310763_INSPECTIONS_20171231

NUH 1 H UAHULINA
Department of Environmental Qual

Division ofAWater Resources
FacilityrNumbe®Division of Soil and�V1? 1— Conservation
�- � Other �► enc
Type of Visit: ompliance Inspection 0 Operation Review p Structure Evaluation p Technical Assistance
Reason for Visit: Qlfoutine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: �, u� ( Arrival Time: `w Departure Time: County: Dlks Region I L
Farm Name: GV4 S ,,jam Owner Email:
Owner Name: 1�(�Jtt is�+�5t_f �� Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
`oVL Title:
Latitude:
Phone:
yy
Integrator:
Certification Number: G� i
Certification Number:
Longitude:
Design
C►urrent
Design
Current
Design Current
Swine
C�apSacity
Pap.
Wet PzoultrJ
Capacity
Pop.,
Cattle Capacity fop.
Wean to Finish
Layer
Dairy Cow
Wean to Feeder
Sao
'soU
I INon-Layer
I
Dairy Calf
Feeder to Finish
et"zo
2
Dairy Heifer
Farrow to Wean
2
Design
Current
Dry Cow
Farrow to Feeder
Dr. :P,oult ;
Ca aci_ty
Pao
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
on -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. is any discharge observed from any part of the operation? ❑ Yes [3-1157- ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No []—NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR) ❑ Yes ❑ No D-?qA ❑ 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 E No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes [:5No ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 - 2/4/20I S Continued
i

Facili Number: 111 - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
ELNe--❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
E3-'11A
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure
6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
�fo
❑ 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
[ to
❑ 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
No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
❑1' 'oo
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
Er oo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
[] Yes
RJ'No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [!I '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): CG(j N
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [1 <o ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes <o D NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes �o ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes [�No ❑ NA ❑ NE
❑ Yes [DNo ❑ NA ❑ NE
Rewired Records_& Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes [ (No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check [:]Yes [] No ❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [Z'No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 " Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [i"No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ZNo
NA ❑NE
Weather Code
Sludge Survey
NA ❑ NE
❑ NA ❑ NE
Page 2 of 3
21412015 Condnu d

Facility Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [r3'1❑ NA ❑ NE
f5. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes D<__�❑ 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 Q' oo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [o ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes I ❑ 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 [B"1 T—U 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
Q.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
( o
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
LJ 1"o
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
[J-Nm
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or"any other;comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
tcx� CJ`,r ` 7 j -} ` L(-- (&— ,/v. a`5, o - 3 7 3� 70
Reviewer/Inspector Name: V5 i
c
Reviewer/Inspector Signature:
Page 3 of
Phone: Ir" 3
Dale:
21412015

r",
0
(Type of Visit: Q) Co(pliance Inspection O Operation Review O Structure Evaluation O Technical Assistance I
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Zn ( Arrival Time: ® Departure Time: I County: Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Owner Email:
Phone:
Facility Contact: / Title:
Onsite Representative: �n irk r k l
Certified Operator:
Back-up Operator:
Phone:
Integrator:
Certification Number: 14 k1 1
Certification Number:
Location of Farm: . Latitude: Longitude:
Design Current
Swine Capacity Pop.
can to Finish I
Wet Poultry
ILayer
Design
Capacity
C«urgent
Pop.
Design Current
Cattle Capacity P.op.
Dairy Cow
Wean to Feeder
I
iNon-Layer
I
EE
Dairy Calf
eeder to Finish
arrow to Wean
Farrow to Feeder
Dt, P■ouIt
Design
apjkcit
Current
P,o
Dairy Heifer
D Cow
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
IPUIlets
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)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
[—]Yes dNo ❑NA ❑NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑Yes
❑No
❑NA
❑NE
❑ Yes
[2-11;Fb
❑ NA
❑ NE
❑ Yes
[]'No
❑ NA
❑ NE
Page 1 of 3
21412015 Continued

Facilit Number: - 76J Date of Ins ection: ""
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes Ej No D. 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): -27
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes ErNo ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes EfNo ❑ 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 ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
0 No ❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
o ❑ NA
5No
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
[:]Yes
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
2� ❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
L No ❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes dNo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
[:]Yes ZNo
❑ 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
Sludge Survey
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall InspectioeNo
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes❑
NA
❑ NE
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes❑
NA
❑ NE
Page 2 of 3 214120I5 Continued

acili • Number: rZ,- Date of Inspection: i ,
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑Yes ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑ No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes 6 No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [:]Yes ❑ No J�KNA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes 6 No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern? [::]Yes &No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the [:]Yes V(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 P]rNo ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes V"No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes j2NNo ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? [:]Yes [7, No ❑ NA ❑ NE
Comments (refer to question ##): Explain any YES answers and/or any additional recommendations or any tither comments.
Use drawings of facility to better explain situations (use additional pages`as necessary' ).
Reviewer/Inspector Name: 1)CV V c f (�. _' /r/
ReviewerlInspector Signature:
Page 3 of 3
Phone:
Date: 2 �6
21412014

•' vision of Water Resources
Facility Number 13 1 _1- LO Division of Soil and Water Conservation
D Other Agency
_41-
Type of Visit: ompli a Inspection 0 Operation Review 0 Structure Evaluation Q Technical Assistance
Reason for Visit: Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: I
JWrT ( Arrival Time: ® Departure Time: H O F— County: Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: / Title: Phone:
Onsite Representative:`) L-i� T r�/1 Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Certification Number:
Longitude:
Swine
can to Finish
vlWean to Feeder
Design
Capacity
,O
Current
Po01
Layer
Non -La er
Design
Current
DairyCow
DairyCalf
Design
Capacity
Current
Pop.
eder to Finish
o�
g!j
DairyHeifer
Farrow to Wean
17r
qSg
D P,ouitr,
Design
Ca aci_
Current
D Cow
Farrow to Feeder
Farrow to Finish 'Layers
P,o
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
i urke s
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes EJINo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
[]NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
[/] No
❑ NA
❑ NE
❑Yes
10
❑NA
❑NE
Page I of 3 21412015 Continued
IL

Facili Number: 3.r Date of Ins ection:
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [v]'�o ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): J ;
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes Z?No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes Eg,'I<o ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes [E'No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes [J 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 [Ejl�o ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [31�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
ET<10
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
6'N'o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[2/No
0 NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Required Records &_Documents.
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
E�J`No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[�No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ETINo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No ❑ NA ❑ NE
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes Ej No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facility Number: - Date of Inspection: r
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [ o
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [] Yes 191( 0
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 To
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ NA ❑ NE
❑ NA ❑ NE
DNA
❑ NE
D-,-A ❑ NE
❑ Yes 7 No ❑ NA ❑ NE
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
[:]Yes No ❑ NA ❑ NE
[:]Yes ffNo
❑ Yes rNo
❑ Yes
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Keviewerninspector name: V - • 4 L. u - I rnone: v ✓
Reviewer/Inspector Signature: C4"Date:
Page 3 of 3 21412015

Type of Visit: Dtompliance Inspection O Operation Review 0 Structure Evaluation O Technical Assistance
Reason for Visit: 96utine 0 Complaint 0 Follow-up O Referral 0 Emergency 0 Othheer`,.,100 Denied Access
Date of Visit: Arrival Time: ® Departure Time: . aJJ County _)_)P DJ Region:
Farm Name:
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: �1 Title:
Onsite Representative: , j�) & A j k:E
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator:
Certification Number: CT gK��
Certification Number:
Longitude:
Design
Current
Design Current
Design
Current
Swine Capacity
Pop.
Wet Poultry Capacity Pop.
Cattle
Capacity
Pop.
Wean to Finish
Layer
Dairy Cow
Wean to Feeder b Cx---s
I jNon-LMer
I
6,nt
Dairy Calf
Feeder to Finish
Da' Heifer
kX
Farrow to Wean
Design
D Cow
Farrow to Feeder
D . P.oul Ea aci
Non -Da'
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
113ecf Feeder
Boars
Pullets
113ccf Broad Cow
Turke s
Other
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
[]Yes No ❑ NA ❑ NE
[:]Yes [:]No
❑ Yes ❑ No
[:]Yes ��o
N
[:]Yes I
[]Yes No
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 214120I4 Continued

Facility Number: - (p Date of Inspection: s
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
Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 40
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
❑ Yes No ❑ NA ❑ NE
❑ Yes [ (No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes [:?�o ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? [—]Yes ❑ No [DNA ❑ 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 ❑*o ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes E3"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
[/J No
❑ NA,
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
�No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
L�r_No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
E3`No
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
Ef�No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
E-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
2<0
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather
Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and l" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
Q No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
[:]Yes
No
❑ NA
❑ NE
Page 2 of 3
21412014 Continued

7
Facility Number: 51-2Q3 jDate of Ins ection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes . No ❑ NA ❑ NE
2S. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below. TT
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? [:]Yes o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes E(No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document [:]Yes No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
[: "'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
I__I 1V o
❑ 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
No
❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
El Yes
9
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
o
❑ NA ❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional.recommendations or any other tomments. = =
Usedrawings of facility to better explain situations (use additional page as necessary):
?u��C_' �C-Coa-DS D6(__�C �acL TC_ ID D(>3E
Reviewer/Inspector Name:
Phone: C ((b) e7q( `-13eg
Reviewer/Inspector Signature:
Page 3 of 3
Date: "<I a 5
214120

Type of Visit: (XColwiance Inspection O Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: ® Departure Time: ® County: Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: jCrc k-r &— - Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Certification Number: "l25 f 3 P
Certification Number:
Longitude:
Wean to Finish I I ILayer I Dairy Cow
Wean to Feeder COU SOO Non -La er I Dairy Calf
Feeder to Finish toob 10no Dairy Heifer
Farrow to Wean Z Design Current D Cow
Farrow to Feeder Dry, P.o_ultr. Ga achy P,o , Non -Dairy
Farrow to Finish Layers Beef Stocker
Gilts Non -Layers Beef Feeder
Boars Pullets Beef Brood Cow
Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
[:]Yes
No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
[:]Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (if yes, notify DWQ)
❑ Yes
❑ o
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
o
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
No
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

Faeflity Number: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes /No❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): S-
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes 1ZNo
❑ 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 E3/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 enviironmen threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes Zo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes [
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
[:]Yes M�No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes 0 No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application
Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does
❑ Y s No
❑ NA
❑ NE
the receiving crop and/or land application site need improvement?
Yes ❑ o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes ]No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes &7o
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the.Certificate of Coverage & Permit readily available?
❑ Yes ff XN
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections [:]Monthly and V Rainfall Inspections Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes [211N
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes o
❑ NA
❑ NE
Page 2 of 3
21412011 Continue

IJ
Facility Number: 221- Date of inspection:
24'. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ ICJl�o Yes ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes FZ`N0 ❑ 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 Iagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [:]Yes I 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)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes 2 No ❑ NA ❑ NE
❑ Yes [f No ❑ NA ❑ NE
[:]Yes �No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes
34. Does the facility require a follow-up visit by the same agency? ❑ Yes
I YNo ❑ NA ❑ NE
7`' ❑ NA ❑ NE
No ❑ NA ❑ NE
Comments (refer.to;question.ft Explain any -YES answers and/or any additional recumrnendations. or any other -comments :
Use 'dfawulgs.of facility -to better ex
plain situations -(use "additional pages as necessary). -
�5 Ar�'� APPL'►' ��rJ �ia SRZ. ,
C� E J [-`r APG- 4z-S Fo CAO
Reviewer/Inspector Name:
Reviewer/Inspector Signature
Page 3 of 3
-i
Date: 3
2/4/201
s

Type of Visit: GfZoutine
pliance Inspection O Operation Review 0 Structure Evaluation 0 Technical Assistance
isit:Reason for V0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access I
Date of Visit: Arrival Time: QS' Departure Time: IUOG County: Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Phone:
Title: Phone:
Onsite Representative: i --r-sl AU— Nub"j Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number: kwl C)
Certification Number:
Longitude:
Swine
Wean to Finish
Design
Capacity
Current
Pap.
Wet Poultry
La er
Non -Layer
D . loult .
La ers
Non -La ers
Pullets
Design
Capacity
Design
Ca aci.
Current
Pop.
C*urgent
P,o
Design Current
C►attle Capacity Pop.
Da' Cow
Da' Calf
DairyHeifer
D Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow I Ej
Wean to Feeder
J
Feeder to finish IDO
+ago
Se Farrow to Wean
Farrow to Feeder
Farrow to Finish
(
Gilts
Boars
Other
Other
Turkeys
Turke 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 DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
[:]Yes No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑Yes FNo
❑NA ❑NE
Yes[] NA ❑ NE
Yes ❑ NA ❑ NE
Page I of 3 21412011 Continued

Facitity Number: - Date of Ins ection:
Waste Collection & Treatment
4. I§ storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [7(NNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? [:)Yes ❑ No ❑ NA ❑ NE
Structure l Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):_
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a [:]Yes ZNo ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environment threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes W 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 dNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes Nc ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 101/16 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
[]I No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
dN0
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
E(No
❑ NA
❑ NE
acres determination?
No
17. Does the facility lack adequate acreage for land application?
❑ Yes
[Z
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
Ld i�o
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
Yo
❑ 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 �i . ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes YNo ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Fadlity Number: - Date of Inspection: ; -L
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes VN
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ]Yes ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes �No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes hTo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes ❑ No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes ❑s "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 b'*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 /o ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes VNo
❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes o ❑ NA ❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or an other comments.
Use drawings of facility to better explain situations (use additional napes as necessarv).
Reviewer/Inspector Name: j O44") Phone: �} 3
Reviewer/Inspector Signature: Date: c7lo it L,
Page 3 of 3 21412011

(Type of Visit: Q Co liance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: 35 Departure Time: 10 County: � Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Owner Email:
Phone:
Onsite Representative: ersDp'u UvermAo Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone:
Certification Number: ((,V l q
Certification Number:
Latitude: Longitude:
Swine
Wean to Finish
Design
Capacity
C►urgent
Pop.
Wet Poultry
Design
Capacity
Current
Pop.
C•arile
DairyCow
Design C«urgent
Capacity Pop.
Wean to Feeder
w
oo
ELayer
Non -La er
DairyCalf
Feeder to Finish
b
00
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
&4S -L,
4 L
D t P,ouIt ,
Layers
Design
Ca aci_ty
Current
P,o
Dry Cow
Non -Dal
Beef Stocker
Beef Feeder
Gilts
Non -La ers
Boars
Pullets
Beef Brood Cow
Turkeys
OtherI Turkey Poults
Other I Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
E(No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
o
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
WN o
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

Facility Number: - Date of Ins ection: j2jj 11%
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No
Structure 1
Identifier: LA Gaa r
Spillway?:
Designed Freeboard (in):
❑ NA ❑ NE
❑ NA ❑ NE
Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Observed Freeboard (in): 4S
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
[:]Yes
2/No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environment I threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
[:]Yes
7No
❑ NA
❑ NE
S. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
E3/No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes [ No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [2/No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 101bs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence 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 E(No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable [:]Yes [�Wo ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
1$. Is there a lack of properly operating waste application equipment?
❑ Yes v❑ Yes
❑NA ❑NE
❑NA ❑NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes dN0 ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check [:]Yes hio ❑ NA ❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design 0 Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. []Yes Ko ❑ 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 DNA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facili Number: - Date of Ins ection: 1 tIt'
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes 0No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? []Yes [2(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)
31. Do subsurface tile drains exist at the facility? if yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
[:]Yes [ /No ❑ NA ❑ NE
❑ Yes [I/No ❑ NA ❑ NE
❑ Yes [; No ❑ NA ❑ NE
[:]Yes O/No [DNA ❑ NE
❑ Yes dNo
❑ Yes gNo
NYes
❑ NA ❑ NE
❑ NA ❑ NE
❑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).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
. Page 3 of
Phone:(_%) 7
Date: 1141 1 i}
21412011

ri
�. DlVlsion of Watgr,Qualiity �
:Fac�lrtyNumkier°.M_�J_M
DYviston ofSoil and!Water ConservatioO— Other
E
Visit Co pliance Inspection O Operation Review O 5tructure Evaluation O Technical Assistance
.for Visit Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: ERZ7pArrival Time: O Departure Time: County: Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: �L/�/WAJ Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: = o E__1 " Longitude: = o = 4
Destgn Current;
Destgn� CurrentM # Design Current
Swme : Capac�ty°.µl'opeil'atton
.M
,Wet Poultry Capacity=��o�iulation
❑ Layer
.Cattle L q � Capacity Poqulation,
d ❑ Dair y Cow
❑ Non -Layer
El Dairy Calf
a;„ :, El Dairy Heifer
❑ D Cow
•Dr�,l?oultry �� �. �.
❑ Farr
ow to Finish
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: [I Structure El Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes '� No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
[I NA
El NE
❑ Yes
❑�No
El Yes
L�J No
❑ NA
❑ NE
❑ Yes dNo ❑ NA ❑ NE
I2/28/04 Continued

