710012_INSPECTIONS_20171231

NOHTH CAHOLINA
Department of Environmental Qual

(Type of Visit: Q Compliance Inspection U Operation Review
Structure Evaluation Q Technical Assistance J
Reason for Visit: 0 Routine 0 Complaint 0 Follow-up 0 Emergency 0 Other 0 Denied Access 1
Date of Visit: Arrival Timer Departure Time: County: Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
OnsiteRepresentative: Gam(- '"6ag�
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator:
Certification Number: q 915U
Certification Number:
Longitude:
nit
Design Current
1Design
Current
Design
. Cu
Swine
Capacity Pop.
Wet. Poultry
Capacity
. Pop.
Cattle
Capacity
Rop.:, '
Wean to Finish
La er
Dairy Cow
Wean to Feeder
-Layer
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
DrF .P,ouitr,
Ca acit
P■o ,
Non -Dairy
Farrow to Finish
Layers
J
I Beef Stocker
Gilts
Non -Layers
UBeef
Feeder
Boars
Pullets
I
113ecf Brood Cow
Turkeys
Other
Turkey Poults
Other
rj5ther
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 ofthe State? (Ifyes, 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 2/No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑Yes
❑No
❑NA
❑NE
❑Yes ON ❑NA ❑NE
❑Yes L✓JN ❑NA ❑NE
❑ Yes No ❑ NA ❑ NE
Page 1 of 3 21412015 Continued

F'acilit .Number: f 1 - I jDate of Inspection:
,Waste=C"ollectibn & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? �yc'
o
a. if yes, is waste level into the structural freeboard? ❑ Yesfo
Identifier:
Spillway?:
Designed Freeboard (in);
Observed Freeboard (in)
❑NA ❑NE
❑NA ❑NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
L
t6
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
O Yes d-No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental hreat, 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 C No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
11. is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ElHeavy 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
E24o
[] NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
E/No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
D NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
0 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.
es
❑ No
❑ NA
D NE
aste 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
�o
❑ 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
21412015 Continued

IFacilg Number: - Date of Inspection: f
J4. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [yJ ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes I_J No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes VNo
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes 9No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? if yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes [�No ❑ NA ❑ NE
❑ Yes [2"N'o ❑ NA ❑ NE
[:]Yes V No ❑ NA ❑ NE
❑ Yes No ❑ NA
❑ Yes 9 ❑ NA
❑ Yes ❑ NA
Comments (refer,to question #): Explain any YES answers'and/or any additionatrecommendations oraany,-other comments.,_,.
Use. drawings of facility to, better explain situations fuse additional pages as necessary).
w1 U,
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
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21412015
❑ NE
❑ NE
❑ NE
Date:

(Type of Visit: l2rCompliance Inspection O Operation Review Q Structure valuation O Technical Assistance
Refe Reason for Visit: Q Routine O Complaint O Follow-up O rral Structure
0 Other 0 Denied Access
Date of Visit: Arrival Time: I Z '25 Departure Time: County: Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Onsite Representative: 11 " 4 ,'wy Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Certification Number:
Certification Number:
Longitude:
Design
C*urrent
Design
Current
Design. Current
Swine
Capacity
Pop.
Wet Poultry
Capacity
Pop.
Cattle
Capacity Pp.
Wean to Finish
La er
Dair Cow
Wean to Feeder
Non -La er
DairyCalf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design
C►urgent
D Cow
Farrow to Feeder
ltr,
Ca acit
P,o
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
irp7,p
Non -Layers
Beef Feeder
Boars
Beef Brood Cow
oults
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 E:fNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes [] No ❑ NA ❑ NE
❑ Yes ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Page 1 of 3 21412015 Continued

Facility Nhmher: - Z Date of Inspection: (�
Was* C&Iection & 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? E] Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes QNo ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes E No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes DNo ❑ 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 E:fNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
[:]Yes
�No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application
Outside of Approved
Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ No
❑ NA
©'NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ No
❑ NA
[Z(NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
❑ No
❑ NA
rE
acres determination?
for land
Yes
No
NA
17. Does the facility lack adequate acreage application?
❑
❑
❑
[]'fVE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
❑ NA
ETNE
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
❑ 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
EJNE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ No
❑ NA
��NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
❑ NA
NE
Page 2 of 3
21412015 Continued

Ifatili Number: - Date of Inspection: 2 l
• 24, Did-tht facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ❑ No ❑ NA �E
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑ No ❑ NA [2 ME
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes ❑ No ❑ NA EJ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No TA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes ENo ❑ 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 ENo ❑ 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 Er/No ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes ❑ No ❑ NA Q- l�E
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes [�No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes [7"No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? es ❑ No ❑ NA ❑ NE
C©mments (r"efe'r to}queshon=#} Ezplann any YES ariswers;andlor any additional recommendations or`any,'oth'erconiments k
44 ?� ,t a 4 ':�
Use drswings;of�facilitydto�better�;explainasituationst(use ad'ditianalpagesas,nece'ssary):.�;; , _, ;•��i,''
reLe((
4— SaY.
LC,-) "'I
FTc c u�� C `
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
w I a
(�V1 � ' �R �l o .L --�✓A C fit' Phone: I l/
p 7 71 ?3Q cf
,r-i -.�f _ V6► Date:
21412015

Type of Visit: 0 Compliance Inspection U Operation Review Q Structure E"Juation Q Technical Assistance I
Reason for Visit: 0 Routine 0 Complaint 0 Follow-up 0 Referral;UEmergency 0 Other 0 Denied Access II
Date of Visit: Arrival Time: Departure Time: County: Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: O) Title:
Onsite Representative: / 1.9i o f{ r ��It j° �6e �'�
Integrator:
Phone:
Certified Operator: Certification Number:
Sack -up Operator: Certification [Number:
Location of Farm: Latitude: Longitude:
Design C+urrent Design Current Design
Swine Capacity Pop. Wet Poultry Capacity Pop. Cattle Capacity
Wean to Finish I JLayer Dairy_Cow
CRurrent
Pop.
Wean to Feeder I iNon-Layer I
Dairy Calf
Feeder to Finish Dairy Heifer
Farrow to Wean Design Current Dry Cow
Farrow to Feeder It Ca aeit Pao , Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Qther
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 [ No ❑ NA ❑ NE
❑ Yes [:]No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes Ef; ❑ NA D NE
❑ Yes No ❑ NA ❑ NE
Page 1 of 3 21412015 Continued

pci t Nu fiber: - Date of Inspection:
Weste'Ctillection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? Y s ❑ 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): -'
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 FrNo ❑ 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 Z/j N
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes [:]No ❑ NA g 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 ONE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ❑ No ❑ NA Ej"NE
maintenance or improvement? �/
1 l . Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [] No ❑ NA I/1 NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.) i"-
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ No
❑ NA
N
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ No
❑ NA
NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
❑ No
❑ NA
ANE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA
N
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
❑ NA
NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
❑ No
❑ NA
"
KN
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
❑ No
❑ NA
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 ❑ No ❑ NA E
23. If selected, did the facility tail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No ❑ NA NE
Page 2 of 3 21412015 Continued

ticiU N.uFiber: 7 - Date of Inspection: 41
24: Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ❑ No ❑ NA E] 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?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes ❑ No ❑ NA Zj'NE
[:]Yes ❑ No TJINA ❑ NE
❑ Yes r No ❑ NA ❑ NE
❑ Yes j:f'No
❑ Yes /❑ No
❑ Yes ❑ No
❑ NA ❑ NE
❑NA ❑NE
❑ NA ,E NEE
❑ Yes 0 No ❑ NA
❑ Yes .LJ N ❑ NA
❑ Yes P] No ❑ NA
❑ NE
❑ NE
❑ NE
Reviewer/Inspector Signature: Date: s l
OF
Page 3 of 3 21412015

(Type of Visit:0 Co"liance Inspection Q Operation Review/ O Structure Evaluation O Technical Assistance j
Reason for Visit: &Routine 0 Complaint 0 Follow-up Referral 0 Emergency 0 Other 0 Denied Access I
Date of Visit: Arrival Timer Departure Time: County: ftiU Region:
Farm Name:
Owner Name:
Mailing Address:
Owner Email:
Phone:
Physical Address:
Facility Contact: Title: l % Phone:
Onsite Representative: R 6 943J_(_ ' +/E ` Integrator:
Certification Number: 'T 3
C2 9
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design Current Design Current
Swine Capacity Pop- Wet Poultry Capacity R.
Wean to Finish I I Layer
Cattle
Dairy Cow
Design C*arrant
Capacity Pop.
Wean to Feeder
I INon-Layer I
Dairy Calf '
Feeder to Finish
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
MWe7sign Current
Dr, P,ou1, C►_a aci Po ,
ILaycrs
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
NJ Other
Turkeys
Turkey Puults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify 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 ffNo ❑ NA ❑ NE
❑ Yes
[:]No
[:)NA
[:]NE
[:]Yes
❑ No
❑ NA
❑ NE
❑ Yes ❑ ❑ NA ❑ NE
[:]Yes ❑ NA ❑ NE
❑ Yes L No ❑ NA ❑ NE
Page I of 3 21412014 Continued

