670002_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental Qual

(Type of Visit: a rRoutine
pliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
isit: Reason for V0 Complaint 0 Follow-up 0 Referral 0 Emergency O Other 0 Denied Access f[
Date of Visit: (o Arrival Time:® Departure Time: County: 0 Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Owner Email:
Phone:
Onsite Representative: Tc ol-c-srA C ou_x S Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Certification Number: 03273
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Design Current Design Current
Wet Poultry Capacity Pop. Cattle Capacity Pop.
ILayer IDairy Cow
Wean to Feeder
I INon-Layer I
airy Calf
Feeder to Finish
airy Heifer
Farrow to Wean
Design Current Dry Cow
Farrow to Feeder
D , Poultry Ca achy P,o Non -Da*
Farrow to Finish
Layers
Beef Stocker
Gilts
I
Non -Layers
Pullets
Turkeys
Turkey Poults
10ther
'
Beef Feeder
Beef Brood Cow
Boars
Other
Other
7
1
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
Page I of 3
❑ Yes ZNNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes �o ❑ NA ❑ NE
❑ YesWNo
o ❑ NA ❑ NE
[—]Yes ❑ NA ❑ NE
21412015 Continued

Facility Number: jDate of Inspection: S
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure I Structure 2 Structure 3
Identifier: LA(OW LAGOON Wk
Spillway?:
Designed Freeboard (in):
Structure 4 Structure 5
Observed Freeboard (in): '3ti
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
No ❑ NA ❑ NE
❑ No ❑ NA ❑ NE
Structure 6
[:]Yes No ❑ NA ❑ NE
[:]Yes ZNo ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environment,11 threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes o ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? [:]Yes 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 WNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s): ,
14. Do the receiving crops differ from those designated in the CAWMP?
• ❑ Yes
2) No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
ypo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
o
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
W
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
u No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
o
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and F Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes o ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? El Yes ;No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facility Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes o
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes 2 No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ NA ❑ NE
❑NA ONE
❑ 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 WNo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes [3] No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes O'No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
Dlo
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
[� o
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
E, J N
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
VNo
❑ NA
❑ NE
Comments (refer to question #): Explain any,YES answers and/or any additional recommendations or any other comments.
... : ".
Use drawin s of:facili to:.better explain situations use additional pages,as.necessa
Reviewer/Inspector Name:
Reviewer/Inspector Signatu
Page 3 of 3
G N E Phon fit � ! 3 D U
re: Date: J
214 OI S

Type of Visit: O Co=outine
nce Inspection U Operation Review Q Structure Evaluation Q Technical Assistance I
Reason for Visit: O Complaint O Follow-up 0 Referral O Emergency O Other O Denied Access
Date of Visit: sfl-7�� Arrival Time: Departure Time: 03 County: Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: Olt le + � C .111 n S
Certified Operator:
Title:
Back-up Operator:
Location of Farm: Latitude:
Phone:
Integrator:
Certification Number:
Certification Number:
Longitude:
Design Current Design Current
city Pop.
7RFder
Finish La errBeef
Cattle
Design Current
Capacity Pap.
Feeder
Non -La er
o Finish
70go
G.3oD
er
arrow to Wean
Design Currentarrow
Dr, P.oultr. C►_a aci P,o
Layers
to Feeder
Farrow to Finish
Non -Dairy
er
Gilts
Non -Layers
er
Boars
Pullets
d Cow
Other
Other
Turkeys
Turke Poults
Other
Dischargesand Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes dNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes o ❑ NA ❑ NE
❑ Yes 2No ❑ NA ❑ NE
❑ Yes B No ❑ NA ❑ NE
Page 1 of 3 21412011 Continued

Facility Number: (pi - -I,- Date of inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ENo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: `_%� 1
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in)
ZZA VJ
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
❑ Yes No ❑ NA ❑ NE
❑ Yes [/No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
[v]/No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[fNo
❑ 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
b� No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[EI/No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
[/No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application
Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[9/No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement? -
❑ Yes
[✓"No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
[3/No
❑ NA
❑ NE
acres determination?
f
17. Does the facility lack adequate acreage for land application?
El Yes
E No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
&No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
[:]Yes
[2/No
❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[j No
❑ NA ❑ NE
the appropriate box.
❑WUP El Checklists ❑Dcsign ❑ Maps ❑ Lease Agreements
❑Ot r:
21. Does record keeping need improvement? If yes, check the appropriate box below.
WYes
[:]No
❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard [Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
[g5ludge Survey
22. Did the facility fail to install and maintain a rain gauge?
[:]Yes
[�No
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
Fg No
❑ NA ❑ NE
Page 2 of 3
21412014 Continued

I'
Facility Number: .7 - 7� Date of Inspection: t/ Z A.,
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ONo [DNA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [a No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to -develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? [:]Yes ETNo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No E]"``A ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document [—]Yes EJ/No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
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 [1No
❑ Yes �No
[:]Yes ErNo
❑ Yes Ka"No
❑ Yes �No
❑ Yes No
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to .better explain- situations (use�additional pages as necessary).
(4 ,5/ _S Toe 9eCilo- b0- el"
��.4 �� i'�(ne 11Q l9►C% 'te
P9 5 tojIt Sri y
It\ C a
�o �Y y j0 0 w
R ( p.wi� e°Ler,
5C,9j.►
fq-
Reviewer/Inspector Name: a { Phone: Ii j 7 v G 73O i
Reviewer/Inspector Signature: ]�t-.,.R� Date:
Page 3 of 3 21412014

(Type of Visit: Q CoZoutine
liance Inspection 0 Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: � O Complaint O Follow-up O Referral Q Emergency O Other Q Denied Access
Date of Visit: Arrival Time: -, 6 Departure Time: County: CW SU W Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: CR.(;.S A 6 L.L±4VS
Phone:
Integrator:
Phone:
Certified Operator: Certification Number: ;?2 .77 3
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Design Current
Wet Poultry Capacity Pop.
Layer
Desigu Current
Cattle Capacity Pop.
Dairy Cow
Wean to Feeder
I
INon-Layer I
Dairy Calf
Feeder to Finish
,"i
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Design Current
D . P,oul Ca achy P,o
I Layers
Dry Cow
Non-Dai
Beef Stocker
Gilts
Non -La ers
I Beef Feeder
Boars
Pullets
113eef Brood Cow
Other
Other
Turkeys
Turkey Puults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
[] Yes ENo [] NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
[:]Yes ❑ o ❑ NA ❑ NE
❑ Yes o ❑ NA ❑ NE
❑ Yes Wo ❑ NA ❑ NE
Page I of 3 21412011 Continued

[Facility Number: 62 - 2, jDate 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: LA6.,. d rA C.1L LA&QJ
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 30
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a [—]Yes ONo [ ] 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 environment threat, notify DWQ
7. Do any of the structures need maintenance or improvement? [:]Yes [ No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No [] NA ❑ NE
maintenance or improvement.
11. is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes �No ❑ NA ❑ NE
❑ Excessive Pending ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
Zvo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
D No
[] NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
�o
❑ NA
❑ NE
18. is there a lack of properly operating waste application equipment?
❑ Yes
�o
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑Yes
No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
[:]Yes
dNo
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists [:]Design [:]Maps [:]Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check a appropriate box below. Yes ❑ No
[Waste Application ❑ Weekly Freeboard [Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? [:]Yes [%f o
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [—]Yes �No
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑NA ONE
Page 2 of 3 21412011 Continued

[Facility Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? Yes ❑ ✓[]�o ❑ NA ❑ NE
25. Iethe facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [7 No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑Yes ❑'No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
��//
;] No
❑ NA ❑ NE
and report mortality rates that were higher than normal?
/
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
—TTTT
l 2 No
❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
T
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
7/No
❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
/No
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
E
❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
N
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑Yes
NoVo
Y
❑ ❑ NA NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to.better explain situations (use additional pages as necessary).
i jk-rc APht, Y.ts rb n- 6GT Z,0 t3 wA:s MOF COKAt.F0, /nOZ-f- (W--16UL a,J
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�P Pc,sr�7�
6?r Cc n-� f��L;�'�,
l� C �S �u'1+�Ci n^ �a a ! �r/{fl d �� Gail t"!1}V�l. T N (J�
Niys� I
AFPIr`✓, EN of (TvAC
Reviewer/inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
tJi�hl �J tQ 1U L G�' Phone(
y-. Date:
11

Type of Visit: Q C pliance Inspection O Operation Review O Structure Evaluation 0 Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up O Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: County: (3&ASC6(, j Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative: R-CSA CA LL t:K S Integrator:
Certified Operator: Certification Number: Z 3 Z?3
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
II Design Current
Swine Eapacity Pop.
Wean to Finish
Wet Poultry
Layer
Design
Capacity
Current
Pnp.
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Wean to Feeder
I
JNon-Layer 1 E3
Feeder to Finish
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
D . P,ou1..
Layers
Design
Ca aci
Current
P.a ,
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Non-Laye
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turke s
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation? [:]Yes /No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) ❑ Yes [:]No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes ❑ ❑ NA ❑ NE
❑ Yes VN
NA ❑ NE
Yes ❑ NA ❑ NE
Page 1 of 3
21412011 Continued

