310097_INSPECTIONS_20171231

2 'N
NUH I H UAHULINA
Department of Environmental Qual

- C3Drvisionof"WaterResources�„� �,�� s � � �� ;
Facility -Number - Dn�s�on of,So�l a d Water Conservatton `t M
Type of Visit: Co lance Inspection
Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: Routine 0 Complaint
0 Follow-up Q Referral Q Emergency 0 Other Q Denied Access
Date of Visit: Arrival Time: Departure Time: L�Y� County: Region:
Farm Name:
Owner Email:
Owner Name:
Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title: Phone:
Onsite Representative: ' I �f i ,
�u<< rZ Integrator:
Certified Operator:
r�
Certification Number:
Back-up Operator:
Certification Number:
Location of Farm:
Latitude: Longitude:
Design
Current " `�"Desigq Current -=' "�`�" De§ign :.Current
. _. Swine
Capacity
Pap.. :Wet P.onitry _Capacity Pop Cat#te Caacjty "-Pop
._ .._ _ _ .+,... a,_rr.-� .. •r: +;ram u . `�` _ _ a 3.w _
Wean to Finish
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation? [-]Yes No ❑ NA ❑ NE
Discharge originated at: ❑Structure ❑Application Field ❑Other:
a. Was the conveyance man-made? ❑Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR) ❑Yes ❑ No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes FfNo ❑ NA ❑ NE
Page 1 of 2/4/2015 Continued

Facility Number: -7 Date of Inspection: 3 z
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:
Spillway?:
Designed Freeboard (in):
Observed Freeboard o
(in): L
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
6No ❑ 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
rNoD NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental t eat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes 0 NA ❑ NE
maintenance or improvement? "`777"""
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
o ❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
kNo❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
" ❑ Yes
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ NA
gNt
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ NA
D 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
VN'o ❑ NA
❑ NE
the appropriate box.
❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑ Other:
2 1. 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 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
No . ❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
No ❑ NA
❑ NE
Page 2 of 3
21412015 Continued

>h'acili Number: - Date of Inspection: 2, At
7
24. Did 6e facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ NA
gNA
❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes
No ❑rNA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
[]Yes
[] No
❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
ffNo ❑ 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 No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes
❑ Yes
❑ Yes
[� No ❑ NA ❑ NE
No NA ❑ NE
No ❑ NA ❑ NE
a C., Ste, / l6er s71. i__1 //o -_
Reviewer/Inspector Name: Phone:? t Q 79P 7 y
Reviewer/Inspector Signature: Date: 3 Z i2.
Page 3 of 3 21412015

(&-Division of Water Resources
Facility Number - I� 0 Division of Soil and Water Conservation
0 Other Agency
(Type of Visit: pfCom ance Inspection () Operation Review Q Structure Evaluation Q Technical Assistance I
Reason for Visit: _ Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: 7 Departure Time: County: Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: s ' ' �r r I �u )�•
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
eeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Owner Email:
Phone:
Phone:
Integrator:
Certification Number:
Certification Number:
Latitude: Longitude:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
La er
Non -La er
Design Current
Dry Poultry Ca acit Pop.
Layers
Non -Layers
Pullets
—.Turkeys
Turkey Poults
Other
Discharges and Stream impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify D WR)
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?
Design Current
Cattle Capacity Pop.
DaijX Cow
Dairy Calf
Dairy Heifer
Dry Cow
.Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes Ef No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ��No
❑ NA ❑ NE
❑ Yes [-] NA ❑ NE
Page 1 of 3 21412015 Continued

Facili .Number: -V1 jDate of Inspection: r
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 0 No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure i Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes ff No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes ZrNo ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? [:]Yes ZfNo ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes 0.'No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes jEfNo ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes PJ'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):
i`-
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
,5 o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
,No-
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
dNo -
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
F'J'No
❑ NA
❑ NE
Reouired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 6 No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes o ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [24 to ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facili •Number: 1-7 Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit. ❑ Yes �No
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑ 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? 0 Yes J i No F ❑ 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 �Ko ❑ 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
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
0 Yes 4No 0 NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes ❑ NA ❑ NE
2eZo
Comments' ''(refer.to questio -##)-. Explain anyYES'answers and/or any additional recommendations or any other comments.
Usedrawings.offacility;tobetteregplain`situations,(use additional pages as necessary).
Cr
I - wPA
c./t -I- i
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: R (O 7C 7
Date:
Y /s jC
21412015

V (:�-Division of Water Resources
Facility Number L�1J - ® O Division of Soil and Water Conservation
O Other Agency
Type of Visit: Com nee Inspection 0 Operation Review O Structure Evaluation p Technical Assistance
Reason for Visit: Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Z Arrival Time: li S- Departure Time: County: Region:
Farm Name:
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title: Phone:
s , �
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Integrator:
Certification Number: / 16 S
Certification Number:
Longitude:
Design Current Design Current
Swine Capacity Pop. Wet Poultry Capacity Pop. Cattle
Wean to Finish
W an to Feeder
eeder to Finish 432o (ofl
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
La er
Non -Layer
Other
Poults
Design Current
U
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)?
Design Current
Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
.Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
[]Yes Z "' ❑ NA ❑ NE
❑Yes
❑No
DNA
❑NE
❑ Yes
[] No
❑ NA
❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWR) ❑ Yes ❑ No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes 13<o ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes &No ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412015 Continued

Facili tmber: 31 -91 Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 10 ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? []Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 2 �%
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes D<o ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes [ "No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes [3] N ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes ❑''1\10 ❑ 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 LJ 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 LJ 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 [frNo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes E�J lvo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes Q'No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Reauired Records & Documents
❑ Yes
No
❑ NA
❑ NE
❑ Yes
0 No
❑ NA
❑ NE
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
[3 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.
eyes
❑ No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield �20 Minute Inspections ❑ Monthly and I" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
[—]Yes
La'No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
F�(No
❑ NA
❑ NE
Page 2 of 3 21412015 Continued

Facility umber: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? [] Yes ❑ No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes CE No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes E:fNo
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
24. 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?
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
O NA ❑ NE
❑ Yes E]lNo ❑ NA ❑ NE
❑ Yes ENo ❑ NA ❑ NE
❑ Yes U rNo ❑ NA ❑ NE
❑ Yes [' No ❑ NA ❑ NE
0 Yes
ET'5o
❑ Yes
/ No
❑ Yes
Noo
014
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question #):; Explain any YES answers,and/or any additional recommendations or. any othersvomments ° a
Use drawin s of facili to betterea lain situations use additional "a es as necessary
-
g t3 P ( P g rl')�'
/�R (�
Q q V11l P —Z "T e ' Cr it f w ti t, �_ A ", "i O
2 �t
b ram . c e i ��, 5 /A
�
Reviewer/Inspector Name: t' a -LA 1 V_1-_t' V r
Reviewer/Inspector Signature:
Page 3 of 3
Phone: )j 0 7 3, I
Date: z-7
14 015

Division of Water Quality
facility Number 0 Division of Soil and Water Conservation
0
Other Agency
Type of Visit: eTCompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: QrRoutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: County:
Farm Name: 4 lk' I M6` t GI` DL�irf�i�
Owner Email: i
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Phone:
Onsite Representative: J �y� integrator:
Certified Operator: : ��' i 1 p4A Gf ' Certification Number:
Back-up Operator:
Location of Farm:
Design Current
Swine Capacity Pop.
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Certification Number:
Latitude:
Design
Current
Wet Poultry
Capacity
Pop.
Layer
Non -La er
Design
Current
Dry Poultry
Capacity
Pon.
Layers
Non -Layers
Pullets
Turkeys
Turkey Poults
Other
Discharges and Stream Impacts
1. Is anydischargeobserved 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)?
Longitude:
Region:.
Design" ' Current
Cattle Capacity Pop
Dairy Cow
Dairy Calf
Daig Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes )2t No ❑ NA ❑ NE
[:)Yes [:)No
[::]Yes [:)No
❑ NA ❑ NE
❑NA ❑NE
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes ❑ No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes �ffNo ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes eNo ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

[Facility Number: -Sri Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
Z'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: L
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):�
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
�%j No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
r
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
�No
❑ NA
❑ NE
waste management or closure plan?
T
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes 9 No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes KNo ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
�4❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > tO% 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?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes 'No
❑ Yes No
[:]Yes KNo
❑ Yes in No
❑ Yes YfNo
❑ Yes A No
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes �00
the appropriate box.
❑ WUP ❑Checklists [:]Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ONO
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes K No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes PT"
No
❑ NA
❑ NE
❑ NA
❑ NE
❑ NA
❑ NE
❑ NA
❑ NE
❑ NA
❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facili Number: -7 IDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes WNo
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [] Yes No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ff No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes VrNo
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern? [:]Yes R No
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 V1 No
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. ❑ Yes 10 No
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes V6 No
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes VT No
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Phone:C95ra'�61"' ajQ
Date: b—
21412011