I.Faci!h Numijer: Ds ection: !O 1A,6 It S
Waste Collection & Treatment
�4: Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
ISttruuctuurre�I Structure 2
Structure 3 Structure 4 Structure 5
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?
M/No DNA ❑ NE
❑No ❑NA ❑NE
Structure 6
❑ Yes No ❑ NA ❑ NE
❑ Yes WNo ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environment threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ YesVNo
❑ 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 No ❑ NA ❑ NE
maintenance or improvement?
Waste ApBlication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes dNo ❑ 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
Lff No ❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑Yes
E-N/( ❑ 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
19. Is there a lack of properly operating waste application equipment?
❑ Yes
, N ❑ NA
❑ NE
Reauired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
o ❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No ❑ NA
[] NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑2Y'es
21. Does record keeping need improvement? If yes, check the appropriate box below. D No ❑VA ❑ NE
ste Application ❑ Weekly Freeboar ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers eather Code
Rainfall ❑Stocking ❑Crop Yield 120 Minute Inspections El Monthly and 1" Rainfall Inspections ❑ Sludge Survey
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? El Yes ZNo ❑ NA ❑ NE
Page 2 of 3 21412014 Continued

still Number: - Date of Inspection: 1012-61 t
24, Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑
25 ' Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes 0 No ❑ NA �NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26, Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes if]o ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes YNo
❑ 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 ❑ 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 d 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?
❑ Yes No
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes No
❑ NA ❑ NE
Comments (refer to question #):.Explain any YES.answers and/or any.additional',recommendations or.; any,other comments,..
Use drawings of facility to'better,explain situations (use additional pages;,as necessary). :, n
orb
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
lD/2o/IS
Phone f`� a
Date: O so
11412015
- 773 $
PaN

Type of Visit: (D Compliance Inspection O Operation Review C) Structure Evaluation Q Technical Assistance
Reason for Visit: 0 Routine 0 Complaint 0 Follow-up O Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: 7 Arrival Time:® Departure Time: _ County: %EnjDflK— Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator;
Sack -up Operator:
Location of Farm:
Latitude:
Owner Email;
Phone:
Phone:
Integrator:
Certification Number;
Certification Number:
Longitude:
Design
Current
Design
Current
Design
Current
Swine
Capacity
Pop.
Wet Poultty
Capacity
Pop.
Cattie
Capacity
Pop.
Wean to Finish
ILayer
I I
Cow
Wean to Feeder
Non -La er
I I
Calf
Feeder to Finish
Dai Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
Di, Pmoult .
Ca aci
P,o
Non -Dairy
Farrow to Finish
ILayers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
I Pullets
I Beef Brood Cow
Turkeys
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 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?
❑ Ycs No ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes [:]No
❑ NA ❑ NE
❑ NA ❑ NE
Yes []No ❑ NA ❑ NE
❑ YesVNo
o ❑ NA ❑ NE
❑ Yes ❑ NA [] NE
Page I of 3 21412011 Continued

Facility Number:. - Date of Inspection: I
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 [2"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 O/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 environmenta threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
S. Do any of the structures lack adequate markers as required by the permit? ❑ Yes �No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require [] Yes E�No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes EfNo ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [:]Yes 0o ❑ 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? ❑ Y 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 [/] No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application? ❑ Yes EI'No
18. Is there a lack of properly operating waste application equipment? ❑ Yes Ld `vo
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes [-]No
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [:]No
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking [] Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes ❑ No
❑ Yes [—]No
❑NA ❑NE
❑NA ❑NE
❑ NA [(NE
❑ NA ONE
❑ NA Qk
❑ Weather Code
❑ Sludge Surve
❑ NA
❑ NA YNE
Page 2 of 3 21412011 Continued

Facility 1sNumlier: - Date of Ins ection: 1 I
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ❑ No ❑ NA [� E
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑ No ❑ NA [NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey []Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑Yes ❑ No ❑ NAVNE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No ❑ NA
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 2/No
❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes [J/No
❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes [!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 2�10
❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes No
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
[2"Yes ❑ No
[] NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
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ReviewerAnspector Name: �_W N TA 6Z1.X�l�
Reviewer/Inspector Signature:
Page 3 of 3
Phone:(g10 6 3g�
DateILI
Y�2Z2011

0.
Type of Visit: 0 Compliance Inspection Q 7Follow-up
ation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: 0 Routine 0 Complaint 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: County: N#J0GCL Region:
Farm Name
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Owner Email:
Phone:
Integrator:
Phone:
Certified Operator: Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Swine
Wean to Finish
Design Current
Capacity Pop.
Wet Poultry
Layer
Design
Capacity
Current
Pop,
Design Current
Cattle Capacity Pop.
DairyCow
Wean to Feeder
L
DairyCalf
Feeder to Finish
Farrow to Wean
(4U0
DrF P,ouIti.
Layers
Design
Capa ci
Current
Po ,
DairyHeifer
D Cow
Farrow to Feeder
Farrow to Finish
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turke s
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Yes
❑ No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
[�fNo
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
VJ 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
dNo
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
6/No
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

FacilitNun=r: - j Z Date of —inspection: I
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):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
ff No
❑ NA
0 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
EffNo
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
dNo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
[]Yes
CyNo
❑ 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
eNo
❑ NA
❑ NE
maintenance or improvement?
ere evidence of incorrect land application? if yes, check the appropriate box below.
11�Kxcessivc
(2/Yes
[:]No
❑ NA
❑ NE
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? 0 Yes [] No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes []"No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes [3/No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[Z/No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[Er/No
❑ NA
❑ NE
Required Records & Documents
19. Did facility fail have Coverage & Permit
the to the Certificate of readily available?
❑ Yes
❑ No
❑ NA
E
r?NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
❑ No
❑ NA
the appropriate box.
❑WUP El 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 �20 Minute Inspections ❑ Monthly and 1 ° Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ No
❑ NA
O�4E
23. If selected, did the facility fail to install and maintain rainbrcakers on irrigation equipment?
❑ Yes
❑ No
❑ NA
NE
Page 2 of 3
21412011 Continued

Facili ' 1VUmber: - Date of Inspection: (o L
dNE
24s'Did'thy' facility fail to calibrate waste application equipment as required by the permit?
[]Yes
❑ No ❑ NA
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
❑ No ❑ NA
[31NE
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
[Zr—NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
[]Yes
❑ No ❑ NA
C3�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 [Z*No ❑ NA ❑ NE
ZrYes [—]No ❑ NA ❑ NE
dyes ❑ No ❑ NA 2 NE
❑ Yes Q No
�es ❑ No
Yes ❑ No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
1.) C1Cu0 �5M-TC34 (tu01,1r6&- &E:I4zNV NoG 4%0.5rr,.S OQSGfWC-D Ta KAU6 eoSSsi3LG WA516
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LATEK. 317/1Ll M6ci�CY LA"'0 0tj0LR �0V(LU ;TEST�I�C 1j�'� G�r� .
Reviewerhnspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
%}all A Vp"w_ &6z.Ec'6014 )014ti Cat_Le"c Phone: ri 33$
C
. D5VC- Date: 3 13
21412011

Type of Visit: 0 Compliance Inspection U Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 0 Routine 0 Complaint Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit:
Farm Name:
Arrival Time., I /r_1 � Departure Time: L County: Region:
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: "� �iiGl�t(soM�ft�
Certified Operator:
Phone:
Integrator: �QI
Certification Number: 3
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Design Current
Wet Poultry Capacity Pop.
La er
Design C►urrent
C►attle Capacity Pop.
DairyCow
Wean to Feeder
[Non -Layer
DairyCalf
Weeder to Finish 2da
Design Current
Dr, P■nultr, t!a uci. P,o ,
DairyHeifer
Farrow to Wean
Farrow to Feeder
D Cow
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Srood Cow
Other
Other
Turke s
TurkeyPoints
Other
E
I
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
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
r�N
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yeso
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

Facility Number: -_j Date of Inspection:
'Waste C-Weetion & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [iNo ❑ 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: 1.
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed`? ❑ Yes o 0 NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes No ❑ NA ❑ NE
waste management or closure plan?
If any or questions 4-6 were answered yes, and the situation poses an immediate public health or environ m
enI threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ❑ NA [3NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes o [3NA ❑ 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 jNo ❑ 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?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ WUP ❑Checklists [] Design [:]Maps [] Lease Agreements
❑ Yes
[Y. o
[3NA
❑ NE
❑ Yes
o
❑ NA
❑ NE
❑ Yes
VNo
❑ NA
❑ NE
❑ Yes
o
❑ NA
❑ NE
❑ Yes
UNo
[] NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ 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 [%� o ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE
Page 2 of 3 214.12011 Continued

