310297_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental Qua

Type of Visit: WC mpliance inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: Routine 0 Complaint O Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: I'j2_j2jJ IIIArrival Time: ! � Departure Time: County: DU 1 IV-, Region: 4 �Q
Farm Name: 2. Owner Email:
Owner Name:
Mailing Address:
Phone:
Physical Address:
Facility Contact: V-4 Title: Phone:
Onsite Representative: integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Certification Number:
Longitude:
Swine
Wean to Finish
Design Current
Capacity Pop.
Design Current' Design Current
Wet Poultry Capacity Pop. Cattle Capacity Pop.
Layer Dairy Cow
Non -La er I Dairy Calf
Wean to Feeder
Feeder to Finish
Design C*urreut
D.. P,©ult , Ca act
Layers
Non -La ers
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Dry Cow
Non-Dai
Beef Stocker
Beef Feeder
Gilts
Boars
Pullets
Beef Brood Cow
Other
Other
Turkeys
Turkey Poults
Other
Discharges and Stream impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes (K No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWR) ❑ Yes ❑ No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes X No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes [KNo ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 21412015 Continued

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

Facili Number. - ' Date of Inspection: ZI
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [] No ❑ NA NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑ No ❑ NA NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes ❑ No ❑ NA'
NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [] Yes [] No ❑ NA NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
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)
[—]Yes [—]No ❑ NA [ NE
[:]Yes [—]No ❑ NA [WNE
❑ Yes ❑ No ❑ NA kNE
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below. ❑ Yes [] No
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes ❑ No
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes ❑ No
34. Does the facility require a follow-up visit by the same agency? MYes ❑ No
❑ NA X NE
❑ NA XNE
❑NA ❑NE
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_.
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Reviewer/Inspector Name: Phone:
Reviewer/Inspector Signature: Date:
Page 3 of 3
21412015

Type of Visit: j2rcompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 0 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time Departure Time: County: Region:
Farm Name: 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 Number:
Certification Number:
Longitude:
Design C«urrent
Swine Capacity Pap.
Wean to Finish
Wet Poultry
La er
Design
Capacity
Current
Pop.
Design
Cattle Capacity
Dairy Cow
Current
Pop.
Wean to Feeder
Non -La er
D , P,ouIit
WDn
C+urrent
P,o
Dairy Calf
Dairy Heifer
D Cow
Non -Dairy
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turkeys
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWR)
❑ Yes ONo ❑ NA ❑ NE
❑ Yes
VrNo
❑ NA
❑ NE
Yes
VNo
❑ 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 ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ 'Yes ZfNo ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes �rNo ❑ NA 0 NE
of the State other than from a discharge?
Page I of 3 21412015 Continued

Facili Number: - Date of Inspection:
Waste C � Ilectio & Treatment
4. Is stor ge capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes �TNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes FfrNo ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: f
Spillway?:
Designed Freeboard (in).
Observed Freeboard (in): 3r
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ATNo ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes �No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes ,/ o ❑ NA [3 NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes �f No ❑ 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 dNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ONo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
�No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
5 No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
j2]"No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
EfNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
[:]Yes
E3o
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
❑'Ro
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
��o
❑ NA
❑ NE
the appropriate box.
T
❑WUP ❑Checklists ❑Design ❑Maps []Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
[:)Yes
❑"No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
[-]Yes
fNo
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[ qo
❑ NA
❑ NE
Page 2 of 3
21412014 Continued

Facility Number: jDate of Inspection: 12,1
24. Did the'racility fail to calibrate waste application equipment as required by the permit? ❑ Yes ;2No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes 4E�No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
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 C2'lsfo ❑ NA ❑ NE
❑ Yes [a'Ro ❑ NA ❑ NE
❑ Yes �>o ❑ NA ❑ NE
❑ Yes P No ❑ NA ❑ NE
❑ Yes 12-No ❑ NA ❑ NE
❑ Yes J?TNo ❑ NA ❑ NE
❑ Yes ,❑'R o
❑ Yes ETNo
❑ Yes 0 No
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
Reviewer/Inspector Signature: Date:
41
Page 3 of 3 2/4/20 S

Type of Visit: _,G�-C-ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: —0-9-outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: y' 1r7 Arrival Time: Departure Time; County• Region:
Farm Name: �T �KC.16c"' Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
OnsiteRepresentative: �I�o &(�,,�
Certified Operator:
Back-up Operator:
Location of Farm:
Title:
Latitude:
Phone:
Integrator:
Certification Number:
Certification Number:
Longitude:
Design Current
Design
Current
Design Current
Swine C*apacity . Rop.
Wet Poultry
Capacity
Pop.
C►attle
Capacity
Pop.
Wean to Finish
Layer
Dairy Cow
Wean to Feeder
Non -La er
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
Dr, P,oWtrf
Ca aci
P,o ,
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Soars
Pullets
Beef Brood Cow
Turkeys
Other
Turkey Poults
Other
Other
Discharees and Stream Imuacts
1. Is any discharge observed from any part of the operation? ❑ Yes_,EjNo ❑ 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 DWR) ❑ Yes E5 No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR) ❑ YeVjf No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes ,� No❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes � —❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 21412015 Continued

Facili Number: - Date of inspection:
Waste C.Ilection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes La No ❑ 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: r 3
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): � 2 - 3
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes ,0 No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes/ No
❑ 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 D No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes ETNo
❑ 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 2]-No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes [�:1 No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes [�r No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals
(Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes ❑ No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [;3-No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes 2rNo ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Reauired Records & Documents
❑ Yes ❑' No ❑ NA ❑ NE
[:]Yes �o ❑ NA ❑ NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
El -No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
,Q-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
[i] No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather
Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
�o
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
[:]Yes
❑ No
❑ NA
❑ NE
Page 2 of 3 21412014 Continued

Facility Number: Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes Jallo
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes Lddo
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 E T o
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes 13No
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑NA ❑NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
[:]Yes �i�To ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
[:]Yes �o ❑ 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 C314o ❑ 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 �To ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes [allo ❑ NA ❑ NE
33. Did the Reviewer/Inspectot fail to discuss review/inspection with an on -site representative?
❑ Yes E3'No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes e'No ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or. any other comments.
Use. drawings of facility to better explain situations (use additional pages as necessary).
` min e %L,-C11J lr
scl p
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: -7-6 7f 2
Date: �
//,r--
1141244

Type of Visit: 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 0 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: ( Arrival Time: /0�0G eparture Timer County: Region:
Farm Name: j�1kdtr \ Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: L4, IL Q L',
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator:
Certification Number:
Certification Number:
Longitude:
Design
Swine Capacity
Wean to Finish
Current
Pop.
Design Current
Wet Poultry Capacity Pop.
Layer
JNon-Layer I
Cattle
Dairy Cow
Dairy Calf
Design Current
Capacity P.
Wean to Feeder
I
Feeder to Finish
Farrow to Wean
Design Current
D , P,oul Ca aci P,o .
Layers
Dairy Heifer
Dry Cow
Farrow to Feeder
Farrow to Finish
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other HOther
Turkeys
Turkey Poults
Discharees and Stream Impacts
T. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes./n No ❑ NA ❑ NE
❑ Yes e6No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWQ) ❑ Yes 4No ❑ 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 J�!J`No ❑ NA ❑ NE
❑ YesNo ❑ NA ❑ NE
❑ Yes ��No ❑ NA ❑ NE
Page 1 of 3
21412011 Continued

Facility Number: I;? / - 0- —7 IDate of Insnection:
Waste Collection & Treatment '
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes O—No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: 21&3-
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes J[] No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes P No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes 0 No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit? [:]Yes ETNo
❑ 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 J2 No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes �2No
❑ 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 4 No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes Z No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes ZNo ❑ 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 No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the 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 O 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 Z No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes jn No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes p No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit. ❑ Yes 2rNo
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ['No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No
Other Issues
❑ NA [] NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes JZ 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 ;n No
❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes No
❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes No
❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes 21"No
❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes JZNo
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes qNo
❑ 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 exulain situations (use additional napes as necessarv).
�ugz
G• �/ a r83
Reviewer/Inspector Name:
halln fi rPei7l-Cf5 //I
�G✓l TlPf e
Phone:
Reviewer/Inspector Signature: 1 1Z '1111" Date:
Page 3 of 3 2
r

l>•/
-e'bEvts�on of Water Quality � �� °'�
Faciilty:Mu'M' bCr a Dwision of Soil and Water Conser�'agon `"
= i
then Apien.cy
Type of Visit 06ompliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit PeRoutine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: Arrival Time: E� Departure Time: County: Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
//,Onsite Representative: . — I - I — —
Certified Operator:
Back-up Operator:
Location of Farm:
Owner Email
Phone:
/Phone No:
Integrator: 1�'I
Operator Certification Number:
Back-up Certification Number:
Latitude: [_—] o [—]' [—] Longitude: [= ° [= , =
m.
Design
Current, mDes>g© Current Desrgn Curre`nE
wine Capacity
Population a Wet Poultry Capacity Popctlatton
Cattle:xCapacity pulation
,
❑ Layer
❑ Dairy Cow
❑ Non -La er
Z ❑ DairyCalf
%:
❑ Dairyheifer
p
Dry Poult ' �' � "` ��
�,El Dry Cow
-
_
; ❑ Non -Dairy
❑ Beef Stocker
w
e' ❑ Beef Feeder
❑ Beef Brood Cow
y� Others ;''
z
= ❑ Other
3
`Number of 5truc#ores
❑ Wean to Finish
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
❑ Layers ---
❑ Non-Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
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 12No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
[:]Yes
1�3`No
❑ NA
❑ NE
❑ Yes
L1 No
❑ NA
❑ NE
Page I of 3
12/28/04 Continued

