820225_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental Qual

lD
Type of Visit: (D'Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: EJ Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: ' D Departure Time: �� County: S .
Farm Name: M{gs�(WIf S/] Owner Email:
Owner Name: [i k i f Phone:
Mailing Address:
Physical Address:
Facility Contact: �ovvld�5 �'„��wt� Title:
Onsite Representative: j L
Certified Operator: �`T 1 -2- d e )O
Back-up Operator:
Location of Farm: Latitude:
.g�SI - -1- ,V.
Phone:
Integrator: .
Certification Number: ! l
Certification Number:
Longitude:
Region:
Design Current
Design Current
Design
Current
Swine 1,000411Wc-
apaity,Poultry
Capacity Pop.
Cattle Capacity
Po
emu.
Wean to Finish
Layer
Da" Cow
Wean to Feeder
Non -La er
I
Dairy Calf
Feeder to Finish
DairyHeifer
v
S 7U
Farrow to Wean
Design Current
Cow
Farrow to Feeder
—Dry
D , Foul Ca aei P,o
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Turkey Poults
Other
Other
Discharges and Stream Impacts
I. 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 []' o ❑ NA ❑ NE
❑ Yes
[-]No
E34t
❑ NE
❑ Yes
[-]No
❑ TTA
❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes
❑ No
B ITA-
❑ NE
[:]Yes
ff No
❑ NA
❑ NE
[:]Yes
Et No
❑ NA
❑ NE
Page I of 3 21412015 Continued

Facility Number: Date of Inspection:
Waste Collection & Treatment
4. 6 storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes []'No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes [] No []-Iq'' ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):'
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ 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 DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes to ❑ 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 r� NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 0<0 ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): 1 0
13. Soil Type(s): ���, „ �li Z— A'
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes ETNo. ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
❑ Yes QUO ❑ NA ❑ NE
❑ Yes ❑ ❑ NA ❑ NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
ICJ i"o
❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
❑'lTfo
❑ 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
❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and i ° Rainfall Inspections
Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
0 NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
Fb/No
❑ NA ❑ NE
Page 2 of 3
21412015 Continued

Facili Number: - Date of Inspection: '
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes Ly '`"' ❑ NA ❑ NE
25 *Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes Lam° ❑ 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
b'IQo ❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
DIKO�E] NA
❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
[] Yes
Q.Pfo ❑ 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
❑ 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
O4O ❑ 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
L J"No ❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
o ❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑Yes
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
��No ❑ NA
❑ NE
Reviewer/Inspector Name

%lok3 w to t7 (�
' rvi'sion of Water Resources
F Facility Number:�_ , - LC�`-3� O Division of Soil and Water Conservation
`J � Other Agency
Type of Visit: C Hance Inspection Operation Review O Structure Evaluation p Technical Assistance
Reason for Visit: Routine O Complaint O Follow-up p Referral O Emergency O Other O Denied Access
Date of Visit: _3i- - Arrival Ti e: O� Departure Time: t County: Region:
Car�I`1 � �a
Farm Name: Owner Email:
Owner Name: 01l &-5 GKOcP,511 11t4 Phone:
Mailing Address:
Physical Address:
Facility Contact: JlG-�- ,a, f C_ Aw i� t Title:
Onsite Representative: l
Certified Operator: 'G `T r y�yt
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator: �F( _P _
Certification Number: I b 1. CZ f
Certification Number:
Longitude:
Design Current
`
ign Current
-
FD
Design Current
Swine Gapacity Pvp.'
..
Wet Poultry c ty D.
Cattle Capacity Pop.
- _ -
Wean to Finish
Dairy Cow
La er
Dairy Calf
Wean to Feeder
I JNon-Layer I
Feeder to FinishDai
Design
r s
Cu rent
Heifer
Farrow to Wean
Dry Cow
Farrow to Feeder
D . P,ouIt . Ca'acit
La ers
_ o
Non -Dairy
Farrow to Finish
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars Pullets
3� Turkeys
Beef Brood Cow
-
Other TurkeyPoults
Other Other
._,,sue
Dischartes and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
[J-No—
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
0 Yes
❑ No
❑-4VA
❑ NE
b. Did the discharge reach waters of the State? (Ifyes, notify DWR)
❑ Yes
❑ No
P-?,tA
❑ 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
[2<A
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
C3" l`lo
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
�No
❑ NA
❑ NE
of the State other than from a discharge`?
Page I of 3 21412015 Continued

Facility Number: jDate of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [9-No-0 NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No 0-NA__0 NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No
❑ 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
Vo
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
10
[] NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[]No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
[ Na
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
Eff No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes E]-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) •I lee f-v,&s� k, 6 v k,-,r Pt5-4 ✓'e ......
13. Soil Type(s): tj4
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [-rlq ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes D o ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes [!J-I�o ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application? [:]Yes 3-1 o
18. Is there a lack of properly operating waste application equipment? ❑ Yes [a -No
Reguired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? [] Yes Q o
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ❑Ado
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements El other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ONo
❑ 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 ❑Y'rNo
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facility Number: W- Date of Ias ection: = a
.24. Did the facility fail to calibrate waste application equipment as required by the permit? [] Yes [g-No-
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes EJ-No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑'No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes [3 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 [2No
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) T
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. [:]Yes [i]No
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes dNo
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes EfNo
34. Does the facility require a follow-up visit by the same agency? ❑ Yes [f_No
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
DNA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments,(refer.to question,#):.Explain any.YES a&#ers aodlor any additional recomn*6datiaus.or-anytotLer.comments.
Use drawn o 6 f µ
�s" f factlt to better explain situations';(use'saddit�ona[ pales as: necessary)
h' -
c!( --I !C-- '3-0- K- r6
Reviewer/Inspector Name:
Reviewer/Inspector Sipatui
Page 3 of 3
Phone'-PU-J, 5 5- ')i L) 1D-I
Date: t ::f ll l
2/4/201

(Type of Visit: O'Compliance Inspection Q Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: Q I outine 0 Complaint 0 Follow-up O Referral Q Emergency Q Other O Denied Access
Date of Visit: HIA Arrival Time: Departure Time: County: Region:
Farm Name: o��� �r -,,,
Owner Name: &.91cim
Mailing Address:
Physical Address:
Facility Contact: j kohx < G ✓Ii Title:
Owner Email:
Phone:
Onsite Representative: I( _
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
47
Integrator: j rn(nte
Q� �(
Certification Number: ` l (,�j <( p
Certification Number:
Longitude:
Design Gurrent
Design
Current
Design Current
Swine Capacity Pap.
Wet Poultry
Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
La er
Dai Cow
Wean to Feeder
Non -La er
Dai Calf
Feeder to Finish S
Dai Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
Dr, P,oul
Ca aci
]
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
-
Turke s
Other
Turkey Poults
Other LTOther
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at; ❑ Structure ❑ Application Field ❑ Other:
0 Yes 0'�o ❑ NA ❑ NE
a. Was the conveyance man-made? ❑ Yes [] No [2'NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR) ❑ Yes [] No E] 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 [D'Ro ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes �No ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412015 Continued

A It
Facilti Number: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [D-W ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No E2rNA ❑ 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
[2<
❑ 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
�o
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
[no
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
DNo
❑ 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
E314o
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
[:]Yes
[7rNo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [] Yes [! No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
C3'No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[frNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
L�FNo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
['f No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
Q No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
�io
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[/] No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes EX0 ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [?fNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [2`No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Faclli Number: Date of Ins Inspection: V
24. Did the facility fail to calibrate waste application equipment as required by the permit?
[—]Yes
C No
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
[f N
❑ 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
[JNo
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
[]'I1'o
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
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
1b
❑ 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
[]s to
❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[3 N
❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
[ -tTo
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
Q No
❑ NA ❑ NE
Reviewer/Inspector Signatut
ti
214120 5
Page 3 of 3

Dwu 401��
Structure Evaluation Inspection
Facility Number: cPz -- Zz S Date: I Pul, (-�- i'0
Time in: /vP oo 14, Time out: 1,0(15 4
Farm Name: ao C& rVk r Farm 911 address:
Owner Name: T A a t-,,?
Facility Contact:
le
Onsite Representative: Integrator: l3
Certified Operator: ��r-�- ��o�-[ Cert. Number
Is storage capacity less than adequate? Yes No
If yes is waste level into the structural freeboard? Yes No
Structure: 1 2 3
Identifier:
Spillway?
Designed Freeboard (in.):
Observed Freeboard (in.): 1.7
4 5 6
Are there any immediate threats to the integrity of any of the structuresY
observed? Yes No —L�
Do any structures lack adequate markers as required by the permit? Yes _ No
Does any part of the waste management system need repair Yes No ✓
Condition of field's J-J 1
v
Condition of receiving crop _ wi u , S d w� �C WuCel oyr r—sr�[�'
Comments:

Type of Visit: ft],e�,'o/mpliance inspection U Operation Review Q Structure Evaluation U Technical Assistance
Reason for Visit: C'� Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency Q Other 0 Denied Access
Date of Visit: Arrival Time: ' Departure Time: ra County-.. Region:
Farm Name: [ n d-3 Owner Email:
Owner Name:Phone:
Mailing Address:
Physical Address:
ty jj�M/l4 S f� h
Facility Contact: i *%t1e: Phone:
Onsite Representative: r Integrator:
Certified Operator: �`-•c.t r ! R, Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design Current Design Current
Swine Capacity Pop. We# Poultry Capacity Pop.
Design Current
Cattle Capacity Pop.
Wean to Finish
Layer
Da' Cow
Da Calf
Wean to Feeder
Non -La er
Feeder to Finish O
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Design Eurrent
D . PUuI C aci P,o
Layers
Da' Heifer
D Cow
Non-DaiLy
Beef Stocker
Non -Layers
Beef Feeder
Boars
Pullets
Turkeys;
Turkey Poults
rrOther
Beef Brood Cow
Other
Other
Discharges and Stream Imnacts
1. Is any discharge observed from any part of the operation?
❑ Yes
QNo
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
LQ A
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
❑ No
WA
❑ 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
eNA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
C3 Io
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
O No
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412014 Continued

Facili Number: - Date of Inspection,
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Spillway?:
Designed Freeboard (in): _
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
�[ NA ❑ NE
❑ No Q-NA ❑ NE
Structure 6
❑ Yes [a*T— ❑ NA ❑ NE
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
Ale-- _] NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
❑ No D NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[g-? 16 ❑ 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
[a -No ❑ 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
❑' 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): i.JhaL4Pa,%+(fl V-f-
�V 13. Soil Type{s}: �] O o CA,
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
Now❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[3-140 NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑Yes
o ❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
©'Now❑ NA
❑ NE
18" Is there a lack of properly operating waste application equipment?
❑ Yes
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAW MP readily available? If yes, check [::]Yes No ❑ NA ❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design [:]Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. [::]Yes 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 o ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 0 No ❑ NA [] NE
Page 2 of 3 21412014 Continued

lccility Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[5-<o__�E] NA
❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
ISNo ❑ 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
[q'hlo NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Yes
to ❑ NA
❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
[r'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
3-1 o ❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
[E o ❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
ETNo ❑ 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
To ❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
No ❑ NA
❑ NE
Comments (refer to question ft Explain any E-S answers and/or any additional recommendations or any other comments
Use drawings of facility to better explain situations(use additional pages as necessary).
}-
cr,(t`� C4 \ g.�,s �- r
l
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
L!
a o-33
Phone:
Date:
21412014

c w-s I?-- Ate
Type of Visit: LAD Co ance inspection O Operation Review O Structure Evaluation 0 Technical Assistance
Reason for Visit: Routine 0 Complaint O Follow-up O Referral 0 Emergency O Other O Denied Access
Date of Visit: Arrival Time: ® Departure Time: County: Regio
w:��
Farm Name: rj /KpPJ' (0 �r Q'L Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:-
Facility Contact:
1 RO ttk bs
6
a dOW M_ Title: Phone:
Onsite Representative:
Certified Operator: C
Back-up Operator:
Location of Farm:
Latitude:
Integrator: Led=e
E -67
Certification Number:
Certification Number:
Longitude:
11j.—a-t-m-
gn,Cnrrent. Design ,Current s Design Current
Swine I' Capaty Pop. ' Wet Poultry CaRactty�P p °' . Cat#le Capacity Pop.
Wean to Finish La er DairyCow
Wean to Feeder Non -La er DairyCalf
Feeder to Finish D Dai Heifer
Farrow to Wean FDeM]!*C7-urre'n._
Cow
Farrow to Feeder pDry P,oW ci Po : T.` Non -Da'
Farrow to Finish I Layers Beef Stocker
Gilts Non -Lavers Beef Feeder
Boars Pullets Beef Brood Cow
Rar
Turkeys
Other Turkey Poults
L_tOther Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
❑ Yes [3'1 0�❑ NA ❑ NE
a. Was the conveyance man-made? ❑ Yes ❑ No [3-1qA'~❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) ❑ Yes ❑ No 2 A ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes [:]No NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes No ❑ NA ❑ NE
of the State other than from a discharge?
Page l of 3 21412011 Continued

Facility Number: - Date of Inspection'
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ❑� ❑ NA❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑N"AB❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes El-Na— ❑ 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< ❑ 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?
Wes
❑ No
0 NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
Q-1go—
❑ 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
EJ 1 o
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
IQ"o
❑ NA
❑ NE
maintenance or improvement?
l I. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
D<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):
2 telrAkA_4 y & D
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAW P?
❑ Yes
[3] N
❑ 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
Q/No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
�o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
�o
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
ff No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
Fa<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 C3 No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ZNo ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

..
[Facility Number: - Date of Ins ection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes �o ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [] Yes [3 110 ❑ 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 No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [:)Yes ❑'No ❑ NA ❑ NE
Otherlssues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
[-]Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
EfrNo
❑ 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
/-
NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
To
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
[2rNo
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
ENo
❑ NA
❑ NE
Comments (refer to question # Explainlany YESansRersr:and/or any additional recomniendahons or any other comments.
Use drawu�gs'of facility to better eiplahFUtuations.;{use aclditi6nal pages as necessary).,;
eb— 2,L -13
0-3-0 PS3
4�1 Ck1�� �uQ ���(:..4 (�1owV� I.�001A t)aJj1
Q aAka�h;i 045�1cPr a� _41
Reviewer/Inspector Name: < t { 1LE Phone: 3✓ 'J �J
Reviewer/Inspector Signature: Date: !
Page 3 of 3 21412014

SIwu "- ( -,­41�3
'Type of Visit: UCom ance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: V Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit:Ar
Arrival Time 0 Departure Time, Coun C� Region: `'
Farm Name: I G-J►�ul S Owner Email:
Owner Name: p",\ 0- JT a s .0 (mil" Phone:
Mailing Address:
Physical Address:.
Facility Contact: L dyVl R.S 6qaL4,;'1-VTitle: a4A
Onsite Representative: C,
Certified Operator:.{
Phone:
Integrator: Fpe A C,
Certification Number: I C�
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current=
Designgc3tDesign
C..��»Swe
Capacity Pop
Wet Poultry
Capacitop ; ' -
Cattle Capacity Pop.
Wean to Finish
La er
Non -La er
DairyCow
Wean to Feeder
Da Calf
Feeder to Finish
". : ;- '
Da Heifer
Farrow to Wean
Design
Current
D Cow
Farrow to Feeder
D . P,oult .
Ca aci
Po .,
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
}
Turkeys
Other
TurkeyPoults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a- Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
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 NA ❑ NE
❑ Yes [-]No
[:]Yes [-]No
❑ Yes ❑ No
[—]Yes Qjxo
❑ Yes QKo
ff jNA ❑ NE
Q NA ❑ NE
Cp A ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3 21412011 Continued

Facili Number: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? [-]Yes Ul-'o ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes [a>S_ ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): l
Observed Freeboard (in): R2---+"�
5. Are there any immediate threats to the integrity of any of the structures observed?
0 Yes
ZL�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
[ii6
❑ 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,>io
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[Z>e
❑ 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
Q "'
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
n No
❑ NA
❑ NE
maintenance or improvement?
Ti
I L Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes F0,M8 ❑ 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): (Cr�1,0- Q
13. Soil Type(s): i5 0�
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes Q.,q6 ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? [:]Yes E3, ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes [B Ko- ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
U], o ❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
MNtf ❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[; dXcb ❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check
❑ Yes
❑�'iQO ❑ 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 [JN ❑ 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? El Yes No ❑ NA ❑ NE
21 if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [—]Yes El -No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Of
Facili Number: - Date of Ins ection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ❑.b� ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes o-- ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
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?
Reviewer/Inspector Name:
❑ Yes r ❑ NA ❑ NE
❑ Yeses ❑ NA ❑ NE
❑ Yes [�-1 E] NA ❑ NE
❑ Yes []PTo ❑ NA ❑ NE
0 Yes l5"""' ❑ NA ❑ NE
❑ Yes [3'No ❑ NA ❑ NE
❑ Yes I_ 9"
❑ Yes [j'No
❑ Yes Q,Ko'
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Reviewer/Inspector Signature:
Page 3 of 3
21412011