F$cili ` Dumber: - Date of Ins eetion:
24_Did tip: 'facility fail to calibrate waste application equipment as required by the permi ? es No ❑ NA �7NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check Yes ❑ No NA
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
261 o ❑ 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
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
❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
No ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
VN�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
❑ NA ❑ NE
io
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
No ❑ NA ❑ NE
(Comments (refer to question ft Explain any YES answers and/or any additional recommendations or',any other comments- I
Use drawings of facility to better explain situations (use add itional,pages 'as necessary), .
29, ',,M4 - A5 11 - 6
Reviewer/Inspector Name:
6 / 1�Gam/
Phone:
Reviewer/Inspector Signature:
Page 3 of 3
Date:

Type of Visit OCompliance Inspection
Reason for Visit 0 Routine 0 Complaint
Date of Visit
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Arrival Time:
0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Departure Time: Z �a /)'� County: f Region:
J Owner Email:
Facility Contact: Title:
Onsite Representative: /6/+40�y1 &"2ZLe=�
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Boars
Phone:
Phone N
�Q
Integrator: / nislt4 - ✓'
Operator Certification Number:
Back-up Certification Number:
Do =4 =1 g =a ❑d =
Latitude: Longitude:
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
}❑ La er
I `
❑Non -La et
Other
❑ Other_.__ —.--_--_--
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
Number of Structures:EZJ
Discharges & Stream Impncts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
h. 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 aldischarge?
i
❑ Yes vNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
9Yes
❑ No
❑ NA
❑ NE
ZYes
❑ No
❑ NA
❑ NE
12128104 Continued

Facility Number: — Z Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes �No
❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes ❑ No
❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes �No
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes No
❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as requirrcd 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 gNE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes ❑ No
❑ NA [ lNE
[I Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
/
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drifl ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ No
❑ NA NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ No
❑ NA
to
KNE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determinations❑
Yes
❑ No
❑ NA
PNE
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA
NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
❑ NA
ONE
4gwz-11,6, / -,j ') /00
Ao e
Reviewer/Inspector Name Phone:
Reviewer/Inspector Signature: Date: 2 6
12128104 Continued

Facility Number: Date of Inspection I f1
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ❑ No ❑ NA NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ❑ No ❑ NA jpl�NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design El Maps [I Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA �NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 " Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ No
❑ NAzo NI?
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
❑ NA
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
❑ NA
'ONE
;2rNE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No
❑ NA
ZN E
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
❑ No
❑ NA
ANE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ NA
�NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
❑ No
❑ NA
;ZNE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
❑ No
❑ NA
{21NE
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
Ifyes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ YesZA'No
[I 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/zNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
JNo
❑ NA
❑ NE
Additional Comments and/or Drawings:
�2�Cri
N
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Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency A Other ❑ Denied Access
Date of Visit: I y/
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Arrival Time: 1,3 'O!i Departure Time: 1 5; 4/ County:
Facility Contact: Title:
Onsite Representative: �� E G
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
U Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
ti
•"Owner Email:
Phone:
hone Na:
Integrator-,
r
Operator Certification Number:
Back-up Certification Number:
Region: WW
Latitude: 0 0 = 1 = « Longitude: = ° =' = 11
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
i
❑ La er
I JE1 Non --Layer
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field 90ther
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifei
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
0 Yes ❑ No ❑ NA ❑ NE
❑ Yes XNo
❑ NA ❑ NE
❑ Yes , No
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes R(No
❑ NA ❑ NE
Yesto
G
❑ NA ❑ NE
12128104
Continued

Facility Number: — f Z Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): `L
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes XNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes ❑ No ❑ NA ONE
❑ Yes ❑ No ❑ NA XNE
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 )ZfNE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ❑ No ❑ NA ezNE
(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 El No El NA ;?NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
maintenance/improvement?
❑ Yes ❑ No ❑ NA gNE
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA X 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)
t4. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ No
❑ NA NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ No
❑ NA XE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination:
❑ Yes
❑ No
El NA XNE
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA 9NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
❑ NAXNE
A ,'Zt/�D �< 14 ,�t/ 60/;¢/ IZC-f �ieDn�o
�J C
is�/1'�l ¢ rCtiZ�✓���� D� �!�[•�$�/ C�zAJ�£ /7Z �uS,E A�
S C dAW-e' �l iv F 7 �,z� j �z'r ,c! �/�'%Sr•—` f
Reviewer/inspector Name
Reviewer/Inspector Signature:
_O �:N, f, a 9. - , -
Phone: A9
Date: Z
6 —
12128104
Continued

Facility Number: Date of Inspection
Requirea Records & Documents
19, Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ❑ No ❑ NA NE
20. Does the facility fail to have ail components of the CAWMP readily available? If yes, check ❑ Yes ❑ No ❑ N V NE
the appropiiate box. ElWUP El Checklists ❑ Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA WrNE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stacking ❑ Crop Yield ❑ 120 Minute inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ No
❑ NA
NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
❑ NA
1VJ
kE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
❑ NA
PfNE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No
❑ NA
9NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
❑ No
❑ NA
ON8
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ NA
XN E
Other Issues
t`.RC
28,
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
#'es
❑ No
❑ NA
;KNE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
' ❑ No
❑ NA
XNE
and report the mortality rates that were higher than nonnal?
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
, ,(
lLJ No
❑ NA
❑ NE
32.
General Permit? (ie/ discharge, freeboard problems, over application)
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative'?
❑ Yes
/
No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
VYes
❑ No
❑ NA
❑ NE
Additional Comments and/or Drawings:'
D.5/yl��,
�Qe
�/rl,�` �G,O // lD`7DGL. t�7G �`O �l�-,�!✓ y���i��v �'�cJ ,��fi
12128104

Type of Visit (ViC pliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: Arrival Time: Q 3O Departure Time: County: ?i'tL- Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: {�EwA�►JE ��r:~Ei,t, .
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: = c = 6 = Longitude: = ° = ,
Design Current Design Current
Capacity Population Wet Poultry Opacity Population
❑ Layer
❑ Non -La et
❑
Wean to Finish
❑
Wean to Feeder
91
Feeder to Finish
❑
Farrow to Wean
❑
Farrow to Feeder
❑
Farrow to Finish
❑
Gilts
❑
Boars
Other
❑ Other
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Design Current
Cattle Capacity Population
❑
Dairy Cow
❑
Dairy Calf
❑
Dairy Heifej
❑
Dry Cow
❑
Non -Dairy
❑
Beef Stocket
❑
Beef Feeder
❑
Beef Brood Cow
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes ENo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes E(No ❑ NA ❑ NE
❑ Yes ZfNo ❑ NA ❑ NE
12128104 Continued

Facility Number: 7 (— Date of Inspection 1145I&LOY
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: tA64Vhl
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): Q
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
YNo
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑Yes
dNo
❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes
ffNo
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
E�No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑yes
,�/
LJ No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need El Yes
,
El No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application'? If yes, check the appropriate box below. ❑ Yes
6No
❑ 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 ElApplication Outside of Area
12. Crop type(s) W3
13. Soil type(s) /
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes 2 NNo ElNA ElNE
15. Does the receiving crop and/or land application site need improvement? El9 Yes o ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination` ❑ Yes El No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ NA
El NE
18. Is there a lack of properly operating waste application equipment?
El Yes
�Zo
❑ NA
❑ NE
VIA
O&W
Reviewer/Inspector Name ' ;' FA 11� Phone: �J 7 G - 7
Reviewer/Inspector Signature: Date:
12128104 Continued

Facility Number: Date of Inspection i6 �
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? 1f yes, check
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps [I Other
❑ Yes ILI No ❑ NA ❑ NE
❑ Yes �No [DNA ❑ 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 V
Rain Inspections ❑ Weather
Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
0
[INA
❑ NE
23,
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
L o
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
D No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ YesEJ'No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
D oo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
E o
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
Z No ❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
ONo ❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
El Yes
�
ZJ 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
El-<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
RN q ❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
No ❑ NA
❑ NE
Additional Comments and/or Drawings:
s r
12128104