Facility Number: Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yeso
t
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [:]Yes RNo
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
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑NA ❑NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
[] Yes .0No
❑ 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 ONo
❑ 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 )2 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 Feno
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes ETNo
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes J' No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes 12 No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other.comments
Use -drawings of facility to better explain situations (use additional pages as necessary).
° & j'O
P ZA/e -6 r 6 &91�
P1 A
V%/s flees ✓
,S Glle j 6(re-'/ 60
k a ck'
7 /;//i2 � J'e G0✓-o�s �110� �ae�
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date: (O
A41211

Facility Number: -a Date of Inspection:
Waste Collection & Treatment
4. Is storhge capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA [3NE
a. If yes, is waste level into the structural freeboard? [:]Yes No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: 3
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): � 3-7
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes No ❑ NA ❑ NE
waste management or closure plan? TTTTTT
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement? T
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need [] Yes 0 No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes 14 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 d No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes VNo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes Vj No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Required Records & Documents
l9. 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
0 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 O No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes W(No D NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 0 No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

.�Dtvtston of Water QuaLty �� � ,,� � s
Facility' Number f a� 0 Dtvtsidn of Soil, and Water Conservation
g 1
they Agency,
Type of Visit Com liance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 67IRoutine O Complaint O Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: p2 Arrival Time: Q aperture Time: County: Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Phone:
Facility Contact: Title: Phon
e
No:
Onsite Representative: � � ______ integrator: rn
Certified Operator: Operator Certification Number:
Back-up Operator:
Location of Farm:
Back-up Certification Number:
Latitude: = 0 = i Longitude: = o , =
11
Destgn Currentu Design Current
* Design Current
Swttie Ca act P , Wahop_ 6•,Wet Poultrv�' Ca aciw Po ulation.4� Cattle r Capacity Population
p P
..
,P
�
❑ Wean to Finish
a ❑ Layer
❑ Dairy Cow
"' ❑ Wean to Feeder
❑ Non -Layer
E]Dairy Calf
❑ Feeder to Finish
tag,
❑ Dairy Heifer
❑ Farrow to Wean4
Dry Poultry'
. ❑ Dry Cow
Farrow to Feeder
ElElFarrow
'' '°
r. ❑ Non -Dairy
to Finish
❑ Layers
m; Beef Stocker
El Gilts
❑ Non -Layers
❑ Beef Feeder
LL ❑ Boars=
❑ Pullets
Brood Co
❑❑Beef
Turkeys
Other�, O T urkey Poults,
q ❑ Other.
❑ Other
umoerlof Structures:
m
7777777
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 JZ`No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
P63o
❑ Yes
N
❑ NA
❑ NE
❑ Yes
VNo
❑ NA
❑ NE
Page 1 of 3 12128104 Continued

Facility Number: Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes bNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes o No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes qNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes fiTNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 27No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes ;allo
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes "o
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes PNo
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes 4 No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes %oNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
[I 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
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
/ffNo
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes J No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes ZNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes ,Z] No
❑ NA
❑ NE
Additional Comments and/or Drawings: ,.
9/
d, 4;301
CG r % ��•'�
y ,
y
Page 3 of 3 12128104

Facility Number• — Date of Inspection
AAA Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes �No ❑ NA ElNE
a. If yes, is waste level into the structural freeboard? ❑ Yes ZfNo ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: / 2 3
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): a
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes P'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 ZO No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks) ,�No
9. Does any part of the waste management system other than the waste structures require ❑ Yes,ONo
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes EfNo
[DNA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ;2(No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 1 O 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?
'ONo
❑ Yes .�no
❑ NA
❑ NE .
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes 2r No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes�No
❑ NA
❑ NE
18. is there a lack of properly operating waste application equipment?
❑ Yes �Vo
❑ NA
❑ NE
Comments (refer to question ft Explain any YES answers, and/or any.recommendario;ns or�any other comments
a
Use drawings of facility to better explain situations. (use additional pages as necessary):
IReviewerlInspector Name =j Phone:
Reviewer/Inspector Signature: Date: � od &d
Page 2 of 3
Continued

-G7 t�ivision of Water Quality
Facility Number 3 Q - O Division of Soil and Water Conservation
O Other Agency
Type of Visit 7compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technica=Assistance
Reason for Visit�Routino OComplaint OFollowup 0Referral OEmergency 0Other ❑
Date of Visit: Arrival Time: / �00, Departure Time: County: Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: ZV
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Gilts
Other
❑ Other
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: = o = 4 Q Longitude: = ° = t
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -La et
Dry Poultry .
Non-L
Pullets
Poults
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocket
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures:
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes [ *o ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes ❑ NA ❑ NE
❑ Yes 2 No ❑ NA ❑ NE
12128104 Continued

[Facility Number: 3 -61 Date of Inspection O
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes �No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ICI No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: f/
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):y2 I« 3 3
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes eNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes 1KNo ❑ 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 ONo ❑ 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 4No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 16No ❑ NA ❑ NE
maintenance/improvement? ,/
11. Is there evidence of incorrect application? If yes, check the appropriate box below. El Yes U No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind 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 y�No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes ETNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes ZNo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes Z No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
[:]Yes ,0 No
❑ NA
❑ NE
Reviewer/Inspector Name L/ Phone:
Reviewer/Inspector Signature: Date:
,Page 2 of 3 12128104 Continued

Facility Number: Date of Inspection i3` cT G
Renuired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes fNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ONo ❑ 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 2f No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections [:]Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
�YNo
❑ NA
❑ NE
-23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
EfNo
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
CJ No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
ErNo
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
ONo
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
E!fNo
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
J21 No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
ONo
❑ 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
,, {
CJ 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
t! No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
dNo
❑ NA
❑ NE
12128104

Type of Visit compliance Inspection O Operation Review O Structure Evaluation
Reason for Visit Routine O Complaint O Follow up O Referral O Emergency
Date of Visit:
Farm Name: / Pll
Owner Name:
Mailing Address:
Physical Address:
Departure Time:
Owner Email:
Phone:
O Technical Assistance
O Other ❑ Denied Access
Region:
Facility Contact: r Title: Phone No:
Onsite Representative: Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator:
Location of Farm:
Back-up Certification Number:
Latitude: = o = I 0 11 Longitude: = ° ❑ 4
Design
Current
Design Current Design Current
et Poultry Capacity Population Cattle Caacity Populationan
to Finish
r
❑ La er
❑ Dai Cow
an to Feeder
❑ Non -La er
❑ Dai Calf
der to Finish
❑ DairyHeifer
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
Dry Poultry
❑ La ers
❑ Non -Layers
❑❑Beef
Pullets
❑ D Cow
❑ Non -Dairy
❑ Beef Stocker
Feeder
Gilts
POBoars
❑ Beef Brood Co
❑ Turkeys
❑ Turkey Poults
❑ Other
Other.
❑ Other
Number, of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes PT'No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ONo ❑ NA ❑ NE
❑ Yes �No ❑ NA ❑ NE
Page 1 of 3 12128104 Continued

Facility Number: ' — Date of Inspection / D
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ YesJ;3'No
❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes ❑ No
❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: C7 `
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 7d
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
/ZNo
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes P-fgo
❑ 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 ONo
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ yes ,Q No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes ZNo
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes ZNo
❑ NA ❑ NE
maintenance/improvement?
11, Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes./[jNo
❑ 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,0 No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes PNo
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination? El Yes ZNo
17. Does the facility lack adequate acreage for land application? ❑ Yes R(No
18. Is there a lack of properly operating waste application equipment? ❑ Yes 2No
❑NA [I NE
❑NA [I NE
❑ NA ❑ NE
El NA El NE
Reviewer/Inspector Name j U Phone:
Reviewer/Inspector Signature: Date: O
poop 2 of 3 12128104 Continued

r'
Facility Number: j — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ONo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes �TNo ❑ NA ❑ NE
the appropiate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. 0 Yes #9 No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
PNo
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
JZ'NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
[:]Yes JZNo
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
.0Yes ❑ No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes )ErNo
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes 0 No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes /0 No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes 0 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 ;3'No
❑ NA
[__1 NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/]nspector fail to discuss review/inspection with an on -site representative?
❑ Yes P-No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes ❑ No
❑ NA
❑ NE
Additional Comments and/or
a S�° o S u LSu i v .a 00
bJee: �e S1 SUIf1%
0, 6 7 � y �3
- CaIIto flens °* a ...
- Cu{ren�l� stw"JeiQ
ever q �/��r ca t 6��# n
f.v a s it every o44-er Year
Nc3 Saki ,(,Qf d r t 4C alao`7.
jacd lee-careey ^a-4
67 r IV .
Page 3 of 3 12128104

Type of Visit VCompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: d Arrival Time: Departure Time: County: Region:
Farm Name: ✓I Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: Ale&40A
Certified Operator:
Back-up Operator:
Phone No:
Integrator:
Operator Ce 'fication Number:
Back-up Certification Number:
Location of Farm: Latitude: 0 0 E—_1 " Longitude: [= ° [� ` = u
Design C►urrent
Design Current
Design Current
Swine Capacity Population
Wet Poultry -Capacity Population
Cattle
Capacity
Population
❑ Wean to Finish
❑ La er
❑Dai Cow
❑ Wean to Feeder
❑Non -La er
❑Dai Calf
❑ Feeder to Finish
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ Da Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
❑ Layers
❑ Beef Stocker
Gilts
❑ Non -Layers
❑Beef Feeder
Boars
EElTurke
❑ Pullets
❑ Beef Brood Cowl
i
s
Other
❑ Turkey Poults
❑ Other
❑ Other
Number of Structures:
Discharzes & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes ZNo
[DNA
❑ 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 0 No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes allo
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes E No
❑ NA
❑ NE
other than from a discharge?
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?:
❑ Yes ONo ❑ NA ❑ NE
❑ Yes j2+No ❑ NA ❑ NE
Structure 5 Structure 6
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes Pwo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly 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 Lxo ❑ NA ❑ NE
8. Do any of the stuctures 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 [2'No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes No []NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drifl ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
-EI'No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[�],No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[]
Yes
C:'No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
B'No
❑ NA
❑ NE
18. Is there a lack of property operating waste application equipment?
❑ Yes
Ef No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
o. 60
a. yy
A.
aY430 a.a /j •
PO%i�
0.7/
o
0,sy
scllpf�,l�d�
V4
Reviewer/Inspector Name ffeapt
(�
Phone:
Reviewerlinspector Signature:
Date: iS
12/28/04 Continued

