310160_INSPECTIONS_20171231

NUH I H UAHULINA
Department of Environmental Qual

Division of Water Resources
❑ Division of Soil and Water Conservation
Other Agency
Facility Number: 310160 Facility Status: Active
Inpsection Type: Compliance Inspection
Permit: AWS310160
Inactive Or Closed Date:
Reason for Visit: Follow-up County: Duplin Region:
Date of Visit: 11/18/2015 Entry Time: 11:10 am Exit Time: 1:00 pm
Farm Name: Carter & Sons Nog Farm 1 &2
Owner Coy Carter
Mailing Address: 668 Rivenbank Town Rd
Physical Address: 112 Dobson Chapel Rd
Facility Status: ❑ Compliant ❑ Not Compliant Integrator. Murphy -Brown LLC
Incident #
Owner Email:
Phone:
Wallace NC 28466
Magnolia NC 28463
❑ Denied Access
Wilmington
910-285-4456
Location of Farm: Latitude: 34` 53' 58" Longitude: 77° 55' 42"
South of Kenansville. On East side of SR 1737. Site #1 is approx. 0.4 mile West of Hwy 50 and Site #2 is approx. 0.8 mile West of
Hwy 50.
Question Areas:
Dischrge & Stream impacts Waste Col, Star, & Treat ® Waste Application
® Other issues
Certified Operator: Clay K Carter Operator Certification Number: 994541
Secondary OIC(s):
On-Sfte Representative(s): Name Title Phone
24 hour contact name Clay Carter Phone:
On -site representative Clay Carter- Phone:
Primary Inspector. Kevin Rowland Phone:
Inspector Signature: Date: `� S
Secondary Inspector(s):
Inspection Summary:
page: 1

Permit: AWS310160 Owner - Facility: Coy Carter Facility Number: 310160
Inspection Date: 11/18/15 Inpsection Type: Compliance Inspection Reason for Visit: Follow-up
HAD SCEDULED INSPECTIONS THE MORNING OF THE 18TH. FOLLOWED UP ON COMPLAINT AGAIN IMMEDIATLEY AFTER.
CHECKED GOOGLE EARTH ON THE AFTERNOON OF THE 17TH AFTER INITIAL INSPECTION TO DETERMINE WHICH WAY
AND WHERE THE WASTE WOULD FLOW IF IT LEFT THE SITE. CONSULTED WITH THE WIRO STREAM SPECIALIST AND SHE
BELIEVES WHAT WE WERE CALLING A DITCH IN BETWEEN THE 2 FARMS IS ACTUALLY A TRIBUTARY
11:10AM CHECEKED STOCKING HEAD CREEK AT HWY 50. NO PINK WATER SEEN. PHOTOS TAKEN
11:17AM CHECKED STOCKING HEAD CREEK AT STOCKING HEAD RD. NO PINK WATER SEEN. PHOTOS TAKEN
11:29AM CHECKED AREA OF RUNOFF ON FRONT SPRAY FIELD. PINK WATER IN FIELD DRAINIAGE AREA BEHIND DAM (DAM
WAS KEEPING WASTE BLOCKED). WALKED DOWN-CANALIDITCHITRIBUTARY . WATER APPEARED CLEAR ABOUT 50 FT
DOWN. COULD SEE SMALL POCKETS OF WASTE WITHIN THAT 50FT.
12:OOPM MET WITH CLAY CARTER: SUGGESTED MR, CARTER PUMP WATER OUT OF ERODED FIELD DITCH SO NO OTHER
WASTE COULD ENTER TRIBUTARY IF DAM WERE TO FAIL. ALSO SUGGESTED A SLAM GATE BE INSTALLED.
"2:OOPM STREAM SPECIALIST @ DWR DETERMINED THAT WHAT I ORIGINALLY CALLED A CANAUDITCH COULD BE A
TRIBUTARY
page: 2

Permit: AWS310160 Owner - Facility : Coy Carter Facility Number: 310160
Inspection Date: 11/18/15 Inpsection Type: Compliance Inspection Reason for Visit: Follow-up
Waste Structures
Dislgnated Observed
Type Identifier Closed Date Start Date Freeboard Freeboard
Lagoon
1-3064
27.00
Lagoon
2-3064
19.50
Lagoon
3-3065
19.50
F
page: 3

• Permit: AWS310160
Owner- Facility : Coy Carter Facility Number: 310160
Inspection Date: 11/18/15 Inppection Type: Compliance Inspection Reason for Visit: Follow-up
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at:
Structure
Application Field
Other
a. Was conveyance man-made?
b. Did 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 DWO)
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 Waters of the
State other than from a discharge?
Waste Collection, Storage & Treatment
4. Is storage capacity less than adequate?
If yes, is waste level into structural freeboard?
5. Are there any immediate threats to the integrity of any of the structures observed (Le./ large
trees, severe erosion, seepage, etc.)?
6. Are there structures on -site that are not properly addressed and/or managed through a
waste management or closure plan?
7. Do any of the structures need maintenance or improvement?
8. Do any of the structures lack adequate markers as required by the permit? (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
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
maintenance or improvement?
11. Is there evidence of incorrect application?
If yes, check the appropriate box below.
Excessive Ponding?
Hydraulic Overload?
Frozen Ground?
Heavy metals (Cu, Zn, etc)?
PAN?
Is PAN > 10%/10 lbs.?
Total Phosphorus?
Failure to incorporate manure/sludge into bare soil?
Outside of acceptable crop window?
Evidence of wind drift?
Application outside of application area?
Yes No Na No
® ❑ ❑ ❑
❑
❑
0 ❑
❑
®-❑
❑
❑
ONLY OBSERVED APPROX
5 GALLONS
®
❑ ❑
❑
®❑❑❑
❑
®❑
❑
Yes No Na No
❑ ® ❑ ❑
❑
®❑
❑
❑
®❑
❑
❑
®❑
❑
❑
M ❑
❑
Yes No Na No
❑
BE]
❑
®
CIE]
❑
Im
page: 4

Permit: AWS310160
Owner - Facility : Coy Carter Facility Number: 310160
Inspection Date: 11/18/15 Inpsection Type: Compliance Inspection Reason for Visit: Follow-up
Waste Application Yes No Na No
Crop Type 1
Crop Type 2
Crop Type 3
Crop Type 4
Crop Type 5
Crop Type 6
Soil Type 1
Soil Type 2
Soil Type 3
Soil Type 4
Soil Type 5
Soil Type 6
14. Do the receiving crops differ from those designated in the Certified Animal Waste
❑
❑ ❑
IM
Management Plan(CAWMP)?
15. Does the receiving crop and/or land application site need improvement?
❑
110
16. Did the facility fall to secure and/or operate per the irrigation design or wettable acre
❑
❑ ❑
determination?
17. Does the facility lack adequate acreage for land application?
❑
❑ ❑
BE
18. Is there a lack of properly operating waste application equipment?
❑
❑ ❑
Other Issues
Yea
No Na No
28. Did the facility fail to property dispose of dead animals within 24 hours andlor document
00113
and report mortality rates that exceed normal rates?
29, At the time of the inspection did the facility pose an odor or air quality concern? if yes,
01100
contact a regional Air Quality representative immediately.
30. Did the facility fail to notify regional DWQ of emergency situations as required by Permit?
❑
®❑
❑
(i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility?
❑
❑ ❑
IN
If yes, check the appropriate box below.
Application Field
❑
Lagoon / Storage Pond
❑
Other
❑
If Other, please specify
32. Were any additional problems noted which cause non-compliance of the Permit or
❑
❑ ❑
CAWMP?
33. Did the ReviewerAnspector fail to discuss reviewfinspecflon with on -site representative?
❑
®❑
❑
34. Does the facility require a follow-up visit by same agency?
❑
®❑
❑
page: 5

$Division of Water Quality
Facility Number 1 0 Division of Soil and Water Conservation
0 Other Agency
Date of Visit: Arriva Time:}}. , Departure Time: County: Region: Lila
ff
Farm Name: 4 Owner Email:
Owner Name: L Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: �,, Phone No:
Onsite Representative: 4 Integrator: — L' 1 j 0
Certified Operator: Operator Certification Number:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Back-up Certification Number:
❑o ❑' ❑« g �t =«
Latitude: Longitude: =o
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
_ ❑ La er
_� ❑ Non -Layer I — - I El
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ urkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population'
❑
Dairy Cow
❑
Dairy Calf
❑
Dairy Heifej
❑
Dry Cow
❑
Non -Dairy
❑
Beef Stockei
❑
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?
M
o Yes ❑ No ❑ NA ❑ NE
❑ Yes
ONo
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
j'NE
El NA
❑ NE
Oyes
❑ Yes
,J❑�No
,1CNo
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
)aNE
12128104 Continued