Type of Visit $6 Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit P Routine O Complaint O Follow up O Emergency Notification O Other p Denied Access
Facility Number Date of Visit: // Tune:
� Not O erational � Below Threshold
C/Perntitted 93 Ce ' ed 0 Conditionally Certified © Registered Date -Last Operated or Above Threshold:
Farm Name: .. _ . 1L o1��...... ..... ..................... County:
Owner Name: ....... sf~.�. P� .f.� ...rB�, .ff ... W W... _ ....... Phone No: ......»................ .......... ..»... ............ ......
_............._...._._.
MailingAddress:.._..._.............._......_._../.»....................__._._............. _........ ..
Facility Contact:
Onsite Representative:
Certified Operator:._,,,.,,,,,.».,,,„„,.—_._......._..._..
Location of Farm:
Title:
Phone No: _
Integrator:
Operator Certification Number:.w...,.._
Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 1 66 Longitude �• �� �«
< D )es gn ^ viCiilTCnt r F x kii r r DCQgno CUrle�t D gn �Ci1 iNt
Swute Ca ;Po �trnn APonitry,` wow. city iilattonr:.., Cattle ` Ca aat Po tiion
Wean to Feeder ❑Layer ❑Dairy
Feeder to Finish p0 ❑Non -Layer ; ❑Non -Dairy
❑ Farrow to Wean
Farrow to Feeder ❑Other
Farrow to Finish
[ TOIL. aCl
�•h .. a .. {�yv,
Gilts
• .. .._. _.�. ... Design... P
�.
Boars �.OtBI`SSLM 3`
Numlter of Lagoons::
.' Held�ii¢IRoeds "/-So1rd :Tra
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
❑ Yes J'No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes P No
❑ Yes ;'No
❑ Yes ['No
Structure 5
Identifier. -
Freeboard (inches): 25
12112103 Continued

Fatality' Number: Date of inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑ Yes Q( No
closure plan? /
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenancelimprovement? ❑ Yes [XNo
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes 9No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes �No
elevation markings?
Waste Aonlication
10. Are there any buffers that need maintenance/improvement? ❑ Yes No
11. Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes No
❑ Excessive Poonn�ding ❑ PAN ❑ Hydraulic Ovve�rt%ad ❑ Frozen Ground ❑ Copper and/or Zinc /
12. Crop type eVX AI fJ Z:
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes Jallo
14. a) Does the facility lack adequate acreage for land application? ❑ Yes 10 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 ONo
16. Is there a lack of adequate waste application equipment? ❑ Yes JdNo
Odor issues
17. 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?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes Y No
19. 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)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional ❑ Yes J�No
Air Quality representative immediately. /
se +�rsw�ngs'ot facility,tofibetterexpField Copy ❑ Final Notes"
'�»�t_`�"•�.,5�`i�`.?�°:"."'`�it�ii�.'.;u�"�.:,°�s..::��:«h Z'1�
Af Afar /*as..e /V4<Og
g '246r/o W Z 711f 15CORJORJ05Af .
ft9X Zoo V- W,E"7, �g pu r �/✓� NS
l w-2" (?//,4�
r/4� ea6e,
Reviewer/Inspector Name � ,
ReviewerlInspector Signature:
Date:
12112103 Continued

' Faulty Number: _ —1z Date of Inspection
Re uired Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes ❑ No
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 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 No
00
25. Did the facility fail to have a actively certified operator in charge?
❑ Yes ZNo
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes No
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes XNo
28. Does facility require a follow-up visit by same agency?
❑ Yes ;2(No
29. Were any additional problems noted wFJch cause noncompliance of the Certified AWMP?
❑ Yes /ClINo
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Pernlit? (If no, skip questions 31-35)
Yes ❑ No
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes 9No
32. Did the facility fail to install and maintain a rain gauge?
❑ Yes �(No
33. Did the facility fail to conduct an annual sludge survey?
❑ Yes �eNo
34. Did the facility fail to calibrate waste application equipment?
❑ Yes ❑ No
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below.
❑ Yes No
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After 1" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
12112103

ANDIAL'FACILITY ANNUAL CERTIFICATION FORM
Certificate of Coverage or Permit Number -,---VI p 12" County /j e1/ Year 200
Facility Name (as shown on Certificate of Coverage or Permit)
Operator in Charge for this Facility. /', VGA Certification #Q
Land piication of animal waste as allowed by the above permit occurred during the past calendar year
YES NO. If NO, skip Part I and Part II and proceed to the certification. Also, if animal waste
was generated but not land applied, please attach an explanation on how the animal waste was handled.
Part I : Facility Information:
1. Total number of application Fields ❑ or Pulls lease check the appropriate box) in the Certified Animal
Waste Management Plan (CAWMP). Total Useable Acres approved in the CAWNIP
ysS
2. Total number of Fields ❑ or Pulls lease check the appropriate box) on which land application
occurred during the year: Total Acres on which waste was applied S�a�
3. Total pounds of Plat Available Nitrogen (PAN) applied during the year for all applicat'
4. Total pounds of P t Availab e Nitrogen (PAN) allowed to be land applied annually by the CA and
the permit: - i. 5 ;L - Is
5. Estimated amount of total irlanure, litter and process wastewater sold or given to other persons and taken
�1 off site during the year /Y tons ❑ or gallons ❑ (please check the appropriate box)
6. Annual average number of animals by type at this facility during the previous year:
7. Largest and smallest number of animals by type at this facility at any one time during the previous year:
Largest
5450 . ..*W
Smallest 1300
(These numbers are for informational purposes only since the only permit limit on the number of animals
at the facility is the annual average n
8. Facility's Integrator if applicable:
Part II: Facility Status:
IF THE ANSWER TO ANY STATEMENT BELOW IS "NO", PLEASE PROVIDE A WRITTEN
DESCRIPTION AS TO WHY THE FACILITY WAS NOT COMPLIANT, THE DATES OF ANY NON.
COMPLIANCE, AND EXPLAIN CORRECTIVE ACTION TAKEN OR PROPOSED TO BE TAKEN TO
BRING THIS FACILITY BACK INTO COMPLIANCE.
1. Onlyanimal waste generated at this facility was applied to the permitted sites during es ❑ No
g t3' pp P g
the past calendar year.
AFACF 3-14-03

i��e's !b No
6 _-(es 0 No
B-YI-le's 11 Nb
2. The facility was operated in such a waythat there was no direct runoff of waste from
the, facility(in'6udinig the'libuses, lag . oons/storage ... ponds and the application sites) during
the past calendar year.
3. _There was no -waste to surfa6_6 water" fr6m 'ihis facility during the past
calendar year.
4. There was no freeboard violation in any lagoons or storage ponds at this facility during
the past rn1pTirinr year.
5. There was no PAN application'to any fields oir'crops at this facility greater. than the --._B­fes
0 No
levels specified in this facility's CAVRVIP during the past calendar year..
6. All land application equipment. was calibrated at least once during the past calendar year.
0 Yes 11 No-j�A
7. Sludge accumulation in all lagoons did not exceed the volume for which the lagoon
El Yes 0 No—P'ft-
was designed or reduce the lagoon's minimum treatment volume to less than the volume
for which the lagoon was designed.
8. A copy of the Annual Sludge Survey Form for this facility.is attached to this Certification.
O.-Yes 0 No-04
9. Annual soils analysis were performed on, each field receiving animal waste during the
es C1 No -
past calendar 'ear
. . ,
10. Soil pH was maintained.
as specified. in the permit during the past calendar Year?
Zr-Yes 11 No
I'l. All required monitoring and reporting was performed in accordance with the facility's
3--es 11 No
permit during the past calendar year.
12. All operations and'm'ainienancerequirements in the permit were complied with during
�es 11 No
the past calendar year or, in the case of a deviation, prior authorization was received
from the Division of Water Quality.
13. . Crops as specified in the . CAVrNV were maintained during the past calendar year on all
2' es [],No
sites receiving animal waste and the crops grown were removed in accordance with
the facility's permit'
14. All buffer requirements as specified on the permit and the CAWW fbi-thisTacility were.'' Yes El No
maintained during each application of animal waste during the past calendar year.,
I certify under penalty of law that this document and all attachments were prepared under-iny dir6ci ion or
supervision in accordance with a system designed to assure that qualified personnel properly gather and
evaluate the information submitted. Based on my inquiry of the person or persons who manage the system, or
those persons directly responsible for gathering the information, the information submitted is, to the best of
my knowledge and belief, true, accurate, and complete. I am aware that there are significant penalties for
submitting false information, including the possibility of fines and imprisonment for knowing violations."
or print
Signature of Permi'tfee
Signature of Operator in (Marge
(if different from Pennittee)
.,Date.
Date
AFACF 3-14-03 2.