� Division of Water Quality
ono
Facility NumberDivisif Soil and Water Conservation
♦Q Other Agency
r
e of Visit: Compliance Inspection Operation Review Q Structure Evaluation Q Technical Assistance
son for Visit: Routine Q Complaint Q Follow-up Q Referral Q Emergency Q Other Q Denied Access
Date of Visit: I Ql� Arrival Time: l0',30 P^1 Departure Time: i �'�►,5 County: S� Region: 1'{Z(>
Farm Name: GC3A wMN T- Ao"(r\ S Owner Email:
Owner Name: G C) O W:L ✓) Phone:
t
Mailing Address: 1`R hA(L>L eA oPk C`i n L'.
Physical Address:
Facility Contact: 01,tnaLft,,\ Title: ()L LmqR Phone:
Onsite Representative: p rx> Integrator:
Certified Operator: day tZ=4 16, Zsn C%n Y-1 Certification Number: 1Q 6 ya: ttl
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
�4Dner Currentent
�tyPop,WetPoultry Capac�tyPop r f Cattle Capacity Pop.
IiWllLa e,r _ DairyCow
w Non -La er DairyCalf
E�tjII
DairyHeifer
Design Current D Cow
D kP,oult . Ca aci I'o P. Non -Dairy
La ers Beef Stocker
Non -Layers Beef Feeder
Pullets Beef Brood Cow
,4
p Turkeys
Other TurkeyPuults
Other a , Other
Discharges
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
(�
Farrow to Feeder
Farrow to Finish
Gilts
Boars
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 E�No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
[—]No
E] NA
❑ NE
❑ Yes [:]No ❑ NA ❑ NE
❑ Yes 9No ❑ NA ❑ NE
❑ Yes F� No ❑ NA ❑ NE
Page l of 2/4/2011 Continued

FaciliNumber: - 3.3.5 Date of Inspection: Wjl
=
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) Iess than adequate?
❑ Yes
(3 No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Lrnj0n3 C%-', 1_f'500nk5-$)
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): 1CA
Observed Freeboard (in): GL5 a _
5. Are there any immediate threats to the integrity of any of the structures observed?
[—]Yes
VNo
❑ 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
dNo
❑ 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 environmen I threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes O No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes Ey `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 [ rNo ❑ 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): C
13. Soil Type(s): BUv } � o , X A A m _
14. Do the receiving crops differ from those designated in the CAWW? ❑ Yes ❑'No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes gNo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes [j]lNo ❑ NA ❑ NE
acres determination?
IT Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
[:]Yes [2rNo ❑ NA ❑ NE
[:]Yes [2�No ❑ NA ❑ NE
_Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes [v�No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [:kNo ❑ 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 [v]rNo
❑ 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 [9/No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes [yNo
❑ NA ❑ NE
[] Weather Code
❑ Sludge Survey
❑NA ❑NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

1' - - '-
Facility Number: lb 2L 113ate of Inspection: g rt
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes G'No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [�]�Yes ❑ No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
[v"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 [TNo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [5No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
No
❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
[v] No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? if yes, check the appropriate box below.
❑ Yes
Callo
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[];rNo
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
[B"'No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
[3/No
❑ NA
❑ NE
Reviewer/Inspector Signature: 'i"Date: (:� I j-111
Page 3 of 3 214/2011

.1lf
iv'ision of -Water Qnalety _
Facility Number ®- ® ® Division of Svil and Water Conservation
Other Agency
Type of Visit: Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: tine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: f7D County: Region:
Farm Name: �p u f; r%- Fae,m f Owner Email:
Owner ;Name: T/Q.w d :5 � Gv�ur ; �� Phone:
a
Mailing Address: 14 7& Srl a,, e C,;,, fC � rZ�, 0 / ,
Physical Address:
Facility Contact:
Title: 92,2A l Phone:
Onsite Representative: _Zr � .r Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
_30�—
Latitude:
Certification Number:
Certification Number:
Longitude:
t
Destgn Current.
I
Design Current,},.-
tgn
Swine
,
Po
Capacity ? p„ _
J GCS
Wet Poultry
Layer
Non -Layer
Capacity
I
W.
Pop.
'
Cattle Capacity
Dairy Cow
Daia Calf
Dairy Heifer
Pop.
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Design 'Current
Dry Cow
Farrow to Feeder
I)ry Poultry
Layers
Ca aci
Po P.
Non -Dairy
Beef Stocker
Farrow to Finish
Gi Its
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
m .:
Turke s
Qther
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)?
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 E] No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
[-]Yes ❑ No
[:]Yes E. No
[:]Yes PS -No
[DNA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 21412011 Continued

- Facility Number. - Date of inspection: - %
Waste Collection & Treatment
\/4. Is
storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
2 .No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: %^ q $�
Spillway?:
Designed Freeboard (in): 1/9��
Observed Freeboard (in): 15W 7 '3
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
13 No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
[. No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
® No
❑ NA
❑ NE
8_ Do any of the structures lack adequate markers as required by the permit?
❑ Yes
F[No
❑ NA
❑ NE
(riot applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
[] Yes
LZ No
❑ NA
❑ NE
maintenance or improvement?
Waste_ Application
10. Are there any required bu#%rs, setbacks, or compliance alternatives that need
[:]Yes
MNo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application'? If yes, check the appropriate box below. ❑ Yes Callo ❑ 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 0 Application Outside of Approved Area
12. Crop Type(s): J/sl�` - —
13. Soil Type(s): a X Gl G L!'yl / T / � DW
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes Eq No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes allo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes F No [DNA [3 NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[g No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
[:]Yes
allo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
® No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
El 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
fK[No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
E] 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
21412011 Continued

• Facility Number: - Date of inspection: 771
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [3.No ❑ NA ❑ NE
1�
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [0-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: H /D'-` 1
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes E3,No ❑ NA ❑ NE
27. Did the facility fait to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes 21No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e_, discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32_ Were any additional problems noted which cause non-compliance of the permit or 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 [SNo ❑ NA ❑ NE
❑ Yes Z No DNA ❑ NE
❑ Yes KNo ❑ NA ❑ NE
❑Yes ®No ❑NA ❑NE
❑ Yes ® No
❑ Yes fe] No
❑ Yes jZ No
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
Comments (refer to question=;#):Explain any YES answers and/or any -additional recommendations or any other cothments. ii
Use. drawings of facility to better explain situations (use additional pages as necessary).
7,4
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Phone:
Date: a
21412011
Page 3 of 3

'r
Type of Visit 9Wmpliance Inspection 0 Operation Review �ructure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency her ❑ Denied Access
Date of Visit. © Arrival Time: ' a Departure Time: County; Region:
JV
Farm Name: JM&•R� i� Owner Email:
Owner Name:-TU/i Phone:
Mailing Address:
Physical Address: Facility Contact: �= (`.T/&,�Q2_ Title: Phone No:
Onsite Representative: Integrator:, ��- ,
Certified Operator: Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude; 0 0 ❑ , 0 « Longitude: ED ° = , ❑
Design Current
Design - Current
Design
Current
Swine Capacity Population
Wet Poultry
Capacity Population
Cattle Capacity
❑ Dairy Cow
Population
❑ Wean to Finish
❑ Layer
❑ Wean to Feeder
10 Non -Layer
❑ Dairy Calf
Feedcr to Finish
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
❑ Layers
❑ Beef Stocker
❑ Gilts
❑ Non -La ers
❑ Beef Feeder
❑ Boars
❑ Pullets
❑ Beef Brood Co
❑ Turku s
Other
❑ Turkey Poults
Number of Structures:
❑ Other ❑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 ®.No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
N No
❑ NA
❑ NE
❑ Yes
allo
❑ NA
❑ NE
Page I of 3 12128104 Continued

