310288_INSPECTIONS_20171231

NUH I H UAHULINA
Department of Environmental Qual

Type of Visit: Compliance Inspection 0 Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit: Q Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: 1 I 1 Arrival Time: Departure Time: County: Region:
YY1; r+o OPN
Farm Name:
11jt,r
Owner Email:
Owner Name:
tdA&12
Phone:
-
9 10 lrp � �j OS-1
Mailing Address: /1. y I
Physical Address: 2b Z 6 N CT1�11 j '-
Facility Contact: `Title:
Onsite Representative: -�1`� "1 1, 1 le T
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator:
Certification Number:
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish I
Design Current
Wet Poultry Capacity Pop.
I Layer I
Design Current
Cattle Capacity Pop.
jDairyCow
'
Wean to Feeder
pp 1
jNon-Layer I
Dairy Calf
Dairy Heifer
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Design Current
D P,oultl, Ca _aci_ P,o
Layers
D Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Turke s
Turkey Poults
Other
113eef Brood Cow
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes X No [DNA ❑ NE
[:]Yes
[:]No
K] NA
❑ NE
❑ Yes
❑ No
q NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR) [:]Yes ❑ No [�j NA ❑ NE
2. is there evidence of a past discharge from any part of the operation? ❑ Yes Z No DNA ❑ 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? 91
Page I of 3 21412015 Continued

Faciti Number: jDate of Ins ection: Z
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes fZ No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes [:]No a] NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): L4 `I
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes A No ❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes No ❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement?
0 Yes [:]No ❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
[]Yes M No ❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes m No [] NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that.need
❑ Yes [Z 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 TYFe(s): rv► V �q . r1 n 54 -r Y tr~
�(�l
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes E] No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [ No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes 6� No DNA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application? ❑ Yes XNo ❑ NA JL NE
18. Is there a lack -of properly operating waste application equipment? ❑ Yes [:]No ❑ NA E0 NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes ® No D 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 EA No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Mo7thly and I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? l A.V-11 ❑ Yes a] -No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No
Page 2 of 3
❑NA ❑NE
❑ Weather Code
❑Sludge Survey r--/ei
❑ NA ❑ NE
❑NA fp�NE
21412015 Continued

Facili Number: - Date of inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? Z y (2� ❑ Yes E] 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
❑ Yes
® No
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
[� 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
Y] 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.
-ef gA A
Yes
❑ No
PApplication Field ❑ Lagoon/Storage Pond ❑ Other:
32, Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
r] No
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
® No
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
No
❑NA ❑NE
❑NA ❑NE
❑NA ❑NE
Z]NA ❑NE
DNA ❑NE
DNA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
Commen".(refer to gyestio'na#): Explain any YE5fanswers-and/or any additional recommendationsior any other comments.
Use"drawinas explain, situati©ns,Iuse addifionat pnges as,necessary).
WR, cjj1?Ii-7 ` I•DZ
III in ^ 0.63
�Ausy I Z_ A&
bti
�-
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
L.l e c. �r
7.0 ks�'
�,,ee� S ��• � � "'� Ca�ec
Phone: 5ibie,
Date:
21412015

Type of Visit: compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: _C)6�outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: ram. Arrival Time: (IC) Departure Time: County: 1 Region:
Farm Name: �1 % �Jii1 �jIju OL Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: �p
Certified Operator:
Back-up Operator:
Title:
Phone:
Phone:
Integrator:
Certification Number: L b
Certification Number:
Location of Farm: Latitude: Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Design C•nrrent
Wet Poultry Capacity Pop.
Layer
jNon-La er I
Design Current
Cattle C+apacity Pug.
Dairy Cow
Dairy Calf
Wean to Feeder
I
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Design Current
D , P,oul Ca aci Po ,
Layers
Non -Layers
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Beef Feeder
[E
Boars
Pullets
Beef Brood Cow
Other
Other
Turke s
Turke Pouets
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 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 LNo 0 NA ❑ NE
❑ Yes J!fNo
❑ Yes JVNo
❑ Yes � No
❑ Yes WNO
o
❑ Yes
❑NA ❑NE
❑ NA ❑ NE
[DNA ❑NE
❑ NA ❑ NE
❑NA ❑NE
Page I of 3 21412015 Continued

Facili Number: 31 - Date of Inspection: Z Z
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
-EzNo
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
12No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): �r
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
P 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
E!fNo
❑ 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
C2-No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
P 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
Er No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes F,�JNo ❑ NA ❑ NE
maintenance or improvement?
11. is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes �o ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes P No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes E?J'No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes E] 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 Z No ❑ NA ❑ NE
❑ Yes allo ❑ NA ❑ NE
_Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes ;�No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes C2-'Iqo ❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes �No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and i" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [ 0
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ,❑ No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facili Number: - Date of Inspection: .2
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 ZfNo ❑ 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?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond . ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes 11-No ❑ NA [] NE
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes .0 No ❑ NA ❑ NE
❑ Yes J'No ❑ NA ❑ NE
❑ Yes allo ❑ NA ❑ NE
❑ Yes P�'No
❑ Yes 0'No
❑ Yes ��<o
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facilityto :better explain situations (use additional pages' as necessary). ".
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: QlG ZF ��z3
Date:
.1412015

Type of Visit: mpliance Inspection 0 Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: �9.I%utine O Complaint O Follow-up O Referral 0 Emergency O Other Q Denied Access
Date of Visit: Arrival Time: eparture Time: County:/ -Region:
Farm Name: Q Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Title:
Latitude:
Phone:
Phone:
Integrator:
Certification Numb r:
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish I
Wet Poultry
ILayer
Design
Capacity
I
Current
Pop.
Design Current
C*attle Capacity Pop.
Dairy Cow
Wean to Feeder
Non -La er
I
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
D . P,oult .
I Layers
Design
Ca aci_
Current
P,o ,
Dry Cow
Farrow to Feeder
Farrow to Finish
Non -Dairy
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turkeys
Turkey Poults
Other
Discharges and Stream [moacts
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 thaf 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 12No ❑ NA ❑ NE
❑ Yes
0No
❑ NA
❑ NE
❑ Yes
J2�No
❑ NA
❑ NE
❑ Yes �]/ 'No
[:]Yes ,TNo
❑ Yes E!rNo
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Ige I of 3 21412014 Continued

