820349_INSPECTIONS_20171231

2 V
NORTH CAROLINA
Department of Environmental Qua

iypc uI vise: W k.umpuau%;e inspecuon V vperanun iceview V atrueLure L' VajUUUUn V iecunicai 4ASSIbLanue
Reason for Visit: ® Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit:
b Arrival Time:
: a0
Departure Time: County:SAP,-.�
Region:
Farm Name:
24—r
Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone:
Title:
Phone:
Integrator:
.11
Certification Number: 9 (0 I
Certification Number:
Latitude: Longitude:
Design Current 1"NDesign Current Design Current
Swme CapactPop Wet P-oultry Capacity Pop Cattle Capacity Pop.
t_
Wean to Finish La er Dai Cow
Wean to Feeder
on -Layer
9'
Design Current
Ca aci Po
DairyCalf
Feeder to Finish
t f - "
D : P.,oult ..
Dairy Heifer
XI]Faffow
to Wean
Farrow to Feeder
Dry Cow
Non-Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Beef Brood Cow
Boars
Pullets
Other =_ .._
Other
.
lOtber
Turkeys
Turkey Poults
Dischar2cs and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes � No ❑ NA ❑ NE
[:]Yes
❑ No
NA
❑ NE
❑ Yes
❑ No
NA
❑ NE
❑ Yes
❑ No
[ j NA
❑ NE
[—]Yes
r No
❑ NA
❑ NE
❑ Yes
4n,No
❑ NA
❑ NE
Page l of 3
21412011 Continued

FaciliHumber: - Date of Ins ection: 4 ZS
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
Struc e l 5truc e 2 Structure 3 Structure 4 Structure 5
Identifier: G
No ❑ NA ❑ NE
❑ No 99 NA ❑ NE
Structure 6
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3711 yl
5. Are there any immediate threats to the integrity of any of the structures observed?] Yes IGI1 No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.) 1P
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
"No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
[—]Yes
tpNo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
Ep No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? if yes, check the appropriate box below. ❑ Yes ® No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Windo/ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crap Type(s): / P.S'
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes No ❑ NA ❑ NE
❑ Yes Ir
No [DNA ❑ NE
❑ Yes M No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes 9 No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste TraVisfers
❑ 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 [P No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes Qg No
❑ NA [] NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Fhcili Number: - Date of Inspection.
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes [P No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes IM No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes T
No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29_ At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes � No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
® No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No
ENo
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
[DNA
❑ NE
Reviewer/Inspector Name:
Reviewer/inspector Signature:
Page 3 of 3
Phone: �t331-33G0
Date: h4he
21412011

Type of Visit: 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 0 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: O f Departure Time: ® . O County: T Region:
Farm Name: PP_ 22 o -c-_ Owner Email:
Owner Name: _ Y'eSt>rt 41Phone:
Mailing Address:
Physical Address:
Facility Contact: V a-ro-P.5 [wry`' Title:
Onsite Representative: [I
Certified Operator: M - ez, PaAna Y.,
Back-up Operator:
Phone:
Integrator: Pe ° S e—
Certification Number:
Certification Number:
Location of Farm: Latitude: Longitude:
Design Current Design Current Design Current
Swine Capacity Pop. Wet Poultry Capacity Pop. Cattle Capacity Pop_
Wean to Finish
La er
Dairy Cow
Wean to Feeder
Non -La er
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
{
Design Current
Dry Cow
Farrow to Feeder
D . P,outt Ca aci l?o P.
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars Pullets
Turke s
Beef Brood Cow
Other Turkey Poults
Other } Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation? [] Yes No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
[] Yes
❑ No
NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (Ifyes, notify DWR)
❑ Yes
❑ No
NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
[ No
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412015 Continued

Facility Number: Date of Inspection:
Waste`Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Stru1 Structure 2 Structure 3
Identifier: c e C
Structure 4 Structure 5
Spillway?:
Designed Freeboard (in): _
Observed Freeboard (in): L .3 — l
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
No ❑ NA ❑ NE
No P9 NA ❑ NE
Structure 6
❑ Yes No ❑ NA ❑ NE
r
❑ Yes No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
[] Yes j'�f No
❑ NA
❑ NE
maintenance or improvement?
Waste ARplication
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes No
❑ NA
❑ NE
maintenance or improvement?
I. 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): `iy✓ I Li } sC "S
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ Yes No
❑ NA
❑ NE
❑ Yes No
❑ NA
❑ NE
❑ Yes No
❑ NA
❑ NE
❑ Yes No
❑ NA
❑ NE
❑ Yes
�o
[] NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes V No
El Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Tr sfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes] No
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412015 Continued

4 Id
Facility Number: Date of Inspection:
24. Dib the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE
25, Is the facility out of compliance with permit conditions related to sludge? Ifyes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes 0 No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
IM No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
V
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
[a No
❑ NA
❑ NE
i rk a = ri yu ? fln}' OtI1CT CQI1iII1eDtS. � ommeq ire er�to ueshoa rn,aD flnswers-and/or an additional recominendatious or, ii I
Use,drawines'otfacihiv, - 6better eaulain situations (use additional DaQes as necessarW
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date:
21412015

(Type of Visit: • Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance I
Reason for Visit: 46 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: 1► 1 Arrival Time: ,, Departure Time: Oz' County:InAl—w-SVIJ Region: *0
Farm Name: P— 22 2 4 `C Owner Email:
Owner Name: P( r- S'tactL Phone:
Mailing Address:
Physical Address: )
Facility Contact: Title: Phone:
Onsite Representative: td Integrator: Pr-e jggt'
Certified Operator: A& `tq r,� Certification Number: 1?91 Z1114
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design - Current Design ...-Current
v►hne Ca op.
SM pacit . Q-= Wet Poultry Capacity Pop.
Wean to Finish JLayer
Design Current
Cattle Cacity Pop.
pa
Dai Cow
Calf
Dai Heifer
Wean to Feeder
Non -La er I
IDai
Feeder to Finish
"� " " '. 9
a
Desin
D . PoWt - Ca acl _ Po
Farrow to Wean
Dry Cow
Farrow to Feeder
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Other
Pullets
Beef Brood Cow
Turkeys
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes
No
❑ NA
❑ NE
❑ Yes
❑ No
0 NA
❑ NE
❑ Yes
❑ No
® NA
❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWR) ❑ Yes ❑ No )Fg] NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes EF No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters [] Yes M No ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412014 Continued

Facili Number: - 35 1 1 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: A- 9_ C
No ❑ NA ❑ NE
❑ No NA ❑ NE
Structure 6
Spillway?:
Designed Freeboard (in): _
Observed Freeboard (in): '7
5. Are there any immediate threats to the integrity of any of the structures observed? [:]Yes R9 No [DNA ❑ 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 0] No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes 0 No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes [R] No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes M No ❑ NA ❑ NE
maintenance -or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need [:]Yes E� No D 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 ❑11�Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): LP'+1&1jW ,_--
13. Soil Typc(s): All /r r
14. Do the receiving crops differ from those designated in the CAWMP?
[] Yes
No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
[]Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
[] Yes
® No
❑ NA
❑ NE
acres determination?
IT Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[5g No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
W No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [�] No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall []Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑ NA ❑ NE
Page 2 of 3 21412014 Continued

Facility Number: - Date of Inspection
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check 0 Yes wi No ❑ NA ❑ NE
the appropriate box(es) below. ]�
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑Yes
0No
❑NA
❑NE
❑ Yes
[P No
❑ NA
❑ NE
❑ Yes
g No
0 NA
❑ NE
❑ Yes Pg No ❑ NA ❑ NE
❑ Yes (A No ❑ NA ❑ NE
❑ Yes [P No ❑ NA ❑ NE
❑ Yes [P No
❑ Yes ER No
❑ Yes P9 No
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
Comments (refer to question # ): Explain any YES answers and/or any additional recommendations.or any other comments:
Use drawings of facility to better explain situations (use_ additional pages as necessary), y'_
Reviewer/Inspector Name:
Reviewed]nspector Signature:
Page 3 of 3
-46'f YVI�
Phone: 4fA-q3,_?--33oD
Date: /".7
21412014

Type of Visit: 4D Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: ® Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: OZFBD Departure Time: County: Region:
Farm Name: l a Iei%_.� Owner Email:
Owner Name:��Phone:
Mailing Address:
Physical Address:
Facility Contact:Title: Phone:
Onsite Representative: G-S �� CriA-_-_-, Integrator: �16 _4t✓
Certified Operator: 1 Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design Current
Swine Capacity Pop. Wet Poultry
Design Current
Capacity Pop_
Cattle
Dairy Cow
Calf
Design Current
Capacity Pop.
Wean to Finish
Layer
Wean to Feeder
I jNon-Layer
I —Dairy
Feeder to Finish
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
)0 Farrow to Wean
Farrow to Feeder
Farrow to Finish
D . P,oultr
Layers
Design Current
Ca aci 1'.0 P.
Gilts
Non -Layers
Beef Feeder
Beef Brood Cow
Boars
Pullets
Turkeys
Other Turkey Poults
Other Other
Discharges and Stream Imaacts
1. Is any discharge observed from any part of the operation?
❑ Yes
EDNo
❑ 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 DW R)
[:]Yes
❑ No
[� NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
[-]No
Ej NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
® No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
No
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412014 Continued

