310857_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental Qua

Type of Visit: QQ Corr Hance Inspection V Operation Review U Structure Evaluation U Technical Assistance I
Reason for Visit: Q(RRoutine O Complaint Q Follow-up O Referral O Emergency O Other Q Denied Access
Date of Visit: Arrival Time: Departure Time: County: Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: �'� �`a { O/prr.s
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Phone:
Integrator:
Certification Number: q s-1 1 Ys—
Certification Number:
Longitude:
Design Current Design Current
Swine Capacity Pop. Wet PoultrJ' Capacity Pop.
Wean to Finish Layer
RNon-Layer
Design Current
Cat#fe Capacity Pop.
Dairy Cow
Wean to Feeder
Dairy Calf
Feeder to Finish
Design Gurreat
Dr. P.oultr. _a aci Pia
ILavers
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
D Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Beef Brood Cow
Boars
Pullets
Other
Other
Turkeys
Turkey Poults
Other
Dischar eg s and Stream Impacts
1. Is any discharge observed from any part of the operation? [:]Yes o ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR) ❑ Yes ❑ No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
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
II
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
Page 1 of 3 21412015 Continued

Facility Number: 1 1
Date of Inspection: 47-1
Wmte�Coliectlon & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes Vo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3 ► _3 r— 40
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes �NoD ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmenta threat, notify DWR
7. Do any of the structures need maintenance or improvement? El Yes ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes rNo ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste A2plication
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
o ❑ NA
❑ NE
maintenance or improvement?
11. is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
No ❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals
(Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAW -AP?
❑ Yes
o ❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
{LJ 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
� ❑ 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
❑ 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 D<o ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ YesgNo
No NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facili Number: jDate of Inspection: /
24..Didthe facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [� N�No
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑ 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 o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No Ej< ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes [;?'11ro� ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes &No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes Ea<om ❑ NA ❑ NE
❑ Yes �NoEj
NA ❑ NE
Yes NA 0 NE
Reviewer/Inspector Signature: - Date:
Page 3 of 3 21412015

-Facility- Ntirnlier :
."livision of Water Quality
QMDvision of SSoil and —Water Conservation-
.
Q Other Agency
Type of Visit compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit outine Q Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: eparture Time: County:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: / Title:
Onsite Representative: ��A -
Certified Operator:
Back-up Operator:
Location of Farm:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Region:
Latitude: [—] c = Longitude: = ° =, =
s D 'g urrent �D r rrent�
3. es� n C" esgn~ CU
s
;.Swine- Capacity.'Population Wet Poultry Capacity ropqlation. C
❑ Wean to Finish ❑ La er ❑
El to Feeder ❑Non -La -Layer ❑
❑ Feeder to Finish u� ❑
.. ❑Farrow to Wean Dry,' Poultry -' ❑
❑Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other C`
❑ La ers
❑ 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?
:tea
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood
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,(
pffNo ❑ NA ❑ NE
❑ Yes
[--]No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
gfNo
❑ Yes
JoNo
❑ NA
❑ NE
❑ Yes
hIo
❑ NA
❑ NE
Page 1 of 3 12128104 Continued

FacilityNumber: Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ❑ No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
St ruf— Structure 2 Structure Structure 4 Structure S Structure G
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ❑ No ❑ NA ❑ NE
(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 ❑ No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ❑ No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ❑ No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate ManurelSludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift [:]Application Outside of Area
12. Crop type(s)
13. Soil types)
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' [I Yes
❑ No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
-Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/Inspector Name or Phone:
ReviewerlInspector Signature: Date: O�
1212810 Continued

Facility Number: Date of Inspection �
Rebuired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes qNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes PrNo ❑ NA ❑ NE
the appropriate box.
❑ WUP ❑Checklists El Design El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 2No ❑ 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,XNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
o
❑ NA
El NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
El 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
El NA
El NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
VNo
❑ 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
El Yes
VNo
❑ 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
El NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
PNo
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
f
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
o
[I NA
[I NE
33.
Does facility require a follow-up visit by same agency?
El Yes
7No
❑ NA
❑ NE
Additional Comments andloe'Drawings:LA)
14
Page 3 of 3 12128104

Type of Visit O'Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit J2H:routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: �j� Arrival Time: eparture Time: �� County:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Phone:
Facility Contact: Title: Phone No:
Onsite Representative: Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Region:
Location of Farm: Latitude: = o = 1 ❑ Longitude: ❑ ° = , ❑
��" "+ _. _, 1�2'ki , - '.y,°.
''kC' -t`*. ,fib
.W Design C.urrent"� �Desrgn�urrent-
Swtne Capacity Population Wet Poultry" Caapa�city Populat on Cattle
❑ Wean to Finish ❑ Layer I QDairy Cow
, __
'6
Design , Cnrrent
Capacity Population
❑ Wean to Feeder
10 Non -Layer I
is ❑ Dairy Calf
❑Feeder to Finish"
`"ow
� ❑ Dai Heifer
[]Farrow to Wean
D Point y
SI "% ❑ D Cow
'"
❑ Farrow to Feeder
' ❑ Non -Dairy
❑ Farrow to Finish
❑ La ers
„ El Beef Stocker
❑ Gilts
❑ Non -Layers
❑ Beef Feeder
❑ Boars
- ElPullets
❑Beef Brood Cowl
. �b ❑ Turke s
❑Turkey Points
❑ Other
❑ Other L
Structures:
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
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 XfNo ❑ NA ❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes No
❑ Yes feNo
❑ NA
❑ NE
❑ Yes 91 No
❑ NA
❑ NE
Page I of 3
12128104 Continued

Facility Number: 3EEaj Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 0 No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes VNo ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: Z
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):Yd
3 7
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes /[�No ElNA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes 9rNo ❑ 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 V No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes VNo ❑ 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 Jam-' No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 4-No ❑ NA ❑ NE
maintenance/improvement?
It. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift [:]Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ Yes
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
17. Does the facility tack adequate acreage for land application? ❑ Yes
18, Is there a lack of properly operating waste application equipment? ❑ Yes
V-No
❑ NA
❑ NE
"No
El NA
El NE
No❑
X
NA
El NE
W-t
❑NA
❑NE
o
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments
Use drawings of.fadlity to better explain situations. (use additional pages.as necessary)
•
Reviewer/lnspector Name Phone;
Reviewer/Inspector Signature: Date:
p 2 f3 12 28104 Continued

Facility Number: — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes oNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ElYes No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes PNo ❑ 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 ZNo ❑ 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 �Ao ❑ NA ❑ NE
26. Did the facility fail to have an actively certified operator in charge? ❑ Yes �Ko ❑ 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 PNo ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document ❑ Yes WNo ❑ NA ❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes �Vo ❑ NA ❑ 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 FyNo ❑ 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 PNo
❑ NA ❑ NE
33. Does facility require a follow-up visit by same agency? ElYes ❑ NA ❑ NE
Additional Comments and/or Drawings: = "`
si'
Page 3 of 3 12128104

�� 4vision of Water Quality
Facility Number 0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit utine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit:ET/,,E�rrival Tim t efU rture Time: County: _ .Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Owner Email:
Phone:
Facility Contact: /� Title: Phone No:
Onsite Representative: l %f=4 ca df�f Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Other
❑ Other
Latitude: 0 c = 4 = Longitude: = ° [= d = a
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -La et
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
DischarEes & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current .
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ D Cow
❑ Non -Dairy
❑ Beef Stocket
❑ Beef Feeder
❑ Beef Brood Cowl
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes E No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA
❑ NE
❑ Yes ❑ No ❑ NA
❑ NE
❑ Yes VfNo ❑ NA
❑ NE
❑ Yes i No ❑ NA
❑ NE
❑ Yes ZNo ❑ NA
❑ NE
12128104 Continued

Facility Number: — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
❑ 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: ! .2--
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
❑ No ❑ NA
❑ NE
(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 ❑ No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ❑ No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ❑ No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ❑ 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)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
❑ No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
❑ NA
❑ NE
Reviewer/Inspector Name
Phone: `
Reviewer/Inspector Signature:
Date:
poop 7 nf ?
1212RIO Continued

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

(Division of Water Quality
[Facility Number Q Division of Soil and Water Conservation
Q Other Agency
Type of Visit d Co pliance Inspection 0 Operation Review O Structure Evaluation 0 Technical Assistance
Reason for Visit Routine O Complaint O Follow up O Referral Q Emergency O Other ❑ Denied Access
Date of Visit: ViTA4
Arrival Time: Departure Time: County: Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: CAU Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: o = ` = " Longitude: = ° ❑ ` "
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
--� ❑ Layer
❑ Nan -La et
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ urkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifei
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocket
❑ 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?
M
M
❑ Yes dNo ❑ NA ❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
❑ o El NA
❑ NE
❑ Yes
❑ Yes
El NA
[I NE
El Yes
VNo []NA
❑ NE
12128104 Continued

Facility Number: — Date of Inspection 1 1677
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [ No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: _LA �° �!✓, 1 __ —� 69I✓ L 4969111� 3
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(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 environmentalth
Eleat, 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 ZNo ❑ 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 INo ❑ NA ❑ NE
maintenance or improvement?
WasteAoolication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 5dNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes CI 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)
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 o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes N
ElNA
ElNE
17. Does the facility lack adequate acreage for land application?
❑ Yes L.� No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes EAo
❑ 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):
Zo, j vP�A 1,11/e
^�
Reviewer/Inspector Name FA g7t, Phone: �lQ 7p ! 73 Op dd
Reviewer/Inspector Signature: A4.,4 U Date: /4
1212RI04 Continued

,Facility Number: — ,� Date of Inspection l b
Required_ Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have a 1 components of the CAWMP readily available? If yes, check
the appropirate box. xin 7p ❑ Checklists ❑ Design ❑Maps ❑Other
❑ Yes q4o ❑ NA ❑ NE
❑ Waste Transfers ❑ Annual Certification
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Yes Ei /No ❑ NA ❑ NE
ca/yes ❑ No ❑ NA ❑ NE
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and l" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
(Additional Comments and/or Drawings:
❑ Yes E No ❑ NA ❑ NE
❑ Yes � o El NA El NE
El Yes 20 ❑ NA ❑ NE
El s LdNo El NA ❑NE
VYs �`No
N VNA
❑ NE
❑ Yes ❑ NE
❑ Yes /No
El NA El NE
El Yes ❑ NA ❑ NE
❑ Yes Lvl No ❑ NA ❑ NE
❑ Yes O"No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
12128104

Type of Visit o-c ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: �i }(, �L Arrival Time: Laa Departure Time: County: PlA Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
OnsiteRepresentative; .N4!: 46,w6 Q$-XsTCN,SE)�
Certified Operator:
Back-up Operator:
Location of Farm:
Owner Email:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: [= c = , „ Longitude: = o = , „
Design Current Design Current
Design
Current
Swine JaEpZacity Population Wet Poultry Capacity Population
Cattle C►apacity
Population
❑ Wean to Finish ❑ Layer
❑Dai Cow
❑ Wean to Feeder -Layer
❑ Dairy Calf
© Feeder to Finish
❑ Dairy Heifer
❑ Farrow to Wean Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
ElNon-Dairy
❑ Farrow to Finish ❑ Layers
El Beef Stocker
❑ Gilts ❑Non -La Non -Layers
❑ Beef Feeder
❑ Boars El Pullets
❑ Beef Brood Cowl I
❑ Turke s
Other ❑ Turkey Poults
❑ Other ❑ Other
Number of Structures:
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?
Page 1 of 3
❑ Yes No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes �o [I NA El NE
❑ Yes L No ❑ NA ❑ NE
12128104 Continued

Facility Number: - Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes I"J No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: LA 6a-*V l &4 &zwN Z LA CaCFN .3
Spillway?: / p
Designed Freeboard (in):'„S t' ! ! . S_
Observed Freeboard (in): -6
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 0 7No
❑ NA [I NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed El Yes ❑ NA ❑ NE
through a waste management or closure plan?
ental threat, notify DWQ
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or envi7yes
improvement?
7. Do any of the structures need maintenance or
❑ o ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
ElNA ElNE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
7No
4. Does any part of the waste management system other than the waste structures require ❑ Yes
El NA El NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
El NA ❑ NE
maintenance/improvement?
YNo
11. Is there evidence of incorrect application? If yes, check the appropriate box below. El Yes
❑ 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 ElEvidence of Wind Drift ElApplication Outside of Area
12. Crop type(s) )3L #) R o
13. Soil type(s) K-AAWS ( C.AAf-LAAJb ,16"6d<
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
15. Does the receiving crop and/or land application site need improvement? EK/es
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
[]Yes
❑ Yes
❑NA ❑NE
El No El NA El NE
VNo ❑ NA ❑ NE
Yo
� ❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question ft Explain any YES answers and/or any recommendations or any other comments:.:
Use drawings of facility to better explain situations. (use additional pages as necessary):
we, U�1j'/iOL 6Sa'�L�iQt.LV' r vs64 FZ—LD JQL-Q,�cerit60,
L/Posm ctoP wsTJj WI PG l' ,dN� SENY� COPY T�
Reviewer/Inspector Name-- - �f�_ -Ap. - - -- - Phone:
Reviewer/Inspector Signature: Date: � d L
Page 2 of 3 1 12128104 Continued