Division of Water. Quality <,
Facy Number - ® O Division of Soil and Water Conservation
Other Agency
O g Y
Type of Visit: O Compliance Inspection 00peration Review O Structure Evaluation O Technical Assistance
Iteason for Visit: O Routine Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: 'Arrival Time: /lid -Departure Time: : j® County: omtobjvl Region: 4
Farm Name: 1�i11�i1 _ILV\ Owner Email:
Owner Name: �; 1 � J �: Phone: �9 D-
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: Integrator:
Certified Operator:
Phone:
Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Design Current Design Current
Swine Capacity Pop. Wet Poultry Capacity Pop.
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
11 Boars
Other
Other
Layer
Non -La er I I - —d
Pullets
Poults
Design Current
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?
Longitude:
-Design ','Current -,""-
Cattle Capacity Pop.,,, 5k
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dal
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes [ErNo ❑ 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)
0 Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
,EEINo
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

Facili Number: -Ck rl Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? 9TYcs 9'No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? 7 Yes [] No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: L' i
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): J
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
VNo
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
0 No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
Oyes
[]No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
R No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
ETNo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
R'No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
Ca 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
Z No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
VNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
.ZrNo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
❑ No
Z NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
❑ No
FTNA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and l" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? [-]Yes [] No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [—]Yes [—]No
L2'NA ❑ NE
❑ Weather Code
❑ Sludge Survey
NA ❑ NE
NA ❑ NE
Page 2 of 3 21412011 Continued

FaciliNumber: f5i jDate of inspection:
. 24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ❑ No ZNA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑ No NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes ❑ No XNA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [—]Yes ❑ No L2NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes C2fNo ❑ 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
[2 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
[ANA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
❑ No,
[ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[]No
21 NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
❑ No
Z NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
es
[:]No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other _Q2rents.
Use drawings of facility to better explain situations (use additional pages as necessary). ..
30 d. PaA1~t�
9) Nor ktl A-ew, c4ay. e- 40 Cogs a4 1A.0A
sue. 4D
Reviewer/Inspector Name:iA�
p g �1
Reviewer/Ins ector nature: Si
Page 3 of 3
Phone: OW b �a �
Date: Lf
21412011

ivision of Water Quality - - - - -
Facility Number - ® 0 Division of Soil and Water Conservation'
0 Other Agency 7..
type of Visit: 0 Compliance Inspection QrOperation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 0 Routine 0 Complaint Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: County: � Region: 1 Ro
Farm Name: �J� �, `� � }0 �,1^ 6yyy,\ Owner Email: ������
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Onsite Representative: k Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Design Current
Swine Capacity Pop.
Wean to Finish
Wean to Feeder
Feeder to Finish 3
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Discharges and Stream Imt)acts
Latitude:
Phone:
Certification Number:
Certification Number:
Design
Current
Wet Poultry
Capacity
Pop.
Layer
Non -La er
Design
Current
Dry Poultry
Capacity
Pot).
Layers
Non -Layers
Pullets
Turkeys
Turkey Poults
Other
Longitude:
Cattle
Design Current E
Capacity Pop gy
Daia Cow
Daig Calf
Dairy Heifer '
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
1. Is any discharge observed from any part of the operation? ❑ Yes Z No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) ❑ Yes ❑ No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (if yes, notify DWQ)
2, Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes
❑ No
❑ NA
❑ NE
[:]Yes
No
❑ NA
❑ NE
[:]Yes
[�rNo
[DNA
❑ NE
Page I of 3 21412011 Continued

Facility Number: jDate of Inspection: i
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? Yes P No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
0 Yes
❑ No
[DNA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
0 No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
jZrNo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
❑ No
�2r NA
0 NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
❑ No
�YNA
❑ 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?
El Yes
❑ No
PINA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
[:]No
�NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ Yes
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes
the appropriate box.
❑ No 2 NA ❑ NE
❑ No �JNA ❑ NE
0 No 0 NA ❑ NE
❑ No O NA ❑ NE
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ;D NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and l" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? [:]Yes ❑ No A NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No Fef"NA ❑ NE
Page 2 of 3 21412011 Continued

Facili Nnmber: jDate of Inspection: —
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ❑ No ;!INA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑ No O NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of fast survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes ❑ No
❑ Yes [—]No
FZrNA ❑ NE
[ XNA ❑ NE
❑ Yes ❑ No P NA ❑ NE
❑ Yes [] No 4NA ❑ NE
❑ Yes ❑ No
❑ Yes ❑ No
P NA ❑ NE
�NA
❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
❑ No
0 NA
0 NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes
❑ No
�Z NA
❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes
[] No
P 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).
La y, Qre��� \Y,��
S
Nu•
WA6�w�' n_e_6� - ����- y,a l � �a , wins � 11;w) -4, wDf K ovi _
Reviewer/Inspector Name: �U,� �a�� Phone:
Reviewer/Inspector Signature: L! ���,� Date:
Page 3 of 3 21412011

Division of Water Quality
Facility Number - u O Division -of Soil and Water Conservation
O Other Agency
Type of Visit: QJCompliance Inspection 0 Operation Review O Structure Evaluation O Technical Assistance
liieason for Visit: QfRoutine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: %pp / Departure Time: { County:
Farm Name: 1 a&nncsOwner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator: W 4 � jz Y • 1'�) 1 /f1
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Phone:
Region: �%, i�LD
Integrator:
Certification Number:
Certification Number:
Longitude:
Design Current Design Current
Swine Capacity Pop. Wet Poultry Capacity Pop. Cattle
Wean to Finish
Wean to Feeder
Feeder to Finish 4
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars 1 +771
Other
Other
La er
Non -Layer
Ury rouirry
Layers
Non -Layers
Pullets
Turkeys
Turkey P_oults
Other
Design Current
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?
Design Current
Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
riBeef
Feeder
Beef Brood Cow
❑ Yes ;'No ❑ 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
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
[:]Yes
ONo
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
[:]Yes
0 No
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3
21412011 Continued

F-acility Number: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? [:]Yes ZNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? 0 Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):�
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes e] 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 lam-' No
[DNA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes Ef No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes ej No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
[] Yes 0 No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes ;Z No
❑ NA
0 NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes RrNo
❑ 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 12 No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes L2 No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes Z No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes e No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes 12 No
❑ NA
❑ NE
Renuired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes Jallo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes [20No
❑ 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 E2 No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking [] Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ,❑ No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

l'acili Number: IDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
wr No
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
Yf No
❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey [] Failure to develop a POA for sludge
levels
❑ Non -compliant sludge levels in any lagoon ,
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
❑ Yes
No
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
No
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
0 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
�TNo
❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
�_e] 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
�R 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
0 No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
O No
[]NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
(2 No
❑ 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).
Pa9w '1,, 77% tomQ1C4e,4.
Con4y\kt, Ltwh U.'ary CVn� c4,4-;V-�
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: "
Date: •�
21412;11

Division of Water Quality
Faz4lity Dumber ©- Cj' 0 Division of Soil and Water Conservation
0 Other Agency
V r w
Type of Visit: Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: County: t/1/
Farm Name: �f LL ice► _Jkj C K_ (L (Y) Owner Email:
Owner Name: 'Li L24TRI C4C.- Phone: q)C3 - r�90" d(019 CX r
Mailing Address: Lq (jr 'SRcN t ie_1C� 6& S ! Y_e/'/'q' / 5 U 1 LC..0 , /VL D &3c I
Physical Address:
Facility Contact: Title:
Onsite Representative: ZI[LL.K% LPAT 2I tJ-C.
Certified Operator: \C4 L1 4 %Q G C
Phone:
Region:
integrator:
Certification on Number: 19659
Back-up Operator: Certification Number:
Location of Farm:
Swine
Latitude:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
La er
Non -Layer
Wean to Finish
Wean to Feeder
Feeder to Finish
4
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
F-TO—ther
Non-L
Pullets
Other
Pouets
Design Current
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)?
Longitude:
Design Current .-
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dr
y Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes '0 No ❑ NA ❑ NE
[:)Yes
[:]No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes ❑ No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes No ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

Facili Number: t - Date of Inspection:
Wastfii-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: CA C0061
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):�
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes * No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify 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 j No ❑ NA ❑ NE
maintenance or improvement? ��LL
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes )6 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 A :) Application Outside of Approved Area .
12. Crop Type(s): CO" I'tCAT SCE �I eA(LL 1"t I L_L rT (?� �t+�� CP� ?j ZCQ.ltt)
13. Soil Type(s):
I LJ-E U-A N C
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes ko ❑ NA ❑ NE
❑ Yeso ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes . No ❑ NA ❑ NE
OWUP ❑Checklists Q Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No
Q Waste Application 0 Weekly Freeboard Q Waste Analysis 0 Soil Analysis El"te ranfers
❑ Rainfall ❑ Stocking Crop Yield 0120 Minute Inspections [] Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes 9-No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? El Yes PrNo
❑NA ❑NE
0 Weather Code
El Sludge Survey
❑ NA ❑ NE
❑NA ❑NE
Page 2 of 3 21412011 Continued