" Facility Number: - Date of Inspection: /
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure I Structure 2 Structure 3 Structure 4
Identifier: �^
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 017- z ,7
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
Structure 5
®No ❑NA ❑NE
❑ No ,e NA ❑ NE
Structure 6
❑ Yes P No ❑ NA ❑ NE
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes 0 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 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 �p No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes R No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): t _(] {
13. Soil Type(s): —lO
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [�bNo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes ® No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[2 No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
® No
❑ NA
❑ NE
Required Records & Documents
19, Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
® No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes R No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall []Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? [:]Yes ® No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412014 Continued

Facili Number: _ TA-971 Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? Yes P No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check Yes rA No
the appropriate box(es) below.
0 Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? Yes No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? Yes No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? if yes, check the appropriate box below.
Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAV;W?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ NA NE
❑ NA NE
NA NE
�NA NE
Yes rO No � NA [3 NE
Yes i"= No NA NE
Yes ® No ❑ NA ❑ NE
❑ Yes [P No ❑ NA NE
Yes ® No
❑ Yes No
[:]Yes No
NA NE
NA NE
�NA ❑NE
Comments (refer to question #)Eiplam any YES answers andlor any additional recommendations or-any4other comrttents.
Use deawwgstof-faciHty to betteKemlain situations (use additional aazes'as necessary).,,-,.-- s
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: U-j3l-3 30D
Date: ('3
21412014

I ype of visit: 0 Compliance inspection U Operation Review U Structure Evaluation U Technical Assistance
Reason for Visit: 49 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: j ; Departure Time: Z'r County: SON
Farm Name: —q_1- A-e'- Owner Email:
Owner Name: �) L �`kc, Phone:
Mailing Address:
Physical Address: r
Facility Contact:Qw~QS-LL.fv�b Title: Phone:
4
Onsite Representative:
Certified Operator: �O-A _PUaQ
Back-up Operator:
Location of Farm:
Latitude:
Region: 692
Integrator: r r
Certification Number: ` 6L116
Certification Number:
Longitude:
Desr n
g -
Swine Ca act
p ty
Current
Po p.
_ -
� Des
Poaltry Cap �gnF Current, Design Cerrrertt
Wet actty r Pop Cattle Capacity Pop.
inish
La er
DairyCow
eeder
Non -La er
DairyCalf
Dairy Heifer
Cow
Finish
Wean
F
-
Po
'ISz]
D ,P,oul Y
La ers
Des' gnCurre_nf.
,Ca aci
Feeder
Finish
Non -Dairy
Beef Stocker
Non -La ers
Beef Feeder
Pullets
Beef Brood Cow
Other ,
Other
Turkeys
T—t Poults
Other
DischarSes and Stream 1111133ets
I. Is any discharge observed from any part of the operation?
❑ Yes
RNo
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
[] No
NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
Qg NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
W No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
® No
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

Facility Number: - Date of Inspection: 1I
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: �_ 41
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 95-11 3! y
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 0] No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
No No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[ No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
[:]Yes
No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement`?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes � No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): G6-t Y� j 0 k Ea ,
13. Soil Type(s): 0
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
I & Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[P No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
P No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. [—]Yes ® No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I " Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

JFacility Number: Date of Inspection. ( 3
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
No
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
No
❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
❑ Yes
No
YM
D NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
DQ No
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
® No
❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
R 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
f@ No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAW MP?
❑ Yes
No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
� No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
X No
❑ NA
❑ NE
ents (refer t&4di ttoti #): Explain any YES answers and/or any additional recommendations or any other comments Y
FtJs6
awiags:of facWty to better explain situations (use additional naees as necessarv).
r
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: �!D—`�33r3SQD
Date: U �3
21412011

r
Type of Visit: 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 0 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: L Z Arrival Time: Departure Time: County: SAM PW Region:
Farm Name: 'r;.2 Z Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator: Ra*/6m
Back-up Operator:
Phone:
Integrator: ll__
Certification Number:D7 a✓p
Certification Number:
Location of Farm: Latitude: Longitude:
Design Currents ¢ y HDesEgn
Current
Design Current
Swine , _ Capacity�r Pop VI'et Poil CaPap.
itypacity.
@attlet-- CapacP.
Finish
Layer
DairyCow
Feeder
Non -Layer
DairyCalf
o Finish
VFeeder
.. ",.Dai
Heifer
o Wean
Design
Current
D Cow
o Feeder
D roult. aei
P:o
Non -Dairy
Farrow to Finish
ILayers.
I
jBeef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes No ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes ❑ No
® NA ❑ NE
NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d- Does the discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes ❑ No 4 NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes [� No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes �a No ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

Faciii Number: Date of Inspection: L
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [8 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: F_
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): --
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes [�j 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
V@ No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
� No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
® No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[ ] No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
` N No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 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&rris
13. Soil Type(s): Q;
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
[] Yes
`P No
D NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[� No
❑ NA
❑ NE
Required Records & Documents
19, Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[ 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 P No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking 0 Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [g No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 5j No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA D NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Faci ' Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[N) No
❑ NA
[a NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
W No
❑ NA
❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
[:]Yes
[� No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
® No
T
[DNA
❑ NE
Other Issues
2& 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
No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
Ep No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
[:]Yes
® No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
M No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or,any additional recommendations or; aay othet��ominents. w .
Use drawings of ficility to better explain situations (use additional pages as necessary):
.
Reviewer/]nspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 119(0_ O(0
Date: L-2g i2
21412011

Type of Visit: • Compliance Inspection O Operation Review p Structure Evaluation p Technical Assistance
Reason for Visit: 0 Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: PTIE-T] Arrival Time: 'Q Departure Time: :d County: �M Region:
Farm Name: p'p C Owner Email:
Owner Name: Phone:
Phone:
Mailing Address:
Physical Address:
Facility Contact:
I" Title:
Onsite Representative: �QQ l.yr.ljD
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator:
Certification Number:
Certification Number:
Longitude:
Design
Current. ,: Design Current Design Current
Swine Capacity
Pop.. WePpoultry Capacity Pop. Cattle CPAC_itVJMP,ap.
Wean to Finish
Layer Dairy Cow
Non -La er Dairy Calf
Dairy Heifer
Wean to Feeder
Feeder to Finish
Farrow to Wean_
- Design Current Dry Cow
Farrow to Feeder
AD ; Pouit '; ' =Ca "aci P,o Non -Dairy
Farrow to Finish
Lay ers Beef Stocker
Gilts
Non -Layers Beef Feeder
Boars
Pullets I 113eef Brood Cow
Turke s
Qthe
urkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
y No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
[ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
No
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

Facility Number: jDate 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: F? C—
Spillway?:
Designed Freeboard (in): _
Observed Freeboard (in): 39
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
No ❑ NA ❑ NE
No F NA ❑ NE
Structure 6
❑ Yes 91 No ❑ NA ❑ NE
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? T
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 5@ No ❑ NA ❑ NE
maintenance or improvement?
1 I . Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes F 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 Wind w ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): 0 am(
13. Soil Type(s): did 4D C-: 5 j f
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes P No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes �fl 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
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ Yes ® No
[:]Yes No
❑ Yes No
[—]Yes �O] No
❑ WUP ❑Checklists ❑ Design [] Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [0 No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
22_ Did the facility fail to install and maintain a rain gauge? ❑ Yes EP No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 1P No
[] NA ❑ NE
❑ NA ❑ NE
[] NA ❑ NE
❑NA ❑NE
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: PIZ - Date of Ius ection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes]
No ❑ NA ❑ NE
25. is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes
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 stnicture(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes
® No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [] Yes
Q No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes
H No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes ® No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the ❑ Yes [ No ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
3 i. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. Yes ❑ No
® Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? 0 Yes No
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes No
34. Does the facility require a follow-up visit by the same agency? [:]Yes No
Ker�s r e Ji ` ew-e,1 9 "/
rr S/ 1, s� ' off
Reviewer/Inspector Name:
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Phone: q10-V_?-3YG0
Reviewer/Inspector Signature:
Page 3 of 3
Date:
21412011

j
IType of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance I
Reason for Visit Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
I .
Date of Visit: f 0 1 C)Arrival Time: '00 t- Departure Time: County: YIWPRegion:
Farm Name: P' �2 �� S arl� Owner Email:
Owner Name: Pne_,4aQe_ Rty t"s Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: L
Certified Operator:
Back-up Operator:
�7 Phone No:
integrator: 't'CIL
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: ❑ o ❑ . = Longitude: = ° =1 ' ❑
Design Current
Swine Capacity Population Wet Poultry
Design
Capacity
Current
Population
Design Current
Cattle Capacity Population
❑ Wean to Finish
L
IEI Layer I
I
❑ Dairy Cow
❑ Wean to Feeder
10 Non -Layer
❑ Dai Calf
❑ Feeder to Finish
Dry Poultry
❑ Dai Heifer
❑ D Cow
❑ Non
Farrow to Wean
El Farrow to Feeder
❑ Farrow to Finish
❑ Layers
fE
-Dairy
❑ Beef Stocker
❑ Gilts
Nan -La ers
❑ Beef Feeder
❑ Boars
❑ Pullets
❑ Beef Brood Co
❑ Turke s
Other ❑ Turkey Poltets
❑ Other ❑ Other1
of Structures:
1Number
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 PNo ❑ NA ❑ NE
❑ Yes
❑ No
DNA
❑ NE
El Yes
❑No
WNA
❑NE
8BNA
❑ NE
❑ Yes
❑ No
❑ Yes
JNo
❑ NA
❑ NE
❑ Yes
W No
❑ NA
❑ NE
Page 1 of 3 12128104 Continued