Facility Number: - Date of Inspection: Sli O
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
[q 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: (,I�(�N f (KtJ 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[_] ❑ 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 7 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 environment threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? [—]Yes E(No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes fo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes No
❑ NA
❑ NE
maintenance or improvement?
/No
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ 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 ❑ Evidence of Wind Drift ❑ Application
Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes N
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes La No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes O/No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes <o
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
[:]Yes YNo
❑ 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. R Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections Dludge Survey
22. Did the facility fail to install and maintain a rain gauge? [:]Yes Q No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 2No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: 70 jDate of Inspection: a 3
24. Did the facility fail to calibrate waste application equipment as required by the permit
[:]]Yes
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
❑ Yes
o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
�No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
[:]Yes
No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
L2�/No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
[�J/No ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
L=J �No ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes N ❑ NA ❑ NE
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative? ❑ Yes7No
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes ❑ NA ❑ NE
Comments (refer to question i): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary)..;:.
Z.) M Ss(--D 5c.v oG�E r4P-- ZfOZ , PO 5L,0 0" sun.Vw kstp � 9,01X9
Cw, 7vv6? wu-r-H kswi-S,
Reviewer/Inspector Name: 11_/0
Reviewer/Inspector Signature:
Page 3 of 3
Phone: r .-7
Date:rv~ 3
214 01

Type of Visit: U Co pliance Inspection Q Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: (Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: 7 Arrival Time: Departure Time: d0 County: �a Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title: Phone:
Onsite Representative: R-A- C S-A Co L La_kiS Integrator:
Certified Operator: Certification Number:�a1'3
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Designurrent Design Current
Swine !Yhc"
P. Wet Poultry Capacity P.op.
ed
Finish Layer
Design
Cattle Capacity
Dairy Cow
Current
Pop.
Feeder
Non -La er
EA
DairyCaif
o Finish
Dairy if
Heifer
tFarrowtoWean
o Feeder
Finish
Design Current
Dr P,oulti, Ca a_city P,o ,
La ers
D Cow
Non-Daio
Beef Stocker
Non -La ers
Beef
Boars Pullets
Turkeys
Other Turkey Pouits
Other Other
Beef Brood Cow
-
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
[:]Yes EZINO ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes ❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑Yes
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes VNN
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes I-J o
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

Facility Number: `? - Z. Date of Inspection: Z. 2
Waste Collection & Treatment
4.19 storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No
a. if yes, is waste level into the structural freeboard? []Yes ❑ No
❑ NA ❑ NE
❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: QV aa.j
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): Is_ 951
-Sc
5. Are there any immediate threats to the integrity of any of the structures observed?
[-]Yes
No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
[2/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 environme al threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
P
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
UJ'No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
11. is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
2/No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
EdNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
E(No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
ffNo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes-
dNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
F21/No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
/No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
—7
� 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. E� Yes ❑ No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 " Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes rNo
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes
❑ NA ❑ NE
❑ Weather Code
Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

FaciliNumber: Date of Inspection: Z
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes o ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ElYesgo
No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the ❑Yes No ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
[:?*No ❑ NA
❑ NE
❑ Application Field ❑ Lagoon./Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yesd-vo
❑ NA
❑ NE
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑Yes
No ❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
No ❑ NA
❑ NE
(refer to question ft Explain any YES answers and/or any additional recommendations or any other conlments •
lComments
Use,drawings of facility to better explain situations (use additional pages as necessary).
') Ka e CDC Y a
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Sail 1&ADitTs kl—TtN f.ECo"s Lf i o Ohc. CALF. 9WP
� WaL-'
Phone:
Date: 'Z
21412011

d Dtvision of Water Quality
FaCtl�ty Ntltnber #'J. s ,� Drvision of Soil and Water"Canseryahon
OtherAgeney,�
Type of Visit 7Routine
mpliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical AssistaReason for Visit 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other El DeniedAccess
Date of Visit: Arrival Time: Q OC7 Departure Time: County: ("UQJ Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Onsite Representative: fL�ES � Vol_t -,,S Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone No:
Operator Certification Number:
Back-up Certification Number:
Latitude: = c ❑ I Longitude: = o ❑ ' =
a w�k
Design Current Design Current �t, Des■ Current
Ca"` act Po ulat�on Wet Pout
p ty p y try Capacity Population° 'Cattle Capac�ty'Popul lion
❑ Wean to Finish
❑ Wean to Feeder
Feeder to Finish
l 000
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
der
Other "
�JLI Non -Layer I
j i ,
U Dairy Calf
` w '•
.Dry Poultry' " , r�
71
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Layers
❑ Beef Stocker
❑ Non -Layers
ElBeef Feeder
❑Pullets
.,
❑ Beef Brood
J 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?
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 2No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
d o
❑ NA
El NE
El Yes
WNo
❑ NA
❑ NE
Page I of 3 12128104 Continued

Facility Number: 0 — 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: LA(Toor.N 6-00� Z
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 0 Zlo
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
dNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
U(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
[2"No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
El Yes
❑ No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
4. Does any part of the waste management system other than the waste structures require
❑ Yes
dNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
13 No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
ffNo ❑ 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
[TNo
❑ 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
Lam' No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
[�rNNo
[I NA
El NE
18. Is there a lack of properly operating waste application equipment?
El Yes
[3 No
❑ NA
❑ NE
Comments(referto question .Ex lain any YES answers and/or an r,ecomm endatons or "any other comments ­
Use drawings of facility, to better explain situi66ns .(use additional pages as necessary) 4 :
T
Reviewer/Inspector Name- �' �,•„ Phone:
Reviewer/Inspector Signature: Date: 11,
Page 2 of 3 12128104 Continued

1
Facility Number: `, — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 2TNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ❑Xo ElNA ElNE
the appropriate box. ❑ WUP ElChecklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ErNo ❑ 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 eNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes JF�zo
K ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ❑ NA El NE
25. Did the facility fail to conduct a sludge survey as required by the permit? ElYesZto
❑ NA ❑ NE
26. Did the facility fail to have an actively certified operator in charge? ❑ Yes
El NA [-INE
27. Did the facility fail to secure a phosphorus toss assessment (PLAT) certification? ❑ Yes ❑ NA ❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes d�' ElNA ElNE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document ❑ YesVNo ❑ 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 7No
❑ 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 ❑ 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 N ❑ NA ❑ NE
33. Does facility require a follow-up visit by same agency? El Yes L� No ❑ NA ❑ NE
Additional Comments.and/or Drawings:
Page 3 of 3 12128104

L
f Visit D�Co pliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
n for Visit Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: County: 010 SCAL) Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: /� Title:
Onsite Representative: C9X,_SP. U6uXAS
Certified Operator:
Owner Email:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm:
Latitude: = o = I = Longitude: [= o = i [� u
Design Current Design
Current Design Current
Swine Capacity Population Wet Poultry Capacity
Cattle Capacity n
Population Populatio
❑ Wean to Finish
10 Layer
1
❑ Dairy Cow
❑ Wean to Feeder
10 Non -Layer I
I
❑ Dairy Calf
01 Feeder to Finish 0
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
❑ Layers
❑ Beef Stocker
❑ Gilts
❑ N ers
❑ Beef Feeder
❑ Boars
Nets
Pullets
❑ Beef Brood Co
❑ Turke s
Other
❑ Other
❑ Turkey Poults
❑ Other
Number of 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?
Page I of 3
❑ Yes dNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
El No
❑ Yes
o
❑ NA
❑ NE
❑ Yes
YNo
❑ NA
❑ NE
12128104 Continued

Facility Number: (p - Date of Inspection l [�
'}Waste Collection & Treatment
Z1,10
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes ❑ No
❑ 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 Cl 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
Comments (refer to question #) Explain any YES answers and/or, any recommendaho.ns orany other comments
Use. drawings°of facility twbetter explain situations (use additional pages as necessa t`y.)
al•) "IS AT(-- ZVTo APe4-10-VJL,
t Lx C2oP 4it-t.05. 0T.fA 54U 14 1p C_ RO &( PUA
�
i�•Z KIP Go?t' a L'6C- ��c-et.w�-z('
w 1N Q�E�v[�.DS 0-094)
ems) Sl.J 0 Gf� $uRt1C `{ IJo �Nf
f3� OZ �Z_L.�'aD bb t- 14A, * F .N.%3q.
Reviewer/Inspector Name.
Phone: Q toi10 -13�
Reviewer/inspector Signature:
AA, Date: l'1-
Page 2 of 3 12128104 Continued

Facility Number: Date of Inspection 3 ti t0
.'
Re uired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? dyes ❑ No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes �No ❑ NA ❑ NE
the appropriate box. ❑ WUp ❑ Checklists ❑ Design ❑Maps El Other
21.
Does record keeping need i rovement? If yes, check the appropriate box below.
VYes
El No
❑ NA
[I NE
❑ Waste Application ]Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking EfCrop Yield ❑ 120 Minute Inspections ❑ Monthly and I"
Rain Inspections ❑
Weather
Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
L' I No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
El NA
El NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
ElLJ Yes
,_K(No
No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
dyes
❑ No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
dNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
WN o
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
2�40
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
1:1 Yes
dNo
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
[?(No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
Z No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
,�/
L'7
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
LI No
❑ NA
❑ NE
Additional Comments and/or Drawings:
Page 3 of 3 12128104