7
Type of Visit ,0tompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit �outine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: Q Departure Time: County: Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: _ Title:
Onsite Representative: ,._.,��/,�I/�
Certified Operator:
Back-up Operator:
Owner Email:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: E__1 o = ' E__1 u Longitude: 0 ° = ,
III
Design Current
Design Current
* _ -
PIN 111!! 11
•_
Design C•urce nt
Swine
Capacity Population
Wet Pltry, . Capacity Population
ou
Cattle Capacity Population
Q
❑ La er
❑ Non -Layer
❑ DajEy Cow
❑ DairyCalf
❑ Wean #o Finish
Wean to Feeder
❑ Feeder to Finish
❑Dai Heifer
❑ Farrow to Wean
Dry Poultry
❑ Dix Cow
❑ Farrow to Feeder
x
❑ Non-Dai
❑ Farrow to Finish
❑ La ers
❑ Beef Stocker
❑ Gilts
❑Non -La ers
❑ Beef Feeder
❑ Boars
❑ Pullets
❑ Beef Brood Coyd
❑ Turkeys
-
Other
❑ Turkey Poults
❑ Other
❑ Other
:Number'of S;.;cZ=r.es-.:
_,4..s ss.idWRHM33M 9�?"�llti5:9ik,
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page 1 of 3 _r�_Rlv
❑ Yes No ❑ NA El NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes 0 No
❑ Yes
❑'No
❑ NA
❑ NE
❑ Yes
RlQo
❑ NA
❑ NE
12128104 Continued

Facility Number: Date of Inspection
-'Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? [:]Yes P-No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes [:�No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 1;7 C1
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes j2vo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly 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 PNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes Q-No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes �,ONo ❑ NA ❑ NE
maintenance/improvement?
l I . Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes E 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) �� J 36,
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes,4 No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes O No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes O—NO
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes ,E No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations.or any other comments
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/Inspector Name
Reviewer/Inspector Signature: Ll Date: C�
Pone 2 of 3 12/158/01 Continued

facility Number: r.— Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 9No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes p No ❑ NA ❑ NE
the appropriate box.
❑ WUP El Checklists El Design El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes _PNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ONo I--] NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ � NNo A ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ❑ No 01NA ❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit? ❑ Yes ❑ No 2NA ❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes Jallo
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes ❑ No
❑ NA )?fNE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes ,01qo
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes f'No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes �❑'No
❑ NA
❑ NE
General Permit? (ie/ discharge, frecboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes No ElNA
ElNE
33. Does facility require a follow-up visit by same agency?
ElYes No
❑ NA
❑ NE
Comments and/or
Page 3 of 3 12128104

Type of Visit t�ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 19 12outine O Complaint O Follow up O Referral 0 Emergency 0 Other`` ❑ Denied Access
Date of Visit: O Arrival Time: % Departure Time: County: `/� Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Owner Email:
Phone:
Facility Contact: Title: Phone No:
Onsite Representative: /K Integrator: w zYo/
Certified Operator: Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = o = 4 = Longitude: = ° = d = ff
Design Current.
Design Current
-- s , Design
Current
Swine Capacity
'Population
Wet Poultry Capacity Population
Cale Capacity
Population
❑ Wean to Finish
❑ Laver _ _
❑ Dairy Cow
Wean to Feeder 17 60
on -La er
❑ Dairy Calf
Feeder to Finish
❑ Dairy Heifej
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
❑ La ers
❑ Beef Stocker
❑ Gilts
❑Non -La ers
❑ Beef Feeder
❑ Boars
❑ Pullets
❑ Beef Brood Cow
❑ Turkeys
Other
❑ Turkey Poults
Number of Structures:
❑ Other
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes ZNo
❑ 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 D WQ)
❑ 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
;2'NTo
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
j[J No
❑ NA
❑ NE
other than from a discharge?
12128104
Continued

Faci Number:-3 } —cZ1 Date of Inspection .2
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes -fTNo ❑ NA ❑ NE
a. if yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?: g
Designed Freeboard (in): 1'7c [c
Observed Freeboard (in): az _ 3
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes R<o ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.) ��
6. Are there structures on -site which are not properly addressed and/or managed El Yes .ICJ 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 A No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes �TNo ❑ 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 o ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes hTo ❑ NA ❑ NE
maintenance/improvement?
IL Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ;-,Ko ❑ 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 W ind w ❑ Evidence of Wind Drifl ❑ Application O side of Area
12. Crop type(s)
13. Soil type(s) /�-/Cw''7 ._ - - - - •- — — — — „_ _ —,_.._ _,
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes Z14o ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes O'No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination, ❑ Yes Z No ❑ NA ❑ NE
l7. Does the facility lack adequate acreage for land application? ❑ Yes allo ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes �1�3`No ❑ NA ❑ NE
Comments (refertto gnestron<#) �� Explain airy YES answers ana/or,an recommendations or y other, comments. '
` ��
Usedraw►ngs�ofgfacdzty tabetter�egplam°sitriahonss:(usesadd�honal pagesfas necessary) �.
..- t
Reviewer/inspector Name 1 Phone:
Reviewer[Inspector Signature: Date: y2
12128104 Continued

Facilsty Number: Date of Inspection 2
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ZNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ONo ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21,
Does record keeping need improvement? If yes, check the appropriate box below,
ffYes ❑ No
❑ NA
❑ NE
WWaste Application Weekly Freeboard ❑Waste Analysis ElSoil Analysis ElWaste Transfers ElAnnual Certification
5Elainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections OMonthly and 1"
Rain Inspections ❑
Weather
Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes ,ETNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes ❑ No
t NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes ❑ No
ZNA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes ❑ No
;21hTA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes JD No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes ❑ No
. ❑ NA
ONE
Other issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes -,00"No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes ZNo
❑ 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 Z 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 j2 No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
�(No
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes J2<0
❑ NA
❑ NE
Additional Comments and/or Drawings:
ejeGUSQ CeCOK9 CY01 (Q I rrf7p I t-t Ck-
6-(T er I" d-a i Yt(; U
pumped re ca,. S-e k k� ib� wqs k-,,
Q,na I S 1 S b LA S nab (��-�-U r •.
i ►'\ C jC ode s Fl y
12128104

Type of Visit ZCompHance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit Routine O Complaint O Follow up O Emergency Notification O Other © Denied Access
Facility Number Date of Visit:
Permitted 9/certified ❑ Conditionally Certified 0 Registered
Farm Name: //;All, 1! . �lst.,,<. _
Time: SS
loerational O Below Threshold
Date -Last Operated or Above Threshold: _
County: _
Owner Name: _ _ . .... _ _ _ Phone No:
N- Luling Address:
Facility Contact: . ________. _ __ Title: Phone No:
Onsite Representative: c1 �' Integrator.
Certified Operator.. _. _ .... _ .._ Operator Certification Number:, ,
Location of Farm:
A6
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 4 " Longitude • C "
_ - =.Cirxnt Dew C t Desiga urren ti: Design �Ct
5wwe TCa Po tion. f�'3'= cit _-Po Fain. Cattle ` tton
ZFW
ean to Feeder Layer Dairy
f-r
Feeder to Finish Non -Layer Non -Dairy
Farrow to Wean��.:, .,
Farrow to Feeder
Other
E
Farrow to Finish
1_i Y Taial �eSIgR
El Gilts i _
Boars
Discharges & Stream Impacts
1 _ Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier: _ ! _ 7
Freeboard (inches): �' c�
❑ Yes,,ergo"
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ffNo
❑ Yes OlZo
❑ Yes af(o
Structure 5
12112103 Continued

Facility Number: 31— Date of Inspection O '
5..Are there any immediate threats to the integrity of any of the structures observed? Cie/ trees, severe erosion,
❑ Yes ja<
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
❑ Yes ,214o
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 maintenancefimprovement?
❑ Yes ZNo
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes 13''No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
❑ Yes ENo
elevation markings?
Waste Aaaliratian
10. Are there any buffers that need maintenancefunprovement?
❑ Yes 1314o
11. Is there evidence of over application? If yes, check the appropriate box be1ow.
❑ Yes
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Coppjer) and/or Zinc
12. Crop type l7C�f � 1 �5 69
13, Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes Jallo
14. a) Does the facility lack adequate acreage for land application?
❑ Yes ,-No
b) Does the facility need a wettable acre determination?
❑ Yes .ETNo
c) This facility is pended for a wettable acre determination?
❑ Yes .EMo
15. Does the receiving crop need improvement?
❑ Yes .0 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 ,fNo
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours?
❑ Yes 42No
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes _L;�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 __Q No
Air Quality representative immediately.
Reviewer/Inspector Name
Reviewer/Inspector Signature:
❑ Feld Copy ❑ Final Notes
Date:
12112103 / Candnued