-11 IL
Date of Inspection
Facility Number: —
[
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
I$ No ❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No 1>� NA
❑ NE
Stru tore 1 Structure 2 Structure 3 Structure 4
Structure
5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): u 20 � 35
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
P 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
® 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
[PNo ❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
0 No ❑ NA
❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
PLNo ❑ NA
❑ NE
maintenance or improvement?
Waste Apulication
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
nNo ❑ 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 Crap Window ❑ Evidence of Wind Drift ❑ Application Outside
of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
Wo
❑ NA
❑ NE
Fe c e-yd S
(P CO Le: j7COV)
Reviewer/Inspector Name ON
' j `', , '� '� ' Phone: � i3
ReviewerfInspector Signature: Wdiff Date: O
Page 2 of 3
1212&04 ' Continued

Facility Number: Date of inspection UI 1 1 f ! ! U J
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes IT No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No [INA ❑ NE
the appropriate box. ElWUP ❑ Checklists ElDesign ElMaps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ' No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
F No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
F NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
Kn No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
No
❑ NA
❑ NE
Other Issues
1
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[P No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
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
EP No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
[P No
❑ NA
❑ NE
General Permit? (ic/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
[P No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
M No
❑ NA
❑ NE
Additional Eommeni a3ndlor Drawings:
Page 3 of 3 12128104

Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
20
Date of Visit: Arrival Time: i Departure Time: ! O.rQ"Ji%'t' County: �S!InIf � _ Region: F 1
Farm Name: K-iz( ?i /Ii tl• ftcl U
Owner Name:. QP rl h5 1 � _
Mailing Address: _
Physical Address:
Facility Contact: Ctj--- , Title:
Onsite Representative:
Certified Operator: - jL ' f3w
Back-up Operator:
Owner Email:
Phone:
Phone No:
Integrator:
Operator Certification Number: f!
Back-up Certification Number:
Location of Farm: Latitude: 0 n 0 { = Longitude: [� o = & = H
Design
Swittc Capacity
Current Design Current Design Current
Population Wet Poultry Capacity Population Cattle Capacity Population
❑ Wean to Finish
ILE] Layer ❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
I 43qG1Dry Poultry ❑ Da Cow
❑ Non -Dairy
❑ La ers
❑ Beef Stocker
❑ Non -La ers ❑ Beef Feeder
❑ Puilets ❑ Beef Brood Co
❑ Turke s
❑ Turkey Poults
❑Other Number of Structures:
❑ Wean to Feeder
❑ Feeder to Finish
arrow to Wean
Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Discharees & Stream Impacts
1. is any discharge observed from any part of the operation?
❑ Yes
EoNo
❑ 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
El
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
ElYes
No
❑ NA
❑ NE
other than from a discharge?
12128104
Continued

Facility Number: 027 Ell Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes U�Vo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No 9�NA ❑ NE
Stricture I Structure 2 Structure 3 Structure 4 Structur,: ? Structure 6
Identifier: A- C_
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
k 7'
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes 1�3 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 Mo ❑ NA ❑ NE
r
8. Do any of the stuctures lack adequate markers as required by the permit? ElYes No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks andlor 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 ApOication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes rpNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes yNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > IV/n or 10 lbs ❑ Total Phosphorus ❑ Failure to incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop
�Window ❑ Evidence of Wind Drift [I Application Outside of Area
12. Crop type(s) l _� of , (�IUCux" , 5&t4 " S
13. Soil type(s) (
f a S 6-ro
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
136LNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
1P No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination', [I Yes
R%No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
1W
Reviewer/Inspector Name r? pn Ct;ff Phone: 3
Reviewer/Inspector Signature: Date: Q et
]Z/78104 G"onh[nued

FacilityNumber: Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 'E#No ❑ NA ❑ NE
20, Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes JpNo ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 01No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
YNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
yallo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
INo
❑ NA
❑ NE
25_
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
N No
❑ NA
❑ NE
26.
Did the facility fail to have are actively certified operator in charge?
❑ Yes
;lNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
T No
❑ NA
❑ NE
Other issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
EpNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
;n 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
[ANo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
Q§No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
VINo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
PNo
❑ NA
❑ NE
Additional:Cuntments and/or Drawings: „
A,
Page 3 of 3 12128104

of
Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: 9 D Arrival Time: Departure Time: /.� K, County: `r�N Region:
� cX)/�
Farm Name: r- —A A 0./10[ Owner Email:
Owner Name: Ms _hrtc i Phone:
Mailing Address:
Physical Address: �� ,.�A ,
Facility Contact: r a+14 �'� AQ4_ Title: Phone No:
Onsite Representative: ��m�s �imD Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Operator Certification Number:
Back-up Certification Number:
Latitude: = o = { = Longitude: 0 e = i
Design CurrenillEl
Current ` :' Design Current
Swine
Capacity Pop latioWet Poultry
Capaciry Population- 'Cattle. Capacity Population
❑ an to Finish
Layer
❑ DairyCow
❑ an to Feeder
❑ Non -Layer
�"
❑ DairyCalf
❑ Feeder to Finish
-`' ❑ DairyHeifer
Farrow to Wean
❑ Farrow to Feeder
,Dray Poultry
{' ❑ D Cow
� ,
` El Non -Dairy
❑ Farrow to Finish
❑ Layers
❑ Beef Stocker
❑ Gilts
❑ Non -La ers
❑ Beef Feeder
❑ Boars
❑ Pullets
❑ Beef Brood Co
- - - ❑ Turkeys
-
Other
_-
- ❑ Turkey Poults
❑ Other
❑ Other
Number of Structures:
DischarEes & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
010
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
&A
❑ 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
rNA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
?9 No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
ONo
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12128104
Continued

L
L.
Facility Number: 3 Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes r No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No LTA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: t✓
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): S� a
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
No ElNA [INE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes
No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 46 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 ElNA [INE
(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 ARplication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
f9 No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
1�1 No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window [:]Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) C" r
13. Soil tyP?ks) Y
14. Do the recet
ops differ from those designated in the CAWMP?
❑ Yes
V No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement'?
❑ Yes
C9No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
® No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
�3 No
❑ NA
❑ NE
18. is there a lack of properly operating waste application equipment?
❑ Yes
PNo
❑ NA
❑ NE
as
Reviewer/Inspector Name I Phone:� r
Reviewer/Inspector Signature:"61A&I10?Date:
rage -, of -i uonunaea

Facility Number: Date of Inspection / l
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes b�No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 10 No ❑ NA ❑ NE
the appropriate box.
❑ WUP El Checklists El Design [I Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 1PNo ❑ 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
nNo
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
N No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
J0 No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
P No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
rNo
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
N No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
RNo
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
JpNo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
P No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
tj�No
❑
32_ Did Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
❑ NA
NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
Wo
❑ NA
❑ NE
Additional.Comments andlor Drawings:
w
Page 3 of 3 12128104

. I
Division of Water Quality
Lility Number 0 Division of Soil and Water Conservation
_.. - 1 0 Other Agency
Type of Visit*Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Routine O Complaint O Follow up O Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: f _ Departure Time: �j , �/j 0 County: Region:
hie tiFarm Name: Da A-1D 1 C Owner Email:
Owner Name: Res-RM2lrwmS Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: Integrator. /P S
Q,
Certified Operator: Operator Certification Number:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
,Farrow to Wean
Farrow to Feeder
Farrow to Finish
Boars
Other
❑ Other
Back-up Certification Number:
Latitude: 0 0 0' = « Longitude: = o =1 a "
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
_ ❑ Layer
I1 ❑ Non -La et
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifej
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
As
❑ Yes r o ❑ NA ❑ NE
❑ Yes ❑ No A
ElNE
ElYes
[INo
NA
❑ NE
❑ NE
❑ Yes
❑ No
❑ Yes
*No
lM
1PNA
ElNA
ElNE
ElYes
No
❑ NA
❑ NE
12128104 Continued

Facility Number: a, Date of Inspection
t 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?
❑NA El NE
5Z NA El NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 tructure 6
Identifier: -:), 19' _ 9;;�B PAC.
❑ Yes Wo
❑ Yes ❑ No
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):D
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 No ❑ NA El 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 environments threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes o ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No [I NA ❑ NE
maintenance/improvement? r
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes U? No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drifl ❑ Application Outside of Area
12. Crop type(s) ( , ` W S
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
o ❑ NA
El NE
15. Does the receiving crop and/or land application site need improvement?
El Yeso
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination'?❑ Yeso
❑ NA
[No
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ NA
❑NE
18. Is there a lack of properly operating waste application equipment?
❑ Yeso
❑ 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):
IReviewer/Inspector Name Jai Phone: 'Y_c/Ol�,3 3
Reviewer/Inspector Signature: A h A-4 "o aj Date: " 11?S OW-1
12/28/04- Continued

Facility Number: — Date of inspection
r
Re uired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes jNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA [INE
the appropirate box. ElWUP ❑ Checklists ElDesign ElMaps ElOther
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes I No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
o
❑ NA
[INE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
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
No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
k, No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
10 No
❑ NA
❑ NE
Comments and/or Drawings:
W
12128104