Facili •Number: -I Date of Inspection: t
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ❑ No ❑ NA ',2 NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ffNE
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
Eq-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?
T
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes ❑ No
❑ NA
.❑'NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes [:]No
❑ NA
gaIJE
(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
,dNE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
[] Yes ❑ No
❑ NA
,T NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
,ETYes [:]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 2 NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ❑ No ❑ NA 0 NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes ❑ No ❑ NA F2-NE
acres determination?
17. Does the facility lack adequate acreage for land application?
l8. Is there a lack of properly operating waste application equipment?
Reauired Records & Documents
❑ Yes ❑ No
❑ Yes ❑ No
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 1" 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?
Page 2 of 3
❑ Yes [:]No
❑ Yes ❑ No
❑ NA '�3 NE
❑ NA P'N E
❑ NA 0 NE
❑ NA 2 NE
❑ NA JZNE
❑ Weather Code
❑ Sludge Survey
❑ NA ff NE
❑ NA ;2"NE
21412014 Continued

Facility Number' - Date of Inspection:
24. Did the. facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ❑ No ❑ NA ��tNE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑ No ❑ NA - f NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes ❑ No ❑ NA _[ErNE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No ❑ NA �NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes ❑ No ❑ NA [3NE
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 [E]"No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the ❑ Yes No ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes O No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes Ef No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? jzYes ❑ 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) .; ..
COY"" 05� 1 V, 4- reC; e Ue (`� J tee a� -
We- CoU�d
look- 1 to G ck 50 �°�
urr�
a me, 5
�� ba c� 5 P I -t -F e� u i fl- - 'fro , 1O
n� T
� ins �G-�1.r,•, � �1.�6c�i�+e►-t�c� �n�' � �` r�
du (� b -� � �o+ spe
�,e
a,,. bask sP �
Pr°Pe1 S f ��a-currrrnd� +
inseec d-rrrcrt ll r n �a
ftc�- � !, vc WaS Gas ��t i✓t
era d�.P �1� d )6 -�Wo �gNfMS .
--��eU.slr�r cr�� S � C� 1 �-e..l� i ✓� b�-�`� b''
w , -trcu (,� S S - � lie x�
cc,,r er do m med L-Lp eioc4 i trte}d
WGL' e" Vector" CjGCtA^ -FiCAd.
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 71 U 7-1b 7,51
Date:
_/1 /17 // 5--
IV4120114

�.� Div
tston of Water Quality
C. D1v1sion of Soil and Water Conseivahon ��, y � �'
Facility ii�rnber ��
� .
- Other'Agency
Type of Visit_101-compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit )2r Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit:n Arrival Time: i Q Departure Time: Y County: Region:
Farm Name: .Tf�'L' r [Yv.S ttw' M Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: �ra
&4
Certified Operator:
Back-up Operator:
Phone No:
Integrator: _
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: =' =' = Longitude: E—_1 o =, =
y Design Current Y NDesign� Current uDes�gns Current`
Swine
-,< k
Capacity Population 'et Poultry e Capacity Population. ;Cattle:" Capacity"Pop ]a on,
❑ Wean to Finish
❑ Layer
, El Dairy Cow
❑ Wean to Feeder
° ❑ Non -Layer
❑ Dairy Calf
El Feeder to Finish
❑Dairy Heifer
❑Farrow to Wean
"" > '� ❑ D Cow
TDry
Poultry <,:,
❑ Farrow to Feeder
`s
" ❑ Non -Dairy
ElFarrow to Finish
El Layer
❑ Beef Stocker
El Gilts
❑ Non -Layers
El Beef Feeder
�. ❑ Boars
❑pullets
❑Beef Brood Cowl I
❑ Turkeys
Other
{ ❑ Turkey Poults 1
tea:: u
d ❑ Other
jr1E3 Other
Number of 5tructuure�s
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ZApplication Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Yes ❑ No ❑ NA ❑ NE
❑ Yes
allo
❑ NA
❑ NE
Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
XYes
❑ No
Oyes
❑ No
❑ NA
❑ NE
❑ Yes PNo ❑ NA ❑ NE
Page 1 of 3 12128104 Continued

',�.1.•yrfr'•r.i^:.._-.i�i�r.-�.:;�,.�',1.d%.y'� r?ss.�.:a^C"' r,..-. �.�., : �-W,;-:.r+�•.y°q^.'9e,. r-:.--'S��-••._w:'i.� :�r.,.,�a<. ,r.- . � _. -, -
Division of Water Quality
ITi n.�.il:hr AT.a a.. L.r... �� 1 � � !'ti ■�• I]i..:oin.. r.f�C..:i n...i \xraear l:nncnr.rat:nn
Type of Visit_,�Compliance Inspection Q Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit farlftoutine O Complaint O Follow up O Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: �Q-��Deeparture Time: County: 1 Y� Region:
Farm Name: ? �,Q�Cr�� -`+� �c?� �y's 5P, f M Owner Email:
Owner Name:f! Phone:
s
Mailing Addi ress:
Physical Address:
Facility Contact: c6kx(2ar1-r_
Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: o Longitude: 0 0 0`= u
s
•r
Design Current
Design
Current Design Current
Swine Capacity Population Wet Poultry
Capacity
Population Cattle C**opacity Population
❑ Wean to Finish
❑ La er
❑ Dairy Cow
❑ Wean to Feeder
1 ❑ Non -Layer I
❑ Dairy Calf
❑ Feeder to Finish-
❑ Dairy Heifer
❑ Farrow to Wean Dry Poultry
El Dry Cow
El Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish ❑ Layers
❑ Beef Stocker
Gilts ElNon-La ers❑El
Beef Feeder
Pullets
PE]Boars
❑ Beef Brood Cowl
❑ Turkeys
~
Other ❑ Turkey Poults
❑ Other ❑ Other
I
Discharges & Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure PKApptication Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page 1 of 3
0Yes ❑ No ❑ NA ❑ NE
❑ Yes JZNo
❑ NA
❑ NE
Oyes ❑ No
❑ NA
❑ NE
❑ NA
❑ NE
Xyes ❑ No
E2ryes ❑ No
❑ NA
❑ NE
❑ Yes PNo
❑ NA
❑ NE
12128104
Continued

Facility Number: - Date of Ins ection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 0 No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes �3 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 0 No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes ZNo
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes jP No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes �No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
[:]Yes P'No
[DNA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
[:]Yes [:]No
❑ NA
E31NE
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 P] No
❑ NA
PINE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes Q No
❑ NA
ONE
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 ❑ No
❑ NA
1;3NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes ❑ No
❑ NA
WNE
Reauired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
❑ No
❑ NA
ZrNE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
❑ No
❑ NA
VNE
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
VNE
❑ 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
][�j NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
❑ NA
0 NE
Page 2 of 3 21412014 Continued

Facility Number. - Date of Inspection:
-Waste doIlection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ YesNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes J2 No ❑ NA ❑ NE - . .f
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
'.*
Spillway?:
•
Designed Freeboard (in):,;
Observed Freeboard (in):
P
5. Are there any immediate threats to the integrity of any of the structures observed?
❑Yes
❑/ No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑Yes
[ZNo
❑ NA
❑ NE '
,•
o -
waste management or closure plan?
If any of questions 44were answered yes, and the situation poses an immediate public health
or environmental
threat,
notify DWR .}V
#.
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
5J;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 [ kNo
❑ NA
❑ NE
maintenance or improvement?
r
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes ❑ No
❑ NA
f2jNE
Vj
maintenance or improvement?
q
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):
s
;�_
13. Soil Type(s)-
�T�
F
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes E2 No
❑ NA
P"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 onerate ver the irrigation design or wettable n Yes n No
n NA
n NE _.
`." acres determination?
• r ,
r,x = 17. Does the facility lack adequate acreage for land application? []Yes ❑ No • ❑ NA [3`NE
18. Is there a lack of properly operating waste application equipment? ❑Yes ❑ No ❑ NA ❑'NE .
>=
Required Records & Documents
r ; •.
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[:]No
❑ NA 0 NE
'
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
❑ No
❑ NA VNE
t'
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements
❑Other:
E"
t"r .
21. Does record keg in need improvement? If es, check the appropriate box below.
P g P Y❑
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 r
xr i
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 ONE
`
Pa e 2 0 3
g, f .
214/2014-Continued `
�:.. t•:. !ice , � -_ ' . .. ._ ...f}- . „ .. .. -,- . _ _ ., ._ . _.. _. -. ... -,. - ..._
� ._ _ �
� i..
- .r .. - ,