Facility Number: Date of Inspection
—ftaired Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes�10
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
VAT,
❑ Yes �o
(ie/ checklists, design, maps, etc.)
23. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes ❑ No
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes _EErNo
25. Did the facility fail to have a actively certified operator in charge?
❑ Yes ,ENO
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
Yes
(iel discharge, freeboard problems, over application)
❑ ONO
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes o
28. Does facility require a follow-up visit by same agency?
❑ Yes 'ONO
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes J'No
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, slip questions 31-35)
❑ Yes 2j`&o
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 ❑ Na
34. Did the facility fail to calibrate waste application equipment?
❑ Yes ❑ No
35. Does record beeping for NPDES required forms need improvement? If yes, check the appropriate box below.
❑ Yes ❑ No
❑ Stocking Form ❑ Crop Yield Form [:)Rainfall ❑ Inspection After l" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
12112103

Urvisron.ofWaterQakht
F N
Q'i�i1YLS101I pf So�'aAd Water Coinserv8tiOn
r '
Qoth x
er Agency
�� .-7,-
w
Type of Visit aCo fiance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit Routine O Complaint O Follow up O Emergency Notification O Other J] Denied Access
Facility Number Date of Visit: I
Permitted Certified © Conditionally Certified © Registered
Farm Name: ......... ----......
Owner Name:
Mailing Address:
Time:
)nerational O Below
Date Last Operated or Above Threshold: ...... ......... .......
County: ....... Q wl .................. ................
PhoneNo: _ ............................................. ...._ .._ .
Facilitv Contact: .............. ................ Title- _ Phone No: _
Onsite Representative:.-----•... ! ._. ............. ._...........Integrator:
Certified Operator:
Location of Farm:
Operator Certification Number:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' 6 46 Longitude • & «
_Swine
Wean to Feeder
'% R60
06
Feeder to Finish
Farrow to Wean
3
Farrow to Feeder
Farrow to Finish
Gilts
❑ Boars
I❑ Non -Layer [ �. ❑ Non -Dairy
t Oher YYg y
:.
Total Design CapaatyF
� ,
T©talssL'}
Dischagg & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gallmin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier: ........i......_......... _.... ... _.....3.... _._
Freeboard (inches): —5 36 7-4
❑ Yes [(No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ Rio
❑ Yes y
/o
❑ Yes
❑ Yes 7No
Structure b
12112103 Continued

Facility Number: 3) EiU Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenancelimprovement?
8. Does any part of the waste management system other than waste structures require maintenancelimprovement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? If yes, check the appropriate box below.
❑ Excessive Ponding ❑ PAN ❑rr Hydraulic Overload ElFrozen Ground ElCopper and/or Zinc
12. Crop type O Cey -o ck I..ET)— -SG d - -
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?
1S. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours?
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
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
Air Quality representative immediately.
Yes ❑ No
❑ Yes . CO
dYYes ❑ No
❑ Yes �40
El Yes
❑ Yes �No
Yes
❑ Yes d o
❑ Yes 9
❑ Yes LJ o
❑ Yes
❑ Yes L'J o
❑ Yes [7No
❑ Yes pNo
❑ Yes
❑ Yes �io
❑ Yes �No
'CAMS Zrefcr tE1`�quesh� t#) ',E�plam a�YIB`fiaosvvers for any or:atty�other�w�ea�� ' .,� _.. `"
1Use drswu�gs d�':iaattYLo`be�ter acplesa staalsons-(tee additional pages as neoery ~ ❑Field Cop ❑ FinaI Notes
5,) R-T L-A&coj� 004tfR 14flD AWSkJMVS' GUE"N Z5-) QV-C V4ALL-
Ab
KL..E� $ Arc l� AJ� �.s U CD Wo t� , TALAC w/ 7 EG R•n7aQz- t2 7e-C H
Spy, ro canes SX&P CY4"
Cj_1 ox�Gc wwu,s aT IRLL 3 t_av06N.S, �6VS G 56 U6�fbi.
Orr cAc 3 QC-toc,t-E Puw►p WAs ad wvrs Low L61d�[. C�►vSEr� ��m
-t-.jJ - u V fL& ,
r_ Reviewer/in spectorName ..� . .�...` X:�° .�"
ReviewerAnspector Signature: Date: % L -7 t9
12112103 t ontinued

Facility Number: I-.
Date of Inspection 7
Required Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
23. Does record keeping need improvement? If yes, check the appropriate box below.
❑ 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?
25. Did the facility fail to have a actively certified operator in charge?
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
29. Does facility require a follow-up visit by same agency?
29. Were any additional problems noted which cause noncompliance of the -Certified AWMP?
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, slip questions 31-35)
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
32. Did the facility fail to install and maintain a rain gauge?
33. Did the facility fail to conduct an annual sludge survey?
❑ Yes No
❑ Yes Wo
❑ Yes ;,ro
❑ Yes Leo
El Yes L,.l;vo
❑ Yes fa 4
40
ElYes t,y'No
❑ Yes �Q-KO
❑ Yes L71vo
❑ Yes o
❑ Yes ❑ No
❑ Yes ❑ No
❑ 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 V Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
12112103

n
r
f �0'btvtstotii of "17 Water Quality _ x ,
DMA6nof,Soil and"Water Conservation
� .. 0 Other Ageney o f k
Type of Visit ,6Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number 1 2 Date of Visit: Time: (Q �Printed on: 7/21/2000
rO Not Operational 0 Below Threshold
jarpermitted ❑ Certified ❑ Conditionally Certified ❑ Registered Date Last Operated or Above Threshold: .............
Farm Name: �� Z 3.P•!.'.......
....................
.............. ................__..... •._. �..`....� o �...........................•. r .............J...................__.................... County:.......v h
Owner Name:..... 4.......r.. k.e.....9­_br,s'1.......................................I............... Phone No:........................... ..........
Facility Contact:
Mailing Address:
Title:
Phone No:
Onsite Representative: .......M,;kP_..9,t b o - integrator: _-M O.r - h
....................................•--.._................__..
Certified Operator: ................................... ..... Operator Certification Number:............................ --
................................................................. .. __........
Location'of Farm:
=A.
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude �' �' ��� Longitude
Design
Current Design' Current
Design Current
4„She....s:`.Ca ci
�........-.
Population Caaci Po ulation Cattl
Ca Po ilaiionPoultry
Wean to Feeder
❑ Layer ❑ Dairy
Feeder to Finish
❑ Non -Layer ❑ Non -Dairy
Farrow to Wean
- Farrow to Feeder
❑Other
`= Farrow to Finish
Total Design Capacity,
Gilts
n a Boars
T©w SSLW
Number aVIA or
❑ Subsurface Drains Present
❑ LagM►n Area
❑Spray Field Area
`. olkd'ing'Ponds / SoLd Traps
❑ No Liquid Waste Management System
DischaMg & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed. wha[ is the estimated flow in gal/min?
d_ Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4_ Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier; ................ ...•--.._................._.....�..... ................................... ....................................................._._,...._.._.....
Freeboard (inches): 25 28 31
5100 '
❑ Yes ONo
❑ Yes V No
❑ Yes No
❑ Yes YrNo
❑ Yes PNo
❑ Yes IffNo
❑ Yes JANo
Structure 6
Continued on back

Facial Number::? 1 —2_jq Date of Inspection 09P
5' Are there any immediate threats to the integrity of any of the structures observe ? (ie/ trees, severe erosion, ❑ Yes fi�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 0 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? ❑ YesA No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes J!fNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes eNo
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes [ZrNo
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN [I�
Hydraulic Overload ❑ Yes ,No
12. Crop type 09ei. q u r C 3 r�q 6 F'y r'in
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes �&No .
14- a) Does the facility lack adequate acreage for land application? ❑ Yes ONO
b) Does the facility need a wettabie acre determination? ❑ Yes ONO
c) This facility is pended for a wettable acre determination? ❑ Yes jZfNo
15. Does the receiving crop need improvement? ❑ Yes ONO
16. Is there a lack of adequate waste application equipment? ❑ Yes lerNo
Required Records &_Documents
17. Fail to have Certificate of Coverage & General Permit readily available? ❑ Yes XNo
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 XNo
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports) XYes ❑ No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ YesNo
21. Did the facility fail to have a actively certified operator in charge? ❑ Yes )R(No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
Yes ONO
23. Did Reviewer/Inspector fail to discuss reviewrnspection with on -site representative? ❑ Yes No
24. Does facility require a follow-up visit by same agency? ❑ Yes P'No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes.XNo
' �10 •yiol;aiiQnjs:g�F dgf cjieBctes •v�re ngfed• ¢itring vtt; • Y;ou witl •l�ee�iye too fu�t�gs • '
corresooridence agouti this visit' :........
...................................
.. .
lg - Yac& need 4d beJ;n Us 4�Q we-Hct le AC/es an 4ke ap lir_ 4,`c;1 `
feG6r4S {��.,n,'n� Ld�-�� 2.�Gj1-ZL02- sail ,jcret�.•.lInA Con1 i►�t v►i4Al
+c kee.P once ZIV(Z- Z per {;elf Bind nc4 ee- (A)coi1
cis e S GvrrC,rl1[� bei,�c. done, yet1 cave r)a-}e orn 4� e one qOe-2 Lihiek
I c,5 oor, t J ny t v Sed! 1�d- Ced cu 1 °r-k w 4 �arn`s�cre�iJ� I..r �, S. gr�ct�yS9S.
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Date 1 /2'fl p_Z- sroo

