820212_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental Qua

—/ e
(Type of Visit: 0 Compliance Inspection U Operation Review 0 Structure Evaluation 0 Technical Assistance I
Reason for Visit: 0 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: /� — Arrival Time: `� Departure Time: 1.' D0 County:
Farm Name: /y)r_ [�[���n raen► %_ Owner Email:
Owner Name: ; la G& M0 Lu Ll= 't Phone:
Mailing Address:
Region:
Physical Address:
Facility Contact: 7,ae-1k Title: Phone:
Onsite Representative: Integrator: 225
Certified Operator: 5 Certification Number:
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Dischar es and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑Yes E510 ❑NA 0 N
❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
❑ No
[:]NA
❑ NE
Design Current
Design Current
Design Current
Swine Capacity Pop.
Wet Poultry
Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
Layer
❑ Yes
[ " o
Dai Cow
Wean to Feeder
Non -La er
❑ Yes
[D -No
Dai Calf
Feeder to Finish Qa
of the State other than from a discharge?
Dai Heifer
Farrow to Wean
Design Current
D Cow
Farrow to Feeder
D . P.oult .
Ca aci
P,o .
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Hpullets
Beef Feeder
Boars
Beef Brood Cow
Turkeys
Other
TurkeyPouits
Other
Other
Dischar es and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑Yes E510 ❑NA 0 N
❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
❑ No
[:]NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (if yes, notify DWR)
[:]Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
[ " o
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
[D -No
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 2/4/2015 Continued

.Facility Number: 97!� "Z1.;7-1 (Date of Inspection: /p //—�/
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes E] -No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes D N -o ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
❑ NA ❑ NE
Identifier:
[—]Yes
[D -N -o
❑ NA ❑ NE
the appropriate box.
Spillway?:
❑WUP ❑Checklists [—]Design ❑ Maps ❑ Lease Agreements
❑Other:
Designed Freeboard (in):
21 _ Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
©-i�o
Observed Freeboard (in):
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
Q 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
[D No
[:INA
❑ 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
[3 -No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[�JNo
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
[ -N-o
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
�o
❑ NA
❑ NE
maintenance or improvement?
11. is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [J o ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): Z2_ ��e�j�z�-�
13. Soil Type(s): /1J0�1!_ / XGt
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes (]-I�o ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes [:I-110 ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Reouired Records & Documents
[:]Yes [�]"�lo ❑ NA ❑ NE
❑ Yes [a -No ❑ NA ❑ NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
E3 -No
❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
[—]Yes
[D -N -o
❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists [—]Design ❑ Maps ❑ Lease Agreements
❑Other:
21 _ Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
©-i�o
❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
[2 -No
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes E3 ol� ❑ NA ❑ NE
Page 2 of 3 2/4/2015 Continued

11 Facili Number: - Date of _Inspection: — //—,P0/
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE
■ 25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [3-1�o ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey El 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 E] "'o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [3-lCo ❑ NA [] NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
34. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
❑ Yes ❑ No [] NA 0 NE
❑ Yes E]"No
❑ Yes LJ '"o
❑ NA ❑ NE
❑ NA ❑ NE
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
I_J iNo
❑ 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
Ffl" o
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
No
❑ NA
❑ NE
Reviewer/Inspector Name:�� ��--
Reviewer/Inspector Signature:Y7— -
Page 3 of 3
Phone:
Date:
2/4/2015

r
Type of Visit: O'Com ance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: eRoutine O Complaint Q Follow-up O Referral Q Emergency O Other O Denied Access
Date of Visit:- S j Arrival Time: ; GQ Departure Time: County: Region:
Farm Name: Owner Email:
Owner Name: `�C./'� %%�� ��v-- Phone:
Mailing Address:
Physical Address:
Facility Contact: fT /7i C&g',�, Title: trfr r- Phone:
Onsite Representative:
Certified Operator: s S
Back-up Operator:
Location of Farm: Latitude:
Integrator:
Certification Number:
Certification Number:
Longitude:
DesignCurrent
❑ Yes
Design
Current
urrent
Swine Capacity Pop.M�tP6'
city
PopCattle
ni0esigM*
Eapacity Pap.
Wean to Finish
❑ Yes
❑ NA
Dai Cow
Wean to Feeder
er
❑ No
0 NA
Dai Calf
Feeder to Finish5,2 L12
Dairy Heifer
Farrow to Wean
❑ Yes
Design
CurrentDry
Cow
Farrow to Feeder
DEW P,aultr
Ca aci
P,o
Non -Dairy
Farrow to Finish
Layers
Non -Layers
5jNo
❑ NA
Beef Stocker
Beef Feeder
Gilts
Boars
Pullets
Beef Brood Cow
Turke s
Other
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 DWR)
❑ Yes
❑ No
0 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
0 NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
allo
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
5jNo
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 2/4/2015 Continued

Facili Number: - / Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [,RNo ❑ 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? ❑ Ycs EZNo ❑ 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
fRINo
❑ NA
❑ NE
waste management or closure plan?
❑ Yes
RNo
❑ NA
❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
allo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
2, No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
❑ NA
❑ NE
the appropriate box.
9. Does any part of the waste management system other than the waste structures require
❑ Yes
54 -No
❑ NA
❑ NE
maintenance or improvement?
Waste A plication
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
Oa
[:]NA
[:]NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes r2LNo ❑ 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): /"p % , c --L- S
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes ,�E] No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes MNo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes fo No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
fNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
RNo
❑ NA
❑ NE
Required Records & Documents
19_ Did the facility fail to have the Certificate of Coverage & Permit readily available?
[:]Yes
FNo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
FNo
❑ 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 I" 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 No
�] NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 2/4/2015 Continued