Facility Number: Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box. ❑ WUP ❑Checklists ❑Design ❑Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly reeboard ❑ 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 2(No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 2K o ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes VN',
❑ NA ❑ NE
❑Yes /NE1
El NA ❑NE
❑ Yes NA ❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑Yes
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑Yes
VN9 ❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
VN ❑ 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
2 rNo
❑ 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
0 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?
ElYes
o
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
No
❑ NA
❑ NE
at Comments and/or Drawings:
Page 3 of 3 12128104

Type of Visit Compliance Inspection O Operation Review O Structure Eva[uation O Technical Assistance
Reason for Visit V Routine O Complaint O Fallow up 0 Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: MaRCounty-
Farm Name: D 0'1_c Owner Email:
Owner Name: flcl - „Vr- r��?�_ /Yl�n� Phone: _
Mailing Address:
Physical Address:
Facility Contact: Title: hone No:
4,(4,4 7e
Onsite Representative: Integrator: �•
Certified Operator:
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
Operator Certification Number:
Back-up Certification Number:
Region: %mod
Latitude: = = 6 = Longitude: = o =
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
I; ❑ Non -La et
Other
❑ Other-- -- -- - -
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures: a]
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 )dNo ❑ NA ❑ NE
❑ Yes ❑ No
❑ NA ❑ NE
[]Yes ❑ No
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes No
❑ NA ❑ NE
❑ Yes No
❑ NA ❑ NE
12128104 Continued

Facility Number:`] — gjr Date of Inspection r O
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
El NA ❑NE
El NA El NE
Structure 1 /St_ructurp 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?: /V!>
Designed Freeboard (in): /q, .5' _
Observed Freeboard (in): 1
❑ Yes XNo
❑ Yes ❑ No
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes XNo
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ YesXNo
❑ 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?
0 Yes ❑ No
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes No
❑ NA
❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes )ZNo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ZNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below_ ❑ Yes VrNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 101bs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence f Wind Drift ❑ Application Outside of Area
12. Crop type(s
13. Soil type(s)
v. C..lnle'e5gAo'
111-464
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ Yes
16, Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination: ❑ Yes
17. Does the facility lack adequate acreage for land application? ❑ Yes
18. Is there a lack of properly operating waste application equipment? ❑ Yes
�O CO,✓riQ�7G �O� � o�,�
,VNo
❑ NA
❑ NE
JgNo
❑ NA
❑ NE
/No
❑ NA
❑ NE
�No ElNA El NE
ZNo ❑ NA ❑ NE
Reviewer/Inspector Name f-t"[�"' . �F_�97 Phone: a— W
Reviewer/Inspector Signature: Date:
12128104 Continued

f t
Facility Number: Date of Inspection [
Re uired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes /No
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes �No
the appropirate box.
❑ WUP ❑Checklists El Design ❑Maps El Other
21. Does record keeping need improvement? if yes, check the appropriate box below. 10Yes
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ NA ❑ NE
❑NA ❑NE I
❑ No ❑ NA ❑ NE
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections
❑ Annual Certification
❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes VNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes VrNo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes JFZrNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes JVNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes VfNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes PNo
❑ NA
❑ NE
Other Issues
28.
Were -any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes zl� 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
31
❑ NA
[INE
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 VNo
❑ 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 VrNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes XrNo
❑ NA
❑ NE
Additional-ComEmentsandlor,Drawings.
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AUG-08-2005 MON 02:34 PM PSF OF NO, INC
FAX NO. 9102993016 P. 01
To.
Date: 190
Re: I 1C�A:
Premium Standard Farms of NC
PO Box 349
Clinton, NC 28329
Phone [phone]
Fax [phone]
From: 3&zmm ill
Pages: including cover sheet
Z tL Fax: lky— 350'
0 Urgent 0 For Review © Please Comment ❑ Please Reply i] Please Recycle
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FORM IRR-2 Lagoon Liquid Irrigation Fields Record
One Form for Each Field per Crop Cycle
Tract # Fieid # 11 Facility Number 31 - t157
Field Size (wetted acres) = (A) 0.64
Farm Owner Premium Shandard Farms of NC lnigalion Operator Chris Cottle
Owners Address P.O. 80K 349 Irrigation Operator's
Clinton, NC 28328 Address
Owners Phone q 1 1 Operators Phone #
From Waste 111111zation Plan
Crop Type Reoommended PAN
BN Loading pblacre) = (B) 275
ri, r21 171 rep I.9;1 rst rn (R) slat rtirn (111
Lagoon
ID
Date
(mmlddlyr) i
I rrigation
Waste Analysis
PAN'
(W1000 gal)
PAN Applied
(Iblacre)
(a) x (9)
1000
Nitrogen
Balance"
(iblacre)
(B) - 00)
Weather
Code `
inspections
(Initials) "
Start
Time
End
Time
Total
Minutes
(3) - (2)
0 of
Sprinklers
Operating
Flow
Rate
(gallmin)
Total Volume
(gallons)
(6) x (5) x (4)
Volume
per Acre
(gaPacm)
(7) ! (Al
0= 275
3
07/05105
3:00 PM
4M PM
1
145
8,7110
13.593
1.4
19,03
25&97
c
bw
crop cycle r mats ( at, ruu_ I I otaa I -AN I _ 1
Operators Name R±2)ne Hering Number 985725 Operator Signature
' Weather Codes: C-Clear, MPartly Cloudy, Cl-Cloudy, R-Rain, S-SnowlSleet, W-Windy
" Persons completing the irrigation inspections must initial to signify that inspections were completed at least every 120 minutes.

{ AUG-09-2005 TUE 09:58 AM PSF OF NC, INC
FAX N0, 9102993016
P. 01/17
Premium Standard Farms of NC
PC Box 349
Clinton, NC 28329
Phone [phone]
Fax [phone]
W—A VIL -;:2
. 4b V M.
To: 4iv� COaO
From: ?CW+
v V
Date-' . $ b5 Pages: including cover sheet17
Re: SMA �Ww 1la$ /L--'. Lew. -Is Fax: q10 39-2oallf
❑ Urgent 0 For Review ❑ Please Casement ❑ Please Reply ❑ Please Recycle
•Comments: pAiX• 46
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21
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'�tx io\6
6�t4\ level bq4 10" �) A6� 24
V661K T� C" fflTCW ;+

6 Farm Weekly Lagoon, Level Tracking Sheet Q00 S
Week Of Date Jan. Level Date Feb. Level Dale March Level Date April Level Date May Level Date June Level
1 2 3 1 2 3 1 2At&- 1 2 3 1 2 3 1 2 3
1st
2nd
3rd
4th
5th
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Week Of Date July Level Dale Aug. Level Date Sept.Level Dale Oct. Level Date Nov. Level Date Dec. Level
1 2 3 1 2 3 1 2 3 1 2 3 1 2 3 .1 2 3
1st
2nd
3rd
4th
5lh
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4-s
41
-7/j
41
1ln
5
31
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VS
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Date: The actual date that the lagoon level was retarded
Level: All levels are recorded in inches
Fax Weekly: [phone] Or Phone in Weekly: [phone]

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FORM IRR-2 Lagoon Liquid Irrigation Fields Record
Cne Form for Each Field per Crop Cycle
Tract 0 Field q 1 ftcdity Number 31 - 857
Fleid Size (wetted acres) = (A) 0.95
Farm Owner Premium Standard Farms at NC Inigation Operator Chds Cottle
Owner's Address P.O. Box 349 Irriigatioh Operators
Clinton, NC 28328 Address
Owners Phone 0 Operators Phone 4
From Waste Utilization Plan
Crop Type Reoomrnended PAN
Small Grain Loading (Iblacre) = (D)l 50
ill f2l 131 141 (51 161 (7) IB1 19) f101 fill
Lagoon
10
Date
(mmlddtyr)
Irri at[an
Waste Analysis
PAN'
(lb11000 gal)
PAN Applied
(Iblacre)
(81 K 9
1000
Nitrogen
Balanoe"
(Iblacce)
(a) - (10)
Weadier
Cade
Inspealans
(Initials)"
Start
Time
End
Time
Total
Minutes
(3) - (2)
0 of
Sprinklers
Operating
Flow
Rate
(gallmin)
Total Volume
(gallons)
(6) x (5) x (4)
Volume
per Acre
(gallacre)
(7)1(A)
6= 50
3
02J22105
3:00 PM
5:00 PM
120
1
150
18,000
3,409
0.97
3.31
46.69
C
FD
3
03M4105
11:40 AM
12:40 PM
60
1
1 206
12,380
13,011
1.6
12.48
34.21
c
DH
3
OW15M
4:40 AM
1:00 PM
1
223
44,600
8,447
1.6
13.52
20.69
c
DH
2
03r2M5
9:30 AM
12:30 PM
1
210
37,800
7,159
2.2
15.75
4.94
c
DH
Grop Gycta Totals 112,7bu j Total PAN I I
Operator's Name Dwayne Hering Number 985725 Operator Signature
Weather Cases: C-Clear, PC -Partly Cloudy, CI -Cloudy, R-Rain, S-Snow/Sleet, W-Windy
" Persons oornplefing the Hgation inspections must initial to signify that inspections were completed at least every 120 minutes.

FORM IRR-2 Lagoon Liquid Irrigation Fields Record
One Form for Each Field per Crop Cycle
Tract p Field 4 2 Facility Number 31 - 857
Field Size (wetted acres) = (A) 4.09
Farm Owner Premium Standard Farms of NC Irrigation Operator Chris Collie
Owner's Address P.O. Box 349 Irrigation Operator's
Clinton, NC 28328 Address
Owner's Phone # Operator's Phone P
From Waste Utilization Plan
Crap Type Recommended PAN
Smatl Grain Loading (Iblacre) = (8) 50
111 (21 131 f41 151 16) 171 181 f91 1101 till
Lagoon
ID
Date
(mmlddfyr)
Inigatian
Waste Analyeia
PAN*
(Ibl1000 gal)
PAN Applied
(iblacme
(8)xto
iD00 .
Nitrogen
Balance"
(lb/acre)
(8) - (10)
Weather
Code
tnspetllans
(Initials)"
Start
Time
End
Time
TOW
Minutes
(3) - (2)
# of
Sprinklers
Operating
Flow
Rate
(gathnin)
Total Volume
(gallons)
(6) x 45) x (4)
Volume
per Acre
(gallacre)
(7) I (A)
6= 50
3
02/22/05
10.30 AM
2:30 PM
240
1
150
36,000
8,802
0.97
8.54
41.46
C
FD
3
03JO4106
10:00 AM
2:00 PM
240
1
150
36,000
8,802
0.97
8.54
32.92
C
fU
3
03/14/05
3:00 PM
5:00 PM
120
1
206
24 720
6,044
1.6
9.67
23.25
PH
3
03II5l05
1.00 PM
4:00 PM
180
11
223
40,140
9,814
1 1.6
15.70
7.55
c
D H
2
03=05
12:30 PM
1:30 PM
60
1
210
12,600
3,081
2.2
6.78
0.77
c
DH
Crop Cycle Totals l 149,460 ' I Total PAN I
Operators Name Dwayne Hering Number 985725 Operator Signature
'Weather Codes: C-Clear, PC -Partly Cloudy, CI -Cloudy. R-Rain, S-SnowlSteet, W-Windy
`" Persons completing the irrigation inspections must Initial to signify that inspections were completed all least every 120 rninutes.