Notification of Change of..Ownership
Animal 'Waste I'vianagement'Faeility
(Please type or print all information that does not require a signature)
In accordance with the requirements of 15A NCAC 2H .0217(a)(1)(H)(xii) this form is official
notification to the Division of Water Quality (DWQ) of the transfer of ownership of an Animal Waste
Management Facility. This form must be submitted to DEM no later than 60 days following the transfer
of ownership.
General Tnfor'mation:
Name of F
Previous Owner(s) Name:
New 0wner(s) _N1ame:_L!j
Mailing Address: 3!�
acility
hone No:1) -2 -4,'0$Y
hone No:
Farrn Location: Fourteen Digit Hydrologic Unit:
Latitude and Longitude: County:
Please attach a copy of a county road �p with location identified and describe below (E3e specific: road
names, directions, milepost, etc.): -raw Ila V-t� fCL
ri ll P ry Y 3 m ill'_ S' 104 eT`:�_ 41 J_CL U o 'zk . •
Operation Descrintion:
Type of Swine NO. ofAnimals Type of Poulin-
M Wean to Feder Layer
ceder to Finish o�OU_ J Pullets
::1 Farrow to Wean
'D Farrow to Feeder
7) Farrow to Finish
NO. ofAninnals
Other Ttipe of Lives
Type of Cattle
`r Dairy
:D Ee-�f
No. of Animals
Number of Animals:
Acreage Available for Application: - Required Acreage: ✓�
Number of Lagoons / Storage Ponds : Total Capacity: iS y ��U Cubic Feet (ft3)
M Yt�xi�ie Y[fkai ie r.it;�it �!rxre�i•�!c �;e�:!e re�fir'e kc x, X>;e fje;i is se ie ae �caF ac i �t �t ie ie aYx:t �;e Y��i iz •h ai ;i ie i,��;ese is i,rM;eKia:<tc�x:F?�:<xe!e ie;i k�ie ai age ie rye Kie
Owner / Manager Agreement
I (we) verify that -all the above information is correct and will be updated upon changing. I (we) understand the operation and
maintenance procedures established in the approved animal waste management plan for the farm named above and will
implement these procedures. I (we) know that any. expansion to the existing design capacity of the waste treatment and
storage system or construction of new facilities will require a new certification to submitted to the Division of Water
Qualiiy'(DWQ) before the ne%v animals are stocked. I (we) understand that there must be no discharge of animal waste from
the srocage or application system to surface waters of the state either directly through a man-made conveyance or from a storm
event less severe than the 26-year, 24-hour storm and there must not be run-off from the application of animal waste. I (eve)
understand that run-off of pollutants from lounging and heavy use areas must be minimized using technical standards
developed by the iVaturai Resources Conservation Service. The approved plan will be tiled at the farm and at the office of the
local Soil and Water Conservation District. I (we) Mow that any modification must be approved by a technical specialist and
submitted to the Soil and Water Conservation District prior to implementation. A change in land ownership requires written
notification to DWQ or a new certification (if the approved plan is changed) within 60 days of a title transfer.
Name of New rid Owner 4oi,/ e
Signature: Date.
Name of;Diana'ger(if different from owner):
Signature:
Date:
Please sign and return this form to: N. C. Division Of `,Voter Qualihy
NVater Quality Section. Compliance Group
Raleigh, NC 37f26-050 S
.NCO -- `,lay l 1996

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Faduty M Number: - 7-- - Caunty:
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Zip
C.ertifcate 7 5 Sock Securtty # —
Work Phone ->S& �ok�-Eume one
S9$nature l Date_
BACKUP OPERATOR (Optional:
Home Mailing Address Awi k-
City �c i State Zip
Culiffciste# J-715 W _ Social sty # _,
Work Phone _?5 d, - -d'G - ?Ok;. ----Home a a S�
�f,+�f**�r►��� Wr�r��,��ri�f#f*�r*�,�,a#***rr*��.��'����r**�r�r*�*ti
..AVVVVT)�� L 1:. 7/iIiLL.i 1i.fVrr�l
Mailing Address Sfirn.l- 4 x cc , :14�1 City
StateZip Telephoun# cx,s
Signature Data_ -�
Please Mail to: WPCSOCC
DM91on of Water QuaUty
1618 Mail Service Center
Raleigh, N.C. 27699-1618

Michael F. Easley, Governor
William G. Ross Jr., Secretary
North Carolina Department of Environment and Natural Resources
Alan W. Klimek, P.E. Director
Division of Water Quality
November 24, 2004
Odom and Dwayne Futrell
Crooked Run Farm
3408 Old Pink Hill Road
Deep Run NC 28525
Subject: Certificate of Coverage No. NCA271012
Crooked Run Farm
Swine Waste Collection, Treatment,
Storage and Application System
Pender County
Dear Odom and Dwayne Futrell:
In accordance with your Notification of Change of Ownership received on November 5, 2004, we are
hereby forwarding to you this Certificate of Coverage (COC) issued to Odom and Dwayne Futrell,
authorizing the operation of the subject animal waste collection, treatment, storage and land application
system in accordance with NPDES General Permit NCA200000.
This approval shall consist of the operation of this system including, but not limited to, the management
of animal waste from the Crooked Run Farm, located in Pender County, with an animal capacity of no
greater than an annual average of 4200 Feeder to Finish swine and the application to land as specified in
the facility's Certified Animal Waste Management Plan (CAWMP). If this is a Farrow to Wean or
Farrow to Feeder operation, there may also be one boar for each 15 sows. Where boars are unneccessary,
they may be replaced by an cquivalent number of sows. Any of the sows may be replaced by gilts at a
rate of 4 gilts for every 3 sows
The COC shall be effective from the date of issuance until July 1, 2007, and shall hereby void Certificate
of Coverage Number NCA271012 dated May 1, 2003, and shall be subject to the conditions and
limitations as specified therein. Pursuant to this COC, you are authorized and required to operate the
system in conformity with the conditions and limitations as specified in the General Permit, the facility's
CAWMP, and this COC. An adequate system for collecting and maintaining the required monitoring data
and operational information must be established for this facility. Any increase in waste production
greater than the certified design capacity or increase in number of animals authorized by this COC (as
provided above) will require a modification to the CAWMP and this COC and must be completed prior to
actual increase in either wastewater flow or number of animals.
Please carefully read this COC and the enclosed General Permit. Since this is a new joint State and
Federal general permit it contains many new requirements in addition to most of the conditions contained
in the current State general permit. Enclosed for your convenience is a package containing the new and
revised forms used for record keeping and reporting. Please pay careful attention to the record keeping
and monitoring conditions in this permit. The Devices to Automatically Stop Irrigation Events Form
must be returned to the Division of Water Quality no later than 120 days following receipt of the
Certificate of Coverage.. The Animal Facility Annual Certification Form must be completed and returned
to the Division of Water Quality by no later than March 1st of each year.
Aquifer Protection Secti6n 1636 Mail Service Center Raleigh, NC 27699-1636
Internet: http;//h2o.enr,state,nc.us 2728 Capital Boulevard Raleigh, NC 27604
Phone [phone]
Fax [phone]
Fax [phone]
Customer Service
1-877-623-6748
N ihCarolina
�ntrrra!!�
An Equal OpportunitylAffirmative Action Employer — 50% Recycledl10% Post Consumer Paper

If your Waste Utilization Plan has been developed based on site specific information, careful evaluation
of future samples is necessary. Should your records show that the current Waste Utilization Plan is
inaccurate you will need to have a new Waste Utilization Plan developed.
The issuance of this COC does not excuse the Permittee from the obligation to comply with all applicable
laws, rules, standards, and ordinances (local, state, and federal), nor does issuance of a COC to operate
under this permit convey any property rights in either real or personal property.
Upon abandonment or depopulation for a period of four years or more, the Permittee must submit
documentation to the Division demonstrating that all current NRCS standards are met prior to restocking
of the facility.
Per 15A NCAC 2H .0225(c) a compliance boundary is provided for the facility and no new water supply
wells shall be constructed within the compliance boundary. Per NRCS standards a 100 foot separation
shall be maintained between water supply wells and any lagoon or any wetted area of a spray field.
Please be advised that any violation of the terms and conditions specified in this COC, the General Permit
or the CAWMP may result in the revocation of this COC, or penalties in accordance with NCGS 143-
215.6A through 143-215.6C, the Clean Water Act and 40 CFR 122.41 including civil penalties, criminal
penalties, and injunctive relief.
If you wish to continue the activity permitted under the General Permit after the expiration date of the
General Permit, an application for renewal must be filed at least 180 days prior to expiration.
This COC is not automatically transferable. A name/ownership change application must be submitted to
the Division prior to a name change or change in ownership.
If any parts, requirements, or limitations contained in this COC are unacceptable, you have the right to
apply for an individual NPDES Permit by contacting the staff member listed below for information on
this process. Unless such a request is made within 30 days, this COC shall be final and binding.
This facility is located in a county covered by our Wilmington Regional Office. The Regional Office
Aquifer Protection Staff may be reached at [phone]. If you need additional information
concerning this COC or the General Permit, please contact J R Joshi at [phone].
Sincerely,
v '
for Alan W. Klimek, P.E.
Enclosures (General Permit NCA200000, Record Keeping and Reporting Package)
cc: (Certificate of Coverage only for all ec's)
Ponder County Health Department
Wilmington Regional Office, Aquifer Protection Section
Ponder County Soil and Water Conservation District
Permit File NCA271012
AFOU Files