L
Facility Number: - q4 jDate of Inspection:
24. Did the. facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes [ No
❑ Yes No
❑ Yes No
❑ Yes No
❑ NA ❑ NE
❑ NA 0 NE
0 NA ❑ NE
NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? 0 Yes No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes No ❑ 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).
Cgt�Q � rc�v C �6114
W.A.
;�I` b a o. %!�>
1913 H 13
.I Pi I I I I
AN// I � .1
0)_3 4I3
O IUD Rp` ?w i w[ (i.FLOWS O(t- t)v ?"m1P
Names
,,Po r u.cir -- cc,_#jS OL i"MCIAK R &V SS
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
NDA 1NCS Phone:
OIX?'L-V Date: YJ
21412011

r
Division of Water -Quality
Fty--Number. �) Division of Soil
ki ianihWater Conservation
_. n _ether- Agency
IType of Visit )� Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance I
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Og Arrival Time: w Departure Time: County: L l Al Region:
FarmName: Z- �- 4 (L�►n} 1C'l A 12m Owner Email: p
Owner Name: ���t lAm 1` • �Ar� Phone: 0����r ��� c t EOXT /� d
Mailing Address: `-'1�
Physical Address:
Facility Contact:
Title: Phone No:
Onsite Representative: �I L—L kA I L A C Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Operator Certification Number:
Back-up Certification Number:
Latitude: [� o [� 6 [� 64 Longitude: = ° = . =
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -Layer
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
Design Current
Cattle Capacity Population
❑
Dairy Cow
❑
Dairy Calf
❑
Dairy Heifer
❑
Dry Cow
❑
Non -Dairy
I
❑
Beef Stocker
❑
Beef Feeder
❑
Beef Brood Co
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures:
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes N No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
0No
❑ NA
❑ NE
❑ Yes
�K&
❑ NA
❑ NE
Page I of 3 12128104 Continued

Facilfity Number:
Date of Inspection /D
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: LAC-iCeY
❑ Yes 0No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ElNA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes ANO ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes N No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes *o ❑ 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 ElNA ElNE
maintenance/improvement? V
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes OkNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) C a R.o;IIII . W HER 7 �
13. Soil type(s) 11L&T(Z-kAQ-L CL-C--- _LA6NCy9Lt1Z9 Al32rQuIr"
J `'
14. Do the receiving crops differ from those designated in the CAWMP?
❑Yes
kNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
CKNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination? El Yes
19 No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
JN No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
0No
❑ NA
❑ NE
1Cser fR+o wervsk.andr` s ow anyr-ie� mien�d.y'<w ns Oanyo- h.�. - o_m. me�L. ntS.omentn� l
@S
I' eydrawmgs:of facility to better explain,situations. (use additional pages as necessary). 4
Senlp Copc5of rod So1L sAmPLF 1 o ;
AMAN0.4
q la- 350- �y
Reviewer/Inspector Name F_, S Phone:
Reviewer/Inspector Signature: Date:
Page 2 of 3 12128104 Continued

Facility Number: `� — �' Date of Inspection O O
Re uired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes bo No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [ANo ❑ NA ❑ NE
the appropirate box. Q WUP 0 Checklists
0 Design 0 Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes `No ❑ NA ❑ NE
❑ Waste Application 0 Weekly Freeboard 0 Waste Analysis oil Analysis ❑ I/aste Transfers ❑/nnual Certification
0 Rainfall 0 Stocking 0 Crop Yield 0 120 Minute Inspections 0 Monthly and 1" Rain Inspections 0 Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
ONo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
DqNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
W No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
b6o
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
$,No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
VNo
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
A 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
1� 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
F4 No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
[:3 Yes
C4 No
❑ NA
❑ NE
log 0IC' C1qQ_Z)5 N6T nuc - - Cy--� V ]]M 3 CIG)4C-T1U s`
X(&-Ep RAI &-t:f ou L446doAt BL-S
gLk,VLOw016j l/vTv wAcL
Page 3 of 3 12128104

~ Division of Water Quality
Facility Number 3 1 O Division of Soil and Water Conservation
O Other Agency v
Type of Visit Compliance inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit &Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: 3 ? l 11 Arrival Time: ?� Departure Time: County: Region:
Farm Name: K I LQ 1 QJ CIC �a \ _ Owner Email:
Owner Name: 1C I LW P_FfL1 C - Phone: 1 l U — cal &_ N, (f irk _r 63k
Mailing Address: L4 l9 J ZoAtE;�)6 a '57- )<_fw/4NS v )LLE A/C —
Physical Address:
Facility Contact: �( Title: Phone No:
Onsite Representative: 61 LL '`1 L 21CiC _ _ Inte rator:
Certified Operator: U� 1 LU i�rn z' A �0 Wetorl Certification Number: 1910S
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: 0 e =;
= d Longitude: = e = I = u
Swine
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
❑ Non-Layet
❑ Wean to Finish
❑ Wean to Feeder
Feeder to Finish
L43o%
C)
Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ TurkeyPouits
❑ 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)
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifej
❑ Dry Cow
❑ Non-Dai
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures:
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes
)INo
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑NA
[INE
Yes
)No
❑ NA
❑ NE
12128104 Continued

Facility Number: — Date of inspection 1 _!M 1 11
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes $"No [3NA ❑ NE
a. If yes, is waste level into the structural freeboard? ElYes ❑No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: L wGccw
Spillway?:
Designed Freeboard (in): 19. S
Observed Freeboard (in): '5
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes V
No ElNA ElNE
(iel large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes No ElNA [3NE
through a waste management or closure plan? A
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 0,No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes )� No ❑ NA ❑ NE
maintenanceli mprovement?
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) L.C�iC.1�1 l J� I�tC � S V V &xu_ 1 t I t 1,�7T � gaa_
1
13. Soil type(s) Au TaLkU} LLB L-w�IGN e LV4 /V(jlzFG";
v
14. Do the receiving crops differ from those designated in the CAWMP?
Cl Yes
No ❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
O No ❑'NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
A No ❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
No ❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No ❑ NA
❑ NE
x
Comments (refer to question #). 'Explain any YES answers "&or any recommendations or any other coniIIeents
;Use drawings of facility to better explain situations; (use additional pages as necessary):
2�
Reviewer/Inspector Name I A'„ �. Phone: 10"-16''M
Reviewer/Inspector Signature: Date: 31
Page 2 of 3 12128104 Continued

Facility Number: `3 —�' Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? El yes Q(J No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check [:]Yes )(No ❑ NA El NE
the appropriate box.
WUP ❑Checklists El Design E] Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. 11 ❑ Yes )4 No ❑ NA ❑ NE
El Waste Application 0 Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ }Waste Transfers
//// ❑ ,ual Certification
0 Rainfall ❑ Stocking 1❑ Crop Yield 0 120 Minute Inspections El Monthly and I" Rain Inspections 1❑�nWeather Code
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes] No
❑ NA ❑ NE
❑ Yes No
❑ NA ❑ NE
❑ Yes No
❑ NA ❑ NE
❑ Yes No
❑ NA ❑ NE
❑ Yes 14-No
❑ NA ❑ NE
❑ Yes ❑ No
'M'NA ❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
O] No
❑ NA
❑ NE
❑ Yes
6 No
❑ NA
❑ NE
❑ Yes
&No
❑ NA
❑ NE
❑ Yes
EkNo
❑ NA
❑ NE
AdditionafCoriitnentsand/or :Drawings: x -� �,.
CQu(jW�) WJ 0I+G 19,
_
c).$1
W 1 u PX`L4- Q+Q u w/ RcCca03
VVV
GK4.15 75. S 6,- x1G)
Page 3 of 3
12.128104