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FORM lRR-2
Lagoon Liquid Irrigation Fields Record
One Form for Each Field per Crap Cycle
Tract 11 Feld # 3 Facility Number 31 857
Field Size (wooed acres)=(A) 5.52
Farm Owner Premium Standard Farms of NO Irrigation Operator Chris Cottle
Owners Address P.O. Box 349 lnigation Operators
Clinton, NC 28329 Address
Owners Phone g 1 Operators Phone 0
From Waste Utftlzation Plan
Crop Type Recommended PAN
Small Grain Loading (iblacre) = (8} 50
11) 121 131 141 15) 161 171 la1 (9) 1101 111)
Lagoon
10
(late
(mmlddlyr)
Iffigatioc
Waste Analysis
PAN'
. (ib11000 gal)
PAN Applied
(lblacre)
iaix(9t
1000
Nitrogen
Balanca—
(Iblacre)
(B) - (10)
Weather
Code
InspeL73o+ts
(initials)"
I Start
Time
End
Time
Total
Mlnutes
(3) - (2)
got
Sprinklers
Operating
Flow
Rate
(gadmin)
Total Vatume
(gallons)
(6) x (5) x (4)
Volume
per Acre
(gallaue)
(7)1 (A)
B= 50
3
12110J04
9.00 AM
2.30 PM
330
1
220
72,600
13,152
0.97
12.76
37.24
c
dh
1
01l27105
10:55 AM
2:30 PM
215
1
225
48,375
8 764
0.14
1.23
36.02
c
dh
3
02J22J05
10:30 AM
2:30 PM
240
1
150
36.000
6.522
0.97
6.33
29,69
c
dh
3
031041D5
1 D:OO AM
2:00 PM
240
1
150
36,000
6,522
0.97
6.33
23.36
c
fd
3
03/14/05
5.00 PM
7:00 PM
120
1
206
24,720
4,478
1.6
7.17
16.20
c
DH
3
03/15105
9.40 AM
12:00 PM
140
1
223
31,220
5,656
1.6
9.05
7.15
c
dh
2
03WO5
1:30 PM
2:30 PM
60
1
210
12,600
2,283
2.2
5.02
2.13
C
DH
Crop Cycle Totals 261,515 _ j Total PAN I 41.15f
Operator's Name Dwayne Hering Number 985725 Operator Signature
" Weather Codes: C-Clear, PC -Partly Cloudy, CI -Cloudy, R-Rain, S-Snow6lee1, W-Windy
" Persons completing the irrigation inspections must initial to signify that inspections were completed at least every 12D minutes.

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FORM IRR-2 Lagoon Liquid Irrigation Fields Record
One Form for Each Field per Crop Cycle
Tract A Field # 4 Facility Numbef 31 - t157
Field Size (wetted acres) = (A) 6.27
Farm Owner Premium Standard Fames of NC Irrigation Operator Chris Cottle
Owners Address P.O. Box 349 Irrigation Operators
Conlon, NC 28328 Address
Owners Phone # Operalaes Phone 0
From Waste utilization Plan
Crop Type Recommended PAN
Es,,ll Grain Loading (lblacre) = (S)I: 50
Ill (2) (31 (4l f51 (61 1171 181 131 (101 till
Lagoon
10
Bate
(mmlddlyr)
lrsigation
Waste Analysis
PAN'
(ltNi000 gal)
PAN Applied
(lblaere)
8 x 9
1000
Nitrogen
Balance"
(Wacre)
Weather
Code `
inspectinns
(Initials) "
Start
Time
End
Time
Total
Minutes
(3) - (2)
#of
Sprinklers
Operating
Flow
Rate
(galhnin)
Total Volume
(gallons)
(6) x (5) x (4)
Volume
ptif Acre
(ga!lacre)
(7)1 (A)
8= 50
3
12/10/04
9:00 AM
2:30 PM
330
1
220
72,600
11.579
0.97
11.23
38.77
c
dh
3
02/22/05
10:30 AM
5:00 PM
390
1
150
58.500
9,330
0.97
9.05
29.72
c
fd
3
03104405
10:00 AM
2:00 PM
240
1
150
1 36,000
5,742
0.97
5.57
24.15
c
fd
3
03l14105
11:40AM
4:00 PM
260
1
200
52,000
8,293
1.6
13.27
10.80
c
DIH
3
03115105
1,00 PM
4:00 PM
180
1
223
40,140
6,402
1.6
10.24
0.64
c
OH
Lfop cycle totals I zsy,z4u I Total TAN [ 4y.M
' Weather Codes: C-Clear, PC -Partly Cloudy, CI -Cloudy, R-Rain, S-SnowlSleel, W-Windy
" Persons oompleting the irrigation inspections must initial to signify that inspections were completed at least every 120 minutes.

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FORM iRR•2
Lagoon Liquid Irrigation Fields Record
One Form for Each Field per Crop Cycle
Tract Field a 5a Fatality Number 31 857
Field Size (wetted acres) = (A) 3.8g
Farm Owner Premium Standard Farms of NG lrrtgation Operator Dwayne Henn
Owner's Address P.O. Box 349 Irrigation Operators
Clinton, NC 28328 Address
Owner's Phone tf I Operators Phone 0
From Waste U(Itlzatlon Plan
Crop Type Recommended PAN
11314 Loading (ttuacre) = (B) 50
rn (21 c3t 141 151 I61 171 tat (9) f101 rill
Lagoon
ID
Date
(mmlddlyr)
Irrigation
Waste Analysis
PAN'
(lb11000 gat)
PAN Applied
(Iblacre)
8 K 49
1000
Nitrogen
Balance"
(lblacre)
A - 00)
Weather
Code
irupectiuns
(Initials)"
Start
Time
End
Time
Total
Minutes
(3)- (21
# o1
Sprinklers
Operating
Flow
Rate
(gatfmin)
Total Volume
(gallons)
(6) x (5) x (4)
Volume
per Acre
(gavacre)
(7) l (A)
B= 5o
2
03131/05
2:00 PM
3:00 PM
60
1
150
9,000
2,314
2.2
5.09
44.91
C
FO
00
0
0
0.00
44.91
00
0
0
0.00
44.91
00
0
0
0.00
44.91
00
D
0
0.00
44.91
00
0
0
0.00
44,91
00
0
0
0.00
44.91
00
0
0
0.00
44.91
00
0
D
0.00
44.91
00
0
0
0.00
44.91
00
0
0
0.00
44-91
00
0
0
0.00
44-91
00
0
0
0.00
44.91
00
0
0
0.00
1 44.91
crop cytre Iotats I a,uuu l l otat PAN . I twin
Operaloes Name DRa a Hedn2 Number 985725 Operator Signature
' Weather Codes: GClear, PC -Partly Cloudy, CaCtoudy, R-Rain, S-SnowlSleet, W-Windy
Persons completing the irrigation inspections must initial to signify that inspections were completed at least every 120 minutes.

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FORM IRR-2
Lagoon liquid irrigation Fields Record
One Form for Each Field per Crop Cycle
Tract d Field # 6a Facility Number
Field Size (wetted ages) = (A) 5."
Farm Ownef Promium Standard Farms of NC trdgaWrb Operator Chris Cottle
Owner's Address P.O. Box 349 irrigation Operator's
Clinton, NC 28329 Address
Owners Phone fl Operators Phone #
From Waste (1MlIzatron Plan
Crop Type Recommended PAN
Small Grain loading (Wac(e) = (9) 50
f11 f21 (31 f41 i5l 161 171 fal f91 1101 fill
Lagoon
ID
Date
(mm/ddryr)
Irri align
Waste Ana"is
PAN*
(Ih11000 gal)
PAN Applied
pblacrej
@I_X 91
1000
Nitrogen
Balance"
(161aore)
(M - (t 0)
Weather
Code'
i rnspedlons
(Initials)"
Start
Tirne
End
Time
Total
Minutes
(3) - (2)
fi of
Sprinklers
Operating
flow
Rate
(gallmin)
Total Volume
(gallons)
161 x (5) x (4)
Volume
per Acre
(gatlacre)
(7)1(A)
B= 50
1
10121i104
10:30 AM
6:46 PM
495
1
218
107.910
18,352
0.14
2.57
47.43
C
dh
3
02/22105
2:30 PM
5:00 PM
150
1
150
22,500
3,827
0.97
3.71
43.72
c
dh
3
03104105
10:00AM
2:00 PM
240
1
150
36,000
6.122
0.97
5.94
3718
c
fd
3
03114/05
4:00 PM
7:00 PM
180
1
200
36.000
6,122
1.6
9.60
27.99
c
dh
2
03/22/05
9:30 AM
2:30 PM
1 300
1
207
62,100
10.561
2.2
23.23
4.75
c
dh
Crop Cycle 1 otal9 I zb4,51 U 10tar PAN ( 4:).15j
'Weather Codes: C-Clear, PC -Partly Cloudy. CI -Cloudy, R-RaiR S-SnowlSleet, W-WIndy
" Persons completing the irrigation inspections must initial to signify that inspections were completed at least every 120 minutes_

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FORM IRR-2 Lagoon liquid Irrigation Fields Record
One Form for Each Field per Crop Cycle
Traci # Field it 7a Facility Number 31 - fi57
Field Size (wetted acres) = (A) 6.2.7
Farm Owner Premium Standard Forms of NC Irr(gatlon Operator Chris Cattle
Owner's Address P.O. Box 349 Imgatlon Operators
Clinton, NC 28326 Address
Ownee3 Phone fF I Operator's Phone A
From Waste Utilization Plan
Crop Type Remnmendad PAN
Small Grain Loading (Ib/acre) = (9) 5a
111 12) 131 (0 t51 IBl 171 (61 491 1101 1111
Lagoon
ID
Date
(mmfddtyr)
irrigation
Waste Analysts
PAN'
(ab11DD0 gal)
PAN Applled
(lblacre)
181 x 9
tDOO
Nitrogen
balance"
(Ibfacre)
(9) - 0%
Weather
Code `
Inspections
(Initials) "
start
Time
End
Time
Total
Minutes
(3) - (2)
f1 of
Sprinklers
Operating
Flow
Rate
(gallmin)
Total Volume
(gat4ons)
(6) x (5) x (4)
Volume
par Ape
(gallacre)
(7) f (A)
8= 5A
1
10126104
10:30 AM
6:45 PM
495
1
215
106,425
16,974
0.14
2.38
47.62
C
dh
3
02/23/05
9:00 AM
1:00 PM
240
1
150
36,000
5 742
0.97
5.57
42.05
C
fd
3
03104105
2:30 PM
4:30 PM
120
1
150
18,000
2,871
0.97
2.78
39.27
c
Id
3
03/14/05
11:40 AM
4:00 PM
260
1
215
55,900
8.9.15
1.6
1 14,26
25.00
c
fd
2
0312210
9:30 AM
2.30 PM
300
1
210
63,000
1 10,046
2.2
22.11
2.90
C
dh
Crop Cycle Totals 1 279,325 j Total PAN I 47.101
` Weather Codes: GClear, PC -Partly Cloudy, Cl-Ctoudy, R-Rain, S-SnowlSleet, W-Windy
Persons completing the irrigation inspections must initial to signify that inspecHons were completed at least every 120 minutes.

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FORM IRR-2
Lagoon Uquid Irrigation Fields Record
One Form for Each Field per Crop Cycle
Tract 0 Field 0 8 Facility Number 31 - 857
Field Size (wetted acres) = (A) 1.21.
Farm Owner Premium Standard Fauns of NC Irrigation Operator Chds Cottle
Owner's Address P.O. Box 349 Irrigation Operators
Clinton, NC 28328 Address
Owner's Phone 0 1 1 Operator's Phone #
From Was11e Utilization Plan
Crop Type Recommended PAN
Small Grain Loading (Wacre) = (8)50
41) 421 i31 (4) (5) (61 171 (81 (91 001 i11)
Lagoon
ID
Date
(mmlddlyr)
Irrigation
Waste Analysis
PAN'
(ibl1000 gal)
PAN Applied
(Iblacm)
8( i x t9#
1000
Nitrogen
Balanoe"
(lblaae)
A - (10)
Weather
Code "
tnspmIlons
(Initials) "
Start
Time
End
Time
Total
Minutes
(3) - (2)
p of
Sprinklers
Operating
Flow
Rate
(gaUmin)
Total Volume
;gallons)
(6) x (5) x (4)
Volume
per Acre
(galfacre)
(7) l (A)
13= 50
3
02/23l05
1:00 PM
3:00 PM
120
1
150
18,000
14,876
0.97
14.43
35.57
c
fd
3
03/07105
11:30 AM
1:30 PM
120
1
150
18,000
14,876
0.97
14.43
21.14
c
fd
3
03122105
9:30 AM
10:20 AM
1
223
11.150
9,215
2.2
20.27
0.87
c
DH
Crop Cycle Totals l 47,150 ) Total PAN ) 1
` Weather Codes: C-Clear, PC -Partly Cloudy, CI -Cloudy, R-Rain, S-SnuwlSleet, W-Windy
" Persons oompleting the irrigation inspections must initial to signify that inspections were oompteted at least every 120 minutes.