I Type of Visit 0 7Routine
rtpliance Inspection O Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit O Complaint 0 Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: F71aqTo-71 Arrival Time: 9 da Departure Time: County: rsA —mkt Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Owner Email:
Phone:
Onsite Representative: 'IIL04 CO Lail) Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone No:
Operator Certification Number:
Back-up Certification Number:
Latitude: = o = 4 = 6, Longitude: = o ❑ 6 ❑ [I
urrent
DesigMP
Swine pulation
Design
Wet Poultry Capacity
Current Design
Population Cattle Capacity
Current
Population
❑ Wean to Finish
❑ Layer
❑ Dairy Cow
❑ Wean to Feeder
110 Non -Layer
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures:
© Feeder to Finish
'1 O L[O
❑ Farrow to Wean
❑ Farrow to Feeder
Dry Poultry
❑ La ers
❑ Non -Layers
Pullets
❑ Turke s
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑Turke Poults
❑ Other
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes dNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes dP, o ElNA ElNE
ElYes 7No ❑ NA ❑ NE
Page 1 of 3 12128104 Continued

i
Facility Number: — Date of Inspection 1sf i
I
Waste Collection & Treatment ,_,/
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes L-�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 (,a-60 i ja c7dbN1 Z
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 011,15 30
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes l( 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
❑ eat, 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 Di No ❑ NA ❑ NE
maintenance or improvement?
Waste Aanlication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ENo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes [�/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
dNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
L{J No
. ❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
d o
❑ NA
El NE
17. Does the facility lack adequate acreage for land application?
El Yes
Wo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
WNo
❑ NA
❑ NE
`t.. stCouesttan
Useedrawtngs�of facility to.better�explaEn:sttuat�ons (nse addrtEorial pages as,n _„ ,�
i
Reviewer/Inspector Name _ N W Phan - 7 -��
Reviewer/Inspector Signature: Date: vZ oZ� O
Page 2 of 3 12128104 Continued

r
Facility Number: Date of Inspection d
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 appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps ❑Other
❑ Yes Zo
o ❑ NA ❑ NE
❑ Yes ❑ NA ❑ NE
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1"
Rain Inspections ❑
Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
d No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
d No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
Uj 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
[XNo
❑ 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
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
El Yes
,L,i(No
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
[2No
❑ 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
ZINo
❑ 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
ElNA
❑NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
7NoWl�lo
❑ NA
❑ NE
Additional Comments and/or Drawings:
Page 3 of 3 12128104

2
Type of Visit C pliance Inspection O Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit Routine O Complaint O Follow up O Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: County: dJVsfiaK% Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
On site Representative: TOL-&SA G Lk-S.IJS Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone No:
Operator Certification Number:
Back-up Certification Number:
Latitude: = o = d = « Longitude: 0 ° = 1
Design Current
Design,ff
Current
Design Current
Swine Capacity Population
Wet Poultry
Capacity
Population
Cattle Capacity Population
❑ Wean to Finish
❑ Layer I
I
❑ Dairy Cow
❑ Wean to Feeder
ILI Non -Layer I
I
❑ Dairy Calf
® Feeder to Finish y 7 -LAM
❑ Dairy Heifer
❑ Farrow to Wean Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish ❑ La ers
❑ Beef Stocker
❑ Gilts ❑ Non -La ers
❑ Beef Feeder
❑ Pullets
❑ Boars
ElBeef Brood Co
❑ Turkeys
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?
❑ Yes 3 No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes [� El No
[3 NE
El Yes No ❑ NA ❑ NE
Page I of 3 12128104 Continued

Facility Number: 7 — Date of Inspection �4 6
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?
Structur I Structure 2 Structure 3 Structure 4
Identifier: 1 CACrGdr� 7/
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3 Q
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes VJ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes No ❑ NA ❑ NE
❑ Yes dNo ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmentalthr at, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes El"No 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 f'�No ❑ NA ❑ NE
maintenance or improvement?
Waste AnDlication
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 ZNo ❑ 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
to
t
El NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
N
El
El NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
o
YNo
❑ NA
El NE
18. Is there a lack of properly operating waste application equipment?
El Yes
❑ NA
❑ NE
Comment9vefer,to question;#)" ExplainFany.YE Mai sveers andliorfanyrrecomrnendations or any other comments.
Use drawrngsoffac! [v [o bed r'�e]rplain i� ttons (use additional pages- asnecessa k
a'.Y,ie''_p`.,`..." �i'�u'•ri.�.
wt._Coj1S ITENF'. •
Reviewerllnspector Name `j a601AA LUjI. I Phone: q16 7 _ 73V
Reviewer/Inspector Signature: Date: ; a 6
n ..e -) _f 2 12/29/0B Irantinuvd

I. Facility Number: — Date of Inspection 4
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 appropiate box.
❑ WUP El Checklists [:3 Design [I Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes EfNo
❑ Yes ONO
El NA ❑NE
❑NA ❑NE
EYes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly FreeboarV12
Waste Analysis ElSoil Analysis El Waste Transfers El Annual Certification
❑ ❑ ❑ Rainfall Stocking Crop Yield0 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ElYes LJ No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes E No • ❑ NA ❑ NE
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? (iel discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes �o ❑ NA ❑ NE
❑ Yes Co ❑ NA ❑ NE
❑ Yes Ll No ❑ NA ❑ NE
❑ Yes
❑ No
&NA
❑ NE
❑Yes
L1No
El NA
El NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
L/1 No
❑ NA
❑ NE
❑Yes
!JN
El NA
❑NE
El YesVN
El NA
❑ NE
El Yes
❑ NA
❑ NE
A.dditional_Comments: and/or Drawings.
H
Page 3 of 3 12128104

Type of Visit ,Coompliance Inspection 0 Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit V Routine 0 Complaint 0 Follow up O Referral Q Emergency 0 Other ❑ Denied Access
Date of Visit: 7 Arrival Time: 30 Departure Time: County: O/VSLoW Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Owner Email:
Phone:
Onsite Representative: 17AUt6 ± T« Sk C. -L.K - - - Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone No:
Operator Certification Number:
Back-up Certification Number:
Latitude: = o = 6 0 Longitude: = ° = t = l{
�Popuirae
Wet Poultry
Design C*urgentn
Capacity Population CattleIIIIIIIIIIIIIIIgavacilmoroulition
❑ Wean to Finish
1
IEJ Layer I
T
❑ Dairy Cow
❑ Wean to Feeder
❑Non -Layer
❑ Da Calf
® Feeder to Finish
? 46 6 wv�
El Dairy Heifer
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to FinishEl
Dry Poultry
El Layers
❑Non -La Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Pouets
JE1 Other
❑ Dry Cow
ElNon-Dairy
Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures:
❑ Gilts
❑ Boars
Other
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. Wbat 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 CrNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes [/"�No ❑ NA El NE
El Yes �QNo ❑ NA ❑ NE
12128104 Continued

Facility Number: (,1 — 2 Date of Inspection 3 '}
• Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes E�No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: LAGna/V I (A G116A! �-
Spillway?:
Designed Freeboard (in): `L* Zo
Observed Freeboard (in): a-! P_q
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 2(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 dNo ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
4. 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 1/J No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes [3 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?
❑ Yes
ENo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[2 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
o
❑ 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 recomtpendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
j.1.) (jp 0A'T� STa tX_XANj_ eta- (rc�EP 7CC—.G i1AThtX � L0 AT l Jt .
+
a.}i,) (�t�6fi-ArtE w�NY� 3o OA%h A..Jb (7IL— CaPY to OW W►
Reviewer/InspectorName kT614�J Phone: V_&&� 1g6 2.3'�e
Reviewer/Inspector Signature: Date: 3 `7167
Page 2of3 12128104 Continued

Facility Number: L7 — 'Z Date of Inspection
A
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps ❑ Other
❑ Yes [33/No ❑ NA ❑ NE
ElYes ETNo ❑ NA ❑ NE
21. Does record keeping need improvement? If yes, check the appropriate box below.
Yes
❑ No
❑ NA
❑ NE
❑ Waste ApVl-,,n'❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste
Transfers
❑ Annual Certification
❑ Rainfall king ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain
Inspections ❑
Weather
Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
El NA
El NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
,L�No
LI No
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
[ryes
❑ No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
E�Ko
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge? ❑ Yes Ll No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ❑ Yes [ No ❑ NA ❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes ❑Xo ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
Q 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�'No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
0-fgo
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
[7 No
❑ NA
❑ NE
Comments and/or Drawings:
Page 3 of 3 12128104

Type of Visit i, Compliance Inspection O operation Review O Structure Evaluation O Technical Assistance
Reason for Visit O Routine * Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: Ohm //Owl Arrival Time: �(�� Departure Time: � County: _WZ� Region:
Farm Name: t�� YyIm Owner Email:
Owner Name: Phone:
`� Mailing Address: f� �`yo
Physical Address:/�✓ `?• �_
Facility Contact: Title: Phone No
GL—(Jr� ] C.US integrator: Onsite Representative:
Certified Operator:'gh—!&e's GC.. 9:�2LLc1ZS Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: 0 0 = 4 =66 Longitude: = ° = 4 =
Ig
Design Gurrent _ Desrgn FE: Current Design Current
Capacity P
Swine Capacity Population. Wet Poultry , pulp Cattle Capacityt Population
- — r,.-_
❑ Wean to Finish ❑ La er` ❑ Dairy Cow
❑ an to Feeder ❑Non -La et I El Dairy Calf
Feeder to Finish
Y
..iru.T.:-' . �'. ram. iti,F:: � .� - "H's4'o
� .El Dairy Heifer
Dry Poultry - ❑ Dry Cow
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
❑ Layers
La [I Beef Stocker
❑ Non -Layers ❑ Beef Feeder
❑ Gilts
❑ Boars
❑ Pullets
Li Turke s ❑ Beef Brood C01,1
Other
❑ Turkey Poults
❑ Other
❑OtherI umber 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?
❑ Yes 21o ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
Mo
❑ NA ❑ NE
❑ Yes
M o
❑ NA
❑ NE
12128104 Continued

Facility Number:-7— 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?
El Yes 2 o ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
/� N
Observed Freeboard (in): _ L_ / r'J
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes B<o ❑ NA ❑ NE
(iel large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
�/
ElE 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?
& tr es ❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
&I'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 Wyes
,.,/
I " No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10, Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
B No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
[3
❑ 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).c,11 S
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
2<o
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes
E No
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[:] Yes
5'l<o
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes
21Vo
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ErYes
❑ 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):
Ti+ Or!�-e �ca4t— Ga b-e— A-15 .fi z� c[, 4JC f�Z c�dd L. ccGc,c -mac r
/ t�
Reviewer/Inspector Name / �. R� a� Phone: IyES S�C7�
Reviewer/Inspector Signature: ' Date: 46
12128104 Continued