State of North Carolina
Department of Environmeiit and Natural Resources
Division of Water Quality
Animal Waste Management Systems 3 '�"� 7
Request for Certificate of Coverage
Facility Currently Covered by an Expiring NPDES General Permit
On July 1, 2007, the North Carolina NPDES General Permits for Animal Waste Management Systems will expire. As required by
these permits, facilities that have been issued Certificates of Coverage to operate under these NPDES General Permits must apply for
renewal at least 180 days prior to their expiration date. Therefore all applications must be received by the Division of Water Quality
by no later than January 2, 2007.
Facilities that do not discharge animal waste to the surface waters or do not propose to have a discharge have the option to request
coverage under either an appropriate NPDES General Permit (that will be issued with an effective date of July 1, 2007 and will expire
on June 30, 2012) or to request coverage under an appropriate existing State Non -Discharge General Permit (that was issued on
October 1, 2004 and which will expire on September 30, 2009).
This application form is to be used regardless of the type of General Permit under which coverage is requested. Therefore please
select and circle your requested type of permit below and then complete all the information on the application form.
Please do not leave any question unanswered Please make any necessary corrections to the data below.
1. Select General Permit Type: ❑ NPDES PERMIT or O<TATE NON -DISCHARGE PERMIT
2. Facility Number: 310097 and Certificate of Coverage Number: NCA231097
3. Facility Name: Billy Kilpatrick Farm RECEIVED/ DENRIM
4. Landowner's name (same as on the Waste Management Plan): William R Kilpatrick AQUIFER PROTECTION SECTION
5. Landowner's Mailing address: 463 Routledce St ,IAN 0 2 2001
City/State: Kenansville, NC Zip: 28349
Telephone Number (include area code): 9102960619E-mail: `
6. Facility's physi�caal address: _ -3 Lv 547tXCS : Ny� f a u
City/State: _ T1�_ P_MaP—s u 4-1r Zip:
7. County where facility is located: DgRlin (! ��IVE+ D
8. Farm Manager's name (If different than the Landowner):
9. Farm Manager's telephone number (include area code):
10. Integrator's name (if there is not an integrator write "None"): Carroll's Foods Inc
11. Lessee's name (if there is not a lessee write "None"): l ,y G
12. Indicate animal operation type and number:
Swine
Cattle
Dry Poultry
Wean to Finish
Dairy Calf
Non Laying Chickens
Wean to Feeder
Dairy Heifer
Laying Chickens
Farrow to Finish
Milk Cow
Turkeys
Feeder to Finish 4320
Dry Cow
Other
Farrow to Wean
Beef Stocker Calf
Pullets
Farrow to Feeder
Beef Feeder
Turkey Poults
Boar/Stud
Beef Brood Cow
Gilts
Other
Other
Wet Poultry
Horses - Horses
Sheep- Sheep
Non Laying Pullets
Horses - Other
Sheep - Other
Layers
FORM RENEWAL-NPDES-11/06

k
.4
Submit two (2) copies of the most recent Waste Utilization Plan for this facility with this application. The Waste Utilization
Plan must be signed by the owner and a technical specialist. If a copy of the facilitys most recent Certified Animal Waste
Management Plan (CAWMP) has not previously been submitted to the NC Division of Water Ouality, two (2) copies of the
CAWMP must also be submitted as part of this application.
I attest that this application has been reviewed by me and is accurate and complete to the best of my knowledge. I understand that, if
all required parts of this application are not completed and that if all required supporting information and attachments are not included,
this application package will be returned to me as incomplete. Note: In accordance with NC General Statutes 143-215.6A and 143-
215.613, any person who knowingly makes any false statement, representation, or certification in any application may be subject to
civil penalties up to $25,000 per violation. (18 U.S.C. Section 1001 provides a punishment by a fine of not more than $10,000 or
imprisonment of not more than 5 years; or both for a similar offense.)
Printed Name of Signing Official (Landowner, or if multiple Landowners all landowners should sign. If Landowner is a corporation,
signature should be by a principal executive officer of the corporation):
lZi
t
, �/'tr.. i'1
Title: �Jt•y/�Cf
Signature: Date:
Name: Title:
Signature: Date:
Signature:
Title:
Date:
THE COMPLETED APPLICATION SHOULD BE SENT TO THE FOLLOWING ADDRESS:
NCDENR — DWQ Animal Feeding Operations Unit
1636 Mail Service Center
Raleigh, North Carolina 27699-1636
Telephone number: [phone]
Fax Number: [phone]
FORM RENEWAL-NPDES-11106

V
Facility Number �]
ODIN ision of V4'ater Quahty
Q Division of Sod and Water:.Conseryation
D Other.Agency �'_ '`J.
Type of Visit Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 1ARoutine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: ! 1►el Arriival Time: Departure Time: County: Region:
Farm Name: P�. I L_LcA �[�1L;)Q721Ct_' � ~ Owner Email:
Owner Name: (.'A�l [_LI A.f ) �('I upo- l lC ' Phone: gK) � ��Q� O( T, 164 _
Mailing Address: "1 i`5'J �'T LEZ 6Gc - T 1��:�RN$U) L� `1
/
Physical Address:
Facility Contact: Title:
1
Onsite Representative: SJLLA C1 L PO 7R-4 CIC
Certified Operator: wl (_L1 Am C1C
Back-up Operator:
Location of Farm:
Phone No:
Integrator:
QG 1Q �5�
Operator -Certification Number:
Back-up Certification Number:
Latitude: = 0 ='
0 Longitude: = ° =' = "
Design Current Design Current.` n' �� D signE C?urgent
Swine Capacity Population Wet Poultry, Capacity Population; 'Cartle Capscty� Population`
10. Wean to Finish
❑ Wean to Feeder
Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
Boars
Other
❑ Other
❑ La er
❑ Non -Layer
' Dry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ TurkeX 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)
QDairyCow
7
1
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
N(No
❑ NA
❑ NE
❑ Yes ANo ❑ NA ❑ NE
12128104 Continued

. Facility Number:' — — Date of inspection
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes �No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: COCA✓
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc_)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes +��J No ❑ NA ❑ NE
8_ Do any of the stuctures tack adequate markers as required by the permit? ❑ Yes 1, No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes 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 X No El NA El NE
El Excessive Ponding El Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.) J \
❑ 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. Crap type(s) ��a(4 U'.j&Aj
13. Soil type(s)
.J v
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes V No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes,( No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes j�J No ❑ NA ❑ NE
17, Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes lo
o El NA ❑ NE
❑ Yes ❑ NA ❑ NE
Comments (re€er;to gnestion;#) ; Explain•any YES.answers and/or, any recom nendahons or any otLI—LPher comments„ ;
Use drawings of facility to better'explain"situations (use, additional pages as necessary)
L
er/Inspector Name I m AI"/ES ,.e. 4 Phone: qJ6 - 1qt'
er/Inspector Signature: Date: 01DI0 116
12128104 Continued

r
Facility Number: Date of Inspection
Required 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
❑ Yes
No
❑ NA
❑ NE
the appropriate box. 0 WUp ❑ Checklists ❑ Design � Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Waste Application 0 Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑/aste Transfers ❑
!iinual Certification
0 Rainfall El Stocking [3 Crop Yield ❑ 120 Minute Inspections El Monthly and 1" Rain Inspections 0
Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
FM No
El NA
El NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
toNo
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
PkNo
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
)INo
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
PfNo
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Cl Yes
❑ No
NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
�No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
0 Yes
No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No
[INA
❑ NE
33. Does facility require a follow-up visit by same agency?
[IYes
No
❑ NA
❑ NE
12129104

Facility Number 3 I 9
0 Division of Water Quality
0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit 1 D Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit tZ) Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: /5'S7 Departure Time: County: Lk L4 Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: `! Title:
Onsite Representative: �-A� C-K
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: [—] a [�] ' = « Longitude: = ° = 6 = «
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -La er
❑ Wean to Finish
❑ Wean to Feeder
❑ Feeder to Finish
L43 O
L j ggC�
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ urkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes DQ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
[X No
❑ NA
❑ NE
❑ Yes
a No
❑ NA
❑ NE
12128104 Continued

Facility Number: -- �� Date of inspection
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
0 No
❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA ❑ NE
Structure l Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
identifier: C AC 8nN
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): pip
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
C4 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
A 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
N No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
[Z No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
[] Yes
[ No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[a, No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
El Yes
ja No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[)9 No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
U No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
[XNo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
[�Wo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[A 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):
al • S �fl 'f t_ sINuS"T4E,2cAnE * ►N5'pccTlo,l cOwrAN
6 e"i� e0O C-RG P (; l.G �-n °1 1Y1A1 L Tp DI,J{�
G E_T" ?yoF 5L-uX_-"6 E SL,90E�gk rrlaIL7v I�c�Q
as.
919. YKEEp 01e-, w I 9-Eco(Zb5 . C''p- 1 co C* M41 L q O �WIV
Reviewer/Inspector Name GAI JOi-W CIaA/L Phone:
Reviewer/Inspector Signature: 4AMJV Date:
12128104 Continued