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FORM IRR-2 Lagoon Liquid Irrigation Fields Record
r'- One Form for Each Field per Crap Cycle
Tract # Field a 9 Facility Number 31 t357
Field Size (wetted acres) = (A) 2.89
Farm Owner Premkrrn Standard Farms at NC Irrigation Operator Chris Cattle
Owners Address P-O, Box 349 Irrlgation Operators
Clinton, NC 28328 Address
Owner's Phone # I Operators Phone 4
r�
o From Waste Utillzatlen Plan
M Gop Type Recommended PAN
rn
�
Small Grain Loading (iblacre) = (B) 50
o
rn (1) (2) (3) (4) (5) (6) (7) 48) (9) (10) (11)
ca
z
0
Lagoon
ID
Date
(mmlddlyr)
Irrigation
Waste Analysis
PAN'
(Ull000 gal)
PAN Applied
(Iblacre)
(8) x (91
1000
Nitrogen
ealanoe"
(blacre)
(B) - 00)
Weather
Coda'
tnspecuons
(initials) "
Start
Time
End
Time
Total
Minutes
(3) - (2)
# of
Sprinklers
Operating
Flow
Rate
(gallmin)
'total Volume
(gallons)
(6) x (5) x (4)
Volume
Per Acre
(gallaare)
(7) l (A)
B= 50
3
0212YO5
3-00 PM
57.00 PM
120
1
150
18,000
6.228
0.97
6.04
43.96
C
ld
3
03/07105
9:00 AM
11:00 AM
120
1
150
18,000
6,228
0.97
6.04
37.92
c
fd
3
03/14/05
4:00 PM
7:00 PM
180
1
215
38.700
13,391
1.6
21.43
16.49
c
dh
3
03l'22105
10:20 AM
1 L'20 AM
60
1
223
13,380
4,630
2.2
10.19
6.31
C
dh
Crop cycle Totals I t1a.G60 I Total PAN I 43.b'9I
' Weather Codes: C-Clear, PC -Partly Cloudy, CI -Cloudy, R-Rain, S-SnowlSleet, W-Windy
" Persons completing the irrigation inspections must initial to signify that inspections were completed at least every 120 minutes.

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FORM IRR-2 Lagoon Liquid Irrigation Fields Record
a- One Form for Each Field per Crop Cycle
Tract a Field d F 10b Facility Number 31 - 85l
Field Size (wetted acres) = (A) 4.68
Farm Owner Premium Standard Farms or NC Irrigation Operator Chris Cottle
Owners Address P.O. Box 349 Irrigation Operator's
Clinton, NC 28328 Address
Owner's Phone 0 Operator's Phone N
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From Waste Ullltution Plan
Crop Type Recommended PAN
Small Grain codin kg (Iblacre) _ (B) 50
Ill 01 (31 (41 i51 161 (71 (R1 M (1f11 r11%
Lagoon
ID
bate
(mm/ddlyT)
IrrigaUan
Waste Analysis
PM.
(Ibfi000 gal)
PAN Applied
(lucre)
8� 1 M (9)
Iwo
Nitrogen
Balance"
(lb/acre)
1 (13) - 00)
I Weather
Code '
Inspections
(Initials) "
start
Time
End
Time
Total
Minutes
(3) - (2)
0 of
Sprinklers
Operating
Flow
Date
(gaVmin)
Total Volume
(gallons)
(6) x (5) x (4)
Volume
per Acre
(gallacre)
(7) / (A)
B= 5o
3
02/20/05
12:45 PM
3:45 PM
ISO
1
150
27,000
5.533
0.97
5.37
44.63
C
fd
3
02/23105
9:00 AM
1:00 PM
240
1
150
36,000
7,377
0.97
7.16
37.48
C
ld
3
03/07/05
9:00 AM
1:00 PM
240
1
150
36,000
7,377
0.97
7.16
30.32
c
fd
3
1 03114105
4:30 P M
7:00 PM
150
1
205
30,750
6.301
1.6
10.08
20.24
C
dh
2
03/22105
12:00 PM
2:30 PM
150
1
223
33.450
6,855
2.2
15.08
5.16
C
DH
crop Cycle Totals I_ 163,zuu ( Total PAN 1444.941
`Weather Codes. C-Ctear, PC-Pargy Cloudy, CI -Cloudy, R-Rain, S-Snow/Sleet, W-Windy
Persons completing the irrigation inspecdmis must initial to signify that inspectbirs were completed at least every 120 minutes.

FORM (RR-2
Lagoon Liquid Irrigation Fields Record
One Form for Each Field per Crop Cycle
Traci N Field N 11 Facility Plumber 31 B57
Field Size (welled aces) = (A) 0.64
Farm Owner Premium Standard Farms of NC Irrigation Operator Chris Cottle
Owner's Address P.O. Box 349 Irrigawn Operatns
Cliniun, NC 28326 Address
Owner's Phone # I I Operators Phone If
From Waste U611,ntion Plan
Crop Type Recommended PAN
ISMaUGFaln Loading (Iblaae) = (B) 50
t11 121 131 (4) (51 (6) (71 lei (sl (101 fill
lagoon
ID
[Yale
(mmld&`yr)
Irrigation
Waste Analysis
PAW
(INN 000 gal)
PAN Applied
(Iblacre)
(s),%-L)
1000
Nitrogen
Galanoe"
(Iblacre)
(B) - (10)
Weather
Code
inslw9ons
(Initials)"
Start
Time
End
Time
Total
Minuites
(3) - (2)
got
Sprinkkn
Operating
Flaw
Rate
(gaflmin)
Total Volume
(gallons)
(6) x (5) x (4)
Volume
per Acre
(gatfacre)
(711(A)
B= 50
3
03/14/05
4:00 PM
4.30 PM
30
1
205
6.150
9,609
1.6
15.38
34.63
c
dh
2
03131/05
2:00 PM
3:00 PM
1
150
9.000
14.063
2.2
30.94
3.69
c
dt1
crop uycie iamis I 10,1ou I total r►tn I I
'Weather Codes: C-Clear, PC -Partly Cloudy, Ct-Cloudy, R-Rain, S-SnowlSleet, W-Windy
" Persons completing the irrigation inspections must initial to signify that inspections were completed at least every 120 minutes.

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FORM IRR-2 Lagoon Liquid Irrigation Fields Retard
p One Form for Each Field per Crap Cycle
Trap Field q 12a FaciliOl Number 31 -F 857
Field Size (wetted antes) = (A) 3.8
Farm Owner Premium Standard Farms of KC Irrigation Operator Chris Cottle
Owners Address P.O. Box 349 Inigalior+ Operators
Clinton, NC 26328 Address
Owners Phone d Operators Phone if
co
From Waste Utiillzation Plan
Crop Type Recommended PAP!
small Loading (Iblacre) _ (B) 50
T ill (91 131 14) (5) 161 171 fat (91 i10) 1111
Lagoon
ID
Date
(mmlddlyr)
Irrigation
Waste Analysis
PAN'
(ttN1000 gal)
PAN Apprred
Oblacre)
(a)xt91
1060
Nitrogen
6alanoe"
(Iblacre)
(B) • 410)
Weather
Code
Inspedons
(Inillats)"
Start
Tune
End
Time
Total
Minutes
(3) - (2)
it Of
Sprinklers
Operating
Flow
Rate
(gal/min)
Total Volume
(gallons)
(6) x (5) x (4)
Volume
per Acre
(gallacre)
(7)1 IA)
fj= 50
3
10/25104
11:30 AM
2:30 PM
180
1
197
35,460
9.332
0.97
9.05
40.95
C
dh
2
10125/04
3:15 PM
6:00 PM
165
1
204
33,660
8,858
0.93
6.24
32.71
C
dh
1
12/09/04
11.00AM
4:30PM
330
1
217
71,610
18,845
0.14
2.64
30.07
c
dh
1
01127105
10:55 AM
2:30 PM
215
1
223
47,945
12.617
0.14
1.77
28.31
C
dh
3
02120105
9:45AM
2A5PM
300
1
150
45.000
11,042
0.97
11"49
16.62
c
td
3
02/23/05
L 1'00 PM
5:00 PM
240
1
150
36,000
9,474
0.97
9.19
7.63
C
1d
crop cycle rotam t ` ze%b75 I 101211 PAN I 44srl
Weather Caries: C-Clear, PC -Partly Cloudy, Cl-Cloudy, R-Rain, S•SnowlSleet, W-Windy
" Persons completing the irrigation inspections must initial to signilty that inspections were oampi Med at least every 120 minutes.

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FORM ERR-2
Lagoon Liquid Irrigation Fields Reoord
One Form for Each Field per Crop Cycle
Traci 0 Field # 13 Facility Number 51 - 857
Field Sae (wetted acres) = (A) 4.84
Farm Owner Premium Standard Farrns of NC Irrigation Qperatar Chris Cottle
Owner's Address P.O. Box 349 Irrigation Qperalars
Clinton, NC 28328 Address
Owners Phone #t I Operaloes Phone #
from Waste Utilisation Plan
Crop Type Recommended PAN
Small Grain Loading (lbfacre) = (B) 50
ill 421 r31 141 f51 r61 f7l f81 (9) Mill rill
Lagoon
ID
Date
(mmlddlyr)
trTigation
'haste Analysis
PAN'
(1b11000 gal)
PAN Applfed
(Ib/acre)
(8) x {91
1000
Nitrogen
Balance"
(Iblacrel
(B)-4101
Weather
Code'
Inspections
(Initials) "
Start
Time
End
Time
Total
Minutes
(3)- (2)
# of
Sprinklers
Operating
Flow
i Rate
(gallmin)
total Volume
(gallons)
(a)x (5)x (4)
Volume
per Acre
(gallacre)
(7)1 (A)
B= 50
1
10126/04
10:30 AM
6:45 PM
495
1
215
106,425
21.989
0.14
3.08
46.92
C
dh
1
12/09/04
11:15 AM
4:45 PM
330
1
213
70,290
14,523
0.14
2.03
44.89
c
dh
3
02120105
9A5 AM
12:45 PM
180
1
150
27,000
5.579
0.97
5.41
39.48
c
dh
3
03107l05
9:00 AM
1:00 PM
240
1
150
36,04x1
7,438
1 0.97
7,21
32.26
c
Id
3
03114105
41:40 AM
2:40 PM
180
1
205
36,900
7,624
1.6
12.20
20.06
c
dh
3
03115105
9.40AM
1100 PM
200
1
223
44,600
9,215
1.6
14.74
5.32 1
c
dh
Grog cycle Totals L 321,215 j Total PAN I 44.ti81
' Weather Codes: C-Clear, PC -Partly Cloudy. CI -Cloudy, R-Rain, S-SnowlSleet, W-Windy
Persons completing the irrigation inspections must initial to signify that inspections were completed at least every 120 minutes.

FORM IRR-2 Lagoon Liquid irrigation Fields Record
0.- One Form for Each Field per Crop Cycle
Tract 0 Fir.1d 11 14 Facility Number 31 857
Field Size (wetted aces) = (A) 4.84
Farm Owner Premium Standard Farms of NC Irrigation Operator Chris Cot2a
Owner's Address P.O. Box 349 Irrigation Operators
Clinton. NC 28328 Address
Owne-es Phone 9 Operator's Phone 9
co
o From Waste Utiliratlor Plan
Crop Type Recommended PAN
CD Small Grain Loading (lb/acre) = (B)F 50
cu -- —
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Lagoon
ID
Date
(mmlddlyr)
Irrigation
Waste Analysis
PAN'
(SW 1000 gal)
PAN Applied
(Iwacre)
Bi ) x (9
1000
Nitrogen
Balance-
(Ib/ace)
(6) - (t0)
Weather
Code '
inspections
(Initials) "
Start
Time
I End
Time
Total
Minutes
(3)-(2)
tl of
Sprinklefs
Operating
Flow
Rate
(gaUmin)
Total Volume
(gallons)
(6) x (5) x (4)
Volume
per Acre
(gallacre) 1
(7)1(A)
B= 50
3
10125104
11:30 AM 1
230 PM
180
1
202
36,360
7.512
0.97
7.29
42.71
c
dh
2
10/25/04
315 PM
6:00 PM
165
1
205
33,825
6.989
0.93
6.50
36.21
c
dh
1
01/27/05
10:55 AM
2:30 PM
215
1
217
46.655
9,639
0.14
1.35
34.86
c
dh
3
02120/05
9:45 AM
12:45 PM 1
180
1
150
27,000
5.679
0.97
5.41
29.45
c
dh
3
03/07/05
9:00 AM
11.00 AM
120
1
ISO
18,000
3,719
0.97
3.61
25.85
c
fd
3
03/15105
1:00 PM
4:00 PM
180
1
223
40,140
8,293
1.6
13,27
12.58
c
dh
2
03/31105
12:00 PM
100 PM
180
1
150
27,000
5,579
2.2
12.27
0.30
1 C
DH
crop cycle TOtais I zzrf,ytsu I 1 Otis) t'AN I 413.1UI
Weather Codes: C-Clear, PC -Partly Cloudy, CI -Cloudy, R-Rain, S-5nowlSleet, W-Windy
Persons completing the irrigation inspections must initial to signify that inspections were completed at least every 120 minutes.