Facili Number: -JPS Date of Inspection: Z
Waste Collection & Treatment
,t Is storage capd6ty (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
"'o
F'Po
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): Q
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
LjNo
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
ONo
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
[—]Yes
12-No
❑ NA
❑ NE
S. Do any of the structures lack adequate markers as required by the permit?
[:]Yes
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
JG3-Wo
9. Does any part of the waste management system other than the waste structures require
[:]Yes
Ito
❑ NA
❑ NE
maintenance or improvement?
T
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ):�No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes )2-No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
Zo
❑ 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
PNo
❑ 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
J�allo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
allo
❑ 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 I No
JID-
❑ 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 �o
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes �No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA FINE
❑NA ❑NE
P page 2 of 3
21412014 Continued

Facility Number: Date of Inspection: " fil, 116.
24. Did the facility fail to calibrate waste application equipment as required by the permit?' ❑ Yes jEjNo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes JETNo ❑ NA ❑ NE
the appropriate box(cs) 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 J:?No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes LEI"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 Ef['No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes ,Eno
❑ 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 �ZNo
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
T
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes E] No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes 0 No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes PNo
❑ 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).
_
�S1
10I(I L�f a •ook�
yCC-'f-.
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Pagk 3 of 3
Phone:
Date: Q
2 /20 4

Type of Visit: Compliance Inspection 0 Operation Review p Structure Evaluation O Technical Assistance
Reason for Visit:-GrAoutine O Complaint Q Follow-up O Referral Q Emergency O Other O Denied Access
Date of Visit: Arrival Time: O Departure Time: County: Region:
ir
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator:
Owner Email:
Phone:
Phone:
Integrator:
Certification Number: A2 ka
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Design C*arrent
Swine Capacity Pop.
Design Current
Wet apacity Pop.
Poultry C
Design Current
Cattle acity Pop.
Cap
Wean to Finish
Wean to Feeder
Layer
DairyCow
Non -La er
DairyCalf
Feeder to Finish
Da' Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Design Current
Dr. P,oult . Ca act P,o
Layers
D Cow
Non -Da"
Beef Stocker
Non -Layers
I
113cef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turkeys.
Turkey Poults
Other
Discharnes and Stream Impacts
1. is any discharge observed from any part of the operation? ❑ Yes �allo ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ff No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) ❑ Yes "o ❑ 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 9No
[:]Yes .KNo
❑ Yes j(No
❑ NA ❑ NE
NA ❑ NE
NA ❑ NE
Page I of 3 21412011 Continued

Facili Number: Date of Inspection: Z.
Waste Collection & Treatment
4. 1, 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 ZNo ❑ 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
Z No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
2!fNo
❑ 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
E�J'No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
P�fNo
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes L2rNo
❑ 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?
jo
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes Jam-' 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 [3'No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes JfNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes eNo
❑ 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 ZNo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes. CErNo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
[]Yes EjNo
❑ NA
❑ WE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 12'No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? [:]Yes ETNo
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ,❑ No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facili Number: jDate 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 Tj j❑ 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 ZfNo ❑ 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
L2r$4o
❑ 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
2f No
❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the ❑ Yes
iZNo
❑ 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
ZNo
❑ 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
;3'No
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes
[2rNo
❑ 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).
tia's jud
f )
aoJ
d /
/f z. j__
Reviewer/Inspector Name:
Phone:
Reviewer/Inspector Signature:
Page 3 of 3
Date:
21412011

NCDENP*
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Beverly Eaves Perdue Coleen H. Sullins
Governor Director
July 1, 2010
Anthony Miller
M&G Nursery
2582 E. NC 24
Beulaville, NC 28518
Dee Freeman
Secretary
Subject: Sludge Survey Testing Dates
Certificate of Coverage No. AWS3.10288
M&G Nursey
Animal -Waste Management System
Duplin County
Dear Anthony Miller:
The Division•of Vater Quality (Division) received your sludge Survey information on June-] 4,: :
2010., With -the survey results, you requested an, -extension of the sludge surveyxequirement fort
. the lagoon at -,the M&G Nursery.. Due to•the amount of treatment volume available,Ahe:Division• i
agrees that a sludge survey is not needed unti1.2014 for your lagoon.
The next sludge survey for the lagoon at M&G Nursery facility should be performed before
December 31;:2014.,Thank you for your attention to this matter: Please call me at (949),7.1.5
6937 if you have any questions.
Sincerely,
Miressa D.-Garoma
Animal, Feeding Operations Unit
cc: Wilmington Regional Office,.Aquifer Protection Section
Permit'File AWS310288
163E Mak Service Center, Raleigh, North Carolina 27699-1636
Location: 2728 Capital Bled.. Raie gh. North Carolina 27634
Phore: 919-733-3221 1 FAX: [phone] Customer Service: 1.877-523-6748
Internet: w-*w.n,,water;k€ Mi+v.nm
RJECRIVED'
JUL 0 6 2010
BY:
NOne tliCarolina
,,/ atitt'ally
An 1 noel Ck)mftniN 1 mrirmat�,% Action . innl vet

F�acifity.Number.
Division of Water Quality
O,,Division of Soil and,Water Conservation"
Type of Visit compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit eRoutine O Complaint O Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: f eparture Time: County: Region: 4
fl;K
Farm Name: Owner Email:
Owner Name: I Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone No:
Integrator
0
Operator Certification Number: 2 V6'
Back-up Certification Number:
Latitude: = c = i Longitude: = ° =
=:..�esign
a Swine Capacity
❑ Wean to Finish
'Current Design°Current "° Design _Current
Population Vet Poultry Capacity Population '- Cattle ""Ca aci1'aulation
❑ Layer ❑ Dairy Cow
El Wean to Feeder
❑Non -Layer I
Q Dairy Calf
El Feeder to Finish`
Dairy Heifer
❑Farrow to Wean
❑ Farrow to Feeder"
El Farrow to Finish
El Gilts
❑ Boars
Other
❑ Other
Dry Pool#ry ':F
ElLayers
" ❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
14' ❑ Other
❑ D Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
Number of StreJctures� ""
Discharges & Stream impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes ;?"No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑Yes rNo
�❑NA ❑NE
El Yes ❑ NA ❑ NE
Page 1 of 3 12128104 Continued