Facility Number: 3 � �—� Date of inspection Printed on: 7/21/2000
' Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below 'OYes ❑ 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 XNo
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes JZNo
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 ,INO
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 ,ETNo
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes XNo
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ❑ No
JAdditionaMomments'and/orDrawings: i
7"' yleC3d�-�� !lMA46 411e --Tctz- Z'f
Aee4 4o ensvre Vla ove^�t�v�olicd,-}t'os,
'fJeed 40 u,se a wc's-4e t1" [ s 5 *dei w�-��� bD
e Ane l; r✓ iov, eVOM4r 44 Zr' v1 A4e 4 "e ?RM a tied O'.%
L► o e rl v /'eyev Ftal it 1 a v id sa )e, � iry Ga me^A 1
eve>^ �� da s 1VeeD� �a14k0 5- '1 sq 16s -far eact, �';erd.
� y �
M&IC : T e re- v;redl-P,,aeba a-d for 4ke l� cons ;�
/\ja,4e,: Your- Leafs q.re Well oiq.1n4ctined q4d loc.t -
ka-s a nea4l1 ke fa appeel" lce .
5100

rj - ^Division Of rater Qaality
ti Q ivision of Soil and Water ConservatiotA " e '
y t
Type of Visit Compliance Inspection O Operation Review O Lagoon Evaluation
Reason far Visit 0\13outine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Date of Visit: / Erne: L�= Printed on: 7/21/2000
Facility Number
Q of O erational Q Below Threshold
© Permitted Certified OCoDdlutiolpally Certified 0 Registered Date Last Operated i#bove Threshold
_
Farm Name: ........../� ................... �.,.,..�%-J_.................. Cflunty:..... ......_......... ,-.......
Owner Name: ... 1....'..�/..... .............. ....... .......... _ Phone No:
FacilityContact: �L.�K......................... � ....... "Title:............................................................ Phone No......................................................
MailingAddress : ...............................................................................................................................................................
-IL
Onsite Representative: -, ,-..... Integrator: ,,,_,.,,,,,
P l; J.............................................
Certified Operator :..................... ............................................................. Operator Certification Number:.................
Location of Farm:
i
�.i
Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude �' �° �•' Longitude �• �� �«
Design Current Design Current Design Current
Swine Capacity Population Poultry Capacity Population Cattle Capacity Po ulation
Wean to Feeder jy p JCI Layer ❑ Dairy
❑ Feeder to Finish ❑ Non -Layer ❑ Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder ❑ Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ Boars Total SSLW
Number of Lagoons
❑ Subsurface Drains Present ❑ Lagoon Area ❑ Spray Field Area
Holding Ponds / Solid Traps i ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made'
b. If discharge i� observed. did it reach Water of the State? (If yes, notify DWQ)
c. II discharge is observed. what is the estimated ]low in gal/ruin`'
d. Doe,, discharge bypass a lagoon system'' (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4- Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure Structure Structure 4 Structure 5
1+ Identifier: .. ...................... �F......-.._....................-......-.....-....-.-.................
Freeboard (inches):
5100 '3`b
❑ Yes No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes �JNo
❑ Yes No
❑ Yes �No
Structure 6
Continued on back

Facility Number: Date of Inspection [ 1 �v Printed on 7/21/2000
5e Are fPkre any i e iate t rear to the integrity of any of the structures obsery d? te/ trees, severe erosion, ❑ Yes Xi
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes 4No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
12. Crop type
S
B. Do the receiving crops differ with those desic,, aVd in the CWtified 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?
(le/ discharge, freeboard problems, over application)
23. Did ReviewerMspector 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: Nn •yiolattoris:oi•• deficiencies -vt=ere noted during this:visit: "iii will •receive Rio fui-th&
............•................
correspondence abatit thus visit .. .......... I .... .
❑ Yes No
❑ Yes o
❑ Yes )(No
❑ Yes KNo
❑ Yes ff'No
❑ Yes I�No
❑ Yes o
❑ Yes o
❑ Yes o
El Yes o
❑ Yes No
❑ Yes ECNo
❑ Yes ;EVNo
❑ Yes 191-No
❑ Yes RfNo
❑ Yes �No
❑ Yes A No
❑ Yes 2fNo
❑ Yes )j No
❑ Yes No
Comments (refer to question #): Explain any YES answers and/or any recommendations or any.other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
& Aoh� a6r,-S) 17� , - - �_,XW',
�14'e�t Q�� s . l�U
Reviewer/Inspector Name
Reviewer/Inspector Signature• Date: 1 JZ �a-V 5100
Z5

Facility Number: — Date of Inspection Printed on: 7/21/2000
Odor Issues
25. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge dt/or below ❑ Yes ,No
liquid level of lagoon or storage pond with no agitation? ko
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes )t-No
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes *0
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ,Yes ❑ No
Additional Comments an orDrawings: _
AL
w
5100

N.C. DIVISION OF. _.WATER QUALITY
Wafer Quality Section
Complaint/Emergency Report Form
WILMINGTON REGIONAL OFFICE
Received by r� //4/ Dated Tim C�Iz) 4t
Emergency Complaint 'Catty-W('r1��/l�(.11 ,_•� County �lfll�cr ird;
_Report Received From
Agency 0W 01 — W1 912 _ Phone No.�y�� �32:20 . leiWd f J
Complainant W 11 w a f-f"n r -_ -- 7 eo
Address one No. LD 2) ';7-33 - 1/T*
Check One• Fish K�l �.P
Spiff Bynimal NPDES N.D.
Surface Waters Impacted ~�1�//� Classification
S: I WG S LSHELLSIREPORT. SHL
EPA Region 1V [phone] Pesticides 733-3556 Emergency Management 733-3867 Wildlife Resources 733-7291
Solid and Hazardous Waste 733-2178 Marine Fisheries 726-702f Water Supply 733-2321 Coast Guard MSo 343-4881
127 Cardinal Drive Extension, wlnn ngton, N.C. 28405-3845 • Telephone [phone] Fax [phone]

3

Facility Number 31 297 Date of Inspection 2n/2000
Time of Inspection 16:30 124 hr. (hh:mm)
Permitted M Certified 13 Conditionally Certified 13 Registered 10 Not O erational I Date Last Operated: p • .........................
Farm Name: R.ahaxkNun=.1.2.A.J........................................................................... County: D.0 �............................................... WAD
OwnerName: 1llike........................................ Kam ......................................................... Phone No: 91D.-.293=160 ..........................................................
FacilityContact: .............................................................................. Title:................................................................ Phone No:...................................................
Mailing Address: M0.GAoitge.Gamer..R.1aad................................................................ W..Rm r..N.C......----------.......................................... 2839$.............
Onsite Representative: .... Integrator: l vMjby..Fwtpiiy..kar .......................
Certified Operator: Milw.0. ................................. Rahon ............................................... Operator Certification Number:18.13.8 .............................
Location of Farm:
Y��af\'ldaars�tyx�..dY�s�e�.#1.xs.sin.�n�.aitsl�.af.S�4..aRp.�s►aimately,�.S.naiile.�.�xRsx.�fiwtE�s�tiQA.x�it�.H�_�4,,..�iurs�y.
md.1t3.acne.at.=d.DfSR.134.4.......... ...... .............................. ............................. ............................................................................................................ w
Latitude 35 ' 01 25 K Longitude 78 • 07 06 u
Discharges & Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at- ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gallmin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from- any part of the operation? '
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection &'Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure 1 Structure 2 Structure 3 , Structure 4 Structure 5
Identifier: ................................... ..........................................................................................................
Freeboard (inches): ............... 21................ ................ 1................ ............... 34...............
.........................................................
5. Are there any immediate threats to the integrity of any of the structures observed?(ie/ trees, severe erosion,
r 3/23/99 seepage, etc.)
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
H No
Structure 6
...............................
❑ Yes
❑ No
Continued on back

R
Faciif� Nuttiber: 31-297 '•' Date of inspection
2/7/2000
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
❑ Yes
❑ No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenancelimprovement?
❑ Yes
❑ 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 ApWication
10. Are there any buffers that need maintenance/improvement?
❑ Yes
❑ No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN
❑ Yes
❑ No
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
❑ No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
b) Does the facility need a wettable acre determination?
❑ Yes
❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes
❑ No
15. Does the receiving crop need improvement?
❑ Yes
❑ No
16. Is there a lack of adequate waste application equipment?
❑ Yes
❑ No
_Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
❑ No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
❑ No
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
❑ No
20. Is facility not in compliance with any applicable setback criteria in effect at the.time of design?
❑ Yes
❑ No
21. Did the facility fail to have a actively certified operator in charge?
❑ Yes
❑ No
22. Fail to notify regional DWQ of emergency situations as required by General Pen -nit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
❑ No
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
❑ No
25, Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
❑ No
C -No-iri,olaiiofis:Qr'ckfiriericies•vvere:aoied:duiingibis•visit:: V•ouwllfreceivenofiiritier:
: -c a o�d iee abou> :1�5i -yi i :: ...... ... ... .
Follow-up of a complaint received by Ms. Wilma Hall that Mr. Rabon had been spraying waste on her adjacent land. Ms. Hall saw
what she thought to be reel tire ruts on her property. Ms. Hall was down visiting from Raleigh and noticed this over the weekend and
informed DWQ of this situation on 2/07/99. Mr. Rabon currently leases 3 acres of land behind Ms. Hall's property where he keeps is
-attle. Farm path to get to Mr. Rabon's cattled runs along the side of home that Ms. Hall owns (her farther, who lived in the home
recently pasted away and Ms. Hall is currently trying to sell the home and therefore visits the area occasionally). There are tractor wheel
ruts down dirt path where Mr. Rabon travels to and from when bring cattle hay. •
Mr. Rabon's spray equipment is sitting in his field and approximately 1200 ft. from the road. According to Mr. Rabon's spray
records there has been no pumping done since Dec. 12th 1999. There is no evidence of any recent pulls made.
rI
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Date:

�"�'^' v��':�.,r "k,,.."'� .i.%�'l"`�ti�tiv:i-i.` � �.-, �5 ,.,^v'-`,., . . _ ,,.f,.�:. .� s�.r�t.rs�tt`���',i^dt . .•. . • s �..—�'+..
on of Soil a"
on of .sWari
10 Routine «Complaint O Follow-up of DWQ inspection Q Follow-up of SWC review Q Otber J
Facility Number Date of Inspection1-7-'ot7-ap
Time of Inspection �� 24 hr. (hh:mm)
© Permitted [3 Certified © Conditionally Certified © Registered 113 Not O erational Date Last Operated:
............
FarmName: ....... tJ.46)lj....... .1_i f-4,........... ....... ..3.............._.._......---------.... County:........-. ...1 1�ifin............................. .:f�...:......_.
Owner Name:....Ado
Ili............................
Y %.............................-......... ... Phone hto:..... .r / .P��. .. f....�C� Sl........
Facility Contact: ... Title:.!!Y.lI.ItX:1f........................................ Phone No: ...._._................_........................
MailingAddress: ............................ [... ..._... .r �� (:Y........... ......-................................................................................... ..............
OnsiteRepresentative: J. ........ .. .............................................I.......... Integrator: .....�I...r............................................................
Certified Operator:.....AA..�.Q.......................... .. ...................................... Operator Certification Number:..........................................
Location of Farm:
A
........................................................................................................................................................................................................................................ �
Latitude = • =' 0•: Longitude • =' ="
Design
Current - Design Current _ Design Current
Swine Capacity
.....
Poult Cattle,
Population - _ ry .._. Ca «city .Population _, - Capacity Population _
' ❑ Layer tl' ❑ Dairy
❑ Non -Layer
=
❑Non -Dairy
e m r
U ❑ Other
Total Design Capacity _
- =
,. ,.._ ,
t� Total SS
y er of -Lagoons
0` ❑ Subsurface Drains Present ❑ Lagoon Area ❑ Spray Field Area
TT
Holding Ponds / Solid Traps
�; ` ❑ No Liquid Waste Management System
Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts,
❑ Boars
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? , ❑ Yes I&
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other r
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
h. if discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ 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 gNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes❑ No
Waste Collection &.Treatment ��
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes �/J No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure h
Identifier: �� 3� A
Freeboard(inches): ..............................................................._........._........................................................ ...................................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes ❑ No
seepage, etc.)
3123/99 Continued on back

`T ! A('
"
Facility Number: ?� —
Date of Inspection
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? I
- ❑ Yes
[:]No
(If any of questions 4-6 was answered yes, and the situation poses an
r
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
❑ Yes
❑ No
8. Does any part of the waste management system other than waste structures require maintenarice/improvement?
❑ Yes
❑ No
9- Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
❑ No
Write Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes
❑ No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN
❑ Yes
❑ No
12, Crop type —56
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
❑ No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
b) Does the facility need a wettable acre determination?
❑ Yes
❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes
❑ No
15. Does the receiving crop need improvement?
❑ Yes
❑ No
16. Is there a lack of adequate waste application equipment?
❑ Yes
❑ No
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
❑ No
I8."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
❑ No
20,
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
❑ No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
❑ No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
❑ No
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
❑ No
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
❑ No
yi9lati�ris ;or rieiicieucies v�ere noted• diWihii tbis:v-tsit; - Y:oii :will •reeeiye fio €u"bl> r • , • : •
corresoondeitce. about this .visit_ . . ;
)r;dlorv{d up on ' ['o"yIttfrtf fee-e t(ar Av 1�106. W;lw,, 0411 4-haf /11. Ake �&1� fad beer, AL
s/,rKyi wasf-(. #" her l4Y,,t ret rn+l . /•r4. Ad/ /t0lr£re( -h're 4rA(ks in aW,a« 4-e 5' a"X
�1IdS II[o �vn1� 'f:tlt4
kAd
I inVrs�t9a+�oC ''Ylti� 1t455/Ge r+
I�rcv� a7 Lwin itlds
,�jA
Ttfsd 6u'000. = Wak-4 all dj*A1rt,-i �ir1�s
' .�'eld.S � {�►�dcttic r-F lMt. V.abon�
} Fa u,•ol ne Sig'^ o FMv+�as�fjcrr
OL. 1" Fa�ariS S toy 1tfD19tS ir�y(iCa 1n0 s�ta,jt✓Y� OtD�3t
1{rli►bei'� n,ovt aFt' �t y l.cs � 3linclu5# 3�' J
rAr. #4ALMt5 i-�f{[r7l r� is CtirrtN-+�� �J ft1C�-IS1 . jjy
Mr �u pnY FAr't I- J_yj (/du'�5e7 #{ �y tt.3 j. QTF et
AaAs c( rQO(d
`y
h�S r"t� 'OS C%A11(f tk0 sIA4 chvOrpy,� _4)u �Zl1Z? �}, �o„ his p opfy}yt�5?.at� �
Reviewer/Inspector Name E�f!
i ` w
Reviewer/Inspector Signapxe. Date:

'�YF, .4 ice- - - ; j.,fiT., r i �°a . .r r• •f,;,t r • • - -:+... - T _-
;t'ci'l �Y YY•/-�?'-.r3 "i,,.� " � .i T.•. � 1 Yk• \ � 'l � n.• rs 5 �. �f .. =L rv. ✓ .. K.�• 0
J 1
Facility Number: 3 '- Date of Inspection Z-t7?'OZJ
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below [-]Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes ❑ No
28. Is there any`evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes ❑ No
roads,building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? []Yes ❑ No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes ❑ No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes ❑ No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ❑ No
ona , ommen "an or rawmgs
�if A O"A S� �34I . /i�1s �'1p1 1s htwC is acv�SS SR ta�►y /bl'Pusit� Sic ( of
a, {oavt5Vm p
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3/23/99

LQ Routine 19 Complaint O FoRow-up of DWQ inspection O Follow-up of DSWC review O Other
Facility Number 31 297 Date of Inspection I 2/7/2000
Time of Inspection 16:30 24 hr. (hh:mm)
Permitted M Certified 13 Conditionally Certified [3 Registered 0 Not O erational Date Last Operated:
FarmName: Rakan.dursm.1.2A.1............................................................................ County: Dmpft ............................................... MR0.........
Owner Name: Mike .. Phone No: - .
FacilityContact: .............................................................................. Title:................................................................ Phone No:...................................................
Mailing Address:?i0..G=rge..C;armer.Raad................................................................ Wars.axe...NC.......................................................... 2B398.............
Onsite Representative: ........................ Integrator: W y..a�t d1X. -
................................................................................... M � F )�'arms.....................................
Certified Operator: Mike_C.................................. RalzRn............................................... Operator Certification Number: .18138.............................
Location of Farm:
Latitude 35 • O1 < Longitude 78 * 07d F-0-6-"
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow": in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier: ..........................................................................................................
Freeboard (inches): ............... .21................ ................11................ ............... 34...............
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
3/23/99 seepage, etc.)
❑ Yes ❑ No
❑ Yes []No
❑ Yes ❑ No
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
® No
Structure 6
..............................
...............................
❑ Yes
❑ No
Continued on back

Facility N ber: 31-297 Date of Inspection 2/7/2000
6. lkre tLe a structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? El Yes [I 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 ❑ No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes ❑ No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes ❑ No
Waste Application
10. Are there any buffers that need maintenanee/improvement? ❑ Yes ❑ No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Yes ❑ No
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes ❑ No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes ❑ No
b) Does the facility need a wettable acre determination? ❑ Yes ❑ No
c) This facility is pended for a wettable acre determination? ❑ Yes ❑ No
15. Does the receiving crop need improvement? ❑ Yes ❑ No
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?
•1�....� .... rir:tiefrcierici .... eoted:dvring Nils visit........ ceivE no fiirNie . .
. � d•Fl!'1'PC�Ll►AlI�IIPF► Si�l(l�it �I�IIt.HaG�� . � . . . . . . . . . . . . . . . . . . . .
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑Yes ,❑No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
0 Yes ❑ No
Follow-up of a complaint received by Ms. Wilma Hall that Mr. Rabon had been spraying waste on her adjacent land. Ms. Hall saw y
hat she thought to be reel tire ruts on her property. Ms. Hall was down visiting from Raleigh and noticed this over the weekend and
informed DWQ of this situation on 2107/99. Mr. Rabon currently leases 3 acres of land behind Ms. Hall's properly where he keeps is
cattle. Farm path to get to Mr. Rabon's cattled runs along the side of home that Ms. Hall owns (her farther, who lived in the home
Ft
ently pasted away and Ms. Hall is currently trying to sell the home and therefore visits the area occasionally). There are tractor wheel
s down dirt path where Mr. Rabon travels to and from when bring cattle hay.
Mr. Rabon's spray equipment is sitting in his field and approximately 1200 ft. from the road. According to Mr. Rabon's spray
records there has been no pumping done since Dec. 12th 1999. There is no evidence of any recent pulls made.
I rivl nnntAnt Mc 145111 the nPvt rlav of my fiindinac Chp did infnrm rnP that cl— sv 1,1 hp rnntartinv t?nlPinh fnr fi 4hor
P