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FORM IRR-2 Lagoon Liquid Irrigation Fields Record
One F'onn for Each Field per Crap Cycle
Tract # FieMi # r 15 Facility Number 31 857
Field Sue (wetted acres) = (A) 5.26
Farm Owner Premium Standard Fars of NC Irrigation Operator Chris Cottle
Owner's Address P.O, Box 349 Irrigation Operalors
Clinton, NC 28328 Address
Owners Phone # 1 Operator's Phone #
From Waste Utilization Plan
Crop Type Recommended PAN
Small Grain Leading (Iblacre) = (8) 50
(11 (21 (3) (4) (5l (B) 471 (al 191 (101 till
Lagoon
10
Date
(mmlddlyr)
Irrigation
Waste Analysis
PA .
(lb11000 gal)
PAN Applied
(Iblacre}
(a) x (sf
1000
Nitrogan
Balance"
(lb/acre)
(B) - (10)
Weather
Gale '
Inspeclicas
(Initials) "
Start
Time
End
Time
Total
Minutes
(3) - (2)
# of
Sprinklers
Operating
Flaw
Rate
(gaVrnin)
Total Volume
(gallons)
(6) x 45) x (4)
Volume
per Acre
(gallacre)
(7) l (A)
B= so
3
10125/04
11:30 AM
2:30 PM
180
1
197
35,460
6,716
0.97
6.51
43.49
C
dh
2
10/25104
3:15 PM
6:00 PM
65
E345
1
202
33,330
6,313
0.93
5.87
37•81
C
dh
i
12/09/04
11:00 AM
4A5 PM
1
213
73.485
13,918
0.14
1.95
35.67
c
dh
1
01/27/05
10:55 AM
2.30 PM
215
1
210
45,150
8,551
0.14
1.20
34.47
C
dh
3
02120105
12:45 PM
3:45 PM
160
1
150
27,000
5,114
0.97
4.96
29.51
C
dh
3
03/07105
1:00 PM
4:00 PM
180
1
150
27,000
5.114
0.97
4-966
24.55
c
Id
3
03/15105
9:40 AM
1,00 PM
200
1
223
44,600
8,447
1.6
13.52
11.03
C
dh
crap cycle Totals I lti6.UZ5 I TOMI PAN I 31i.97�
Weather Codes: C-Clear, PC -Partly Cloudy, Cl-Cloudy, R-Rain, S-SnowfSleet, W-Windy
•' Persons complefing the inrigation inspections must initial to signify (hat inspections were completed at least every 120 minutes.

Type of Visit 0 Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit faRoutine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Date of Visit:
OPermitted eCCertified © Conditionally Certified 13 Registered
Farm Name: .... �...._ .
Time: ��
Not
Date Last Operated or A ve Threshold: ------..----...--_
County:
Owner Name: . .... ......................... ............. .............. .. Phone No: ................
Mailing Address:
FacilityContact: .. . ....... ......... .............. ........ .............. ....._... Title: ... ............... .......... --................. ......... Phone No: .. ..............
Onsite Representative:. i_C//Mk.....,�f'xj4�aQdP2...................... .. Integrator: O&A-w1kl!Y! � y
Certified Operator:
Location of Farm:
Operator Certification Number: ....... . ........ . ........ . . . . .......
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 0 ` " Longitude • 6 64
4.
pesa�nCurrr�nt Design Current j Design Current
_
PonitrJ'�®
'elation Cattle. Yo nlatton
. , _ . mCa au
.rPo ulabon_. ,_ Ca
ci ?.Po ,Ca acr
Wean to Feeder
' ❑Layer
- ❑ Dairy
❑ Non -Layer
-[]Non-Dairy
eerier to Finish
/.2
Farrow to Wean
r;10 Other
Farrow to Feeder
=
Y
�� ys � Total Des>ign�`Ca acl_<
Farrow to Finish
Gilts
m
`� Tota1SSLWtl
❑ Boars
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes ZNo
Discharge originated at. ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes Z No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ❑'No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes Q-iQo
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: .. ... 1. -........ _ ,/.. _- —----....... _. ................... ..._._.._......... ......................................
Freeboard (inches): _ a Z. .,
12/l2103 Continued

Facility Number: 7% — s Date of Inspection ,S' .25-
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes ej No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑ Yes PfNo
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 0Slo
8. Does any part of the waste management system other than waste structures require maintenance improvement? ❑ Yes 014o
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
❑ Yes
2No
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes
014o
11. Is there evidence of over application? If yes, check the appropriate box below.
❑ Yes
13-110
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type Pi'"31A11 w YZMZLI
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
,B'No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
RNo
b) Does the facility need a wettable acre determination?
❑ Yes
EfNo
c) This facility is pended for a wettable acre determination?
❑ Yes
131No
15. Does the receiving crop need improvement?
❑ Yes
❑ &o
16. Is there a lack of adequate waste application equipment?
❑ Yes
ZNo
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
❑ Yes
.0'No
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours?
❑ Yes
,0"No
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
014o
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
0-No
Air Quality representative immediately.
-Comrneiuts (refer to quesfsfln?t))Eplaw aay YFS answeis and/or any recommendations or aayFoter coEnments. µ'
Use drawings of �ciLity=ta $etier explain sitx�aa (use,riLL anal�pages as neary)s Field Co Final Nates
�''--r ..' � ^° . a , �� ram, ,P --� ,z^°r � �� � «r �-•,"���"�. ���� ,�x,.��� .��t �. �.
Reviewerdmpector Name
ReviewerAnspector Signature: Date. d
12112103 Continued

Facility Number: 3 Date of Inspection �' Q
Required Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
O] No
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
❑ Yes
(ie/ WUP, checklists, design, maps, etc.)
[QNo
23. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
❑to
❑ 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
ff No
25. Did the facility fail to have a actively certified operator in charge?
❑ Yes
®'No
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes
(ie/ discharge, freeboard problems, over application)
2"N'o
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
[I Yes
ONO
28. Does facility require a follow-up visit by same agency?
❑ Yes
ONO
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
Q'No
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
orlyles
❑ No
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
01qo
32. Did the facility fail to install and maintain a rain gauge?
❑ Yes
ONO
33. Did the facility fail to conduct an annual sludge survey?
❑ Yes
E]rNo
34. Did the facility fail to calibrate waste application equipment? ❑ Yes ❑ No
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After I" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
0 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
.-FA Ga i 1 b r A-ior-) f r W CLS le
��e�rlev2 �cM Carl�vcr r.ilv,��
� J
r'e Corals
all
fOall
I'Vea7-1 oral•-
12112103

Type of Visit 0 Compliance Inspection 0 Operation Review 0 Lagoon Evaluation I
Reason for Visit 0 Routine 0 Complaint 0 Follow up 2FEmergency Notification 0 Other ❑ Denied Access
Facility Number Date of Visit:
Permitted Q%/EJC��ertified 0 Conditionally Certified [3 Registered
Farm Name: (� 54W22 L(� _ �sQj
Owner Name:
Mailing Address:
Facility Contact: Title:
Onsite Representative: 4=140'Q _A2e&C
Certified Operator:
Location of Farm:
Time:
Date Last Operated Above Threshold:
County:
Phone No:
Phone No:
Integrator: /i7AY/r\-
Operator Certification Number:
)6 Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude a L ou Longitude 0' 6 0"
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
M
Discharges & Stream Impacts
P
N
Field Area
1. is any discharge observed from any part of the operation? ❑ Yes ONO
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (if yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ZYes ❑ No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ,RTNo
Waste Collection & Treatment
4. is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ❑ No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard (inches):
05103101 Continued

Facility Number: —g Date of inspection / O
5. Are there any immediate threats to the integrity of any of the structures observed? (iel trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
S. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do anv stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenancelimprovement?
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ hydraulic Overload
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14- a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wertable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(iel WUP, checklists, design, maps. etc.)
19. Does record keeping need improvement? (ie/ irrigation. freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22- Fail to notify regional DXVQ of emergency situations as required by General Permit?
(ic! discharge. freeboard problems. over application)
23. Did Reviewer/Inspector fail to discuss reviewiinspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes [:]No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes [:]No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes XNo
❑ Yes XNo
❑ Yes ❑ No
❑ Yes ❑ No
113 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Comments,{refeF to gnrestmn #j:. Eigisin'aity YFS answers and/or.: s recaimmendattans;or sIIy offier comme�s.
fit b lam sitn (ase addth gal es as n _ ` -. • = Use drawtngs of fac ty to etter ezp ahons- � o pag ecessary) ,❑ Field Copy ❑ Final Notes `
. _
.ate.,..-1^'S.ti.S.._....,..'��".:&:ti.=...�.v-.s.a4;.�+-. �..-..r}.Y-;'^_ wms> �^. r��....r.-...-•---.�-..c.+..r-..-�u-a+_., _.�.at...m-.- ,ffi?.. °F.ae=«
-��:.�'�� i �r�� r►�,D�IC �G,o ,BEC'�fuS,� �i� �.�- D�'ZFzc°,q. T���,
Reviewer/InspectorNgme s r = -,,
Reviewer/Inspector Signature: Date:
05103101 Continued

Facility lumber: 13 1 — Date of inspection / 4
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours?
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt.
roads, buildin_ structure. and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon?
30. N ere any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missin4 or
or broken fan blade(s). inoperable shutters. etc.)
31 _ Do the animals feed storage bins fail to have appropriate cover?
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes ❑ No
❑ Yes ❑ No
El Yes ❑No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
2� SOin eFf-4N /�`R O %9�1��r /9 �D
"ie,4-Tr19S;P-/40"�I�Jvp �Ai�Ti9":-'F0 41jo A/AP/-C'O
ZiA 0-1.7o rJ, -prI'JC f
�EF?
Gr��-sue
/Q 1)r/ Act cFo % ,q> m��� Stu r 00""w
W•�T �o,Bc.��en
ta Ole
A -OR
/ACC- I;WYV�� ;�' Z/N& 7-
0510310I

r
i Type of Visit P Compliance Inspection 0 Operation Review 0 Lagoon Evaluation I
IReason for Visit fb Routine 0 Complaint 0 Follow up 0 Emergency Notification 0 Other ❑ Denied Access
Date of Visit: Time:
Facility Number
Not O erational 0 Below Thresho
O Permitted 0 Certified [3Condij nally Certified Q Registered Date Last Operate or Above Threshold:
Farm Name: -,—Q(z, c_ - _ County: �tP� J✓
Owner Name: iCCL1nz11f4 ,:5 �_ /�i4h) f�&A��AFIPCneNo:
Mailing Address:
Facility Contact: 19 Title:
Onsite Representative: DQ/-ff—
Certified Operator:
Location of Farm:
Phone No:
Integrator: Z! / /�� Ak4
Operator Certification Number:
lysline ❑ Poultry ❑ Cattle ❑ Horse Latitude ' 4 " Longitude 0' 06
Wean to Feeder
Feeder to Finish
Farrow to Wean
Other
Farrow to Finish
Gilts
Boars
Subsurface Drains Present
No Liquid Waste ManaQen
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Freeboard (inches): �J3
05103101
Field Area
❑ Yes /ZNo
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes
V.No
❑ Yes
XN0
❑ Yes
XNO
Structure 6
Continued

Facility Number: 31 — Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Anolication
l0. Are there any buffers that need maintenance/improvement?
11. Is there evidence
12. Crop type ( IT,,'/ 1 4
13. Do the receiving crops differ with those designa ed m the Ceti
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Rea uired Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ic/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes No
❑ Yes XNO
❑ Yes �No
❑ Yes YNo
❑ Yes XNO
❑ Yes
❑ Yes
LJ Yes yj No
❑ Yes P_r'No
Cl Yes No
❑ Yes No
❑ Yes EgNo
El Yes
Yes No
❑ Yes ONo
❑ Yes No
❑ Yes No
❑ Yes E2(No
❑ Yes No
❑ Yes F, No
❑ Yes XNo
❑ Yes X No
ElYes XNo
0 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Ctimrnents (referto question #) Explain a"ny YES'answers aadlor.;any recommendattons.or any#iither comments.: m
Use drawings ©f facility to better eiplarn srivahons:'(usejad'ditronal pages"as necess ry) �,. `
Field Copy ❑ Final Notes
/� F_``p �Om� FFO ?/Ivy �i✓ S�R�y zFc�s,.....
pf�s A-4v �®w �o� SozG /�s� ,��o� ;,
P lzz 1114P
�02 ���� r•�8�1Fy ���J ' ZF'Lo �dCi¢T�N� ,
� �:.<: ,
Reviewer/inspector Name /" .,
ReviewerfInspector Signature: Date: d
05103101 1 Continued

Facility Number: — Date of Inspection
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge attor below ❑ Yes No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes No
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes IeNo
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes o
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ❑ No
Additional Comments and/or Drawings: , ' :, ,
6/7
law
40 ree,
O
05103101