Facility Number: — �, Date of inspection /
Required Records & Documents 19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes [INo 2 A ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ❑ No 2 A ❑ NE
the appropirate box.
❑ WUP ❑Checklists El Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No -PMA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ No RrNA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No Q'NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
QrNA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No
2<A
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
❑ No
OXA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
ELNA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
❑ No
ETA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
❑ No
ErNA
❑ 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
LEI IAA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
❑ No
2NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
❑ No
Q' qA
❑ NE
33.
Does facility require a follow-up visit by same agency?
O'Yes
❑ No
❑ NA
❑ NE
Additional Comments and/or Drawings:
/ Ott, '
C%%.,
'/ L
�����,s
12,28/04

t
Division of Water Quality
acility Number 6- —�-- O Division of Soil and Water Conservation
O Other Agency
Type of Visit pliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit Routine O Complaint 0 Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: ® Departure Time: County: 0&4Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: TErs� �Q:�L.a11is Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: a [::] ' =" Longitude:
Design ';.Current.
Design Current:':- Design
Current.
Swine y
!Capacity Population
' Wet Poultry
Capacity: Population Cattle Capacit} ,
Populatio0
❑ Layer
I,
❑ Non -Layer
Dry Poultry
r
f'
f
Other
-
❑ Other
h Number of Structures:,
❑ Wean to Finish
❑ Wean to Feeder
Feeder to Finish
v
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turke s
❑ Turke Poults
❑ Other
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ D Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Discharges &Stream Impacts
l . Is any discharge observed from any part of the operation?
❑Yes
�No
❑ NA
❑ NE
Discharge originated at: El Structure ❑Application Field El Other
a. Was the conveyance man-made?
El Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the,State? (If yes, notify DWQ)
(I Yes
❑ Na
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? ([f yes, notify DWQ)
❑yes
❑ No
❑ NA
❑ NE
2. is there evidence of a past discharge from any part of the operation?
El Yes
l�� No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
El Yes
L_'f`No
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12/28/04
Conhinued

Facility Number: — Date of Inspection
yt
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
Identifier: LA ( / A &-n#d -2-
❑ Yes [;4 ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
Spillway?:
Designed Freeboard (in): tA31
Observed Freeboard (in): �-� 9 V
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes U(No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.) /
6. Are there structures on -site which are not properly addressed and/or managed ElYes u1 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 Ef 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 EXio ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ETNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes El"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) G 0 f
13.
Soil type(s) 't1Vcrjj
M.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
ro
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yeso
WN
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
[20No
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
RI No
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
W.
❑ 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):
AL
wvp rTr<.., N rzew &emm"
s o,W rs X ✓
�ReGbss
CWaAA1:)W r DW(J
W1 A16W -cCu6L1 MAXKL Ks
IV660 6 b 04tv
-ro Pax x a7 )
Reviewer/Inspector Name F
Phone: 71b We- 724r
Reviewer/Inspector Signature:
Date: f
Page 2 of 3 r 12128104 Continued

r
acility Number: — Z, Date of Inspection
Required Records & Documents ,.,,/
19. Did the facility fail to have Certificate of Coverage & Permit readily available? El Yes G] No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check []'Yes ❑ No ❑ NA ❑ NE
the appropriate box. G3" ❑ Checklists ❑ Desig
n ❑Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. EJ Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking P"Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
[TNo
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
0 Yes
[E�No
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
IQ Yes
❑ No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
ElYes
O'No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
&No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
El Yes
,_ _,�
O No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
12No
❑ 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?
El Yes
�,/
E3 No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
9-No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
"o
'yWN
El NA
❑ NE
33. Does facility require a follow-up visit by same agency?
El Yes
o
❑ NA
❑ NE
Comments and/or Drawings:
Page 3 of 3 12128104

Type of Visit 0 Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit d Routine O Complaint O Follow up Q Referral O Emergency O Other ❑ Denied Access
Date of Visit: I q ,) Arrival Time: ® Departure Time: County: QAJSC ew Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: l Fkl-5A ioL.t. M5'
Certified Operator:._T-'"SA _(ALA-LT3 S
Back-up Operator:
Location of Farm:
Swine
Title:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: 0 0 =1 = Longitude: = ° =1 ❑ «
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
❑ Non -Layer
❑ Wean to Finish
❑ Wean to Feeder
® Feeder to Finish
O O
1 75700
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Pouets
❑ Other
Discharges & Stream Impacts
I. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifei
75ry Cow
❑ Non -Dairy
❑ Beef Stocket
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures: F-1
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 L/ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
d
VNo
❑ NA
❑ NE
❑ Yes
❑ NA
Cl NE
12128104 Continued

Facility Number: b1 — z
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier: LA1WIJ I tob*0--J 2_
Spillway?:
Designed Freeboard (in): 1-0 Zo
Observed Freeboard (in): a,a-
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes E No ❑ NA ❑ NE
❑Yes ❑No El NA El NE
Structure 5 Structure 6
❑ Yes RfNo ❑ NA ❑ NE
❑ Yes VNo ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes E o El NA El NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes Two ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes M/No ❑ NA ❑ NE
maintenance or improvement?
Waste ADDlieation
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [/No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 0 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) C, 0 S
13. Soil type(s) �4�SAyS
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes ONo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes E) <o ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination',[] Yes E14D ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes WX
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? El Yes ❑ NA ❑ NE
t,1 Up OCC 0s t.. ID"I . W3 L3 PULLA W10 _MC;r it") (c0 1AX #'x GAYio,J J 0 PAID P"%_ IAJ aaT
a t.� j ra� n.Mu�Ta,A N.se_ .-a-
_T�ftj_,-Tj-AL. froR— It-0 MX-I'J SPGGTj�.
"f.P COPq of St,JoGC SU"Cf ? AtJo CA., xBQ-Altt J
�tjp-MARW7ETM s A�� J
Reviewer/Inspector Name ��o a 4 f qQ-y L Phone: xb3
Reviewer/Inspector Signature: (- �U11a ,GAF M A,,(1) Date:
12128104 Continued

Facility Number: 6 - a Date of Inspection
Re wired Records & Documents /
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check Yyes ❑ No ❑ NA ❑ NE
the appropriate box.
WUP El Checklists ❑Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ❑ NE
❑ Waste Application El Weekly Freeboard El Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ f Rainfall Stocking 3 Crop Yield ff 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes 2No ❑ 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?
❑ YesEl
YVt,
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
ElNA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
ElYeso
7dT'o
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
dNo
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
D 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
[:140
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
ZNo
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
❑ 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
dNA
El NA
❑ NE
33. Does facility require a follow-up visit by same agency?
El Yes
Wo
❑ NA
❑ NE
Additional Comments and/or Drawings:
12128104

of wA rF
O� QG
0 �
CERTIFIED MAIL
RETURN RECEIPT REQUESTED
David Collins
394 Deppe Rd
Maysville, NC 28555
Michael F. Fasley, Governor
WilliamG. Ross Jr., Secretary
North Carolina Department of Environment and Natural Resources
September 2, 2005
RE: Sludge Management Plan of Action
Collins Farms
Facility`#` 673t
Onslow County
Dear David Collins:
Alan W. Klimek, P.E. Director
Division of Water Quality
RIEIEIV D
SEP 0 9 /-UU!)
BY:
The Division of Water Quality (DWQ) received your sludge survey information on July 1, 2005.
Upon review of the information submitted, it was determined that the minimum treatment depth of the
Lagoon #1 is inadequate. Your NPDES General Permit Number NCA267002, Condition IV.16 specifies
that within 90 days, a plan of action must be created to document the sludge management procedures to
be used. DWQ has not received an adequate plan of action for this facility.
Attached is the Plan of Action for Lagoon Sludge Reduction form that is to be used. The form
outlines the compliance and reporting timeframes to satisfy Condition IV.16 of your NPDES General
Permit.
Please submit the plan of action within 30 days of receipt of this letter to:
Keith Larick
Division of Water Quality
1636 Mail Service Center
Raleigh, NC 27699-1636
Thank you for your attention to this matter. If you have any questions, please call me at (919)
715-6185, or the Wilmington Regional Office at [phone].
Sincerely,
Keith Larick
Animal Feeding Operations Unit
cc: File# 67-2
Wilmington Regional Office
qhCarolina.
71
Wilrally
North Carolina Division of Water Quality 1636 Mail Service Center Raleigh, NC 27699-1636 Phone [phone] Customer Service
Internet: h2o.ennstate.nc.us 2728 Capital Blvd. Raleigh, NC 27604 FAX [phone]
An Equal OpportunitylAffirmative Action Employer— 50% Regcledl10% Post Consumer Paper