Facility Number: 31— Date of Inspection o
Waste Collection & Treatment
' 4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ZNo ❑ NA ❑ NE
a. if yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: LACct�ti.%
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 4-M
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.) ,��f/
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes t_7 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? ElYes ,NNo ❑ NA El NE
O
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes 2 No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes M /No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes CYNIo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus [:]Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ Yes
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
17. Does the facility lack adequate acreage for land application? ❑ Yes
18. Is there a lack of properly operating waste application equipment? ❑ Yes
EJNo
El NA
El NE
[�4o
❑ NA
❑ NE
No
❑ NA
❑ NE
No
❑ NA
❑ NE
�No
❑ NA
❑ NE
Comments (refer to question #) Explain any YES answers,and/or any, recommendations or,any o"her-'comments n R
UseJdrawings of:faeility to ,betterexplain situations {useadditiorial pages as necessary)_•. x;;
AL
Reviewer/Inspector Name diQ �, ` 14�2rti1 �(al " , Phone: g 3 6 D
Reviewer/Inspector Signature: Date: Virl
Page 2 of 3 1 12128104 1 Continued

Facility Number: Date of Inspection
Re uired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check
the appropriate box. ❑ WUP ❑ Checklists ❑ Design El Maps El Other
❑ Yes b No ❑ NA ❑ NE
❑ Yes ff No ❑ NA ❑ NE
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual
Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ MonthIy and 1"
Rain Inspections ❑ Weather
Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
ZNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
1!I N
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
K0
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
�: o
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
L_I No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
�,/
E3 o
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
E 1vo
❑ 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
CPNo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
/
31. Did the facility fail to notify the regional office of emergency situations as required by
El Yes
❑'1�10
❑ 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
Elilo
:❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
❑ NA
❑ NE
Additional Comments and/or Drawings::"
Page 3 of 3 12128104

Type of Visit .0 Co Hance Inspection 0 Operation Review 0 Structure Evaluation () Technical Assistance
Reason for Visit I1 outine O Complaint O Follow up Q Referral O Emergency O Other [],Denied Access
Date of Visit:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Arrival Time: Departure Time: r_� County:
Owner Email:
Facility Contact: Title:
Onsite Representative: a L,&—
Certified Operator:
Back-up Operator:
Location of Farm:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Region:
Latitude: E-1 o ET = « Longitude: = ° =' = "
Design Current
Wet Poultry Swine Capacity Population
DesignTP
Iapaciopulation
Current
Design
Cattle Capacity
Current
Population
❑ Wean to Finish
❑ Layer
❑ Dairy Cow
Wean to Feeder
SO 6
❑ Non -Layer— I
I
❑ Dairy Calf
Feeder to Finish
Farrow to Wean
p
E k-r—M Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
El TurkeysTunkeys
❑ Turkey Poults
10 Other
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
El Farrow to Feeder
❑ Farrow to Finish
❑ Beef Stocker
❑ Gilts
❑ Beef Feeder
❑Beef Brood CnvA
Number of Structures:
❑ Boars
Other
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes io ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes ❑ NA ❑ NE
❑ Yes t No ❑ NA ❑ NE
12128104 Continued

Fdcility Number: — Date of Inspection [! G
Waste Collection & Treatment
4.a Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ElNA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
ONo
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes
ZNo
❑ NA ❑ NE
through a waste management or closure plan?
rat, notify DWQ
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmenta;No
7. Do any of the structures need maintenance or improvement? ❑ Yes
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
o
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes
No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
E.!/No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
4n 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
0 ❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
El Yes
No ❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[:] Yes
� ❑ NA
El NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
7 ❑ NA
XNo
❑ NE
18. is there a lack of properly operating waste application equipment?
❑ Yes
❑ NA
❑ NE
Reviewer/Inspector Name Phone: YI Y6 15Y4
Reviewer/Inspector Signature: Date:

Facility Number: 3 —'j Date of Inspection h
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
❑ Yes Ld No ❑ NA ❑ NE
❑ Yes U(No ❑ NA ❑ NE
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual
Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1"
Rain Inspections ❑
Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
d o
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
WNo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
0 No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes 'O'No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
El Yes
❑ No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
I No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
d
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
7No
❑ 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
dNo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
ZNo
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
2(
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
El Yes
;Zo
❑ NA
❑ NE
_. �.._ sin ,� - . -�``C w"-.,�;".". :x''
„ �. �.,
Additional Comments and''/or Drawings ; �� t Y , v� ;,r
Page 3 of 3 12128104

3
Type of Visit Q Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit Routine O Complaint O Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: 1 ibb I Arrival Time: Q6 6 Departure Time: County: UP Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Owner Email:
Phone:
Facility Contact: �) Title:) Phone No:
ta Onsite Representative: Eh�'aA L_ u�fVA Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Operator Certification Number:
Back-up Certification Number:
Latitude: 0 0 = 0 At Longitude: [� o[= d 0 46
Design Current
Swine Capacity Population Wet Poultry
Design
C►apacity
Current
Population
Design Current
Cattle CapacityPopulation
❑ Wean to Finish
❑ La er
❑ DairyCow
21 Wean to Feeder
�
❑ Non -Layer
❑ DairyCalf
19 Feeder to Finish
ov p
❑ Dai Heifer
Farrow to Wean
ws
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Dry Cow
ElNon-Dairy
❑ Beef Stocker.
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures:
❑ Farrow to Feeder
El Farrow to Finish
Gilts
PElBoars
Ot1l
❑ Other
=10
❑ Turkeys
Turkey Poults
I JE1 Other
Will
�IWIII
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes dNo ❑ NA ❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
❑ o El NA
El NE
❑ Yes
El Yes
LJN El NA
❑NE
❑ Yes
Ld No ❑ NA
❑ NE
Page I of 3 12128104 Continued

Facility Nq mber: — 3 Date of Inspection 11 d
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. if yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): L
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
,_(
E 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 th eat, notify DWQ
7. Do any of the structures need maintenance or improvement? El
7NNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ yes
[lo ❑ NA El NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
f7�
9. Does any part of the waste management system other than the waste structures require El Yes
LJ No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
ENo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
[o []NA ❑ NE
El Excessive Ponding ❑Hydraulic Overload ❑Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs [I 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 A
o ElNA ❑ NE
l6. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[]Yes YNo ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes ONo ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes ❑A4 ❑ NA ❑ NE
Reviewer/Inspector Name bW JAR-Atc t . I Phone: 6 — 13 Y &
Reviewer/Inspector Signature: Date: b i
Page 2 of 3 1212 Continued

Facility2umber: 'j` Date of inspection ll o$
Reemired 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 0 No ❑ NA ❑ NE
the appropiiate box. ❑ WUP ❑ Checklists ❑ Design El Mans ❑Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
[/No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections El
Weather
Code
22.
Did the facility fail to install and maintain a rain gauge?
ElYes
O No
❑ NA
❑ NE
23.
if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes
VNo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[f-No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
[ No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
[No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
W1�4o
❑ NA
❑ NE
Other issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
o
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
[3/No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
El
o
El NA
El NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes
C�Z_
El NA
El NE
❑ Yes
❑ NA
❑ NE
Additional Comments and/or Drawings:
._ •s. - ��. ,:
Page 3 of 3 12128104

Division of Water Quality
0 Division of Soil and Water Conservation
Facility Number 96-3
-.3 O Other Agency
Type of Visit 016ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit dRoutine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: t o Arrival Time: ID30 Departure Time: County: Region:
Farm Name:
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: 1t_C-ND At y Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Phone No:
Operator Certification Number:
Back-up Certification Number:
Latitude: = c =1 = Longitude: = ° [= d
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
ElLayer
Sav ❑ Non -Layer
❑ Wean to Finish
© Wean to Feeder
® Feeder to Finish
oap
® Farrow to Wean
S IZ
❑ Farrow to Feeder
El Farrow to Finish
❑ Gilts
El Boars
Other
❑ Other
Dry Poultry
ElLayers
ElNon-Layers
El Pullets
❑ Turkeys
❑ TurkeyPoults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: El Structure El Application Field El Other
a. Was the conveyance man-made?
Design Current'
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifej
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes EZ/No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes lK No ❑ NA ❑ NE
❑ Yes �No ❑ NA ❑ NE
12128104 Continued

Facility Number: 3� — (p3 Date of Inspection �� o
Waste Collection & Treatment
4. is siorage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes Ed"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: LACrw6►J
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 56
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes Z1No ❑ 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 ❑ 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? El Yes [� No El NA El NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes � No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10, Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes L G<o ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes LJ No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l 0 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
IJ No
ElNA
[INE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
�
�No
❑ NA
ElNE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
E "NNo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
E NNoo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
ElYes
Ejl o
❑ 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):
2-)) FtaAT A5 S aAmE A S 3►— S
Reviewer/Inspector Name a.( Phone:( 30
Reviewer/Inspector Signature: Date: 1 e ►'

Facility Number: I — Date of Inspection t rt
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 [2 No ❑ NA ❑ NE
the appropiate box.
❑ WUP El Checklists - ❑Design El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes E 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 Cade
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
E31No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑1o
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
O No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
N'[2"o
❑ NA
[INE
26. Did the facility fail to have an actively certified operator in charge?
s
D No
El NA
El NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
7yes
❑ No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes 0-1510 ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
D No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
Ko
❑ 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
<o
❑ 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
[PQo
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
VNo
❑ NA
❑ NE
Comments and/or Drawings:
12128104

q&3
Type of Visit Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit XRoutine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: &6v,424 Departure Time: County: Zf" Region:
Farm Name: -"P cJ Owner Email:
Owner Name: I✓/rY1 1c�S Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: &Zzo-"i Q�fAve'kY�%S_
Certified Operator: k F_ nl 6a ^,
Back-up Operator:
Location of Farm:
Swine
Phone No:
Integrator• _e
Operator Certification Number:
Back-up Certification Number:
Latitude: = o = f Longitude: = ° ❑ 1
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑_Layer
�1 ❑ Non -Layer
❑ Wean to Finish
Wean to Feeder
Feeder to Finish
I 0j) 0
Farrow to Wean
3
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other ---
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turke s
❑ Turke Poults
❑ Other
Discharges & Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifei
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stockei
❑ Beef Feeder
❑ Beef Brood Cqwi
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 �'No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes ANo. ❑ NA ❑ NE
❑ Yes XNo ❑ NA ElNE
12128104 Continued

Facility Number: —O Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes VNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Structure 6
Identifier: A,
Spillway?:
Designed Freeboard (in): ,j
Observed Freeboard (in): 41-0
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes Rl No
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes No
❑ NA ❑ NE
through a waste management or closure plan? I
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes_ No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ElEvidence of Wind Drift ElApplicationOutside of Area
jnd
�r{�fiR%. (� rr�a
12. Crop type(s) ! _ , ���lE' �9s
0�l
13. Soil type(s)
► i i
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes VNo ❑ 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 [7No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes f�"rNo ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes 0 No ❑ NA ❑ NE
G q) W1_16 I V'-t0 !' GA%
T I
Reviewer/Inspector Name , i.Phone: D
Reviewer/Inspector Signature: Date: !�Z
Z�/ 12128104 Continued

r 4/
Facility Number: — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Pen -nit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropirate box. ❑ WDp ❑ Checklists ❑ Design ❑Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes E� No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers //❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
VNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ NA
NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CA ,AIMP?
❑ Yes
No
rrm
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
/
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
0 No
❑ NA
❑ NE
General Permit? (ic/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
0 No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
No
❑ NA
❑ NE
Additional Comments andlor Drawings:
12128104

c
Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied �� Access
Date of Visit: Arrival Time: l/l / Departure Time: ounty: � 14/ 11L ti _ Region: �lD
Farm Name:_�&JFZ Y 6&/_n Owner Email:
Owner Name: 1 � 5 ��� L/ Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: L 9,1204,,J
Certified Operator: ,Ei��!}CC� lnite &12
Back-up Operator:
Phone No:
Integrator: r` `t&P�—
AcbuJ�
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: = 0 0 g = Longitude: = ° = t =
4
Design Currents
Swine. Capacity
I}estgnC.urrentx . Design Curren#
WetPoultryCapactty Population Caftle Capacity Population
Populations
'.`o•d 1.1 \ Y... a -
t.
n.G- s� u, .... _
❑ Wean to Finish
❑ Layer
a
El Dairy Cow
Wean to Feeder QQ
❑ Non -La er
❑ DairyCalf
Feeder to Finish a00
"':
El Dairy Hcifei
Farrow to Wean /
Dty Paul�, ,
try
El D Cow
�'
Farrow to Feeder
.
❑ Non -Dairy
❑ Farrow to Finish
❑ Layers
❑Beef Stocker
❑ Gilts ❑ Non -Layers
❑ Beef Feeder
❑ Boars
❑ Pullets
"ElBeef Brood Co
O#her
❑ Turkeys
❑ Turkey Poults
� -
-
;-}€�
❑ Other
❑ Other
Number of Structures:
Discharges St Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes gNo ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
No
❑ NA
❑ NE
other than from a discharge?
12128104
Continued

Facility Number: Date of Inspection Q
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
St cture 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes �] No ❑ NA El NE
(ie/ large trees, severe erosion, seepage, etc.) !�No
6. Are there structures on -site which are not properly addressed and/or managed El Yes ElNA ElNE
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
KNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
VNo ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes
No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
No ElNA ElNE
X
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
)6 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 Cr�op, ❑ Evidence of Wind Drift ElApplication Outside of Area
/Window
12. Crop type(s) L Wj,/ Wi9�f }� js/g�An1S ( 0 7-:M.J Z I/e
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes XNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination%❑
Yes No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes VNo
❑ NA
❑ NE
use
z?] _Z,
NOrE' 4AU D,¢o.Ee�f!' �A.Qn't LookFD Gam,
Reviewer/Inspector Name f v+v Phone: / 6-- Z
Reviewer/Inspector Signature: Date:
12128104 Continued

Facility Number: 75k3lDate of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes P No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ElNA ElNE
the appropirate box. ElWUP ElChecklists ElDesign El Maps El Other 14
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 10No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste 'transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
No
llllllllV�No
El NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
'9No
❑ NA
El NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
El Yes
PfNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
VN o
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ NA
XNE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
PfNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
No
X
❑ NA
ElNE
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
El NA
El NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
[�(No
❑ NA
❑ NE
12128104

Type of Visit BrCompliance Inspection O Operation Review O Lagoon Evaluation
Reason far Visit 0Routine O Complaint O Follow up Q Emergency Notification Q Other ❑ Denied Access
FFacility Number Date of Visit: / . Time: �
O Not Operational Q Below Threshold
Permitted ACertified © Conditionally Certified [3 Registered Date -Last Op or A ve Threshold•..
Farm Name: �G. .
>r� 5...�.�..........�..................... County. ...... __.- - - ..........
Owner Name:
-Mailing Address:
Facility Contact:
0
Onsite Representative:
Certified Operator.
Location of Farm:
Title:
Phone No:
Phone No:
Integrator. ..
Operator Certification Number:.....-----.----
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • " Longitude • 9 0"
Discharges & Stream jMocts
1. Is any discharge observed from any part of the operation? ❑ yeso
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. if discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ yes ❑ No
c. If discharge is observed, what is the estimated flow in gaumin?
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 P�NQo
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? Cl Spillway ❑ Yes ❑ No
Structgre 1 Structure 2 Stricture 3 Structure 4 Structure 5 Structure 6
Identifier: _T r W
Freeboard (incises): J
12112103 Condnued

Faciiity Number: .3— T
Date of inspection
5. Are these any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
_r seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste 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 ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type
13. Do the receiving crops differ with those designa*8 in the Certified Animal Waste
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?
❑ Yes 2<0
❑ Yes )214o
❑ Yes ja lqo
❑ Yes Saoso
❑ Yes ,ergo
❑ Yes Q-No
❑ Yes ,2•No
Plan (CAWMP)? ❑ Yes Q-No
❑ Yes Lamo
❑ Yes _ETNo
❑ Yes )2-No
❑ Yes Ja No
16. Is there a lack of adequate waste application equipment? ❑ Yes
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes J'Ro
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes -Ergo
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes _CjNo
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 No
di Air Quality representative immeately-
fsc drawm�of fa�"hty tQ bet#rr.atp}am �. {nseiaopail?� � r3'� )~zeld C Final N
ReviewerAuspecter Name
Reviewer/Inspector Signature:
�7i/c/
Date: 9/% VZ-e
12112103
Continued

Facility Number: 3 — Date of Inspection ! �+
ReauiredRecords & Documents
21 Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes 21go
22. 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
23. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes _,CI -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 ,E3to
25. Did the facility fail to have a actively certified operator in charge?
[I Yes
.M
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
_C],No
27. Did ReviewerAnspector fail to discuss reviewfmspection with on -site representative?
❑ Yes
Q—No
2$. Does facility require afollow-np visit by same agency?
❑ Yes
NO
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
E:Wo
NPDES Permitted FacHities
30. Is the facility covered udder a NPDES Permit? (If no, skip questions 31-35)
J2'Yes
❑ No
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
ONo
32. Did the facility fail to install and maintain a rain gauge?
❑ Yes
Mo
33. Did the facility fail to conduct an annual sludge survey?
❑ Yes
❑"No
34. Did the facility fail to calibrate waste application equipment?
❑ Yes
❑-No
35. Does record keeping for NPDFS required forms need improvement? If yes, check the appropriate box below.
❑ Yes
DNo
❑ Stocking Foam ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After 1" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
12112103