Facility Number: - Date of Inspection
24. Did the facility fail to calibrate waste application equipment as required by the permit? [:]Yes ❑ No ❑ NA 12'NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [] No ❑ NA J:� NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes ❑ No ❑ NA ❑^NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No ❑ NA [3 NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes ❑ No ❑ NA ❑CIE
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 jj�No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately. h
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)
3 L Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes 'D No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA L3-NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
❑ No
❑ NA
Ef NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes
JZ No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes
ZNo
❑ 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 necessar
y).'
f14ac Schedui IV1Wer,+>j`- �e ma(nIrN3 oar -Y)4 1�;� t-�,1�a�� 'A
ar. carTlalr. o,���r. lrrmed����� 01"r:
Checjcd Goo3�e ec fA-� or ii, -- 4;4- Ct- f
kvXA-IR0 1n%)eCV( ar ko de.�,errh►a- w1hic1� v3c%,is�Orle._
w rz_s-�e w v u td low ip 14- W --- � Si fie. Carls(&69 w t 4,
eLxr W i Re fC'.�r+^ e r�' + 5)-e belleues cc-W
p` �, ��-c�'• j �•• �j��- uiQ� �-. �_ 2 -�t � S , S c.- c-�-uc.tl,' G� -� r � b v:�ar J
111 G Ryn -- Ch cc 560(v6r,
eG� C{ � ek o� 1"
qua , n k i,,0,4r- - pk�04-t S _1101C0_
seen, 9} r s ►.. n 1
i 9q1M - Cl' 6w a �- a� T w\4rr Oe1 flirt S�ZALryj
-kett� 6fr—1 Q Gtirco._. L.,�.W-Aicon[ �w rt Uj cAe r a ppet red
c eae- abox�v- 1Go _. + down. Co�W ,see Sral pac" orc l.-.w,:�­s
f�Ik�►,,. �'�- �oG �-1 vv5se� � Mf� Curler pL&Vnp Lzcctee 0-AA- o
Cd'0&c1 ���c d ew so (\13 a Woe' w­�Ae_ co„�d erler -�rtbwkr� ,mere,
Reviewer/Inspector Name: K-e u 1 v\-
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date: [�
2 4/2014

Facili "Number: '� = i rr (� Date of Inspection: I 1 �•
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑Yes ❑ No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑ No
the appropriate box(es) below.
`f ❑ 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:
❑ NA �NE-
❑ NA _[2 NE
26. Did the facility fail to provide documentation of an actively certified operator in charge?
❑ Yes
' ❑ No
❑ NA
[2-NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
❑ No
❑ NA
[2 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.
J'
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
WYes ,oNo
❑ NA
❑ NE
❑ Yes '0 No
❑ NA
❑ NE?
.t
❑ Yes ❑ No ❑ NA J 'NE
❑ Yes ❑ No
[:]Yes ❑ No
❑ Yes allo
❑ NA NE
❑ NA ❑ NE
❑ NA ❑ NE
Use drawin(s of faeili to better explain any. YFS.answers and/orAany addifional recommendations oraany other comments Comments re er to question . Ex
g ty' plain situations (use additional pages. as necessary),
I a -1 a c Sche t i ri5Fnc '�"s the >mfl r n lr� 4-
0 y0% . CG ON � A I ► N7- p� S�� r. ! rn mod t "A6 GJ llf_4
Vu N�..a wh�c�
WAS wo�•�.d FtQw 1 I �� �- ��e 5� e. �vnSul�t� w144,
C• a � �-c �°• j �• �e� vJQ4 ►-. ��. �.. �G Of
► ! 17Rr�. - ChtcW S-hAr 1-Lael Cf eek @,Slo8cy,�, Ho,-QW . N'<) k
sepl, - 9)\, I-,
119qArn- Che0W arem v_� (Lk^G.,�,_ O,n -�(C �Pc klc9 r �IY•1Cw
4'(e�C7 &CG1 GreC>. l,.x.11rA(7( awn
C 140 .F �. r�own co'_k1d See srnal pc:) is Grr w0.sl'-
wr4�'�^w� 1av SA ;US5�5kc� �'1�E C�►rte,r PkA>rP W�,er a1� off"
erOd�d tl { d !" 50 ro G r wa'a-� �o�.�.d e+�1e� 4rrlb�lcs� if- d1�n �,��re
o fKA A c SA`SStS,[ec 4�1 IPe Ir5.1c0,2d .
ro Reviewer/Inspector Name:
vein e\•' G
7
Phone:
Reviewer/Inspector Signature:
Date:
Page'3 of 3
4/201 1
-� - iv '' •' a -
.':. Y. ... _ .. ,.. .�.. -
. % '. [" '... i .-. ',be. �. .. ��. r
.t....... .•d�<_..k.�.,:L_...:, �"t-u . ... +..� _,.
' - e --
a ��. - ._ . •
._. S- c' �'..�n,. �h� fr_ .��. � r.+� .� Y..

Type of Visit: Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: p Arrival Time: 3 (� Departure Time: County: Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator: M la
Certification Number:
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
Design Current
Wet Poultry Capacity Pop.
Design Current
Cattle Capacity Pop.
Wean to Finish
Layer
Dairy Cow
Wean to Feeder
Non -La er
I EEI
Dairy Calf
Feeder to Finish
MWeNkign Current
Drr PIouqPTC it $o ,
Layers
Dairy Heifer
D Cow
Non-Dal
Beef Stocker
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other I
Turkeys
Turkey Poults
10ther
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 ;20&o ❑ NA ❑ NE
❑ Yes 1;37No
❑ Yes P1110
❑ Yes ❑A0
❑ Yes
❑ Yes No
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 21412015 Continued

Facility Number: — Date of Inspection
4.
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes []1No
a. If yes, is waste level into the structural freeboard? ❑ Yes /:2 No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier: ,�
Spillway?: _
Designed Freeboard (in):
Observed Freeboard (in):
❑ NA ❑ NE
❑ NA ❑ NE '
Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ;2VNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes V!rNo ❑ 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 o ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes No ❑ NA El 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 )6No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes PPNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ICJ No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift [:]Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [:;?&o ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ZNo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination? ❑ yes JO-No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes J!fNo ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes 20 ❑ NA ❑ NE
Comments (refer to question #}: Explain any YES answers and/or any recommendations or any other comments„
Use drawings of facility to better explain situations. (use additional pageSras necessary)
•
t�cL t.S t�fy
...,.,.
Reviewer/inspector Name Phone:
Reviewer/Inspector Signature: Date:
ye 2 of 3 1212 04 Continuer/

"-S'fI' } ..-. - .1.f'.- - ..1•� .n •C"3'<. .� E0.
:'— �.�w r�iM:t'�r+�. a';.• �, 2 s�a� r'y, ...'�., a .. �^ � _fie �+e a. �
Type of visit:—.7compliance Inspection 0 Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit: ,Routine 0 Complaint O Follow-up 0 Referral O Emergency O Other O Denied Access
Date of Visit: / Arrival Time: „ ;;P_-4.FPPeparture Time: County.,
Farm Name:G.r�j�y"7 Owner Email:
Owner Name: Phone:
Mailing Address: -
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative: (,f� -_ Integrator:
Certified Operator:
Back-up Operator:
Certification Number:
Certification Number:
Location of Farm: Latitude: Longitude:'
Region:
Design
Current
Design
Current
Design Cur nt
Swine
Capacity._
_ Pop.:�<
w:Wet°Poultry; .a .Capaci
Pnp-„-
Cattle-
Capacity
Pop.
La er
DairyCow '
Wean to:Feeder,
�`
Non —Layer
Daig Calf
f eeder to Finish'
T6 0
Dai y,HeiferN
Farrow to Wean
Design
Current
"
Dry Cow''-
Farrow4o Feeder%'
D $ P&oul -. Ca aci
Pao
Non-Dai _
Farrow to Finish
La ers
$eef Stocker)
Gilts .. t
�\
Non -Layers
Beef Feeder
Bois ,-� ''
Pullets\�`�'
.. ,,:
, . �„
_J
Beef Brood Cow
Turkeys
Other
Turkey Poults
Other
Other
r jr " . i' N\
Discharges and'Stream Impacts
1. Is any d charge observed from any part of the operation?
❑ Yes
.0 No
❑ NA
❑ NE
Discharge'originated at: Sans c❑ Application Field ❑ Other:
`4,
�Q
a. Was the conveyanlcl� mvmade?
❑ Yes ff No
❑ NA
❑ NE
1b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
No
❑ NA
❑ NE
c. Whatyis, the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (if yes, notify DWQ)
❑ Yes
-6 No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
Ta No
❑ NA
❑ NE
3. Were there any. observable adverse impacts or potential adverse impacts to the waters
❑ Yes
❑ �To
❑ NA
❑ NE
-of the State other than from a discharge?
/
Page 1 of 3 21412011 Continued
._..�.. . e., i. �. e, .. ..i � 1 b •1�_ . ,. ..- � . .. ?�.. '.. a�- il�. _.,. .. .r _. .. - .. - .. ya .. -s. iM�. . i„S` .-. •..4„!

i
Facili ,Number: 3 - 40 jDate of Inspection:
24, Did th&facility fail to calibrate waste application equipment as required by the permit. ❑ Yes 'V�er No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes PI'No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes No
27, Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes D/No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
Comments (refer to question ft Explain any YES answers and/or any additional
Use drawings of facility, to better explain situations (use additional, pages as neces
w' S -
9
Pepi rrn:!j il2e&"
., �o� �:
Vssl2�
.� / �l
Reviewer/Inspector Name: "�/4
Reviewer/Inspector Signature:
Page 3 of 3
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes _Ea`No ❑ NA ❑ NE
❑ Yes [2"No ❑ NA ❑ NE
❑ Yes 9No ❑ NA ❑ NE
❑ Yes Vf No ❑ NA ❑ NE
❑ Yes ,Ej No ❑ NA ❑ NE
❑ Yes Z No ❑ NA ❑ NE
❑ Yes O No ❑ NA ❑ NE
ations or any.,©ther comments.
Phone:
Date:
2141201, f