Facility Number: Date of Inspection f
1 Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes M-No. ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure l Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): �0 yS
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes D�_NNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes C&No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ®-No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes 1.No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes RNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes L No ❑ NA ❑ NE
maintenance/improvement?
II. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes C5No ❑ 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)
13. Soil type(s) (/�,�,� Z-1W
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
ENo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
LRNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
[5j No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
ONo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[&No
❑ NA
❑ NE
To !�k cam, rZe-e-1 '2- l
--
�/' cv, �arrn cups rn��- �ao� dam,
Reviewer/Inspector Name Phone:
Reviewerllnspector Signature: Date: 9/js
Page 2 of 3 12128104 Continued

I[lacility Number: — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 19 No ❑ 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 ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes B.No. ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ® No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 12 No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
10 No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
[5No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
O No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
[)I No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
allo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
[Z 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
C5NO
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
3 I.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
ONo
❑ 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
B No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
C.No
❑ NA
❑ NE
Ai c4a0onal Comments and/or Drawings
Page 3 of 3 12128104

IType of Visit Q)-C—ompliance Inspection O Operation Review O Structure Evaluation Q Technical Assistance I
Reason for Visit outine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: lv / Arrival Time: p Departure Time:
Farm Name: w i n sad ✓Y S II
Owner Name- '3 �adW� It
Mailing Address:
County: 8 '' Region: /a
Owner Email:
Phone:
Physical Address:
Facility Contact: `K— Title: QfY-�iy� Phone No:
Onsite Representative: s-e g Integrator: -
Certified Operator: Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: 0 0 1--] ' E=1 " Longitude: = ° = I = u
Design Current
Design Current Design
Current
Swine Capacity Population
Wet Poultrt.y
Capacity Population
Cackle Capacity
Population
❑ Wean to Finish
❑ La er
❑ Dairy Cow
❑ can to Feeder
❑Nan -La er
❑ Dairy Calf
® Feeder to Finish <ZoI
Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
❑ Non -Dairy
El Farrow to Finish
❑ Layers
❑ Beef Stocker
❑ Gilts
❑ Non -Layers
❑Beef Feeder
❑ Boars
❑Pullets.
ue
❑ Beef Brood Coyd
❑ Turkeys
Other
❑ Other
❑ Turkey Poults
❑Other
Number of Struc#ures:
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 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 gLNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
P3.No
❑ NA
❑ NE
❑ Yes
KNo
❑ NA
❑ NE
Page I of 3 12128104 Continued

Facility Number: —
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
J&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): f
Observed Freeboard (in): yL
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
CTNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
RNo ❑ 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
0 No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
C9 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
[3 No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
M No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
FLNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN [:IPAN > l0% or ] 0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside
of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
03No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
S,No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
a No
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
[INo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
®,No
❑ NA
❑ NE
AL
azj
To re L
f7
mot{ G�
C-v_ir— ZZIV5
ReviewerlInspector Name — �'phone; i% -- pn
Reviewer/Inspector Signature: Date:
Page 2 of 3 laia61v4 uonttnuea

i
Facility Number: — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
❑ Yes " No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
21. Does record keeping need improvement? If yes, check the appropriate box below. L?FYes JR hlo U NA U NE
❑ Waste Application ❑ Weekly Freeboard ;Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 " Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency'?
Additional Commentsts and/or Drawings:
❑ Yes
KNo
❑ NA
❑ NE
❑ Yes
KNo
❑ NA
❑ NE
❑ Yes
13.No
❑ NA
❑ NE
❑ Yes
PNo
❑ NA
❑ NE
❑ Yes
JU3 No
❑ NA
❑ NE
❑ Yes
JS No
❑ NA
❑ NE
&lei , - 0�- -J-5 j /04
❑ Yes
;R-No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
JR No
❑ NA
❑ NE
❑ Yes
KNo
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes ® No ❑ NA ❑ NE
Page 3 of 3 12128104

npmp— FRn
fif�fA NOV 3 0 2011
NCDENR MID
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Beverly Eaves Perdue Coleen H. Sullins Dee Freeman
Governor Director Secretary
November 15, 2011
Thomas H. Godwin
Godwin Farms
2476 Share Cake Road
Clinton, NC 28328
Subject: Certificate of Coverage No. NCA282225
Godwin Farms
Animal Waste Management System
Sampson County
Dear Thomas H. Godwin:
In accordance with your September 21, 2011 application, we are hereby forwarding to you this Certificate
of Coverage (COC) issued to Thomas H. Godwin, authorizing the operation of the subject animal waste
management system in accordance with NPDES General Permit NCA200000.
This approval shall consist of the operation of this system including, but not limited to, the management
and land application of animal waste as specified in the facility's Certified Animal Waste Management
Plan (CAWMP) for the Godwin Farms, located in Sampson County, with an animal capacity of no greater
than the following swine annual averages:
Wean to Finish: 0 Feeder to Finish: 5650 Boar/Stud: 0
Wean to Feeder: 0 Farrow to Wean: 0 Gilts: 0
Farrow to Finish: 0 Farrow to Feeder: 0
If this is a Farrow to Wean or Farrow to Feeder operation, there may also be one boar for each 15 sows.
Where boars are unneccessary, they may be replaced by an equivalent number of sows. Any of the sows
may be replaced by gilts at a rate of 4 gilts for every 3 sows
The COC shall be effective from the date of issuance until June 30, 2012 and replaces the COC No.
AWS820225 dated October 1, 2009. Pursuant to this COC, you are authorized and required to operate the
system in conformity with the conditions and limitations as specified in the General Permit, the facility's
CAWMP, and this COC. An adequate system for collecting and maintaining the required monitoring data
and operational information must be established for this facility. Any increase in waste production
greater than the certified design capacity or increase in number of animals authorized by this COC (as
provided above) will require a modification to the CAWMP and this COC and must be completed prior to
actual increase in either wastewater flow or number of animals.
Please carefully read this COC and the enclosed General Permit. This General Permit contains
many new requirements than the previous NPDES General Permit. Enclosed for your convenience
is a package containing the new and revised forms used for record keeping and reporting. Please
vav careful attention to the record keeoinL7 and monitorinLy conditions in this permit. The Animal
Facilitv Annual Certification Form must be completed and returned to the Division of Water
uallfty by no later than March 1st of each year.
1636 Mail Service Center, Raleigh, North Carolina 27699-1636
Location: 2728 Capital Blvd., Raleigh. North Carolina 27604
Phone: [phone] FAX: [phone] Customer Service: 1-877-623-6748
intemet www.nmate uai .o
One
North Carolina
Aaturallry
An Equal Opportunity 1 Affirmative Action Employer

If your Waste Utilization Plan has been developed based on site -specific information, careful evaluation
of future samples is necessary. Should your records show that the current Waste Utilization Plan is
inaccurate you will need to have a new Waste Utilization Plan developed.
The issuance of this COC does not excuse t; c PerrnittPP from the obligation to comply with all applicable
laws rules standards and ordinances (local state and federal), nor does issuance of a COC to operate
under this permit convey any property rights in either real or personal property.
Upon abandonment or depopulation for a period of four years or more, the Permittee must submit
documentation to the Division demonstrating that all current NRCS standards are met prior to restocking
of the facility.
Per 15A NCAC 02T .0111(c), a compliance boundary is provided for the facility and no new water
supply wells shall be constructed within the compliance boundary. Per NRCS standards a 100-foot
separation shall be maintained between water supply wells and any lagoon or any wetted area of a spray
field.
Per 15A NCAC 02T .1306, any containment basin, such as a lagoon or waste storage structure, shall
continue to be subject to the conditions and requirements of the facility's permit until closed to NRCS
standards and the permit is rescinded by the Division.
Please be advised that any violation of the terms and conditions specified in this COC, the General Permit
or the CAWMP may result in the revocation of this COC, or penalties in accordance with NCGS 143-
215.6A through 143-215.6C, the Clean Water Act and 40 CFR 122.41 including civil penalties, criminal
penalties, and injunctive relief
If you wish to continue the activity permitted under the General Permit after the expiration date of the
General Permit, an application for renewal must be filed at least 180 days prior to expiration.
This COC is not automatically transferable. A name/ownership change application must be submitted to
the Division prior to a name change or change in ownership.
If any parts, requirements, or limitations contained in this COC are unacceptable, you have the right to
apply for an individual NPDES Permit by contacting the staff member listed below for information on
this process. Unless such a request is made within 30 days, this COC shall be final and binding.
This facility is located in a county covered by our Fayetteville Regional Office. The Regional Office
Aquifer Protection Staff may be reached at [phone]. If you need additional information
concerning this COC or the General Permit, please contact the Animal Feeding Operations Unit staff at
[phone].
Sincerely,
for Coleen H. Sullins
Enclosures (General Permit NCA200000, Record Keeping and Reporting Package)
cc: (Certificate of Coverage only for all cc's)
Fayetteville Regional Office, Aquifer Protection Section
Sampson County Health Department
Sampson County Soil and Water Conservation District
APS Central Files (Permit No. NCA282225)
AFO Notebooks