Facility Number: jDate of Inspection: /
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes E No ❑ NA ❑ NE
+' 25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes IQ No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes ® No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes 0 No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
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.
34. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32_ Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes [S No ❑ NA ❑ NE
❑ Yes [3 No ❑ NA ❑ NE
❑ Yes [ANo ❑ NA ❑ NE
El Yes �No ❑ NA ❑ NE
❑ Yes [,S No
[—]Yes [&No
[—]Yes &No
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question #i): 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: 2U"3 D 3—(0 �
Reviewer/inspector Signature: Date:
Page 3 of 3 21412015

wisi of Water Resources
Facility Number ®- Q Division of Sail and Water Conservation
� Other Agency
type of Visit: ompliance Inspection 0 Operation Review O Structure Evaluation Z5 Technical Assistance
Reason for Visit: eMG-utine O Complaint Q Follow-up Q Referral O Emergency Q Other O Denied Access
Date of Visit: Arrival Time: Departure Time: County: „ ��.� Region:
.OV
Farm Name: &'/X. Fa"1)7�L C Owner Email: �
Owner Name: '2 /%7 _ C& Phone:
Mailing Address:
Physical Address:
Facility Contact: _ /►'i [lY Title: -c�'f Phone:
Onsite Representative: �,gt�� Integrator: 2 ��_
Certified Operator: I 571,_� Certification Number: �/ ?A 1.
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
` Design Current
❑ Yes
Design
Current
Design Currept
Swine - Capacity Pop.
Wet Poultry
Capacity
Pop.
Gattle Capacity Pop.
Wean to Finish
La er
[—]No
❑ NA
Dairy Cow
Wean to Feeder
Non -La er
[KNo
❑ NA
Dai Calf
Feeder to Finish
❑ Yes
[aNo
❑ NA
Dai Heifer
Farrow to Wean
Design
Current
D Cow
Farrow to Feeder
D . P.aul
Ga aci
P,a -
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
_
Turke s
Other
Turkg 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?
❑ Yes rRNo [DNA ❑ NE
F-1 Yes ❑No ❑NA 0 N
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
[—]No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
[KNo
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
[aNo
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 2/4/2015 Continued

Facility Number: J Date of Inspection:
Waste Collection & Treatment
. 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
[allo
❑ NA
0 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
[�JNo
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
®,No
[DNA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
� No
E] NA
E] NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
0 No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
[M No
❑ NA
❑ NE
maintenance or improvement?
Application
_Waste
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
F7/1 No
❑ NA
E] NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [K No ❑ NA ❑ NE
❑ Excessive Ponding p 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): U
13. Soil Type(s): Z2Zt {D E C i rz
14. Do the receiving crops differ from those designated in the CAWMP? [:]Yes M -No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes U3 -No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes ® No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes [,a No ❑ NA ❑ NE
[] Yes allo ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes E+No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes V 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 allo
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes V] No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 2/4/2015 Continued

lFacility Number: jEZ - Z f Date of Inspection: f� —
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes J.No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [aNo ❑ 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 E[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
S 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
D NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
® No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[allo
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
gNo
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
2 No
❑ NA
❑ NE
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date:
2/4/2015

Ri-ype of visit: t!i-uompnance inspection V uperatton Review V Structure Evaluation V technical Assistance
eason for Visit: autine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: to—fes Arrival Time: L7p Departure Time: County:Region: D
FarmName: /� - , f j /6 /, / l t_ �a.�MS L L G Owner Email:
Owner Name: -Z—e,e k M c _44 Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative: 2!t -
Certified Operator: L-5.
Back-up Operator:
Location of Farm:
Latitude:
Integrator: / r
Certification Number:
Certification Number:
Longitude:
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 ® 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 QNo E3NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters [:]Yes [KNo ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 2/4/2014 Continued
Design Current
Design
Current
Design torrent
Swine Capacity Pop.
Wet Pointry
Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
La er
Dairy Cow
Wean to Feeder
Non -Layer
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Dry Cow
Farrow to Feeder
D . P,©ni
Ca aci
Po
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
1--p—od
Boars
Pullets
Cow
Other
Turkey Poutts
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 ® 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 QNo E3NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters [:]Yes [KNo ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 2/4/2014 Continued

jFaciUty Number: - ( 771 IDnte of Inspection:
Waste Collection & Treatment
❑ Yes
V1 No
❑ NA
❑ NE
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
E3 -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:
17. Does the facility lack adequate acreage for land application?
❑ Yes
[S -No
❑ NA
Spillway?:
18. Is there a lack of properly operating waste application equipment?
❑ Yes
® No
❑ NA
Designed Freeboard (in):
Required Records & Documents
Observed Freeboard (in): 3
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[gNo
❑ NA
5. Are there any immediate threats to the integrity of any of the structures observed?
[:]Yes
F No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
the appropriate box.
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental threat,
notify DWQ
7_ Do any of the structures need maintenance or improvement?
❑ Yes
RNo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[Z 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�jNo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
EgNo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes O -No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): X j enlet
13. Soil Type(s): OR ZAI,91�2A Gt ih
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
V1 No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
L.No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
1K No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[S -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
[gNo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[0 No
❑ NA
❑ NE
the appropriate box.
WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes rNo
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield [:1120 Minute inspections ❑ Monthly and I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes Callo
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes U4 No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑NA ❑NE
Page 2 of 3 2/4/2011 Continued

Facili Number. - Date of Inspection: 6—
r 24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [H No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes 5J -No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes _3 No .❑ NA ❑ NE
❑ Yes%E No ❑ NA ❑ NE
❑ Yes [a No ❑ NA ❑ NE
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes [&No ❑ NA ❑ NE
❑ Yes MNo ❑ NA ❑ NE
❑ Yes Jallo
❑ Yes ,] No
❑ Yes 2g_No
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
Reviewer/Inspector Name:!� �_ Phone:
Reviewer/Inspector Signature:
Page 3 of 3
Date: 6, -,/ 13-
21412011

Type of Visit: ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit; outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: ® Arrival Time: 4! Departure Time:County-5 Region: J �
Farm Name: Me_�lga,Q/ �y,_ L [rG Owner Email:
Owner Name: /%% Phone:
Mailing Address;
Physical Address:
Facility Contact: 177C�,.-.__ Title: k-.-'
Phone:
Onsite Representative: jIntegrator:
Certified Operator:Certification Number:
Back-up Operator:
Certification Number:
Location of Farm: Latitude: Longitude:
R� Design Current
❑ No
Design
Current
t Design Current
❑No
Swine sCapacity Pop.
Wet Poultry
Capacity
Pop.
Cattle Capacity Pop.
ean to Finish
La er
Dai Cow
ean to Feeder
Nan -La er
Dai Calf
eder to Finish (�
Dai Heifer
rrow to Wean
t
Design
Current
Cow
rrow to Feeder
Dr P,oultr.
Ca aei
P,o
Non -Dairy
rrow to Finish
La ers
Beef Stocker
lts
Non -La ers
Beef Feeder
ars
Pullets
Beef Brood Cow
- x
cy
Turke s
__
Either
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 DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes [0 -No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑Yes
❑No
[_]NA
ONE
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes ❑ No
❑ Yes fj�j No
[:]Yes [-No
❑ NA ❑ NE
[:INA ❑ NE
[:INA ❑ NE
Page 1 of 3 2/4/2011 Continued