, 4- .
Facility Number, 3
0 Division of _-water.,Qnahty
0 Division of Soil and Water Cdosersation
O Other Agency`
Type of Visit )Dtiompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 40rRoutine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: U'�KK County. �V? Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Owner Email:
Phone:
Facility Contact: Title: Phone No:
r? Onsite Representative: integrator:
Certified Operator: Operator Certification Number:
Back-up Operator:
Location of Farm:
.,'Swine . .:..:
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other ..-..
❑ Other
Back-up Certification Number:
Latitude: I--] o [= i 1=1 u Longitude: [= ° [= i 0
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
I'
❑ Layer �II
❑Non -La erEH=
Dry. Poultry
❑ Layers
❑ Non -La ers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
M
J Dairy Calf
] Dairy Heifer
] Dry Cow
] Non -Dairy
] Beef Stocker
] Beef Feeder
] Beef Brood Cowl
Number of Structures:" .�
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes dNo ❑ NA ❑ NE
❑ Yes
❑ No
f�NA
❑ NE
❑ Yes
❑ No
WNA
❑ NE
Q NA
❑ NE
❑ Yes
❑ No
❑ Yes
2 No
❑ NA
❑ NE
❑ Yes LSNo ❑ NA ❑ NE
12128104 Continued

Facility Num)?er: — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes n,4o ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No B KA ❑ NE
Stru ture 1 Structure 2 structure 3 Structure 4 Structure 5 Structure 6
Identifier: +J
Spillway?:
Designed Freeboard (in): M
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes o ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes t 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 Z(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 No ❑ NA ❑ NE
maintenance or improvement?
Waste ApDlication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ON. ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 2 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) Qpv-n tour
- _..UJQQ�
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
21No NA
ElNE
15. Does the receiving crop and/or land application site need improvement?
El Yes
o ❑ NA
❑ NE
16. Did the facility fail to securc and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
El Yes
,�No
�,,,No ❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
El Yes
E No ❑ NA
❑ NE
Comments (refer tb,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):, x�
Reviewer/Inspector Nam ` �' _.� Phone:
Reviewer/Inspector Signature: Date:
Pape 2 of3 12 8104 Continued

Fae[lity Ndmber: 3 Date of Inspection
Re aired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes O3Xo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 0�< ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Desig
n El Maps El Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
U o
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1"
Rain Inspection�No,
Weather
Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
El NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
I��Ko
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
El1` Yes
No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
WNo
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ❑ Yes U Igo ❑ NA ❑ NE
Other issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
[:1 NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
[] yes
ETNo
❑ 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
eNo
❑ 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
[Z No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
,_,/
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
O No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
�lo
❑ NA
❑ NE
Additional Comments and/or Drawings:
Page 3 of 3 12128104

Type of Visit 6 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit:
y /47101>
1 Arri,al Time:
/ D: bc1 Departure Time: County: s �►ti-as �� Region: EQ0
Farm Name:
P-
Owner Email:
Owner Name:
_
r C_ e } a 4
��, �s _ Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone No:
Onsite Representative: dr Integrator: c�i k a
Certified Operator: Operator Certification Number: T^774' C
IF
Back-up Operator:
Location of Farm:
Swine
Back-up Certification Number:
Latitude: [:Do =] ' E—] Longitude: ❑ ° ❑' = u
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -Layer
❑ Wean to Finish
❑ Wean to Feeder
❑ Feeder to Finish
El Farrow to Wean
C o o 0
(, O 7Ji
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other _
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turke s
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ElStructure ElApplication Field ❑ Other
a_ Was the conveyance man-made?
Design �
Cattle Capacity Pi
El
Dairy Cow
El
Dairy Calf
ElDai
Heifei
❑
Dry Cow
❑
Non -Dairy
❑
Beef Stocket
El
Bed f Feeder
El
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
Beef Brood Co
Number of Structures:
d. Does discharge bypass the waste management system? (lf 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
El Yes
MNo
El NA
El NE
❑ Yes
® No
❑ NA
❑ NE
12128104 Continued

Facility Number: &07 --3t1 Date of Inspection
Waste Collection & Treatment
4✓Is stoNge capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ® No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: wopq —18 c:-.0 -
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): —.to? G cal y " I S
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
® 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
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
[(a No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
E� No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
❑ No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > l0% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Croptype(s) �nw Crdp P.-k-o 60
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
0 No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
Q No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination, El Yes
No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[p No
❑ NA
❑ NE
ReviewerA n Spector Name MOW /1002 RIM
Phone:
Reviewer/Inspector Signature: Date: 'VId '7 %cs
r znRin� !'nnri,,,.nrl

Facility Number: �a — �?1� Date of Inspection `_/77/aY
Required Records & Documents
I�' Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ® No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ® No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps [3 Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [�] No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ® No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [XI No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
® No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
® 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
[l No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
® No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
M No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
® No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
[] No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
® No
❑ NA
❑ NE
Acidifiooal�"Commerits''andUor. Drawings
12128104

r
Type of Visit 0 Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit 0 Routine Q Complaint Q Follow up O Emergency Notification O Other El Denied Access
Facility Number Bate of Visit:F 3 - Time:
,,.�.,,..
0 Not O erational Q Below Threshold
04 ermitted 01:!erppfified 0 Conditionally Certified [:1 Registered Date Last Operated or Above Threshold: --- _.
Farm Name: ... Lw� -t r�� - Ct a -- ----� .. —� County:. _ 9_e�P- 4
Owner Name:..��e4�£ ....r�L �x1 ------ f_ ._. _.. -Phone No: . ��� � ��J� � �2�� .........
Mailing Address:.._ �^ - Qo,K • y�..... __._.f'► tr.CQ!� y� l� �.........
FacHity Contact: ..—Gm 5�4% ' ..�_ rifle Phone No: _
pper ............................................ .................
Onsite Representative:
Certified Operator:— �! Ct1?�� (�.._....Operator Certification Number: —yam .�
Location of Farm:
Eww'ine ❑ Poultry ❑ Cattle ❑ Horse Latitude 0 4 49 Longitude • 6 44
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes EMo.
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes Quo
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes Q.W
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes U-No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes G-No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes e-Mo
Waste Coliection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Identifier:
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
A Q L
❑ Yes ❑-w
Structure 6
Freeboard (inches):
12112103
Continued

Facility Number: &2
Date of Inspection --0�
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes E].—
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑ Yes [moo
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 E3'lq-o
8. Does any part of the waste management system other than waste structures require maintenancefimprovement? ❑ Yes EM
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes ©-k�o
elevation markings?
Waste ADDlication
10. Are there any buffers that need maintenance/improvement? ❑ Yes [a..No
11. Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes U-lk%
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type t~m/ I �r-pans
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 gwo-
b) Does the facility need a wettable acre determination? ❑ Yes [-No
c) This facility is pended for a wettable acre determination? ❑ Yes RM
15. Does the receiving crop need improvement? ❑ Yes GNO
16. Is there a lack of adequate waste application equipment? ❑ Yes [3-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 ©Alo
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes 8-No
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes O-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 U-No
Air Quality representative immediately.
amid/
Comments (refer to quesixon #) �E]tpiaun any YFS any _ any other � answ or bons or
`Use dra*mgs of facility to= -better r pla n'st eat<ons. (nse t<oaal pales necessary) [field Copy ❑ Final Notes
h ,. — a,
A,
- 7
E
er/Iaspector Nameer/Inspector Signature: IM�Date:if
- U
zaiz_'itrj c.onAnuea

Facility Number: Date of Inspection
Required Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
al o
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
Yes
ONo
(ie/ WIT, checklists, design, maps, etc.)
❑
23. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
G1lo_
❑ 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
❑ 66
25. Did the facility fail to have a actively certified operator in charge?
❑ Yes
M-Ko
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
Yes
(ie/ discharge, freeboard problems, over application)
❑
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
EH6
28. Does facility require a follow-up visit by same agency?
❑ Yes
M N'o
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
ElKo
NPDES Permitted Facilities
30_ Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
R4e-s
❑ No
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[9f4o
32. Did the facility fail to install and maintain a rain gauge?
❑ Yes
Bfgo
33. Did the facility fail to conduct an annual sludge survey?
[des
❑ No
34. Did the facility fail to calibrate waste application equipment?
Q Yes
❑ No
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below.
❑ Yes
M.Ko
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After I" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
U-No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
-PP 3 3 and 3 1 1► r, (3a refoof s1adPd AO i fti e unn Vd ( 51(1a1ge
Svrvey G„CI fhe CaIA—r ��`04 07) 4✓4sle aAP4'cexlion if yv,'/aen
L„Ur�f61 At r1_111_5hPy by /Ae end v/' 00Ll
E r&5.oyj f4or C11W5 _200_2 Gyl ke 1GCjo urr5
ae,U-eS 9e l a,./ 9rGss ,t5 14D I(.r 9 A O�C/ .
air
on a 4156P0 q 64;p ve s,AUf) b U4 9 Coss s •t" y,,, 4 40
Fr� lap (es 9 6,061,
Rec6rdf load'l Gy Oocf,
A a-,C 6'e e,7
12112103

Site Requires Immediate Attention: NQ
Facility No. rZ 341
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: [ , 1995
Time:
Farm Name owner: P ZZ A
Mailing Address: PO i30X_ *3 S Al _Z$3Z,9
County: Soap so.-y
Integrator:
On Site Representative:_
Physical Address/Location:
Phone: WO-)
Phone: 07/0Sq Z - ,` 77 /
Type of Operation: Swine - 'ouItry Cattle
Design Capacity: _z_ooy So�,�►jrar_ W umber of Animals on Site:
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: 3 j ° 41 ' 00" Longitude: * i 7 ' 0a
Circle Yes or No
Does the Animal Waste Lagoon have sufficie
(approximately 1 Foot + 7 inches) Yes r No
Was any seepage observed from the la oon(s)?
Is adequate land available for spray? or No
Crop(s) being utilized: �earw�
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings? Ye or No
100 Feet from Wells? es r No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or N®
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line: Yes o No
Is animal waste discharged into water of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes or 10 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 or No
Additional Comments:
nt freeboard of 1 Foot + 25 year 24 hour storm event
Actual Freeboard: Z Ft. G Inches
Yes o6N Was any erosion observed? Yes o0
Is the cover crop adequate? Ye or No
R,'k�l R4-ve.Is R R ..
Inspector Name Signature
cc: Facility Assessment Unit Use Attachments if Needed.