State of North Carolina
Department of Environment
and Natural Resources
Division of Water Quality
James B. Hunt, Jr., Governor
Bill Holman, Secretary
Kerr T. Stevens, Director
Mike Rabon
Rabon Nursery 1, 2 & 3
446 NC 50 & US 117
Warsaw NC 28398
Dear Mike Rabon:
` •
NCDENR
NORTH CAROLINA DEPARTMENT OF
ENVIRONMENT ANc, NATURAL RESOURCES
December 30, 1999
Subject: Fertilizer Application Recordkeeping
Animal Waste Management System
Facility Number 31-297
Duplin County
This letter is being sent to clarify the recordkeeping requirement for Plant Available Nitrogen (PAN)
application on fields that are part of your Certified Animal Waste Management Plan.
In order to show that the agronomic loading rates for the crops being grown are not being exceeded, you
must keep records of all sources of nitrogen that are being added to these sites. This would include nitrogen
from all types of animal waste as well as municipal and industrial sludges/residuals, and commercial fertilizers.
Beginning January 1, 2000, all nitrogen sources applied to land receiving animal waste are required to
be kept on the appropriate recordkeeping forms (i.e. IRR1, IRR2, DRY1, DRY2, DRY3, SLUR1, SLUR2,
SLD1, and SLD2) and maintained in the facility records for review. The Division of Water Quality (DWQ)
compliance inspectors and Division of Soil and Water operation reviewers will review all recordkeeping during
routine inspections. Facilities not documenting ail sources of nitrogen application will be subject to an
appropriate enforcement action.
Please be advised that nothing in this letter should be taken as removing from you the responsibility or
liability for failure to comply with any State Rule, State Statute, Local County Ordinance, or permitting
requirement.
If you have any questions regarding this letter, please do not hesitate to contact Ms. Sonya Avant of the
DWQ staff at [phone] ext. 571.
Sincerel l_ 147
Kerr T. Stevens, Director
Division of Water Quality
cc: Wilmington Regional Office
Duplin County Soil and Water Conservation District
Facility File
1617 Mail Service Center, Raleigh, North Carolina 27699-1617 Telephone [phone] Fax [phone]
An Equal Opportunity Affirmative Action Employer 50% recycled/10% post -consumer paper

Division of Soil and-WaterConservation'-.Operation Review
}
,Division of Soil and.Water Conservation .Compliance Inspection `ram r
Divisiion of Water Qieality Compliance Inspecrtioii
13 OtherAgency- Opeiatione ew
Routine O ComDlaint O Follow-uo of
I Facility Number I
Follow -tip of DSWC review 0 Other
© Permitted Certilfied (] Conditionally Certified Q Registered
Farm Name: ........,�.!c"...t` y.....................................................
OwnerName: ................................................... ...........
Date of Inspection j'�OIt `�
Time of Inspection 24 hr. (hh:mm) JI
0 Not O erational Date Last Operated:
1
County:..C.... .......... r
Phone No: .....l.la.'.a.13......... °..
Facility Contact:........................................................................... Title:....................... ..... Phone No:
MailingAddress: ....................................................................................... ................................................................................................................... ..........................
Onsite Representative: Q -W--,Q . Integrator: IV ............ 1-
1-1-1-1-Certified Operator: ....................................... I ............ ............................................... I ........ Operator Certification Number:..........................................
at5 of F• m
u c..rr� kCQ 1i a� y
G.................................................................................................... !.K......... :.�.....
..................................................................................................................................................................................................... c .._._ 1�Ct�-_:.-......... .......... T
Latitude '' .4 Longitude • ° ig
Design Current =Design Current ,' Design Current"'."
Swine Capacity Population. Poultry; �Ca acity.Po ulation Cattle Capacity Population'
Wean to Feeder X0 110 Layer I Dairy
Feeder to Finish ❑ Non -Layer ❑Non -Dairy
Farrow to Wean
Farrow to Feeder
❑ Other
Farrow to Finish Total Degigrt Capacity
❑ Gilts,
❑ Boars. _TotaUSSLW
Number of Lagoons` ❑ Subsurface Drains Present JR5LagoonArea ❑ Spray Field Area
Holding Ponds / S61id Traps (] No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes 9No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
h. 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 [XNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes EkNo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes tS(No
Structure l Structure 2 Structure 3 Structure 4 Structure 5 Structure b
Identifier: �}� nl.�
Freeboard (inches): ................................... ......... ct...l................
........... ...............
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes kNo
seepage, etc.)
3/23/99 Continued on back

joilFacility Number: 3) — a!j Date of Inspection
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate puhlic health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence, of over application? ❑ Excessive Ponding ❑ PAN
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
0: N,6-yiulafi6wis:oi-- deiidea�ies *re hoted• dirrtrtg this:visit; • Y:ou iviil•reeeiye iio further'-
correso6iidence. about. this visit_ .. . .... .
❑ Yes KNo
❑ Yes %No
❑ Yes U'No
❑ Yes N`No
❑ Yes KNo
❑ Yes XNo
❑ Yes 34 No
❑ Yes ONO
X Yes ❑ No
❑ Yes KNo
❑ Yes ONO
❑ Yes 0 No
❑ Yes 9 No
❑ Yes J<No
Yes ❑ No
❑ Yes Wo
❑ Yes )K No
❑ Yes �No
❑ Yes M No
❑ Yes VNo
❑ Yes �o
Comments (refer --to question #t).. Explain any -YES answers aud/os any. recor wet hdations:or,any other comments='
Use -drawings of facility to-bctter explain situati©ns (use additiorial5pages as-nece'ssary) r
Reviewer/Inspector Name ( 4 V
Reviewer/Inspector signature:
Ac
c�.-e' yp-��-
hl tt
T
Date:--
3/23/99

_ Facility Number: —a [)ate of Inspection
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below )<Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes ;E�No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes )0 No
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes ANo
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 *0
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes 4No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? .'Xes ❑ No
A44itional _ omnients and/or. Drawin
A.1
3/23/99

Division of Soil and Water Conservation 0 Other Agency
21Division of Water Quality
am .,..,. Fy '-c.,., ,-,x..-„>-,..: � . 'Y--'�..-'P"..'a.y.y�-ate.:-��":'�=•y"::4'&:8�� _,".�...-,...c, w-.:...��- '�'.::.. -y:�'
L.Routine O Complaint O Follow-up of DWQ ins cction O Follow-up of.DSWC review O Other
Date of Inspection
Facility Number
Time of Inspection 24 hr. (hh:mm)
© Registered 0 Certified [3 Applied for Permit © Permitted 113 Not Opera Date Last Operated
Farm Name:....G..b..�..�,.......tl--�..9-r..... r..a...7 ..,... Z............... County:...v..t �t..h...................................In�.�.. ..0
�r
Owner Name:...............1`.N�..i..�..�...................g a....O.XIIX.-................ .......... Phone No: �........��. �.�. �. ...... . �. .
Facility Contact.. ........................... .. Title: . Phone No:
MailingAddress: ..y..........,..........0 5........�. ........................... ...
Onsite Representative: .�..si <v ..... -G��: �n.�.. ...�.rp . .,C + P.! ........ [ntegrator:..M:u.,c.t ....................................................
. 1
Certified Operator: ............... M.-i �..2,,................ a .................................... Operator Certification N tuber:...isu.. -. ..............
Location of Farm:
Latitude •=1 °i Longitude • =' "
Design's Current Design Ciurreiit = IiCSlgn<�Curretit
Swine' Capacity Population Poultry Capacity I'opulafion Cattle Capacity NPoptilation
❑ Wean to Feeder
'
❑ Layer
I
1E] Dairy
I
Ir=
❑ Feeder to Finish
"A
❑ Non -Layer
❑Nan -Dairy
❑ Farrow to Weanzr-
❑Other
Total DestginCapactty
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
K .Total SSLW
❑ Boars
- _ .......
..
r
Number of Lagoons !Holding Ponds `� Subsurface Drains Present ❑Lagoon Area
❑ Spray field Area
z.....
F
......
,. No Liquid Waste Management System
P�
z r
General
1. Are there any buffers that need maintenancelimprovement?
2. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Surface Water? (if yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
A. Does discharge bypass a lagoon system'? (If yes, notify DWQ)
3. Is there evidence of past discharge from any part of the operation?
4. Were there any adverse impacts to the waters of the State other than from a discharge?
5. Does any part of the waste management system (other than lagoons/holding ponds) require
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
7. Did the facility fail to have a certified operator in responsible charge?
7/25/97
❑ Yes ® No
❑ Yes ® No
❑ Yes U No
❑ Yes ER No
❑ Yes ( No
❑ Yes ® No
❑ Yes El No
❑ Yes 91 No
❑ Yes ® No .
❑ Yes 12 No
Continued on back

Facility Number: —
8. Are there lagoons or storage ponds on site which need to be properly closed?
❑ Yes
No
Structures (Lagoons.11olding 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: Z , 1 Z + S-. z .....
Freeboard(ft):...................................................................................................................................................................................
....................................
10. Is seepage observed from any of the structures?
❑ Yes
JQ No
11. Is erosion, or any other threats to the integrity of any of the structures observed?
❑ Yes
® No
12. Do any of the structures need maintenance/improvement?
❑ Yes
®.No
(if any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
❑ Yes
`0 No
Waste Application
14. Is there physical evidence of over application?
❑ Yes
KNo
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type ... +:.. ...............I........--..Yµ.ko.1%...............................
16, Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
❑ Yes
® No
17. Does the facility have a lack of adequate acreage for land application?
❑ Yes
tgNo
18. Does the receiving crop need improvement?
❑ Yes
bi 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 Reviewertinspector fail to discuss review/inspection with on -site representative?
❑ Yes
® No
22. Does record keeping need improvement?
RYes
❑ No
For Certified or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑ Yes
® No
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
No
25. Were any additional problems noted which cause noncompliance of the Permit?
❑ Yes
No
® No violations or deficiencies. were noted B ring this;visit..Y.ou.rvill i-eeei�e no ftirih r-:
OfrespondehO aV:iout this:visit:
l0. � a�(J i. V + t iti e S t. V a /t VA-V
o f r a cl c o, �i +' G" p " �.,e-.r o..✓`�l. S J
a 1lti e�wte. [t! i L,-P h;S` ) ci ` _1 S 9ee
c. , 'C I —1 C L (2, b ^ S`a r ✓"� W 4 [ jet p Uo_ . S .
7/25/97
..ice
Reviewer inspector Name .t ; E °.
Reviewer/Inspector Signature: �s��y� Date: L 1 10 ��
NJ