11011EYE lity NUm
Type of Visit ompliance Inspection O Operation Review Q structure Evaluation O Technical Assistance
Reason for Visit outine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: Arrival Time: P Departure Time: r County: 8L Region:
Farm Name: `•'L / Owner Email:
Owner Name: �, (_l"$'�!/�i �� _.. Phone:
Mailing Address:
Physical Address:
Facility Contact: 22"g gY:: 61—j*,(V,1" V- Title:
Onsite Representative: _Co _ate
Certified Operator: 74w"-, ���� "'- '.S"-` -
Back-up Operator:
Phone No:
Integrator tf
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: ❑ c =' ="
Longitude: = ° ❑ I =
Design Current
Design Current
Design Current
Swine Capacity Population
Wet Pouftry Capacity Population
❑Layer _
Non -Layer
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Wean to Finish
❑ Wean to Feeder
1 r❑
Feeder to Finish 0
_
❑ Dai Heifer
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
ElN Layers
❑ Non -Dairy
❑ Farrow to Finish
El Non-Laers
El Beef Stocker
El Gilts
❑ Beef Feeder
❑ Boars
❑ Pullets
❑ Beef Brood CoyA
❑ Turkeys
Other
❑ Other
❑ Turkey Pouets
❑ Other
Humber of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
BLNo
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made`?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
[.No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
RNo
❑ NA
❑ NE
other than from a discharge?
12128104
Continued

Facility Number: g— Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
ANO
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): _ 1,91
Observed Freeboard (in): 3
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[&No
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
f kNo
❑ 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
RNo
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
RNo
❑ NA
❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
&.No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
[]Yes
.E9,No
❑ NA
❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ANo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu. Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes dNo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
17. Does the facility lack adequate acreage for land application? ❑ Yes
18_ Is there a lack of properly operating waste application equipment? ❑ Yes
Jallo ❑ NA ❑ NE
EK No ❑ NA ❑ NE
[Alo ❑ NA ❑ NE
Jg.No ❑ NA ❑ NE
f... h� W$��5 -. i f :: ' '.. � f � A #'ci .Z•s+a - �'H
Comments {refer to question #} Explain any YES answers and/oiany recommendatroits or any other comments.)
Use d"a t f
w m sof facile
g ty Ito better :explain situations. (use additional pages as necessary):
Reviewer/Inspector Name `'
Phone:
Reviewer/Inspector Signature:
Date:
v !/ 12128104 Continued

1, Facility Number: Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ WUP ❑Checklists ❑Design ❑Maps El Other
❑ Yes
[RNo
❑ NA
❑ NE
.yes
❑ No
❑ NA
❑ NE
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes RNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes
RNo
❑ NA
❑ NE
❑ Yes
®,No
❑ NA
❑ NE
❑ Yes
JWNo
❑ NA
❑ NE
❑ Yes
Wo
❑ NA
❑ NE
❑ Yes
ISNo
❑ NA
❑ NE
❑ Yes
(RNo
❑ NA
❑ NE
❑ Yes [ZNNo ❑ NA ❑ NE
❑ Yes J.No ❑ NA ❑ NE
❑ Yes ff No ❑ NA ❑ NE
❑ Yes [RNo ❑ NA ❑ NE
❑ Yes
RNo
❑ NA
❑ NE
❑ Yes
E No
❑ NA
❑ NE
12128104

n
u
Type of Visit C>-C—onipliance Inspection 0 Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit outine 0 Complaint 0 Follow up 0 Referral 0 Emergency O Other ❑ Denied Access
Date of Visit: I Arrival Time:
? a
Departure Time: Q rat 6) County:
Region: ALL
/7-lb
Farm Name: -LSD �+ ►'1
r
FA �f///YlS
Owner Email:
�l
Owner Name:
�
r--r�
/�W i YL _ Phone:
Mailing Address:
Physical Address: I
Facility Contact: _ ?�i'yJas C�-.,y 1V1 k- Title: Phone No:
Onsite Representative: Integrator: / S
Certified Operator: Operator Certification Number:�57
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: 0 0 [= 6 = « Longitude: = o =, = u
IM
Domes gnu Current
Design Curren#
Design Current
Swine
Ca ty�Population
Wet Poultn p ctty P�opulatio©°
Catte Capacity Population
-pa
❑ Wean to Finish
10 Layer
❑ Dairy Cow
❑ Wean to Feeder
IuNon-Layer
❑ Dairy Calf
Feeder to Finish
1? %
_;- E
❑ Dairy Heifer
❑ Dry Cow
❑ Farrow to Wean
Dry Poultry�F _
El Farrow to Feeder
,
❑ Non -Dairy
❑ Farrow to Finish
❑ La ers
❑ Beef Stocker
❑ Gilts
❑Non -La ers
El Beef Feeder
❑ Boars
❑ Pullets
❑ Beef Brood Co
:'-
Other
❑ Turkeys
[:]_Turkey Pouets
❑ Other
❑ Other
Humber of Structures:
Cliff
__qL**9VkLAiQWN
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
I&No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made'?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
JKNo
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
allo
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12128104
Continued

Facility Number: Date of inspection
s Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes KNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check [39yes ❑ No ❑ NA ❑ NE
the appropirate box. ❑ W UP ❑ Checklists ❑ Design CaMaps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. RYes ❑ No ❑ NA ❑ NE
Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 ° Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
M No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
1K No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
ER No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
LKNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
ER No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
19 No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes®
No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
KNo
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
KNo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
3 1.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
14 No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
® No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
NNo
❑ NA
❑ NE
Addihonai Comments and/or Drawings `_. , �.. }.. ",'...-..v
AL
Page 3 of 3 12128104

• Facility Number: )— Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
O-No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):_
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
ERNo
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
14No
❑ NA
❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
,Yes
❑ No
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
® No
❑ NA
❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
C.No
❑ NA
❑ NE
maintenance or improvement?
Waste Auolication
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
5d No
❑ NA
❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes jr,'42 No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) J lZOV
13. Soil type(s) mQ 163
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes F,No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes
NNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
29 No
❑ NA
❑ NE
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
51No
❑ NA
❑ NE
1,e! w-00-fk- eZ".KS C' 4�r,PA_
Do Z4
Reviewer/Inspector Name IN., Phone: '/p �J33-33c7t7
Reviewer/inspector Signature: Date:
Page 2 of 3 � 1P28/04 Continued

4DIbrivision of Water Quality
Facility Number O Division of Soil and Water Conservation
Q Other Agency
Type of Visit (_-_1-Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit outine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time:: `, flC7 Departure Time: Q' 3 County•, Region:
Farm Name: . �74 _f c—'rngi �- i�Q! ► ' - Owner Email:
Owner Name: % ,h for caS Phone:
Mailing Address:
Physical Address: JJ q� I
Facility Contact: ��PT a- -5 IAJ � !L Title: Phone --No: 960 *f /�-pb - ,22 3�
�/ Onsite Representative: r Integrator: 'C3/Q4-G
Certified Operator: �5�-* •� Operator Certification r:
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
Boars
Other
❑ Other
Back-up Certification Number:
Latitude: = o = 6 Longitude: ❑ ° ❑ ❑
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
_ ❑ Layer
❑ Nan -La cr
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharxes & Stream Impacts
I . 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)
Design Current
Cattle Capacity Population
❑
Dairy Cow
❑
Dairy Calf
❑
Dairy Heifer
❑
gry Cow
❑
Non -Dairy
❑
Beef Stocket
❑
Beef Feeder
❑
Beef Brood Co
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures:
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes 9No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes EgNo ❑ NA ❑ NE
❑ Yes 54 No ❑ NA ❑ NE
12128104 Continued