Facili Number: - Date of Inspection:
❑ Yes
SNo
❑ NA
❑ NE
Waste Collection & Treatment
❑ Yes
2. No
❑ NA
❑ NE
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
E[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
❑ NA
Identifier:
the appropriate box.
Spillway?:
Designed Freeboard (in):�
Observed Freeboard (in): S�
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
allo
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
R!.No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
Pq No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
fg 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
JZLNo
❑ NA
❑ NE
maintenance or improvement?
Waste Aoolication
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 R No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload [] Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):/Duns—}d,/
13. Soil Type(s): _ CJ l �p�/� / X';t'-t3, _
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes (Z 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 E[ No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
SNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
2. No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
�jNo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check
❑ Yes
E[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 21 No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall []Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I " Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes 54 No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes QLNo
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
E] NA ❑NE
Page 2 of 3 2/4/2011 Continued

[Facility Number: / Date of Ins ection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes JK No ❑ NA ❑ NE
' 25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes MNo ❑ 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 1�1 No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes JZJ No ❑ NA ❑ NE
Other Issues
2$. Did the facility fail to property dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately_
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes 0,No ❑ NA ❑ NE
❑ Yes S No ❑ NA ❑ NE
[]Yes [KNo ❑ NA ❑ NE
❑ Yes ®No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes )23,No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative? ❑ Yes [&No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes C!�iNo ❑ NA ❑ NE
Comments (refer to question #f): 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:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 2,'7 3 33
Date: 41 +�d�
2/4/2011

Date of Visit: �CIrrival Time: Departure Time County'1'
Farm Name: '2� 114
fiu%�r,,� / J,�t.cs Owner Email:
Owner Name: [ �C�v�-(/L- Phone:
Mailing Address:
Physical Address:
Region:{ tZA
Facility Contact: 7_Az k 4Ca r i, Title: Phone:
Onsite Representative: Integrator:
Certified Operator: Certification Number: ( Q W
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Discharzes 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 1TNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes
Design Current=
❑ NA
Design
Current
��� Design Current
Swine
Capacity Pop,
Wet Poultry
Capacity
Pop.
Cattle = Capacity Pap.
Wean to Finish
La er
Dairy Cow
Wean to Feeder
-Layer
Dairy Calf
Feeder to Finish
S35
"'*"
Dai Heifer
Farrow to Wean
Dry Cow
Farrow to Feeder
D _Poult ,
Ca aci
P.o
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
, ..._.
O#her
Turkey Poults
Other
Other
-
Discharzes 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 1TNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
EfNo
❑ NA
❑ NE
❑ Yes
Eg No
❑ NA
❑ NE
Page 1 of 3 2/4/2011 Continued

Facili Number: a z- Date of Ins ection.
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes Z '< ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes 0 No ❑ NA . ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
identifier.-
Spillway?:
dentifieriSpillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3
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
E!No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
[a No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[]i 'Ho
❑ 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
[ lf' 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
[g<o
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals
(Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into
Bare Soil
❑ Outside of Acceptable CropWindow❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): C 13 ©-s
13. Soil Type(s): pN`iti� 1L a irk
14. Do the receiving crops differ om those designated in the CAWMP?
❑ Yes
0]No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
©�f4o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
[2"N- o
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[R'No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
ENo
❑ NA
❑ NE
Reouired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yeso
❑ NA
C] NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
MNo
❑ 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 Q'10 ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes iN ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes �W "" ❑ NA ❑ NE
Page 2 of 3 2/4/2011 Continued

Facili Number: - Date of Inspection: 0d
24'. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes E] -Ko ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes (3 -No 0 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 E]I<o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes E31<o ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes Q lAo ❑ 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
®'bio
❑ 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
[Rlo
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface file drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
[ 1410
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
Cg -No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
M o
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
LU4o
❑ NA
❑ NE
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone o— 3,-J3_3
t Date: [�
2/4/2011

GILL iv`ision of Water Quality54,
Facility Number Division of Soil and Water Conservation
Q Other Agency
Type of Visit: ompliance Inspection 0 Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: GrIfoutine O Complaint 0 Follow-up O Referral 0 Emergency O Other O Denied Access
Date of Visit:— A/rrival Time: /, Departure Time: t Countyf­ Region:
Farm Name: Z& r �( f%l��/,�1/�vt r -I 116, Owner Email:
Owner Name: _,p e, rYl e C'.0 JI �� Phone:
Mailing Address:
Physical Address:
Facility Contact: Za e, /7 k e& ���s� Title: e er— Phone:
Onsite Representative: _j cc , Integrator:
Certified Operator: Certification Number:
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Design
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
Page I of 3
[:]Yes �No ❑ NA ❑ NE
[:]Yes ❑No
[:)Yes ❑No
[:]Yes ❑No
[:]Yes ® No
❑ Yes No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
21412011 Continued
'A P,r
-
Design
Current" Design Current
Swine
Capacity= Pop
Wet Poultry
Capacity
Popes Cattle Capacity Pop.
Wean to Finish
La er
Dai Cow
Wean to Feeder
Non -La er
Dai Calf
Feeder to Finish
–
Dai Heifer
Farrow to Wean
Design
Current _
D Cow
Farrow to Feeder
D . Poul
Ca aci
Po .
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
-
Other
Turk,-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 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?
Page I of 3
[:]Yes �No ❑ NA ❑ NE
[:]Yes ❑No
[:)Yes ❑No
[:]Yes ❑No
[:]Yes ® No
❑ Yes No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
21412011 Continued

Facility Number: jDate of Ins ection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
nNo
❑ 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): 3
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
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
0 NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[a No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
ZLNo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
MINo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
29 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): to' -TT f goo
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
® No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
['71 No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
MNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[2.No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
0 No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
RNo
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists [—]Design [:]Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes O—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 [a No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes CF�No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑ NA ❑ NE
Page 2 of 3 214/2011 Continued

a
Facility Number: Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes Callo
25. Is the facility out of compliance with permit conditions related to sludge? if yes, check ❑ Yes ES 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 M No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes N--JNo
Other issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
® No
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
® No
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
[—]Yes
® No
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
®-No
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
® No
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
� No
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
Q No
❑ NA ❑ NE
❑ NA ❑ NE
❑NA E] ME
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question #): Explainany,YES'answers and/or any additional recommendiitions.or any other comments
Use drawings, facility to better expI In,.s.ituations' a additional pales as necessary) _ _ 4 _ r ,
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Page 3 of 3
�v��--� Phone: g/Q z)0
Date:/�-
2/4/2011