L
Facility Number: Date of Inspection 1 3a O
Required 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 ❑ Yes [1 No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. [A Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking N Crop Yield ® 120 Minute Inspections ❑ Monthly and I" Rain inspections ® Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [A No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ® No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit? a Yes %No ❑ NA ❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit? ® Yes ❑ No ❑ NA ❑ NE
26. Did the facility fail to have an actively certified operator in charge? ® Yes ❑ No ❑ NA ❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
C3 No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
R No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
[;�No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
qNo
❑ 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
(A No
❑ NA
❑ NE
General Permit? (iel discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
[&No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
QkNo
❑ NA
❑ NE
Additional Comments and/or Drawings:
NcbENR-'Vz:,u4
AITN'. AM ANDJ4
la� C_'A2pIlJAC_ 1�>4Z-1 Ue
Wry++t/�ccS s O�l� NC
9?�o
Ak9-F/JyZ"«—r NcEtls 7c,
12128104

f
Michael F. Easley, Governor
William G. Ross Jr., Secretary
North Carolina Department of Environment and Natural. Resources
Alan W. Klimek, P. E., Director ,
Division of Water Quality
April 9, 2003
Billy Kilpatrick
Billy Kilpatrick Farm
463 Routledge St.
Kenansville NC 28349
Subject: Certificate of Coverage No. NCA231097
Billy Kilpatrick Farm
Swine Waste Collection, Treatment,
Storage and Application System
Duplin County
Dear Billy Kilpatrick:
On March 14, 2003, the North Carolina Division of Water Quality (Division) issued an NPDES General
Permit for swine facilities...The General.Permit was. issued to enable swine facilities in North Carolina to
obtain coverage under a single permit that addresses both State and Federal requirements.
In accordance with your application received on January 9, 2003, we are hereby forwarding to you this
Certificate of Coverage (COC) issued to Billy Kilpatrick, authorizing the operation of the subject animal
waste collection, treatment, storage and land application system in accordance with NPDES General
Permit NCA200000. The issuance of this COC supercedes and terminates your COC Number
AWS310097 to operate under State Non -Discharge Permit AWG100000.
This approval shall consist of the operation of this system including, but not limited to, the management
of animal waste from the Billy Kilpatrick Farm, located in DuplinCounty, with an animal capacity of no
greater than an annual average of 4320 Feeder to Finish swine and the application to Iand as specified in
the facility's Certified Animal Waste Management Plan (CAWMP). If this is a Farrow to Wean or
Farrow to Feeder operation, there may also be one boar for each 15 sows. Where boars are unneccessary,
they may be replaced by an equivalent number of sows. Any of the sows may be replaced by gilts at a
rate of 4 gilts for every 3 sows
The COC shall be effective from the date of issuance until July 1, 2007. Pursuant to this COC, you are
authorized and required to operate the system in conformity with the conditions and limitations as
specified in the General Permit, the facility's CAWMP, and this COC. An adequate system for collecting
and maintaining the required monitoring data and operational information must be established for this
facility. Any increase in waste production greater than the certified design capacity or increase in number
of animals authorized by this COC (as provided above) will require a modification to the CAWMP and
this COC and must be completed prior to actual increase in either wastewater flow or number of animals.
Please carefully_ read this COG and the enclosed General Permit. ; Since this is a new joint State and
Federal general permit it contains many new requirements in addition to most of the conditions contained
in the current State general permit. Enclosed for your convenience is a package containing the new and
revised forms used for record keeping and reporting. Please pay careful_ attention to the record keeping
and monitoring conditions in this permit. The Devices to Automatically Stop Irrigation Events - Form
must be returned to the Division of Water Quality no later than 120 days following_ recent of the
Certificate of Coverage. The Animal Facility Annual Certification Form must_ be completed and returned
to the Division of Water Quali1y by no later than March 1st of each year.
Non -Discharge Permitting Unit
1617 Mail Service Center, Raleigh, NC 27699-1617
Customer Service Center
An Equal Opportunity Action Employer
Internet http:#h2o.enr.state.nc.us/ndpu
Telephone [phone] Fax [phone]
Telephone [phone]
50% recycled/10% post -consumer paper

If your Waste Utilization Plan has been developed based on site specific information, careful evaluation
of future samples is necessary., Should your records show that the current Waste Utilization Plan is
inaccurate you will need to have a new Waste Utilization Plan developed.
The issuance of this COC does not excuse the Permittee from the obligation to comply with all applicable
laws, rules, standards, and ordinances (local, state, and federal), nor does issuance of a COC to operate
under this permit convey any property rights in either real or personal property.
Upon abandonment or depopulation for a period of four years or more, the Permittee must submit
documentation to the Division demonstrating that all current NRCS standards are met prior to restocking
of the facility.
Per 15A NCAC 2H .0225(c) a compliance boundary is provided for the facility and no new water supply
wells shall be constructed within the compliance boundary. Per NRCS standards a 100 foot separation
shall be maintained between water supply wells and any lagoon or any wetted area of a spray field.
Please be advised that any violation of the terms and conditions specified in this COC, the General Permit
or the CAWMP may result in the revocation of this COC, or penalties in accordance with NCGS 143-
215.6A through 143-215.6C, the Clean Water Act and 40 CFR 122.41 including civil penalties, criminal
penalties, and injunctive relief.
_- ..__If-yau_wislz_to_eontinue the. activity permitted under the -General Permit after the expiration date of the
General Permit, an application for renewal must be filed at least 180 days prior to expiration.
This COC is not automatically transferable. A name/ownership change application must be submitted to
the Division prior to a name change or change in ownership.
If any parts, requirements, or limitations contained in this COC are unacceptable, you have the right to
apply for an individual NPDES Permit by contacting the staff member listed below for information on
this process. Unless such a request is made within 30 days, this-COC shall be final and binding.
This facility is located in a county covered by our Wilmington Regional Office. The Regional Office
Water Quality Staff may be reached at [phone]. If you need additional information concerning
this COC or the General Permit, please contact Sue Homewood at [phone] ext. 502.
Sincerely,
for Alan W. Klimek, P.E.
Enclosures (General Permit NCA200000, Record Keeping and Reporting Package)
cc: (Certificate of Coverage only for all ce's)
Duplin County Health Department
Wilmington Regional Office, Water Quality Section
Duplin County Soil and Water Conservation District
Permit File NCA231097
Permit File AWS310097
NDPU Files

9 ,;,
-t-
µ W Division of Water Quality
Facility Number 3/ 7 Q Division of Soil and'Water Conservation
In Other Agency
Type of Visit
Compliance Inspection
O Operation Review O Structure Evaluation
O Technicat Assistance
Reason for Visit
0 Routine 0 Complaint
0 Follow up 0 Referral 0 Emergency
0 Other ❑ Denied Access
Date of Visit: 3 23 D Arrival Time: ; � Departure Time: Wr ounty: 4(6G__ Region:
Farm Name: _ /LPL y ZL n x/1T�Gf � /t Owner Email:
Owner Name:/_rJ�ZGLLY� e Phone:
Mailing Address:
Physical Address:
Facility Contact: f� LLa1!2e4C_A
Title:Onsite Representative: \' 1_Z((rl/
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Phone No:
i
Integrator:ny"_a�
Operator Certification Number:
Back-up Certification Number:
Latitude: = o=' 0 Longitude: 0 0 0 t=«
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -La er
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ urkey Poults
❑ Other - - - - -- - -
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocket
l
❑ Beef Feeder
❑ Beef Brood Co
I
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes WNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
[-]Yes
No
❑ NA
❑ NE
❑ Yes
JVNo
❑ NA
❑ NE
12128104 Continued

Facility Number: Date of Inspection Y�
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes A No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
S,t�ru ure l Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: X
Spillway?: D
Designed Freeboard (in):
Observed Freeboard (in): 2�
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes P No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes Uf 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 P No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes [;9 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. KYes ❑ No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN '0 PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ElEvidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) eo'w-
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
El 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
VINo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
0 No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
ZI No
❑ NA
❑ NE
C"X" ""j ;'F!A* / 2X�. a� 1* , 7,-,, , /�'c
C//�I - 4,4a.4,r &z7, 7zoJ A) t9x- 19,9&1 -
Reviewer/Inspector Name I [� f ' Phone: y/JP" ���'3IVy Z2G,
Reviewer/Inspector Signature: Date: Z
12128VU4 C.'onhnuea

i• . . r
Facility Number: — Date of Inspection
Required Records & Documents
19.
Did the facility fail to have Certificate of Coverage & Permit readily available?
❑ Yes
XNo
❑ NA
❑ NE
20.
Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
ZNo
❑ NA
❑ NE
the approprrate box.
❑ WUP El Checklists El Design El maps El Other
21.
Does record keeping need improvement? if yes, check the appropriate box below.
Oyes
❑ No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking oCropYield ❑ 120 Minute Inspections ❑ Monthly and l"
Rain Inspections ❑
Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
VNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
VYes
❑ No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
Pf Yes
❑ No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit'?
❑ Yes
No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ NA
Other Issues
'ONE
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes 0 No ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document ❑ Yes VI 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 Vf No Cl 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 6 No ❑ NA ❑ NE
General Permit? (iel discharge, freeboard problems, over application)
32. Did ReviewerfInspector fail to discuss review/inspection with an on -site representative? ❑ Yes IVNo ❑ NA ❑ NE
33. Does facility require a follow-up visit by same agency? ❑ Yes V1 No ❑ NA ❑ NE
Additional Comments and/or Drawings:
�60 ��o�o a �,g� Q� P�vdFp a.�•,
&W,00 �. o cogs .
! , 3�3��a y6cr Pgo
PZ !, 3 ��s L►.� fac
��u9aJB� `7 &gone- Aa4oi�p
z3� RA-7-tJaZ6-A-trt� s
`���
—p�F� �( �ca�or✓o nzc7
6 Ar n20
/Y) o Gl7 -7; 72ew +( 7T&2 �fi1G(i
S iG eLA eRAL/ �S,