Type of Visit O Compliance Inspection 0 Operation Review Q<agoon Evaluation
Reason for Visit O Routine 0 Complaint Q Follow up Q Emergency Notification 0 Other ❑ Denied Access
Date of Visit: Time: � .QO
Facility Number �—
Not Q erational. 0 Below Threshold
D Permitted O Certified [3 Conditionally Certified [3Registered Date Last Operated ar Ab ve Threshold:
Farm Name: Cr'0,0Ic e- "✓L F - " County: � el -
Owner -
Name: V i 11 I +e l / f'a Phone No:
Mailing Address:
Facility Contact:
Title:
Onsite Representative: Integrator:
Certified Operator:
Location of Farm:
Phone No:
Operator Certification Number:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' �� �64 Longitude ' 1 «
Design Current Design Current Design Current
Swine Capacity Population Poultry Capacity Population Cattle Capaciltv Population
❑ n to Feeder ❑ Layer ❑ Dal
Eff'Feeder to Finish 1 10 Non -Layer I I JEJ Non -Dairy
❑ Farrow to Wean
El Farrow to Feeder ❑Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ Boars Total SSLW
Number of Lagoons Subsurface Drains Present ❑ Laloon Area 10 Spray Field Area
Holding -Ponds / Selid.,Traps-
❑ No Liquid Waste Management System
Dlscharues & Stream Impacts
1. Is any discharge observed from any part of the operation'? ❑ Yes ❑ No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. if discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. if discharge is observed, what is the estimated Flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes ❑ No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ❑ No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ❑ No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure b
Identifier:
Freeboard (inches):
05103101 Continued

N
- Facility Number: — ( Z Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes ❑ No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes ❑ No
(if any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes ❑ No
8. Does any part of the waste management system other than waste structures require maintenancelimprovement? ❑ Yes ❑ No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑Yes ❑ No
Waste Application
10. Are there any buffers that need maintenancelimprovement? ❑ Yes ❑ No
11. is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes ❑ No
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
❑ No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
b) Does the facility` need a wettable acre determination?
❑ Yes
❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes
❑ No
15. Does the receiving crop need improvement?
❑ Yes
❑ No
16. Is there a lack of adequate waste application equipment?
❑ Yes
❑ No
Rewired Records & Documents
17.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑Yes
❑ No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps. etc.)
❑ Yes
❑ No
19.
Does record keeping need improvement? (iel irrigation, freeboard, waste analysis & soil sample reports)
❑Yes
❑ No
20.
is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
❑ No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
❑ No
22.
Fail to notify regional DN Q of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
❑ No
23.
Did Reviewer'Inspector fail to discuss reviewiinspection with on -site representative?
❑ Yes
❑ No
24.
Does facility require a follow-up visit by same agency?
❑ Yes
❑ No
25.
Were any additional problems noted which cause noncompliance of the Certified AWW?
❑ Yes
❑ No
No violations or deficiencies were noted during this visit You will receive no further correspondence about this visit.
�Carintments; refer to` uestioa T` E lain an' YFS `answers andlvir'asf retnendations'via otiit rer c`omtne is
Lse drawings of facilityto_bett ezglain sitdations:,(use additional P ges as necessary) . ° Field Copv 1 ❑ Final Notes
,3 .�. ,.
,SS :,.• jr
P�F-
/l (? ��fq�p� 5P�
AL
Gt ell cv'-v Ail �f� "ek e 470
Reviewerllns ector Name h
ReviewevInspector Signature: Date:
05103101 Continued

Fa ' i)Ivlsioa of WaterRQsllty +
ofSollaand WaterrCo3ikr.vatlon,.
ar
'type of Visit 0 Compliance Inspection 0 Operation Review 0 Lagoon Evaluation
Reason for Visit o Routine 0 Complaint O Follow up O Emergency Notification Q Other ❑ Denied Access
F 10 Facility Number Hate of visit: Time:
Not Operational Below Threshold
©Permitted ©Certified M Conditiana11 Certified [3Registered Date Last Operated or Above Threshold:
Farm Name: County:
Owner Name: AJPhone No:
Mailing Address:
Facility Contact: Title: one No:
Onsite Representative: F 17r r tegrator:
Certified Operator:
Location of Farm:
Operator Certification Number:
Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude Longitude 0
','Design Current a Design Current_, :Design Current
Ca achy Population
Swine latio�n Poultry. ��Ca �acity: ','Pa uliitionz � °Cattle �:.f• Cap acatv'Po elation
❑ Wean to Feeder 1,l ❑ Layer I ji ❑ Da'
Feeder to Finish ; Non -Layer []Nan-Dai j";..
El Farrow to Wean ❑ "
ElFarrow to Feeder I . Other
❑ Farrow to Finish cints
Design C>llpgc><ty
'TotsUSSM 11
❑ Boars �.P
Number of Lagoons; l 1_ _ I j ❑ Subsurface Drains PreseQt ❑ La oon Area ❑ Spray Feld Area ,
Iiialdtng Portals 1�Solici�Traps ❑ No Liquid Waste Management System
Discharges 8 StreaLm 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 Cgliection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Freeboard (inches):
05103101
❑ Yes No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes
❑ No
❑ Yes
VNo
❑ Yes
0 No
❑ Yes
VNo
Structure 6
Continued

Facility Nuipber: — Z. Date of Inspection Q
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?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
12. Crop type I,,VRP . `_'20y$EAiJ5 . W14FA-1 .
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 improvementZ
16. Is there a lack of adequate waste application equipment?
Re uir d R c rds & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes No
❑ Yes No
❑ Yes ;dNo
Yes ❑ No
❑ Yes XNQ
❑ Yes A No
❑ Yes 9No
❑ Yes O No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes �No
❑ Yes ;P1'NO
❑ Yes gNO
❑ Yes
XYes
❑ Yes
❑ Yes
❑ Yes
❑ Yes
❑ Yes
❑ Yes
II ,
❑ No
ONO
,ZNo
�No
ZVNo
9,No
INo
No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Comments (wefer to.questiGn:#) xplsin any,YES,answers andlorranylrecanamendations or nnv other comments.�i E, ,
...du. rn.��.-i.«!%Ew.rN•.a...ro.l A ........I...A.F. .....�ti #.
Use drawuigs of facility'to tietter explain situations. (nse adcEit�onal:pages as necessa}'ry) r0 Field Conv ❑ Final Notes+,
r . , r.... . .r .... r .. i ..• 3... a ... .. .. ... ... Y r ,r r Crn ere uleml.rw !^w
�47- usE �5- 'irJ�.Eas In BE
AL
PN> Fus,y 7�&
(&JA •
,
Reviewer/Inspector Name'°
Reviewer/Inspector Signature: Date: 0
05103101 Continued
-TO

Facility ltiumber: , — %Z Date of Inspection
dor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes 0NTo
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 ,Q No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes ,No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ❑ No
Additional -Comments,and/or,`DraNings:.
NN604- to �C y)"E�nIF
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ND �N� Lr G5 0 �r�vffZE ����/g TtAvs So t/[�•
14*6
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az2
05103101

Division of Water Qualtty+ , r
j.4 Q Division df,Soil and Water Conservation:
t Q Other Agency
Type of Visit tp Compliance Inspection O Operation Review Q Lagoon Evaluation
Reason for Visit O Routine O Complaint AFollow up O Emergency Notification O Other ❑ Denied Access
Facility Number Bate of Visit: � I Time: 0 i00 Printed on: 7/21/2000
0 Not Operational O Below Threshold
Permitted © Certified C] Conditionally Certified [] Registered Date Last Operate r Above Threshold: .........................
Farm Name: ...../...!.7••.�.....�..v. ,l�'/r'El
................... I.......................... County:..........A.......nn.......!.�..................... .......................
JU�
Owner Name: �?,�']F�, Phone No ............
FacilityContact:..............................................................................•ritle:................................................................ Phone No
MailingAddress: .......................1.,.,.r.....................................................
Onsite Representative: •....N�"/!'C .........................................
.................................
Certified Operator:
Location'of Farm:
..................................................... .. ............ .........................
.................. Integrator: . . ! 1./........ /..!-�'............
Operator Certitication Number
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • 6 it Longitude ' & «
} Design Current
Design Current
Aestah :. Current
+; Po ulation .
PoultryCpj)acity Po ulation Cattle.
Ca ei .)'ft ulation
t "
Wean to Feeder
❑ Layer ❑Dairy
s;
Feeder to Finish
10 Non -Layer ❑Non-Da+ry-+
`
:'o
Farrow to Wean
t :'
Farrow to Feeder
❑ Other
3°
Farrow to Finish
Total Design Capacity.
Gilts
..................
Boars
........... _..... .....
TOM :SSLW„
nttt tie%I.Bgoons ,
❑Subsurface Grains Present ❑ ►ii LagMArea
❑Spray Field Area
._
p1tliggsPk p 7 '/ 5ot<d,Traps No Liquid Waste Management System
k
:
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 gallrnin'?
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
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ❑ No
Structure l Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ..........................................................................
Freeboard (inches):
5100
Continued on back