Type of Visit: compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: Q1144tftine 0 Complaint 0 Follow-up Q Referral 0 EmergeneV 0 Other 0 Denied Access
Date of Visit: Arrival Time: v Departure Time: 'pa County: �. rte— Region:/Lj�2
Farm Name: , a6 % fP/i - /w-4 I—, c Owner Email: "�
Owner Name: 26cGlc /SIC ek en _ Phone:
Mailing Address:
Physical Address:
Facility Contact: Z4GA /NO-6?//ewL_ Title: 67eJhPhone:
Onsite Representative: �.��« Integrator: 2?z
Certified Operator: Certification Number:
Back-up Operator:
Certification Number:
Location of Farm: Latitude: Longitude:
Discharges and Stream lmnacts
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)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes [—]No
❑ Yes �R No
[:]Yes [NLNo
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 2/4/2011 Continued
Design . CurrentDestgnrCent�D`esign
Current
Swine
pacity Pop.
Wet Poultry, Capacity F'P,.op.
Cattle
Capacity Pop.
Wean to Finish
La er
Dai Cow
Wean to Feeder
Non -La er
Dai Calf
Feeder to FinishF
.
Da Heifer
Farrow to Wean
�Design�Current
D Cow
Farrow to Feeder
D , Poult _ Ca actty . Pio ,
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other;
-TurkeyPoults
Other
Other
Discharges and Stream lmnacts
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)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes [—]No
❑ Yes �R No
[:]Yes [NLNo
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 2/4/2011 Continued

Facili Number: Date of Inspection: l
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes (D 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): g
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
10 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
E&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
Q No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[K 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
to 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 E] Evidence of Wind Drift [3 Application Outside of Approved Area
12. Crop Type(s): - Ee_e 'yyt241Q i���e
13. Soil Type(s): I `,
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes allo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes MNo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes allo ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes &No ❑ NA ❑ NE
[]Yes E&No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes E[ No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check [:]Yes allo ❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes Q No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes R No [] NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ®. No ❑ NA ❑ NE
Page 2 of 3 2/4/2011 Continued

Facility Number: _a jDate of Inspection. fo /
24. Did the facility fail to calibrate waste application equipment as required by the permit?
'1
❑ Yes Qg No
❑ NA ❑ NE
25. is the facility out of compliance with permii conditions related to sludge? If yes, check
❑ Yes jo No
❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes M No
E] NA E] NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes 0 No
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes ® 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 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 Q No
❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below.
❑ Yes 5g�.No
❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes ® No
❑ NA ❑ NE
33. Did the Reviewer/inspector fail to discuss review/inspection with an on-site representative?
❑ Yes ® No
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes M No
❑ NA ❑ NE
Comments (refer to:question #): Explain any YES.answers and/or. any additional recommendation's oraany other comments
, (use addit,onel pages as necessary).Use drawns'offacilit3 to better explain situations k
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: �3
Date: b -?z &
2/4/2011

a
Type of Visit UFCommppliance Inspection U Operation Review O Structure Evaluation U Technical Assistance
Reason for Visit routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: v j Q Arrival Time: Departure Time: County: Region:
T AV
Farm Name: 6rM_5 , /PG Owner Email:
Owner Name: 7—etc A _ _ M42- 0141 .... Phone:
Mailing Address:
Physical Address:
Facility Contact:2 �r./� b2ejC& :, Title: 1910,—a .cam _ Phone No:
Onsite Representative: ezx _ Integrator: 0WIxe g!i✓� rt_
Certified Operator: Operator Certification Number: 1 �
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: 1:10 E__11
=11
Longitude: 0 0 = f = "
Design Current
Design Current
Design Current
Swine C*apacity Population
Wet Poultry Capacity Populstion
Cattle Capacity Population
❑ Wean to Finish
❑ La erI
on -Layer
❑ Dairy Cow
El Dairy Calf
❑ Wean to Feeder
❑ NA
® Feeder to Finish j2;L
❑ Yes
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
❑ Yes
ElNon-Dairy
❑ Farrow to Finish
❑ Layers
❑ Beef Stocker
❑ Gilts
❑ Non -Layers
❑ Beef Feeder
❑ Boars
❑ Pullets
❑ Beef Broad Co
❑ Turkeys
Other
❑ Other
❑ Turkey Poults
❑
lNumberloubtrMu ures
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?
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
[]Yes A -No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
IQNo
❑ NA
❑ NE
❑ Yes
PS No
❑ NA
❑ NE
Page 1 of 3 12/28/04 Continued

12. Crop type(s)
0
13.
Facility Number: rz — Date of Inspection
Waste Collection & Treatment
14.
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
QSNo [:1NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure
5 Structure 6
Identifier:
❑ NE
16.
Spillway?:
❑ Yes
f. No
Designed Freeboard (in):
❑ NE
17.
Observed Freeboard (in): 3D
❑ Yes
Wo
❑ NA
❑ NE
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
RNo ❑ NA EINE
(ie/ large trees, severe erosion, seepage, etc.)
❑ NA
❑ NE
6. Are there structures on-site which are not properly addressed and/or managed
❑ Yes
®,No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
F[No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
4 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
JR No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
I0. 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
45 No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
0
13.
Soil type(s) C/ j D X Z�K Q 16 r
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
r9No
❑ 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 acre determination ?
❑ Yes
f. No
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
Wo
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
LgNo
❑ NA
❑ NE
Comments {refer toaquestion #): Explarny'YES answers and/or any recommends#ions or any other comments.
Use drawings af�facility to better explain` srtuahons.t(use additional pages as necessary) u
Reviewer/Inspector Name Y .e r Phone:
Reviewer/Inspector Signature: Date: l 0
Page 2 of 3 LZIZ5/04 Gonanuea

Facility Number: ON— Date of Inspection
Re uired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes E.NO ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes allo ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
2 i . 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 V Rain Inspections ❑ Weather Cade
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 reviewlinspection with an on-site representative?
33_ Does facility require a follow-up visit by same agency?
❑ Yes
10 No
❑ NA
❑ NE
❑ Yes
0 No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
ZNo
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
fR No
❑ NA
❑ NE
❑ Yes CR No ❑ NA ❑ NE
❑ Yes [9No ❑ NA ❑ NE
❑ Yes [3No ❑ NA ❑ NE
❑ Yes [3 No ❑ NA ❑ NE
❑ Yes S No ❑ NA ❑ NE
❑ Yes [)I No ❑ NA ❑ NE
Addthonal Cpmment5 atllor'
aD ar wig s �.
Page 3 of 3 12/28/04
Page 3 of 3 12/28/04

Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
. I
Date of Visit: 19k-109 I Arrival Time: � Departure Time: D.Z` County: 34n^ o,*'! Region: 'k0
Farm Name: , MCCU 1 en C Owner Email:
Owner Name: Ark , _ l C 64 t ep►_ --UL Phone:
Mailing Address:
Physical Address:
Facility Contact:__ G�� Title:
Onsite Representative: N
Certified Operator: _ L C (r'et _
Back-up Operator:
Phone No: 22
Integrator: Mt�pJ�.,
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: =0
=d
a Longitude: = ° =, a u
Design Current
DesignWrrent
Design Current
Swine Capacity Population
Wet Poultry Capacity Population
Cattle Capacity Population
❑ Wean to Finish
❑ Layer
❑ Dairy Cow
❑ Yes
❑ No
❑ Dairy Calf
❑ Wean to Feeder
❑ Non -Layer
Feeder to Finish g
❑ No
❑ Dairy Heifer
Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
El Layers
❑ Beef Stocker
El Gilts
❑ Non-LayMetsers
❑ Beef Feeder
[I Boars—___
El Pullets
Beef Brood Cowl
❑ NE
❑El
Turke s
❑ Yes
Other
❑ Other
❑ Turkey Poults
❑ Other
1Vumtser of Structures:
other than from a discharge'?
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
RNo
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
0 NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
1P 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
PNA
❑ NE
2. Is there evidence of a past discharge from any part of the operation'?
❑ Yes
�DNo
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
No
❑ NA
❑ NE
other than from a discharge'?
12/28/04
Continued

Facility Number: �2 j;t
Date of Inspection
Waste Collection & Treatment
U NA
4. Is storage capacity (structural plus storm
storage plus heavy rainfall) less than adequate?
a. if yes, is waste level into the structural freeboard?
Stntcre I Stntcture 2 Structure 3 Structure •1
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
❑ Yes rNo ❑ NA ❑ NE
❑ Yes ❑ No .0 NA ❑ NE
Structure i Structure G
5. Are there any immediate threats to the integrity of any of the structures observed? 0 Yes � No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed ❑ Yes (tANo ❑ NA ❑ NE
through a waste management or closure plan? r
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 PNo ❑ NA ❑ NE
8. Do any of the stuctures Zack adequate markers as required by the permit?
(Not applicable to roofed pits, dry stacks and/or wet stacks) El Yes No
Y. Does any part of the waste management system other than the waste structures require ❑ Yes iP9 No
maintenance or improvement?
Waste AuDlication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ YesNo
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes N No
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground [:1 Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or ] 0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soi
❑ Outside of Acceptable Crop Window [:]Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
❑ NA ❑ NE
❑ NA ❑ NE
0 N El NE
❑ NA ❑ NE
I
11( �t
14. Do the receiving crops differ from those designated in the CA WMP?
{J Yes
W No
U NA
LI NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
1� No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination'
❑Yes
P No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments. I
Use drawings of faeility to better explain situations. (use additional pages as necessary):
Reviewer/inspector Name <..D Phone,7/0— - SS��
Reviewer/Inspector Signature: j&J24Date: S
1228/04 Continued

Facility Number: — Date of luspection 1 0
It
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes T No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? lfyes, check ❑ Yes[�No [INA El NE
ElEl❑Design El El the appropirate box. WUp Checklists II
21. Does record keeping need improvement? if yes, check the appropriate box below. ❑ Yes y No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I " Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge'?
❑ Yes
P No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
In No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
leNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
[P No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
TNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
EN No
❑ NA
❑ NE
Other issues
2$.
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
EINE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
1p No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
`p No
❑ NA
❑ NE
Additional'Commerttsandlor;Drawings:
Page 3 of 3 12/28/04

[3.rlqS 4--Al-kre W 00,112009
® Division.6f Water Quality
Facility Number �Z 2IZ 0 Division of. Soil and Water Conservation
- - 0 Other.:Agcncy
Type of Visit ® Compliance Inspection 0 Operation Review 0 Structure Evaluation Q Technical Assistance
Reason for Visit ® Routine 0 Complaint O Follow up O Referral () Emergency O Other ❑ Denied Access
Date of Visit: /2-Z7-0 % Arrival Time- Departure Time: County: gtAt - (/
Farm Name: ` a e Z D - 2 S— Owner Email:
Owner Name: 45mygW3 Phone:
Mailing Address:
Physical Address:
Facility Contact: 2:+l 1 Title: �r,c3rJt.1� Phone No:
Onsite Representative: _ maw Po 0� _ Integrator: 44!� Bpo
Certified Operator: Operator Certification Number:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Back-up Certification Number:
Region: -147Q9
Latitude: =0
❑ 1 =&A Longitude: El ° =' = a
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -La et
Other
❑ Other _-
Dry Poultry
❑
Layers
❑
Non -Layers
❑ Pullets
❑ Turkeys
❑
- urkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Cattle
Design Current
Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifei
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
Number of Structures:
b. Did the discharge reach waters of the State'? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation'?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes P No ❑ NA ❑ NE
❑ Yes
V No
❑ NA
❑ NE
❑ Yes
(j No
❑ NA
EINE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
12/28/04 Continued

Facility Number: Z/2 Date of Inspection
[--]Yes
®No
[:INA ❑NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
Waste Collection & Treatment
Reviewer/Inspector Name
9. Does any part of the waste management system other than the waste structures require
[-]Yes
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
[ANo
[INA
❑NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
[UNo
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier: 4
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
Spillway?: /SIO
[�R No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
Designed Freeboard (in): 9
❑ PAN [I PAN > 10% or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window ElEvidence of Wind Drift E]Application Outside of Area
Observed Freeboard (in): tf/
1
12. Crop hFPe(s)U'Xu �� Linry GfU elj:,,J favN cads
13. Soil type(s) IVO A Or A
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[?No
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
�?No
6. Are there structures on-site which are not properly addressed and/or managed
❑ Yes
[]?No
❑ NA
LINE
through a waste management or closure plan?
0 No
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
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
[HNo
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
[--]Yes
®No
[:INA ❑NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
Reviewer/Inspector Name
9. Does any part of the waste management system other than the waste structures require
[-]Yes
[RNo
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
0 No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
[�R No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN [I PAN > 10% or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window ElEvidence of Wind Drift E]Application Outside of Area
1
12. Crop hFPe(s)U'Xu �� Linry GfU elj:,,J favN cads
13. Soil type(s) IVO A Or A
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[gNo
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
�?No
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
[8 No ❑ 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
® No
❑ NA ❑ NE
?Comments (refer "tn question #): Explain any OYES answers and/or. any recommendations or any outer comments�l�
-,Use drawingsa`ot facility to better explain situat,ons.(use`additional pages as necessary)
Reviewer/Inspector Name
{� r C �e;�S - -Phone: `j/o. 4133 • 3 30 0
Reviewer/Inspector Signature:
Date: %Z --2 7—ZQ0-1
Page 2 oj'3 12/28/04 Continued