Type of Visit 0 compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 complaint 0 Follow up 0 Referral —0 Emergency /Other ❑ Denied Access
Date of Visit: Arrival Time: �,'LF5 Departure Time: County: Region: l
Farm Name: C I �� t Owner Email:
Owner Name: Ct/ Phone:
Mailing Address:
Physical Address:
Facility Contact: /� Title:
: Onsite Representative, LT AA71e�GJ
Certified Operator:
Back-up Operator:
e
Location'of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Phone No:
Integrator: 62wzmC S
Operator Certification Number:
Back-up Certification Number:
Latitude: = 0 ❑ 4 = is Longitude: ED ° = ' ❑ u
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
❑ Non-Laye i
Other
❑ Other
Dry Poultry
❑ Lavers
❑ Non -La ers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑
Dairy Cow
❑
Dairy Calf
❑
Dairy Heifej
❑
Dry Cow
❑
Non -Dairy
❑
Beef Stocker
❑
Beef Feeder
❑
Beef Brood Co
Number of Structures: FTJ
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
12128104 Continued

r
Facility Number: — �' Date of inspection f
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:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
S. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ❑ No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes ❑ No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ❑ No ❑ NA ❑ NE
8. Do any of the stuctures tack 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 Drifl ❑ 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
y�S4 7
Reviewer/Inspector NameAA
Phone:
Reviewer/Inspector Signature:
?
Date:

r .
Facility Number: — Date of Inspection
Required Records & Documents
t9. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ❑ No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ❑ No ❑ NA ❑ NE
the appropirate box. ❑ WUp ❑ Checklists ❑ Design ❑Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
❑ No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
❑ No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
❑ No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
❑ No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
3 1 .
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
;dNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
❑ No
❑ NA
❑ NE
Additional Comments and/or Drawings:
14v),VA dAnl
,6-13
j
® et-,PY P,-"' CAexv rA_&.-f_ 12128104

ANIMAL FACILITY ANNUAL CERTIFICATION FORM
Certificate of Coverage or Permit Number V_9q County _Q„4 Year 200
Facility Name (as shown on Certificate of Coverage or Permit) 9;16e
Operator in Charge for this Facility &;•I Ij ;ll , r !� —Certification ' V � `gam `
Land application of animal waste as allowed by the above permit occurred during the past calendar year t/ YES
NO. If NO, skip Part I and Part II and proceed to the certification. Also, if animal waste was generated but
not land applied, please attach an explanation on how the animal waste was handled.
Part I : Facility Information:
1. Total number of application Fields E or Pulls V'(pl S se check the appropriate box) in the Certified Animal Waste
�ianagement Plan (CAW�IP): I9 i Total Useable Acres approved in the CANV11P
2. Total number of Fields r or Pulls G'�(please check the appropriate box) on which land application occurred during
the year: r It Total Acres on which waste was applied
3- Total pounds of Plant Available Nitrogen (PAN) applied during the year for all application sites:
4. Total pounds of Plant Available Nitrogen (PAN) allowed to be land applied annually by the CANk1iP and the
permit: i v O3 2-
5. Estimated amount of total manure, litter and process wastewater sold or given to other persons and taken off site
during the year Ail A tons ❑ or gallons 1 1 (please check the appropriate box)
6. Annual average number of animals by type at this facility during the previous year:
yv 80
7. Largest and smallest number of animals by type at this facility at any one time during the previous year:
Largest Q ,
Smallest
(These numbers are for informational purposes only since the only permit limit on the number of animals at the
facility is the annual average numbers) --
S- Facility's Integrator if applicable:l {.4 Rt% ✓ — �',
Part LI: Facility Status:
IF THE ANSWER TO ANY STATENiE.NT BELOW IS "N O", PLEASE PROVIDE A WRITTEN DESCRIPTION
AS TO WHY THE FACILITY WAS NOT CONIPLI- NT, THE DATES OF AXtiY NON CO_IPLI_A_`CE, AN-D
EXPLAIN CORRECTIVE ACTION TAKEN OR PROPOSED TO BE TAKE` TO BRIG THIS FACILITY
BACK L\70 COMPLIANCE.
Only animal waste generated at this facill was applied to the permitted sites during ' Yes `o
the past calendar year
= •:� yt�`� SEC i ;C� S .
..a

The facility was operated in such a way that there was no direct runoff of waste from F3 Yes ❑ No
the facility (including the houses, lagoons/storage ponds and the application sites) during
the past calendar year. ,,�
3. There was no discharge of waste to surface water from this facility during the past Yes ❑ No
calendar year.
4. There was no freeboard violation in any lagoons or storage ponds at this facility during ❑ Yes a
the past calendar year. c.,rld ''" :No• r,,,-4,.r
5. There was no PA_�,' application to any fields or crops at this facility greater than the P'Yes ❑ No
levels specified in this facility's CAWMP during the past calendar year.
5- All land application equipment was calibrated at least once during the past calendar year. VZ Yes ❑ No
7. Sludge accumulation in all lagoons did not exceed the volume for which the lagoon IJ Yes ❑ No fi/P
was designed or reduce the lagoon's minimum treatment volume to Iess than the volume 3:S_oq .
for which the Iagoon was designed. JKK 5 e— 5u J'eY o,J 3 _9-0y
8. A copy of the Annual Sludge Survey Form for this facility is attached to this Certification. ❑ Yes
No = 3 -S-OLI
9- Annual soils analysis were performed on each field receiving animal waste during the D--fe-s E. No
past calendar year.
10. Soil pH was maintained as specified in the permit during the past calendar Year? C_-I<s 0 No
1 I. All required monitoring and reporting was performed in accordance with the facility's G___�es - No
permit during the past calendar year.
12. All operations and maintenance requirements in the permit were complied with during uYes '•- No
the past calendar year or, in the case of a deviation, prior authorization was received
from the Division of Water Quality-
13. Crops as specified in the CA`V1iP were maintained during the past calendar year on all es - No
sites receiving animal waste and the crops grown were removed in accordance with
the facility's permit-
14. All buffer requirements as specified on the permit and the CANN P for this facility were '- -,,'o
maintained during each application of animal waste during the past calendar rear.
1-1 certify under penalty of law that this document and all attachments were prepared under my direction or supervision
in accordance with a system designed to assure that qualified personnel properly gather and evaluate the information
submitted. Based on my inquiry of the person or persons who manage the system, or those persons directly responsible
for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and
complete. I am aware that there are significant penalties for submitting false information, including the possibility of
Fines and imprisonment for knowing violations."
Name and Title (type or print)
KII) 1�1�i _ 3.1-oaf
of Perrruttee Date
3 _! <#
Date

°s = • = _ . O Drvision of Soil and Water'Conser'vation'= Operation ltevrew `,
_ 13 Drvi§ion of Soil and Water Conservation - Coniplia i& inspection
Division of;Water' Quality - Complinnce Inspection
D.Other Agency - Operation Review
Q Routine Q Complaint 0 Follow -tip of DWQ inspection Q Follow -up -of DSIVC review Other
Facility Number j i late of Inspection
Time or Inspection Lam, _i 24 hr. (hh:mm)
Permitted PICertified C[ Conditionally Certified 0 Registered 0 Not Opera Date Last Operated:
FarmName: .... •....I A� '.......�;�..A�]C1ck......�.t:,r•!................................................. County:.....DL. Ii...............................................................
O►ti�rer Nance: 1? .�I.............. .� Q�t.1!iL........................................ Phone No: _ 1Q16:(.CiEviq..............................................
Facility Contact: ............................. ............. Title: ..................................... - ......................... Phone No:
Alailirrg\cldress: ....................................................................... .....SJ,iI...t�.3!�.�}......
p l{�../!
Onsite Representative, ...............dJ1�...... L.. .i �..................................I....... Integrator: ..........60-VYX16..................................................
......
Certified Operator ................. jj.aitm..... ?-, ...... ......................... Operator Certification Number:.jj.jks' .........................
Location of Farm:
...ta L..'W. L.....0.e .5.................--...................................................................................................
...........................................................................................................
Latitude Off' « Longitude Z • S� r ®��
Swine Capacity Population
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts T
Boars
Design Current Design Current
Poultry Capacity Population Cattle Capacity Population
❑ Layer I ❑ Dairy
❑ Non -Layer I I I JE] Non -Dairy
❑ Other I 1
Total Design Capacity q1 "
Total SSLW
Number of Lagoons 10 Subsurface Drains Present ❑ Lagoon Area ❑ Spray Field Area
Holding Ponds / Solid Traps JEI No Liquid Waste Management System
DischargEs & Stream Impacts
I. Is any discharge observed from any part of the operation (If yes, notify DWQ)? ❑ Yes ❑ No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-rnadc? ❑ Yes ❑ No
h. If discharge is observed. did it reach: ❑ Surface Waters ❑ Waters of the State ❑ Yes ❑ No
c. If dischar_e is observed, what is the estimated flow in ryal/min'?
d. Does discharge bypass a lagoon systcm? ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? [Yes ❑ No
3. Were there any 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? ❑ Yes No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard(inches):............L7....................................................................................................................................................................................................
1/6/99 Continued on back