Type of Visit OCompliance inspection O Operation Review O Lagoon Evaluation
Reason for Visit Routine O Complaint O Fonow up O Emergency Notification O Other ❑ Denied Access
Facility Number 1 j S? Bate of Visit: `7 2 Time:
Q Not Operational Q Below Threshold
U Permitted [3 Certified © Conditionally Certified © Registered Date Last Operated or Above Threshold:
L,
Farm Name: .................���`..'1°Y`..� t��....cf•'`........................................... County:...�l.f:^................................... ......... .. _.
.. L 1'f ' 1 G
OwnerName:................... �sC..k.`.`J........_1�....................................... Phone No: ................................................................................. »_.
FacilityContact: .....................:........................................................ Title:................................................................ Phone No:..................................................
MailingAddress: ......................... ..................................................................
Onsite Representative: .�Tec%�i�LfQ.��P e.' .L✓! :..!!..!�j1....---•---------•------ Integrator: �' 7 urn. ' %°t 1 .u...U{ ........ ....
Certified Operator:............................................................................................._.................. Operator Certification Number:..........................................
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' 4 64 Longitude _ 0 • 6 44
Design :
Current. _ . _ :
Design . Current Design - Current
Swine -'- Cif aci
Po ulatiiori Poultry
: Ca aci Po ulation Cattle Ca aci . Pti Yialation ;=
Wean to Feeder
❑ Layer
❑ Dairy
..
❑ Feeder to Finish
❑ Non -Layer
❑ Non -Dairy
=
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Other
❑ Farrow to Finish
ToW Desigo-CApagitty
❑ Gilts
❑ Boars
T©tal:S$LW
Nuinber of Ligoons ` - ❑ Subsurface Drains Present 11OLagoonArea 10 Spray Field Area
Holding PofidstSd1id-Tra#$.1L ❑ No Liquid Waste Management System }.
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes )dNo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes P140
b, if discharge is observed, did it reach Water of the State? (If yes, notify DWQ) [] Yes o
c. If discharge is observed, what is the estimated flow in gaUmin? h G�
d. Does discharge bypass a lagoon system? (if yes, notify DWQ) ❑ Yes ,E:fNo
2. Is there evidence of past discharge from any part of the operation? ❑ Yes'j2(No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes �No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes 'Q'<o
Structure 1 Structure 2 Structum 3 Structure 4 Structure 5 Structure 6
]dcnti fier:................................................. Z............................................. ...... .............................. ......... ............ ............... ...... I ........ .....................
Freeboard (inches):
5100 Continued on back

Facility Number: 3 f — 8 Date of Inspection 7 -2- Q
5_ Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenancelimprovement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN Hydraulic Overload
12. Crop type —Re r V-% vd qzk S,A, tl r r,,t;7
13. Do the receiving crops differ with those esignated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
1.7. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
i4*i0lati0As:or dgfieWhctes vcre noted during this'vjsit; • Yoit wdi-teogiye iio iurt. h0r
cor'respo deuce: abaitt: this visit:
❑ Yes ONO
❑ Yes ) JNo
❑ Yes dNo
❑ Yes PNo
❑ Yes ONO
❑ Yes ONO
Yes ❑ No
❑ Yes ONO
❑ Yes ,fNo
❑ Yes )TrNo
❑ Yes ONO
Q Yes ❑ No
�❑ Yes RfNo
❑ Yes )Z(No
❑ Yes IdNo
❑ Yes PNo
❑ Yes No
❑ Yes g No
❑ Yes "No
❑ Yes )Z No
❑ Yes ONO
❑ Yes j2'No
-------•—mow--.---�.--,_-- --r.—_-----_-7,.-------,r-n---<--- a. .�• -
11. �eGarats Sloc.1 h�,d�a�l c over low; ort 1},�d�a►� fan 61Z�aIOl ' �{ L(2 35S .e
1S. 1..Jo✓'F To el,+�t;-�t,�e �1�n�jcrn.tu�ct • I�.t Wt�io� q�'Yi{ �?�¢r eS-�uDj;t�r
�i �►e �AnJ 6alaKGQ Golv�►� ��,e ee�-.pv-�e�-�Q►1���t�ed �rM ZjS _r
r)o-1. 6e (0 on 'Ra-21S .r1-X0eti1d sVta3.614ctes.
Vote: 1�+e�-2�s �S�,vw ZDS Jc,4n1
_ Z6lDy��'+�
n�JJiTD rvtl,Ike SvrC �-r 5A'"'te qZ'a ;S Cove,-ed f.�07w Oceease. tS dccUrft�Penfew4 __.
Reviewer/Inspector Name �1;;-1Reviewer/Inspector Signature: /y`q%4' Date: 1 2-b o) 51fw

Facility rJumber:.7f -Q$ +] Date of .Inspection
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes�No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes,IffNo
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes 'i No
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ YeSA�No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes-,E](No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes�o
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ❑ No
AdditionW.Comments.an or.' ravings:
w
S/00

F Dtnsign of Water Quality U:
d Drvision oI Soil and -Water Conservation
- Q Other':Agency ,3 s '� r
Type of Visit IxCompliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number
"ate of visit: MT—d0 Time: � Printed on: 7/21/2000
0 Not Operational Q Below Threshold
© Permitted [3 Certified 13 Conditionally Certified 0 Registered Date Last Operated or Above Threshold : ................
Farm Name: 1 ..... 1�..........................................
5' )Q.................................................................. County. t-?..1.............
OwnerName:............................:.............................................................................................. Phone No: .....
Facility Contact: .............................................................................. Title:
Phone No:..
MailingAddress:.....................................................................................................................
Onsite Representative: ��'�:�.,.A.A..„ .. - Integrator:......1l..r,'................ ..................
�l^'�
Certified Operator:
Location of Farm:
................................................................ Operator Certification Number:..........
I&
T
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude �' �° Longitude �• ��«
Design Current
Design Current Design Current
Swine Capacity Population
Poultry
Capacity Population Cattle Capacity Population
❑ Wean to Feeder
❑ Layer
❑ Dairy
5TFe-eder to Finish
w
❑ Non -Layer I
JE1 Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder
❑Other
❑ Farrow to Finish
Total Design Capacity
❑ Gilts
❑ Boars
Total SSLW
Number of Lagoons IfUsubsurface Drains Present ❑ Lagnan Area ❑ Spray Field Area
Holding Ponds / Solid Traps ❑ No Liquid Waste Management System -
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes XNo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discllaa-ge is observed. did it reach Water of the State'? (If yes, notify DWQ) ❑ Yes ❑ No
c. II' dischar4 e is observed. what is the estimated flow in gal/rain''
d- Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes MNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes tE(No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes KNo
Structure I Structure 2 Structure , Structure 4 Structure 5 Structure 6
Identi ficr:......................._...............................................
Freeboard (inches): �L(
5100 Continued on back

lVaeility Number. -M Date of Inspection Printed on: 7/21/2000
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? El Yes � No
(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?
XYes
❑ No
8. Does any part of the waste management system other than waste structures require maintenancelimprovement?
❑ Yes
ONo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
V No
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes
tg'No
11. Is there evidence of over application? ❑ Excessive Ponding P(PAN ❑ Hydraulic Overload
XYes
❑ No
12. Crop type V�
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
NNo
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
NNO
b) Does the facility need a wettable acre determination?
❑ Yes
❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes
❑ No
15. Does the receiving crop need improvement?
❑ Yes
M No
16. Is there a lack of adequate waste application equipment?
❑ Yes
bdNo
Required Records & Documents
17.
Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
VNo
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
Yes
j'5No
(ie/ WUP, checklists, design, maps, etc.)
❑
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
Yes
❑ No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
IgNo
21.
Did the facility fail to have a actively certified operator in charge?
XYes
❑ No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
ElYes
t4No
(ie/ discharge, freeboard problems, over application)
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
XNo
24.
Does facility require a follow-up visit by same agency'?
❑ Yes
MNo
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
X No
El: �i,6 •yiolaii6ris ;ar• d_i iciertcies mere noted• d* 66Ag this:visit: • Yoit i* ii! -i eeeiye iio: i'tzrther • : - : -
coeres�oncieitce: abotalk t(zis visit. :: : . . : . . . . ...... : :.. : .::.. ..:...
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):
e 4\►-0� �l'-�v� �� 2S i14' -, CV— . a� fn�c.--�es A�
''1 � ,t'l33 ct�.-�1t1--1�5-�2 �t•G�1Rt� c�' �� �'i'T Cc�--BIZ} \JU`�C.�-•e (,•+��"_'
\S 1����-«`fit\� 5�--�i„r� "�t--at`•-�a3-�'�1�,
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date: [I--� 9-0Q 5100

I Fiacility Number: Date of inspection G-{ rCrc] Printed on: 7/21/2000
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge ftJor below ❑ Yes KNo'
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes JP(No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes 4 No
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes PfNo
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes P-No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes PfNo
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes No
Additional Comments, and/orDrawings:
h- `ee51 `v�
(•-r�e�
57C1\11Y jz_" V-e
QZ�. �� l } Cst �y� t,.r� (2\'C_5 C06L'it
M���—t-
U
5/00

10 Routine p uomplatnt p rollow-up of VWQ inspection p r'ollow-up of VSWU review 9 utner
Facility Number Date of Inspection
Time of Inspection ® 24 hr. (hh:mm)
■ Permitted p Certified E Conditionally Certified p Registered In NotOpera hona Date Last Operated:
Farm Name: Gash ARidge.Farms,._LLC..................................................................... County: Duplin WIRO
Owner Name:
Facility Contact:
Goshem.Itidgz.Far-m_%.LLC............. Phone No:(910.).592-.210.4 .......................................................
Title:
Phone No:
MailingAddress: P.O.Sox.42...............................................................................................CUM10K..N.0 ............................................................ 28329 ..............
Onsite Representative: .......................................................................................................... Integrator: DogwoodF.arms...................................................
Certified Operator: Bryan C................................ SPCU ................................................... Operator Certification Number: 19.118 ............................
Location of Farm:
Latitude ©• ®4 ©" Longitude ©0 ®' ®"
es urrent,-
es�gn urrent-- u�_ es�gn urrent
_ .
Swine Capacity, Population
=Poultry mmCapacity PopulationCattle CapacttyPopulation
_ - m
_.�
an to eeer
p ayer
_
p airy
gy
_
Ec er to inis
-p on- ayer p on- auy
row to can
p Farrow to Feeder
p Other
otal Desf Ca aci - 12,960
P tye
p Farrow to Finish
n Gilts
Total SSLW '= 1,749,600
p Boars
N mer o bf Lagoons ® u surface Drains Present JJE3 Lagoon Area
in Spray Fie rea
Holding=Ponds`/ SoLd Traps _ p o iquid Waste Management ys em
0.0
uisenarges & stream impacts
1. Is any discharge observed from any part of the operation? n Yes p No
Discharge originated at: p Lagoon p Spray Field p Other
a. If discharge is observed, was the conveyance man-made? n Yes p No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) [3 Yes p No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) p Yes p No
2. Is there evidence of past discharge from any part of the operation? p Yes p No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? [3 Yes 13 No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? p Spillway p Yes p No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard(inches) 14.............................. 12............... ................ 12................ ................................... ......................................................................
5. Are there any immediate threats to the integrity of any of the structures observed? (iel trees, severe erosion, 0 Yes (3 No
seepage, etc.)
3/23/99 Continued on back

(Facility Number: 31-857 I Date of Inspection
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? p Yes p No
(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? p Yes p No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? p Yes p No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? p Yes p No
Waste Application
10. Are there any buffers that need maintenance/improvement? p Yes p No
11. Is there evidence of over application? p Excessive Ponding p PAN p Yes p No
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
p Yes p No
p Yes p No
p Yes p No
p Yes p No
p Yes p No
p Yes p No
p Yes p No
p Yes p No
p Yes p No
p Yes p No
p Yes p No
p Yes p No
p Yes p No
p Yes p No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? p Yes p No
Reviewer/Inspector Name IStauewallMath�s' � ��rt�. TImiHolla�nd`{DI:Q),
�.
g
Reviewer/Inspector Signature: Date:

Division of Soil and Water Conservation - Operation, Review T
El Division of Soil and Water Conservation - Compliance Inspection
Division of Water Quality - Compliance inspection =,
Other -A' ency - Operation Review '
Routine 0 Com laint 0 Follow-u p of DWQ ins pection 0 Follow-u of DSWC review 0 Other
Facility Number Date of Inspection Z
I inic ref inspection b ► O 24 hr. (hh:mm)
IpPermitted Certified © Conditionally Certified, +0 Registered [3 Not Operational I Date Last Operated:
Farm Name: .................. .... C-....... !'P.:1,k6.t....1�t�.�t............................ County:
........ [bvp.[iA.....
.............................. .......................
OwnerName:...................L�lLdin...................) l-7e_ F�:tf t .►dc.....I....�1�-................-..... Phone No:.............................................---.......................................
Facility Contact: ....................Gx.........�..r�?41.�. - l'itle:........L1y�lt[}t1 ..( ......... Phone No:..�a.1�� S.�Z'.ZQ....-..-....
MailingAddress: ...........P.. ......UIQ.........`.t.1.................................................................J ` ........�L....Arm .r[J.c ...................................... ... -u-n. ......
Onsite Representative: .............{ Integrator
Certified Operator:.......................&��.................1.1........ ............................ Operator Certification Number:..........................................
Location of Farm:
.......... Qn... za...5Z&....Q-.V......5?.....12161......Q.-A....m1...._.. we'st...&F........P'.1.1e.to................................... ...............................
Latitude Longitude
Swine
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Capacity Population Poultry Capacity Population Cattle Capacity Population
❑ Layer I 1 ❑ Dairy
z4tG D ❑ Non -Layer ❑ Non -Dairy
❑ Other
Total Design Capacity z_g40
Total SSLW
Number of Lagoons Subsurface Drains Present I ❑ Lagoon Area IIQSpray Field Area
Holding Ponds / Solid Traps ❑ No Liquid Waste Management System
Discharges 8 Stream Impacts
1. is any discharge observed from any part of the operation (If yes, notify DWQ)? ❑ Yes ;J�No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If' discharge is observed, was the conveyance nian-made?
h. If discharge is observed. did it reach: ❑ Surface Waters ❑ Waters of the State
c. If discharge is observed. what is the estimated flow in gal/min'!
d. Does discharge bypass a lagoon system?
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts to the waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure I Structure 2 Structur: 3 Structure 4
Identifier: ii 2l 3
Freeboard (inches): ............ M................. .............
...................... ....................
❑ Yes ® No
❑ Yes ® No
N
❑ Yes j, No
❑ Yes 11 No
❑ Yes C4 No
❑ Yes J�j No
Structure 5 Structure 6
1 /6/99 Continued on back

Facility Number: 3 i - 4?S-1 Date of Inspection
'5..Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, �— �j Yes f9 No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes CR No
(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! 5d Yes ❑ No
8. Does any part of the waste management system other than waste structures require maintenancelimprovement? M Yes ❑ No
9. Do any stuctures lack adequate, gauged markers with required top of dike, maximum and minimum
liquid level elevation markings?
❑ Yes
"ONo
Waste Application
10. Are there any buffers that need maintenancelimprove ment?
❑ Yes
® No
11. Is there evidence of over application? ❑ Ponding Nitrogen
❑ Yes
JONo
r❑
12. Crop type X.m4 l(L...... ............................ i.lh...... ......................................................................... .............................................
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
No
14. Does the facility lack wettable acreage for land application`! (footprint) .
❑ Yes
No
15. Does the receiving crop need improvement?
❑ Yes
El No
16. Is there a lack of adequate waste application equipment?
❑ Yes
No
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(iel WUP, checklists, design, maps, etc.)
❑ Yes
No
19. Does record keeping need improvement? (iel irrigation, freeboard, waste analysis & soil sample reports)
M Yes
❑ No
20. is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
0 No
21, Did the facility fail to have a certified operator in responsible charge?
❑ Yes
C2 No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
t4No
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
P No
24. Does facility require a follow-up visit by same agency?
❑ Yes
R No
N:o'violations.or. deficiencies .were noted during Ais"visit:: Y-oui �vill:reeeive no further :::::
cgrresp6iidence; about: this :visit.; ; ; ; ; ; ; ; ;;;; ; ; ; ; :: :: ; ; ' ;
Comments (refer -to question..#): Explain any YES answers and/or any.recommendations or any other comments -! x
Use
'drawhngs of facility-4o better euplaidsituations. (use additional pages as necessary)i
7. GW-6ion &Kc,5_. Q t- 0,A4- Wtu�l a AO aC)!l5
ate, " Diner, 0 ?Ac5 ,
kfAS[-e c�L sk' �ovS�es ova (Q)con *l!! P � ; r" �O�Se 3 inns 6V42r �,Iw
ptlas� 5V1cti1�J �e �ur,.`iecq�` it GAL i (a��ar�. r2cc1L �{rou[d
�GLe� 7. O �G•� l 0� S�t7l Yh l`r �t`UG�ft�an arJ
!k � S. � j�tL�.t� t�ru,� �- i-t � � i rtc� ►rs.;"r�"� 7
Reviewer/Inspector Name
Reviewer/Inspector Signature:ZL Date: _ 3>'�j99 11/6/99

Facility Number: Date of Inspection: Z
Additional: Comments and/or Drawings f, y . .
PQ
4130W

13 Division of Soil and Water Conservation 13 Other Agency
® Division of Water Quality
10 Routine 0 Comnlaint M(Follow-up of DWO inspection O Follow-uv of DSWC review O Other I
Date of Inspection 1 9 1d 178
Facility Number 3 i S Time of Inspection MkD24 hr. (hh:mm)
0 Registered © Certified 0 Applied for Permit © Permitted 113 Not Operational I Date Last Operated:
..F
Farm Name:.1tY .... ......... :. ...... M5.,,.....1..l 6. .... County:.... %........................... .......................
' z Z10V
OwnerName:................1................ ................ ..--•--.......--...........--......----......------............I...... Phone No:.....��...........................................................................
Facility Contact: ....... 1. ......................"Jr"'... ..L.... Title:4i"-tj p Phone No: ...........................
Q....R .
MailingAddress: ......!..,.v........ .........1................................................... .. '. r............1..L! cl....................... ..�........................
Onsite Representative :............. ...01........................./Joe................. ... Integrator: ........ '.1.1-4.4d. ...............................................
Certified Operator ............................. ................................................................................... Operator Certification Number:.........................................
Location of Farm:
Latitude Longitude
General
1. Are there any buffers that need maintenancelimprovement? ❑ Yes ❑ No
2. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
3. Is there evidence of past discharge from any part of the operation?
4. Were there any adverse impacts to the waters of the State other than from a discharge?
5. Does any part of the waste management system (other than lagoons/holding ponds) require
maintenance/improvement?
6- Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes
❑ No
❑ Yes
❑ No
Ayes
❑ No
❑ Yes
❑ No
❑ Yes ❑ No
7. Did the facility fail to have a certified operator in responsible charge?
7/25/97
❑ Yes ❑ No

... Facility Number:
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (Lagoons,Ilolding Ponds, Flush fits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure 1 Structure 2 Structure 3 Structure 4
❑ Yes 0 No
❑ Yes 9No
Structure 5 Structure 6
Identifier: Freeboard (ft):............................... `Z/........... ........ ................................... .................................... ................................... ....................................
10. Is seepage observed from any of the structures? ❑ Yes JXNo
11. Is erosion, or any other threats to the integrity of any of the structures observed? Yes ❑ No
12. Do any of the structures need maintenance/improvement? Yes ❑ No
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers? ❑ Yes 64 No
Waste Application
14. Is there physical evidence of over application? ❑ Yes ❑ No
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type..............................................................................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)? ❑ Yes ❑ No
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
22. Does record keeping need improvement?
For Certified or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
25. Were any additional problems noted which cause noncompliance of the Permit?
0- No.vialations-or dd kiencies were-noted-d'ing this', visit'. Youm'iH- iecei*e-no-furttier. -
:.�cQrrespQndenceatioutf>Ehis:visit.:::•::•::.::•::::•.•�.:.:::: :• •:•;:::•::•:•
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes IR No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
L
ps
r Z/G,fG­on
�,//� f.��P�'+i Z 78 Z. � ��''�`" � �� /�f [�"�i fn h �,e, , 2✓dl�
h3 fe. D 7O £PA jeAj,A `t S S-r� it j /aj—,575
7/25/97
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Date:

Division of Soil and 'Water Corservation 0 Other A2enck' .....
13 Di N -ision of Water Quality
Routine OComplaint OF(ilioA--uptirl)IN'Qinsnf-clion OFi)ll(sN4--up(if'[)SWCru%,iea, 00ther
Dale oF1risp-,-:tiot-
Time of Inspection t l 2A hr. (hh:mm)
M Ref0stered 13 Cert , ified [3 Applied for Permit RPermitted JE3 Not OpL:ralio�nal Date Last Operated: ............. I ............
... ......................
Co
.... .................... -:i- ..................... ........... .. ....................... Farm Nam,,:. .....
0"vocr C.
............ .................. ....... L,&.c . ...... I ................ Phone No,
Faciiit.y Contact: ............................................... ........................... Title . ................................................................ Phone - No . ....................................
r1% I
LJo 1, - - . ),- ) C;,
A,;, . ............................................................. ..........................
N12iiin- Address:....' C I t"AN,
............................... ... .............. ........ ......................... .. . ...
............................
...... . ..................... U ........................... ................... ........... -------
Certified Operator; ................
................I..--. Operator Certification Number;
Location 01 tarm:
;.e
........... ............... ...........................................
.............
Latitude 6 1 49 Longitude ;4
C
Design', �Cuefent
urrent -n Current
.' �Capacy-Tooulatioli.-, PoultryCapacit3, Population Cattle..,... Cap'ac.ity. Po'Pubifioll �.-'
V----ean to Feeder
fRFeeder toFinish
jV2-Ct,'(-1
17 Farrow to Wean
:10 Farrow to Feeder
'11:3
Farrow to Finish
Boars
ttm. ero -N b f La-eiciomsY'Holdink'POD& TED Subsur-ace Drains Present? Lagoon Area Spray
t, Liquid Waste Mana-ementSi,stem
L Are there any buffers that need mainteriancriimprovcritent! Yes [�,No
2. Is any observed
discharge g ;-j-vtd from any part of the operation? El Yes N, No
Di.qchar-e originated at: [J- La-oop [] Spray Field J Other
a. ["discharge is observed. was the conveyance man-made'? ❑ Yes [•No
b. Is discharge is observed. dill it reach Surface '%Vaier' notif\- D'N"'Ti Yes No
c. Udischar,-,e is observed. what is th5estirnattd flow in-aVniinl!
d. Does discharge bypass a lagoon system? (Ify.-s. notify MVQ.)
- - - - 0 Yes No
3. Is there evidence of past discharge from any part of the operation? 1:3 Yes No
4-- -
4. NVert there anv adverse impact- to the waters of the State other than from a discharge? El Yes Of No
5. Doc; any part of the waste management -%,stern (other than lagoons/holding ponds} require Yes No
maintenancehmproverntnt?
6- Is facility not in comphance with any applicabie sttbacl, criteria in eff--c-, at the time of d---,i-n" ❑ Yes No
7. Did the facility fail to have a certified operator in rtsponsibie charge? Yes No
7/25/97

.L.acility Autnber:3 \ —�57
S. .are there lagoons or storage ponds on site which need to be properly closed' ❑ Yes MN,
Structure- (LaeoonsJIoldin; Ponds, Flush fits. etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes No
Structure I Structure 2 Structure 3 Structure 4 - Structure 5 Structure 6
Identifier:
....... .. ................... ..-................3.... _............. ............... -.................. ................................... ........................ -.........
Freeboard (ft)_ .. �.: S 5 S .......................
10. Is seepage observed from any of the structures?
11. Is erosion, or any other threats to the integrity of any of the structures observed?
12- Do any of the structures need maintenancelimprovement?
(If any of questions 9-I2 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
Waste Application
14. Is there physical evidence of over application?
(If in excess of IWMP, or runoff entering waters of the State, notify DWQ)
15- Crop type ....... `�'� _.....................
�................................_..............----------...
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20- Does facility require a follow-up visit by same agency?
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
22. Does record keeping need improvement?
For Certified or Permitted Facilities Only
,721 Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
25. Were any additional problems noted which cause noncompliance of the Permit?
No.violations•orde"FtcieitGie's:we're-notedduringthis:visit. You.vKill.receive•Ro"forth:er:
correspondence about -this: visit:
❑ Yes ($No
cg�yes ❑ No
Yes ❑ No
❑ Yes %No
❑ Yes 19 No
❑ Yes D,No
❑ Yes MNo
ayes ❑ No
❑ Yes ClNo
,Yes ❑ No
❑ Yes Mo
❑ Yes mNo
❑ Yes t4 No
❑Yes No
❑ Yes KNo
5�r ►f'_Co��ic���t�AL
c 45 t 4-
SC'C
C4i 7/25197
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Date-