-q(03
Type of Visit Qkompliance Inspection 0 Operation Review 0 Lagoon Evaluation
Reason for Visit GLRoutine 0 Complaint 0 Foliow up 0 Emergency Notification 0 Other ❑ Denied Access
Facility Number 7(� Bate of Visit: Time:
Not O erational Q Below Threshold
Permitted ©Certified O Conditionally Certified t3Registered Date Last Operated or Above Threshold:
Farm Farm Name: 8�i A,QH_— �d *1 County: I�!
Owner Name:
Mailing Address:
Facility Contact:
Title:
Onsite Representative: e2wAL/ _—
Certified Operator:
Location of Farm:
Phone No:
Phone No:
Integrator:
Operator Certification Number:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' 6 K Longitude 0' 4 4
Design Current
Design Curs ent Design Current
Swine
Ca aci P.o ulation
Poultry Ca acity P,o ulation Cattle Ca achy P.o ulation
Wean to Feeder
❑ Layer
I
I JEI Dairy
Feeder to Finish
❑ Non -Layer
❑ Non-Dai
Farrow to Wean
❑ Farrow to Feeder
❑ Other
❑ Farrow to Finish
Total Design Capacity
❑ Gitts
❑ Boars
Total SSLW
Number of Lagoons ❑ Subsurface Drains Present ❑ Lagoon Area ❑ Spray Field Area
Holding Ponds 1 Solid Traps
❑ No Li uid Waste Mana ement S stem
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 stone storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
identifier: l
Freeboard (inches): 3
05103101
❑ Yes 6ZNo
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ESNo
❑ Yes CKNo
❑ Yes [5,No
Structure 6
Continued

Facility Number: 31 — $?/
�I--7-63
Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
' seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes j�3 No
❑ Yes FKJ No
❑ Yes Co No
❑ Yes W No
❑ Yes RNo
Waste Application
10. Are there any buffers that need maintenance/improvcment? ❑ Yes KNo
11. is there evidence of over application}? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes XLNo
12. Crop type �1_ G(/�P�� �D ✓
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes ® No
14. a) Does the facility tack adequate acreage for land application? ❑ Yes f�[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
EZ[No
Required
Records & Documents
17.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
[D 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
(91 No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
ELNo
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
KNo
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes t No
23. Did Reviewer/Inspector fait to discuss review/inspection with on -site representative? ❑ Yes KLNo
24, Does facility require a follow-up visit by same agency? ❑ Yes JEJ No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes KLNo
Igo No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Comments (refer to quesboe #) Explain any YES ans� ers and/o��anyomme es or any�other comments. a�
+Usedrawuigsoffacrhty to better.explatn srtuattons (use addittonal p�es asnecessary): ❑Field Copy ❑Final Notes
Hy
Reviewer/Ins ectorName may,001- %
p i� ¢� 77. ;'
Reviewer/Inspector Signature: Date:
0510310I Continued

1_7&3
Facility Number: 3— % Date of Inspection
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes RNo
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes SNo
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes E� 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 E9 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 UNo
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ZLNo
Additional Coenifients audlor Dfawrngsz-��.
i
05103101

a x ` '
Divrsron of Water QuE ifity
Divrsion_ of Soif and .Water Conservation .
_ 6 ..,.
_ Q
Elgeney _
- -
;Other
Type of Visit %Compliance Inspection Q Operation Review Q Lagoon Evaluation
IReason for Visit F, Roufine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Date of Visit: ® Time: I tociQ Printed on: 7/21/2000
Not Operational 0 Below Threshold
Permitted 0 Certified 13 Conditionally Certified © Registered Date Last Operated or Above Threshold: .........................
Farm Name: . ��� County:..... .. ......... L1 11�"1 �...............................I...__...
................................................................................................... ` . .....
OwnerName: ................................................... ........................................................................ Phone No:......................................................._._.............................
Facility Contact: .............................................................................. Title:..................... .. Phone No:
.........................................
MailingAddress: ....................S....................................................................................................................................... ..............................
KOnsite Representative:.. ,. ...Ur.. .................. .. .................... Integrator:.... ..
's
Certified Operator: ................................................... ................................................. Operator Certification Number:....................
Location -of Farm:
IT_
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude Longitude �' �� �__
Design Current
-'.'C_anacity Poroulation
Wean to Feeder
413 0
Feeder to Finish
10 Go
Farrow to Wean
v
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Design Current Design_ Current
Poultry Capacity Population Cattle Capacity.Population
❑ Layer ❑ Dairy
❑ Non -Layer ❑ Non -Dairy
❑ Other I
Total Design Capacity
Total SSLW
❑ Subsurface Drains Pres!jtJ10 Lagoon Area ILI Spray Field Area 1.
❑ No Liquid Waste Management System
Disciharees & Stream Impac
1. Is any discharge observed from any part of the operation? ❑ Yes )�No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. if discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. if discharge is observed, did it reach Water of the State'? (If yes, notify DWQ) ❑ Yes ❑ No
c. li' discharge is observed. what is the estimated flow in gal/ruin'?
d. Does discharge bypass a lagoon system? (if yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes} No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
identifier: ................................................................... .....................
Freeboard (inches):-f
5100 Continued on back

Facility Number: - —1 3 Date of Inspection printed on: 7/21/2000
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes KNo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? [I Yes 4 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 N'No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes )4 No
9. Do any stuctures lack adequate. gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes NrNo
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes krNo
11. Is there evidence of over application? ❑ Excessive Ponding- ❑ PAN ❑ Hydraulic Overload ❑ Yes JXNo
12. Crop type e' { W 15c"A . V-4-e . y.• �.,.� ►-2
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes EfNo
14.
a) Does the facility lack adequate acreage for land application?
❑ Yes
1"No
b) Does the facility need a wettable acre determination?
❑ Yes
50 No
c) This facility is pended for a wettable acre determination?
❑ Yes
t4No
15.
Does the receiving crop need improvement?
❑ Yes
Wo
16,
Is there a lack of adequate waste application equipment?
❑ Yes
KNo
Required
Records & Documents
17.
Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
N(No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
Yes
No
(ie/ WUP, checklists, design, maps, etc.)
❑
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
gNo
20,
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
CR(No
21,
Did the facility fail to have a actively certified operator in charge?
❑ Yes
PrNo
22_
Fail to notify regional DWQ of emergency situations as required by General Permit?
Yes
�o
(ie/ discharge, freeboard problems, over application)
❑
23.
Did Reviewer/inspector fail to discuss review/inspection with on -site representative?
❑ Yes
Uf4o
24.
Does facility require a follow-up visit by same agency?
❑ Yes
9No
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
ONo
. �i4-* aigris:or• dgfidrend'' - * ..r. noted dirrtng this'visit:- You will-t&OW Rio fu�-th�r:
icorre,spondeizce.alboufthis visit.
ornments (refer to quesLon #) Ezpiaiin any YES aniswers and/or airy recommendations or°
se d_rawtnigs,oi factlity to_better explain situataions _ (tree addi�o_naI-pages as necessary) 7� �,
Wes- t .. cc WL,,JP A-v .
WA �e_ AL c k - hem �� rz� L
atL_4 r vet. r- �- .
Reviewer/Inspector Name
Reviewer/Inspector Signature: _ Sa.11
Date:
5/00

Facility Number: elk --rX3 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 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? Ell, es 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 '�F'j 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 O-NO
5100

L - f
IS
t
J13 Division of Soil and Water Conservation ❑ Other Agency ; �..
Division of Water Quality
0 Routine O Cam faint O Follow-up of DW inspection Q Follow-up of DSWC review 0 Other
. FDate of Inspection
Facility Number
Time of Inspection _ P 24 hr. (hh:mm)
© Registered M Certified © Applied for Permit [3 Permitted 10 Not Operational Date Last Operated:
FarmName: ............... i-!, ............................... .............. County:......+Z'.'..i...`..........................................
..................
Owner Name: ........ .Lt... f� Phone No. '.......:...............................................................................
.................................................................................
Facility Contact:.... Pil St w Title:...�,t� �'J`t/ .......................... Phone No: ...................................................
Mailing Address: .......... ..... I'JI,.X i fS�..........................................................�1~..�.�..�.l�... `. .................I..................... . �..�....LS-
Onsite Representative:......... .. -.L ... .........Of ..... k............. ........... Integrator: ......... (4. v ... f.....................................
Certifted Operator: .................................................. ............................ I.........,........... ..... Operator Certification Number-,
.....................
Location of Farm:
Latitude 0' ' 04' Longitude u` =f "
Design Current
Desi Current Design ;Current
Swuie Capacity Population
Poultry Capa Populahot C ttie Capacity, Population
❑ Wean to Feeder
❑ Layer ❑Dairy A~
ElFeeder to Finish
{] Non -Layer ` ❑Non -Dairy
Farrow to Wean
❑ Farrow to Feeder
❑ Other f
':] Farrow to Finish'
- e
Total DeSig Capacity,
w ❑ Gilts
❑ Boars
F
•� o ta14SSLW
Number of Lagoons (Hoidiug Ponds
Subsurface Drains Present Kagoon Area
Spray Field Area e
r a
3 y "� ' s ❑ No Liquid Waste Management System
-U
General
1. Are there any buffers that need maintenancelimprovement? ERYes' ❑ 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 U(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/ nin? l G P"
-d. Does discharge bypass a lagoon system`? (If yes, notify DWQ) ❑ Yes 91"No
3. Is there evidence of past discharge from any"part of the operation? ❑'Yes PrNo
4. Were there any adverse impacts to the waters of the State other than from a discharge? ❑ Yes VNo
5. Does any part of the waste management system (other than lagoons/hotding ponds) require R[Yes ❑ No
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes k] No
7. Did the facility fail to have a certified operator in responsible charge? ❑ Yes UNo
7/25/97
Continued on back

Y 1
Facility Number:
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (Lagoons,Ilolding Ponds, Flush Pits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate?.
Structure 1
Identifier:
Freeboard (ft.): .......!...l.
Structure 2 Structure 3
r. .
.............. .......... ...�...................................
.._..
10. Is seepage observed from any of the structures?
❑ Yes 10 No
19Yes ❑ No
Structure 4 Structure 5 Structure 6
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)
r
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan.(AWMP)?
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
22. Does record keeping need improvement?
For Certified or Permitted Facilities Only
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?
i
25. Were any additional problems noted which cause noncompliance of the Permit?
❑ Yes +WNo
❑ Yes 91 No
❑ Yes EK No
❑ Yes ff No
XYes ❑ No
❑ Yes
,i"No
❑ Yes
94 No
❑ Yes
0 No
❑ Yes
jo No
K'Yes
❑ No
❑ Yes
® No
❑ Yes
® No
[] No. violations -or deficiencies:were noted -during this.'visit.- You.4.ill receive-ni &ftirther '
:. et rrespbndence aV"t this;visit. ;
W Yes ❑ No
❑ Yes ® No
❑ Yes ® No
►cis c7 1,41-
ot�D �� �'bsz�u�,D rlv»2 SPA
TA tcEti% Ste-
Z
7/25/97
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date: f - �[)— Fr

V\

rvirochem
CONSULTING
CHEMISTS
Customer:
Environmental Chemists, Inc.
MAHJNG ADDRESS: TELEPHONE: SHWING ADDRESS:
P.O. Box 1037 [phone] (Office) 6602 Windmill Way
Wrightsville Beach, [phone] (Lab) Wilmington,
Carolina 28480 [phone] (Fax) North Carolina 28405
NCDEHNR: DWQ CERTIFICATE #94, DLS CERTIFICATE #37729
FEB 0 9 1998
NCDEHNR-DWQ
127 N. Cardinal Drive Ext.
Wilmington, NC 28405
Attn: Rick Shiver
David Holsinger
Date Sampled:
Sampled By:
STREAM:
01/30/98
David Holsinger
REPORT OF ANALYSIS
Date of Report: February 6, 1998
Purchase Order #:
Report Number: 8-0298
ReportTo: Rick Shiver
Copy To: David Holsinger
PARAMETER
Sample ID
31-763
F1&N1
31-763
F2&N2
Lab ID
# 0645
# 0646
Fecal Coliform, colonies/100m1
520,000
27,000
Nitrate + Nitrite Nitrogen, NO3 + NO2 - N mg/L
1.50
4.00
Ammonia Nitrogen, NH3-N, mg/L
23.0
12.3
Total Kejeldahl Nitrogen, TKN mg/L
31.4
13.7
Total Phosphorus, P mW%
3.16
1.27
Reviewed b and approved for release to the client.
AS

cEIVEV Environmental Chemists, Inc.
�B 0 9 1999I G ADDRESS: TELEPHONE: SHIPPING ADDRESS:
P. . Box 1037 [phone] (Office) 6602 Windmill Way
Wri tsville Beach, [phone] (Lab) Wilmington,
CONSULTING BY: lina 28480 (910) 392A424 (Fax) North Carolina 28405
CHEMISTS NCDEHNR: DWQ CERTIFICATE #94, DLS CERTIFICATE #37729
Customer:
NCDEHNR-DWQ
127 N. Cardinal Drive Ext.
Wilmington, NC 28405
Attn: Rick Shiver
David Holsinger
Date Sampled:
Sampled By:
STREAM:
01/30/98
David Holsinger
REPORT OF ANALYSIS
Date of Report: February 6, 1998
Purchase Order #:
Report Number: 8-0298
Report To: Rick Shiver
Copy To: David Holsinger
PARAMETER
Sample ID
31-763
F1&N1
31-763
F2&N2
Lab ID
# 0645
90646
Fecal Co6form, colonies/I00m1
520,000
27,000
Nitrate + Nitrite Nitrogen, NO3 + NO2 - N mg/L
1.50
4.00
Ammonia Nitrogen, NH3-N, mg/L
23.0
12.3
Total Kejeldahl Nitrogen, TKN mg/L
31A
13.7
Total Phosphorus, P mg/L
3.16
1.27
Reviewed band approved for release to the client.

ENVIRONMENTAL CHEMISTS, INC
virochem
® Sgmple Collection and Chain of Custody
li n • � �-
Collected B . ! r
SAmn1P 'rvnP- lnfluPnt_ F.01 Pnt_ WP11_ P�Cnii. C)thprr
6602 'Windmill Way
Wilmington, NC 28405
Phone: [phone]
YAX: [phone]
SAMPLE
IDENTIFICATION
COLLECTION
BOTTLE
ID
LAB
ID
PRESERVATION
ANALYSIS REQUESTED
DATE
TIME
NONE
O
HNO3 I
N90H
TRIO
OTHER
ci
iS! 30
Pt
y56
yt1'1fz'tA'f�5 IN
6 •'
L"
F £ �
Nv
Maximum Holding Time Between Collection and Analysis: BOD 48 Hourl, Coliform in Wastewater 6 Hours,
Coliform in Drinking Water 39 ap rs,
Transfer
Relinquished By:
Date/Time
Received By:
Date/Time
1
2
Received wit Water ille to 4°C: Yes '--� No Accepted: ✓ Rejected:
• Delivered By: ` Received By: �, Date: 3D Time:
Comments•

Routine 0 Complaint Q Follow-up of DWQ inspection Q Follow-up of DSWC review Q Other
Facility Number !b3 Date of Inspection —1--00
Time of Inspection F 0 24 hr. (hh:mm)
*Permitted © Certified 0 Conditionally Certified [] Registered 0 Not O erational Date Last Operated:
FarmName: .....L....... JU I.`................................................................................ County:................ ►...a .......................................
OwnerName:........................................................................................................................... Phone No:
FacilityContact:.............................................................................. Title:...................................... Phone No:
MailingAddress: ..................................................................................................................... ..................................................................................... ..........................
Onsite Representative:. .......... ...................... -- Integrator:........
...................................................
Certified Operator:................................................................................................................ Operator Certification Number:.........................................
Location of Farm:
Latitude =•=' 44 Longitude =• 0° ="
-
Design'. - Current Design urrent ' Design -Current
Capaci '-PoTulation
Poultry_ . C ' aci -Po ulation _, 7=Cattle _ --
Wean to Feeder
❑ Layer Y [] Dairy
Feeder to Finish
❑ Non-Layera ❑ Non -Dairy
- -
-
❑ Other
Total Design .Gaparity ,.
_
-- :Total SSLW
Number=of Lagoons
❑ Subsurface Drains Present ❑ Lagoon Area ❑ Spray Field Area g;
-- . -"
Holding Ponds / Solid'Traps
w
❑ No Liquid Waste Management System
UO
C:K� Q
arrow 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 KNo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes ff No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes RNo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway El Yes �No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard (inches): ..........�
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes gNo
seepage, etc.)
3/23/99 Continued on back

` Facily Number: 3� -� �63 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 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 Pondirig ❑ PAN
12. Crop type t' cv► 1 S[S 1..1 � �11 Ow —
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? (iel 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?
�C .*Watidiis:or• deficienci-es vt re ppted• djWin, thls:visit. - Yoi} V111- -eceiye Rio further -
:. rorresnoridence: abaut: this visit: :::::..........::.:::::::::::::::: :
❑ Yes WNo
❑ Yes )4 No
❑ Yes JX(No
❑ Yes 'b�No
❑ Yes kNo
❑ Yes �(No
❑ Yes tNo
[:]Yes �gNo
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes D(No
❑ Yes 9No
❑ Yes P(No
❑ Yes ANo
❑ Yes �No
❑ Yes ba-No
❑ Yes ANo
❑ Yes C<No
❑ Yes �No
❑ Yes NfNo
❑ Yes M No
Comments (refeirr-to question #):` Explain any Y-ES aTnswers and/or any recommendations or any_other: comments.
LTse drawings offaciltty to"better. explainsituath (use additional pages as!necessa ) r=
Ax "i
i
6;,UL *lei_ C\y
Reviewer/Ins ector Name
p„ : W a v-37o0s :
Reviewer/Inspector Signature: Date:

-� FacMty Number: '3 — Date of inspection -( o
Odor Issues 93
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge attor below Wes ❑ 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 b(No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes M'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 6�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 C�No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes tErNo
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes D(No
AdditionaMornments an or; rawings: ,z ; • M� ,,t�_.;

Routine
T Division of Soil and;Water'.Couseevation;-:operation=Review W ~
•
;t D Division of Soil and Water Conservation -,Compliance Insoil - a
Division of Water Quahty Compliance Inspection ;
u.Qther Agency Operition=Re�ew
Follow-un of
of DSWC review O Other
Facility Number r - �3 ] I Date of Inspection
j Time of Inspection 24 hr. (hh:mm)
Permitted [3 Certified (] Conditionally Certified 0 Registered JE3 Not O crational Date Last Operated:
FarmName: $.A......_.._ County: y�.....�...................-�.................................................--.....- �.....�..---................................................
Owner Name: ............. Phone Not�:�)/ty
............... t ?.
Facility Contact: .............................. Title:.. .. `.`''� raz Y"............................. Phone
MailingAddress: ..............
Onsite Representative:..✓..........e5.....�.�
..........I............
..................................................................................... ..........................
Integrator:....."11.mtr...............................................
....... .....
...........
....
Certified Operator: ...................................................
.............................................................
Operator Certification Number: ..........................................
Locatiop of Vgrm_ 1
......... ............. .... ...C3..................................................................... ........... .............. .........-...........................................................................
..........._.......... .
Latitude 0 S - Longitude • 4 "
Design Current Design_ Curren# Design Current
Cattle
:Swine Capacity Population Poultry Capacity Population Capacity Population
❑ Wean to Feeder
- 60
❑ Feeder to Finish
73E c)
❑ Farrow to Wean
9,6 i2-
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts,
❑ Boars
Number of.Lagoons mi ❑ Subsurface Drains Present 1. ❑ Lagoon Area ❑ Spray Field Area
Holding Ponds / Solid'`I'raps �_ ❑ No Liquid Waste Management System
Discharees & 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: LL r
Freeboard(inches): ............ f4?....,........................................... .............. ................ .........................................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
❑ Yes D(No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes gNo
❑ Yes VNo
❑ Yes P<No
Structure 6
❑ Yes V No
Continued on back
3/23/99

it 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?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenarice/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN
12. Crop type <�J_ (n1 { S'
r
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: did -yiolatidris;or doffcientkf; -W&b hofea• ftn" igjhis:visit: Y:oii :will •reoO WO d �uthdz'
_ 6 rispozidenk' ab"f this visit ... .... .
❑ Yes 9No
❑ Yes XNo
Cl Yes 9No
❑ Yes 9No
Cl Yes NfNo
❑ Yes '%No
❑ Yes KNo
❑ Yes j<No
❑ Yes Q,No
Z'Yes ❑ No
�❑ Yes "9No
❑ Yes 'KNo
❑ Yes J� No
❑ Yes % No
❑ Yes j No
❑ Yes jNf No
❑ Yes gNo
❑ Yes No
❑ Yes No
❑ Yes gNo
❑ Yes � No
Use;drarntigs of facility to=better;expla�ia situations Ouse additional pages as necessary)
-fie r,,,€'��'� K `_ ��U� A-E,C7A
�� Al
` ,r,%�5y ` (�G. c ��i ►-mod
OCC�-��52-• � t V s w c�-�� ee�4� S�•.•� C �� e+� � � L
sp
Reviewer/Inspector Name
Reviewer/Inspector Signature. z Date:
3/23/99

Facility Number: Date of Inspection
Oder Issues 1
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below Yes ❑fNo
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes t�No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes (gNo
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 XNo
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 V 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
Mditional'Edinments an or Draw�ags:
3/23/99

O Routine O Complaint qP Follow-up of DWQ inspection O Follow-up of DSWC review v Other
,.,.,,....�, Facility Number 31 7fi3 Date of Inspection 2/5/98
�m Time of Inspection 13:00 24 hr. (hh:mm)
(3 Registered 0 Certified [3 Applied for Permit E Permitted JE3 Not Operational Date Last Operated:
Farm Name: B.tli�Ix.s�.Sxu�nne.B.tilk.S.n)x.Fatxm...................................................... County: D.uplin. ............................................... ..IR.Q.........
Owner Name: Rallphj&ztuaae................... B.eilt............................................................. Phone No: 9.19458 40.7.0...........................................................
FacilityContact: .............................................................................. Title:................................................................ Phone No:
MailingAddress: P.Q.Box.188............................................................................................ Calypsu..Nc .......................................................... 28325 .............
Onsite Representative:
Integrator: Marphy-Family-Fums.....................................
Certified Operator: ,homes..Ralph....................... BritUx............................... ............. Operator Certification Number:.18.60.8 .............................
Location of Farm:
Latitude 35 • 09 1S Longitude 78• 04 10 1,
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?
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
❑ Yes
[I No
maintenance/improvement'?
6. is facility not in compliance with any applicable setback criteria in ellect at the time of design?
❑ Yes
[] No
7. Did the facility fail to have a certified operator in responsible charge?
❑ Yes
❑ No
7/25/97

Eaciljt. Nuinher: 31-763
8. Are there lagoons or storage ponds on site which need to be properly closed'? ❑ Yes © No
Structures (Layions,Holding Ponds, Flush Pits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes Q No
Stricture I Structure 2 Stricture 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard(ft):...................................................................................................................................................................................................................
10. Is seepage observed from any of the structures'? [] Yes © No
11. Is erosion, or any other threats to the integrity of any of the structures observed'? []Yes © No
12. Do any of the strictures need maintenance/improvement? Ej Yes Q No
Of 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 strictures lack adequate minimum or maxinnim liquid level markers? ❑ Yes [) No
Waste Application
14. Is there physical evidence of over application? ❑ Yes © No
(If in excess of WM', or runoff entering waters of die State, notify DWQ)
15. Crop type.......................................................................................... .....................
16. Do the receiving crops differ with tinose designated in the Animal Waste Management flan (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/hnspector 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 flan 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?
LJ -No.violations' or:derWiftnElcS.Wiv,e'e, oted'duripg rthiS.ViSit,' qtt vuili r eiVe'�o'f�trt�te'r•_•'
.....eorrespoud cn ce a 6io itt .th is. visit;. .. ............
❑ Yes © No
© Yes © No
❑ Yes Q No
❑ Yes 0 No
❑ Yes 0 No
E] Yes (l No
❑ Yes E] No
❑ Yes © No
rl Yes El No
pw till visit Was made to observe spray fields and to take additional water quality samples. Ponding was observed in spray fields
cent to SR 1318. In addition, drainage was running off spray field into the roadside ditch. The drainage appeared to be clear.
iples were taken at this location. A second sample was taken in Jackson's pond, downstream of the discharge.
7/25/97
Reviewer/Inspector Name i n( Nw.,G '1 elmin er
Reviewer/Inspector Signature: Date:

-7 tog
F 7-
Environmental Chemists, Inc.
® MAILING ADDRESS: TELEPHONE: SHIPPING ADDRESS:
P.O. Box 1037 (9l0) 256-3934 (Office) 6602 Windmill Way
Wrightsville Beach, [phone] (Lab) Wilmington,
CONSULTING North Carolina 28480 (910) 392A424 (Fax) North Carolina 28405
CHEMISTS NCDEHNR: DWQ CERTIFICATE #94, DLS CERTIFICATE #37729
Customer:
BECEIFI R f EB, 1 1 rM
NCDEHNR-DWQ Date of Report: February 6, 1998
127 N. Cardinal Drive Ext.
Wilmington, NC 28405 Purchase Order #:
Attn: Rick Shiver
Andrew Helminger Report Number: 8-0356
REPORT OF ANALYSIS
Date Sampled: 02/05/98 Report To: Rick Shiver
Sampled By: Andrew Helinmger a Copy To: Andrew Helminger
STREAM:
31-763
31-763
31-281
PARAMETER
1 FC
2 FC (pond)
3 FC
# 0766
# 0767
# 0768
Fecal Coliform, colonies/100ml
550
18
18
Reviewed b and approved for release to the client.

renvirochlem
�Wr w�
vaace-Wy . +ns
Samnle Tvne: Influent. Effluent. Well.
ENVIRONMENTAL CHEMISTS, INC
Sample Collection and Chain of -Custody-
Soil. Other:
6602 FV:ndmill Way
Wilmington, NC 28405
Phone: [phone]
FAX: [phone]
SAMPLE
IDENTIFICATION --][DATE
COLLECTION
BOTTLE
ID
LAB
ID
PRESERVATION G�
ANALYSIS REQUESTED
TIME
NONE
SO
HNO
NaOH
TRIO
OTHER
i:12rM
1 ` -7 `' ZFC�
4opM
6 762 7L
�l-Z$I AFL
q
z�sort
D 8
Maximum Holding Time Between Collection and Analysis: BOD 48 Hours, Coliform in Wastewater 6 Hours,
Coliform in Drinking Water 39 aura,
Transfer
Relinquished By:
Date/Time
Received By:
Date/Time
1
2
Received with Ice Water Ctiilled to VC: Yes ✓ No
Delivered By: - Received I
Comments:
r/ Rejected
Dater Time:3: �v

eta-06-98 02:44P Envirochem 910 392 4424 P.02
Environmental Chemists, Inc.
MAILING ADDRESS: TELEPHONY: SHIPPING ADDRESS:
°fbib,® P.O. Box 1037 [phone] (Oft -ice) 6602 Windmill Way
Wrightsville Beach, [phone] (Lab) Wilmington,
CONSULTING North Carolina 294M [phone] (Fax) North Carolina 2ROK
CHEMISTS NCDFHNR: DWQ CERTIFICATE #94, DIS CERTIFICATE #37729
Customer:
NCDEHNR-DWQ
127 N. Cardinal Drivc EYt_
Wilmington, NC 29405
Attn: Rick Shiver
Andrew Helminger
Date Sampled:
Sampled By:
STREAM :
Date of Report:
Purchase Order #:
Report Number:
REPORT OF ANALYSIS
02/05/98
Andre►., Hclminger
Report To:
Febnlm 6, 1998
8-0356
Rick Shiver
Copy To: Andrew Helminger
31-763
31-763
31-281
PARAMETER
1 FC
2 FC (pond)
3 FC
# 0766
# 0767
# 0768
Fecal Coliform, colonies/100m]
550
18
18
Reviewed b �. and approved for release to the client.

SECTION
W A-TIM 0 u 4i_ 1
CHAIN OF CUSTIODY' RECORD
For investigation of 91 - 31 1 Incident No.
Samples collected and GW-54
forms completed by: JAI►1D'.0
I-1
L-t-4
Lab Only
Lab No.
Quad
No.
Location
Date
Time
No. of
Containers
1:IZV"
i
GtJl 7
— `1 b
T
z 5
1: 4 a M
E =3a M
FEB
Relinquish d by,(Signature):-
a
ve
natur
Date/Time
i-5-a / :2
Rel.
Rec.
by
/
Rel.
Rec.
by
/
Rel.
Rec.
by
!
Method of Shipment:
Security Type and Condition:
Seal by:-.
Lock by:
Broken b
Open by:
I AR IMP ()KII Y
Lab No.,
From Through I
N o.
Containers
Analysis
Relinquished by
Received by
Date / Time
0 77*007C
�_3_
bf-nt,-// q - c5v
GW-63
Note: Original sent witn snipmeni
Copy retained by collector
M

DIVISION OF ENVIRONMENTAL MANAGEMENT WtT g UALITY FIE --LAB FORM MMU
COUNTY PRIG IT 15,# t`• t SAMPL TYPE Zt�I� I
RIM BASIN Aj
REPORT TO: ARO FRO MRO RHO Wall IRO RO TS ❑AMBIENT ❑ QA 9ST4EAM ❑ EFFLUENT
AT BM Oth ❑ COMPLIANCE ILA CHA[N ❑ LAKE ❑ INFLUENT
V.. 1_wh II.. []NI V 31 _ 7 6 13
Lab Number:
Date Recelve
Time: ' U/
Rec'd b Dft
From: Bu -Courier- and Del
DATA ENTRY BY:
CK:
DATE REPORTED:
er
OF CUSTODY
❑EMERGENCY
❑ESTUARY
Shipped Bus Courier
tall, Other
CO--LECTORIS :
- �C�.� l
/
1
STATION LOCATION: �A C L-L k tv
Estimated ROD Range: 0-5/5-25/25-65/40-130
or 100 plus
Seed: Yes ❑ No ❑
Chlorinated: Yes 13No ❑
REMARKS: 4C
sz6m'
Station }�'
Date Begin (yy/mm/dd) Tlme Begin Date End
Time End
Depth DM DB DBM
Value Type
Composite Sample Type
7 I ` 16 ��
L 5
q g 1= Nb rtA
A H L
T S B C G GNX X
1
B005 310
mg/I
2
COD High 340
mg/1
3
COD Low 335
mg/l
4
Coliform: MF Fecal 31616
/100ml
S
Collform: MF Total 31504
/100mi
6
Collform: Tube Fecal 31615
/100ml
7
Coliform: Fecal Strop 31673
/100m1
R
Residue: Total 500
mg/I
10
Fixed 510 mg/I
11
Residue: Suspended 530 mg/1
12
Volatile 535 mg/I
13
Fixed 540 mg/1
14
PH 403 units
15
Acidity to pH 4.5 436 mg/1
16
Aeldliy to pH 9.3 435 mg/1
17
Alkalinity to pH 8,3 415 mg/I
18
Alkalinity to pH 4.5 410 mg/1
19
TOC 680 mgA
20
Turbidity 76 NTU
Chloride 940 mg/I
Chi a: TO 32217 ug/I
Chi a: Corr 32209 ug/I
Pheophylln a 32213 ug/I
Color: True 80 Pt -Co
Coior:(pH 183 ADM[
Color: pH 7.6 82 ADMI
Cyanide 720 mg/I
Fluoride 951 mg/I
Formaldehyde 71880 mg/I
Grease and Oils 556 mg/1
Hardness Total900 mg/I
Specific Cond. 95 uMhos/cm2
MBAS 38260 mg/1
Phenols 32730 ug/I
Sulfate 945 moll
Sulfide 745 mg/I
NH3 as N 610 mg/l
TKN as N 625 mg/I
NO2 plus NO3 as N 630 mg/I
P: Total as P 665 mg/I
PO4 as P 70507 mg/l
P. Dissolved as P 666 mg/I
Cd- admium 1027 ugA
CrChromium:Total1034 ugA
CuCopper 1042 ug/I
NI -Nickel 1067 ug/I
Pb-Lead 1051 ugA
Zn-21nc 1092 u2A
Ag llver 1077 ug/1
AI -Aluminum 1105 ug/I
Be -Beryllium 1012 ug/I
Ca -Calcium 916 rng/i
Co -Cobalt 1037 ug/I
Fe -[ran 1045 ugA
Li-Llthlum 1132 ug/I
Mg-Magneslum 927 mg/l
Mn-Manganese 1055 ug/I
NaSodlum 929 mg/I
Arsenic:Total 1002 ug/f
Se -Selenium 1147 ug/I
Hg-Mercury 71900 ug/I
Orgenochlorine Pesticides
Orgenoplwsptwrus Pesticides
Acid Herbicides
Base/ Neutral Extractable Organics
Acid Extractable Organics
Purgeable Organics (VOA bottle reg'd)
Phytoptankton
Sampling Point %
Conductance at 25 C
Water Temperature
D.O. mg/l
pH
Alkalinity
Acidity
Air Temperature n
PH 83 pH 4.5
pH 4.5 pH 9,3
2
94
10
300 1.
400 .
82244 1431
82243 182242
20
Salinity %
Preclpfifon an/day)
Cloud Cover %
Wind Direction (Deg)
Stream Flow Severity
Turbidity Severity
Wind Velocity M/H
can Stream Depth 1t.
Stream Width ft.
480
45
32
36
1351
1350
35
64
4
T)MI/Rovised t0/"