Facility Number: 3[ — G^1 Date of Inspection
5. Kre there any. immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any pact of the waste management system other than waste structures require maintenance/improvement?
9_ Do any stuctures lack adequate, gauged markers with required top of dike, maximum and minimum
liquid level elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
I L Is there evidence of over application? ❑ Ponding ❑ Nitrogen
12. Crop type
'r_��1lt�
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. Does the facility lack wettable acreage for land application? (footprint)
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 certified operator in responsible charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did ReviewerAnspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
O: N,o'violatioins.or. deiiciencies .were noted. durink f iis_visit:. Ynti �vill.re�ceive n� further ...:
egrrespo�r.. . .... . t. this : :: :
❑ 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
Comments:(refer to question #)-Explainany YES answers and/or any recommendations.or an otlter comments '
:.
Use drawiings of facilityto better_ explain situations. (use additional pages as_necessary) _. s-
- -�
z Qc.c.Y�.t
jlly , . `t✓L..� �:5 � �.xs. �r�,t;s� e, 5uh„ r �k rO4, rV,— �:� 6L
vW rStcry, K,". 00, aY(.in4a2 �Ntvg3flh eia,��
t_su,� Crete 4CYCL..] Puna e 5 A- a Plopi 04-Ca� 5"aoo 1�1t- /k,. Ak,. �'cy,
1,s'44+,c bl� M cr- dun. a A) aka;r on tAcrr, a.9xYvi . K-,-.r►+i�E- iOc�,t►�
,. dc�cd va .tit, Flo e -a r3v �i�s w[[� �nsr�o j,is< c.0� �s
� d 1�ek tac+or.�� ttu- waz n a� ci �,� d'w.a ge - eurtase�-e.
tr�ts,� d trll . +11tct1 Mx. �•yl�OL d- 1 o cca�A-trwe� r��t. � e Cx �s.
Reviewer/Inspector Name _ .I
Reviewer/Inspector Signature: Date:
1 /6/99

-6-98
rian Wrenn
B
Environmental Specialist
NCDept. Environment and
Natural Resources
127 Cardinal Drive
Wilmington, NC 28405
Dear Mr. Wrenn,
I received your letter concerning my inspection on 5-29-98. Please allow me 6-8
weeks to make the necessary repairs to the lagoon dike, grass waterways, and storm
drains. Thank you very much.
Sincerely,
&Uv- -
Billy Kilpatri
Facility Num r:31-97
Duplin County

Division of Soil and Water Conservation [3 Other Agency
Division of Water Quality ,
[gj Routine O Complaint - O Follow-up of DWQ inspection O Follow-up of DSWC review O Other 1
FDateof Inspection S�QRFacility Number 3of Inspection � 24 hr. (hh:mm)
Registered `� Certified (App1lied for Permit' Permitted 0 Not Operational Date Last Operated; ,,,,,,,,,,,,__,,,,,,,,;,
Farm Name: .......... 8�.�,. ��:. ��..q.',L(.i1t.....V. YTI........................................... County:......�L.!d.!.1...................................... .......................
Owner Name: ................... B..Y\ ........ .................................... Phone No: ...... CC11.9..J.Rio..-.QLe1........................................
FacilityContact: ...................................:.......................................... Title:................: Phone No:.............:.....................................
MailingAddress: .......�..0._�Px .................... :............................................... ..... ............................ .........
Onsite Representative: ......... 91.41........ K4�............................ Integrator: ...... &t..yxo.Ik.......................................................
Certified Operator:............................................._................................................................. Operator Certification Number .........................................
Location of Farm:
Latitude ®':E57-1, OS " Longitude ©• E7:�;71`°
'Design Current L Design Current -Design Current
'_Swm&-' Capacity Population Poultry , Capacity Population Cattle Capacity, Population
4 —
- ❑ Wean to Feeder Layer " EEI Dairy
;3
Feeder to Finish JLJ Non -Layer I I I I[j Non -Dairy
❑ Farrow. to Wean
❑ Farrow to Feeder ❑ Other n
❑ Farrow to Finish Ttital Design Capacity..'
❑ Gilts
❑Boars - , Total SSLW f7j3 zp
u
3Number of ins/Flo"o niWSbsurface Drains Present 110Lagoon Area JE5Npray Field Area
❑ No Liquid Waste Management System
General
1. Are there any buffers that need maintenance/improvement?
2. Is any discharge observed from any part of the operation?
Dischargeoriginated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
3. Is there evidence of past discharge from any part of the operation?
4. Were there any adverse impacts to the waters of the State other than from a discharge?
5. Does any pan of the waste management system (other than lagoons/holding ponds) require
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
7. Did the facility fail to have a certified operator in responsible charge?
7/25/97
❑Yes ONo
❑Yes ®No
❑ Yes
CS No
[]Yes
[,,No
❑ Yes
j No
❑ Yes
No
❑ Yes V] No
® Yes ❑ No
❑ Yes allo
❑ Yes ® No
Continued on back

Facility Number: 1
8. Are there lagoons or storage ponds on site which need to be properly closed'? ❑ Yes ® No
Structures (Lagoons,lioiding_Ponds, Flush Pits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes A No
Structure 1 Structure 2 Structure 3 Structure -i Structure 5
Structure 6
Identifier:
Freeboard (ft): ............ �....................
10. Is seepage observed from any of the structures?
❑ Yes,
P No
11, Is erosion, or any other threats to the integrity of any of the structures observed?
QQ Yes
On No
12. Do any of the structures need maintenance/improvement?
Yes
❑ No
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
❑ Yes
C4 No
Waste Application
14. Is there physical evidence of over application?
❑ Yes
14 No
(If in excess of WMP, or runoff entering waters of the State, DWQ)
(notify
15. Crop type ........ ....... oll!�....................1...... .............. ..'S�FJ�t'to...... ............ ........ ........... .......................... .............................................................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AW,MP)?
❑ Yes
KNo
17. Does the facility have a lack of adequate acreage for land application?
❑ Yes
El No
18. Does the receiving crop need improvement?
❑ Yes
Cd No
19. Is there a lack of available waste application equipment?
❑ Yes
No
20. Does facility require a follow-up visit by same agency?
)0l Yes
❑ No
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
MNo
22. Does record keeping need improvement?
5QYes
❑ No
For Certified or. Permitted, Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑ Yes
No
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
Yes
❑ No
25. Were any additional problems noted which cause noncompliance of the Permit''
Yes
❑ No
0 No.violations or defidencies,were-noted-during' this.v6it.-.Yo'u will receive'no further
correspondence about -this'. visit'.-'-'.
Comments (refer to question #) -Explain any. Y ES"answers and/or'6t reconiaxneindations-or any other comments
Use drawings of fatilit_v�to better explain sttuatipns use additional pages as necessary} f: #
,. .... .....: s
3;.
611CL%e3 (rJ f �i� I�Q S�/t�/ Q �t1y4iXi?11f tr�Jr'L �n �Q1if7iN� �Y
trvna �-, I j
1t'42. Etrosju,• o,,Ctc-g oL, nvtW �Ly_I- a)CLU Of 14S 56(A bo �tl rizeeacd.
\ANy- ci,k� rjwl� � �� una ltci. Z- �� �� �a r, r,�ll s�ta�l iae r
ire 5�i� Wa�4]]1r (�N�+'S;an 5�J1� e �air'tC1• -
ZZ- i.lRS� G�r�fil Si S S%r�� JpdG((�,
Y of rzs jbs���.
7/25/97
Reviewer/inspector Name
4 �
Reviewer/Inspector Signature. �,,,��%• �{J Date: � 12q 1 c1l ?e

State of North Carolina
Department of Environment
and Natural Resources
Division of Water Quality
James B. Hunt, Jr., Governor L
Wayne McDevitt, Secretary
A. Preston Howard, Jr., P.E., Director
Billy Kilpatrick
Billy Kilpatrick Farm
PO Box 723
Kenansville NC 28349
Dear Billy Kilpatrick:
APR 14 1998
E N R
April 8, 1998
Subject: Application No. 31-0097
Additional Information Request
Billy Kilpatrick Farm
Animal Waste Operation
Duplin County
The Non -Discharge Permitting Unit has completed a preliminary engineering review of the
subject application. Additional information is required before we can continue our review. Please
address the following by May 8, 1998:
1) As required by item I.3 of The General Permit for liquid Animal Waste operations
Application Form, please submit two copies of the Certified Animal Waste Management
Plan (CAWMP). On December 12, 1997, you submitted a copy of the certification form for
your animal waste management plan. This is not the same thing as the CAMWP. I realize
the terminology is confusing, and I apologize for any confusion this may have caused. The
CAWMP typically includes such items as the Waste Utilization Plan, the lagoon design, the
irrigation design, the site evaluation, etc. Your technical specialist (Michael Sugg, USDA-
NRCS, PO Box 277, Kenansville, NC 28349, [phone] may be able to help provide
this information. Please submit two copies of the CAWMP.
Please reference the subject permit application number when providing the requested
information. All information should be signed, sealed, and submitted in duplicate to my attention at the
address below. The information requested by this letter, must -be submitted on or before May 8, 1998 or
the Division will return your application as incomplete in accordance with 15A N.C.A.C. 2H .0200 and
your facility will be considered to be operating without a permit.
Please be advised that operation of the subject animal waste management system without a valid
permit is a violation of North Carolina General Statute 143-215.1 and will subject you to the enforcement
authority of the Environmental Management Commission.
P.O. Box 29535, Raleigh, North Carolina 27626-0535 Telephone [phone] FAX [phone]
An Equal Opportunity Affirmative Action Employer 50% recycled/ 10% post -consumer paper