Facility Number: -'
Date of Inspection LLB
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate'?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier:
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): �-S
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes XNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc_)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes 9 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
[3 No
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
N 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
0 No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
®No
❑ NA
❑ NE
maintenance/improvement?
I I. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 10 No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) _ Yn,Ja_-
13. Soil type(s) 4a A lG- is Z1,9 1) a ,/3 1 / n
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes 0 No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes
No
El NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation designs or wettable acre determination?F93 Yes
,[N
M Na
❑ NA
❑ NE
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
9No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
All Mar ojc�: yar
7o rn j�k y° u r'
Reviewer/Inspector Name 1 5 Phone:1
Reviewer/Inspector Signature: Date: 6- &,
«aa/v4 [.onrtnuea

Facility Number: — Date of inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? 29 Yes ❑ No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWAV readily available? If yes, check Yes ❑ No ❑ NA ❑ NE
the appropirate box.
❑ WUP El Checklists El Design ®Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. R9 Yes ❑ No ❑ NA ❑ NE
0 Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
Additional Comments and/or Drawings:
❑ Yes
10 No
❑ NA
❑ NE
❑ Yes
H No
❑ NA
❑ NE
❑ Yes
[M No
❑ NA
❑ NE
❑ Yes
W No
❑ NA
❑ NE
❑ Yes
0 No
❑ NA
❑ NE
❑ Yes
10 No
❑ NA
❑ NE
❑ Yes (0 No ❑ NA ❑ NE
❑ Yes W No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes [9 No ❑ NA ❑ NE
❑ Yes
64 No
❑ NA
❑ NE
❑ Yes
5jNo
❑ NA
❑ NE
CoveraL e it r1hit ; n your-
�
I2128104

Type of Visit tg'Compliance Inspection 0 Operation Review O Structure Evaluation Q Technical Assistance
Reason for Visit C7rioutine 0 Complaint 0 Fallow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit:Arrival Time: 1i f] Departure Time: ' r O a CountyRegion: LL"
Farm Name: f A- Owner Email:
Owner Name: L /` ��d.� r i Phone:
Mailing Address: �t{ 7_ �/lcr041 k r- :j�>,) �f"t .C-
Physical Address: `
Facility Contact: C=Cdw Title:
Onsite Representative:
Certified Operator: S� -
Back-up Operator:
Phone No:
Integrator:
Operator Certification Number:��
Back-up Certification Number:
Location of Farm: Latitude: = o [AI 0 W Longitude: 0 ° = I = "
Swine
.M. ­-.11 11
Design Current Design Current Design
Capacity Population Wet Poultry @apacity Population Cattle Capacity
Current
Population
❑ Wean to Finish
❑ Layer
El Dairy Cow
❑ Wean to Feeder
❑ Non -Layer
El Dairy Calf
Feeder to Finish
❑ Dairy Heifer
Dry Poultry aDry Cow
❑ Non- Dairy
❑ Layers
La El Beef Stocker
❑ Non -La ers
❑ Pullets ❑Beef Feeder
❑ Beef Brood Co
❑ Turkeys
❑ Turkey Poults
❑ Other Humber of 5truetures:
Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Disc_ h� & 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
[4 No
❑ NA
❑ NE
b. Did the discharge reach waters of the State'? (If yes, notify DWQ)
❑ Yes
jo 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
, ELNo
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
M No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
51No
❑ NA
❑ NE
other than from a discharge'?
Page 1 of 3
12128104
Continued

Facility Number: — Date of Inspection — (7
' Waste Collection & Treatment
4. Is storage capacity (structural plus stonn storage plus heavy rainfall) less than adequate? []Yes V9No ❑ NA ❑ NE
a. if yes, is waste level into the structural freeboard? ❑ Yes DiNo ❑ NA ❑ NE
Structure I, Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): q
Observed Freeboard (in): 3,Lr
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes PKNo ❑ NA FINE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes EXNo ❑ 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
N No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
5? No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
® No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10_ Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
� No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
CANo
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift
❑ Application Outside of Area
12. Crop type(s) )r�rrH ttdC1 r T-1-0, :?_'0
C—'7-y-a .L x-
13. Soil type(s) f Z f CFO r7.3 _
lyj J:5
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
f q No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
RNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination` ❑ Yes
MNo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
ZNo
❑ NA
❑ NE
18_ Is there a lack of properly operating waste application equipment?
❑ Yes
allo
❑ NA
❑ NE
Reviewer/ins ector Name ` �'�" � ' �`ilX`'' �� ~" �
t ,u. `' L} l Phone: PN,. ir
Reviewer/Inspector Signature: Date: (o 7-oigCV4'
12128104 Continued

Facility Number: — Date of Inspection FZ; �55- %
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 59.No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check [9Yes ❑ No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ®Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. 0 Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard' ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield 9 120 Minute Inspections ❑ Monthly and I" Rain Inspections j3Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
E& No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
PQ No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
R No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
54 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
®No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
120 No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ yes
JKNo
❑ 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
RINo
❑ 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
DI 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
PA No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
IR No
❑ NA
❑ NE
Addit;onalaComments'and/or, Drawings x . �....
d O, ypq oe-,) yvot" rnap *"o S4w) irack pu1I
{� 1, C �m�✓< �7'-- FV f v� �< m� `�� 5 a ui Crop b &" nn
II
d" C �-f - C-C d e 1'a 0 rn ; .1 J-717 P a'
1212&04

Type of Visit 0 Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit Or -Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Date of Visit: S o Time: .©O
r Not Operational Q Below Threshold
13 Permitted © Certified E3 Can 'tirronally Certified 0 Registered Date Last Operated or Above Threshold: ---
Faroe Name: .....W�....W7i`."1 .. .....FjL— County:.... 5....___ ..... _ . ...W . WW.
Owner Name: Phone No:
_ T
Nfailing Address: S r�e Qd I've
Facehty Contact. �• Yam'!"` _ Title:.._..w!tae __._. �. Phone No:
Onsite Representative:..,.- - -° .-- --� !l� _.._ ._ ..._. � � .. Integrator: ... � ------ ----.........__..
Certified Operator : ............. .!'.!�..................... iroc'!Y+ik` W - _ Operator Certification
Location of Farm:
Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude Longitude �• �° ���
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? afes ❑ No
Discharge originated at: ❑ Lagoon Q,,9pray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes Q'NIo
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes M'Ao
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ElYes BNo
2. Is there evidence of past discharge from any part of the operation? ❑ Yes 31Qo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes B14_0
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure 1 Structure 2 Structure 3 Structure 4
Identifier: ... A. .................. ............ - . _..... � .,_.... .
Freeboard (inches): If/ ^_
12112103
Structure 5
❑ Yes ❑ No
Structure 6
Continued

Facility Number: —a Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenancerunprovement?
I I. Is there evidence of over application? If yes, check the appropriate box below.
❑ Excessive Poring ❑PAN ElHydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type �ry.M� �•=• S✓Se�
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes ❑ No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes ❑ No
b) Does the facility need a wettable acre determination? ❑ Yes ❑ No
c) This facility is pended for a wettable acre determination? ❑ Yes ❑ No
15. Does the receiving crop need improvement? ❑ Yes ❑ No
16. Is there a lack of adequate waste application equipment? ❑ Yes ❑ No
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge atlor below ❑ Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes ❑ No
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes ❑ No
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional [] Yes ❑ No
Air Quality representative immediately.
answers aad/or aay�rxommeada�ons orany othercon:�ilyents.�
Use drawiugs;of faaxifq to better cxplam s�toaboas. (use:addrtlonal Page, to d COPY ❑Final Notes
{[r L� �{ Yh�`�At`Y w�S SG,� 'io A,rfTii,1`�^ r1 Gllrrt�a7 s` 4—d
1 7
V4- -tL, %r r-
5, �� . -11T n T'yU 'I"i '*V' ter., 4SC
4
wQ4!^ oaya
a�J
)
�`f�•r� t.�t`kf Sbt-�C�S.
Reviewer/ImspecwrName.•._e
Reviewer/Inspector Signature: Date: S' .27
12112103
Continued