COUNTY DUPLIN
RIVER BASIN ;
REPORTTO 1VIRO RegionalOfi'ice
Other :
COLLECTOR(S) : IIELMINGER
DIVISION OF WATER QUALITY
Chernistry Laboratory lieporl I Water Qualily
PR10RITY
AMBIENT C] QA
❑ COMPLIANCE C7 C14AINOFCUSTODY
EMERGENCY
El SAMPLE TYPE
STREAM ❑ EFFLUENT
LAKE INFLUENT
El ESTUARY
L763 2 NUl'
E51101aleA HOD Range: Station Lacadow JACKSON POND SR 1313 DITCH
Serf: Chlo6nmed: Remarks:
Lab Number 8W0779
Date Received : 2/6f98
Time Received: 9:00 AM
Received By : DS
Data Released : AR
Date Reponed : 2126198
Statian M Dale Begin (yyhnurldd) Dale End 1yyfr unldd) Time Begin Time End Depth - DNA, DB, DUN Vnhre'Fype - A, If, L Coruposire-T, S. Sample Type
31.1632 NUT 980205 _ 1 0140
BUD 310 mg,'L
COD High 340 mo-
COD Law 13$ mglL
Colifosm' MF Fecal 31616 1100ml
Califosm: MF Total 31504 II OOm[
Coliform; tube Fecal 31615 1100ml
Coliform- Fecal Sirep 31673 1100m]
Residue. Tolal 500 mrdL
Volatile 505 mg/L
Fixed 510 mgrL
Residue. Suspended 530 mg/L
Volatile 535 rnu4-
fired 54D me,L
pit 403 units
Acidity to pi14,5 436 msfL
Acidity to pl 18 3 433 mull
Alkalinity to pl [ 8.3 415 mg/L
Alkalinity to pH 4.5 410 mg/L
I'm 630 mg1L
l usbidit. 76 NTU
C(Ibform Twat Tube "/I00 nils
COMMENTS t
Chloride 140 mg/L
Chia 16 32217 ug/L
Chi a. Corr 32209 ug/L
Pheuphy in a 32213 aglL
Color. True 80 C.U.
Colot.0111 ) 83 PH- c.u.
Culur. pit 7 6 82 c.a
Cyanide 720 mglL
Fluoride "I mglL
Fonnaldehyde 11880 mg/L
Grease and Oils 556 mg/L
I adness Total9(Kt mall.
Specific Cund 95 unpins,C116
hIIIAS 33260 mgll.
Phenols 32730 uglL
Sulfate 945 myL
Sulfide 745 mglL
Boron
la=mind Lignio vWL
I1ew�alcnt Chsomium ug,L
3t
NH3 as N 610
1.1
ml L
TKN an N 625
1.4
mg/L
X
NO2 plus NO3 as N 630
7.3
mgit
X
P', Towl is 1- 665
0.21
mgll.
PO4 as P 70507
mg/L
P: Dissolved as P 666
mgfL
K-Potassiurn
rngtL
Cd- Cadmium 1027
ug/L
Cr-Cbromiuma'oW 1034
ug/L
Cu- Copper 1042
uglL
Ni-Nickcl 1067
ug/L
Pb- Lead 1051
ug1L
Zn- Zinc 1092
tsvJL
V-Vanadium
uglL
AS- Silver 1077
uglL
Al- Aluminum 1105
ugli-
Be-Beryllium 1012
ug/L
Co- Calcium 916
mg/L
Co -Cobalt 1037
ug/L
Fe. lion 1045
uyfL

For Lab Use ONLY '; F ~ 'T 6 3
DIVISION OF ENVIRONMENTAL MANAGEMENT WATER QUALITY FIE. j-LAB FORM (DM1)
` 31-763
COUNTY 1_ I t`J PRIORITY SAMPLE TYPE
RIVER BASIN
REPORT TO: ARO FRO MRO RRO Wall WlRO SRO TS EIAMB=ENT tZA �?. � (r;= STREAM 11 EFFLUENT
4 h
AT BM ❑COMPL[ANCE CHAIN Sl , �•LI�KI� �' "°•�' �p INFLUENT
Othsr OF CUSTODY n�3,r�
Shipped by Bus Courl Staff, Other ❑EMERGENCY ❑ ESTUARY
Lab Number UkDQ
Date Recelved 0 Ix Tlme;
�l
Rec'd b rom; Bu -Courier- and Del
DATA ENTRY BY: CK:
DATE REPORTED;
COLLECTORIS); Dth101` T--W CY •
Estimated BOD Range: 0-5/5-25/25-65/40-130 or 100 plus STATION LOCATION: VrTCH Ftpr,-L-f— l lS1:, i L 1' - S
Seed; Yes ❑ No❑ Chlorinated: Yes ❑ No ❑ REMARKS: * R; C Q� /} kj T� Ll> -rn �'i /� AA P I-C-
Station # Date Begin (yy/mm/dd)) Time Begin Date End Time End Depth DM DU DBM Value Type Composite Sample n
3- Z S 9$ I' I z P A H L T S B CGNXX
2
COD High 340 mg/1
3
COD Low 335 mg/I
4
Coliform: MF Fecal 31616 /100ml
5
Coliform: MF Total 31504 /looml
6
Collform: Tube Fecal 31615 /IOOml
7
Coliform: Fecal Strap 31673 /100ml
8
Residue: Total 500 meA
9
Volatile 505 mg/I
10
Fixed 510 mg/1
11
Residue: Suspended 530 mg/1
12
Volatile 535 mg/1
13
Fixed 540 mg/1
14
pH 403 units
15
Acidify to p[i 4.5 436 mg/I
16
Acidity to pH 8.3 435 mg/I
17
Alkalinity to pH 9.3 415 mg/I
Alkalinity to pH 4.5 410 mg/l
19
t2018
TOC 680 mgA
Turbidity 76 NTU
Chloride 940 mg/1
Chi a: Trl 32217 USA
Chi a: Corr 32209 eg/I
Pheophytln a 32213 ug/1
Color: True 80 Pt -Co
Color. -(pH ) 83 ADM[
Color: pH 7.6 82 ADMI
Cyanide 720 mg/1
Fluoride 951 mg/1
Formaldehyde 71880 mg/I
Grease and Oils 556 moll
Hardness Total900 mg/1
Specific Cond. 95 uMhos/cm2
MBAS 38260 mg/1
Phenols $2730 ug/1
Sulfate 945 mg/I
Sulfide 745 mg/1
NH3 as N 610 moll
TKN as N 625 mg/1
02 plus NO3 as N 630 mgA
P. Total as P 665 mg/I
PO4 as P 70507 mg/1
P: Dissolved as P 666 mg/I
CdCadmium 1027 ugA
Cr-Chromlum Total 1034 USA
Cu-Copper 1042 ug/I
NI -Nickel 1067 ug/1
Pb-Lead 1051 ug/I
Zn-Zinc 1099 ugA
A Ilver 1071 ug/1
Al -Aluminum 1105 utl/I
Be -Beryllium 1012 ug/I
Ca -Calcium 916 m8/1
Co -Cobalt 1037 ugA
Fe -Iron 1045 ugA
LL-Llthlnm 1132 ugA
Mg -Magnesium 927 mg/1
Mn-Manganese 1055 ug/l
Na-Sodlum 929 mg/I
Arsenic:Total 1002 ug/I
Se-Selenlum 1147 ug/1
Hg-Mercury 71900 ug/1
Organochlorine Pesticides
Or4arwplwspiwrus Pesticides
Acid Herbicides
Base/ Neutral Extractable Organics
Acid Extractable Organics
Purgeable Organics (VOA bottle reg'd)
Phytoplankton
Sampling Point%
Conductance at 25 C
ater Temperature IM
D.O. mgA
pH
Alkalinity
Acidity
Air Temperature QC)
PH 8.3 pH 4.5
pH 4.5 pH 8.3
2
94
10
300 10
400 1•
82244 431
82243 182242
20
Salinity X
Preciplllon On/day)
Cloud Cover X
Wind Direction OJeg) `
Stream Flow Severity
Turbidity Severity
Wind Velocity M/H
can Stream Depth It.
Stream Width It.
480
45
32
36
1351
1350
35
64
4
DM1/Revl�cf 10/96

DIVISION OF WATER QUALITY
Chemistry Laboratory Report! Water Quality
Lab Number :
8W0778
El SAMPLF TYPE
Date Received:
2I6/91
COUNTY DUPLIN
PRIORITY
Time Received:
9,00 AM
RIVER BASIN:
AMBIENT
QA�
STREAM
EFFLUENT
Received By
DS
REPORT TO WIRO Regional Office
COMPLIANCE
V❑ CHAIN OF CUSTODY
LAKE
INFLUENT
Olhtr :
EMERGENCY
ESTUARY
Data Released :
AR
COLL£CTOWS) t HEMiNGER
31.7631NP
DateReparied:
2/261911
Estimated ROD Range:
Station Location: ROADSIDE DITCH SR 1318
Seed: Chlorinaled:
Remarks:
-
Station M
Dale Begin O)film/dd)
Date End (yy/mmfdd)
Time Begin Time End
Depth - DSI, DR, DBM
Valle Type- A, H, L
Composite-T, S,
Sample Type
31.763 I NUT
980295
0112
BOD 310 mow
COD High 340 mgll.
COD Low 335 mull.
Colifarm MF Feca1 31616 /100ml
Coliform' MFTotal31504 /100nd
Cohform. tube Fecal 31615 Il oon11
Coliform: Fecal Strep 31673 11001111
Residue Total500 mclL
Volatile 505 myA'
fixed 510 u1g1L
Residue: Suspended 530 Inuit.
Volatile S35 me-1-
Fiaed 540 q.00
p11403 wets
Acidily to pH 4 5 436 mgrL
Acidily to pI18 3 435 a1g1L
Alkalinity to PH 8.3 415 mg/L
Alkalinity to pH 4.5 410 mg/L
7OC 610 mg/L
Turbidity 76 NTU
Colifrnm Total rube "111H1 MIS
COMMENTS:
Chloride 940 mg/L
Chi a: Tri 32217 uglL
Chl a- Carr 32209 ug7L
Pheophylin a 32213 ug/l.
Color; True 10 c-u.
Color (pH ) 13 pH- C.U.
Color, p1I 7,6 12 c.0
Cyanide 720 mg/L
Fluoride 931 mpf L
Formaldehyde 71830 mgI1L
Grease and Oils 556 mg/l.
Il;udness Total °Hl0 mg/L
Spec if is Cand. 95 umhos1cm2
MBAS 39260 mg/L
Phenols 32730 uWL'
Sulfale 945 mg/L
Sulfide 745 mg/1.
Boron
Tannin d Lignin ua/L
Ilcxa.alcn[Chlomium ug/L
X
NH3 as N 610
5.3
mg/L
X
TKN in N 625
5,9
mg/L
S
NO2 plus NO3 as N 630
0.46
mgfL
X
P Total as P 665
Ilk
mgtL
PO4 as P 70507
mg/L
P: Dissolved as P 666
mg/L
K-Potassium
mglL
Cd-Cadmium 1027
ug/L
Cr-ChrmniumTotal 1034
ug/L
Cu-Copper 1042
ug/L
Ni-Nickel 1067
ug/L
Ph- Lead 1051
uglL
Zn- Zinc M92
ug7L
IV-Vnuadium
ug/L
Au- Silver 1077
ug1L
Al- Aluminum 1 105
ug/L
Be -Beryllium 1012
ug/L
Ca- Calcium 916
mg/L
Co- Cobalt 1037
uStL
1'c- Iron 1045
ug/L

qplM,
Division of Soil and Water Conservation [3 Other Agency
Division of Water Quality
IV Routine O Com taint O Folimv-uE of DNV2ins eTtion O Follow-uE of DSWC review O Other
Facility Number
Date of Inspection �T
�
Time of Inspection L �.L 24 hr. (hh:mm)
0 Registered .R Certifiedf Applied for Permit ® Permitted 113 Not O erational Date Last Operated; ,,,,,,,
Farm Namc:..�v,, h..'f"...J.U:�Ab ..�C� ....se4 ....... V.ixr ............................... county: -r............................................ .......................
Owner Name:...... ................... nht,... fir:%y ... Phone No: %.(M)...(r.T440..7V..............................................
Facility Contact: ..................................... ...... Title: ...... Phone No:
g :..N.& [. �........................ ........ ... ... ............. C:1. s.G ��................................................2 .......
Mailing Address: ..G . yG....... g. ............... ............. .... ........... .... �� �....
Onsite Representative:..........Uk................................................................... Integrator: .... Alv.....................................................
Certified Operator:............................................................................................................... Operator Certification Number:.......... i....._........................
Location of Farm:
....... saf...0A 5-IL..Wb... trAi....Z.... A4.....l3......
......................................................................................................................................................................................................................................................................... .
Latitude ' « Longitude 4 "
Design"'' Currents %` ` ry Desigu Current ' Designer ,Current
Swtne
Capacity Papulatson ' Poultry Capacity Populattog Cattle„ Capacity Population
Wean to Feeder
U
❑Layer
❑Dairy
n
v
® Feeder to Finish
1000
[] Non -Layer
''
❑ Non-Dairy
50 Farrow to Wean
r
❑ Farrow to Feeder
.❑ Other r M
El Farrow to Finish
Total Design Capacity
❑Gilts
'i
❑Boars
Total SSLW'
of La Dons
g
i Holdxn Ponds°K0
l;
i
Subsurface Drains Present ❑ )lagoon Area Spray Field Area
l'),ANumber
❑ No Liquid Waste Management System u
General
1. Are there any buffers that need maintenance/improvement? ❑ Yes ® No
2. Is any discharge observed from any part of the operation? ❑ Yes No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes [ 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? Jd
A. Does discharge bypass a lagoon system`? (If yes, notify DWQ) ❑ Yes EP 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 Yes ❑ No
maintenancelimprovement?
6. -Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes IN No
7. Did the facility fail to have a certified operator in responsible charge? ❑ Yes �11 No
7/25/97 Continued on back

Facility Number:
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (Lagoons,11olding Ponds Flush Pits, etc.)
9. is storage capacity (freeboard plus storm storage) less than adequate?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier
Freeboard(ft):..........b:.g................... .................................... ............
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?
;'Paste Application
14. Is there physical evidence of over application?
(If in excess,of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type Car11....................................5``4.e
❑ Yes
1�1 No
Yes
❑ No
Structure.5 Structure
b
❑ Yes
® No
❑ Yes
N No
Yes
❑ No
❑ Yes
No
❑ Yes
® No
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 Iand application?
❑ Yes
J9 No
18.
Does the receiving crop need improvement?
❑ Yes
® No
19.
Is there a lack of available waste application equipment?
❑ Yes
is No
20.
Does facility require a follow-up visit by same agency?
[9 Yes
❑ No
21.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
® No
22.
Does record keeping need improvement?
® Yes
❑ 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
;9 No
0- No.violations•or deficiencies.were-noted during this;visit: You:will iikei i'vena ftirther-:
corresp¢ndence A oid this.visit::
Comtn a is (refer to queshart #) ,' Exptaiu any YE5 ans vers at d/or any recouun dattons bnany,outer com xe�pts
expiam '
Use drawings of fatinty to better srtuahoas use additional pages as necessary) „ ��
ME
r v Vof &OA 4 iWA %e Pod 1yk&e ; aJ... r Qa�cd_ Lally L'r4w' "� o►wa
'
s1��ib r>netr� aa" K d4lt,tt..
�ncuAjL1vtf �ree(ooarc� (. Qy�� &A
t�S a►►sli7j� Gw`t� t1� Ovitwl
11- &re- �..5 5 �a a 1,p Seve�-.) .
44A*- earlet� N,-�Yvy-n- toe
zZ, k ?arock lFa.z Pv-m jkA �e�, 11iea 4r- e:" Ci'o�
t
Y��• S�'+n;i' tw�c� Gcar�►fit��c efi C►trWA,� Should �c on r► �t{c a�C+�5i3 5�tbz•�t� �E �� r
7/25/97
T
Reviewer/Inspector Name `
_ _:�. _
Reviewer/Inspector Signature: Date:

O Routine • Complaint O Follow-up of DWQ ins ection O F(illow-up of DSWC review O Other
Facility Number 763
-,Date of Inspection 2/23198
31 _
Time of Inspection 15:00 24 hr. (hh:mm)
13 Registered 0 Certified E3 Applied for Permit H Permitted JE3 Not O erational Date Last Operated:
Farm Name: li;al�tbt.�C. �tzttttxtG. ri t.San'.Fa�rtm...................................................:..:.. County: Ruplin................................................ WWRO .........
Owner Name: RalpbjSuzaBnC ................... Rtilt.................... ............. ........... .:...:..., ::.:.; Phone No: 2.1.9.15&.40.70..........................................................
FacilityContact:....................................................................I.......... Title:................................................................ Phone No:...................................................
Mailing Address: 1'1~1-Box..1.88.......... ....... ........................................................................ :... C,alyp&u..SIC.......................... ................................ n325 .............
Integrator. Onsite Representative: .......................................................................:................................. . Inte g lJ.CI} y.. StilA y.. flrm......................................
Certified Operator: 3,;unts RAll11t....................... BidtlIr............................................ . Operator Certification Nurnber:.18.60.8 .............................
Location of Farm:
l Kran.is.oata�ah�i�1G.nli.3.X1a�.0r2�.nnil�s.�rstxn.R.X�R................
Latitude 3S • 09 'r 187 Longitude 7R " . 0 1D
® Wean to Feeder
500
® Feeder to Finish
1000
® Farrow to Wean
4512
❑ Farrow to Feeder
❑ Fa1T0w to Finish
❑ Gifts
❑ Boars
General
1. Are there any buffers that need maintenance/iinproventent? ❑ Yes ® No
2. Is any discharge observed from any part of the operation?
❑ Yes
❑ No
Discharge originated at: ❑ Lagoon ❑ Spray. Field ff Ether
7:,
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)
[j Yes
© No
c. If discharge is observed, what is the estimated flow in gallmin?
d. Does discharge bypass a lagoon system? (If yes, notify, D_WQ)
❑Yes
0 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
❑ Yes
❑ No
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the'time of design'?
❑ Yes
❑ No
7. Did the facility fail to have a certified operator in responsible charge?
❑ Yes
❑ No
7/25/97