Type of Visit: QCompliance Inspection 0 Operation Review O Structure Evaluation Q Technical Assistance
Reason for Visit: GeRoutine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit:
Arrival Time: ' ' c Departure Time: County: �G
Region: �o
Farm Name:
%lam/
�(��/ Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: �[(,�(�} l�07 f
Certified Operator:
Back-up Operator:
Location of Farm:
Phone:
Title:
Phone:
Integrator: �7?
Certification Number:
Certification Number:
Latitude Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Design Current
Wet Poultry Capacity Pop.
ILayer I
Design Current
Cattle C►apacity Pop.
Dairy Cow
Wean to Feeder
I
iNon-Layer I
EE-
Dairy Calf
Feeder to Finish
Dairy Heifer
D Cow
Non -Dairy
Beef Stocker
Beef Feeder
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Design Current
Dr, P,oultr. Ca aci. P,o ,
ILayers
Gilts
Non -La ers
Boars
Pullets
Beef Brood Cow
Other
Other
Turkeys
Turkey Poults
Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes,,[ETNo
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes 'f:fNo
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes �No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes � o
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse jmpacts to the waters
❑ Yes -No
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Condhaed

Facili Number: - Date of —Inspection: 3
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? 0-Yes O�No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in);
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes] No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes_,EfrNo ❑ 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 PNo ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes ( No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks) TT
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 F] No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. 0 Yes Ef No ❑ NA
❑ 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.
r
❑ NE
❑ Yes No
❑ NA
❑ NE
❑ Yes -El-No
❑ NA
❑ NE
❑ Yes _,No
❑ NA
❑ NE
❑ Yes-,B No ❑ NA [] NE
❑ Yes ► ff No ❑ NA ❑ NE
❑ Yes] No ❑ NA ❑ NE
❑ Yes, --No ❑ NA ❑ NE
❑WUP [—]Checklists ❑Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [7�No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes--b No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes -ID'No
❑ NA ❑ NE
❑ Weather Code
Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Faciti Number: - Date of Ins ection:
24. Qid.the facility.fail to calibrate waste application equipment as required by the permit? ❑ yesotl No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes �'No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [n"No ❑ NA ❑ NE
Other issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes allo ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes ��o ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately. T
30. Did the facility fail to notify the Regional Office of emergency situations as required by the ❑ Yes 2rNo ❑ 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 ic..j 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 ff 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 J;?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).
AV4, mar,
Reviewer/Inspector Name:
Reviewer/Inspector Signature: / `--
Page 3 of 3
Phone:
Date: 713
2/4/ Il

Factitty_Number; 3 Q
Q Division of Water Quality
O Division of Soil and Water Conservation'.
0-Other-Agency .,.� ,�
Type of Visit 101tompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 'Routine 0 Complaint 0 FolIow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: I V k— Arrival Time: Q Departure Time: County: Region:
Farm Name: �/ // /S,,-0�'7 _ -,, Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone No:
Integrator:
Operator Certification Number ?._y_S_Y.Z _
Back-up Certification Number:
Latitude: = o =1 = « Longitude: = ° = j = «
Design` Current =Design Current Design"' �"Corrent.
Swine Capacity. Population Wet Poultry. ..Capacity Populatton �-�-iCpacity 1'opulation;„
❑ Wean to Finish ❑ Layer
>" El Wean to Feeder ❑ Non -Layer
El Feeder to Finish
_ ❑ Farrow to Wean Dry Poultry {
❑ Farrow to Feeder `
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other:' 3
❑ Other �r
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ urkey Pouets
❑ Other
❑
Dairy Cow
❑
Dairy Calf
❑
Dairy Heifer
❑
Dry Cow
❑
on - airy
❑
Beef Stocker
❑
Beef Feeder
❑
Beef Brood Cow
Discharges & Stream Facts
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 VNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
No
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
Page I of 3 12128104 Continued

[Facility Number: G Date of ins ection:
!/
Waste Collection & Treatment
4. Is storage cal5acity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
VNo
❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
ZNo
❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
VNo
❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
PfNo
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 ZNo ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes PfNo ❑ 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? i)""""""''
Waste ARnlication
10. Are there any required buffers, setbacks, or compliance alternatives that need [] Yes ONo ❑ 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
;2rNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
�KNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
VNo,
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
;'No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[2rNo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
�No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
'[2fNo
❑ 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 Ca"No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes YNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 0No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: jDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit.
❑ Yes No
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes P-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 ONo
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes P"'o
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes 014o
❑ 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 V'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 ONo
❑ 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 0No
❑ 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 2�No
❑ 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).-
a ';
¢- �//6,�„,
y
c `C,/C&,- hens o.-, 61;"
eoh �&/
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date:
14120I

Facility Number
Division of Water Quality
O Division of Soil and Water Conservation
O Other Agency
Type of Visit Compliance Inspection O Operation Review O Structure Evaluation 0 Technical Assistance
Reason for Visit PAoutine 0 Complaint 0 Follow up 0 Referral 0 Emergency Q Other ❑ Denied Access
Date of Visit: / Arrival Time: ���/ Departure Time: County: Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Other
❑ Other
Phone No:
Integrator:
aj
Operator Certification Number:
Back-up Certification Number:
Latitude: ❑ o ❑ 4 = Longitude: ❑° 0 d 0«
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
I❑ Non -La et
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ urkey Poults
❑ Other
Discharges & Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifej
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures:
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes O�No ❑ NA ❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
❑ Yes No
❑ NA
❑ NE
❑ Yes No
❑ NA
❑ NE
❑ Yes7 No
❑ NA
❑ NE
12128104
Continued

Facility Number: _ — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ;3"No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
4
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ;]No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes P�No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes VNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes VNo ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes [;7No ❑ NA ❑ NE
maintenance or improvement?
Waste Aanlication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [ No ElNA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. []Yes VNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes,WNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes �ZNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes P, No
❑ NA
[__1 NE
17. Does the facility lack adequate acreage for land application?
❑ Yes f No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes V] No
❑ NA
❑ NE
Comments refer.to: uestion # : Explain any YES" answers , -an any:recommendattons or-;apy other
( q ) p r comments
,�
Usedrawing's of facElity to better explain situations. (use additional pages as necessary)
-
Reviewer/Ins ector Name
p Phone:
Reviewer/Inspector Signature: Date: 2
Page 2 of 3 12/f8/04 ' Continued

Facility Number: Date of Inspection 2
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ONo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes �No ❑ NA ❑ NE
the appropriate box. ElWUP El Checklists ❑ Design ❑Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. [:]Yes ;5'F4o ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
jZNo
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
PNo
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
Ko
❑ NA
ElNE
25. Did the facility fail to conduct a sludge survey as required by the permit?
[IYes
/
;5-No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes P1,10
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes PNo
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes P'No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
,,fNo
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes 7No
❑ 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 ;XNo
❑ 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 XNo
❑ NA
❑ NE
Page 3 of 3 12128104

Type of Visit ( Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit( )6Routine Q Complaint Q Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Date of Visit: 6 Time: s `i
.. ..... -.... - O Not Operational O Below Threshold
Permitted 13 Cerified Conditionau Certified ,� 3 Registered Date -Last Operated or Above Threshold: - -
Farm Name: ' i� r _ 1..¢-. Countyjn-
Owner Name: .... _ ._ W _ Phone No:
Mailing Address:
Facility Contact: . ___ Title: Phone No:
Onsite Representative: _� . Integrator. Jmid r i2hLA
Certified Operator: _ _ Operator Certification Number: ,
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude Longitude �• ��"
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes Po
Discharge originated at: El Lagoon ❑ Spray Field ❑ Other yy
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 VNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes }/No
Waste Colliection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes 17,10
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: . _ a _.
Freeboard (inches): ,
12112103 Continued

Facility Number: 3 ' — Date of inspection
5. Are there any immediate threats to the integrity of any of the structures observed? Cie/ 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 [l Yes 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 maintenancetimprovement? ❑ Yes �No
8. Does any part of the waste management system other than waste structures require maintenancelimprovement? ❑ Yes Po
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes JVNo
elevation markings?
Waste Application
10. Are there any buffers that need maintenancerunprovement? ❑ Yes �No
11. Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes P'No
❑ Excessive
Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type l ,
13, Do the receiving crops differ with those designated in the &rtified Animal Waste Management Plan (CAWNP)? ❑ Yes [9No
14. a Does the facilitylack a for land
adequate acreage application? ❑Yes VNo
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 /allo
16. Is there a lack of adequate waste application equipment? ❑ Yes Po
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge actor below ❑ Yes E2(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 0No
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 }� No
Air Quality rept�esentative immediately. /
❑ Feld Copy ❑ Final Notes
C0n+IIvv,,kk-
c:�`20Y1 - C U :ACC (,t.t. d Cd [ C� n c
KG
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Date: /),I / L
12112 03 Continued