Site Requires Immediate Attention: I o
Facility No. NIA75 be-
-
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: _S4!4 1'9 1995
Time: i 4 : 3 3
Farm Name/Owner:
Mailing Address: f'o LS oX 4-3 S Cl:m*M AIC- Z S 3Z S
County: So.4soN -
Integrator: Phone:
On Site Representative: Phone: 57 71
Physical Address/Location:
Type of Operation: Swine Poultry Cattle
Design Capacity: zoofl 1Asca„ / Number of Animals on Site:
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: 3 4 ° 4-0' ► S " Longitude: -7S ° / 7 ' Q5 "
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm
(approximately 1 Foot + 7 inches) (e or No
Was any seepage observed from the la oon(s)?
Is adequate land available for spray. e or No
Crop(s) being utilized: ,Bei,-Mu 4,!5"
Actual Freeboard: * Ft. Inches
Yes o No Was any erosion observed? Yes or©o
Is the cover crop adequate? es r No
event
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings? (nc) or No
100 Feet from Wells? (r No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes o<9
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line: Yes 04�s)
Is animal waste discharged into water of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes o6� If Yes, Please Explain.
Does the facility maintain adequate waste management reco(volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? Y or No
Additional Comments:
&'c-k , R" �s
"Inspector Name
Signature
cc: Facility Assessment Unit Use Attachments if Needed.

Farm Name/Owner:
Mailing Address:
Site Requires Immediate Attention: AJ O
Facility No. V2 " -?50
DMSION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: MAt _ 17 , 1995
Time: 14 % 30
p zZ s / proms fc,
x
LCLVA4 s -ZVC .
0
County: SafV50tj -
Integrator: Phone:
On Site Representative: Phone: t/q/4-2 S 4 z. — 57 7 !
Physical Address/Location:_
Type of Operation: Swine Poultry Cattle
Design Capacity: Z000 Far Number of Animals on Site:
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: 3 4 30 " Longitude: ° i 7 ' 00 "
Circle Yes or No '
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches) Ye or No Actual Freeboard: 3 Ft. 0 Inches
Was any seepage observed from the la (s)? Yes o<l Was any erosion observed? Yes or
Is adequate land available for spray? (Ye&kr No Is the cover crop adequate? (�r No
Crop(s) being utilized: cL
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellin s? r
100 Feet from Wells? es or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or(P
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line:
O
Yes o No
Is animal waste discharged into water of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes 06� 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)? O or No
Additional Comments:
) ?sc-k �eue 1S
Inspector Name
&�4
� Re'�"L�
Signature
cc: Facility Assessment Unit Use Attachments if Needed.

r
DEPC, 1 + Ent V Envircnment,
Hed' cnC: Ncturcd Rescurc-as
Civisicr. of Envircnmertc! Mcncgerrent
Jc-mes S. Ht t, fr.. Geverncr
jCr7Cittcn 8. Hcwes, Sqc etcry
A. Preston HCwC.-d..1r., P.E. Director
A**
EDE
.wT7-r► �►—r-YEW MR =a== A
DIS i�CC'2:CNS TCS C=x='� =GOON OF .29RC4'� � L `+�rl.ar' Z !QQAG _VT PLANS FOR
Y=i OR =.`• =— A<�4VAL WAS—M.."SLOTS
ar_er to be dee=ed pe=it_ed 'by t :e Oi-r s_ is _ oz
s.^.vi=ar. aaral Management
(D.r�) . =�Ie c%Wma=
aL any new or expaCded ar-4-aT
waaza =a agement
systezm
Ca=C=Uctec ar_eZ
1, 1994 is desz�;Mea
to se --,re 9--eater C:an
or
equal to t:.e a.�..ai
listed bale+ is re4s:;:sd to suk=i.t a
s_=ed
ce_ i=icaciors Zara to Doi the new ani;a,T.s are stockad on the
facet.
?asr-­s Cperacians
are exempt f_om the re,q.tiremenc to
he
100 Used a& eattls
73 Sorg++. .
254 a.IZAh _
1,0043 alaadep
3 0, 0 0 0 big_-_s_z wtt:L s I iqm3d v"ta system
T!:e carc=ficatiaa =ust be signed by than owner of the feedlot (and =Mag4w iw
d___arsat f_-=UL the. awne�-) _ ard by any te<-j=-; cal srea-;aLst dexigaa=ed by the Soil -
and '+lacer CoaserraC:;_va- CQUImjZxLa:z::7q=TU=r to 25A. BU= .mac _0001-400s_ " =A` :
tec =ical rec'_alist ;List verify by an as -site In ectiom t-hat a21 aFplicabl e
desi,n and conz==u=-_iesm scanda= s arse: specifications are met as instakl2ed and
that all ap?iicabla age=mcfaa-a_nd te.�� statrdards .had s� _ficatio=� eatY- -cs : .
he rat... - �� __. • -.____
;athauSa the a -.sal n,;s,e+r of a,.4=1 = at the say va=.f gram ti= a time,
the desiSmn capac .t:j of tze waste han :I'- Q wyscam should be used to det-1„a i.f
a fare is subbed to. tie certifiratian rsqui_-event _ For e>am:01e. -if the waste
system fez: a feedlot is designed to handle 300 hogs Lu= t :a ave-age pocuij=' c3M
Will ha 200 hGgs, Chess the waste —A eme= System rVqui--es a cer'ificatioa.
7-his cartif=cation is r ui=ed by rer uiatioas gaverri: S am.: waste manaq�ent
systas accpcad b:yam =� L& vim-crsnentai Ma.aagememr, Ccrission ( HC) an Decker 10,
1392 (Title 15A NCAC 2a .0257) .
Cn the _eve,se side of this page is the certification far= which =L:st be
s :ttec to D_"i_ befog; new arii=als ars stac!ced on the fa==_ ' assistance in
Cal ?1BC y the caz� -a QCCai.ZeC _rat CCe CC C::e ?aC3a dri@S:Cies
-s:.:c as the sail a.GA- c=rse raCian dist_'_ct. a CSLra-Sci= Ccrse_�atiaa
sex -rice, or the N.C. 50r-7ice. The fora sbcu;d be sent to:
Depa` =erc a f y r �=ent , Eealth and
Div-_sion of S: -r- rental Manag-ent
'+race= Qua1i=-I Sec=_Qr_' PlamxLiag Brarr!%
P . O . Box 29 S3 5
Raleigh. N.C. 2,625-0535
Phone: [phone]a3
Fars ID: AC:r_-' 0i94
.UC.zra.l RescurCas
•
Steve W. Tedde.; , Chief
water Quality Section
Dace:
P.C. Scx 29525. RCeigh. Nerh. Cc::crir,.z 2?h26-r. ;I Taiechcr,e 419-7 -;C 15 FAX 9 - r-733-2a96
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P22A, P22B & PX22C
Take 421 South to Harrells, at
Harrells take State Road 1007
approximately 6.5 miles to dirt road
on right (State Road 1120). Farm
is approximately 4 miles down on the
left.
jc�

5=10N IZI
FRI"Z
Field Site Management
1. Is animal waste stockpiled or lagoon
construction within 100 f t. of a USGS
Map Blue Line Stream?
2, is animal Waste land applied or spray
irrigated within 25,ft. of a 4SGS Map
Blue Line Stream?
3. Does this facility have adequate acreage
on which to apply the waste?
4. Does the land application'site have a
cover crop in accordance'with the
CERTIFICATION FLAP?
5. Is animal waste discharged into waters of
the state by man-made ditch, flushing system,
or other similar man-made devices?
6. Does the animal waste management at this
farm adhere to Best Management Practices
(BMP) of the approved CERTIFiCATIO Y.
7_ Does animal waste lagoon have sufficient�L
freeboard? How much? (Approximately T i
S. is the general condition of this CAFO facility,
including management and operation,
satisfactory?
SECTION Iy
Comments

lei M= CARQY.nM D"AR3MMM OF E@7 -MOWC M, BBAI.TH' & NATMiAL RESOM:U=5
DIV15ION OF EWMONlMTAL
Fayetteville Regional office
Animal. operation Compliance Inspection Form
AM"rIowi�t3 "<<�
IidSPEGTxd» Dg3'E
,�M ,BARK'' i�lID�1i
�� µ_.:
X27C i (e arrms 4ic
• Y -' DRiw]V
Z
All questions answered negatively will be discussed in sufficient detail in
the -Comments section to enable the deemed Permittee to perform the appropriate
corrections:
SECTION I
Animal pperation TYDe: b fro /
Horses, cattle, ine, poultry, or sheep
5ECRION II
Y I H I COMMENTS
1. Does the number and type of animal meet or exceed
the (.0217) criteria? [Cattle (100 head),
horses (75), swine (250), sheep (1,000), and
poultry (30,000 birds with liquid Waste
systam)3
2. Does this facility meet criteria for
Animal Operation REGISTRATION?
3. Are animals confined fed or maintained
in this facility for a iZ-month period?
4. Does this facility have a CERTIPIF.D L
WASTE I LAMA 1'P PT AW.
5. Does this facility maintain waste management
records (Volumes of manure, land applied,
spray irrigated on specific acreage with
specific cover crop)?
G. Does this facility tweet the SCS minimum
setback criteria for neighboring houses,
wells, etc?