Facility Number: 97 —Z/ Z Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available'? ❑ Yes N No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check ❑ Yes [R No ❑ NA ❑ NE
the appropirate box. ❑ WUp ❑ Checklists
❑ Design El Maps E] Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ® No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I " Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [)4 No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[8 No
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[N No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
VNo
❑ NA
❑ NE
25. Did the facility fail to have an actively certified operator in charge?
❑ Yes
V No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
[4 No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[WNo
❑ NA
El 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
[�j 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
P 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
�FNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
WNo
❑ NA
❑ NE
Comments and/or
12128104

December 1, 2006
CERTIFIED MAIL
RETURN RECEIPT REQUESTED
Joseph A Pope
Pope Brothers Rackley Farm (20-25)
5450 Garland Hwy
Clinton, NC 283285450
Michael F. Easley, Governor
William G. Ross Jr., Secretary
North Carolina Department of Environment and Natural Resources
Subject: Application for Renewal of Coverage for Expiring NPDES General Permit
Dear Permittee:
Alan W. Klimek, P.E. Director
Division of Water Quality
RECEIVED
DEC 0 6 2006
psi — FAYEIiilAl,l.E 141 -
Your facility is currently approved for operation under one of the Animal Waste Operation NPDES General Permits, which expire on
July 1, 2007. Due to changes in federal rules, facilities that do not discharge nor propose to discharge may choose whether or not to
retain coverage under an NPDES General Permit. Copies of the draft animal waste operation NPDES general permits and the State
Non -Discharge General Permits are available at httpalh2o.enr.state.nc.us/aps/afou/downloads.htm or by writing or calling:
NCDENR — DWQ Animal Feeding Operations Unit
1636 Mail Service Center
Raleigh, North Carolina 27699-1636
Telephone number: [phone]
In order to assure your continued coverage under one of these two types of general permits, you must submit an application for permit
coverage to the Division. Enclosed you will End a 'Request for Certificate of Coverage Facility Currently Covered by an Expiring
NPDES General Permit.' The ayplication form must be completed and returned by January 2, 2007. Please note, you must include
two (2) copies of your most recent Waste Utilization Plan with the application form.
Failure to request renewal of your coverage under a general permit within the time period specified may result in a civil penalty.
Operation of your facility without coverage under a valid general permit would constitute a violation ofNCGS 143-215.1 and could
result in assessments of civil penalties of up to 525,000 per day.
If you have any questions about the draft general permits, the enclosed application, or any related matter please feel free to contact the
Animal Feeding Operations Unit staff at 919-733-3221.
Sincerely,
w �
Ted L. Bush, Jr., Chief
Aquifer Protection Section
Enclosures
cc (w/o enclosures): Sampson County Soil and Water Conservation District
Fayetteville Regional Office, Aquifer Protection Section
AFO Unit Central Files - 820212
Carroll's Foods Inc
NorthC=1ina
Aquifer Protection Section 1636 Mail Service Center Raleigh, NC 27699-1636 Telephone: (9 19) Naturdiff
Internet: www.ncwaterquality.ore Location: 2728 Capital Boulevard Raleigh, NC 27604 Fax 1: [phone]
Fax 2: [phone]
An Equal Opportunity/Affirmative Action Employer- 50°% Recycledll0°% Post Consumer Paper Customer Service: [phone]

Type of Visit ® Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: ; Ud County: Ci a ✓ Region: Fns
sr
Farm Name: .tNc . 20 —2S Owner Email:
Owner Name: ^ p �► �, .T"'_ Phone:
Mailing Address:
Physical Address:
[� ro o - , i z , /3 h'3
Facility Contact: C .e_ Title: Phone No:
,_
Onsite Representative: _ ac- �� i - _ integrator: /�w��� ✓ �✓
Certified Operator: Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: ❑ 0 =4
=64 Longitude: ❑ ° =I ❑ "
Design Current
❑ Yes
09No
❑ NA
Design Current
Design Current
Swine Capacity Population
Wet Poultry Capacity Population
Layer I
Cattle Capacity Population
❑Dai Cow
❑ Wean to Finish I I
❑ Yes
❑ Wean to Feeder I I
❑ Non -La er
I I
i Calf
❑ Yes
Feeder to Finish 152 TO I52
❑ NA
❑ Dairy Heifer
Ej Farrow to Wean
Dry Pointry
❑ Dry Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
❑ Layers
❑ Beef Stocker
❑ Gilts
❑ Non -Layers
❑ Beef Feeder
❑ Boars
❑ Pullets
ID Beef Brood Co
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Turkeys
M No
Other
❑ Other
❑ Turkey Poults
❑Other
Numfser of 5truetures:
Discharses & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
09No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
r No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
❑ Yes
[R No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
No
❑ NA
EINE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
M No
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
12/28/04
Continued

Facility Number:
Date of Inspection/8` O
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:
❑ Yes [f] No ❑ NA EINE
❑ Yes � No ❑ NA ❑ NE
Structure 5 Structure 6
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): �r
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes[ No [INA [INE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed ❑ Yes q 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 �O No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes q5 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 T No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10_ Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes I No ❑ NA ❑ NE
maintenance/improvement?
11.
Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
[$ No ❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[]PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window/ ❑ Evidence of Wind Drift ❑rApplication Outside of Area
12.
Crop type(s) *�t.1'M u ( F r4 W
13.
Soil type(s)
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No ❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
1X11 No ❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
[1 No ❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
[9No ❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
[0 No ❑ NA
❑ NE
Comments (refer to gaestion,#): , Explain any YES answers and/or any recommendations or any other co nvents +
Use drawings of facility to better. explain situations. use additional a es as necessary):
Reviewer/Inspector Name K fQ— Phoae %OJ 933; _773 Q
Reviewer/Inspector Signature:Date:
Page 2 of 3 12/28/04 Continued