Facility Number: Date of Inspection T%
Aecfuired Records & Documents
2 L Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes 81So
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 ado
23. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes JaRO
❑ 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 12 No
25. Did the facility fail to have a actively certified operator in charge? ❑ Yes Jallo
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes CNo
27. Did Reviewer/Inspector fail to discuss reviewCmspection with on -site representative? ❑ Yes IO No
28. Does facility require a follow-up visit by same agency? ❑ Yes - ETNo
29. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes QNo
NPDES Permitted Facilities
30. Is the facility covered under'a NPDES Permit? (If no, skip questions 31-35) EfYes ❑ No
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes {I No
32. Did the facility fail to install and maintain a rain gauge? ❑ Yes ONo
33. Did the facility fail to conduct an annual sludge survey? ❑ Yes [3No
34. Did the facility fail to calibrate waste application equipment? ❑ Yes O No
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below. ❑ Yes [a -No
❑ Stocking Farm ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After 1 ° Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
IE3 No violations or deficiencies were noted durins this visit. You will receive no further correspondence about this visit. I
3e �5u f e_ tv add � ea r fe�
n Process c,-F (-QJI,SIYY5 W C�-.
cL&ck Co!n YYtp-r-Lis d 4r� J) z e ?
r re -4 C.r0j)S
. . - IZl2 Z
• 7/ if Soil % ter/ 5hor, c hj1v /fL eGk � n
lell(-d 1-4 d- � , - P%� jrrr►Q a�corc��� jy
.y 00/7
Fl-� 1d� << 3f
P%ase-
I2/12X3

Type of Visit `0 Compliance Inspection 0 Operation Review 0 Lagoon Evaluation
Reason for Visit (D Routine 0 Complaint 0 Follow up 0 Emergency Notification 0 Other ❑ Denied Access
FaciG#v Number
Date of Visit: Time:
Not Operational Q Below Threshold
® Permitted ® Certified © Conditionally Certified ©Registered Date Last Operated or Above Threshold:
Farm Name: County: L
/
Owner Name: l t/. Phone No:
Mailing Address:
Facility Contact: Title:
Onsite Representative: Wit P/
Certified Operator:
Location of Farm:
Phone No:
Integrator: ✓��y
Operator Certification Number:
❑ Swine ❑ Poultry [:]Cattle [:]Horse Latitude ' 0. 0 " Longitude ' k Q"
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Discharges & 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 [K No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes [ZNo
Waste Collection &_ Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes RNo
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: `Z 3
Freeboard (inches): _5 3 Z
05103101 Continued

Facility Number: -3— /LQ 1 Date of Inspection 0 L
5. Are there any immediate threats to the integrity of any of the structures observed?.(ie/ trees, severe erosion, ❑ Yes MNO
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? '9 Yes C3 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? 0 Yes ❑ No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes 10 No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes KNo
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes `'E� No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes 1�9 No
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
W No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
f9 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
Reouired 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 DWQ of emergency situations as required by General Permit?
❑ Yes
[9 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
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
21 No
No violations or deficiencies were noted during this visit You will receive no further correspondence about this visit.
Couimeuts referto_ uesdoit # ".Ex lion an ,Y S:answe. W
( R ) P Y rs and/or.any teomtttettdatEoasor any outer cpmmerits.:
_
W µ -. _—.-----+
Use -drawings of fatuity to better explaut situnttons (nse: addttioraal pages as aPcessart) _' "
❑ Field Cornv ❑ Final Notes _
_a
v7 �0ot73 if dirt TU �C /IlD cA.* Guf,
/5- �l°��e: �;ns C�d� ,`el�s A�J 4 � n��� w>! �rfd/eM� . C e �-/ n e 9
r eW,
`,0- 11, 0/4/y a� a s�c,�l+�l t a J,f�vsn s w4s Af �n a�► S/G/az . /,� d,
/ e;csL�/�.cr,
,no4- zo l e/ Yrtzg U/Y] in �l �/Yo e4 � `/ ! ���`S PQ/ �j` �l�Pa/3"
Reviewer/Inspector Name i-
Reviewer/Inspector Signature: Date: zle j �Z-
05103101 - �� Continued

Facility Number: 31 — /60 Date of Inspection 1D D 02
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours?
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon?
30. Were any mayor maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
31. Do the animals feed storage bins fail to have appropriate cover?
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes 0'Vo
❑ Yes No
❑ Yes 23'1`10
❑ Yes 9-!-eo
❑ ,
Yes �' o
❑ Yes I..�vow
❑ Yes [4" o
Additional Cemments'.and/or Drawings-.:
PW wks h D -' 2-6e e,"
kcao-e- Aa-� ltl,4t e-
/'Jz v— 6
05103101

k ..
G'DMiion of Water ualrt W
OTDivision of Soil and Water Ganservation
,r
then Agency ,
,P -
Type of Visit O Compliance 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 31 160 Date of Visit: Time: 13:40 Printed on: 10131=01
O Not O erational O Below Threshold
® Permitted 13 Certified ® Conditionally Certified [3 Registered Date Last Operated or Above Threshold: . .. .. .. ..
Farm Name: Carter.-&.5mm.HogFarm.M2.............................................. County:]Dupft .................................... Wj.RQ.......
Owner Name: GamCPhone No: 4�Q-Z844�5-LEi)1,2Cr_0?91�$5=592Q.
Mailing Address: (6j%.Rj.yf1jbjAk..TQ.1Y-jX.]l d................................................................ Wallur..N.C........................................................... 2,846.6 ..............
Facility Contact: ........................................................... Title: ..................... .. Phone No:
OnsiteRepresentative: . C t all7il Car#�r_------------------------- integrator:l�u�P1>x�ami�Y�>------------------•
Certified Operator: Cloy.K................................... car.tvj................................................ Operator Certification Number: 116359.............................
Location of Farm:
iouth of Kenansville. On East side of SR 1737. Site #1 is approx. 0.4 mile West of Hwy 50 and Site #2 is approx. 0.8 mile +
Nest of Hwy 50.
® Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude F3470 S3 58 u Longitude 77 ' S5 42 u
Number of Lagoons 1 3 1 JE1 Subsurface Drains Present j❑ Lagoon Area J❑ Spray Field Area
Holding Ponds / Solid Traps ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes ®No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
r
a. If discharge is observed, was the conveyance man-made? ❑ Yes ® No ,s
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? n/a
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 6
Identifier: ............. .-........... .............2----------•-.............3------------...........................
Freeboard (inches): 39 37 39

Facility Number: 31-160
Date of Inspection 10/26/2001
c,unimueu
Printed on: 10/31/2001
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are'not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
Waste Application
10. Are there any buffers that need maintenance/improvement? Cl Yes ®No
11. is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes ®No
12. Crop type Fescue (Graze) Coastal Bermuda (Graze) Matua Graze Small Grain Overseed
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? Is Yes ❑ No
14, a) Does the facility lack adequate acreage for land application? ❑ Yes ❑ No
b) Does the facility need a wettable acre determination? ❑ Yes ❑ No
c) This facility is pended for a wettable acre determination? ❑ Yes ❑ No
15. Does the receiving crop need improvement?
® Yes
❑ No
16. Is there a lack of adequate waste application equipment?
❑ Yes
❑ No
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit 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? (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
113 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Comments (refer o',question -Explain any YES answers and/or any recommendat ons_or. any other comments
Use drawingssof facility to better explain situations (use additional pages as necessary) ❑ Feld �� Copy ❑Final Notes
n
2. There appears to be a small puddle of waste in the drainageway between the hog houses and lagoon at the four house site.
_
13. Part of pulls 11 and 12 are not planted in fescue and they should be. Part of pulls 14,15,17,19, and 20 and all of pulls 16 and 18
appear to be established in summer grass and need to be established with fescue; on site representative said that he had recently planted
fescue in some of these areas. Need to ensure that crop in the field is the crop designated in the waste plan.
15. Need to improve the bermuda stand on pulls 27 and 29.
Reviewer/Inspector Name Stonewall` - atliis
Reviewer/Inspector Signature: Date: jp 31 O