F7t,Wber: 31-763 '
S. Are there lagoons or storage ponds on site which need to be properly closed?,
Structures (Lagoons,Holdine Ponds, Flush Pits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure 1
Identifier:
Freeboard (ft): .,..•,,,,
Structure 2 Structure 3• .. • Structure 4
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/improveusent7
(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 nunoff•entering waters of the State, notify DWQ)
❑ Yes 0 No
[J Yes L] No
Structure 5 Structure 6
................................................................
15. Crop type ........... ..................
16, Do the receiving crops direr with those designated in the Animal Waste .Maiiagctnent 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/hnspector fail to discuss review/inspection with on -site representative?
22. Does record keeping need improvement?
For Certified or Permitted Facilities Onlv
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 AVOR?
25. Were any additional problems noted which cause noncompliance of th'e'Pernnit?
L•7 -No �i'o�atiblls:dx'def�ien'Eies•w6ee-rioted,during rt4is•visit;-•You- wilfreteive_>;ofor't-her
...correspondence abiouf ihis.vis... ...:.... _
0 Yes
© No
❑ Yes
0 No
❑ Yes
0 No
[] Yes
0 No
0 Yes
0 No
❑ Yes 0 No
0 Yes 0 No
❑ Yes 0 No
❑ Yes [l No
[] Yes 0 No
❑ Yes 0 No
❑ Yes [J No
0 Yes 0 No
❑ Yes 0 No
❑ Yes 0 No
ollow up visit was made in response to a complaint. As instructed by DWQ; the,ditch which had been cut from the spray field to the
R 1318 diteln had been filled. No runofffronn the spray field into the SIZ 13 I &ditch was observed at the time of this visit. A water
uality sample was taken from the SR 1318 ditch. It appears that the effluent in this ditch came from the Britt field and from roadway
unotf (the ditch had no upstream beyond the boundary of the Britt field). A second sample was taken in Jackson's pond, downstream of
uc SR 1319 ditch. A third sample was taken in the roadside ditch adjacent to SR1316, where irrigation piping had been placed through a
invert to afield across the road. A dead fish was observed near this sample point. The joints of die piping had been covered with
fibber socks and clamped to prevent discharge. No visible evidence of di§charge was found at this location during die visit.
7/25/97
Reviewer/Inspector Name
Revie«er/Inspector Signature: M_L,_, _r J-j , Date:

State of North Carolina
Department of Environment
and Natural Resources
Wilmington Regional Office
James B. Hunt, Jr., Governor
Wayne McDevitt, Secretary
Division of Water Quality
March 18, 1998
MEMORANDUM
NOTE TO FILE: 31-763
FROM: Andrew G. Helminger Ad'
A lea
FqCDENR
Ncw" CAROLINA DEPARTMENT OF
ENVIRONMENT AND N/3iJRAL RESOURCES
SUBJECT: February 23, 1998, Nutrient Samples from Ralph Britt Farm
In response to a complaint, staff from the Wilmington Regional Office of the Division of Water
Quality collected water samples at the Ralph Britt Farm on February 23, 1998. Fecal coliform
bacteria and nutrient samples were taken from the SR1318 ditch adjacent to Ralph Britt's spray
field, from the head of Neil Jackson's pond (downstream of the SR1318 ditch), and from the
SR1316 ditch where Mr. Britt placed irrigation piping under the State road.
Fecal coliform samples were delivered to Envirochem, Inc., in Wilmington for analysis.
Nutrient samples were labeled, secured in a cooler with tape, and locked in the Wilmington
courier box for delivery to the Water Quality Lab in Raleigh. The cooler was incorrectly
addressed and was not delivered. Thus, no nutrient data will be available from this sample
date.
S :1W Q51AND YA131-763 . NTF
127 North Cardinal Dr., Wilmington, North Carolina 28405 Telephone [phone] FAX [phone]
An Equal Opportunity Affirmative Action Employer 50% recycled/10% post -consumer paper

31--1b3
Environmental Chemists, Inc.
© MAILING ADDRESS: TELEPHONE: SHIPPING ADDRESS:
P.O. Sox 1037 [phone] (Office) 6602 Windmill Way
Wrightsville Beach, [phone] (Lab) Wilmington.
CONSULTING North Carolina 28480 [phone] (Fax) North Carolina 28405
CHEMISTS NCDEHNR: DWQ CERTIFICATE #94, DLS CERTIFICATE #37729
FEB 2 $ 1998
Customer:
BY:
NCDEHNR-DW
127 N. Cardinal Drive Ext.
Wilmington, NC 28405
Attn: Rick Shiver
Andrew Helminger
Date Sampled:
Sampled By:
STREAM:
Date of Report:
Purchase Order #:
Report Number:
REPORT OF ANALYSIS
02/23/98
Andrew Heiminger
Report To:
Copy To:
February 24, 1998
8-0578
Rick Shiver
Andrew Helminger
31-763
31-763
31-763
PARAMETER
1F
2F
3F
# 1248
# 1249
# 1250
Fecal Coliform, colonies/100ml
1020
4900
310
Reviewed b and approved for release to the client.

renvirochlem
Client: N -L_ pLE� V--- R1- J of lnl,
Collected Bv: i- i•
Ramnlo Tlvnn- Inflimanr_ Tr.fflrvpnr_ Wa11�Ch
ENVIRONMENTAL CHEMISTS, INC
$gtllple Collection god Chain of Custody
n*tips.
6602 Windmill Way
Wilmington, NC 28405
Phone: [phone]
FAX: [phone]
SAMPLE
IDENTIFICATION
COLLECTION
BOTTLE
ID
LAB
ID
PRESERVATION
ANALYSIS REQUESTED
DATE
TIME
NONE
SO
HNO
NaOH
TRIO
(T1HE
1`7
=�apM
a�
X
colt
' c-
13 4
0?M
X
K
COL-1 ?- `
Maximum Holding Time Between Collection and Analysis: BOD 48 Hours, Coliform in Wastewater 6 Hours,
Collform in Drinking Water 301iours,
Transfer
Relinquished By:
Date/Time
Received By:
Date/Time
1
2
Received with Ice Water Chill to 4°C: Yes ✓ No Accepted: ✓ Rejected:
Delivered By: Received By: :Lw± Date: a-3 ]°I,!VTime: �—)-aotl
Comments:

1y jl 130
1
_. _.,, 'r.t,.?--`�,c:✓�;.` ,r;;' ,°o� •// f/ r62� Mt GUe 4 C6
_.p f me\"µ ^d''�'i.3�•Z - 6O III �.\ _ �{ `�,('t i
i'��.R; � a -Yam',._ ��i6p_ aa\ 11I � •\ is ;.�.�
60
j' - -! C K `C .J . �'/ '\ \ r� •� _-� - S 'y x, ??.�' mot, � 'sy '�+" '
r64
AT
\ r i
411 V
A as 165
.3 1q
Holy `��`�1a _/3JT
r// 7i324
-_- SAMPL4 It 1
l61 j ° y (l�.+ z�23Ila
1 4/7«lii CCCAAA ° 31 —76316
LN
1 \v 'u)• •, �C �� \ (a#n*�cl vY�tt"••"/1 1:�4rClit '.L.• f '.y: I
. _ �`i • 1318 ` i? ��` I � � 3, 9� ..` .s�r?,rtf �` �,1:. �•�+�•'���V�l'
` rsi� ':i i •�� �� Pl6 ,� 4�r� - f3`z\\ r �',_ � �- -- ?.
1317 i •u/o J ` 4'i' �.,i.' ,S {J / {j C:51 ��l = : ;; w-r
... J4 o u � �a•� % I
If
r � , ° { � a 5'�: i? �../ "� `i r• '�`Yr - y
s .5� ! (�q • tom• j < <� � � r Ft I ${:•'� �� f�.- 1 � ��i`I A
��\ � ISO ,?, m�,F. � •f. - '_ - i
i
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* 1
Mµ _
� � t.� 7 w�t� i z•; �. 4� I l faa r�'g�
306)
767 (wARsAw ORTr) BFAUTANCUS 0.8 ML 2'30
5354 11 §f -
SCALE 1: 4 000
j 0. 1 MILE
2
1000 0 1000 2000 3 4000- 5000 6000 7000 FEET
1 0 - 1 KILOMETER

uixision of tnvironmentai Management
GROUNDWATER SECTION
CHAIN OF CUSTODY RECORD
For Investigation of 3iA LL.Incident No.
Samples collected and GW-54 forms completed by:
�►
Lab Only
Lab No.
Quad
No.
Location
Date
Time
No. of
Containers
,31 _� 3
I ;S 13i iTLH
4 Z3 9S
3=1tP
—�63
2 NS-0T = 7Tr. H
z za 4C
3:3004
- 763
vr : s *s r,�s t'o►.34
2
3: 52PH
11231A
Relinquisheq by Signature):.
Received by(Signature):
Date/Time
Rel.
Rec. by
/
ReL
Rec. by
/
ReI.
Rec. by
/
Method of Shipment:
Seal by:
Security Type and Condition: Lock by:
Broken by:
Open by:
AR IIC1= C)N1 Y
Lab No..
From Through
N °`
Containers
Analysis
Relinquished b Y
Received b Y
Date / Time
I
/
/
Note: Uriginai sent witn snipment
GW-63 Copy retained by collector 2/86

DIVISION OF ENVIRONMENTAL MANAGEMENT WATER QUALITY FIE—J-LAB FORM (DM1)
COUNTY PRIORITY
RIVER BASIN
REPORT TO: ARO PRO MRO RHO WeR WiR WSRO TS ❑AMBIENT ❑ QA
AT BM
Other COMPLIANCE � CHAIN
OF CUSTODY
Skipped by: Bu Courle Staff, Other ❑EMERGENCY
COLLECTOR(S): &blz E---o Cz- 0 1- U A o3 (
Estimated BOD Range: 0-5/5-25/25-65/40-I30 or 100 plus
Seed: Yee ❑ Na ❑ Chlorinated: Yes ❑ No ❑
SAMPLE TYPE
® STREAM
❑ LAKE
❑ ESTUARY
❑
EFFLUENT
❑
INFLUENT
�jioV-r
STATION LOCATION: 3
REMARKS:
Station #te Begin (yy/mm/dd) Time Begin Date End Time End Depth DM DB DBM Value Type Composite Sample Type
3 --1b 3 I IJ \)r Ta2-
Z3 1 q9 1 3- IP" I I I I
A H L T S B C G GNXX
Rn. rwh II.-M41V
Lab Number:
Date Received: 'Time:
Rec'd b : From: Bus -Courier -Hand Del
DATA ENTRY BY: CK:
DATE REPORTED:
1
BOD5 310
mg/1
2
COD High 340
mg/l
3
COD Low 335
mg/1
4
Collform: MF Fecal 31616
/100ml
5
Collform: MF Total 31504
/100ml
6
Collform: Tube Fecal 31615
/100ml
7
Coliform: Fecal Strep 31673
/100ml
al
Residue: Total 500
mg/l
10
Fixed 510 mg/I
11
Residue: Suspended 530 mg/I
• 12
Volatile 535 mg/I
13
Fixed 540 mg/I
14
pH 403 units
15
Acidity to pH 4.5 436 mg/I
16
Acidity to pH 8.3 435 mg/I
17
Alkalinity to pH 8.3 415 mg/I
18
Alkalinity to pH 4.5 410 mg/l
19
TOC 680 mg/1
20
Turbidity 76 NTU
Chloride 940 mg/1
Chi a: TO 32217 ug/1
Chi a: Corr 32209 ug/I
Pheophytin a 32213 ug/I
Color: True 80 Pt -Co
Color -(pH ) 83 ADM[
Color: pH 7.6 82 ADMI
Cyanide 720 mg/I
Fluoride 951 mg/I
Formaldehyde 71980 mg/1
Grease and Oils 556 mgA
Hardness Total900 mg/I
Specific Cond. 95 uMhos/cm2
MBAS 38260 mg/1
Phenols 32730 ug/I
Sulfate 945 mg/1
Sulfide 745 mg/I
,ZNI-13
as N 610 mg/1
-TKN as N 625 mg/l
2 plus NO3 as N 630 m9/1
Total as P 665 mg/l
PO4 as P 70507 mgA
P: Dissolved as P 666 mgA
CdCadmium 1027 ug/I
CrChromium:Total1034 USA
Cu-Copper 1042 ug/I
NI -Nickel 1067 ugA
Pb-Lead 1051 ugA
Zn-Zinc 1092 ug/I
A Ilver 1077 ug/I
Al -Aluminum 1105 ug/I
Be -Beryllium 1012 USA
Ca -Calcium 916 m8A
Co -Cobalt 1037 ug/I
Fe -Iron 1046 ugA
Li -Lithium 1132 ugA
Mg -Magnesium 927 mg/1
Mn-Manganese 1055 ug/I
Na-Sodlum 929 mg/I
Arsenic:Total 1002 ug/I
Se -Selenium 1147 ug/1
Hg-Mercury 71900 ug/I
Organochlorine Pesticides
OrgamnAwosphorus pesticides
Acid Herbicides
Base/ Neutral Extractable Organics
Acid Extractable Organics
Purgeable Organics (VOA bottle reg'd)
Phytoplankton
Sampling Point R
Conductance at 25 C
Water Temperature C
D.O. m2/1
pH
Alkalinity
Acidity
Air Temperature (C)
pH 8.3 pH 4.5
pH 4.5 pH 8.3
2
94
10
300 .
400 1.
82244 1431
92243 182242
20
Salinity %
Precipition Wday)
Cloud Cover %
Wind Direction (Deg)
Stream Flow Severity
Turbidity Severity
Wind Velocity M/H
can Stream Depth fL
Stream Width fL
480
45
32
36
1351
1350
35
64
4
DMl/Revised 10/86

For Lab Use ONLY
DIVISION OF ENVIRONMENTAL MANAGEMENT
WATER QUALITY FIE...3-LAB FORM (DM1)
COUNTY D�J_PL_I f�!
PRIORITY
SAMPLE TYPE
U
RIVER BASIN
❑AMBIENT
SRO TS
❑ QAFZ;t
STREAM
❑ EFFLUENT
REPORT TO: ARO FRO MRO RRO We Wi
AT BM
Other
Shipped by: B Cour , Staff, Other
❑COMPLIANCE
❑
9CHAIN
OF CUSTODY
EMERGENCY
❑ LAKE
❑ ESTUARY
❑ INFLUENT
Lab Number:
Date Received: Time:
Rec'd by: From: Bus -Courier -Hand Del
DATA ENTRY BY: CK:
DATE REPORTED:
COLLECTOR(S):=ja f
Estimated SOD Range: 0-5/5-25/25-65/40-130 or 100 plus STATION LOCATION:
Seed: Yes ❑ No ❑ Chlorinated: Yea ❑ No ❑ REMARKS: —A-.t> I> *p _C 0 u
ate Begin (yy/ram/dd) Time Begin Date End Time End I Depth DM DB DBM
ZLZ3 I 9:90P t -- -
1
BOD5 310 mg/1
2
COD High 340 mg/1
3
COD Low 335 mg/1
4
Coliform: MF Fecal 31616 /loom]
5
Coliform: MF Total 31504 /loom[
6
Coliform: Tube Fecal 31615 /loom[
7
Coliform: Fecal Strep 31673 /100m1
S
Residue: Total 500 mg/I
9
Volatile 505 mg/1
10
Fixed 510 m9/1
11
Residue: Suspended 530 mg/I
• 12
Volatile 535 mg/I
13
Fixed 540 mg/I
14
pH 403 units
15
Acidity to pH 4.5 436 mg/I
16
Acidity to pH 8.3 435 mg/1
17
Alkalinity to pH 8.3 415 mg/1
18
Alkalinity to pH 4.5 410 mg/1
19
TOC 690 mgA
nn
Turbidity 76 NTU
Chloride 940 mg/1
Chi a: Tri 32217 ug/I
Chi a: Corr 32209 ug/I
Pheophytin a 32213 ug/1
Color: True 80 Pt -Co
Color:(pH ) 83 ADMI
Color. pH 7.6 82 ADMI
Cyanide 720 mg/l
Fluoride 951 mg/I
Formaldehyde 71880 mg/I
Grease and Oils 556 mg/l
Hardness Total900 mg/1
Specific Cond. 95 uMhos/cm2
MBAS 38260 mgA
Phenols 32730 ug/I
Sulfate 945 mgA
Sulfide 745 mg/I
A H L
H3 as N 610 mg/l
CN as N 625 mgA
02 plus NO3 as N 630 mg/I
otal as P 665 mg/I
PO4 as P 70507 mg/1
P: Dissolved as P 666 mg/1
CdCadmlum 1027 ug/1
CrChromium:Total1034 ugA
Cu-Copper 1042 ug/I
NI -Nickel 1067 ugA
Pb-Lead 1051 ugA
Zn-Zinc 1092 ugA
AW6ilver 1077 ug/1
Al -Aluminum 1105 ug/I
Be -Beryllium 1012 ug/I
Ca -Calcium 916 m9A
Co -Cobalt 1037 ugA
Fe -Iron 1045 ugA
Composite
T^ S B
Sample Type
C G GNXX
LI-Llthium 1132 ug/I
Mg -Magnesium 927 mgA
Mn-Manganese 1055 ug/1
Na-Sodium 929 m9/1
Arsenic:Total 1002 ug/I
Se-Selenlum 1147 ug/I
Hg-Mercury 71900 ug/I
Organochlorine Pesticides
Orgnophosphorus P2stickles
Acid Herbicides
Base/ Neutral Extractable Organics
Acid Extractable Organics
Purgeable Organics (VOA bottle reg'd)
PtL;plankton
Sampling Point %
Conductance at 25 C
Water Temperature 0
D.O. mg/I
pH
Alkalinity
Acidity
Air Temperature 00
PH 8.3 pH 4.5
pH 4.5 PH 8.3
2
94
10
300 is
400 •
822" 431
82243 82242
20
Salinity %
Precipition (In/day)
Cloud Cover 9i
Wind Direction lD¢g)
Stream Flow Severity
Turbidity Severity
Wind Velocity M/H
can Stream Depth it
Stream Width ft.
480 145
32
136
1351
1350
35
64
14
DMl/Revised 10/86