4 �
-7 <7 tom-. } i S ��. -?0
WORTH CAROLIM DEPARTMENT OF v BRALTS a NATURAL R8.SDIA =
DIVISION OF EfMRONMMAL KANAMMONT
Fayetteville Regional office
Animal Operation Compliance Inspection Form
.G�<�Yr, :x
^'.>.^..%;:;F 6iacz ,LtA�7A/,iIA«L[i.:: Ip"y°
,7T ^■wad
Y _;.p■�
;L
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1j2D
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+yyam���y. T}}�������+.��
?a!^:-JY\ai. y-• Vs 7;: G
- .�w s„�w..� ^�,..y,.w � <w. ' �,.•:
w7+j; u�. ■��� �j�p�� ��_
�,��..+�,'a�'�" '�Rl.1L{30 i7Yi' HM
3 C1 1 nh)n 'z 3z
q 1 o) Saa
All questions answered negatively will be discussed in sufficient detail in
the -Comments Section to enable the deemed Permfttee to perform the appropriate
corrections:
SECTION I
Animal Operation Type: TQ.rrovv
Horses, cattle, AEie poultry, or sheep
-SECTION II
Ps" . �a
1. Does the number and type of animal meet or exceed
the (.0217) criteria? {Cattle (100 head),
horses (75), swine (250), sheep (1,000),..and
poultry (30,000 birds with liquid waste
system) ]
2. Does this facility meet criteria for
Animal Operation REGISTRATION?
3. Are animals confined fed or maintained
in this facility for a 12-month period?
4. does this facility have a CHRTIY= AI L
BASTE lAt+UIG� pi.W.
5. Does this facility maintain waste management
records (Volumes of manure, land applied,
spray irrigated on specific acreage with
specific cover crop)?
6. Does this facility meet the SCS minimum
setback criteria for neighboring houses,
wells, etc?

S2=0jq IxI
jqeld Site Management
I. Ia animal waUw SLUCkpilsd 4r lagoon
construction within 100 ft. of a USGS
Map Blue Line Stream?
Z. Is animal waste land applied or Way
irrigated w4*1,4n 25 ft. of a UGG3 leap
Blue Line Stream?
3. Does this facility have adequate acreage
on which to apply the waste?
4. Does the land application'site have a
cover crop in accordance with the
G3[RTIFICATIQN PLAN?
S. Is animal waste discharged into waters of
the state by man-made ditch, flushing system,
or other similar man-made devices?
6. Does the animal waste management at this
farm adhere to Best Management Practices
(BXP) of the approved CERTMCj1LI-M
7. Does animal, waste lagoon have sufficient `rt
freeboard? How much? (Approximately 3 )
8. Is the general condition of this CAFQ facility,
including management and operation,
satisfactory?
.E=GN IV
mmen�
13 �G4
PGlrm �e�s erec -6ol (oWe bc� cer+ifi Qh ��

Jl.,
0 41
4141 p w ° d v
v;oo9
.°
.
P4 �
y ICJ 4.1
1 1t I o f J
�4
-t r•4 m ca a
d o-H a .
4� NI cao�
i
1� � � �1 . ��, till. ► i � � � �)
•� ,� /y . �'• '` � • . oaf - 's .r � 1 ` ;l�''.� �ti.. � �,F ,:. ,' J � � , ► �� .* 4' ' !j { )l �i .

.NZA * ?IAS:'3 PLAN CZ3Z=7ta__0:i PCR 'WMT OR Z=2AN=Z= PME.^LCTS
Please _at L== the cc :pleted fad to the :,_risioa of at
=`e adWass an the _sv%sa afda of this _oa-
Na.e of ;aim (Please print) : RaEa AGS ;rAAM5In. P- 2 Z 8
Aid d.= es s : P. o . o x 903'e
Lyn on •z ?hone 19 Oro-_91W,11771�
Ccunty: SAYnr3sdn
-a--- _ccacins: Lu=itude and Longitude:j�� ��• Q" / ' �N (-e;-_yscJ . Also,
Please attach a Coos( of a county r.ad mad with location ide_^.tried.
Tyne of operation Wine. layer, daiz y, etc.): 5 w IjI fe
Lesion wapaci_y i::=:=-er of anials) , Zola Sow ;-4 R - W i--An _
Average size of _pe;at;or: (1:- =Camh pCiu'lacOrt avg.) +Z4za o So wr FAR - WE n
Average acreage needed for land application of ,rasa (acres) 35
:asaasaasasssssaaa shahs:s'ssaaaaasaasa aasaaaaaaaaaaaaaaaasaaassaaaassaaaarehash
Tec_, :!cal Specialist cation
AZ AZ a =ethical specialist desig:tated :qy the Isamh Carwlizra. Soil Zak water
Cnaser7acian CcmOssion ,pursuant to 15A NCIZ 57 .0005, I cer=ify that the new or
exzaade= aml=a}_ waste manageme_^-t system as installed for t a -`a-= named ahove
has art ani al wasta marage=ant Man that =eecs the design, ccrs rncticn,
cperat;cn and maj=ce-nance star_da:ds ar_d speci,_cac;ar_s of the Oi.;s'_or_ of
__ __o<=en=al Mkma.gament and the WA-3oi- Ca serrat:oa Ser-r__s ai d/or :he
Ce-___-a Soil and 'Hater Cz sernscion Commission pursuant to iSA NCAC 2H.0217 and
_E ; `iCAC or .0001-.0005. 11he follcwing e` are.^its and their cc__esponding ni.ld�===�
c:ri,aria- ?aus-beenverifiad by me or other designated tec nical. specialists and
are included La the plan as applicable: miaWum separations (huff axe) , liners or
equivalent for lagoons or waste storage poadsr waste storage capacity; adequate
gcastzry and amount of land for waste utilization (or use of mhi=4 parry); access
or awnershop of proper waste application equipment: schedule for tQQ=g of
a__;-cazicrs; application rates: loadi,.g rates: and `..he control of the dischaz e
of pollutants fram stor=.ratar runoff events less severe than the 25-year, 24-hour
stogy. -
Nasso 04 ?0c2 T Spaciai3st {P,eese Print) : Gt�n n CLf FTD�i w Affiliation:
E5Td6 �ARrNS �+c.
Add ess (Age_^.cf Z30 w SO- 38 Cc.n r<n r n Cnj83L8Phone No 92
Sig: ac =e:_ t- Lo. _ Date- 013199t
sasssaaahsaahassssaah=W==W=asaaaasaaaassaasaaasasssaaasaa:atrssaa:asaaa
C+r_dr%���aCeS �g=1�a�L
l (we) understand the operation and =mL nte_rance procedures. established i+Z the
approved animal waste mar-agemer_c plan for tte fa_-= named a ove and will ..^,.lesnert
these Procedures. I (ire) know that any additional expansion to the existing
design_ capacity of the waste t=eatment and storage system or ccrstluct:or, of hew
facilic_es will :equiwe a new Cer_i_icaci0n to be 5utnitted to the Division of
=.v__or=encal mar-aseme_^_t before the new animals are st=c.ked. _ (we) also
_-_tiers _a_nd that `here =ust he ,o dischaye of animal :caste f_== this system to
surface mata=z of the st.ata either t`._aug^ a ear.-^3a.de ccriveya;.ce or thzrcugh
-of; float at sto= e,rent less severe than the 2S-year, 24-hourstory. The
apti zwed plan will he __led ac the farm a_^_4 at the orrice of t e local soil and
waza, Corse= vacion Oiszz-i=.
Ya.__a of La=d O++aer (?T ash P=i=t) _PAkc5-rA6E �c P-44—S+ -�
Sig-..zt.;s: r ata: �JG, ., a / /92t
!ra, o of 3ia2vgar, it diffn=ant flan owner (Please p=i;at) -
51gnacu e: _ _ Cate:
*iCte: A c:.ange in lard cw-nership requiras ncti _cation or a new Certification
the a_prcve�' pla-i is c::anged) to !:e suhmittad to t: a II'_vislon oz
T-v;-crtme_^_tal Management :lit iin 60 days of a -
. -t? a Waxsfe=-
Lz:iliS= 0tMy: AC:%s