O5103101
Continued
Facility Number: 31-160 Date of Inspection 10/2612p01 Printed on: 10/31/2001
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes ® No
28.
is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
® No
roads, building structure, and/or public property)
29.
Is the land application spray system intake not located near the liquid surface of the lagoon?
❑ Yes
® No
30.
Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
❑ Yes
® No
31.
Do the animals feed storage bins fail to have appropriate cover?
❑ Yes
®No
32.
Do the flush tanks lack a submerged fill pipe or a permanenthemporary cover?
❑ Yes
❑ No
AdditionaLComments; and/or Drawings: -~ -
19. The IRR-2's need to be updated from the field sheets. Need to use care in transferring information from the field sheets to the
IRR-2's; some applications which are shown to have occurred in September on the field sheets appear to be recorded as July events
on the IRR-2's. Need to keep up with which lagoon is being pumped from so that the proper waste analysis can be used on the
records. Need to update the PAN that has been applied on the rRR-2's.
5. There appear to be several problems with the waste plan and wettable acres and their implementation. The waste plan has been
written based on an irrigation design but the system has not been installed according to the design. Mr. Clay Carter says that he has
enough aluminum pipe to make the pulls according to the irrigation design and he says that the pulls are made according to design.
However, two guns are pulled out in field 4 contrary to the irrigation design. Mr. Carter's explanation for this is that a high school
student who was helping at the farm pulled the guns out in the wrong direction and Mr. Carter says he caught the mistake. Another
problem with the irrigation design is that one of the lagoons at the 4 house site is shaped differently than shown on the design and
hence it appears that two of the pulls, 23 and 31, which are shown in the irrigation design cannot be made due to the different shape
of the lagoon. These pulls need to be eliminated from the wettable acreage and not counted in the waste utilization plan. Mr. Carter
needs to have the system audited by a technical specialist to address the noted problems and look for any other problems with the
system. Necessary modifications need to be made to the wettable acres design and the waste utilization plan. Spray application
needs to be done in accordance with the wettable acres design and records need to be kept accordingly. Violations may result in
notice of deficiency, notice of violation, civil penalties, injunctive relief, etc.
T

` c Vision.of Water Quality j_
s ? Q msion of Soil and Water Conservation' tt';
Y� �O Other Agency „xt �, P
`-yzt�-✓ ..-Y T. ,. ._ s.�... .,'L� _.. _ .-. _._ ._ ,. , �. _ 3.
Type of Visit IRCompliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit Routine O Complaint O Follow up Q Emergency Notification O Other ❑ Denied Access
Facility Number
Date. of visit:Time: Printed on: 7/21/2000
� �
NNot O erational Q Below Threshold
Wermitted 13 Certified 13 Conditionally Certified 13 Registered Date Last Operated or Above Threshold: .........................
Farm Name: ..
G`F................................. ...... County:......... ...... .1.� .....................---
............................................ .. .... ..................... ....
Owner Name:
Facility Contact:
Title: .................... —
Phone No:
Phone No:
MailingAddress: ............................ ..............................................................................................................................................................
Onsite Representative:. ........................
. ...
' ........................................................ Integrator:..,l..!!.�`1 -
Certified Operator:................................................................................................................ Operator Certification Number: ..........................................
Location of Farm:
❑ swine ❑ Poultry ❑ Cattle ❑ Horse Latitude Longitude •
Design Current Design Current Design Current
Swine Capacity Population Poultry Capacity Population Cattle Capacity Population
❑ Wean to Feeder JE1 Layer I I ❑ Dairy
Feeder to Finish ❑ Non -Layer I I IE]Non-Dairyl
❑ Farrow to Wean
❑ Farrow to Feeder ❑ Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ Boars Total SSLW
Number of Lagoons ❑ Subsurface Drains Present lip Lagolon Area ❑ Spray Field Area
Holding Ponds / Solid Traps ❑ No Liquid Waste Management System
Discharges & Stream Impacts
I. Is any discharge observed from any part of the operation? ❑ Yes tKNo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed: was the conveyancc man-made? ❑ Yes ❑ No
b. if discharge is observed, did it reach Water of the State? (If yes, notify DWQ) El Yes ❑ No
c. If discharge is observed. what is the cstimaled 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 ikNo
3_ Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes tRrNo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes RNo
Structure I SLI-Wture 2 StTUClllre ; Structurc 4 Structure 5 Structurc 6
IdentiFier: ..........................................................
Freeboard (inches):
5100 Continued on back

Facility Number.- ` —`t4Q Date of Inspectiola 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 XNo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closureplan? ❑ Yes ff 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?
8. Does any part of the waste management system other than waste structures require maintenancelmprovement?
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?
U. Is there evident of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
12. Crop type \tD S
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14, a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc_)
19_ Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative'?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
yiolafi[jtis:or deCeiertcies were npfed• di&ing 4iiis:visit; -.Yoi} will-t&ic iye iio further -: -
;correspondence. a�aut t�tis visit. . . .. . .. . ...
XYes ❑ No
❑ Yes 9No
14Yes ❑ No
❑ Yes WNo
❑ Yes bdNo
,KYes ❑ No
❑ Yes W No
❑ Yes ❑ No
❑ Yes ❑ No
[XYes ❑ No
❑ Yes XNo
❑ Yes XNo
❑ Yes JXNo
XYes ❑ No
❑ Yes MNo
❑ Yes ,rNo
❑ Yes ❑ No
❑ Yes XNo
[-]Yes KNo
❑ Yes RrNo
Comments (refer to question #): Explain any YES answers and/or any recommendations or any.other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary): }
'V VA 114� U-4
ks
�vLc.1t--� G�� �2T` �-t IL'�� G�t��«�►-ES t4
S
Reviewer/Inspector Name
la- 3 yS=31O0
Reviewer/Inspector Signature: ���� �` 1` %-_, Date
5100

T
1 Facility Number:Date of Inspection Printed on: 7/21/2000
Odor Issues
26.
Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge Wor Wow
Oyes.
❑ No'
liquid level of lagoon or storage pond with no agitation?
27.
Are there any dead animals not disposed of properly within 24 hours?
❑ Yes
((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 Iand 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
o
32.
Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes
WNo
Additional'Comments'and/orDrawings:
t r�
A�
� --`(S }
sc�-.sz -�Ye�j boa �e�•cc��LLi,
� ►
�
)rv. Lee R;
,
Xr
r
5/00 6, W L-\p

Division of Soil and Water Conservation -,Operation Review
? _
[] Division of Soil and. Water Conservation Compliance Inspection
Division 4 Water Quality = Compliance Inspechoii
y
Other, Agency = Operation Review=_- -
Q Routine Q Complaint Q Follow-up of DWQ inspection Q Follow-ug of DSWC review Q Other
Facility Number Date of Inspection
V Time of Inspection Q 24 hr. (hh:mm)
Permitted © Certified [3 Conditionally Certified © Registered [03 Not Operational Date Last Operated:
Farm Name: ...G.tT....Cs........ County:...... .....
OwnerName: ................................................... ........................................................................ Phone No........................................................................................
FacilityContact: ..............................................................................Title:...................... ... Phone No:...................................................
MailingAddress: ..................................................... .............. ........... ...................................................... ..........................
Integrator1OnsiteRepresentative:.......................................................................... ......&+1......................................................
Certified Operator: ....... Operator Certification Number:
Location of Farm:
Latitude ' 4 " Longitude • 4 �
Design . Current Design Current Design Current
_. -., _
Swine Capacity --Population Poultry Capacity Population Cattle Ca acty Population
❑ Wean to Feeder ❑ Layer ❑ Dairy
ceder to Finish ❑ Non -Layer ❑ Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder ❑Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ Boars Total SSLW
Number of Lagoons~ ❑ Subsurface Drains Present 11n Lagoon Area 10 Spray Field Area
Holding Ponds 1 Solid Traps ❑ No Liquid Waste Management System
Discharizes & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ElLagoon ❑ 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
A.
❑ Yes KNo
[-]Yes [:]No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes No
❑ Yes No
❑ Yes [�rNo
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard (inches):
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
❑ Yes NrNo
Continued on back
3/23/99

Nacilit._,Number: EYE]
Date nl' luslFtclion
6. Are there structures on -site which are not properly addressed and/or managed through a waste managcmenl 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"
S. 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 A1212fication
10. Are there any buffers that need maintenancehmprove ment?
I. is there evidenjK of over application? f ❑ Excessive Ponding ❑ LAN
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination'?
c) This facility is pended for a wettable acre determination'?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment'?
Required Reenrds & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
1S. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps. etc.) y
19. Does record keeping need improvement? (ic/ 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?
.: Rio yiolatitjtis:oi-• d idencies -Were noted• d& tig this:visit; • Y64 WitI-eeeeiye ino further
corris� 6iidence. about: this Visit : : : : : : : : : : :
❑ Yes T�No
❑ Yes XNo
❑ Yes XNo
❑ Yes b(No
❑ Yes JX No
❑ Yes RNo
❑ Yes KNo
❑ Yes �<No
❑ Yes ❑ No
VrYes ❑ No
MYes ❑ No
❑ Yes XNo
❑ Yes MNo
❑ Yes CRrNo
XYes ❑ No
❑ Yes DR'No
❑ Yes [N�No
Comments (refer to question #): Explain any YES -answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
❑ Yes b;rNo
❑ Yes kNo
❑ Yes frNo
❑ Yes [YNo
{C- A I �.R -5�► 1 h ov-ec� ct� ► ,r e 2`4 ,
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Date:
3/23/99