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❑ Division of Soil and Water Conservation (3Other Agency
13 Division of Water Quality
Routine O Complaint O Follow-up of DWQins cTtion O Follow-up of .DSWC review O Other
Facility Number 9Date of Inspection MIMI
Time of Inspection © 24 hr. (hh:mm)
© Registered © Certified [3 Applied for Permit Permitted 10 Not Operational Date Last Operated:
c�_
Farm Name: ......�-�...�.�.:�`-�.................�:� ..........................................._.._.. County:...... .......\!. '................................ ..............: -
lkl
Owner Name: ....l C?.... ~ !�—� . Phone No: aL ..............................................................
5"T�..�....a(C�... i......................
,5...................tl............... ,
FacilityContact:...................................qq................f.......................... Title:...............................
Mailing Address:.. yo.. ... L...1..... C.�a�C......'l�r�°�
Onsite Representative:... S 2 L+....................
.............................................
Certified Operator;
--------------------- Phone No:...................................................
.................................................................................. ..........................
Integrator:.._. ..... ...&:".:............................
Operator Certification Number; .........................................
Location of Farm:
.. ,.. t.t.... ... ... . ...N. N.... .. i
w.5---..�� �.... `
............................................................................................... 9l fry
Latitude 0• =` " Longitude =' 4 94
Design Current. DesignCurrent Design -: Current
Somme Capacity Population Poultry Capacity Population Cattle Capacity Population
❑ Wean to Feeder El Layer ❑Dairy
Feeder to Finish JE1 Non -Layer ❑Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder e. ❑ Other fi
❑ Farrow to Finish yTotal Design Capacity
❑ Gilts
El Boars Total SSLW
Number of Lagoons / Holding Pflnds _�: ❑ Subsurface Drains Present ❑Lagoon Area ❑Spray Field Area
AN-R
>N r..s❑ No Liquid Waste Management System ".
General
1.
Are there any buffers that need maintenance/improvement?
❑ Yes
allo
2.
Is any discharge observed from any part of the operation?
❑ Yes
C�No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
❑ Yes
C(No
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
❑ Yes
P(No
c. If discharge is observed, what is the estimated flow in galhnin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
❑ Yes
151 No
3.
Is there evidence of past discharge from any part of the operation?
❑ Yes
1A.No
4.
Were there any adverse impacts to the waters of the State other than from a discharge?
❑ Yes
) No
5.
Does any part of the waste management system (other than lagoons/holding ponds) require
❑ Yes
19 No
maintenance/improvement?
6.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
01 No
7.
Did the facility fail to have a certified operator in responsible charge?
❑ Yes
KNo
7/25197

Facility Number: —
8. Are there lagoons or storage ponds on site which need to be properly closed?
❑ Yes 16 No
Structures (La2oons.Iloldine Ponds. Flush Pits. etc.
9. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes ANo
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ............ ............... .............. '...................... ..................................... ....................................................................................
Freeboard(fit): ............... :. ...................... .................��................. .................................... ................. ................... ....................................
10.
Is seepage observed from any of the structures?
❑ Yes
CKNo
11.
Is erosion, or any other threats to the integrity of any of the structures observed?
Yes
❑ No
12.
Do any of the structures need maintenance/improvement?
M'Yes
❑ No
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13.
Do any of the structures lack adequate minimum or maximum liquid level markers?
❑ Yes
%No
Waste Application
14.
Is there physical evidence of over application?
❑ Yes
IN No
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
V15.
Crap type .......�.' ..............................................................................................................................................................................................
16.
Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
❑ Yes
C<No
17.
Does the facility have a lack of adequate acreage for Iand application?
❑ Yes
RNo
18.
Does the receiving crop need improvement?
(Yes
❑ No
19.
Is there a lack of available waste application equipment?
❑ Yes
MNo
20.
Does facility require a follow-up visit by same agency?
,Yes
❑ No
21.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
ONo
22.
Does record keeping need improvement?
❑ Yes
VNo
For Certified or Permitted Facilities Onl ,
23.
Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑ Yes
CdNo
24.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
[NJ No
25.
Were any additional problems noted which cause noncompliance of the Permit?
❑ Yes
KNo
1: No.viofations'-ordeiiciencies.were.noted,nuring this:visiL- You;wri11 recei've.no:ftirther_.:
corresO6hdek6 about-this"visit: ,
SA\wta
L1 (�� � �$� v��2'��� .2.S�1�s � • as T�Q� �1s pa35 i �Q
k1l
.v�A�'C,� 'tl\1 oC� 7125/97
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Date:

Division of Soil and Water Conservation [3 Other Agency
M Division of Water Quality
Routine O Com laint O Follow-u of DWQ ins ection O Follow-up of DSWC review O Other
Date of inspection 2 7
Facility Number 1 Time of Inspection E]� 24 hr. (hh:mm)
© Registered $/Certified © Applied for Permit [3 Permitted 0 Not O eratinnal Date Last Operated:
Farm Name: ....... &.oss ..... ...i 5�...... .&vms...� LLL.. County:...A'4... ....................................... .......................
Ommer Name :............}J. h. kuoO.)............ OL(xnS....................................................... ]Phone No:..�`�.1.d�.�9.�.�.ZfD'i.............
Facility Contact:...... 'f . &n....... ...........ii..............................L+xxa ..L�� .... Phone No:.(_. J.Q. T : 2. IG.` �-...
5�� Title
MailingAddress:.... PQ....;t......W.tl ...................................................................................... .4..!H aan....N......................................... Z . g.........
Onsite Representative :....... 190o ...... S.r.A. b
I...................................................... Integrator:...........(f)ca].cY..l....................................................
CertifiedOperator;............................................................................................................... Operator Certification Number. .........................................
Location of Farm.
i,�........... .J...C.tz�.arLA _raa...ua�.:....�n....i......�4.... �...T"�rzr....... x .......,o....i<s��..... i
l9:%......s.U.M!K].�lrl.i(1�....... �. �5.. � Yl..d.+kt �...6. ....s .l. � tCt!.....L%.....1,.,-Ji5...0r.......5 1PA 41�..t........ .
f.afitnrtP Z�+ /�<I 7`i Ire Tnnoitnria !-! 7 ��1�]5( �� l�« t
Design Current Design Current Des n �� +Current
Swine ; Capacity Population Poultry " .;.Capacity PvpWatioq ;Cattle" Capacity,,'Populattan
❑Wean to Feeder ❑Layer ❑ Dairy
Feeder to Finish jjq& p ? ❑Nan -Layer ❑ Non -Dairy
❑ Farrow to Wean « y n
❑ Farrow to Feeder JE1 Other
❑ Farrow to Finish Total Design Capacity z
❑ Gilts ,
❑Boars Total SSIW -%
;a r
I�Tumber ofELagoons 1 Holding Pnnds �, Subsurface Drains Present ❑Lagoon Area Wspray Field Area
lr
g , ❑ No Liquid Waste Management System
`-
General
1. Are there any buffers that need maintenance/improvement?
2. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
3. Is there evidence of past discharge from any part of the operation?
4. Were there any adverse impacts to the waters of the State other than from a discharge?
5. Does any part of the waste management system (other than lagoons/holding ponds) require
maintenancelimprovement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
7. Did the facility fail to have a certified operator in responsible charge?
7/25/97
® Yes ❑ No
❑ Yes ® No
❑ Yes
® No
❑ Yes
M No
❑ Yes
® No
❑ Yes
El No
❑ Yes M No
Yes ❑ No
❑ Yes [ANo
❑ Yes P No
Continued on back

l +
`'Facility Number:
8. Are there lagoons or storage ponds on site which need to be properly closed?
❑ Yes
No
Structures (Lagoons, Holding fonds, Flush Pits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
❑ Yes
No
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5 Structure
6
Identifier: 1 .4. ............. ............ ............
Freeboard(ft): g................... .... .IP............................... ....................................
.................................... ....................................
10. Is seepage observed from any of the structures?
❑ Yes
® No
11. Is erosion, or any other threats to the integrity of any of the structures observed?
Yes
❑ No
12. Do any of the structures need maintenance/improvement?
Yes
❑ No
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
❑ Yes
EA No
Waste Anolication
14.
Is there physical evidence of over application?
❑ Yes
(9 No
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15.
Crop type �MWMV41 H......................... ................................... ..........................................................................................................
16.
Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
❑ Yes
EZNo
17.
Does the facility have a lack of adequate acreage for land application?
❑ Yes
® No
18.
Does the receiving crop need improvement?
Yes
❑ No
19.
Is there a lack of available waste application equipment?
❑ Yes
[3 No
20.
Does facility require a follow-up visit by same agency?
JAYes
® No
21.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
V$No
22.
Does record keeping need improvement?
E& Yes
E No
For Certified or Permitted Facilities Only
23.
Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑ Yes
®,No
24.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
UNo
25.
Were any additional problems noted which cause noncompliance of the Permit?
❑ Yes
($ No
O'No.violations•or. de'ficiencies.were-notied-during this;visit.-Y.oa.vi'ilI receive`no•furthei-:
0fr6pbadence aliout this'visit'.
s6A� ke- a,-o Q
Y• C..eaKs � r Ino�,acc Ska�r�d b e re�a;r� � ,
iae�aazti #'2 CroSior.
a � 4 �. 0t LU 3. c� s4� � �t '�;��� w� C[ M/ yes 1��_ 8G� 45 ati
all `Y `(ev l [BLS `` 1 sY Wt�,� W �' l "][`eI -�� a Cj V ll'�e� - c1 as iw, ; n "'^r iTt-�tk L AI sti� CA
1 Oo, L $ribv�V Infi Gi,K(�, I.r� `+�lQ G'Yy oY� k sl�edd 6 e,%�u.W r 2ppS a�.Lit�
� 11`7121/97
G'�of �en�-Ye� 'a�1a►;10 �n-e ire fAv,, +
Reviewer/Inspector name '! f w
IReviewer/Inspector Signature:
Date:

Lagoon Dame bispection Report
Name of Farm/FaciIity g wed 1-'/ntS
Location of Farm/Facility
Owner's Name, Address Azw-c
and Telephone Number
dnx A/C --
Date of Inspection Names of Inspectors s ��
e. /ii s
Structural Height, Feet /Q Freeboard, Feet 2
Lagoon Surface Area, Acres _ Top Width, Feet /o '
Upstream S1ope,xH: IV Z : I Downstream Slope, xHa V _ =
Embankment Sliding? Yes No
(Check One, Describe if Yes)
Seepage? Yes No
(Check One, Describe if Yes)
Erosion? Yes )_No
(Check One, Describe if Yes)
Condition of
Vegetative Cover
&�) Trees)
Did Dike Overtop? Yes Y No If Yes, Depth of Overtopping, Feet
Follaw-Up Inspection Needed? Yes No
Engineering Study Needed? Yes No
Is Dam Jurisdictional to the Dam Safety Law of 1967? Yes No
Other Comments

Lagoon Dike Inspection Report
Name of Fann/Facility �og u}c�c✓j„gr-� # 2 _
Location of FambTacility
Owner's Name, Address Flo j �Z 2(1-1
and Telephone Number
Ac3a,v 49 I -I vIL Ah ie3r4
Date of Inspection
Structural Height, Feet
Lagoon Surface Area, Acres
Upstream S1ope,xH: IV
Names of Inspectors
/Y Freeboard, Feet
Top Width, Feet
Z . / Downstream Slope, xH: l V Zlz : /
Embankment Sliding? Yes _ No
(Check One, Describe if Yes)
Seepage? Yes X No
(Check One, Describe if Yes)
Erosion? Yes ?_ No
(Check One, Describe if Yes)
Condition of _ zg X CeMey :
Vegetative Cover
ass rees)
Did Dike Overtop? Yes No If Yes, Depth of Overtopping, Feet
Follow -Up Inspection Needed? Yes No
Engineering Study Needed? Yes - No
Is Daze Jurisdictional to the Dam Safety Law of 1967? Yes No
Other Comments

Lagoon Dike Inspection Report
Name of Farm/Facility og -JGv Fd:yl
Location of Farm/Facility
Owner's Name, Address 3rt I /Zly
and Telephone Number
Date of Inspection Names of Inspectors a ff
A 24.
Structural Height, Feet %!�) Freeboard, Feet /
Lagoon Surface Area, Acres I Top Width, Feet /Q
Upstream Slope,xH:IV ? / Downstream Slope, xHAV Z%
Embankment Sliding? Yes C�No
(Check One, Describe if Yes)
Seepage? Yes No
(Check One, Describe if Yes)
Erosion? Yes No
(Check One, Describe if Yes)
Condition of
Vegetative Cover
Frees)
Did Dike Overtop?
Fallow -Up Inspection Needed?
Wl f - - — -- -
Yes No If Yes, Depth of Overtopping, Feet
Yes No
Engineering Study Needed? Yes No
Is Dam Jurisdictional to the Dam Safety Law of 1967?
Other Comments
Yes No
N