Facility Number:- — / Date of Inspection Z 3 p
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes ❑ No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes ❑ No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes ❑ No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes ❑ No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes ❑ No
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes ❑ No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes ❑ No
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
❑ No .
14.
a) Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
b) Does the facility need a wettabie acre determination?
❑ Yes
❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes
❑ No
15.
Does the receiving crop need improvement?
❑ Yes
❑ No
16.
Is there a lack of adequate waste application equipment?
❑ Yes
❑ No
Required Records & Documents
17.
Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
❑ No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
❑ No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
❑ No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
❑ No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
❑ No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
❑ No
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
❑ No
24.
Does facility require a follow-up visit by same agency?
❑ Yes
❑ No
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes.
❑ No
15+*iQ1�ti#ris:oe a0fcjen'{� Wqrp 004 f�1Wift 01s•visit; X0 00 xeeoivo 00 futtb$ .
corresi)o deice'. about this visit, ...........................:...... .
ro A /,
4!5�Mtb_o
r�,�ks� i�� wry 1�,� Dr %�F ����._�M w
Reviewer/Inspector Name 1231 ' y U;� J r�S''
Reviewer/Inspector Signature: -y^ / Date: 5/00

4
(Type of Visit to Compliance Inspection O Operation Review O Lagoon Evaluation J
Reason for Visit 0 Routine p Complaint, p Follow up O Emergency Notification O Other ❑ Denied Access I
Facility Number Date of Visit:
Permitted 0 Certified [3 Conditionally Certified 0 Registered
Farm Name: ......... r�...,.../.k... � ..�. ...........................
Owner Name:...,..! C...?5.........'g ......... ..i,� r���L?.�..................
Time: I / W I
10 Not Ouerational 0 Below Threshold
Date Last Operate r Above Threshold: .........................
County:..!!'�jE.............................................
PhoneNo; ............................................................................ .... . —..
FacilityContact:.............................................................................. Title:................................................................ Phone No:...................................................
MailingAddress :................................... .............. .. ..M �E�e-f%/�✓.... I ............ I ...... I ............... ..........................
Onsite RepresentativeitXJ ....... GTES off% .s i .. �.. Integrator:. r,/IEZIyj%...... ,�.� ..................
J � f.
Certified Operator:.........................................................................................I...................... Operator Certification Number:..........................................
Location of Farm:
Swine ❑ poultry (:]Cattle ❑ Horse Latitude Longitude
Design,. Current` Design Current.. Design Ciurreut F
Ca aci � Po elation Poultry ,Ca aci ,.Pop u6don Cattle "Ca aci
❑ Wean to Feeder 10 Layer ❑Dairy
Feeder to Finish ❑ Non -Layer I I JE3 Non Dairy
sVt
' Farrow to Wean
❑ Farrow to Feeder ❑Other
❑ Farrow to Finish Total Design :Capadty
11 ` ❑ Gilts
Boars `Total SSLW,
I, Number of Lagoons ❑ Subsurface Drains Present jrM Lagoon Area . ❑ Spray Field Ares ;
Holding Ponds I So1fd:Trap§; ; _ ❑ No Liquid Waste Management System
,..,
Discharees & Stream imyacks
1. Is any discharge observed from any part of the operation? Yes ❑ No
Discharge originated at: ❑ Lagoon ❑ Spray Field 00ther V
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) s
c. If discharge is observed, what is the estimated flow in gal/min? L c
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�No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ,INO
Waste Collection & Treatment /
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 - Structure 4
❑ Yes EfNo
Structure 5 Structure 6
Identifier: ....................................
Freeboard (inches): 51
5100
Continued on back

1"'aciiity Numbgr: — Z 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 No
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
(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/improverent? ❑ Yes 0 No
8. Does any pan of the waste management system other than waste structures require maintenance/improvement? ❑ Yes IVNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes j'No
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes XN
o
11. Is there evidence f over application? ,1�❑ Excessive P riding ❑ PAN ]❑ Hydraulic Overload ❑ Yes �INO
12. Crop type �O�CIy z L� �
13. Do the receiving crops diffdwith 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 & Drrcuments
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? (icl 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 Reviewed]nspector fail to discuss reviewlinspection 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?
Rio YiQI'atitirts:o;r defic!<enfAps -ware p0(je� daring th�s;vis t; Yoh wild eeeiye o #u>�t r; ;
corrispondeirce. about this visit_ .
any11
❑ Yes 9No
❑ Yes �yNo
❑ Yes [ No
❑ Yes / No
❑ Yes XNo
❑ Yes 9No
❑ Yes �No
❑ Yes A No
ElYes dNo
r
❑ Yes No
❑ Yes (V No
❑ Yes 6o
❑ Yes XNo
)2f Yes ❑ No
❑ Yes XND
��4WE NDT, V E �7wCIF +0 h%onJe �/� A,
/✓� ��P o �iZ�J %2''�f �255.G%/�
1
u541=,Q�i}rr✓jtl� D�i✓�. Li✓� a G�}GOoN. ,¢� D��F2 T
off I-
Reviewer/Inspector Name
Reviewer/Inspector Signature:
t �.
G- ;•5••• C:f
Date: %29 �. 5100

Facility Nurgber: — 2 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 No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes �No
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? Cl Yes No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes �No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes /M No
pna ptttmen :..an or ra ngs: E< I k` r'I N 3 if { s<zYt i
I - & - A,
/1f���E�J rr' Srif ��O�jl mD�nl �e �r2� ENE
Fox jr;- r
44o 1�fid t4se-lz:PL,4rd
5/00

4
Division of Water Quality
' Q Division of Soil and Water Conservation
Q Other Agency
Type of Visit ACompliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number
Date of Visit: — - Time:3u Printed on: 7/2112000
`�-
Q Not O erational Q Below Threshold
Permitted 0 Certified E] Conditionally Certified Q Registered Date Last Operated or Above "Threshold
-G l�.r` County: ........;r........ ......................
FarmName: ........................................................................................................................
OwnerName: ........... Phone No: .......................................................................................
FacilityContact:..............................................................................'fitle:...................................:.......................I.... Phone No: ...................................................
Mailing Address:
Onsite Representative:..l �:\lam..[`.:...........�r/...................................................... Integrator: .......L.�5.................................................................
Certified Operator:.......................................................{......................................................... Operator Certification Number:........................... ...............
Location of Farm:
T
[]Swine []Poultry []Cattle []Horse Latitude �•°°° Longitude
Design Current Design Current Design Current
Swine Capacity Population Poultry Capacity Population Cattle Capacity Population
❑ Wean to Feeder ❑ Layer I I ❑ Dairy
Feeder to Finish aGQ ❑Non Layer ❑ Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder ❑Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ Boars Total SSLW
Number of Lagoons ❑ Subsurface Drains Present ❑ Lag -ton Area ❑ Spray Field Area
Holding Ponds / Solid Traps ❑ No liquid Waste Management System
Discharges & Stream Imuact5
I. 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. Il' discharge is observed. what is the estimated llow in galhnin'!
d. hoes discharge bypass a lagoon system? (Il'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
SLrUCtUre I Structure 2 Structure 3 Structure 4 Structure 5
Identifier....................................................................................................
....... .................................... .............................
Frechoard (inches): 3
5100
❑ Yes krNo
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes
❑ No
❑ Yes
L No
❑ Yes
M'No
❑ Yes Wo
Structure 6
Continued on back

F�acili�ty4iumDate of Inspection
... � ber: ��'�—_ p I� 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? ❑ Yes ,kNo
(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?
12
13
Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
Crop type <:::kJSG-i
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?
�Va yiolatitios o� . ciencies were hated. dii- ing Ois;visit; - Y:oit} ' ili-teceiye ti furtiter..: .
correspondence. abntit this .visit. . . . . . .
❑ Yes V No
❑ Yes 1WNo
❑ Yes too
❑ Yes NrNo
❑ Yes Z No
Yes ❑ No
❑ Yes XNo
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes No .
❑ Yes XNo
❑ Yes XNo
❑ Yes allo
Yes �N�
❑ Yes WNo
❑ Yes T�(No
❑ Yes JELNo
❑ Yes t5No
❑ Yes D�rNo
Yes ❑ No
Comments (refer to question 11): 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):
43Q r he
Reviewer/Inspector Name �. t. 0— � Q
Reviewer/Inspector Signature: Date:
5/00

Eacilify Number: -- Date of Inspection C,U 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 5tlor below Yes []'No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes o
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) ly
29: Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes f No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes E No
itiona : -omments'an or.Drawings:
,, �U ,
uc-
t-- �-c. '
5100