vi\.iC VI IvVj ij I t, C.:jkjjji IQ - --
DepertllnlEnt of cnvircnment,
hEcith C.-Id Ncturd Resources ; •
OMSicn ct Envircnm�entci Mcncsement
Jc.-rses B. Hurt..Jr., . Secr tc ED E N M
Jencthen S. Hcwes. sec: etcry
A. Prestcn i-?cwc:c, Jr.. P.C.. Direalcr
?!23 MM.'_Vr=
:'IS7.1UC :CNS FCR C=z':'- =C�.TrCN CF APDQCL'= ANL AL WAS' M' PLANS FOR
T _, C R :� ;NL —
or_er to be deemed pe_=.it=ed by t_:e Oi74s;.n of 3avironmental Management
(n "%) . thte cwr.er of any new or wcr a ded an + *na 7 wa.i z e mums gement sys a em.
after Zanua=f 1, 1994 which is designed to serve greater ta: n or
es.:ai to �"a an 4 -a'r �oput aeons lismed below is requi_-ed to s,,;!,}•: t d sided
cswifcacicn form to 7i3 t.'ze new arsimais ara sccc�ced an the fa=-
=as":rs cperatians are exempt from the requi.=emenc to be cer-__,ied-
100 !Lead of catsle
7s horses -
2s0 sor+
1, 0 0 0 sisar�p
30,000 34--3s with a 114n;Ld w"ts systan
The car_i.fication must be signed by the owner ai the feedlot (and manager if
different f_o:a the owrer) and by any tec:.=ical spec'_alist desig=ated by the Soil
and +vacer Canser7atioa Commission pmLz-j^c to 15A NCAC 67 .0043I-.0005. A
tec :=ical wpecialisc mast verify by an on -site inspection that all applicable
design and canst_--uc=ion staezdaras and spec:fications are met as i=x al? ed and
that all applicable ope:-ration and. maintenance: scandartts .and specifications - caa: _ �c3
he net.
AItroug the actual atrber'of areizaais at the facility may vary ¢r= time to time,
the design ca;.acity of the waste hand? i�g system should be used to detes.ai :e if
a !a= is subject to the certification requirement. For exarMPZe, ;f the waste
system for a feed.Ioc is designed to handle 300 nags but the average population
will be 200 hcgs, then the waste management system requires a cerr_ificacian.
Tills certification is required by regulations governing ani:ual waste management
systams adopcad by Chia Znv1ro=enca1 Management Cc=m ssion (M_C) an 13ecember 10,
1992 (Title 15A NCAC 2H .0217) .
Cn thereverse side at this page is the carti_"-cation .o^ which must be
s .i_tsA to 1:22t before new animals are stacked an c e far=. Assistance in
cc..:r? ec;cy th.e F=— Can *--a obtai:.ed f_em one of the !cc. ' agencies
as t e soil a.^_= ;racer ccr-se*vacior. d_sc,ict, the CSL�.-Sal_ Conse_*-T C;an
Sar:ice, cr t e N.C. C�ecerat' mansion 5��'rice. The farm sacuid be sent to:
Ceva tent of zav-i,onment, Fealth and Namtzal Resources
Di r sicr. of r: v`_o=ental Management
Water Quality Section, Plann_imp Branch
P.O. Box 29935
Rale;g;%, N.C. 27626-OS3S
P?zane: 919-733-5083-
steve W. Tedder, Chief
Water Quality Section
Farm 10: Ac:,�,0194 Cate:
P.Q. ie+echcre 919-733-7015 FAX [phone]d96
An c:c Cc_crtnrfy A Ac- an S7scicyer SC% recyGeC/ 1 M perl ::rs.;rnee ;:c=ee

GI ST=.A: ION = r-RM = 0R ANIM-AL E= 07 Q??RA7:0NS
7epa:-�enz of Envitonmenc, ;ieaic!and Natural Rescu;ces
Division of Ezwi ormenzal Management
Water Quality Section
Tf t::e animal waste managemennz system for your feedlot c-e_az-On is
desirne; to ser,7e more tan cr equal_ to 100 head a= cat-- e, 7S
horses, 2!0 swine, 1,000 sL eec, a= 30,000 birds -`_t are served by
a waste S_Jstem, .en t :_s mmust to fill-ed C.:- and mazled
cy Cece.mi:er 3I, _59� ptrsuar__ NC_=C Z =.0G=7 (c) =n a=ce= t:, be
deemed perm: red by OEM. = ; ease print clearly.
= ==n Name:
y
C ;L: I ' ���c 1 r1�1•��r.. .. Phcn a
Owner (s) Name-
Manace= (s) Name:
Lessee Name:
Farm Location (=e as speci=_c as possible: r:zaa names, direcz;on,
:ililepost, etc . } tt20 (4a l Srri,4{� -fit` ' R7',4 y'F 115 .rI !1 iul n L V 1'tF k
Lacitude/L ongi-ude if kr:awn: � f2� Q3- Dy_ )!� -
0esian canac_t_v of animal waste management system (Number and type
cf c:.nf _zed ani_-al (s)) L;cCCC�
Average anima_ population an zze farnt (Number and type of anal (a
-raised) :.C,-or=cL
Year Production Began :/59�1 ASCS Tract No.:_ !a 77 - -
Type of waste Management System Used: g..
Acres Available for Land App?rzcaLi n o4l Waste: /oe
Owner (s) Signatu-re (s) .
DATE':

1 01" 3 CAROXJM DXPARTMaMT OF IWIRONNMM, HEALTH' & IMTU AL RBSOUMMS
DIVISION OF ENViRONMEM%L
Fayetteville Regional Office
Animal Operation Compliance Inspection Form
'v <a�.�..:::��.tlfil7-�/�/Rn.LLS
:Zr'.: r
.r--•��r
�.;'.ui�5"'%`:.`lS`Wk....-'a3.
�'��,-.i/O�L. �+�lAF�3.�
P27,A ��e- 5t-a r m s anc{
r.
ALiL+il.
All questions answered
the,Comments Section to
corrections:
SECTION I
negatively Will be discussed in sufficient detail in
enable the deemed Permittee to perform the appropriate
Animal operation . TY-Pe: Tara)VV
Horses, cattle, swine poultry, or sheep
2HCTION II
Y I N I COLTS
1. Does the numbe' and type of animal meet or exceed
the (.0217) criteria? (Cattle (100 head),
horses (75), swine (250), sheep (1,000),.and
poultry (30,000 birds with liquid Waste
system)]
2. Does this facility meet criteria for
Animal Operation REGISTRATION?
3, Are animals confined fed or maintained
in this facility for a 12-month period?
4. Does this facility have a CERTIFIED ANI1r1AL
WASTE NANAGZMMNT 93.f
5. Does this facility maintain waste management
records (Volumes of manure, land applied,
spray irrigated on specific acreage with
specific cover crop)?
6. Does this facility meet the SCS minimum
setback criteria for neighboring houses,
Wells, etc?

AMMO Q III
kleld SiteNanaaemernt
1. Za animal wauLw HLuckpilad or iagoou
construction within 100 ft. of a DSCS
Map Blue Line Strait-?
2. Is animal waste land applied or spray
irrigatoA wi *h4 j 25 tt. of a UGGO Maps
Blue Line Stream?
3. Does this facility have adequate acreage
an which to apply the waste?
4. Does the land application sits have a
Cover crop in accordance with the
CZRTIFICATLM PLAN?
5_ Is animal waste diachaxged into waters of
the state by man-made ditch, flushing system,
or other similar man-made devices?
6. Does the animal waste management at this
farm adhere to Best Management Practices
(BMP) of the approved CERTIFIGTIW
7. Does anima, waste lagoon have sufficient
freeboard? How much? (Approximately )
8. Is the general condition of this CAFO facility,
including management and operation,
satisfactory?
Sxman IV
Comments
j arm ragged 4�)I1 C)Wed by cer�ifi�adorl �3 q9

"�j
P-22A and P-22B
Take 421 South to Harrells, at
Harrells take State Road 1007
approximately 6.5 miles to dirt road
on right (State Road 1120). Farm
is approximately 4 miles down on the
left.
A