Facility Number: - Date of Inspection: G
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
9No ❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
ff 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
rNo .❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
T
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
�o ❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes 9No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes PrNo ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)T�/
9. Does any part of the waste management system other than the waste structures require ❑ Yes I /l No ❑ NA ❑ NE
maintenance or improvement? 7"
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 , 0 No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes �No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes �^�1V' o ❑ NA ❑ NE
acres determination? T
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.
❑ WUP El Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑ YesN/21
❑ Yes ff No
❑ Yes o
❑ Yes No
❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ONO
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
❑ Yes ZNo
❑ Yes jzfNo
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?
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑NA ❑NE
Page 2 of 3
21412011 Continued

Fa6lity Number: Date of Inspection:
24. Dill the facility fail to calibrate waste application equipment as required by the perm ? ❑ Yes g-No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes Po ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes
ff No
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
ONo
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
gNo
❑ 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'0
No
DNA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
�No
[] NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
[ (No
❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
PrNo
❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
�2rNo
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
L3"No
❑ NA ❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments F �,-.
Use drawings of facility to better explain situations (use additional pages as necessary}.
LAI f'+_ N
elfin
7
5 ;6;
Reviewer/Inspector Name:
0- rcCords 1,
Phone:
Reviewer/Inspector Signature:
Date:
Page 3 of 3 21412011

v �liivtsion of Water Quality
Fnclltty,=Nuutber �:Dtvtston of Soil and Water Coasenahoti,
�.
— _-_ -I
Q.:Other`Agency� :�-- � �,.
Type of Visit -$G`ompliance, Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance I
Reason for Visit,4EMoutine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: d
Farm Name:
Owner Name: _
Mailing Address:
Physical Address:
Arrival Time: 1 Departure Time: County:
/1/rlr Owner Email:
Facility Contact: p�}�% Title:
Onsite Representative: %ZC. Z?Zj
Certified Operator:
Back-up Operator:
Location of Farm:
Phone:
Region:
Phone No:
Integrator: m
Zes
Operator Certification Number:
ago
Back-up Certification Number:
Latitude: = o = I = Longitude: = o [= d
Current'" '.
Dessgn Curreutti
Swine
MUesign
Capacity 'Population, Wet 1'otiltry - `Capacity,'Populahon:
] Wean to Finish ❑ Layer [
] Wean to Feeder
❑ Non -Layer
[
] Feeder to Finish
C
] Farrow Wean
to
Dr Poultry
Farrow Feeder
to
ter
Other%
❑ Lavers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
J
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Brood
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ElStructure ElApplication Field ElOther
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3, Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes ONo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
No
Cl NA
❑ NE
❑ Yes ZNo ❑ NA ❑ NE
Page I of 3 12128104 Continued

Fa0lity Number: —ZE Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
VNo
❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA ❑ NE
Strut re 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
VfNo
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not property addressed and/or managed
[]Yes
O 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
PrNo
❑ 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
[To
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
VNo
❑ NA ❑ NE
maintenance/improvement?
IL . Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
VNo
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
[I Yes
,;VNoPNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
�+ 'No
ElNA
[INE
17. Does the facility lack adequate acreage for land application?
❑ Yes
EN o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
0No
❑ NA
❑ NE
Comments (refer to question #) Explain any YES_answers and/or any:i•ecomuiendatio'ns or.any other comments:
Use drawings of facility to better explain situations (use ajddtteonal pages as neeessary).
u ��µ
AL
Phone:
Reviewer/Inspector Name a ti m —
1 ri
Reviewer/Inspector Signature: Date:
Page 2 of 3 1212810 Continued

Facility Number: — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
❑ Yes
P"No
❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
PfNo
❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
UNo
❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V
Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
W"No
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
VNo
❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
LZNo
❑ NA ❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
[2'No
❑ NA ❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
VNo
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
[1No
[I NA ❑ NE
Other issues
11
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
LYNo
❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
PNo
❑ 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
El Yes
�(J No
❑ NA [I NE
General Permit? (ie/ discharge, freeboard problems, over application)
/
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
ONo
❑ NA ❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
No
❑ NA ❑ NE
Additional Comments and/or Drawings:
� 9 7/1C-9 G'
5/ / 1 1162 6,
1z1.261oq 0- G 7
Page 3 of 3 12128104

Type of Visit Q�Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Vissiit Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: t (,! Arrival Time: Departure Time: C� County: Region:%
Farm Name: w �� Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: d1lI / Pr Title: Phone No:
Onsite Representative: n' Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: [= o = = Longitude: =° = C = I[
Design Current
Design Current
Design Current
Swine Capacity Population
Wet Poultry Capacity Population
Cattle Capacity Population
❑ Wean to Finish
❑ La er
❑ Dairy Cow
❑ Wean to Feeder
❑ Non -La er
❑ Dairy Calf
❑ Feeder to Finish
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ Non -Layers
❑Non -La ers
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
❑ Pullets
❑Beef Brood Co
❑ Turkeys
Other
❑ Turkey Poults
❑ Other
Number of Structures:
❑ Other
Discharges & Stream Impacts
l . Is any discharge observed from any part of the operation?
❑ Yes
,0 No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. is there evidence of a past discharge from any part of the operation?
❑ Yes
X0
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
No
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12128104
Continued

Facility Number: — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): �' +
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes XNo ❑ NA ElNE
ElYes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes ONo ❑ NA ❑ NE
❑ Yes,�TNo ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes/ffNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes xJ 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 ❑ WE
maintenance or improvement?
Waste Application ,��
10. Are there any required buffers, setbacks, or compliance alternatives that need El Yes `tJ No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes p No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
ONo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
j No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[:] Yes
No
El
El NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
��, No
[INA
❑ NE
18. Is there a lack of properly operating waste application equipment?
Yes
El!
�o
❑ NA
❑ NE
rwge c vJ Y .".... ,t ..,....... I-

Facility Number: '3 — 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 YNo
❑ NA
❑ NE
the appropirate box. ❑ WUp ❑ Checklists ❑ ❑ Maps
Design
g p El Other
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes /
❑ NA
❑ NE
ElWaste Application ElWeekly Freeboard ElWaste Analysis ElSoil 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 GKo
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes I o
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes XNo
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes P o
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
[INA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
/Plo
ElYes P�<o
❑ NA
❑ NE
Other Issues
/
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes [4o
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
I] Yes /2/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
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
JVNo
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes ;2'�o
❑ NA
❑ NE
General Permit? (ic/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes �No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes ��No
❑ NA
❑ NE
Additional Comments and/or Drawings:.. ,
tAj 4-
J � eew =s 1601r
/cIl%' D
7/-' 911ce
Page 3 of 3 12128104