9 iIT-o 6
Facility Number: Z -2J Z Date of Inspection ` -/Y-O
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 0 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes JD No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists
❑ Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [)I No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge`? ❑ Yes OfNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [k No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[�f No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
[)i No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
® No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
[ RNo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[P No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
M 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
ERNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
E§ No
❑ NA
❑ NE
F 5 J r:-ew9 T SF
Additional @omments.and/or
- t]i: `xs. - -
Drawmgs „ }'K
d.. ,
� ja
AY^ ...
f
12/28/04

4,
Type of Visit 0 Compliance Inspection ()Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: �-y-off Arrival Time: /,2 :Oa Departure'rime: County: _ _ Region: F'P�
Farm Name: lean .202�) Owner Email:
Owner Name: 1 PooE Phone: `l�D `59� - 5}3SH er 3011'
Mailing Address: Sy �p Ggr�an� �., t! 'n7�or, N�_ _ _ Ir f
Physical Address:
Facility Contact: la;�' o,ce Title: Phone No: cf/0 - 990- �3yo
Onsite Representative: ax Integrator: Carroll ter, Z zx.
Certified Operator:Tap_ �4n _ Operator Certification Number: I7,989
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boats
Back-up Certification Number:
Latitude: [--]'F--]' E:] Longitude: [= e FT
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑
Layer
i ❑ Non -Laver
Other
❑ Other
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkc s
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made`'
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifei
QDry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
Number of Structures:
b. Did the discharge reach waters of the State? (if yes. notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes [;Ko ❑ NA ❑ NE
❑ Yes
[:1 No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
El NA
❑ NE
❑ Yes
❑,<om No
E] Yes
Ltd.
❑ NA
❑ NE
❑ Yes
q<
❑ NA
❑ NE
12128/04 Continued

Facility Number: g3 — Date of Inspection S O�
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 9Tio ❑ 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?: �a
a
Designed Freeboard (in):��� "
Observed Freeboard (in): �
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes B<o ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.) ,�--,,��
6. Are there structures on-site which are not properly addressed and/or managed ❑ l.
Yes " o ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ®-o ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
Pio
❑ 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
LI<o
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
21�o
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
E3 -<o
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals
(Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate
Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
j X30 Sv r 1�% r 32
r co
12. Crop type(s) S�'rm "# S G.K, ;; Corn -5�b'0'04
W;,,
13. Soil type(s) OrA AJ,
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
e lvo
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
Q-90
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination%❑ Yes
❑ No
❑ NA Q -KE
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA CNIE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
Pg10
❑ NA ❑ NE
�`. P'P` �as pla.rt�� /`avnc�•v� r•ca��, co�'n
Reviewer/Inspector Name 1
Reviewer/Inspector Signature:
,QAJ �vJa„S �o S�ora2. roe• �-v�
Phone: Cf/0- LIJ?&-851t/ t-,,
Date:

Facility Number: Date of Inspection
Re aired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
❑ Yes [3<o ❑ NA ❑ NE
20.
Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
tti44
❑ NA
❑ NE
the appropirate box. ❑ >Ty/❑ Che fists ❑ De =n ❑ MaKs'_ ❑ O r
30. At the time of the inspection did the facility pose an odor or air quality concern`?
❑ Yes
21.
Does record keeping need improvement? If yes. check the appropriate box below.
❑ Yes
Eg<o
❑ NA
❑ NE
❑tion ❑ Week! t -Fre and ❑ Wtr,�ysis- ❑ Seii As tti�a ❑ Wva €ers
❑
❑ Yes
LTJ No
❑ NA
❑-Rairrfatt ❑ ❑ ••:_� 1 n ❑
General Permit? (ie/ discharge, freeboard problems, over application)
❑-V4Qath#P4;@de-
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
-Ko
El NA
El NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
Yes
ElD
,R
-Tio
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ NA
El NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
,I<o
E _fNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
EKo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification'?
❑ Yes
Q<o
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes [—::ff'No ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
Ej�o
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern`?
❑ Yes
�,�
[ No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
LTJ No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
o
[3 NA
El NE
33. Does facility require a follow-up visit by same agency'?
❑ Yes
,9,
2 o
❑ NA
❑ NE
A`ddtttonal Commentc.,andlor,Drat Ings' ,
12/28/04
12/28/04

V
V
Type of Visit • Compliance Inspection O Operation Review O Lagoon Evaluation I
LReason for Visit 0 Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Date or V, it: ® Tune:
K7Jey
O =Not Operational Q Below Threshold
015ermitted [Certified U Conditionally Certified [3 Registered Date Last Operated or Above Threshold: ....
Farm Name: ... ,Pt�G W . !�I of .....Far. W �zL._..L� o : ,� County: _5�^'' rs+? _ ..._ _._ F -4o
Owner Name: ._ `ld�-..¢ - Pva: .... .............. _ .__ ... Phone No:
................a...�.�.2�i._......................_----
Facility Contact: ........ ........� a�r........ . Title: ............. .......................... ...... Phone No: . _ ........._.__
Onsite Representative: 2-4
'------RV..e.................. .................
Certified Operator:------ To p r _.. __. Operator Certification Number:. --0.A? -19k.-.-.
Location of Farm:
.,wine ❑ Poultry ❑ Cattle ❑ Horse Latitude • 4 C° Longitude • 1 14
Discharp,es & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes SWC
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes [;-XG
b. If discharge is observed. did it reach Water of the State? (If yes, notify DWQ) ❑ Yes o
c. If discharge is observed, what is the estimated flow in gal/min? 1 —
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes 0'Kb-
2. Is there evidence of past discharge from any part of the operation? ❑ Yes [gNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes E�vo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes EW6'
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure b
Identifier I , ,.,_...... _ .. _ . ....... _.._......... _.....
Freeboard (inches): 37�
12/12103 Continued

Facility Number: —.2,.2
Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, j] Yes [ 1 o
seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a waste management or ❑ Yes l40
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 L�fl
8. Does any part of the waste management system other than waste structures require maintenancelirnprovement? ❑ Yes U40,
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes [�o
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes 91Z
11. Is there evidence of over application? if yes, check the appropriate box below. ❑ Yes 040
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type 6ak. & Lan 3, Car.,
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes [9 -No
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge attor below
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours?
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional
Air Quality representative immediately.
❑ Yes &No
❑ Yes ONO
❑ Yes G No
❑ Yes 0140
❑ Yes Ek90
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes 13 -No
❑ Yes Diqo
Commits (reterto gieest,on #) �EYplrnnairy�YFS_anssverrs anri/oramy.iias oraay,otiier camment4. �` -� �'-� �'`�-r
_Use drawings of>h�ty to better,exp�n sttuaboas (rue admtzoual pages as accessary) Y Wield COPY ❑ Ftnal Nates �� ��
-
Y
Reviewer/Inspector Name
Reviewer/Inspector Signature:Date: ]� U
01
12/12/03 Continued

