Mcncgement
James 8. -Hunt, Jr.. Governer Ada
.lenctt Cn 8.,.+jcwes. Secretary
A. Freson Howcrd..lr., RE, Dire&cr -
C '^ 7C3'^ ;CIT �"rr OR .=2.%'TiET��'
MIS7-ROC':=^NS FCC C T-_--_zTCG.TT_CN OF APP4CV= ANL'•r.AL. WASTE MANAGMJMM PLANS FOR
YZ—,, OR MC2.0 EC AN -----AL WALE:-.R SERVT*IG SOTS
order to be deemed Pe_-=Litted by the Dim szca of cavz.ca=mentaT" management
(::M!) . w.e cw er of any new or exra u4_ed ar- ^-wa;ta management system
corms:-.:c= aster u'aauary i, ?994 which is desi;,ned to sex a greater than or
eq:ai to the anal populations listed below is requi.-ed to submit a signed
c� ___cation foe to DEK h•ta= the new animals are scccked on the faxes_
_as:'.X@ operations are exempt f: ohs the requirement to be cartitied.
100 heed crf aattls
75 horses -
250 aW3.ae
.1, 400 ahseg- . _ ..
3a,,aaa bi.-da .r3t1v a I3ga3r . wast•a. ap»C
Mie cart ifzcatioa_must, be signed by- th r- owner. at the: feedlot (and managQr if
diw;asnC :raw.the.'aw=er). and by- any.rachn cal specialist designated by the Soil
and Water _Ccase=7at4.CXL- -r�T sioa : pu rxua=_: eta - 15A_ NC2C:. 67y _0001-_0005:' A =
te== mZ i��
spt t IL7y as i
ban-site nspec-1 o= that all applicable
design stanch-d and, spee-flcatious- are met as installed and,
;.hat all- a��i�cais3'e og_eration�aai���-**t'eaasc�:�rs�,a.,-.3;•had speciticationa can'
he =at
• - �� � Z�Z ��Q�+�i'C. �F:: �-ii..'+�' 1� :t.� . i1 , } - � .-•yam-..�..�:.�_ � - _ _ rs.-. .•o--? ,'..'ter
Although the acmual ===b*= of an3.mals at- ttw wadi° t-f may vary f�aa� tip to time.
the design caaa itZ 9E'the;.wascee hand?:,,:^� system -should. he usecE to deteraiae
a farm is subject ta- thw- certificatioa raquix =ent- :For exampIa. -it the waste -
system for a feedlot is designed to handle 300 hogs but the average-populatiam
will be 200- hogs, thsm� the waste nsanagffient system- requi.-es a certification.
'Phis certification is =@CST;i..:ed by regulations gcv'er inq ani=al waste =anagemen:C -
syscams adopted. by the avironmencal Management Cc=ission (EMC) an December 10,
1392 (Title 1SA NCAC. 2H _0217)
Cn the _averse side of this page is the certification hone which =st be
su:=itte= to D"&H_ before new animals are stooped on the fazm. Assistance in
c::=p1ec_4-q the fc= ca-a be obtained aram one or the local agencies
stc!t as the soil and ::acar conserlac_on district, the USDA -Soil consex-ration
sevrice, cr the N.0 . Caaperative :xtarsion . Sex-Irice. The form should he sent cc:
Ceoar'=eat-. of 3:aviyormeut, Health- and Na=s-a1 Resources
Dili-isiaa of F.nv_onmental Management
water Quality Section. Plac ninq Branch
P.O. Box 29s35
Raleigh, N.C. 276Z6-0535 l Y+
Phone: [phone]
sieve W. Tedder, Chien'
Water Qu�7al i ty Section
Form ID: Aa4E'4:0194 Date:
P.O. 8vx 2rt35. Zde�Sh. Nash C cGr.u27fsZ5-".�.,".5 7e4echcr,0 9i9-733-;015 FAX 919-,33-2496
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