E
f Visit Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assis=Access
n for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denie
Date of Visit: Arrival Time: /0 • ,3 C Departure Time: County: Regiofl: l' `y
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: /f �yJL" Title:
Onsite Representative: �171/' iWU Z!4
Certified Operator:
Back-up Operator:
Owner Email:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: = o = I = 11 Longitude: = ° =. = 11
� h
El Farrow to Wean
�.
REV 'S':. 4 -', 1< dJ �:..3ff} i`.
■ {
"r�'iy'{s:?'�'
4"�i1Q�`i"t arK3
S} 'a:Ck. '�)�1.'4b Any.
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes ONo
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes ❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes ❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes ❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes -ONo
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes .B'No
❑ NA
❑ NE
other than from a discharge?
12128104
Continued

Facility Number: —a $ S Date of Inspection �l �
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes oNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes O'No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: %
Spillway?:
Designed Freeboard (in): i
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? _ ❑ Yes ZNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes :3No ❑ 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,2No ❑ NA, ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? [:]Yes 4No ❑ 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 eNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 12-No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes )'No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAW?VlP?
❑ Yes
-❑ No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
ONo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination%❑
Yes
RNo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
ErNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[�Ko
❑ NA
❑ NE
N ;'.
Reviewer/Inspector Name v � 4,/ a,` - Phone:
Reviewer/Inspector Signature: L Date: // d
12128104 Continued

14614 Wumber: — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes eNo ❑ NA ❑ NE
20. Does the facility fail to have all components'of the CAWMP readily available? If yes, check ❑ YesEYNo ❑ NA ❑ NE
the appropirate box.
❑ WUP El Checklists El Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes C�-Ko ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes ffNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
,2fNo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
[--]Yes
.[:]No
4B NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
[__1 No
AENA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
E] No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ NA [3<E
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
ENo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
❑"No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
❑"No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
01No
❑ 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
2rNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
❑.No
❑ NA
❑ NE
Additional'Comments and/or Drawings:'"
).s I Yi Vecof s YLent � ot,"Culr
12128104

of Visit . 9F Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit P Routine Q Complaint Q Follow up Q Emergency Notification Q Other ❑ Denied Access
Facility Number r Date ot'4isit: 4 Time: . CI
O Not Operational O Below Threshold
13 Permitted 13 Certified 13RIM;
lly Certified 13 Registered Date Last Opera or A ve Threshold:
Farm Name: 1:�? %l�r County: �u
Owner Name: W _ . Phone No:
Mailing Address:
Facility Contact: _ Title:
Onsite Representative: !?!
Certified Operator:
Location of Farm:
Phone No:
Integrator:
Operator Certification Number: _
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude * 4 46 Longitude • 4 «
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes ,ENO
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes ZNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes EB'No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure l Structure 2 Structure 3
Identifier:
Freeboard (inches): y -5
12112/43
Structure 4
❑ Yes ;3 No
Structure 5 Structure 6
Continued

FacilityNumber: � { � YR Date of Inspection
5.` Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑ Yes ,©No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
❑ Yes O'No
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
`
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
❑ Yes ,0140
8. Does any part of the waste management system other than waste structures require maintenanmrimprovement?
t
❑ Yes ,❑ No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
❑ Yes
elevation markings?
f0'No
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes GD No
11. Is there evidence of over application? If yes, check the appropriate box below.
❑ Yes �ONo
❑ Excessive Ponding ❑ P ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop /.eJ4__,
typePi._�Y' yyl" G 7 Aso k % r rz. r : 74:
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes ONO
14. a) Does the facility lack adequate acreage for land application?
❑ Yes . ) No
b) Does the facility need a wettable acre determination?
❑ Yes JO- io
c) This facility is pended for a wettable acre determination?
❑ Yes ENO
15. Does the receiving crop need improvement?
❑ Yes .®'No
16. Is there a lack of adequate waste application equipment?
❑ Yes 0'No
Odor issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge attor below
❑ Yes ,ONo
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours?
❑ Yes ❑No
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes ET -No
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional
❑ Yes ONO
Air Quality representative immediately.
=Comments (refer ta. ``)sEzpiam sm'` YES aa+ers` 9 or otite toiyui7me�tts.
Use draw�gs4j f W&y to It �s��pl matRotss. {use_addi pages as iy1 Field Copy ❑ Final Notes
_ eT -
COG
_�r� -'9
qV
ReviewerAuspector Name
.mow. �
? In !`
Reviewer/Inspector Signature: Date: VA.2 / =",/-
.12/1VU3 c.osrrnuea

Facility Number: / A- I Date of inspection
1jec uired Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes _12 No
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WLJP, checklists, design, maps, etc.)
❑ Yes --❑ No
23. Does record keeping need improvement? If yes, check the appropriate box below.
© Yes �O-No
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes ,E)'No
25. Did the facility fail to have a actively certified operator in charge?
❑ Yes •O�No
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(iel discharge, freeboard problems, over application)
❑ Yes E'No
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes _ [D-No
28. Does facility require a follow-up visit by same agency?
❑ Yes _Q-No
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes ,0-N6
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
❑ Yes Q-No
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes ❑ No
32. Did the facility fail to install and maintain a rain gauge?
❑ Yes ❑ No
33. Did the facility fail to conduct an annual sludge survey?
❑ Yes ❑ No
34. Did the facility fail to calibrate waste application equipment?
❑ Yes ❑ No
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below.
❑ Yes ❑ No
❑ Stocking Form [:]Crop Yield Form ❑ Rainfall ❑ Inspection After 1" Rain
❑ 120 Minute inspections ❑ Annual Certification Form
12/12103