Facility Number: — Date of Inspection , c
Required Records & Document~
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/3WUF, c sts, dem' ,nes, etc.)
23. Does record keeping need improvement? If yes, check the appropriate box below.
❑ pp cation ❑ Fmeba3rd [I �alysis ❑ Sail £ding
#-/L-> r,Q d-00-> 34
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
25. Did the facility fail to have a actively certified operator in charge?
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
27. Did Reviewer/Inspector fail to discuss review/inspection with on-site representative?
28. Does facility require a follow-up visit by same agency?
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
3I. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
32. Did the facility fail to install and maintain a rain gauge?
33. Did the facility fail to conduct an annual sludge survey?
34. Did the facility fail to calibrate waste application equipment?
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below
❑ &wlin� Crop Yield Form fter l" Rain
❑ 1 ctions ❑
❑ Yes B -Mo
❑ Yes [moo
❑ Yes [I O
❑ Yes KNo
❑ Yes []To
❑ Yes EkNo
❑ Yes SINo
❑ Yes [}No
❑ Yes 9 -No
B -Yes ❑ No
❑ Yes UM
❑ Yes LM
❑ Yes 01%
❑ Yes BlBio
[Q.Ves ❑ No
113 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
ReL'"eWe Lrolo '*U der".S,
7
12112103

t
❑ DS WC Animal Feedlot O Y
peration Review ¢ t
eel
DWQ Animal Feedlot O � peration Site Inspection �
a ..
.. ...... ...... c+eneee..�- �.-'"--. -_.. .w....-... .....
0 Routine O Cum taint O F ollow-u cif DW ins etion O Follow-up of DSWC' review O Other
Facility Number Date of inspection
Time of Inspection : Sd 24 hr. (hh:mm)
D Registered U Certified 0 Applied for Permit O Perm/fitted [] slot O erational I Date last Operated:
Farm Name:.fp'- .�-.., County: ......... ft�
.......................................
....�...............
Owner \ane:......-. Phone \ o C.1.a....�Z ......................................
.....
Facility Contact. �1�ff.SP ... �p��.................... Title:................................................................ Phone No:...................................................
(Mailing Address: ......................7.,�...6-!61.`.9e �1...................................................... ..........................
Onsite Representative:...-. _Z ...
.............. ... ........
II
Certified Operator...........%JA— ........!?�G............. Operator Ceertification Nuntber:... 7 -
Location of Farm: /�/~'���' s� ys S!_� �v �y�i,,..� 6,-%
.........................................................-.....-..................................................:.................................................... - -.............-..............................
19...... r. ........ .......... ................... ........---................. ............
Latitude �« Longitude * 6 ;4
Design Current Design Current Design:;, Current
Swuze -_' Capacity Population Poultry Capacity _Population Cattle=Capacity P' lation "
❑ Wean to Feeder JE1 Layer ❑ Dairy
Feeder to Finish ,z ❑ Non -Layer — ❑ Nan -Dairy
❑ Farrow to Wean • }
❑ Farrow to Feeder 10 Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ Boars Total SSLW
Nu`mber of Lagoons /Holding Ponds: ❑ Subsurface Drains Present ❑Lagoon Area JE1 Spray Field Area
❑ No Liquid Waste Management System
General
L Are there any buffers that need ntaintenance/improvement'?
2. Is any discharge observed from any part of the operation?
Dischar!=c originated at: ❑ Lagoon ❑ Sprav Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it roach Surface Water? (11' yes, notit'y D%k"Q)
c. If discharge is observed, chat is the estimated flow in-.Xmin?
d. Does discharge bypass a lagoon system? i If yes, no DWQ}
3. is there evidence of past discharge from any part of the operation?
4. Were there any adverse impacts to the waters of the State other than from a discharge?
5. Does any part of the waste management system (other than lagoons/holding ponds) require
mai ntenanceli mprovement?
6- Is facility not in compliance with any applicable setback criteria in effect at the time of design?
7. Did the facility fail to have a certified operator in responsible charge?
7/25/97
❑ Yes Wo
❑ Yes 1� No
❑ Yes � No
❑ Yes 0 No
❑ Yes JANo
❑Yes W% No
❑ Yes KNo
❑ Yes KNo
❑ Yes Wo
❑ Yes yuNo
t
Continued on back

Facility Number: Vj —
8. Are there lagoons or storage ponds on site which need to be properly closed'?
Structures (l,agoons.11olding Ponds, Flush Pits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier:
3y� f
Freeboard (ft): ..................C.... .
10. Is seepage observed from any of the structures?
11, is erosion, or any other threats to the integrity of any of the structures observed?
❑ Yes )1 No
❑ Yes FU No
Structure 5 Structure 6
12. Do any of the structures need maintenance/improvement?
(1f any of questions 9-12 was answered yes, and the situation poses
an hnmediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
Waste Application
14. Is there physical evidence of over application?
(If in excess of WMP, or runoff entering waters of the State. notify DWQ)
15. Crap type �.0 �/t i�........................... ... ......
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
17. Does the facility have a lack of adequate acreage for land application'?
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment'?
20. Does facility require a follow-up visit by same agency'!
21. Did Reviewer/Inspector fail to discuss review/inspection with on-site representative?
-4
22. Does record keeping need improvement?
For Certified or Permitted >{acilitie% Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
25. Were any additional problems noted which cause noncompliance of the Permit?
.............................................
❑ Yes M No
❑ Yes 9No
No.violations or deficiencies rvere`note'd-durin ' this`visit..You will receive'no further,
eorrespotidence about this, visit:
❑ Yes [9No
❑ Yes ® No
❑ Yes RNo
......................................
❑ Yes
W No
❑ Yes
R[No
[Yes
❑ No
❑ Yes
i No
❑ Yes
OWNo
❑ Yes
[WNo
❑ Yes
191 No
❑ Yes § No
❑ Yes 14 No
❑ Yes U No
Cotiiments (refer to question #) Explain any YES answers and/or any recotnnienaattons or an} other coimeets.
Use drawtng s of facility to better e(xplain sttuattons ' use additional pag �.7es as necessa`} {/) x K
i
7/25/97
H,
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date: �� �%