Application No. 31-0097
Billy Kilpatrick
Page 2
If you have any questions regarding this request, please call me at [phone], extension 352.
Sincerely,
Michael T. Lewandowski, PE
Environmental Engineer
Non -Discharge Permitting Unit
cc: Wilmington Regional Office, Water Quality
Permit File
Michael Sugg, USDA-NRCS

€¢ ❑ DSWC Animal Feedlot Operation Reviewer
n �® DWQ Animal Feedlot Operation Site Inspection
10Routine O Complaint O Follow-up of D1y2inspection Q Follow-up of DSWC review O Other �
Date of Inspection 97
Facility Number 3
Time of inspection �24 hr. (hh-mm)
© Registered I$1 Certified © Applied for Permit © Permitted � Not O erational Date Last Operated: .... .....................
Farm Name: �a.�V...... .k �G - tot ..... ,fn.......................... County:....... lJ�l!.t�...................................... .......................
,. I I .... . k.. ......
Owner Name: .............�4..`til......{!..�1&�C.......................,................................... Phone No: ....
...................................
......
`++I !I -
Facility Contact: ......... ..1A14.:...... K.!1.--1 I 'It .............. Title: ....... DW.Y1Rt�........................................ Phone
Mailing Address:P.4 IN
Onsite Representative: ........ f.[11-------- L�i�..�y�f.�4( ............................................... Integrator: ........ CA YQ.I-N.........
........................ Operator Certification Number ..--.....11461................
Certified Operator;..---..--.
Location of Farm:
f913.4.q.....
r......... .. ....�1�.319... .... :I"u..a—... .. dn....... y
.....5.K.1311..-,....Farm.......►.5...... a�.5". 5.....a. r�,. . "....s4e.........................................................................................................
Latitude • 1 0:C Longitude ' 1 .°
Design Current Design Current Design , ,Current
Swine Capacity Population Poultry Capacity Population Cattle Capacity Population
❑ Wean to Feeder JE1Layer ❑ Dairy
Feeder to Finish L4 140 1[] Non -Layer I 1 ❑ Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder JE1 Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ Boars Total SSLW
Number of Lagoons / Holding Ponds ® Subsurface Drains Present ❑ Lagoon Area [R Spray Field Area
❑ No Liquid Waste 'Management System
General
1. Are there any buffers that need maintenance/improvement? ❑ Yes "No
2. Is any discharge observed from any part of the operation? ❑ Yes 9No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made`' ❑ Yes 1) No
b. if discharge is observed, did it reach Surface Water'? (if yes.. notify DWQ) ❑ Yes ® No
c. If discharge is observed, what is the estimated flow in gal/min? f�
d. Does discharge bypass a lagoon system? (If yes. notify DWQ) ❑ Yes No
3. Is there evidence of past discharge from any part of the operation? ❑ Yes 19 No
4. Were there any adverse impacts to the waters of the State other than from a discharge? ❑ Yes [a No
5. Does any part of the waste management system (other than lagoonslholding ponds) require ❑ Yes 19 No
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes M No
7. Did the facility fail to have a certified operator in responsible charge? ❑ Yes UNo
7/25/97 Continued on back

Facility Number:
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (Lagoons,Iloldine Ponds, Flush Pits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier:
❑ Yes ETNo
❑ Yes [,No
Structure. 5 Structure 6
Freeboard(ft):.........Z.-.2....................... ........................... .......
10. Is seepage observed from any of the structures? ❑ Yes 21No
1 I. Is erosion, or any other threats to the integrity of any of the structures observed?
12. Do any of the structures need maintenance/improvement?
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
Waste , appliea tion
14. Is there physical evidence of over application?
(If in excess of WNW, or runoff entering waters of the State, notify DWQ)
15. Crop type .....................[ +:?Y.i1 - .....-...............
.................
......
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19- Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/inspector fail to discuss reviewlinspection with on -site representative? .
22. Does record keeping need improvement?
For Certified or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
25. Were any additional problems noted which cause noncompliance of the Permit?
f)- No.violations or' deficiencies were noted during this.visit.- Nou.will receive no further
correspondence about this.visit.:
N Yes ❑ No
91 Yes ❑ No
❑ Yes %No
❑ Yes P No
❑ Yes [gNo
❑ Yes No
❑ Yes No
❑ Yes No
CkYes ❑ No
❑ Yes tO No
j Yes ❑ No
❑ Yes P(No
❑ Yes No
❑ Yes I No
Coinrnerits (refer to question #) Explain any`.YES answers andlorany recutnmendations nr any ether comments.
Use drawings of facility to better:explainsituations (use additional pages as necessary):
l
f(• 2- ErK ion OJfLG or, y1RnlY r,wk� fQ oo;, scour 1n:it-y C.\ pti S�IDu�b� be P11W Uii -y `
c-es eU - 1 r% {,1.�' pll fe6 a heAd be, ex{Wt�eJ a i, 4L wded lyY, *r k NQ a-J r oed ed ,
�.(,�ev.'� V o6 oh �co>` ivskl SHodd foe. 4IUd. )nrU.tir 1NA(1 of I&160v\ 40uld 60lVAW
.Z2- No S�jrlj reGoz)S werc on 64 f "ee, w.f +t*u- 01 ln-spaDko • ray rtagds shoutd be-
e[� riumla�r, rri a-{ on ma s ciPA Oa � ftcdo
1 ,' b rur nutnoer cwtd 9 Q ° r
iCa S 5 l
P
7/25/97
Reviewer/Inspector Name i
w ;
Reviewerllnspector Signature: �, IAlA Date: WWII

Site Requires Immediate Attention: IA C>
' Facility No. 71- 1�
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: e0fj , 1995
Time; Q cf Z:)
Farm Name/Owner:
Mailing Address: _
� County:
Integrator: Cc4^c i i N —
On Site Representative: _
Physical Address/Location:
Phone:] ! o
Phone:q o S"
QA c __ --I-,
Type of Operation: Swine Poultry Cattle
Design Capacity: y 3 0 Number of Animals on Site:
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude:7'4 S-] ' "t '(0 Longitude: ' S.— -7 ' 1_3 5 Elevation: Feet
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches) Yes or No Actual Freeboard _ Ft. Inches
Was any seepage observed from the lagoon(s)? Yes or No Was any erosion observed Ye or No
Is adequate land available for spray? Yes or No Is the cover crop adequate? Yes or No
Crop(s) being utilized: o
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings? Yes or No
V u
� � 2
L
I �n
� yr
O rb
100 Feet from Wells? Yes or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or No
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes or No
Is animal waste discharged into waters of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes or No ? If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage }with cover crop)? Yes or No
Additional Comments: —
-I
kc_1.4y 1 CY-h- 44ul
/1 J t�J} � 1 s
Inspector Name
cc: Facility Assessment Unit
Use Attachments if Needed.
121
dl �s --w ,t w/ ln,-!u J" �, -tog 0-3

Site Requires Immediate Attention: -12-_
Facility No. 31-'3 �-
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE E VISITATION RECORD
DATE
�J� , 1995
r Time: Q T
Farm Na
Mailing
County::.�Sl.c.,- 11.� ��/
integrator: - Phone:!_Qd � ` 3 `f� T
On Site Representative: Phone:
Physical Address/Location: -47N 133 c7
Type of Operation: Swine Poultry Cattle
Design Capacity: y 3 a 3 Number of Animals on Site:
DEM Certification Number. ACE DEM Certification Number: ACNEW
Latitude: K`f 'sue` . 'C� Longitude: :4 S2 3 Elevation: Feet
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot f 25 year 24 hour storm event
(approximately 1 Foot -r 7 inches) Yes or No Actual Freeboard— Ft. Inches
Was any seepage observed from the lagoon(s)? Yes or No Was any erosion observed or No
Is adequate land available for spray? Yes or No Is the cover crop adequate? Yes or No
Crop(s) being utilized: ,Sau�z
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings? Yes or No
100 Feet from Wells? Yes or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or No
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes or No
Is animal waste discharged into waters of the state -by man-made ditch, flushing system, or other
similar man-ri-jade devices? Yes or No If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated.on specific acreage with cover crop)? Yes or No i
Additional Comments:
! _-__ /' Qj �7. ,0a_-C _ �A D, A .. .-, tea--
Inspector
cc: Facility Assessment Unit Use Attachments if Needed.