Type of Visit /" Compliance Inspection O Operation Review O Lagoon Evaluation
Reason forVisit P Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number late of Visit: Time:
O Not O erational O Below Threshold
Permitted [3 Ce ed 0 Conditionally Certified 0 Registered Date Last Operated or Above Threshold: .-
Farm Name: ...... I1GGiJ....mS ......-- �......_ ......... County: iJ[OGtJ.... ..................._ ..._...._.
OwnerName:...... .._. ........................... Phone No: .... ......... __ . .................................. ..................
_Vlading Address: .. _.._ ._._...........
Facilitv Contact: _............ •-----... - -- Tide: ... ....................... hone No: ..._............................ -----,..
Onsite Representative: ,, ; (f Z�J _1,f �,E 1 (.rQ.,l`rG Z�` Integrator:..,,���. fit-' � f lrP ��CQ
Certified Operator:..,,.,,.,,. _....... ..._ .. � � ... �_�.�----- W Operator Certification Number:
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Harse Latitude • 9 4;4 Longitude 4 cc
z ,Design' Curi�eit Design Current ~ `� Design
Current
Swine '.:.. Ca 'act Po ulationo_ Cattle Ca act
illation ,
„r.. ,., _`. Ca tw
..1Po'iulation ,.-iPaultry _ W
;.�sPo
Wean to Feeder
❑ Layer ❑Dairy
=
=- Feeder to Finish p
Q r>' ❑Non -Layers ❑Non -Dairy
a-
, Farrow to Wean
s_ Y
€ r
El Farrow to Feeder
Other r
Farrow to Finish
y
Taal Desl�gn CapSGt
u'
Gilts
f , €
rs
JEI Boars
g
Ury(`�■rr■ yW�)
�f /Y■r�
t 1 ".�.i14i�iJ/i "
G
i Number of Lagoons
�-
? A77
. x- :
§ Y ad
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 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 ONO
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes 5No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes 2f No
Structure I StjUcture 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier
r Freeboard (inches):
12112103 Continued

Facility Number: — Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes ONO
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑ Yes No
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenancelimprovement? lZrYes ❑ No
8. Does any part of the waste management system other than waste structures require maintenance improvement? ❑ Yes V1 No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes 10 No
elevation markings?
Waste Application
10- Are there any buffers that need maintenance/improvement? ❑ Yes VNo
I I. Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes ZNo
❑ Excessive Popi3ing ❑ PAN 0 Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type ( -ZY74J /,(JA 4 -> .` )c/S
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes E? Ro
14. a) Does the facility lack adequate acreage for land application? ❑ Yes JZ&o
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 ONO
16. Is there a lack of adequate waste application equipment? ❑ Yes eNo
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge attar below ❑ Yes ONO
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes 'VNo
19. is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes PrNo
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 1!fNa
Air Quality representative immediately.
;Comrrients (refer to,questiop #) Explarn any YFS answers and/or arryrecomxnr.�atioas or any othee comments.
_...
_Use drawr�s'af facd%ty to Better ezplaui situa�ons. (useddrtranal ages as rnecessary7s ❑Field Cop Y ❑Final Notes
_W
r� 7,Ef &5 os,E T Dz�-,� ��c L�in�rr�p W�
A,
�
/IP /�4y PR45�i� 7- 14�GrrG�2f 7`��o B�EL aiY
�,8 70,- 45=
-- SOMF �Qi4E}Zti1�G� �zP� 5
)07 �Fy ,Df,(>Q r�f ��'1f -�J c y� 7%z/�jl
N y/nz, , D
..y .:
Reviewer/Inspector Name � • /fyG �; ,.: .,_: � �:a. ,���A:�.� :�....�.: ; � ��-�;,.�_� �=:`
ReviewerAkmpector Signature: Date: Q
12112103 Continued

e
Facility Number: 6 7— g Date of Inspection
Required Records & Document-4
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes Z No
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WLT, checklists, design, maps, etc.) ❑ Yes VNa
23. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [;�No
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes A No
25. Did the facility fail to have a actively certified operator in charge?
❑ Yes
P(No
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
Yes
&No
(ie/ discharge, freeboard problems, over application)
❑
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
LdNo
28. Does facility require a follow-up visit by same agency?
❑ Yes
[ZNo
29_ Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
ZNo
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
,91 Yes
❑ No
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
P(No
32. Did the facility fail to install and maintain a rain gauge?
❑ Yes
2�No
33. Did the facility fail to conduct an annual sludge survey?
❑ Yes
❑ No
34. Did the facility fail to calibrate waste application equipment? ❑ Yes ,2�No
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below. Zr Yes ❑ No
AStocking Form ❑ Crop Yield Form ❑ Rainfall fl Inspection After 1" Rain
g 120 Minute Inspections 0 Annual Certification Form
0 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
�ti0n ornrttents°an o!e 5 wtng
_ _.
m
46
2(p)
20 X;V
7
�_A,2 �51-v-em. E&6� )-7
2q) Copo Oo-r bz��5-e-Fo :Z-rj C-6-`L3f'�P
nn V'6-1qg'
`n �' R D -rprYE C1 R r, �i✓��.D (fi x r
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� Q r
;E;) A-R--7,tJ
l�
14nif�UA�- ��R`7ZF?C�Jzv�J �Rrn+ .
12112103 1w Q)o 2 K `b C-£ 7 7c, Div K� Swop /Jit�O L,� d�GS„

M
Type of Visit Q�,Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit O Routine O Complaint O Follow up O Emergency Notification Other ❑ Denied Access
Facility Number Date of Visit: Time:
rO Not Operational 0 Below Threshold
Permitted U Certified 0 Conditionally Certified 0 Registered Date Last Operated or I
ove Threshold:
Farm Name: �1\\�S W County:
Owner Name:
Mailing Address:
Phone No:
Facility Contact: Title: Ph,
a No:
Onsite Representative: Integrator: Uil
Certified Operator:
Location of Farm:
Operator Certification Number:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude �� �6 Du Longitude ' 4
Design
Swine Ca aci
Current Design
l?o uiat*on: Poultry . Ca acity
Current Design
P,o ulation Cattle - Ca aci
Current
P,o uiation
❑ Wean to Feeder
1EILayer
ILI Non -Layer
1
JE1 Dairy
❑ Feeder to Finish
I
10 Non-DaiEy
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Other
Total Design Capacity
Total SSLW
❑ Gilts
1110 Boars
Number of Lagoons ❑ Subsurface Drains Present ❑ Lagoon Area ❑ S ra Field Area
Holding Pgnds / Solid Traps ❑ No Li uid Waste Mana ement S stem
Discharges & Stream Impacts
1. is any discharge observed from any part of the operation? ❑ Yes ❑ No
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 ❑ 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 ❑ No
Structure I Structure 2 Structure 3 Structure 4 Structure S Structure b
Identifier:
Freeboard (inches): o`S
05103101 Confinued

Facility Number: — Date of Inspection 0
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 ves, 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?
11'aste Anulication
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN (I Hydraulic Overload
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CA' 4'MP)?
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 or other 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?
❑ 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 ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
�© No violations or deficiencies_were noted during this visit. You will receive no further correspondence about this visit-
GommeSts;(refer to gnes6on #j..F any- answers_and/ot:anymommendadons or a� outer eotunteats-
I se dra ags of faciltty to better eipla3n situation adldtt<onat pages as ecescary) ❑ Field Copy El Final Notes Y
Reviewer/Inspector Name -
Reviewer/Inspector Signature: Date:
05103101 Continued

i Type of Visit to
Compliance Inspection 0 Operation Review 0 Lagoon Evaluation
IReason for Visit0 Routine 0 Complaint 0 Follow up 0 Emergency Notification 0 Other ❑ Denied Access
Facility Number Date of Visit:
Permitted 0 Certified © Conditionally Certified [3 Registered
Farm Name: DG G'� S
Owner Name: �%2WQ S
Mailing Address:
Time:
Date Last Operated or Above Threshold: _
County: �O�SGa[t /
Phone No:
Facility Contact: Title: Phone No:
Onsite Representative:� ��� l�G��s Integrator:
Certified Operator:
Location of Farm:
Operator Certification Number:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' 6 Du Longitude o 4 Du
ine
Design; Currenlil t. �. DesignCurrent DesignillilliCurrent
Ca aci IIItion Poultry Ca aci P,o ulation Cattle C►a aci Ro ulatian
Wean to Feeder
❑ La er
❑ Dairy
Feeder to Finish
❑ Non-Laye ❑ Non -Dairy
❑ Other
=Total Desin CaGiltsBoars Total SSLW
Farrow to Wean
Farrow to Feeder
rEl
Farrow to Finish
Number of Lagoons ❑ Subsurface Drains Present JD La oon Area
Holding Ponds /Solid Trapsj ILI No Liquid Waste Management System
10 Spray Field Area
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 I Structure 2 Structure 3 Structure 4 Structure 5
Identifier: L 1 ,L Z
Freeboard (inches):
❑ Yes XNo
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes PNo
❑ Yes ❑ No
❑ Yes X"No
Structure 6
05103101 Continued

., r'L
Facility Number: TP77Z 2 Date of inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes XNO
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes Na
(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 maintenancelimprovement? ❑ Yes P"No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes PrNO
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes �NO`
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes �No
11. Is there evident jof over application El Excessive Ponding ❑ PAN ❑ Hydraulic Overload El Yes XNo
12. Crop type l'iO,ed 1,l/hKA-r-. L 14gfiig,
13.
Do the receiving crops differ with those defignated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
0 No
14.
a) Does the facility lack adequate acreage for land application?
❑ Yes
9No
b) Does the facility need a wettable acre determination?
❑ Yes
ONO
c) This facility is pended for a wettable acre determination?
❑ Yes
No
15.
Does the receiving crop need improvement?
❑ Yes
No
16.
Is there a lack of adequate waste application equipment?
❑ Yes
FfNo
Required Records &_Documents
17.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
X121No
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
R�No
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
No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
eNo
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
El Yes
VNo
24.
Does facility require a follow-up visit by same agency?
❑ Yes
�No
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
)2TNo
0 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Comments (refer to quesh€in #) Explain any YES tnswers=,and/organy recommendahons or, any,other comments,
�� se � r ..
Use,drawuigs ofEfaciLty to}bb6tter eeijplam situations.{useeeadditibiial pagesiras7neeeisary) Field Copy ❑Final Notes
`,. .'SN .: "'.. SAS a �'..: ,✓+,., .`x"sV'>RG_ .. - VM
DI & gIP02,L z".00la�— Z
1j
Reviewer/Inspector Namei'�%I
Reviewer/Inspector Signature: Date: p 2
05103101 Continued