N= A * ST3 �.�S7.ZG�iT 2Ld
.1C3Z =7::' X'==X YCR NXX OR "—=L TS
?,a:aw swt.L"a< the ccm:platad lw= to t.L.a Dye sia:. of
t�Ld ad:�asa oa tlsa ravarsa side of tb.'s fad.
,rase of ;a--= (Please pryat) : PRES�EARlns -Tnc, P- ZZA -
Add.-ess : A 0. Box 4-393
C4in72�nf /-) G
Cou: cy : S.aMa� _
'a_W '_ccac_o,-. Lac__ de and Long 4Zude:Z$'17'qc*'/12p-f/ " (_ei i=sd) . AI so,
please attac a copy of a county road Wrap with location idenc;_iec.
�e of operation (s.+i=_e, layer, dairy, etc.)
Iesz.g_ aapacity (r•. ^e= or aaimals) : 2Qao BAR- WE -An
zrerase size of cpe=at;or.- (12 ao.-.t to;.ulaCicr_ avg. ) : ZC&D Sow Fite-vjuAn
=..eraye ac=aase neeced Sa_ land application of waste (ac_es) _ 37 ._.
=aaaMaaasaseas asasa:sass3saaaa:aaasaMaasaasaMa:aaaeaa agaaaaaaaaaMasaaMasaaMaaaa
:'eC_yca; spacfaiist Ca�_a=Gat3Ga
As a technical specialist desig-_ated by the Nort`_z Carolina Soil and Watar
_crse^-orlon Ccaraissior. pu---suant to I5A NCAC 5c .0005, I certify that the tens ar
eXr-anded a^'-a1 :caste marsagement system as installed for t=e fa= :,Area above
zs all an:--1 waste =an_aryemenc plan t!tac meats the design. c=rst__ct_or,
ce.-aC_cr. and M&inter_ar.ce starda.--.s and sceci ficat`ar.s of _. a D: l_s_on of
and the USLA-Soi? Co[:ser': at_on Se^rids aL d/or
Caro!i_.a soil and Water Cnnse_"7atior_ Cc=missicn pursuant to ISM. NCAC 2L.0217 and
15,E NC',C os .0001-.0005 The follow=q eieae.^_c3 and cor_espondinq
? t�-'_ ibasze�een�Ter�;zed by me or other desigr_ated technical. s;seciaiists and
ars _;nc'uded. ? 1 the plan as apalic.a-cle: mi.=;=u separations (huf=a -•s) ; liners or
egairalar:C far lagoons ar Waste storage ponds; waste storage capacity; adequate
.7.zantiry and amount of land _or waste util_sat_am (ar use of hir; pa--f) ; access
o= ow:.e--ship of paper waste application equi;.ment; schedule for tinting of
a=plic_tiens; apniicst'_ou rates; loading rates; and the c--ntrol of the discha=ye
of pollutants from stor-water runoff events less severe than the 25-year, 24-hou=
storm.
Namo at ae o G. aaLEnh CoF nbin
T L , �Z S�acia.Zist {F-ease Print)
�.ffil_ation�R �STA R
Ada...=ess (Agency) :�5e_-�)c u-_�R8 P}tone No_�7ro 591 :5"771 -,-
51g..aC•..:.r e : 9�9. - C._ - Bate s 6P l r
asMMMsaMaaaaaa=aaaaaaa=asa#a MwaaaaaaaasaaasaaasaasaaMaaasaaaassaaasasa
GWtwr/!E&=M ►Q= Agr04uMQ=r_
i (we) understand the operations and mainte_*iance procedures estabJ43hed in the
approved ani=al waste management plan for the :'a--3 named a :eve and w__1 i=plemert
these Yracedures . I (we) know that any ad;c..-' tionaI expansion to the wasting
desk,-_ capac_rf of the waste t,eatment and storage sys=em or corstr_.zctioa of new
fac4l;t4es Will r .:__e a new ce-*_.ficat_an to oe su i=ted to the Di-.rision of
Z:.r_ror ertal marageme_^_t before the new an:_..als are stacked. (we) also
underst3.^d that t :ere oust be ro disci-zarpe of ar.'_a? •.caste i_o:n this system to
su;;ace . iaae=z of z%e state either v=ough a -An-:wade car_veya:.cs or t.=ouq
_.of_ __oat a storms event: less severe than the 25-yea_, 24-i':our storm. The
a'^.c:'led Plan will :e t--eC at the fa= and at the office of C=e local 50-4 and
nz_e_ Corse=rat�or. list_=c__
!la=a of :.Wad a. �Z P;�.^.Cl 7'R 5LC_ rAk AOUS
S_ at;ra.
!Ta=a 01 vM-aqa,: , _= d_ `- erer.t irV= Owner (Please pr:L=t )
5_;:.aC_=s•
Ycte: A c:,ange {n lard ownership re4ui=es
(_ = the approved plan is c.':ansed) to
wa^.agement :Ji=hi_n So days of
Date:
:cc_:.cation or a new certification
be su::mi .-ed to .e Di•r_sion of
a
i.c^_� vS� GAri.i:aClr',r

DePc7417nent of environment,
Heclth crld Ncturd Resources
Civisicn of Envircrr•,entc! ,Mcncgement
J=es a. Hunt, Jr., Gaverncr
,lancthcn E. Howes. Secretcry
A. Prestcn Howard, jr., P.E.. Directcr
1S."ZLC :SNS =CR C:.:?'r T-C�,T_ION OF APPRO4, AUMA-kL WASTE NA=GZ= PLANS FOR
N` 1 OR =-Al= ANI_`IAL 'ATAS
o v...,-z a*� e
�. crcer to be deemed pet-=itted by the Di'Tisi:n of .zviro=ental Management
(01-11) , t. a awns of any new or expanded *arii3al waste management system
cons;.__'cted after 7anua=y 1, 1994 wiiic h is designed to se_-7e greater than or
eq.:ai to the a -:-al populations listed bselcw is required to summit a sided
catrzi-icacian fo= to OE4 3 the new animals ara shocked an the fa—_
as: a cpe;ation,.s are exempt = the yequi.:emeat to be
100 hand df cattle
73 bcsses
250 awl-Mto
1,000 sheep
20,000 b'w_--ds ►ri th a 13gaid waste Z"r.—
The her _ification must be signed by the owner of- the feedlot (and manager if
dif:asgnn t from the ower) and by any tach=i cal specialist designated by the Sail
and Water Cor=eT-TatioA Commission =Y+L to lS,l NG1C .0001+.0005. A
tec_=ical specialist --st verify by an on -site inspec_i.on that all applicable
design and cartst_-uction stands-- a and specifications are mec as installed and
that all applicable ope,�at an_ana maiatenancs standards atxd specifications cau-
be met.
Although the actual nuabar of ani—I a at the facility may vary f--= time to time,
the design ca ac;t-
.Z of the waste haad3ing system should be used to dete=z:--e if
a far. is subject tc the certification requirement. For example, -if the *.caste
systasm for a feedlot is designed to handle 300 hogs but the average population
will be 200 hags, then the waste management system regtd--es a certification.
7-"is certification is re-qui-red by regulations coverr.inq ani:mal :taste management
sysc= adopted by the Eavironmental Management Crmmi sion (E C) an December 10,
1992 (Title LSA NCAC 2I3 .0217) .
On the reverse side of this page is the cez--ification fo = which rL:sr be
su`.:.itts_ to DZt before new animals are stacked on the fa-m. Assistance in
cz=P'emi. g the "o_— c3_ be obtained =_cm one of t: a Iccall agencies
sue: as t e soi_ amd ..acer corserracior. disc=ict, the USCA-Soil Ccnse_r-✓aclon
Sa -r_ce, cr C: a N.C. Cacpe,ative Sxsersian Se=rice. The fora should be sent to:
Ceoartaent of rironment, irealt; and
Di•✓_sicrt or Z�-rr�or=ental Marare=ent
water Qual-Iti Section, Planning Branch
P.0. Sax 2953S
Raleigh, W.C. 27626-0535
Phone: [phone]C33
Form IC: A=W0194
Natural Resources
Steve W. Tedder, Chief
Water Qualit-
y Section
Cate:_ iSs3
PA. Ncr ^ Cerc&r,.z 2762&C.S S ieiecnar,a 919-733-70M FAX 9i9-733-2496
An scud Cc Vcm.;..rty A �`'^1C.-Ne Ac-',=n CTIr-Icyor

r • �
F=-GI5TRA7=CN FORM FOR ANIMAL FEED O7 C?SRAT_ON5
Depa��enz of rtiv;_onment, health and Natural Resources
Olv=sion of E: virormental M.anageufenz
water Quality Seczian
71f tte animal waste manageme^z syszem for your feedlot operation
is
designed to serve more than or
equal to 100 head
of cat --le,'
7S
horses, 250 swine, 1,000 sheep,
or 30,000 birds t at
are se_red
by
a liquid waste sys4em, c-en t his
fcrm �zusz !:e fi_led
out and mailed
cv Ce:em:rer 31' _ga.: pu_sua-^.t _n
!--A NC;LC 2=.0217 (c)
_n e,dq_ Cz
be
deemed permitted ry 0=M. ?=easy print clearly.
a Name:
IJ � �!-`.
fit
f�
Owner (s) Name: 1-i
Manace r (s) Name: -
Lessee Name:
-a--m vocation (tee as speci=;c as pessi:.le : =cad names, drec;.ion,
milepost, e:c.) Fr- ��-n�tr� �n1fF '►, tf21 5«(-f,,j I-r I-�r'���'ca!S ,� : '^
i IClh4- l S .P . 1 1i!1 1 Ij "'9,Y.5 ,rY7 Jf
rat=nude/Loncicude =: known3-.-4 5 -
0es_cn cacac_ty o= animal waste management syszam (Nine= and type
C= can = aed an -;=al (s))
Average animal population on the fart (Number and type of ani 1 (s)
-raised)
Rear Production Began: /9�� ASCS Tract No.: �a%7
Type of Waste Management System Used:�fq0(`n
J
Acres Available for Land Anpl?
Owner (s) Signazure (s) .
of Waste: /ac
0A=-

Site Requires Immediate Attention: No
Facility No. 9 Z - z 9S
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: 3 , 1995
Time: 10 ' SS
Farm Name/Owner: Sacs Nti v-,e_tt F&_ - w. / 3'aw. _ s �6 r r-r.1 l
Mailing Address:Rt i i3o 9 7 14 w j2j L 1 s NC Z s I# Ifl+
'County: w.pSQN - -
.Integrator: n+tkY 1. 'F:6r l rw.S Phone:
�q to) Z$9 —Zt11
On Site Representative:_ Q 16 11 Phone: (9io) 573Z — *09'/ _
Physical Address/14=fion: /VC 441 ,Q, S i••r.' �S _ n'o� t�Y.-� . �..*- ���d
Type of Operation: Swine Poultry Cattle
Design Capacity: 3 6-1-L F; ,-j . Number of Animals on Site: 3& o o
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: ' Longitude: '
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of I Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches) <tc:s>r No
Was any seepage observed from the 1 oon(s)?
Is adequate land available for spray.) r No
Crop(s) being utilized: Cogs l u-o-,c
Actual Freeboard: 2 Ft. Inches
Yes oTC!!�P Was any erosion observed? Yes o(19
Is the cover crop adequate? ®or No
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings? (e or No
100 Feet from Wells? lii)or No
Is the animal waste stockpiled within 100 Feet of USGS Blue We Stream? Yes or®
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line: Yes
Is animal waste discharged into water of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes or V� 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)? Ce br No
Additional Comments:
Inspector Name
RR
Signature
cc: Facility Assessment Unit Use Attachments if Needed.