z'*'zLm. 0. ._ ®Drvtston of Water Qualety /
01D1vtS10n of Sail and -Water GooservakaQ
i Ather Agency s
i _ -• t -
t
Type of Visit 0Compliance Inspection O Operation Review Q Lagoon Evaluation
Reason for Visit O Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number O Date of Visit: I ! bZ Tune: I %QtIzn Pi-inted on: 7/21/2000
c Not Operational 0 Below Threshold
10 Permitted V3 Certifieed [3ConditionallyCertified
[3 Registered Date Last Operated or Above Threshold: ...................
Farm Name: D,rl�Cn�..... �Q✓...C..! ><-[T .N.kry2/�r County: a1 il''.......................................................
Owner Name:... Y./ .5?K......................... !LI.�I.I..P................................................ Phone No..........._........... ..................
..................
Facility Contact: ......................................
Title: ................................................................ Phone No:
MailingAddress: ...._........................................../...........`.._.............._yy................................_............................---....._......�................I....---..................._.... ..........................
Onsite Representative:.._ ...Q.--...L.�P�!.�1............. /!!.: le,..................... Integrator: ..... ../..!�.(trp.h. -....................................
.................
Certified Operator:...................................................... ......... Operator Certification Number: .........................................
Location -of Farm:
AL
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 4 6� Longitude C�' �6 C�«
Design Current Design Current Design Q�rrent
5 due %Capadtv Po ulation . Poultry CapacitV population Cattle.. .. Ca -2' .6 ula6on
s-
a Wean to Feeder Layer ❑ Dairy
Feeder to Finish ❑ Non -Layer ❑Non -Dairy
Farrow to Wean
- - Farrow to Feeder ❑ Other
Farrow to Finish Total-DeMgn Capacity.
s' Gilts
Boars TOM SSLW
Nni® of ❑ Lagoons
Subsurface Drains Present LagoonArea Spray geld Area
t - rends loL d Traits ❑ No Liquid Waste Management System i {
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes �4No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
L If discharge is observed. did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed. what is the estimated Flow in gal/min?
d- Dees discharge bypass a lagoon system'? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes E,No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes RNo
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ...................................................................................................... .....
Freeboard (inches):
5/00 Continued on back

Facility Number: — Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes RNo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes i9 No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
❑ Yes
0 No
8. Does any part of the waste management system other than waste structures require maintenancelimprovement?
❑ Yes
® No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
®•No
Waste APRlicatiOD
10. Are there any buffers that need maintenance/improvement?
❑ Yes
JR No
IL Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
❑ Yes
MNo
12. Crop type 4:%li I in uWL _ li %%a / _gw,11,5 an 6xaeej
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
Q No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
allo
b) Does the facility neea a wettable acre determination?
❑ Yes
RNu
c) This facility is pended for a wettable acre determination?
❑ Yes
UNo.
15.
Does the receiving crop need improvement?
❑ Yes
V,No
16.
Is there a lack of adequate waste application equipment?
❑ Yes
®.No
Required Records & Documents
17.
Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
Q No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
® No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
12 No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
91No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
PgNo
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
RNo
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
® No
24.
Does facility require a follow-up visit by same agency?
❑ Yes
91 No
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes.
® No
To viola iotis:e defeienci #06� nQfe daring this'Aisiti • Yob wild-t&OW 46 WOgtr
i6ries dence:abotutthis visit. .
r a �PP✓ /00r/C 6CtC0r-AdY — Ve" 7L*ik r
eL Feldl,3 101 1- flee ljrphe. -*ngf Cl, e
I&
Reviewer/Inspeetor Name _ .aw _ s��= r _;IV
aw
Reviewer/Inspector Signature: Date: 5100

Facility Number: 31 — Date of Inspection!S
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes JR-No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes RLNo
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes OdNo
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes KI No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes CKNo
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes CRNo
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes UqNo
5/00

x� _ :0"Drvrsion of Soil and Water Conservation =:Operation Review y gyp* �v
r ° Drvrsron of Soil aad Water Conservation Compliance Insgect�on ¢
,IhZlon of Water Qualrty a Compliance Inspection = t_ � R4 :
4 Othel-A in
Routine O Com taint O Follow-uR of DWQ inspection 0 Follow-up of DSWC review 0 Other
Facility Number Date of Inspection
Time of Inspection 24 hr. (hh:mm)
j] Permitted Certified © Conditionally Certified © Registered JE3 Not Opera 4ional.....Date Last Operated: _
Farm Name: .... .5`� .... ���.�. ...... County......��.`1..................................... I.........
Owner Name:
Facility Contact:
Title:
Phone No:
Phone No:
MailingAddress:........................................................................................................................................................................................................ ..........................
Onsite Representative:... .. A. ........................ Integrator: ..... mt.-.,.541!--s.................................................
Certified Operator: .................................................:.............................................................. Operator Certification Number:....: 0�-.1.3�0..>..........
Location of Farm:
i
................ ................. ...... ............... ...........
IV
Latitude ' 6 r---�44 Longitude
Design - Current
.--�wwc
Wean to Feeder
❑ Feeder to Finish
°% ❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
: ❑ Boars
Design - Curr'ent Design Current
Poultry-._ -
Capacity_. Po ulation, . Cattle ;Ca acre Po �ulation;
❑ Layer ❑ Dairy
❑ Non -Layer I ❑ Non -Dairy -
❑ Other
Total Design-tapiic4y.:
Total SSLW,
Number of Lagoons ❑ Subsurface Drains Present ❑ Lagoon Area ❑ Spray Field Area
Holding Ponds/Solid Traps Y ❑ No Liquid Waste Management System
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes 14 No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes Pj No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ()rNo
Waste Collection & Treatment
4. is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes gNo
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: nn
Freeboard (inches): ......... I....`�� ...........................
.................................................................................................................................................................. ..
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes EB�No
seepage, etc.)
3/23/99 Continued on back

e
Facili ty.Number: Date of Inspection
6. Are there structures on -site which are not property addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenancelimprovement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence o over application? ❑ Excessive Ponding ❑ PAN
12. Crop type �.3
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
0: N6-*i6lattgns;o"r• &ficiend'ti s mere noted• 00i ig �his:visit; • Y:oij :will•reeeive lio further .
:. icorresnorideike' abonkthis visit: ::::::: :::............:..: :
[]Yes J�rNo
❑ Yes *0
❑ Yes O�No
❑ Yes X No
El Yes ,N No
❑ Yes kNo
Yes
ONO
❑ Yes
KNo
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
G�No
❑ Yes
XNo
❑ Yes XNo
❑ Yes WNo
❑ Yes CS(No
1
❑ Yes tYNo
❑ Yes fip No
❑ Yes [�'No
❑ Yes jrNo
❑ Yes t�No
❑ Yes O "No
Comments (refer"to question #): Explain any YES answers,and/or.any recommendations or any other eominents _`
g s offac �ty toJlietter.explain siffi ohs (use:adci�tional pages as=necessary) G ,i Use:drawEn„
7S
C'
1366
Revi
ewer/Inspector Name
Name
_ H „
Reviewer/Inspector Signature: Date:

Division of Soil and Water Conservation ❑ Other Agency
Division of Water Quality
14) Routine O Complaint 0 Follow-up of DWQ inspection O Follow-up of DSWC review O Other
Date of Inspection qg
Facility Number
Time of Inspection 24 hr. (hh:mm)
0 Registered JB T Certified 0 Applied for Permit 0 Permitted 10 Not Operational j Date Last Operated:
Farm Name: .......... 6^`�..v......... ML sat ........................................... I........... County:...l......Ll��bN..................................... ................
........
Owner Name :.......... ATiqn.....�.1.�.�.141................................... ...................... Phone No: Lgl�� .'..? R`C........................................
FacilityContact: .............................................................................. Title:................................................................ Phone No:
Mailing Address: ..L.G.4.&...... l. ..............
Onsite Representative:...... r,?.4Acr.,............. ........................
Certified Operator;
Location of Farm:
G......................................... ..� ..........
Integrator:........ guysI ..................................I......I...............
Operator Certification Number, ....../.7)-...............
.......... 5... e.r......:� �.� ,�....� ...... }... : > s.. ,�s�.�.y. ate.:.. s ........................................................................
.... ........I........... ............'........ .......1± ........ ... ................. ...........
Latitude Longitude �• �' 0"
Design Curient
n u
Design . "CurrentDesign CtiirenE
Swine: ' .' _ Ca acit 'Po elation
p y p
,
_•Poultry Capaci Populatian Cattle Capacity =Population
tY
Wean to Feeder
Layer
.,I[:]
Dairy
Feeder to Finish
❑ Non -Layer
❑Non -Dairy
❑ Farrow to Wean
❑Other
❑ Farrow to Feeder
i
❑ Farrow to Finish
Total Design Capacity
Y ❑ Gilts
s
❑BoarsEED
„n Y otal SSL
h:
NiN �uinber of Lagoons 1 Holding Ponds
�'
SubsurfaceDrains Present
❑ Lagoon Area
Spray Feld Area
a .H
❑ No Liquid Waste Management stem r'
Sy
a_ A ,M u
General
1. Are there any buffers that need maintenance/improvement? ❑ Yes [,No
2. Is any discharge observed from any part of the operation? Yes [� No
Discharge originated at: ❑ Lagoon ® Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? Yes P No
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ) ❑ Yes PLNo
c. If discharge is observed, what is the estimated flow in Cal/min?
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 ® No
4. Were there any adverse impacts to the waters of the State other than from a discharge? ❑ Yes JS No
5. Does any part of the waste management system (other than lagoons/holding ponds) require ❑ Yes [% No
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes %No
7. Did the facility fail to have a certified operator in responsible charge? ❑ Yes fig No
7/25/97 Continued on back

Facility \umber:
8. Are there lagoons or storage ponds on site which need to be properly closed? ❑ Yes ,No
Structures f Lapoons.11oidine Ponds, Flush Pits, etc.?
9. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard (ft): ...........�:...Q.......
10. Is seepage observed from any of the structures? ❑ Yes 01 No
11. 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 D`YQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
Waste Application
14. Is there physical evidence of over application'?
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type ............... DvY.1L ijJ—i............................................................................... ....................................... ......................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
22. Does record keeping need improvement?
For Certified or Pertnitted 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'!
[]Yes ® No
❑ Yes No
❑ Yes No
❑ Yes [$ No
t
....................................................
'eyes %Igo
❑ Yes jM No
No.violations or deftciencies.were noted -during' this. visit. Aou.will receive no further
coerespoeidence about this visit'.,'.'.'
,;4 Yes ❑ No
❑ Yes ERNo
❑ Yes tA`o
❑ Yes 14 No
PZ Yes ❑ No
❑ Yes 51 No
'p Yes 10 No
❑ Yes ❑ No
M
Coinments�(refei•_to, question #) lExplatn, any YES answers andlor any recommendations or any other comments.
Use drawings of facility'to better'explain situations. (use additional'pages as. necessary)
HE
AL
3. flax i,u�,�I rcti( 60l4. QoLstL s I + �u� C.VO.4 °`�m rx i h 54D( n• wk#u-
r1i`�►Vr5Z1or.. No C� ,sS y > W11L 0� Qu t Sjr&. NV%-TtcV At. kitLv f, bbck
p�tVt4-tfart -4 )or-Wo.S�e- lv3-0 t"OCA, (IWc e n_ M I
Gro t S�1pi r. brae+ 15-94 J ere Z i :n � o� 31 S D � t.
2Z . L,,�e � $ r(ro,ri i ttif � C-Dtfrte, `i lt� �c tr 4 rpA S {b Ipv1r� �
�MIJ 7/25/97
n
Reviewerflnspector Name �4 :
r
Reviewer/Inspector Signature: Date:

DSWC Animal Feedlot Operation Review
DWQ Animal Feedlot Operation Site Inspection
0 Routine 0 Complaint 0 Follow-up of [MI ) inspection O I'ollo.S-u of DSWC review 0 Other
Date of Inspection $
Facility Number 2
Time of Inspection 13'Od D 24 hr. (hh:mm)
Total Time in fraction of hours
Farm Status: ❑ Registered ❑ Applied for Permit (ex.1.25 for I hr 15 min)) Spent on Review
® Certified ❑ Permitted or Inspection (includes travel and processing)
10 Not O erational Date Last Operated: ........ ....................................................................... ....................
FarmName:.......... `i . ...... Q[Yta..................... ..................................... County :........ .1 11'............................. I ....... ..... I.................
Owner Name:........ 604A wl izi- ........... ................................... ..................... Phone No: �al��. %$.-.. 3l0....................................
Facility Contact: ... ti1�l.......1►�.i.�.�l�...... hit le:......4C......... Cq o1 Z�.A...... ..
Phone No:.....
Mailing Address:... ��?.........5....Clld]. :................................... e. .. y.... ..... JAk11.4-t....N .........V......
Onsite Representative:...... ` 46&40n niltw.......................................................... Integrator:.... !f 1..............................................................
Certified Operator: ......... mi l(tatl......1C:.....kllity�........ ........ Operator Certification Number:..:.n
...........................
Location of Farris:
..........UL'!-�,........y............ Qc5 ......................... ...(1...Q.fi.. •.......
............................................................................................................................................. ................ ................................................................ I..................................
Latitude©c ®:c Longitudes
Type of Operation
Swine
Design Current
Design • Current'; Design ,Current
Capacity Population Poultry Capacity. Population . Cattle : s: Capacity Population
Wean to Feeder
2400
ff Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Other
Number of Lagoons /Holding Ponds -� Subsurface Drains Present ❑ Lagoon Area Spray Field Area
General
1. Are there any buffers that need maintenance/improvement? ❑ Yes Sa No
2. Is any discharge observed from any part of the operation? ❑ Yes Wo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If dischar-e is observed, was the conveyance man-made? ❑ Yes PR No
b. If discharge is observed, did it reach Surface Water'? (If yes, notify DWQ) ❑ Yes EANo
c. If discharoe is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ipNo
3. Is there evidence of past discharge from any part of the operation? ❑ Yes JANo
4. Were there any adverse impacts to the waters of the State other than from a discharge? ❑ Yes No
5. Does any part of the waste management system (other than lagoons/holding ponds) require ❑ Yes No
maintenance/improvement?
4/30/97
Continued on back