DIVISION O For Lab Use ONLY
F ENVIRONMENTAL MANAGEMENT WATER QUALITY FIE... -LAB FORM (DMV
COUNTY t> V L
PRIORITY
SAMPLE TYPE
RIVER BASIN
❑
O-STREAM
❑
REPORT TO; ARO FRO MRO RRO WaR WiRO WSRO TS
AMBIENT
QA
EFFLUENT
AT BM
❑COMPLIANCE
�HAIN
❑ LAKE
❑ INFLUENT
Other
Other
OF CUSTODY
❑
Shipped by: Bu Cour , Staff, Other
EMERGENCY
ESTUARY
Lab Number:
Date Received: Time:
Ree'd by: From: Sus -Courier -Hand Del
DATA ENTRY BY: CK:
DATE REPORTED:
COLLECTORS) ( l t
Estimated BOD Range: 0-5/5-25/25-65/40-130 or 300 plus STATION LOCATION: 3 ! ` �� 3__:Z
Seed: Yes ❑ No❑ Chlorinated: Yea ❑ No ❑ REMARKS: Z!a z Zr��5 u
Station # Date Begin (yy/mm/dd) Time Begin Date End Time End Depth DM DB DBM Value Type Composite Sample Type
7 3 U"Ir Z3 �g �� .$Zp A H L T S B C G GNXX
1
BUD5 310 mg/I
2
COD High 340 mg/I
3
COD Low $35 mg/1
4
Coliform: MF Fecal 31616 /100m1
5
Collform: MF Total 31504 /100ml
6
Coliform: Tube Fecal 31615 /Ioom]
7
Coliform: Fecal Strep 31673 /loom)
g
Residue: Total 500 mg/I
9
Volatile 505 mg/I
10
Fixed 510 mg/1
11
Residue: Suspended 530 mg/I
12
Volatile 535 mg/1
13
Fixed 540 mg/1
14
pH 403 units
15
Acidity to pH 4.5 436 mg/1
16
Acidity to pH 8.3 435 mg/t
17
Alkalinity to pH 8.3 415 mg/I
18
Alkalinity to pH 4.5 410 mg/1
191
TOC 680 m9A
20
Turbidity 76 NTU
Chloride 940 mg/I
Chi a: Tri 32217 ug/I
Chi a: Corr 32209 ug/I
Pheophytln a 32213 USA
Color: True 80 Pt -Co
Color.(pH ) 83 ADMI
Color: pH 7.6 82 ADMI
Cyanide 720 mg/I
Fluoride 951 mg/I
Formaldehyde 71880 mg/1
Grease and Oils 556 mg/l
Hardness Total900 mg/I
Specific Cond. 95 uMhos/cm2
MBAS 38260 moll
Phenols 32730 ug/I
Sulfate 945 mgA
Sulfide 745 mg/1
3asN610 m9A
as N 625 mg/l
2 plus NOS as N 630 mg/1
Total as P 665 mg/I
PO4 as P 70507 mgA
P: Dissolved as P 666 mg/I
4
CdCadmlum 1027 ug/I
CrChromlum:Total1034 ug/1
Cu-Copper 1042 u0/1
NI -Nickel 1067 ug/I
Pb-Lead 1051 up
Zrt-Zinc 1092 ugA
A liver 1077 ug/I
AI -Aluminum 1105 ug/I
Be -Beryllium 1012 ug/I
Ca-Calcfum 916 mg/I
Co -Cobalt 1037 ug/I
Fe -iron 1045 ugA
Li -Lithium 1132 ugA
Mg-Magneslum 927 mg/I
Mn-Manganese 1055 ug/I
Na-Sodlum 929 moll
Arsenic -Total 1002 ug/I
Se-Selenlum 1147 ug/I
Hg-Mercury 71900 ug/I
Organochlorine Pesticides
Orgmwphcsplwrus Pesticides
Acid Herbicides
Base/ Neutral Extractable Organics
Acid Extractable Organics
Purgeable Organics (VOA bottle reg'd)
Phytoplankton
Sampling Point R
Conductance at 25 C
Water Temperature 40
D.O. mgA
pH
Alkalinity
Acidity
Air Temperature 40
PH 8.3 pH 4.5
pH 4.5 pH 8.3
2
94
10
300 ,
400 10
&VA4 431
82249 182242
20
Salinity S
Precipition (In/day)
Cloud Cove X
Wind Direction (Deg)
Stream Flow Severity
Turbidity Severity
Wind Velocity M/H
Mean Stream Depth ft.
Stream Width ft.
480
145
132
136
1351
1350 135
64
14
DMI/Revlsed 10/86

0 Division of Soil and Water Conservation ❑ 0ther Agency
® Division of Water Quality
0 Routine Ot Complaint 0 Follow-up of 2LV ins ection 0 FoHow-up of DSWC review 0 Other
Date o€ Inspection
Facility Number ? 3
Time of Inspection :00 24 hr. (hh:mm)
© Registered IX Certified © Applied for Permit Permitted JE3 Not Operational I Date Last Operated:
Farm Name gri.....SCiLd?.....�`fr:Xtx- ............................................ County: ....Dtl��i.................................... I ..... .......................
.
Owner Name:
...... Lt�k.-4..... SU.L&*wL........ .................................................. Phone No:.614)... ............................................
Facility Contact: ---• ...................... .. Title: ...... Phone No:
MailingAddress:.1. ... &(�.......(.ly ............................................................................... ....... .¢Sa...... 1--�cr...---.---------............................ A. ..........
Onsite Representative: ........,i.Gas25............ NVy.1t<................... .. Integrator: ...... k4
Certified Operator,... J.iA,S...... kljl n,.............. ..4zi......Ayr.................................... Operator Certification Number:..... I.R&OZ ......................
Location of Farm:
.dry...x.�.... L...R.t....?:�oc�M...�. �...... i ... la.... P..: S +�........c . ....Jr ......SK....i l :............. t...
....................................... .............
Latitude ©` ®4 " Longitude ®• 1 04 ' =11
r
'Design Current "" 'i?esign "'Current
Capacity Population Poultry Capacity ;Population C
Wean to Feeder
c
Feeder to Finish
low
Farrow to Wean
j4tZj 2-
Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
I=
4 -
tal Des�ga Capacity I 4
Total SSLW.,,l
General
1. Are there any buffers that need maintenancelimprovement? ❑ Yes ❑ No
2. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gaVmin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
3. Is there evidence of past discharge from any part of the operation?
4. Were there any adverse impacts to the waters of the State other than from a discharge?
5. Does any part of the waste management system (other than lagoons/holding ponds) require
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes ❑ No
7. Did the facility fail to have a certified operator in responsible charge?
7/25/97
❑ Yes ❑ No
Continued on back

r
Facility Number:
8. Are there lagoons or storage ponds on site which need to be properly closed'
Structures (La2oon%,Iloldin2 Ponds, Flush Pits, etc)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure I Structure 2 Structure 3
Identifier:
Freeboard(ft):...........as....................................................
10. Is seepage observed from any of the structures?
Structure 4 Structure 5
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?
`'Paste Application '
14. Is there physical evidence of over application?
(If in excess of WMP, or runoff entering waters of the State. notify DWQ)
15. Crop type...............................................................................................................................................................................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19..Is there a lack of available waste application equipment?
24. 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"
3 No violations or deficiencies were -noted during this visit.:Voilmill receive no ftirtlier
correspotiden ce a-b:ou' t this. visit.-'.'
❑ Yes ❑ No
❑ Yes ❑ No
Structure h
❑ Yes El No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
.........._ E.... I........
I ...............
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes ❑ No
fir] Yes ❑ No
❑ Yes . ❑ No
imenfsxi;efeir to question#): Explain any NTS answers and/or any 'recominendations or any other comiinents:'
drawings of facility to better explain 'situations. (use additional pages as necessary): ,
Ns �ura�� o� wKwcl 6jc,5 t was oI Sevvef1 - No �dv�iv) a� W� t aiosertxd.
mbdol Gtrv�tt_etS S WA �a {�ii�Sed 0 t A plrpP yt,e,. KLe wftJ 60;oi
7/25/97
L
Reviewer/Inspector NameVl­
Reviewer/inspector Signature: - Date: ,�11.I joy

Ir
Division of Soil and Watertonservation ❑ Other Agency
Division of Water Quality
10Routine O Contplaint JMFollow-up of l)WO inspection O Follow-up of DSWC review O Other
Facility Number
13 Registered U Certified [3 Applied for Permit �Xmitted
..
Farm Name:._er....�f ................\. ...............................
Date of Inspection
Time of Inspection / S'ja: � 24 hr. (hh:mm)
1(3 Not O erationai ` Date- Last Operated:
County:... -^c/ b....r:...!..`........................................
Owner Name: Phone No: S' a ^ -7c/
........................................................................................................................ ...................................................................................
r
Facility Contact: ................ .... Title:.... ..c!/yL ,CZ Phone No:...................................................
Mailing Address: � �...�..�X .............. L. k(Y............................................. ..............................................
Onsite Representative: ...... &Gp. r .... Integrator:........ .......... ...... ... ........ .....
Certified Operator;.......................................................................................... Operator Certification Number, ................. ...-•---U..........
Location of Farm:
Latitude • 09 « Longitude • ` 44
:� Destgn Ctirrent a Design Current. Design ;Current
;Swute' Capacity Popeilaiion Poultry Capactty Populatton Cattle Calacttyx Population
❑ Wean to Feeder _ ❑Layer FEE]
Dairy
❑ Feeder to Finish❑Non-Layer Non-Dairy
x
Farrow to Wean ;:: r _ t
❑ Farrow to Feeder ❑Other
❑ Farrow to Finish Tkal Design Ca aCttyW:
❑ Gilts ' �E
❑ Boars Total SSLW= =�
.,
Nttmber of La ns / Holdtn `Ponds %. INSubsurface Drains Present Lagoon AreaJJXSpray Field Area I,'j
a 3 9 4 : ❑ No Liquid Waste Management Systemto
General
1. Are there any buffers that need maintenance/improvement?
2. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made'
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gallmin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
3. Is there evidence of past discharge from any part of the operation?
4. Were there any adverse impacts to the waters of the State other than from a discharge?
5. Does any part of the waste management system (other than lagoons/holding ponds) require
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
7. Did the facility fail to have a certified operator in responsible charge?
7/25/97
AYes ❑ No
❑ Yes jlgkRio
❑ Yes JkNo
❑ Yes RNo
❑ Yes
allo
❑ Yes
PKNo
❑ Yes
9KNo
'ryes
❑ No
❑ Yes ARK No
❑ Yes 10 No
Continued on back

Facility Number: — 1
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (Lagoons,Holding Ponds, Flush Pits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure I Structure 2 Structure 3
Identifier:
Freeboard (ft):
10. Is seepage observed from any of the structures?
Structure 4
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)
15. Crop type L: '•..`.................................................................................................................
❑ Yes 6660
,dyes ❑ No
Structure 5 Structure 6
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
22. Does record keeping need improvement?
For Certified or Permitted Facilities Only
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?
O-No.violations•or. deli, iencies.were-noted during this:visit: You�wifl recei'Ve no further-:
correspondence d out this;visit:-:
I Reviewer/Inspector Name
❑ Yes ANo
❑ Yes ,_No
❑ Yes PjNo
❑ Yes ffiLNo
❑ Yes 429-No
❑ Yes
KNo
❑ Yes
'Q No
❑ Yes
[ANo
,❑ Yes
® No
❑ Yes
G�No
❑ Yes
J'No
❑ Yes
[RNo
❑ Yes No
❑ Yes No
❑ Yes No
eGvn t v r Pt .G �,! 7 I'] �e b� AIL 'p D D i la
A-L/L
7/25/97
I Reviewer/Inspector Signature:
Date:

0 Division of Soil and Water Conservation ❑ Other Agency
JZ Division of Water Quality
10 Routine a Complaint 0 Follow-up of DWQ inspection O Follow-up of DSWC review O Other �
�., r�rirrrnurni
Facility Number 3 Date of Inspection
Time of Inspection blt_:OD 24 hr. (hh:mm)
0 Registered 14 Certified © Applied for Permit P Permitted [3 Not Opera—tio—n-a-1-1 Date Last Operated:
Farm Name: .......X^941,� ....�fi....2�,2....s r!2�.................................................... County: ....... _r....................................... .......................
Owner Name:.......... ` - .(12.hie.......... gat ........................ .... Phone No: ��La�...(c�...`i! � .......----...............
Facility Contact: .......................... ... Y!. .......................... Title:..........................
MailingAddress:...... ��........ IRI.............................................................................
Onsite Representative:.--.----- L� ...&a
Certified Operator;
Location of Farm:
Phone No . .....................................
................................................. . Z ........
Integrator:..... ...............................................................
Operator Certification Number ..........................................
m2c
Latitude • 4 46 Longitude • 0' 064
Design _ Current "
Design Design ' `Current
Swine`= , Capacity Popnlatton;
.Current4
-Poultry _ Capacity ,PopulatYori Cattle ,Capacity4opulation '
Wean to Feeder
r
❑ Layer r ❑Dairy ME
Feeder to Finish
ElNon-Layer` ❑Non -Dairy
Farrow to Wean
NEV , ""In
❑ Other;
❑Farrow to Feeder S
Farrow to Finish
y- Total DeStgn Capacty
Gilts
P.`F.
Boars,."
Total SSLW
i
Number of Lagoons I Holding Ponds'"'
�$ Subsurface Drains Present
Lagoon Area
Spray Field Area
^�
❑ No Liquid Waste Management System
General
1. Are there any buffers that need maintenancelimprovement? ❑ 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?
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 Yes ❑ No
mai ntenancelimprovement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes ❑ No
7. Did the facility fail to have a certified operator in responsible charge? ❑ Yes ❑ No
7/25/97 Continued on back

E�aciktit�thcr: 31 --y�
8. Are there lagoons or storage ponds on site which need to be properly closed? ❑ Yes ❑ No
Structures fLa oons 1-Ioldin Ponds Flush Pits etc.
9. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes ❑ No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard (ft):...........................................................
............. ................................... .................................... .................................... ....................................
10. Is seepage observed from any of the structures? ❑ Yes ❑ No
It. Is erosion, or any other threats to the integrity of any of the structures observed? ❑ Yes ❑ No
12. Do any of the structures need maiwenancelimprovement? ❑ Yes ❑ No
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers? ❑ Yes ❑ No
Waste Application
14. Is there physical evidence of over application? ❑ Yes ❑ No
(If in excess of WMP, or runoff entering waters of the State. notify DWQ)
15. Crop type .................................................... ... .
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)? ❑ Yes ❑ No
17. Does the facility have a lack of adequate acreage for land application? ❑ Yes ❑ No
18.
Does the receiving crop need improvement?
❑ Yes
❑ No
19.
Is there a lack of available waste application equipment?
❑ Yes
❑ No
20.
Does facility require a follow-up visit by same agency?
❑ Yes
❑ No
21.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
❑ No
22.
Does record keeping need improvement?
❑ Yes
❑ No
For Certified or Permitted Facilities Only
23.
Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑ Yes
❑ No
24.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
❑ No
25.
Were any additional problems noted which cause noncompliance of the Permit?
❑ Yes
❑ No
0 No.violations or deficiencies were noted during this:visit. You.will receive no further
cofrespbadence shout this.visit:'
Comments (refer to question #) Ezplait► any ;Y`ES answers and/or any recommendattons: or any other comments x
Use drawtngs of factltty to>better;expEatn situations (usc additional pages as necessary) ,i
ik" 6fi, plo.c.ed -, V, a r,Co a; i(- (tat uyr w ` 'j- roan '4�n"Ve k 0-
W�11 `to trr+c�t t t.2�c�t DV, '�ir.4.. slae- 4 SK 1316. net} worms -e. WacS 06SWV[-6
arotmc� t6twt,t c.�iot. o � � (nose &J a((Jrv.� run, � e j Lotto j6 tk, A& -
No 00,%k ti.1c.a 0b%vrvr� N 4\.,- &61v Qvi%J Mir, %V-c4 i-. pUp,� �or&we-s{z.
100, t &k r pL.r,,_& tw %"`eld• Ar w4wQU01, I-0�-
J a, i n 1n rµ �1 L dzreci dodn-S*c,*r- 4trw 4tu- Atr &e- altdt)
�0,st
7/25197
x
Reviewer/Inspector Name Y
Reviewer/Inspector Signature: Date:

RIECEIN ED MAR t 9 1996
envirochem, Environmental Chemists, Inc.
® MAILING ADDRESS: TELEPHONE: SHIPPING ADDRESS:
P.O. Box 1037 [phone] (Office) 6602 Windmill Way
Wrightsville Beach, [phone] (Lab) Wilmington,
CONSULTING North Carolina 28480 (910) 392- 424 (Pax) North Carolina 28405
CHEMISTS NCDEHNR: DWO CERTIFICATE #94, DLS CERTIFICATE #37729
Customer:
NCDEHNR-DWQ
127 N. Cardinal Drive ExL
Wilmington, NC 28405
Attn: Rick Shiver
Brian Wrenn
Date Sampled:
Sampled By:
STREAM:
03/03/98
Brain Wrenn
REPORT OF ANALYSIS
Date of Report March 13, 1998
Purchase Order #:
Report Number:
Report To:
Copy To:
8-0677
Rick Shiver
Brain Wrenn
PARAMETER
Sample ID
31-763
Lab ID
# 1484
1Fec I 1 Nut
Fecal Coliform, colonies1100m1
48,000
Nitrate + Nitrite Nitrogen, NO3 + NO2 - N mglL
1.04
Ammonia Nitrogen, NH3-N, mg1L
9.07
Total Kejeldahl Nitrogen, TKN mglL
13.0
Total Phosphorus, P mg/L
0.99
Reviewed b k:Ajj��nd approved for release to the client.