Facility Number:3 — o I Date opf ltlspection
'i
Odor Isstles
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
JRrNo
28.
Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
-]Yes
ONO
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
EYNo
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
,INo
31.
Do the animals feed storage bins fail to have appropriate cover?
❑ Yes
�rNo
32.
Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover'?
❑ Yes
KI,, 'No
3/23/99

x [3 Division of Soil and Water Conservation ❑ Other
Division of Water Quality
10 Routine 0 Cam laint 0 Follow-up of DWQ inspection 0 Follow-uE of DSWC review 0 Other
Date of Inspection 7 g
Facility Number 6 d
Time of Inspection '.Oa 24 hr. (hh:mm)
© Registered JoCertified [3 Applied for Permit M Permitted JE3 Not Operational I Date Last Operated:
Farm Name: --.... CLri .. '�......�C3h .....% D ... u+�►� County:......... �.0 ��.?^.......................'�:.................. .........---............---
Owner Name: ........ . ........................e.4........... . c+:! . Phone No: Cq l . .u�i. t.........................................
Facility Contact:.....................................G. .... !! G'� .. Title:........... .. Phone No:
Mailing Address:......Lr$........ AtU �0 ...... 4r.�r..::.... ............................... ..........in �oRf.�,ce G:.3....Nt... .............. ............... Zr$ ......
Onsite Representative ..............0 .... AW.......................................................... Integrator: ..... ti( ...........................
Certified Operator ................................................... ............................................................. Operator Certification Number:..................
Location of Farm:
.....ct,....... s .e:...r� ..... s.... t�..,.... a..:..... r��► .�....s..........:.............Fta.......................................------.........................
.. ....................
Latitude 0 6 66 Longitude 0 4 66
ant Design Current.:_._.
❑ Wean to Feeder
Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
General
1. Are there any buffers that need maintenance/improvement? ❑ Yes 0 No
2. Is any discharge observed from any part of the operation? ❑ Yes R1 No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes JU No
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ) ❑ Yes '10 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 fA No
3. Is there evidence of past discharge from any part of the operation?
❑ Yes
j)I No
4. Were there any adverse impacts to the waters of the State other than from a discharge?
❑ Yes
No
5. Does any part of the waste management system (other than lagoons/holding ponds) require
❑ Yes
No
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
No
7. Did the facility fail to have a certified operator in responsible charge?
❑ Yes
No
7/25/97

Facility Number: _; l -
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (Laeoons,Holding Ponds, Flush Pits. etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier: I t...............................................Z.
. Z.. .....................--....................................... ..
Freeboard(ft): .......... .:.................. Z � .....3 •$ ...................................................................................
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 AoDlication
❑ Yes NJ No
❑ Yes
IN No
Structure 5 Structure 6
............................. ...............................
❑ Yes
Q No
❑ Yes
JQ No
R Yes
❑ No
❑ Yes 6@ No
14. Is there physical evidence of over application? ❑ Yes $ No
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
,L I
15. Crop type ............ �i�Y.YxaUh..'m ........ �Lsuj.:L......... dO.A �il....�yk&;r>.------.......�1:: ...... !_.......... ii48 -......................................•.
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)? ❑ Yes Ewo
17. Does the facility have a lack of adequate acreage for land application? ❑ Yes 0 No
18.
Does the receiving crop need improvement?
00Yes
❑ No
19.
Is there a lack of available waste application equipment?
❑ Yes
ONo
20.
Does facility require a follow-up visit by same agency?
❑ Yes
VNo
21.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
ONo
22.
Does record keeping need improvement?
Yes
❑ No
For Certified or Permitted Facilities Onl
23.
Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑ Yes
P No
24.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
No
25.
Were any additional problems noted which cause noncompliance of the Permit?
❑ Yes
No
[]• No.violatio'ns-or deficiencie's.were-noted-during this -.visit., You.'v0 f eece.i've•'616rther:
:�:-corresponde�ceaiiouE•Ellis:visif.•::.�..�.•..• •. ,-_-. _- �..-_-.•..�...-.•.....- - - • •'
tp�--�fa5
Co�rw L el � �'J& . wo, <4-t A g 1`o ►.
ia. �5,� �v� Woi%,ru� a,_ "uk c you ,5 4-
27- Sk#JJ bt- 'k4t�aciti S a+� `S'Uli. �y4N iaa�t� S M-o acc� i.�U� S�atil�J
6 vs-eci wkL,,- e_,,.Icv1o.4 Y6 �yog w. Lto-ce5_ • t..49acr- Tar V,, Z old-0- 1a9avrLg
7/25/97
Reviewer/Inspector Name
"bdre e
Reviewer/Inspector Signature:j,1,
Date:

Routine O Complaint O Follow-up of DWQ inspection O Follow-up of DSWC review O Other
Date of Inspection
Facility Number .S Time of Inspection ! 24 hr. (hh:mm)
Total Time (in fraction of hours
Farm Status: ❑ Registered ❑ Applied for Permit (ex:1.25 for 1 hr 15 min)) Spent on Review 0
Certified ❑ Permitted or Inspection includes travel andprocessing)
❑ Not Operational Date Last Operated:
Farm Name:. W.i1C . .r�ar-f1_n'..........
Land Owner Name:..
Facility Conetact:...fe.L..�...._............... _........... _ ..�Tiitle:
Mailing Address:.....[ 4.k.......... �-'l e 1 L.�i1 W,LL ... �r1 ..... _..._.......
Onsite Representative:...... t"5 .. .. 1.? Dui ff—i..........._
Certified Operator -
Location of Farm:
County:...... \b-4.... .... __ ... ...... ..... ----
Phone No: J,d,r?�? ..
rr Iqb-�34D.. .
_......... Phone No:..L�] lc� z�'! I?# ..............
—.Lkki(e.r-eT ---.......... W....__.... ........
Integrator:...Xur� 4---.....---- _..... ..................
I _............. .....».. Operator Certifications Number:11,1-7...........
.. ..,» .
- ,...aaI.-._ r-4' .....c�n1._ �� 1�..... - . e '.... ata ...... .. �.12-11 -1
S......0 Lz ..�`1. -4-5 ! ..511 S) ............. _................ ........ ....... ..... ........... _......... ...._._.... . �y
Latitude �• ©� Longitude �•"
Type of Operation and Design Capacity
Design Current . Design Current; ' � Design Current
Swrne Ca aci „ Po ulatian Pouitiy Ca� acit� .Po `ulation - Ca ace - Pa elation
❑ Wean to Feeder ❑ Layer❑ D
Feeder to Finish IM ❑ Non -Laver ',. � . iry
r
Farrow to Wean'W.0R ,
4; Farrow to Feeder TotalDesignapac><ty
Farrow t o Finish
. F „ Tot ssLw01.
❑ Other �. � �� t � � ��
Number of1Lagvons:! Hold�ngPonds Subsurface Drains Present
�F �� � "�° � ��" �,y� ❑Lagoon Area ❑Spray Field Area «:'� � ��
General
1. Are there any buffers that need maintenance/improvement? ❑ Yes PgNo
2. Is any discharge observed from any part of the operation? ❑ Yes ® No
Discharge originated at: ❑ Lagoon ❑ Spray field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes No
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ) ❑ Yes No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes No
3. Is there evidence of past discharge from any part of the operation? ❑ Yes P No
4. Were there any adverse impacts to the waters of the State other than from a discharge? ❑ Yes [A No
5. Does any part of the waste management system (other than lagoons/holding ponds) require ❑ Yes [% No
4/30/97 maintenance/improvement? Continued on back

Facility Number:....]...... •--...._
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
7. Did the facility fail to have a certified operator in responsible charge?
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (Lagoons and/or Holding Ponds)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Freeboard (ft): Structure 1 Structure 2 Structure 3
.: S ....... ...._........... ....... �................
10. Is seepage observed from any of the structures?
Structure 4
11. Is erosion, or any other threats to the integrity of any of the structures observed?
❑ Yes j9 No
❑ Yes W No
❑ Yes EA No
❑ Yes 0 No
Structure 5 Structure 6
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 _.............uxmt. ......... _..... - �._........
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?
For , ertifed FacilitiCs Only
22. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
23. Were any additional problems noted which cause noncompliance of the Certified AWMP?
24. Does record keeping need improvement?
❑ Yes No
�J Yes ❑ No
Yes ❑ No
❑ Yes 54 No
❑ Yes ® No
❑ Yes [%No
❑ Yes 0 No
❑ Yes (&No
❑ Yes ® No
Yes ❑ No
❑ Yes [9 No
E9 Yes ❑ No
❑ Yes EX No
❑ Yes (gNo
Comments (refer to'question #Explain any YES- answers andlo,any recommendationsor any.other comments
Use drav�nngs of facility [o better explain situations: (use additional pages as necessary) �,,
l�•%2• JUIo„�ar cCaSibh ni s -,%Wd be � 14J c, rese4eJ. Ems+or\ lh S,6rrnk# .tr 4
6�vkvs;or• skoulJ Le— t-W c,.4 mse�ecW. goy srts Skould be reseer}ej• i_F „
G.)C'I1 g S kojV b C. VVwU)J
ZZ. CAWM� was na� 4vai�a e �� �inmk o� �nS�QeT14�
a
cc.- "Swaron vl rraicr %&uasuey, rrader Vuuuay aeLwuon, r-acssuy rassessment unit Wjvty 1