•:: . ..�-4-
Facility Number: — 2 Date of Inspection
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge atior 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 drill during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon?
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.)
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?
Additional Comments and/or Drawings:
❑ Yes ❑ No
❑ Yes No
❑ Yes FAO
❑ Ye s/ 2/No
❑ Yes Ao
o
El Yes
El Yes�No
O5103101

Facility Number Date of Visit: Time: E = Prinied on: 10126/2000
Q Not O erational Q Below Threshold
Permitted 13 Certified [3 Conditionally Certified 13 Registered Date Last Operated or Above Threshold
Farm Name: U�S�S.. �}'.!' ..................... County: ....... G! �a....................................................
Owner Name:
Facility Contact:
Phone No:
.............................................................. . Title: ................................................................ Phone No:...................................................
Mailing Address: ......................... .........................
Onsite Representative: _0u" L-je .......
Certified Operator: ................................................... .......
Location of Farm:
................................................
...................
Integrator:..... `.:ice`..... ....................................
Operator Certification Number:... ...............
r•
[]Swine []Poultry []Cattle [:]Horse Latitude ' 4 �6 Longitude • 4 46
Design Current
owu,c l;a aci
❑ Wean to Feeder
Feeder to Finish (/zt0
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Design Current Design Current
Poultry Capacity Population Cattle Capacity Population
❑ Layer I Dairy
❑ Non -Layer I Non -Dairy
❑ Other I 1
Total Design Capacity
Total SSLW
Number of Lagoons J❑ Subsurface Drains Present ❑ Lagaon Area 10 Spray Field Area
Holding Ponds / Solid Traps ❑ No Liquid Waste :Management System
Discharges & Stream Impacts
I. Is any discharge observed from any part of the operation? ❑ Yes kNo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. if discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
h. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) El Yes ❑ No
c. II' disehargc 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 b�No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes 5�No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes "No
Structure t Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identificr:........................................................................................................................................................
Freeboard (inches): -DAC
5100 Continued on back

Facility Number: 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 brNo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes W No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
T Do any of the structures need maintenance/improvement?
❑ Yes
A No
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
%No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
0No
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes
9No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
❑ Yes
allo
12. Crop type C.l t 1 SG q
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
NfNo
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
�(No
b) Does the facility need a wettable acre determination?
❑ Yes
WNo
c) This facility is pended for a wettable acre determination?
%Yes
❑ No
15. Does the receiving crop need improvement?
❑ Yes
P(No
16. is there a lack of adequate waste application equipment?
❑ Yes
Klo
Required Records & Documents
17, Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
kNo
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
❑ Yes
- (ie/ WUP, checklists, design, maps, etc.)
JZNo
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
XNo
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
ONo
21. Did the facility fail to have a actively certified operator in charge?
❑ Yes
)d No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes
%No
(ie/ discharge, freeboard problems, over application)
23. Did Reviewerhnspector fail to discuss review/inspection with on -site representative'?
❑ Yes
A No
24. Does facility require a follow-up visit by same agency?
❑ Yes
'ONo
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
10 No
0: �Cio •violations or def ciencies -were pot£(• d(rritig this:visit: • Yoir will -t�, eegive iio #'urther
corresporideirce. ado k this visit. • . • .. . ...... .
G►mmei is (refer to question #): Explain any -YES answers and/or any recomtitendations or,anv other; comnnents > ,
Use drawings of facility to"better explain situations (use addttio.".j ages as necessary.)
I\-
�t—CC� f krr- 1{. I�'��dGti�� ��•s� �� �2>=�.� h—c�y �CQL
PAO r�-R-R-a

'[Facility Number: — a Date of Inspection O Printed on: 10/26/2000
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 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 VNo
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes ,OF( No
ti
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ,8�No
Additional omments-and/orDrawings:
A,
��� -�- I���•-,� -� '�1�� ��-�.-yes,
�i
r
5100

Division of Water Quality
0 Division of Soil and Water Conservation
0 Other Agency ,
Type of Visit 9\Gompliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit KRoutine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Date of visit; rrTg. o ri
Facility Number me: ® Printed on: 7/21/2000
0 Not Operational 0 Below Threshold
VPermitted [3 Certified P Conditi Nally Certified 0 Registered Date Last Operated or A ove Threshold: ..............
` ���
FarmName: ..... ............ `........1........................................................ County:............................... ..................-.............................
Owner Name: ..... Phone No:
...............................
FacilityContact: ..............................................................................'Title.......................
Phone No:
MailingAddress: .....................................................................................................................
Onsite Representative:.- Integrator:.....
Certified Operator .................................................... ...... Operator Certification Number :...............
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude C • ° .1 Longitude ' 44
Design Current Design Current Design Current
Swine Ca aci Population Poultry Capacity Population Cattle Capacity Population
❑ Wean to Feeder ❑ Layer ❑ Dairy
Feeder to Finish G O ❑ Non -Layer 1 10 Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder ❑ Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ Boars Total SSLW
Number of Lagoons ❑ Subsurface Drains Present 1JE3 Lagoon Area 10 Spray Field Area
Holding Ponds / Solid Traps ❑ No Liquid Waste Management System
Discharges & Stream Impac S
1. Is any discharge observed from any part of the operation?
❑ Yes
$KNo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance inan-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. Dees 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
NINo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
❑ Yes
kNo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
❑ Yes
N No
Structure I Structure; 2 Structure 3 Structure 4 Structure 5
Structure 6
Identifiier.................................................... ................................... .................................... .....-............................................-.....................
Frechoard(inches):
5/00
Continued
on hack

acilit3;Number: - 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 WNo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes VNo
(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 �KNo
S. Does any part of the waste management system other than waste structures require maintenancelimprovement? ❑ Yes JKNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings'? ❑ Yes �<No
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes I�No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes &No
t2. Crop type r__1 W k sGly
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? El Yes PTNo
14.
a) Does the facility lack adequate acreage for land application?
❑ Yes
INo
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
MNo
16.
Is there a lack of adequate waste application equipment?
❑ Yes
VNo
Required Records & Documents
17.
Fail to have Certificate of Coverage & General Permit readily available?
ElYes
VNo
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
DrNo
19.
Does record keeping need improvement'? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
'oYes
❑ No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
No
21.
Did the facility fail to have a actively certified operator in charge?
)'Yes
JWNo*N)�,-
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes (NVo
23_ Did Reviewer/inspector fail to discuss review/inspection with on -site representative? ❑ Yes �_d No
24. Does facility require a follow-up visit by same agency? ❑ Yes KNo
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes NNo
No-yiolatioris;or &ficieundi 5 were noted• d&kid �tbis:visit-' • Y6ir will -receive rio fukth&
: cories oridence. about this 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): 1
�� �-�� s� �--•� 1� l'"` r�,c� i"-4 '�` 4x, 6�'�. ��1�.t--`-lam"�� �
XL
psi
FRe
viewer/Inspector Name DO 5100Q—Date: �3eviewerllnspector Signature: �{� �'

.1 Facility Number:G2 Date of Inspection EVERNM 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 at/or hglow
,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? `
Cl 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
N0
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
No
31.
Do the animals feed storage bins fail to have appropriate cover?
❑ Yes
' 4�'N0
32.
Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes
4110
Additional omments an or raven s:
1,
e---V,
I-+k �G y- -
� s�
SI ~� `
5/00

Revised April 20, 1999
JUSTIFICATION & DOCUMENTATION FOR MANDATORY WA DETERMINATION
Facility Number . -a
Farm Name: VZA
On -Site Representative: d [
Inspector/Reviewer's Name: L - 1e
Date of site visit: (-.)v lc cc 1
Date of most recent WUP:
Annual farm PAN deficit: 1010 pounds
Operation is flagged for a wettable
acre determination due to failure of
Part 11 eligibility item(s) F1 F2 F3 F4
Operation not required to secure WA
determination at this time based on
exemption E1 E2 E3 E4
V Operation pended for wettable acre
determination based on P1 (!p P3
f
Irrigation Systems) - circle #'hard -hose traveler, 2. center:pivot system; 3. linear -move system;
4. stationary sprinkler system w/permanent pipe; 5. stationary sprinkler system w/portable pipe,
6. stationary gun system w/permanent pipe; 7. stationary gun system w/portable pipe
PART 1. WA Determination Exemptions (Eligibility failure, Parr 11, overrides Part I exemption.)
E1 Adequate irrigation design, including map depicting wettable acres, is complete
and signed by an I or PE.
E2 Adequate D, and D�D3 irrigation operating parameter sheets, including map
depicting wettable acres, is complete and signed. by an I or PE.
E3 Adequate D, irrigation operating parameter sheet, including map depicting
wettable acres, is complete and signed by a WUP.
E4 75% rule exemption as verified in Part Ill. (NOTE:75 % exemption cannot be
applied to farms that fail the eligibility checklist in Part II. Complete eligibility
checklist, Part 11 - F1 F2 F3, before completing computational table in Part lil).
PART 11. 75% Rule. Eligibility Checklist and Documentation of WA Determination
Requirements. WA Determination .required because operation fails one of the eligibility --
requirements listedhelow:
F1 Lack ofacreagewhichTesuitedin7overmpplicationmf3wastewater_(PAN) on-spray-
field(s) iaccording-tolarm'sdasttwo years:Df imc ation7ecords.-.
F2 Unclear, -illegible, -or lack of information/ma?.
F3 Obvious -field limitations -(numerous itches,dailure1o:deductTequired-...
buff'er/setbackmcreage;-or25°/"-.of#otal-acreageidentifiedW-CAWMP::includes
small ;-irregUl2dy-shaped.fields = fields.lessthan-5 acres-for.travelers-or less -than
2 acresfor stationary -sprinklers).
F4 WA determination required because CAWMP credits field(s)'s acreage in excess
of 75% of the respective field's total acreage as noted in table in Part Ill_