ENV] RUN111 EN'1'aL CH E1111STS, INC 6602'�'L'indmill'fI'1'ay
• i Wilmington, NC: 28405
® Spmple_Collection and Chain of Custody Phone: [phone]
FAX: [phone]
Client; D . E .//H�� . N . R WILMINGTON REGIONAL. OFFICE J�
ie i e: Innuen
LIII ent eu./-Ntreafl3.
Non utn
r•
SAMPLE
DENTIFICATION
COLLECTION
MOTTLE
ID
LAB
ID
PRESERVATION
DATE
TIME
NONE
I SU
HNU,
NoOH
TIIIO
OTHER
e� 31- 7
% i
1 �-', L
�
/
1 Ge-
�u} 3Ir7#,3`
��3Ig�
1�= Z4
ANALYSIS REQUESTED
Maximum holding Time Between Collection and Analysis: BOD 48 hours, Coliform in Wastewater 6 flours,
Coliform in Drinking Water 30 I-Iours, .
Cc,, (I -
err,
Transfer Relinquished By: Date/Time Received By: Date/Time
I
2
Received with Ice ter Chilled to 4° : Yes No A Acce ted Rejected:
Delivered 13y: Received 11y: Date: 3 3'Time: 4i
comments: JtJ,! .Wo f s S°.l 1GL _

Jo Routine a Complaint 0 Follow-up of DWQ inspection 0 Follow-up of DSWC review 0 Other
Facility Number 31 7(,3 Date of Inspection 3/11/9R
Time of Inspection 1R:00 24 hr. (hh:mm)
[] Registered MCertified [] Applied for Permit EPermitted ❑ Not Operational Date Last Operated:
Faun Name: .ttlRlxsS:.Stueunc..B.ritk.S.a3S..FaU[ut....................................................... County: D.uplia............................................... W..1R.0.........
OwnerName: IL'AlpIVSuzauae................... .B.ritt............................................................. Phone No:9.19A.58.4010 ..........................................................
FacilityContact: .............................................................................. Title:................................................................ Phone No:
MailingAddress: PQ.BA\.18R............................................................................................ CaLypio.AC .......................................................... 78325.............
Onsite Representative: Ridph..Btitt.................................................................................. Integrator:11l0.Cp:1•l:.F.amll\:.F.elms......................................
Certified Operator: da.tacs..Ralph....................... Brit.t.J.r ............................................ Operator Certification Number: .18.G0.8.............................
Location of Farm:
Latitude I 35 ' tl9 18 11 Longitude 78• 04 10 .:
General
1. Arc there any buffers that need maintenance/impirtrvemcnt'?
[] Yes
© No
2. is any discharge observed from any part of the operation?
❑ Yes
E] No
Discharge originated at: E] Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?-, -
❑ Yes
Q No
b. If discharge is observed, did it reach Surface Water? (Ifyes, notify DWQ)
[} Yes
[] No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (Ifyes, notify DWQ)
❑ Yes
© No
1 Is there evidc-race 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 pat of the waste management system (other than lagoons/holding ponds) require
❑ Yes
© No
maintenance/improvement?
G. Is facility not in compliance with any applicable setback criteria in cil'ecl at die lime of design?
❑ Yes
E] No
7. Did the facility fail to have a certified operator in responsible charge'?
❑ Yes
© No
7/25/97

v
Faci lit nher: 31-763
8. Are Ihi,w lagoons or storage ponds on site which need to be properly closed'?
Structures (LaRoons,Holdinff Ponds, Flush_Pits etc.
9. Is storage capacity (freeboard plus stone storage) less than adequate?
Stnucture 1 Structure 2 Structure 3 Structure 4
Identifier:
Freeboard(fl):..................................................................................... .........
10. Is seepage observed from any of the structures?
❑ Yes []No
❑ Yes ❑ No
Structure 5 Structure 6
11. Is erosion, or any other threats to the integrity of any of the structures observed?
12. Do any of the structures need nnaintenancelimprovement?
(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 stnictures lack adequate minimum or maximmn liquid level markers?
Waste Application
14. Is there physical evidence of over application?
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type............................................................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
17. Does the facility have a lack of adequate acreage for land application'?
18, Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/]nspector fail to discuss review/inspection with on -site representative?
❑ Yes ❑ No
(-]Yes ❑ No
❑ Yes ❑ No
❑ Yes []No
❑ Yes ❑ No
❑ Yes
❑ No
❑ Yes
0 No
❑ Yes
© No
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
22. Dees record keeping need improvement?
For Certified or Permitted Facilities Only
23. Does the facility tail to have a copy or the Animal Waste Management Plan readily available'?
24. Were any additional problems doted which cause noncompliance of the Certified AWMI'?
25. Were any additional problems noted which cause noncompliance of the Perniit'?
No•vio,12,6►rls:ox'd'e%CiencieS'W,b,'e:noted-ctwriligt1tiS-visit. Youl-Will'r�elve'nb.'fit rt-he1.'•'•
.:.:.corres�v>adencenhouf this.vis�t -.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.. .:..:. .:::..:.:.:.: :.:.:.:.
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
[j Yes [ No
ite visit was made in response to a complaint received on 3/1 1 /98. The irrigation piping which had been placed through the culvert +
rider SR 1316 had been removed. Mr. Britt stated that he flushed the piping with three thousand gallons of fresh water before pulling it
Lit of the culvert to ensure that no animal waste discharged into the ditch. No evidence of waste was found in the ditch at the tine of this
rspection. Ponding of animal waste was observed around sonic of the irrigation piping joints in the spray field. With the exception of
lie location near the lagoon, this leakage was isolated from any drainage pathways. At the joint location near the lagoon, Mr. Britt had
wilt a been between sonic puddled waste and an adjacent field ditch to prevent it from running off. Mr. Britt had disked all of his spray
olds that day to make [hem more readily available for pumping. He was planning to pump the following day in an attempt get his lagoon
;vel back into compliance. The Jacksons were contacted about the Britt inspection.
7/25/97
Reviewer/Inspector Name
Reviewer/Inspector Signature: �� � _ � JZ,,,,,` io;,, Date: t Z

Routine 0 Complaint 0 Follow-up of DWQ inspection
Facility Number 31 7C3
[3 Registered M Certified [3 Applied for Permit M Permitted
Follow-up of DSWC review 0 Other
.. Date of Inspection 3/17/9R
Time of Inspection 14:34 24 hr. (hh.mm)
1 ❑ Not Opera Date Last Operated:
Farm Name: > tlnbt..&t.SlAz;)[uR�.B.t itt.S.R)!'.Z ate]ou....................................................... County: D.ulthin................................................ .W..IRQ.........
Owner Name: RalnhISu.title................... Britt............................................................. Phone No: 9.19A.M.,.40.7.0 ..........................................................
Facility Contact: .................. Title: .... Phone No:
Mailing Address: P.O. Ax.188...........................................................................
Onsite Representative: Rttlph.RKhtt..
CatLypAo.B.0 .......................................................... Z832a .............
............... Integrator: Marpby-Family-Farim .....................................
Certifies! Operator:Jmums-Ralph ....................... Bx1tt.h:............................................ Operator Certification Number: .18.(0.8.............................
Location of Farm:
>raxm.l4.�n.a�kllSAtAc.(.�i.l>l,.Arz�.l�s.frtt�m.�SR.]�ii...........................:.::.:................................................................................................................ AL
Latitude 3a • 49 ► lR Longitude 7R " 04 10
® Wean to Feeder
500
1� Feeder to Finish
1000
® Farrow to Wean
4512
❑ Farrow to Feeder
Fallow to Finish
❑ Gilts
[] Boars
General
1. Are there.any buffers that need maintenance/improvement'? Yes M No
2. Is any discharge observed from any Dart of the operation? [] Yes E] No
Discharge originated at: E] Lagoon [] Spray Field 0 Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes d No
b. li'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
3. Is there evidence of past discharge from any part of the operation`? E] Yes [] No
4. Were: there any adverse impacts to the waters of the State other than from a discharge? [] Yes El No
5. Does any part of the waste management system (other than lagoons/liolding ponds) require ❑ Yes [j No
maintenance/improvement'?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design'? ❑ Yes E] No
7. Did the facility fail to have a ce►litied operator in responsible charge'? ❑ Yes © No
7/25/97

Fs cilit Number: 31-763 Date of Inspection 3117198
8. Are there lagoons or storage ponds oil site which need to be properly closed'? ❑ Yes © No
Structures (LagoonsMolding Ponds Hush Pits etc.
9. Is storage capacity (freeboard plus storm storage) less than adequate? CR Yes El No
Stricture I Structure 2 Structure 3 StrEclnre 4 Stricture 5 Structure 6
Identifier: ..1,2.................
Freeboard(ft):................................... ................................................................................................................................................................................
10. Is seepage observed fi•oin any of the structures? © Yes © No
1 l . Is erosion, or any oilier threats to the integrity of any of the stntctures observed? Cj Yes No
12. Do any of the structures need maintenance/improvement'? Cf Yes E] No
(If any of questions 9-12 Nvas answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
13. Do any cif the structures lack adequate ttuittinrum or maxinntm liquid level markers? Ca Yes Cl No
Waste. Application
14. Is there; physical.evidence of over application? [-I Yes © No
(If in eNcess of WMI', or rtou>tf entering waters of the State, notify DWQ)
15. Crop type .....
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/Inspector fail to discuss review/inspection with ou-site representative'?
22. Does record keeping need improvement?
For Certified or Permitted Facilities Onlv
23. Does the facility fall to have a copy of the Anneal Waste Management Plan readily available'?
24. Were any additional problems noted which cause noncompliance of the Certified MAW?
23. Wcre any additional problems rioted which cause noncompliance of the Permit?
•No. violations' or'&ricierticia were. noted:durilng thig -visit.: -Y�ott vile: receive -tea Tor'tber : •' .
..... .. ... ... ... ... . ..... ...........
earres.pvndeitce -a .ouf -ibis' " "t. ........
..........................................................
Cl Yes Cl No
© Yes © No
E] Yes [:] No
C Yes E] No
Cf Yes E) No
Cl Yes © No
C1 Yes Cl No
© Yes © No
❑ Yes Cl No
[:] Yes 1E] No
. Britt was observed irrigating in a light rain. Pumping was stopped whcut we arrived at the site. Although Mr. Britt's freeboard is
I out of compliance, lie has trade progress since the last visit to get his lagoon level down. During this visit, Jay Sauber with DWQ in
Ieigh took water samples from the SR 1319 ditch and from the Jackson's pond.
7/25/97
Reviewer/Inspector Name
Revie-,ver/Inspector Signature: Q"JAA"r _41 L- -, Date:

10 Routine O Com Taint O Follow-up of DWQ inspection O Follow-up of DSWC review O Other
Date of Inspection
Facility Number
Time of Inspection i �- 00 24 6r. (hh:mm)
Total Time (in fraction of hours
Farm Status: ❑ Registered ❑ Applied for Permit (ex:1.25 for I hr 15 min)) Spent on Review
® Certified ❑ Permitted or Inspection includes travel andprocessing)
❑ Not Operational Date Last Operated:..... .... ...... .... ..... _ .............._ ..... .... _ .... _... .... `._......_.......
Farm Name:. ] �.. ....� a. .... a �..,R,� 7.... � C ._...........__......._...... County: _11 �... k.vl ......._............... !� a.
Land Owner Name: ... Phone No: _ �..a.`1�...fas �.'.�"�..�
Facility Contact:. Ec ,ca.t.5.... aA yY\ s...,........ .. Title:...... _. Phone No:..�.��...
Mailing Address: Y�A.... lJ .�. p�...._... ...i�s!�..��.b}
Onsite Representative:..{�e1.� �'Z ...2 Y . z �,..._...... . _...._ Integrator:.,
Certified Operator: ., Operator Certification Num er: _.......... . .
Location of Farm:
,.1�r.....,n.a�r...t�-...S..i. :e<..----S.�.l.. �....t......sc..�.,p..rc.3G. .. ..p..:. 5.....��.I.�,.t.._.�..sa..s..E..-.a.. .................4
_ v�.�sr S ��.:i ..4 xa..._ w.4 ? ►_ ...5 ....3..i.8.............. ..... __....... ...... ........_,....-....._.............. ... .................. .-........ ......... .........................
Latitude Longitude �•''
Type of Operation and Design Capacity
41,
Design Current Design Current Design Current
Swine Ca ace , Po alat on Poultry_ E � Ca aci Po ulatio`n Cattle. .Ca aei "` aPo elation`
- 8vk
❑ Wean to Feeder �❑ La JE1 Dairy
❑ Feeder to Finish ❑Non -Layer "�'❑ Nan Da
Farrow to Wean 4dr 040
Farrow to Feeder Total Design Capacity
Farrow to Finish kf
,�� dotal SSLW �1 .�
�L
Number of Lagoons_/ Holding PondsICBSubsurface Drains Present
91 Lagoon Area Spray Field Area
s
x
�jenera1
1. Are there any buffers that need maintenance/improvement?
2. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gallmin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
3. Is there evidence of past discharge from any part of the operation?
4. Were there any adverse impacts to the waters of the State other than from a discharge?
5. Does any part of the waste management system (other than lagoons/holding ponds) require
4/30/97 maintenance/improvement?
❑ Yes [a No
❑ Yes JR No
[:]Yes ® No
❑ Yes No
❑ Yes
IR No
❑ Yes
(R No
❑ Yes
®'No
0 Yes
❑ No
Continued
on back

Facility Number: _.... 7..10.
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 (LaEoons and/or Holding Ponds)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Freeboard (ft): Structure i Structure 2 Structure 3
.....Z.....Q.........
Structure 4
❑ Yes J2 No
❑ Yes Ei No
❑ Yes ® No
❑ Yes KNo
Structure 5 Structure 6
10.
Is seepage observed from any of the structures?
❑ Yes
® No
11.
Is erosion, or any other threats to the integrity of any of the structures observed?
❑ Yes
J&No
12.
Do any of the structures need maintenance/improvement?
19Yes
9 No
(If any of questions 9-12 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
13.
Do any of the structures lack adequate minimum or maximum liquid level markers?
❑ Yes
®,No
Waste Application
14.
Is there physical evidence of over application?
❑ Yes
®.No
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15.
Crop type __ r. ka..... .._..... _........ .. u [ 1 rah i v..
16.
Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
❑ Yes
[R No
17.
Does the facility have a lack of adequate acreage for land application?
❑ Yes
5d No
18.
Does the receiving crop need improvement?
❑ Yes
JKNo
19.
Is there a lack of available waste application equipment?
❑ Yes
UNo
20.
Does facility require a follow-up visit by same agency?
❑ Yes
Q No
21.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
® No
For
C"fied_Facilities Only
'22.
Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑ Yes
® No
23.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
RNo
24.
Does record keeping need improvement?
JR Yes
❑ No
Comments (refer to ;questzoa'#I) Explain any YES answers :and/or.any recommendations or any other comments
Use draranngs of facility toiietter explain situations :;(use additional pagesas necessary):;
S. Rt:�,t1 low s of IV% .S�{� �ie1� a'-JL V�ii�� �0-� wI� a+ti Q
�. Q � � � rti n. � t (� ,t..2,�r C,,rO .
1 Z. iLc e "" e d I w o- S 4F-e E" �-X O s o v a ! 0. 0 0 .
2- . }ul w Yet S J 'e e_ 't` + e- t cL h v w► D ri✓ S V% ` N-` 9- P L tin C 0 V ^ .r C g 0
to [—� er g d K V .+^ b �e vs 0 ri s' / . q a r. 4 S . Ge -f a w� it- P 6--at p
r e 1 e r, f s t ti-P [.a f r e r - s,, -r p•�rs} T a k-Z. CIL) %r k AA-
1 4-- o ci W a. S f4 S ,,,,
M 'OL S � � t �o fl, � ids Q v. d �-d � � 0 x es a
Reviewer/Inspector Name
Reviewer/lnspector Signature: Date: l 0
cc: Division of Water Oualitu Water Ouality Section. Facilitv Assessment kJit 4/30/97

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