Z.,
-A
EIDSWCAhifti Q
o operation Oki
'U
a.
—limar-F."iedlOtMP
M
eratb
'FE: MQ Inspection
sv�
gZ-O" gw
WX
5.
10 Routine 0 Complaint 0 Follow-up of DWQ inspEction 0 Follow-ue of DSNVC review 0 Other
Facility Number Date of Inspection M IN!]
Time of Inspection 46 24 hr. (hh:mm)
Total Time (in fraction of hours
Farm S . tatus: D Registered [I Applied for Permit (ex:1.25 for I hr 15 min)) Spent on Review 7-
ER Certified 0 Permitted or Inspection (includes travel and processing)
D Not Operational Date Last Operated: . ..... . .....
Farm Name: —CV4. -Cadzr... -J't- County:
Land Owner Name: .... . .... . ...... Phone No:
Facility Title: . ............... ...... . ...... . ...... . Phone No:
Mailing Address:-&k1....-1Lt,;iNkftL ... --- Kc,
Onsite Representative:.............. Integrator:.- - - ----
Certified Operator: ....... .... ........... . ..... . ....... . ..... . . .... —, Operator Certification Number:
Location of Farm:
Latitude 0 6 " Longitude A 94
Type of Operation and Design Capacity
Design Q 'Mm
Ccrrent
6,
Swinea Ps onv g-, po"'Pul c VIA
Uy % Capiii0h an tv
1'g,
Feeder Dairy
La er
XI Wean to
y
[I Non -layer ❑ILI Non- Dairy I
10 Feeder to Finish v44 V
0-77=77@ 7��77.75
M-0 Farrow to Wean 77
M,
Farrow to Feeder Total W61ffnA7'aPaCq
Q Farrow to Finish,
T
.... ........ 3SM,
Other
21
. . . . . . . . . .
Number 0-u'Eago ons ID Subsurface Drains Present
Lagoon Area ❑Spray Field Area
K RE.
Qeneral
1. Are there any buffers that need maintenance/improvement?
2. Is any discharge observed from any part of the operation?
Discharge originated at: 0 Lagoon 0 Spray field 0 Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
3. Is there evidence of past discharge from any part of the operation?
4. Were there any adverse impacts to the waters of the State other than from a discharge?
0 Yes No
D Yes No
[I Yes 14 No
[I Yes 1j] No
14
D Yes Et' No
El Yes W No
D Yes 0 No
5. Does any part of the waste management system (other than lagoons/holding ponds) require
4/30/97 maintenance/improvement?
0 Yes qd No
Continued on back

Facility Number:... Z....... —..3!.
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes @j No
7. Did the facility fail to have a certified operator in responsible charge?
8. Are there lagoons or storage ponds on site which need to be properly closed?
Strugtures (Lagoons and/or Holding Vondsk
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Freeboard (ft): Structure 1 Structure 2 Structure 3
r:s .... ...._. .......... ..........._..... _.....
10. Is seepage observed from any of the structures?
Structure 4
11. Is erosion, or any other threats to the integrity of any of the structures observed?
❑ Yes P No
❑ Yes V1 No
❑ Yes Ej No
Structure 5 Structure 6
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 ........................................................
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?
2l. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
Fo-r-Certified Facilitiel fLnly
22. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
23. Were any additional problems noted which cause noncompliance of the Certified AWMP?
24. Does record keeping need improvement?
❑ Yes No
51 Yes ❑ No
® Yes [:]No
❑ Yes Oa No
❑ Yes 0 No
❑ Yes No
❑ Yes No
❑ Yes ® No
❑ Yes FA No
[� Yes fil No
❑ Yes Vd No
MYes ❑ No
❑ Yes ® No
❑ Yes ® No
Cominents,(refer to questioa`#f) EXplam any YES:answers::arid/or any recommendations or any other comments.
Use drawings,of facility to better explain situations.; (use additional pages: as necessary) "" Y
fl1z• emior\ arounr} lr4� lr skod1 be. -O(WeJ "d iA�
rsceaea, �Cbn Walk -- VW L mowed.
c,kWAO was rof QYQl to,b�- ai �Iy'lk of
a
cc: "wiston o> water Livattry, Prater Vuattry.3ecuon, racttrry Assessmenr VISIT 4/3u/y

Site Requires Immediate Attention:
Facility No. 3 1 • / G 4
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: , 1995rfl�
%!9/� �►'� l Time: .
Farm Na
Mailing
County:
Integrate
On Site I
Physical Address/Location:
Type of Operation: Swine Poultry Cattle
Design Capacity: Number of Animals on Site:
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: ° ' P20 Longitude: Elevation:, Feet
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches) es r No Actual Freeboard: S Ft. �,_ Inches
Was any seepage observed from the lagoon(s)? Yes or®o Was any erosion observed? Yes or Q
Is adequate land available for spray? (D or N Is the cover crap adequate? es r No
Crop(s) being utilized: — 3
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings? es)or No
100 Feet from Wells? Ge or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes a5
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes or
Is animal waste discharged into waters of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes oi& If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage, with cover crop)? I&or No
Additional Comments:
•
z6h=16
Inspector Name
Signature
cc: Facility Assessment Unit
Use Attachments if Needed.

3/-/lro
•
•
Site Requires Immediate Attenti
' Facility No.
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT -OPERATIONS SITE VISITATION RECORD O
DATE: 2— ( , 1995 C� 1 b
Time: I jL:, 3
Farm Name/Own(
Mailing Address:
County: OL r?� /j f _.. .
Integrator. V' Phone:
On Site Representative: do AJN 1 ' C—. Phone:
Physical Address/Location:
Type of Operation: Swine. t/ Poultry Cattle
Design Capacity: Number of Animals on Site: �3L I. -Z
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: T ° SY ' �" Longitude: �° �S' Elevation: Feet
Circle Ye or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately •1 Foot + 7 inches) Ye or No Actual Freeboard: 3 Ft_ Inches
Was any seepage observed from the lagoon(s)? Yes or Vo Was any erosion observed? Yes or(9
Is adequate land available for spray? Yeslor No Is the cover crop adequate? es or No
Q_
Crop(s) being utilized:
Does the facility meet SCS minimum setback tena? 200 Feet from Dwellings? ebr No qGY'
100 Feet from Wells? CC)or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or 0 .
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes or
Is animal waste discharged into waters of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes or I�o If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? or No
Additional Comments:
nN�
Inspector Name
Signature
cc: Facility Assessment Unit Use Attachments if Needed.

NORTH CAROLINA
Department of Em mnmental Qual

[Reason
ype of Visit: UCompliance lnspec n O Operation Review O Structure Evaluation O Technical Assistance
for Visit: O Routine Complaint 0 Follow-up 0 Referral O Emergency 0 Other 0 Denied Access
Date of Visit: G 7 Arrival Time: ® Departure Time: A /J County: Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative: f' (4 y co Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number: -T 1 ` r'
Certification Number:
Longitude:
Design Current Design Current
Swine Capacity Pop. Wet Poultry Capacity Po
Wean to Finish Layer I
Design Current
Cattle Capacity Pop.
I Dairy Cow
can to Feeder
I
jNon-L2yer I
Dairy Calf
'Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Design Current
Dr, P.oult . Ca aci P,a
Layers
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turkeys
Turkey Poults
Other
Discharges and Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other: `
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
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 ❑ 5<Fj NA ❑ NE
❑ Yes ❑ NA ❑ NE
❑ YesPNo"*[:] NA ❑ NE
Page 1 of 3 21412015 Continued

Facility Number: jDate of inspection:
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: Z 3
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? Yes o ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental reat, 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? ❑ YesFa"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 E3No ❑ NA ❑ NE
maintenance or improvement?
Waste Aoolication
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 E! 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?
N
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 VNo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yesg�No
❑ NA
❑ NE
the a ro riate box
PP P
❑ WUP ❑Checklists [—]Design ❑ Maps ❑ Lease Agreements ❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. o Yes 6 No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall []Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V 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? ❑ Yes2No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facility Number: i - i Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
No ❑ NA
❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
D. Yes
RNo ❑ 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?
00'Yes
No ❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
LI "'o NA
❑ NE
Other Issues
No
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
E ❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
[—]Yes
O/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
io 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 facilityrequire a follow-up visit by the same agency?
❑ Yes
No ❑ NA
❑ NE
lComments,(refer to;question-#) Explain any YES answers -and/or. any additional recommendations or -any other comments.-
use'drawiugs of facili ao better_ex lain situations, use:additionals aes as=necessa tY F ( 'pages ry)..
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Reviewer/Inspector Name: `� ` ��.-( l 5� LA �1Phone:
Reviewer/Inspector Signature: K�_ /� Date: wh'
Page 3 of 3 21412015