16 Routine O Complaint O Follow-up of DWO inspection O Follow-up of DSWC review O Other 1
Facility Number 31 297
Farm Status: © Registered ❑ Applied for Permit
® Certified 0 Permitted
Date of Inspection 6117/97
Time of Inspection 12:50 24 hr. (hh:mm)
Total Time (in fraction of hours
(ea:1.25 for 1 hr 15 nun)) Spent on Review
or Inspection (includes travel and processing)
10 Not Operational Date Last Operated: ................................... ........... ........... ..... ..»..._......._...................................................
FarmName: ... .... ............... ..................................................... County: Dmplin.............................. .................. WIRO.........
Owner Name:Me......... »»... »..»..»... »... ...» Rabin ..... »................................................. Phone No:21%.2.9&.7092.....»...................................................
FacilityContact: .............................. ..... ........ ................................. Title: ................................. ._........ ............. Phone No:...................................................
Mailing Address: 445.N.C.5a.&US. 17..._......_.-...._....................... _................. ...... wars w.nC._.......-.....- _.- ..._ ._............_... 283-9& .............
Onsite Representative: blikRabm......................... ........... ........................ __.M Integrator: Murphy-Fauuily..F&=&................... ............ _...
Certified Operator: ll%c.Q ................................ ................................ Operator Certification Number: 1$1 8.- ...............
Location of Farm:
Latitude 35 ' of L 25 J" Longitude 78 " 07 * 06 K
1' r'> l= u e of gpt+iai all ii `; j 3 [_ ❑ Subsurface Drains Present 10 Lagoon Area I❑ Spray Field Area
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
® No
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
❑ Yes
® No
c. If discharge is observed, what is the estimated flow in gal/min?
NIA
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
® No
5. Does any part of the waste management system (other than lagoons/holding ponds) require
9 Yes
❑ No
maintenancelimprovement?

Facility Number: 31-297
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
7. Did the facility fail to have a certified operator in responsible charge?
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (ULFoons and/or Holding Ponds)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Freeboard (ft): Structure l Structure 2 Structure 3 Structure 4
............. 2.7.5....... .................. ........ 5..... -....... ...................... 5..................
..................... .
10. Is seepage observed from any of the structures?
11. Is erosion, or any other threats to the integrity of any of the structures observed?
12. Do any of the structures need maintenance/improvement?
(If any of questions 9-12 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
Waste Application
14. Is there physical evidence of over application?
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No .
Structure 5 Structure 6
® Yes © No
® Yes © No
® Yes ❑ No
D Yes ® No
15. Crop type ..........._.......................................
16. Do the receiving crops differ with those designated in the oAm a Waste Management Plan (AWMP)? ® Yes ❑ No
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
For Certified Facilities Only
22. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
23. Were any additional problems noted which cause noncompliance of the Certified AWMP?
24. Does record keeping need improvement?
Yes ® No
CK Yes © No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
® Yes © No
❑ Yes ® No
® Yes © No
5./18. Revegetate bare areas in Nursery #1 spray fields caused by cattle. A,
11./12. Fill in erosion cuts under inflow pipes at all three lagoons. Revegetate these areas. Inflow pipe coming from Nursery #2 needs
o be completely buried as well. Also, fill erosion cuts on inner wall of lagoon for Nursery #2. In addition, Rvegetate this area and any
other bare areas on this lagoon wall.
13. A marker is needed for lagoons at Nursery #2 and #3.
2./16. Operator does not have the plan for Nursery #1. The plan on -site is either the wrong plan or a plan that is incorrect. Either way,
this situation must be immediately corrected Without the plan, it is impossible to to determine if receiving crops are correct.
24. Get soil and lagoon samples taken immediately. Spray records also need improvement.
addition, if you want to spray on fields next to lagoon at Nursery #2 and #3, you must get these fields officially put into your
anagement plan.
Reviewer/Inspector Name
Reviewer/Inspector Signature: � p�,t C, ,, Date:

....:.::... . ........... ....... :. -- . ........:.....:
-_Division of Soil and Water Conservation= Other Agency ncY
-
Division of Water Quality
19 Routine Q Com laint 0 Fo[low-ue of DWQ inspection Q Follow-up of DSWC review 0 Other
: E Date of Inspection 1219197
Facility Number 31 297
Time of Inspection 1135 24 hr. (hh:mm)
❑ Registered M Certified ® Applied for Permit ❑ Permitted © Not Operational I Date Last Operated:
FarmName: ............................................................... .... County: D.uplin........ .... ................................ W..iRla.........
OwnerName: Mike ........................................ Rabwt......................................................... Phone No: 9.10.-.293-.1093 ..........................................................
Facility Contact: A!!ke.Rahau.................................................... Title: .O.Wj.er.................................................. Phone No: 9.lfi:Z1` 3..7.Q9�.......................
Mailing Address: 4.4G.NC.SQ.A..115.11.7......................................................................... Warnw..NC.......................................................... M3_98.............
Onsite Representative:a an....................... Integrator: ttp y. ary.. arms......................................
Certified Operator: MiU..CR................................. Rab.on................................... .•• . .-:. ` Operator Certification Number: .1$.13.8.............................
Location of Farm:
�u.ra�xx.#1.as.uan.ztA.tth.sib.Qf.S.1t.1.3�4,.a�p.Xa�iaaatiely.Q.�.aai�ea.neat.n�aiitexs��tiiata.xt�it�.�1.�3x.�Q.,..�u�,ex�.#2..a�ask#�.a��.at.cnd..
& SRU4.4.................................................................................................................................................................................................................................................... r
Latitude 3S • O1 ' 25" Longitude 78<s •507 06 «
® Wean to Feeder
7800
7800
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
General
. Are there any buffers that need maintenance/improvement? ❑ Yes ® No
2. Is any discharge observed from any part of the operation? _ ❑ Yes CK No
JI
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑;Oth&
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. if discharge is observed, did it reach Surface Water -?;(If yes, notify DWQ) [] Yes ❑ 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
1 Is there evidence of past discharge from any part of the operation? ❑ Yes M No
4. Were there any adverse impacts to the waters of the State other than from a discharge? ❑ Yes JR 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 0 No
7. Did the facility fail to have a certified operator in responsible charge? ❑ Yes ® No
7/25/97

Facility Number: 31-297
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (LagoonsOolding Ponds Flush Pits etc.
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure I Structure 2 Structure 3 Structure 4
identifier: 1........................................................
Freeboard(ft):............. 1.33............. ............. 2.,33............. ............... 2:.5........... .... ................. ............
10. is seepage observed from any of the structures?
11. Is erosion, or any other threats to the integrity of any of the structures observed?
12. Do any of the structures need maintenancelimprovement?
(If any of questions 9-12 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
Waste Application
14. Is there physical evidence of over application?
(If in excess of WMP, or runoff entering waters of the State, notify DWQ}
Structure 5
15. Crop type ...... .................... lye...........................Sznalz.Gzaan.41?aca1,.)Baxley......................................................
Milo, QatsJ
m
16. Do the receiving crops differ with those designated in the Amali Waste Management Plan (AWMP)?
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
22. Does record keeping need improvement?
For Certified or Permitted Facilities Only
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?
-No-v'iolatiarls: or.defi ieriEies•iver'e'rioted:d�ri>n t4is•visit.: You w ll'rNeiVe'rro foriber' • : -
•.-.c6rresp6nde"''hoWihis.visit'.•. . . . .•. . . ... ._.. . ...'. ... ..... . . . .......•...'.•.•
13) Should have markers installed on 42 and #3.
22) Should balance N on IRR-2 for fields/crops listed in WUP. Need waste sample within 60 days of irrigation.
24) Need copy of design for farm.
a T.S. at Murphy fill out odor, insect, and mortality checklists.
Q Yes No
Q Yes No
Structure 6
Q Yes ® No
❑ Yes No
❑ Yes ® No
N Yes Q No
Q Yes N No
❑ Yes N No
Q Yes ® No
Q Yes ® No
❑ Yes N No
Q Yes N No
❑ Yes N No
{Z Yes Q No
N Yes Q No
❑ Yes N No
7/25/97
•
Reviewer/Inspector Name YettnM ltfgerald
ReviewerlInspector Signature: Date:

Site Requires Immediate Attention:
Facility No.�2 q7
DIVISION OF ENVIRONMENTAL MANAGEMENT
• ANIMAL FEEDLOT OPERATIONS SITE'VISITATION RECORD
DATE: 3 1 .1995
Time: �_
Farm Name/Owner: ; W N Vuen
Mailing Address:
County:
Integrator: �_t( _ _ _ Phone: l yo v - 211
On Site Representative: W ,T• I)A-vu� _ _ � _ Phone:
Physical Address/Location: M'e o f
Type of Operation: Swine Poultry Cattle
Design Capacity: 0 0 Number of Animals on Site: DU
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: ° 0 Longitude: :7 _0L __' ____fElevation: Feet
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately I Foot + 7 inches) epr No Actual Freeboard: D— Ft. Inches
• Was any seepage observed from the lagoon(s)? Yes or N� Was any erosion observed? Yes or No
Is adequate land available for spray? npr No Is the cover crop adequate?LJ or No
Crop(s) being utilized:--C.vt tp7%, .. - - - --
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings a of
100 Feet from Wells? es No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or No
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes or No
Is animal waste discharged into waters of the state by man-made ditch,,flushing system, or other
similar man-made devices? Yes or No If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? Yes or No
Additional Comments: W o% D L,r, _ ",,64 /t�-,l
�94,-Ac old
Inspector Name Si t e
cc: Facility Assessment Unit Use Attachments if Needed.