Revised April 20, 1999
Facility Number -
Part III. Field by Field Determination of 75% Exemption Rule for WA Determination
TRACT
FIELD
TYPE OF
TOTAL
CAWMP
FIELD
COMMENTS3
NUMBER
NUMBER'-2
IRRIGATION
ACRES
ACRES
%
SYSTEM
air o 57.5 4 `Y,5
'J 39.`f 7a gLa
5 S vv,5 a�.s 62.a
J
FIELD NUMS-tz' - hydrant, pull, zone, or.point numbers may be used in place of field numbers depending on CAWMP
and type of irrigation system. - If pulls, etc. cross morethan one field, inspector/reviewer will have to combine fields to
calculate 75% field by field determination for exemption; -otherwise operation will be subject to WA determination.
FIELD NUMBER2 - must be clearly delineated on map.
COMMENTS'- back-up fields with CAWMP acreage_exceeding475% of its total.acresand having -received less than 50%
of its annual PAN as documented in the farm's previoustwo years' (1997 & 1998) of irrigationTecords,-cannot serve -as -the
sole basis for requiring a WA Determination.�ack-up fieldsTnust benoted in the -comment sectionand must be accessible
by irrigation system.
Part IV. Pending WA Determinations -
P1 Plan .1acks.fo11owing -information:
./ P2 Plan revision may:satisfy75% rule based on adequate overall PAN deficit -and by
adjusting all field acreage�o below 75% use rate
f
P3 Other (ieCn process of installing new irrigation system):

Lagoon Dike Inspection Report
Name of Farm / Facility David Collins (Collins Farm Inch 67 - 02
Location of Farm / Facility _SR 1436 Pond # i
Owner's Name, Address
and Telephone Number
Date of inspection
Structural Height, Feet
Lagoon Surface Area, Sq. Ft.
Upstream Slope, aH:1 V
Embankment Sliding?
( Check One, Describe if Yes)
Seepage?
( Check One, Describe if Yes )
Erosion?
( Check One, Describe if Yes )
Condition of
Vegetative Cover
( Grass, Trees )
Did Dike Overtop?
David Collins, 129 Co11i&Lane,
Maysville. NC 28555 252-743-3931
9 / 28/ 99 Names of Inspectors Zahid Khan
Vincent Lewis
4-6 Freeboard, Feet _ 24 Inches
87 5500 Top Width, Feet 5-6
2 to l Downstream Slope, x.H:1v 4to 1
Yes X No
Yes �X No
Yes X No
good grass cover_ _
Yes X No
Follow -Up Inspection Needed? Yes X No
Engineering Study Needed? Yes X No
Is Dam Jurisdictional to the Dam Safety Law of 1967?
Other Comments
If Yes, Depth of
Overtopping, Feet
Yes X No
a

a
Lagoon Dike Inspection Report
Name of Farm 1 Facility David Collins -(C
,911ins Farm Inc.)67 - 02
Location of Farm / Facility R 1436 Pond # 2
Owner's Name, Address David,Collins, 129_Collins Lane_
and Telephone Number Matisville, NC 28555 252-743-3931
Date of Inspection „ 2 / 28/ 99 Names of Inspectors Zahid Kin
Mincent Luds
Structural Height, Feet 6-8 Freeboard, Feet 1212 Inch
Lagoon Surface Area, Sq. Ft. 31 250 Top Width, Feet 5 - b
Upstream Slope, aH:1 V
Embankment Sliding?
( Check One, Describe if Yes )
Seepage?
( Check One, Describe if Yes }
Erosion?
( Check One, Describe if Yes )
Condition of
Vegetative Cover
( Grass, Trees )
Did Dike Overtop?
2 to 1 Downstream Slope, aH:1v 3 to 1
Yes X No
Yes �X No
Yes X No
good grass cover
Yes X No If Yes, Depth of
Overtopping, Feet
Follow -Up Inspection Needed? Yes X No
Engineering Study Needed? Yes _ X No
Is Dam Jurisdictional to the Dam Safety Law of 1967? Yes X No
Other Comments Needs to R.U= out

Division of Soil and'_Wa#er.-Conservati&i - Operation -Re iw '
Division of Soil and Water.Conservatlon Y- ComplianceJAS ection
12 Division of Water Quahty Compliance Inspection 7 fl
Other Agency- Opere6on`lteytew,,; ks
W Routine 0 Complaint 0 Follow-up of DWQ inspection 0 Follow-up of DSWC review 0 Other
Facility Number
Permitted [3 Certified[ J3 Conditionally Certified © Registered
Farm Name: ....................................
OwnerName:.... `ll. �.. dl l ...............................................................
Facility Contact: .... ......................................
Flailing Address: ...........................................
Onsite Representative:
Certified Operator: ...................................
Location of Farm:
Date of Inspection
Time of inspection Q 24 hr. (hh:mm)
Not Operational I Date Last Operated:
County:
PhoneNo: ............................................ _
Title: ................. .............................................. Phone No:.........................
................................................................ ..........................
..... Integrator: ....}..........................................................
Operator Certification Number:
ar
..........................................................................................................................................................................................................................................................................
Latitude �� �� �•� Longitude �• �� �«
Design Current =-= `.,.;, Design Current : ` Design Current
Swine Capacity Po ulataon _ Poultry `_ C acity Population .. Cattle Capacity Population
❑ Wean to Feeder ❑ Layer ❑ Dairy
Feeder to Finish G O ❑ Non -Layer ❑Non -Dairy
❑ Farrow to Wean -
❑ Farrow to Feeder ❑Other
2 ❑ Farrow to Finish Total Design C apacity 4
❑ Gilts,
❑Boars � �'�
..Total SSLW .
-Number of Lagoons. JE1 Subsurface Drains Present ❑ Lagoon Area JE1 Spray Field Area
Holding Ponds / Solid Traps r ❑ No Liquid Waste Management System
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 gallmin?
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
Identifier: jjaa
Freeboard (inches): ...............7....L
❑ Yes kNo
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes No
❑ Yes ( No
❑ Yes &NO
Structure 2 Structure 3 SLruCture 4 Structure 5 Structure 6
- ?..................................................................................... ........
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
3/23/99
❑ Yes RNo
Continued on back

Facility Number: — ;5 Date of inspection
b. 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 maintenarice/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN
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?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
0: Nd- iolatidtis:oi deficiencies were noted• during This:visit: • :Y:oi} wiil-reeeiiye iio further • '
corres pride ... a'houf this visit ...
1c,o tkecj
rct
C �P
Ar-
_Tk\V--5-s L�L
J 5
❑ Yes gNo
❑ Yes N No
❑ Yes [�(No
❑ Yes KNo
❑ Yes No
❑ Yes CWNo
—I
❑ Yes gNo
❑ Yes VNo
❑ Yes ❑ No
U' Yes ❑ No
❑ Yes "No
❑ Yes ((No
❑ Yes tg(No
❑ Yes ZNo
,Yes ❑ No
❑ Yes Ci 'No
❑ Yes M No
[]Yes too
❑ Yes JgNo
❑ Yes �SfNo
❑ Yes 9 No
L
3/23/99

,_I Facj ity Number: / — 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
liquid level of lagoon or storage pond with no agitation?
'R"No
27.
Are there any dead animals not disposed of properly within 24 hours?
❑ Yes
*0
28.
Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
5(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
KNo
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
No
31.
Do the animals feed storage bins fail to have appropriate cover?
❑ Yes
D�No
32.
Do the flush tanks lack a submerged fill pipe or a.permanent/temporary cover?
❑ Yes
XNo
itional _ omnien&s an or raivings:, =
_ -,- _ _.
3/23/99

Ion,,
❑ Division of Soil and Water Conservation [3 Other Agency
'Division of Water Quality
1O_Routine O-Complaint O Follow-up of DW9 inspection O Follow-up of DSWC review O Other �
rr nrrru
Date of Inspection ?�{
Facility Number
Time of Inspection ' 24 hr. (hh:mm)
Registered © Certified 13 Applied for
/Permit [3 Permitted r] Not O erational Date Last Operated:
Farm Name: . r f} !'.7 l.......................-�7. E� 0..................................... County:........)'?.. .
Owner Name:...... .......... Phone No, ..... ...r...
Facility Contact: Title: ,... Phone No:
Mailing Address: 3 &�....... AV .... +_.fl.46 r'02 .V4! _ . ....... Z .��.....
Onsite Representative_;_4. ................. Integrator:„., ..........
Certified Operator:............r
.{..................................� ... Operator Certification Number:.....................
Location of Farm:
C
C
Latitude • Q6 " Longitude ' ' "
Design Current Design . Current
C40 city :Population Poultry ''Capacity; Population` Cattle
❑ Wean to Feeder
14 Feeder to Finish
7P460
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
General
1. Are there any buffers that need maintenance/improvement? ❑ Yes Q No
2. Is any discharge observed from any part of the operation? ❑ Yes V,No
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 Surface Water? (If yes, notify DWQ) ❑ Yes Q No
c. If discharge is observed, what is the estimated flow in gallmin?
d. Does discharge bypass a lagoon system'? (If yes, notify DWQ) ❑ Yes H No
3. Is there evidence of past discharge from any part of the operation? ❑ Yes ® 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 JaYes ❑ No
mai ntenancelimprovement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes No
7. Did the facility fail to have a certified operator in responsible charge? ❑ Yes No
7/25/97
M.