DwEsion of Soil and Water Conservation `=Operation Review.�1:1;
. ` © Division of Soil'and Water Conservation - Compliance Inspection
Division of Water Quality-'Compliance'Inspection.
13 Other -Agency - Operation Review r
Routine Q Complaint Q Follow-up of DWQ inspection Q Follow-up of I)SWC review Q Other
Facility Number
I)atc of Inspcc6oll
I'inle of Inspection Q 24 hr. (hh:mm)
Permitted 0 Certified ©.. Conditionally Certified 13 Registered © Not O crational Date Last Operated:
Farm Name: .............. k.A�.........I...Ojdl\.....L1W.V.!^ ...... County: P.
Owner Name:...................W�.'�1+'........._...........YiL�......................._........... Phone No:....i.!��..Z�f.............................................
FacilityContact: ............................................................................... Title: ................................................................ Phone No:..,................................................
Mailing Address: ........ .ki D.....4-.AdMik.........h5?:. ., .... .. �n/.L�.� IkY.lf.t...i.V....................................... ... 14.16........
Onsite Representative: ........... ,M x :....Rlh. ..... wad-.....5. .. 4.rl.iL1� .... Integrator:.........................................................................
r............ {�':.
Certified Operator: ................................................... ............................................................. Operator Certification Number:..........................................
Location of Farm:
................................... OA....... 11' • 4.....0 ....... ..3A..�.................................................................
.........................................................................I....... .............. ................
Latitude 0.0` ��° Longitude �• �° 0°+
Swine Capacity. Population Poultry Capacity Population Cattle Capacity Population
❑ Wean to Feeder ❑ Layer _-� ❑ Dairy
Feeder to Finish j_pp. ❑ Non -Layer Irl Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder Other
❑ Farrow to Finish Total Design Capacity ZGp
❑ Gilts
❑ Boars Total SSLW
IEEE
Number of Lagoons i ❑ Subsurface Drains Present ❑ Lagoon Area 111 Spray Field Area
Holding Ponds I Solid Traps ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation (If yes, notify DWQ)?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. if discharge is observed, was the conveyance man-made?
h. U discharge is observed. did it reach: ❑ Surface Waters ❑ Waters of the State
c. if discharge is observed. what is the estimated floe' in gal/tnin?
d. Does discharge hypass a lagoon system?
2. Is there evidence of past discharge from any part of the operation'!
3. Were there any 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?
Sn•ULAUre I Structure 2 Structure 3 Strucluw 4 Struclw•e 5
Identifier:
❑ Yes M No
❑ Yes No
❑ Yes No
❑ Yes ,q] No
14 Yes ❑ No
❑ Yes W No
❑ Yes ® No
Structure 6
Freeboard(inches)..........27r............................................ ....... .........................................
1/6/99 Continued on back

N yacil :y„Numbers 71— /j. Date of inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ic/ trees, severe erosion, ❑ Yes W No
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
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? Yes ❑ No
S. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes n No
9. Do any stuctures lack adequate, gauged markers with required top of dike, maximum and minimum
liquid level elevation markings? ❑ Yes No
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes No
11. Is there evidence of over application''! ❑yPonding ❑ Niifrrogen ❑Yes No
12. Crop type .!)'r'.......�k�t+tt-T.........�Q1�.',�lLi� .:..................C�.SG..�.,. �r.....
......
..........
........
.......
..........
..........
.....................
................................. 1
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ElYes i No
14. Does the facility lack wettable acreage for land application? (footprint) j� Yes ❑ No
15. Does the receiving crop need improvement? ❑ Yes % No
16. Is there a lack of adequate waste application equipment? ❑ Yes 9 No
Renuired Records & Documents
17.
hail to have Certificate of Coverage & General Permit readily available?
❑ Yes
�j No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ic/ WUP, checklists, design, maps, etc.)
❑ Yes
91 No
19.
Does record keeping need improvement? (ic/ irrigation, frecboard, waste analysis & soil sample reports)
'j Yes
❑ No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design'?
❑ Yes
No
21.
Did the facility fail to have a certified operator in responsible charge?
❑ Yes
No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes
No
(ic/ discharge, freeboard problems, over application)
23,
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
No
24.
Does facility require a follow-up visit by same agency'?
❑ Yes
No
Wvlcklaidons-or. deidei n' e.'s :were noted during:ttiis.visit:: You wilfre�ceiv*e na further ::.
................... ..... .
eorresporideitce: about: this :visit:.: ::::::::::::: :: ...
Comments (refer to question #): Explain any YES answers and/or any. recon►mendatiorris`or any „other comments f t
_... ._
Use drawings of facility to better explain situations. (use additional pages as neces'sary): i
z. WGstt tt\ 56,n, U .d - -or` a jua, 4 con. No c �sf, Gry W f of
OkewV4. wvllSk 6S �,L[W or-.`;rin'?,4e� ��vt�� ry- rOrlO eiev�e.� a cirvet b
c�vDt I`''�•�,rye l' 0 v\ tlor d i I�Ci. 5 v lU �e ao J C� 1 mu"r f
1ti. ar� `
l�� s UG4� p �. w!� f�u t► ��fi'an .
r— Corv\ VUas �`f[1e1e�� �� SD P�S�ac W►`- t�+1z CoVpneeeJr {-ae cam
C� �s i ljt/a vtuc{io,�\ .
�,�,n�uc� c�ASOh �,arw�� cOrC�rtti1 r�
�7. Wn�i n Ut? L'•�0� � tiv� �Yt- GzY'f !n S. __
Reviewer/Inspector Name
t p
Reviewer/Inspector Signature: Date: 1li��$ 11/6/99

Division of Soil and Water Conservation 0 Other Agency
Division of Water Quality
L4KRoutine O Complaint O follow-up of DWQ inspection O hollow -up of DSWC review O Other
Date of Inspection
Facility Number
Time of Inspection S 24 hr. (hh:mm)
D Registered 13Certified ©Applied for Permit Permitted 113Not Operational Date Last Operated:......
FarmName:........ ............... ..n....................................... County:..... . ..✓............................... .......................
OwnerName: .............. �...................................... Phone No:..... �....... Z.Y`..d9........................
Facility Contact: .................................................................... .. Title:.................... _ .. Phone No:
Mailing Address: .............. -'�.a.C?O S.."'.��....�Z..�'(..r.............. .°. .""� �C Z g L[: ............. a................................................................................... ..........................
OnsiteRepresentative: ......... . ................................................................................................ Integrator:..................
Certified Operator; ............../' lo��� Operator Certification Number;......,
!.�-...../�,ok..... ` ...............................
Location of Farm:
...................................................................................................................................................................................................................................................................
I
... ..
Latitude =' 0' =" Longitude =' =' =11
Design Curent
Design Current, x °Destgn ;Current
Sv ne ;.
Capacity Populanon • Poultry
a
Capacity Population Cattle Cactty Population
❑ Wean to Feeder
❑ Layer
❑ Dairy
Feeder to Finish
ZpQ ❑Non -Layer
❑ Nan -Dairy
❑ Farrow to Wean
❑c
Farrow to Feeder
I[] Other
u w
❑ Farrow to Finish
Total Design Capacity1
❑ Gilts
µ
f
SSLW
[I Boars
_
Total
.................._._ ..
. ;.,.
r.,
Number of Lagoons / Holding Ponds: �❑Subsurface Drains Present ❑Lagoon Area ❑Spray Field Area
No Liquid Waste Management System
General
I. Are there any buffers that need maintenance/improvement?
❑ Yes
KNO
2. Is any discharge observed from any part of the operation?
❑ Yes
gNo
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
VNo
4. Were there any adverse impacts to the waters of the State other than from a discharge?
❑ Yes
i(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
VNo
7. Did the Facility fail to have a certified operator in responsible charge?
❑ Yes
(ttt No
7/25I97

Facility Number: ( —
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (Lagoons.11olding Ponds, FlushPits, ete.l
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Freeboard(ft):.......z r .`i..................................................................................................................................................
10. Is seepage observed from any of the structures?
11. Is erosion, or any other threats to the integrity of any of the structures observed?
12. Do any of the structures need maintenance/improvement?
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
Waste Application
14. Is there physical evidence of over application?
(If in excess of WMP, or runoff entering` waters of the State, notify DWQ)
15. Crop type ..... '_.....eV.*.yo......................... .............................................................
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 Perrnitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
25. Were any additional problems noted which cause noncompliance of the Permit?
[]-No.violatio'ns-or. deficiencies.were-notid during this: visit.-Yodwill receive. no- further .
:. cprrespondeke dbout this'visit'.•
�Z. t✓ork 6� ba�G ptfGcf. czro�--� [asJo+^ �r�,��t��
❑ Yes O(No
❑ Yes No
Structu 6
❑ Yes VfNo
❑(Yes �No
9Yes ❑ No
❑ Yes �No
❑ Yes �No
❑ Yes 1(No
❑ Yes (rNo
❑ Yes O(No
❑ Yes PfNo
❑ Yes 0�4o
❑ Yes KNo
❑ Yes KNO
❑ Yes 0 No
❑ Yes -No
❑ Yes No
7/25/97
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date: 11