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

,"Yd'
Type of Visit a Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit *Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number
Date of visit.: 3 `1 Tune:
�.
0 Not 0
perational Q Below Threshold
M'i'rmitted ElE.ertiified [3 Conditionally Certified 0 Registered Date Last Operated or Above Threshold: .-.
Farm Name: ...... cnad (, .4'el........fec.M.i.................. •-.......... -.......... -.... -.... -.... ---..... County: S� r��t?d.rt %r._ .. . �.
Owner Name: tir-c c, , r..1.,�...... ..... Phone NO:
y/o spa - >esr
V- g Whn Address.• Sh ��rl eii�. /V
!i?.� .............ui .....L re �P� .
Facility Contact: .......rC2�a o� .... G e I�(r'c r1.. _--- . ._ Title- Phone No• 5� Cl `7 s s�G 7'r3>s
Onsite Representative: ---- ....................................... .... Integrator:
Certified Operator: -------- 17G.s.._......_�� rt....... _ ............. Operator Certification Number:
Location of Farm:
[436"ine ❑ Poultry ❑ Cattle ❑ Horse Latitude • 4 44 Longitude • & °4
Destgn' Current
Swine - Ca - =Po �alatian
Feeder
er to Finish
$
. p
Ito
w to Wean
w to Feeder
w to Finish
El Gilts
Boars
Number'a Lagoons =�
Poultry =Ca ei Pa nlafiaa Cattle
❑ Layer Dairy
❑ Non -Layer ❑Non-Dai
-10 Other
. , Total Desi Ca Glt
6tal.SSLw
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other ,
1
a. If discharge is observed, was the conveyance man -'made?
tI-
b. If discharge is observed. did it reach Water of the State? (If yes, notify DWQ)
.l
c. If discharge is observed, what is the estimated flow in gallmin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
_ =N
❑ Yes ❑o-
❑ Yes ❑'N0
❑ Yes [1To
❑ Yes G-Ko-
2. Is there evidence of past discharge from any part of the operation? ❑ Yes Rgo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ( io
Waste Collection & Treatment ^�
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes LQ
Structure 1 Structure 2 Structure ; Structure 4 Structure 5 Structure 6
Identifier: ......... ....I...................
...................................................................................................................................................
Freeboard (inches): i y
/r
12112103 Continued

Facility Number: Date of Inspection p-oc
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes [I -Pro'
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑ Yes E94G
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 B-110
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes is
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes OilO
elevation markings?
Waste A RRhcation
10. Are there any buffers that need maintenanceJimprovement? ❑ Yes QDio
11. Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes 9 NO
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12- CIop type(y(��/,�z.rr3�« St_.fr�� f5 Prh7�Jr/Lt� iNr. Grw
11 Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes &Pdo
14. a) Does the facility lack adequate acreage for land application? ❑ Yes PNo
b) Does the facility need a wettable acre determination? ❑ Yes [ado
c) This facility is pended for a wettable acre determination? ❑ Yes [-No
15. Does the receiving crop need improvement? ❑ Yes Leo
16. Is there a lack of adequate waste application equipment? ❑ Yes Q-No
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes UN-o
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes allo
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional ❑ Yes gNo-
Air Quality representative immediately -
pa uy YFS answers and/or any recommendau Ms or>any other comments:
_Use drawsxngs of fa�iity to"bettere><plain simattons. use additional P rY) [9-Field Copy ❑ Final Notes
r-
��,,��}} A.
/�1Jr' L•-G[+iv'.7 ,$ S7: �� Cen�•'�"'n1 2T �ar/S i�c' �'s�ac� �'S� aJoac� �frasS Lev�� C7»
S dM e ��e spsfs a) 1•5aa., ' �r
rtUr'm lu045 90,06
/f L�COrG/S IdU�( G, OOL,,
ReviewerAns ector Name
P
Reviewer/Inspector Signature: % c Date: 3 30--a y
I21I2/03 Continued

Facility Number: $a, — �—
Date of Inspection d d
Required Records & Document,
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
B- eS
❑ No
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
Yes
(ie/ WUP, checklists, de�n, pgps, etc.)
❑
B'9_o
23. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
UNo
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
B-No
25. Did the facility fail to have a actively certified operator in charge?
❑ Yes
e"No
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes
9-No
(ie/ discharge, freeboard problems, over application)
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
O No
28. Does facility require a follow-up visit by same agency?
❑ Yes
C3-No
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
GNo
NPDES Permitted Facilities
30. is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
[a'"es
❑ No
3I. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
Q Yes
❑ No
32. Did the facility fail to install and maintain a rain gauge?
❑ Yes
EWo
33. Did the facility fail to conduct an annual sludge survey?
❑ Yes
❑-No
34. Did the facility fail to calibrate waste application equipment?
❑ Yes
&No
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below.
❑ Yes
OW
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After 1" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
12112103

FmiUry Number. g Z �o 1 Y
Division of Environmental Management
Animal Feedlot Operations Site Visitation Record
Time:
Cene6l Information
Fans Name' 6edwi,,j r-a v.,, S - County; Sa �—n� s ••/
Owner Name:: 0 . G o d wi r.t PhOIIe ND' 4/di SG SL - 2 4000
On Site Representative: - ntegrawr: Fa-•.-�s
Mailing Address: R-t, 3 Bce z70 -A
Ci%N -!aN N L z g 3z8
Physical AddraslLocation:
Latitude: I / Lon 'tude:
Qperation_DescriRdow {based on design characterfsdes)
Type of Swine No. of Animak. Type of Pouirry No. ofAnimals 7jpe of Carle No. of Animak
0 saw 0 layer O Dairy
O Nursery O NorrLym 0 Beef
(3%cda-F;., ZLCI*O
y _
Odxr a of Livvesrock Number ofMineals:
Number of Lagoons: I (iaclude in the Drawings and Observations the f=board of each Ia;ow)
Facft Inns on:
Lagoon _
Ls lagoon(s) freeboard less than 1 foot + 25 year 24 hour storm storage?:
Is seepage observed from the lagoont
Is erosion obse ved?:
Is any discharge observed?
0 Man-made Q No: Mays -made
Cover CrnP
Does the facility need more acreage for spraying?:
( 3, S -Or'f ) Yes Cl No CS'
Does the cover crop need improvement?:
( Ilse dhe crops which need hvropmew)
CMPtypes CE-CL1 M, Awmge:
Setback Crkerfa _ _ ...
Is a dwelling located within 200 feet of waste application?
Is a well located within 100 feet of waste applicatiaa? -
Is animal waste stockpiled within 100 feet of USGS Blue Line Stream?
Is animal waste land applied or spray irrigated within 25 feet of BIue Line Sbram?
AOL — January 17JM
Yes O No or'
Yes 0 No e
Yes 0 No a'
Yes O No e
Yes 0 No C3"
Yes O
No M,
Y. 0
-,No Q'- -:
yes 0
No Q-'
Yes 0
No 0'

maintenan" /
Does the facility maintenance need improvement? Yes O No Or'
Is there evidence of past discharge from any part of the operation? Yes O No
Does record keeping need improvement? Yes O No Q'
Did the facility fail to have a copy of the Animal Waste Management Plan on site? Yes C] NOD'
• A1000S33
MT]ain any Yes answem-
= Faa ty Assessmear Unit
12rawings or Observa&
DM: V--zs—gG Use Ammhmnz ffNeeded
- -1,:��Ir!-"_�...,li- — .. -- - -:,. - -'� ►•x•�yt��tlti..r ��+i.eu 7.R ^1•trMs ��,�4yrt�/.►•w•�.�.�.+_y�ir_..1��'w!r_••+w�
.. ._ ya•�..• t'._ .Ili.• ��� •► •.1� Y♦�YMR �� `
4r i.J -. i - r '�.�..�*i'M`iit�;•.. i{7'•'T.,' �ii `ice :'T�-L'l��s' r'�i
1.7
AOi - Jsnuw7174M - - _