Facilty Number: foI - Tj
I �n compliance with any applicable setbac c - feet at the •
❑ Yes
❑ No
e facility fail to have a certified o
❑ Yes
❑ No
8. Are there lagoons or storage ponds on site which need to be properly closed?
❑ Yes
W No
Structures (Lagoons and/or Holding Ponds)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
JO Yes
❑ No .
Freeboard (ft): Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Structure 6
// r s ...................................... ...........................................................................
.......................................
10, Is seepage observed from any of the structures?
❑ Yes
;4No
1. Is erosion, or any other threats to the integrity of any of the structures observed?
Yes
Wo
12. Do any of the structures need maintenance/improvement?
prYes
❑ No
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public bealth'or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
❑ Yes
VNo
Waste Application
14. Is there physical evidence of over application?
❑ Yes
M-No
(If in excess of WMP, r runoff entering waters of the State, notify DWQ)
15. Crop type ............. r........ .............................. ...................................................................................................................... ...........................
..............-.................
16, Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
❑ Yes
54No
17. Does the facility have a lack of adequate acreage for land application?
❑ Yes
9No
18. Does the receiving crop need improvement?
Yes
❑ No
19. Is there a tack of available waste application equipment?
❑ Yes
® No
20. Does facility require a follow-up visit by same agency?
Yes
0 No
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
Jallo
For Certified Facilities Only
22. Does the facility fail to have a copy of the Animal Waste Management Plan readily available? ❑ Yes $No
23. Were any additional problems noted which cause noncompliance of the Certified AWMP? D4 Yes ❑ No
24. Does record keeping need improvement? Awes A
rr 5v wP�•ajar, ./� y�, �.v 9 A —
(.,a Cis t
�Z• 5'•r�Y•-� ih<�� �j �� d� �� � �j � iJ<� a.-�.�/�•- �./f i4s ,gfy�mp���
W4 s
Reviewer/Inspector Name
Reviewer/Inspector Signature:
cc: Division of Water Qualify, Water Quality Section, Facility Assessment Unit
Date: 0/2 9
4/30/97

A-
ODSWC-.-7Anima l'Feedlot Operation Re i6 - . ....
Routine 0 Complaint 0 Follow-up of DWQ inspection Q Follow-up of DSWC review 0 Other
Date of Inspection
Facility Number
Time of Inspection E�=--Use 24 hr. time
Farm Status: Total Time (in hours) Spent onReview
or Inspection (includes travel and processing)
C
Farm NamCounty e:
Owner Name: —�geo IQ A-) Phone No: .._----
Mailing Address: 111Z) Z,
V
Onsite Representative: =-jg19- Integrator: —A.294o�lklcE
Certified Operator:
Location of Farm:
Operator Certification Number:
Latitude Longitude
❑ Not Oper2donal Date Last Operated:
-pe of Operation and Design Capacity
Fy, umber�i-
C a
El Wean to Feeder
Layer
❑ Dairy
(Feeder to Finish
IQ Non -Laver
FEI Beef I
f.
[I Farrow to Wean
[I Farrow to Feeder
Farrow to Finish
D Other Type of Livestock
General
1. Are there any bu
ers that need maintenance/improvement?
ID Subsurface' Drains Present
JEI La-oon ��Xa 2ii�, 10 Spray Fiel =Area
ff
2. Is any discharge observed from any part of the operation?
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Surface Water? (If yes, notif
DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (if yes, notif
DWQ)
y
y
1. Is there evidence of past discharge from any part of -the operation?
4. Was 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
maintenanceimprovernerit?
0 Yes N,
o
v
0 Yes BNo
E] yes
D Yes B"S,o
Rio
[I Yes [91�0
D Yes GI -No
0 Yes Eiwo
ID Subsurface' Drains Present
JEI La-oon ��Xa 2ii�, 10 Spray Fiel =Area
ff
2. Is any discharge observed from any part of the operation?
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Surface Water? (If yes, notif
DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (if yes, notif
DWQ)
y
y
1. Is there evidence of past discharge from any part of -the operation?
4. Was 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
maintenanceimprovernerit?
0 Yes N,
o
v
0 Yes BNo
E] yes
D Yes B"S,o
Rio
[I Yes [91�0
D Yes GI -No
0 Yes Eiwo

6. Is facility not in compliance with any applicable setback criteria?
7. Did the facility fail to have a certified operator in responsible charge (if inspection after 1/1/97)?
8. Are there Iagoons or storage ponds on site which need to be properly closed?
Struchires (Lagoons and/or NoldinQ Ponds
9. Is structural freeboard less than adequate?
Freeboard (fr): Lagoon 1 Lagoon ? La_oon 3
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 maintenance/irnprovement?
(If any of questions 9-12 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
11 Do any of the structures lack adquate markers to identify start and stop pumping levels?
Waste Application
14. Is there physical evidence of over application?
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type-
16. Do the active crops differ with those designated in the Animal Waste Management Phan?
17. Does the facility have a lack of adequate acreage for land application?.
18. Does the cover crap need improvement?
19. Is there a lack of available irrigation equipment?
For Certified Facilities Oniv
20- Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
21. Does the facility fail to comply with the Animal. Waste Management Plan in any way?
22. Does record keeping need improvement?
23. Does facility require a follow-up visit by same agency?
24. Did Reviewer/Inspector fail to discuss reviewfimspection with owner or operator in charge?
❑ Yes
[�.] -, 10
❑ Yes
B-Tgc '
❑ Yes
[-No
❑ Yes
[ O
Lagoon 4
❑ Yes
Erflo
EKes
❑ No
[9'Yes
❑ No
❑ Yes
Q'i:ro—
❑ Yes
Elmo
❑ Yes
&KO.
❑ Yes
EPNo
❑ Yes
xq o
ElYes
a?
`cam.
❑ Yes El N o
❑ Yes [9'1,70
❑ Yes �o
❑ Yes BWO
P1A Ary t.Ja3+Z- Q,1 o6 nro -► -. ;;�E ,P�,�!-� }�vA;��6(.�. �'I�no�
w.4 GLS
R er/InspectorName ��
eview n� .. ��- .•: • - - - ,� •~'-., -... ,ems., :� �-
-
Reviwer/Inspector Signature:
Date:
Z3
9
rel
cc. Division of Water Quality, Water Qualioy Section, Facility Assessment Unit 11/14/96

OPERATIONS BRANCH - WQ Fax:[phone] Jul 24 '95 18:04 P.OF/18
Site Requires Immediate Attention -La
•
•
Facility Number: G 7—,2
SITE VISITATION RECOIti? ., y
DATE: a i �j. Y 995 -�
a 9995
Owner: Farm NaL�m++e:
County: — O.yW e-v w
.7 �..� .. ._ 4
Agent Visiting Site: �v�t� . Phone: (zr*/ j--
Operatonr; Phone: (fiol3_t,%-so_.ax
On Site Representative: _All oc.c � Phone:
Physical Address: _rvl. ,- ,vz-& 47 oy. /...�' _��k.... s fs�3� ate. .rp�.r.� .rz;;!!e
Mailing Address:
Type of Operation: Swine Poultry Cattle
Design Capacity: 71*yd Number of Animals on Site:
Latitude: o _ _ _ '," Longitude:° "
Type of Inspection: Ground �� Aerial
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of I Foot + 25 year 24 hour storm event
(approximately 1 Foot +$ inches) . (Z�s or No Actual Freeboard: z Feet is Inches
For facilities with more than one lagoon, please address the other lagoons' freeboard under 'the
comments sec€ion.
Was any seepage observed from the lagoon(s)? Yes or�pwas there erosion of the dam?: Yes or Ngo
Is adequate land available for land application?�' r No Is the cover crop adequate? <e br No
Additional Comments: z --��`7cos.�+1 _�:y6r p®w•••Gr,�r
Fax to [phone]
Siati 'lure of A

Site Requires Imnnediate Attention: /\) a
Facility No. 7- ;2-
DIVISION C F ENVIRONMENTAL, MANAGEMENT
• ANIMAL FEED L OPERATIONS SITE VISITATION RECORD DATE-- g -- 1995
Time:
Farm Name/Owner: HAe_-)&6 W 9 TDB/
Mailing Address: a& Colvjj R-I Clue
County:
•
Integrator: Na u
On Site Representative: It A,
Physical. Addressil ocation: ,
1/2. in It %
Type of Operation: Swine _
Design Capacity: r3.
DEM Certification Number. Al
Latitude: 34 So - 13.91"
Does the Animal Waste Lagoon ha
(approximately I Foot + 7 inches)
Was any seepage observed from th,
Is adequate land available for spray
Crop(s) being utilized:
Does the facility meet SCS minimL
Is the animal waste stockpiled with
Is animal waste land applied or spr
Is animal waste discharged into wa
similar man-made devices? Ye
Does the facility maintain ade
spray :irrigated on specific
Additional Comments:
r.& 5 < -
_ 1 (Xyr-0-.Z?�
Inspector Name
` Phone:
Phone: 3� Y - 36.�i
6
Poultry Cattle ._
Number of Animals on Site: 3
DEM Certification Number: ACNEW
Longitude: -7 )z� -Elevation:Feet
Circle Yes or No
sufficient freeboard of 1 Foot + 25 year 24 hour storm event
' or No Actual Freeboard: L% Ft. (e, Inches
lagoon(s)? Yes 1Vo Was any erosion observed? Yes or
r No Is the cover crap adequate0)or No
i setback criteria? 200 Fee; from Dwellings-, � c or No
100 Feet from Wells? e or Na
1 100 Feet of USGS Blue Line Stream? Yes N
irrigated within 25 Feet of a USGS Map Blue Line? Yes o(�Njg
rs of the state by man-made ditch, flushing system, or other
If Yes, Please Explain.
vaste management records (volumes of manure, land applied,
e with cover crop)? Yes "Na
r
Signature
cc: Facility Assessment Unit
Usc Attachments if Needed.
1h! HH_� S6 . ^_ �i11H