Facility Number: — Z
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
[ZNo
7. Did the facility fail to have a certified operator in responsible charge?
❑ Yes
RNo
8. Are there lagoons or storage ponds on site which need to be properly closed?
❑ Yes
F No
Structures (Lagoons. and/or Holding fonds)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
❑ Yes
93 No
Freeboard (ft): Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Structure 6
............-4X4............................................................................................ ................................... .... ... ..............................
..... ... I ...........................
.
10. Is seepage observed from any of the structures?
❑ Yes
�O No
11. Is erosion, or any other threats to the integrity of any of the structures observed?
❑ Yes
[r No
12. Do any of the structures need maintenance/improvement?
ffYes
❑ 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
BNo
Waste Application
14. Is there physical evidence of over application'!
❑ Yes
ER No
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type ...........COP... 4............1my- yuO0......................................................................................................................................................................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
❑ Yes
QFNo
17. Does the facility have a lack of adequate acreage for land application?
❑ Yes
®'No
18.
Does the receiving crop need improvement?
❑ Yes
04 No
19.
Is there a lack of available waste application equipment?
❑ Yes
[&No
20.
Does facility require a follow-up visit by same agency?
❑ Yes
�?No
21.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
KNo
For Certified Facilities Onl
22.
Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑ Yes
I1KNo
23.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
Yes
❑ No
24.
Does record keeping need improvement?
2 Yes
❑ No
t Z j tntur av6— Wo4k 5 ok' (01co. 561d be-- t,.tot e3. Em; ar_ Cut 6 '
P um � 56vt� be �i`1W walk cUuf pe skwjo ioc.
co►�-
n t r� � i {� o a G v yh 0V} ef� i v1 '�Q�.�- ►'1aY I�U�'1 V c a � `Cr�� �JaS� �}�-i � tZ-�ti�-i olti P",
s6A be- w�ufed k�r- e.esrre.J cLc5rt. cs A,v%J "s Ct^ i4ii-se- (4elk .
Ca-. t°!fll
�{% i�GCX'�Jg Ss'tO�dtCJ CO(Yt�S�1� WtiCv�— tt U �l1 ��OY� ��G YId1tJhhtn,
Reviewer/Inspector Name
Reviewer/Inspector Signatt
cc: Division of Water Quality, Water Quality Section, Facility Assessment Unit 4/30/97

State of North Carolina
Department of Environment,
Health and Natural Resources
James B. Hunt, Jr., Governor
Jonathan B. Howes, Secretary
November 13, 1996
Gordon Miller
Gordon Miller (M&G)
2626 E NC 24
Beulaville NC 28518
SUBJECT: Operator In Charge Designation
Facility: Gordon Miller (M&G)
Facility ID#: 31-288
Duplin County
Dear Mr. Miller:
Senate Bill 1217, An Act to Implement Recommendations of the Blue Ribbon Study
Commission on Agricultural Waste, enacted by the 1996 North Carolina General Assembly,
requires a certified operator for each animal waste management system that serves 250 or more
swine by January 1, 1997. The owner of each animal waste management system must submit a
designation form to the Technical Assistance and Certification Group which designates an
Operator in Charge and is countersigned by the certified operator. The enclosed form -must be
submitted by January 1, 1997 for all facilities in operation as of that date. Failure to designate a
certified operator for your animal waste management system is a violation of 15A NCAC 2H
.0224 and may result in the assessment of a civil penalty.
If you have questions concerning operator training or examinations for certification, please .
contact your local North Carolina Cooperative Extension Service agent or our office.
Examinations have been offered on an on -going basis in many counties throughout the state for
the past several months and will continue to be offered through December 31, 1996.
Thank you for your cooperation. If you have any questions concerning this requirement please
call Beth Buffington or Barry Huneycutt of our staff at 919/733-0026.
Sincerely
A. Preston Howard, Jr., P.E., Director
Division of Water Quality
Enclosure
cc: Wilmington Regional Office
Water Quality Files
AW
P.O. Box 27687. V 4
Raleigh, North Carolina 27611-7687 NvfCAn Equal Opportunity/Affirmative Action Employer
Voice 919-715-4100 50% recycled/ 1 (Y% post -consumer paper