Facility Npmbcr: S2 - Z 7_S
Division of Environmental Management
Animal Feedlot Operations Site Visitation Record
Date: -2- 1 —9
Time: / 2-3 4
General Informatirm_
Farm Name: Scot G o d w ! ,.j Fa,, ,,, Cotmty:•.. rp sa.�/ _
Owner Name: %'�oR.,Ls Gadw;� L SCo God w1N __4110nCN0 9/4�56 -Z(p00
On Site Representative: - ar.� integrator.►-�.s,� .�.-
Mailing Address' R-t. 3 Pok z7o -A _ —
Clr,�
Physical Addressll cadon:
�7oi e o� //1 A'� •lia�l 6rcv� a 4�s /'�vw/�u.. I
•� rd, YN A it WA g-eA Ie���'b SR /s%g s O
Latitude: I I Lon 'tude: I�J
Qperation Dit5criptior: (based on design characterbda)
7jpe of Swine No. of Animals . 7jpe of Poultry No. of Animals Toe of Catr4 No. of Animals
O son► O Lyrr 0 Daby
D NMery O Non -Lyn 0 Bad
0Feeder -Frw ?7j0
0AeDEe of L'wjUx C • — Number of Animals:
Number of Lagoons: 1 (mclude in the Dmwfugs and Observations the freeboard of each hnoam)
Ea —ell •
Lagoon
Is lagoon(s) freeboard less than I'foot + 25 year 24 hour storm storage?: ( 40 r4- % Yes O No C3'
Is seepage observed from the lagoon?: - Yes O No C'
Is erosion observed?: Yes 0 No Cir
Is any discharge observed? Yes 0 No al
0 Man-made Q Not Manmade
Cover Grog
Does the facility need more acreage far spraying?:
Does the cover crop need improvement?:
( list the crops which need bvrom mm)
Crop type' Acreage` _
-
Selbaex Criteria `
Is a dwelling located within 200 feet of waste application?
Is a well located within 100 feet of waste application? = -
Is animal waste stockpiled within 100 feat of USGS Blue Line Strom?
Is animal waste land applied or spray irrigated within 25 fm of BIue Line Stream?
AOI — JAnuw717j9%
Yes O No El'
Yes C1 No 3'
Yes O
No Ci - -
Y Yes C] :-.No
Yes a
No a'
Yes ❑
No C�

Maintenance '
Does the facility maintenance need unproveztrent? Yes 0 No G'
Is there evidence of past discharge from any part of the operation? Yes O No Q"
Does rword keeping need improvement? Yes O Nn d,
Did the facility fail to have a copy of the Animal Waste Management Plan on site? .Yes 0 No Q'
Explain any Yes answers• 71--s
T� aravcd &-tcgk- ~,= 4 _ l -4lt, A-' u plcu 6., 1/_�_ /997 _—
ec FacUf y Assessment Unit ..
Drawings or Observatians:
Date: A-- zs - f*G Use Attachments IfNeeded
'e:��i/Y..—V'•'r:y. r ..:c. - - -�• - - irt`A�ir.,.. ��+n.otoy.sl•f*1�'r!i r►S-jV �:iJr:' `-' � 1�,�•-ewr
�.iG:r• � ... f - - .. t :!![ i;r���i�.r.� fir;,... i'ZJ � '�: 9I'�'i� JT�?.'7+'i,�-�"' F•';t--• .. -_
AOI — January 174M

Site Requires Immediate Attention:
Facility No. SW - ad _f—
DMSION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: _ // _: �Z, 1995
Time: a r 2� z'-s I
Farm Name/Owner: 5r- 6o dO-%-- 6 , a s
Mailing Address: z 7 s
County:
Integrator: ss Phone:
On Site Representative: Phone:
Physical Address/l.ocation: )I �a f
Type of Operation: Swine Poultry Cattle
Design Capacity: Number of Animals on Site:
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: Longitude: ,
Circle Yes or No
Does the Animal Waste Lagoon haye sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches) e r No Ac Freeboard: Ft. Inches
Was any seepage observed from the agopon(s)? Yes or("as any erosion observed? Yes or Dqo
Is adequate land available f9r ray. Yes or No is the cover crop adequate? Yes or No
Crop(s) being utilized: 1 JT1---
Does the facility meet SCS minimum setba k ria? 200 Feet from Dwellings? resr No
100 Feet from Wells? e
s No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? 4�'
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line: Yes or�
Is animal waste discharged into water of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes or� If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? Yes o�
Additional Comments:
Inspector Name
ignature
cc: Facility Assessment Unit Use Attachments if Needed.
/71tL

Site Requires Immediate Attention:
Facility No.
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
Farm Name/Owner:
Mailing Address:
County:
Integrator.
On Site Representative:
Physical -Address/Location:
DATE: [ I - Z , 1995
Time:
Type of Operation: Swine Poultry
Design Capacity: Number of
DEM Certification Number: ACE
Latitude: Longitude: ° _
Circle Yes or No
Does the Animal Waste Lagoon have sufficient
Phone:. 91P --- �?,� - s771
Cattle
Animals on Site: z9
DEM Certification Number: ACNEW
freeboard of I Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches) Yes or No Actual Freeboard: _:i !j� Ft. Inches
Was any seepage observed from the lagoon(s)? Yes or No Was any erosion observed? Yes or No
Is adequate land available r spray? Yes or N Is the cover crop adequate? Yes or No
Crop(s) being utilized:Aurt,
Does the facility meet SCS minimum setback criteria? 200 Ileet from wellings? or No
100 Feet from Wells? a or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? es or %
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line: Yes oRD
Is animal waste discharged into water of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes or©o If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? Ye o 0
Additional Comments: r
a:nL�
Inspector Name
Signature
cc: Facility Assessment Unit Use Attachments if Needed.

AHZMA • 'WASTE '.i1NAG2XF.TiT PLAN C37RT?F1CAT.2.02+I FOR NMq OR Z=._2ED
?lease raters the ee splated fox3 to the n1vision of 2SanaQeaeat at
the addraas on the =svarae side of this form. EW MANAGEMENT
Name of farm ( Please print) : 67,5 D W i n FA runs 5 - 8 FAYEI`TEVii�.E RAG. OFFICE--,
Address: P_r 3 _(,ink 2-7o A
CL In rp n r1 G 8 Phone
County: SAMPSOA
rar.a location: Latitude and Longitude:a' oe* 3-4-^/?e a• 9-9" (required) . Also,
please attach a copy of a county road map with location identified.
Type of operation (swine, -layer, dairy, etc.) : SW,ne
Design capacity (number of animals) : Z 9 9- o- 07--a-a—D-
Average size of operation (12 month population avg.): o E - r^0n#S11
Average acreage needed for land application of waste (acres): A4-
'=�sasa=aaaa=�c==aaadeaa=a=a�=na===aa=a=asaaa=aagpaaaaae==aa==aae�aaaaaasasscaa3
Technical Specialist cartification
As a technical specialist designated by the North Carolina Soil and Water
Goner -.ration Commission pursuant to 15A NCAC 6r .0005, I certify that the new or
expanded animal waste management system as installed --or the fa_= named above
has aun ariral waste management plan that meets the- design, construczion.
operation and maintenance standards and specifications of the Division of
,
5nvironmental Management and the USDA -Soil Conservation Service and/or the North
-dater
Carolina Soil. and Conservation Commission pursuant to 15A NCAC 2H.0211,,a-nd
1SA NCAC 6F .0001-.0005. The following elements and their corresponding mi'
criteria7-have-been verified by me or other designated technical specialist�,�-3_#
,
are included in the plan as applicable: minimum separations (buffers); line;s;
equivalent for lagoons or waste storage ponds; waste storage capacity; adedj!aGe
quantity and amount of land for waste utilization (or use of third party) ; acpess
or ownership of prcDer waste applicationequipment; schedule for timin s
applications; anoliWation rates; loading rates; -and the control of the discis6�tse
J, �•��
Of pollutants from.stcr=watdr runoff events less -severe - than the 25-year, 24 Xour
f.�?
storm.
Name of ' Tach=d cal Speci.aliat (Please Print) G. GZE�n n C4IFTor1
Affiliation: f%wsra6g I=AkrAs, Inc.
Address (Agency):AO.Sox49A aJnnan nc- _292,7,phone No.-592-57ZI
Signature: _A cr." G .. _- Date - 7 x 9
�aaaaasxaeraa:3aaaasaaeaaaasaieaaaasasaa:a:as=aaaaatssaaiaaaaaaao�aa�taap==aa=a
owner/liaaager AQrsa+maat
I (we) understand the operation and maintenance procedures established.in the
approved animal waste management plan for the farm named above and will implement
these procedures. I (we) know that any additional expansion to the existing
design_caoacity of the waste treatment and storage system or construction of new
facilities will require a new certification to be submitted to the Division of
Environmental Management before the new animals are stocked. I (we) also
understand that there must be no discharge of animal waste fwom this system to
surface waters of the state either through a man-made conveyance or through
zunoff from a storm event less severe than the 25-year, 24-:_ou: storm. The
approved plan will be filed at the farm and at the office of the local Soil and
Water Conservation District.
Name • of La A owner (Please Print) : e
Signature • i -Date:
Nam^ _of m3 agar, if different, from owner (Please print) :
Signature: Date:
X=a:' A change in land ownership requires notification or a new certification
(if 'the approved.,. plan is changed) to be submitted to the Division of
Envi.ronmental Management within 60 days of a title transfer.
DEM USE 0NLY:AGU W#

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