ANIMAL WASTE MANAGEMENT PLAN CERTIFICATION FOR EXISTING FEEDLOTS
Please return the completed form to the Division of Environmental Management at the address on the
reverse side of this form.
Name of farm (Please print) : f U�; — N
Mailing Address: a to A LQ_F__ JV C. 14 Beftlelijille Nr. Q9518'
Phone No.: 1 b- aq 8 — 31e9R_
County (of farm): nuplw
Farm location: Latitude and Longitude: Ji° _S LFo / Z'L` ,SPi' (required). Algo, please attach a
copy of a county road map with location identified.
Type of operation (swine, layer, dairy, etc.) : S 1.l}iNto
Design capacity (number of animals) : Q10 D b Wean -lro Fp eri2R
Average size of operation (12 month population avg.):
Average acreage needed for land application of waste (acres)
Technical Specialist Certification
As a technical specialist designated by the North Carolina Soil and Water Conservation Commission pursuant
to 15A NCAC 6F .0005, I certify that the existing animal waste management system for the farm named
above has an animal waste management plan that meets the operation and maintenance standards and
specifications of the Division of Environmental Management and the USDA - Soil Conservation Service
and/or the North Carolina Soil and Water Conservation Commission pursuant to 15A NCAC 2H.0217 and
15A NCAC 6F .0001 - .0005. The following elements and their corresponding minimum criteria have been
verified by me or other designated technical specialists and are included in the plan as applicable: minimum
separations (buffers); adequate quantity and amount of land for waste utilization (or use of third party);
access or ownership of proper waste application equipment; schedule for timing of applications; application
rates; Ioading rates; and the control of the discharge of pollutants from stormwater runoff events less severe
than the 25 - year, 24 - hour storm.
When;:._ :=::_ . - - - ..._ - - :a ►r conditions/exceptions.
Name of Technics- .BILLY.W: HOUSTON..
Affiliation (Agency): DUPLIN-S 8i W CONSER. DIST:
(g y)' PO -BOX 277-KENANS'VTLLE NC':, -;'�
Address (Agency):_. F Phone No.: Q�0-196
Signature: Q _ = Date:
Owner/Manager Agreement
I (we) understand the operation and maintenance procedures established in the approved animal waste
management plan for the farm named above and will implement these procedures. I (we) know that any
expansion to the existing design capacity of the waste treatment and storage system or construction of new
facilities will require a new certification to be submitted to the Division of Environmental Management
before the new animals are stocked. I (we) also understand that, there must be no discharge of animal waste
from this system to surface waters of the state either directly through a man-made conveyance or through
runoff from a storm event Iess severe that the 25-year, 24-hour storm. The approved plan will be filed at the
farm and at the office of the local Soil and Water Conservation District.
Name of La n r (P i 1 e L
Signature , _ • Date:
Name of Manager; t if different from owner (Please print)::-._ - — -
Signature: :.. _- - -- -' Date:
RECEM
Note: A change in land ownership requires notification or a new certification (if the approved plan is changgMbRs4349% to the Division of
Environmental Management within 60 days of a title transfer.
FACILMES ASSESSMENT UNIT
DEM USE ONLY: ACE# `-oo0 76C

.rv-, kly
_q

REGISTRATION FORM FOR ANIMAL FEEDLOT OPERATIONS
Department of Environment, Health and Natural Resou
Division of Environmental Management
Water Quality Section
s�
t�OV
ig93
QU.�'_1TY
P�anr.ir%
If the animal waste management system for your feedlot operates
is designed to serve more than or equal to 100 head of cattle,
horses, 250 swine, 1,000 sheep, or 30,000 birds that are served
by a liquid waste system, then this form must be filled out and
mailed by December 31, 1993 pursuant to 15A NCAC 2H.0217 (c) in
order to be deemed permitted by DEM. Please print clearly.
Farm Name: M & G Nursery
Route 1 Box 258
Beulaville, NC 28518
Duplin County 919-298-3694(H)
Owner(s) Name: r a,ez:�1711 III L_L911e,
Manager (s) Name:
Lessee Name:
Farm Location (Be as specific as possible: road names,,
direction, milepost, etc.):�-�-� r'��• f- ___ �-
Latitude/Longitude if known: QBSP # 24-003-22-06
Design capacity of animal waste management system (Number and
type of confined animals) :Gd6 e�-c_e_.[��J�
Average animal population on the farm (Number and type of
animal (s) raised) : e ad ' c, )
Year Production Began: JA.J� i 9y� ASCS Tract No.:
Type of Waste Management System Used:
Acres Available for Land Application of Waste: _ 12, A
Owner (s) S ignature (s) ; Date: 7 2 t- S 3
Date:
(Carl Avery, Serviceman)
31- af5g

'State of North Carolina
Department of Environment,
Health and Natural Resources
Division of Environmental Management
James B. Hunt, Jr., Governor
Jonathan B. Howes, Secretary
A. Preston Howard, Jr., P.E., Director
November 17, 1993
Gordon Miller
Rt. 1, Box 258
Beulaviile NC 28518
Dear Mr. Miller.
INX.AA PAeh"'
A14 so
AMA m
ID FE F1
This is to inform you that your completed registration form required by the recently
modified nondischarge rule has been received by the Division of Environmental Management
(DEM), Water Quality Section.
On December 10, 1992 the Environmental Management Commission adopted a water
quality rule which governs animal waste management systems. The goal of the rule is for
animal operations to be managed such that animal waste is not discharged to surface waters .
of the state. The rule allows animal waste systems to be "deemed permitted" if certain
minimum criteria are met (15A NCAC 2H .0217). By submitting this registration you have
met one of the criteria for being deemed permitted
We would like to remind you that existing feedlots which meet the size thresholds
listed in' the rule, and any new or expanded feedlots constructed between February 1, 1993
and December 31, 1993 must submit a signed certification form to DEM by December 31,
1997. New or expanded feedlots constructed after December 31, 1993 must obtain signed
certification before animals are stocked on the, farm. Certification of an approved animal
waste management plan•can be obtained after the Soil and Water Conservation Commission
adopts rules later this year.
We appreciate you providing us with this information. If you have any question about
the new nondischarge rile, please contact David Harding at [phone].
Sincerely,
Steve Tedder, Chief
Water Quality Section
P.O. Box 29M. Rdelgh, North Carolina 27626-0635 Telephone [phone] FAX [phone]
An Equal Opportunity Affirmative Action Employer 50% recycled/ 10% post -consumer paper

Site Requires Immediate Attention:
Facility No. 3 _- Z $ 8
DIVISION OF ENVIRONMENTAL MANAGEMENT -
ANIMAL FEEDLOT OPERATI NS SITE VISITATION RECORD
DATE: 1995
Tim :
Farm Name/Owner: 6 cL r w �' 4� f
Mailing Address: r4 O a e-
County:
Integrator: Phone: !< t� % oC I
On Site Representative.- rt 4.._ Phone:
Physical Address/Location:
Type of Operation: Swine' Poultry Cattle
Design Capacity: 0 Number of Animals on Site:
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: Longitude: ' n 2- 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) or No Actual Freeboard: Ft. Inches
• Was any seepage observed from the lagoon(s)? Yes,or o Was any erosion observed? Yes o To
Is adequate land available for spray? Yes or No Is e cover crop adequate? Yes or No
Crop(s) being utilized:
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings? Yes o
100 Feet from Wells? j]Yes/or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or D
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue ine? Yes or�
Is animal waste discharged into waters of e state by man-made ditch, flushing system, or other
similar man-made devices? Yes or o If Yes, Please Explain_
Does the facility maintain adequate waste management records (volumes of ure, land applied,
spray irrigated on spec xc a eage with cover crop)? Yes or N
Additional Comment Gc h f / _e O [� 3 t° !t.
2 a / e r17 r h-L
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ha:Y L44
Inspector Name S&e
cc: Facility Assessment Unit
Use Attachments if Needed.