710043_INSPECTIONS_20171231

NORTH CAROLINA �
Department of Environmental Qua

Owner Name:
Mailing Address:
Phone:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative: C4L''! S r1/1 `_ _ Integrator:
Certified Operator: Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Swine
Wean to Finish
Design
C►►opacity
Current
Pop.
Design Current
Wet Poultry C**opacity Pop.
I 11-ayer
Cattle
Dairy Cow
Design Current
Capacity Pop.
Wean to Feeder
I
INon-Layer I
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design Current
Dry Cow
Farrow to Feeder
Dr, P,oult , Ga aci_ $o
Non -Dairy
Farrow to Finish
ILayers
Beef Stocker
Gilts
Non -Layers
jBeef Feeder
Boars
Pullets
113eef Brood Cow
Ot
Other
Turke s
ey Pouits
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 D WR)
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 Ealo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
[:]Yes 6/No ❑ NA ❑ NE
[:]Yes [ No ❑ NA ❑ NE
Page 1 of 3
912412013 Continued

Ivadili Number: - Date of Inspection: .1
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
�Yes��,o
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: 2—(9"
�
wa
S ill�:
P y
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
No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental
threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
❑ No
❑ NA
❑`NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[:] No
❑ NA
ETNE
(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
0--NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ❑ No ❑ NA NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below, ❑ Yes ❑ No [DNA NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ Yes
❑ No
❑ NA
[Z NE
❑Yes
[:]No
❑NA
UNE
❑ Yes
[—]No
❑ NA
El"NE
❑ Yes ❑ No 0 NA 1E
❑ Yes ❑ No ❑ NA &NE
❑ Yes ❑ No ❑ NA &INE
[:]Yes ❑ No ❑ NA F3r<E
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ N
No
❑ NA ❑ Nd
❑ Weather Code
❑ Sludge Survey
❑ NA [�E
❑ NA F7 NE
Page 2 of 3
9124120I3 Continued

Fafi ' jDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the perm t?
❑ Yes ❑ No ❑ NA ETNE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes ❑ No ❑ NA NE
the appropriate box(es) below_
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes ❑ No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
0 Yes ❑ No tA_ ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes ❑ No ❑ NA LJ i E
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 fo ❑ 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 Q-I'o ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes �❑ NA ❑ NE
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes LJ No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes ET�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).
wn A0
0e-[ k L_'3oon
(P ci'- I S 4-, l"t o ^ S'k—)
lr' 0 a b.o" f sit
, i" A-c "�• � S nee
�1Q -�j 6 730Lt
Reviewer/Inspector Name: (_Au,11 `!O ­-C 1
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 1` n -7 7
Date: ! J / G
9/24/20I3

Type of Visit: (Z) Compliance Inspection Q Operation Review p Structure Evaluation p chnical Assistance
Reason for Visit: O Routine O Complaint O Follow-up Q Referral Q Emergency .Other O Denied Access
.I
Date of Visit: Arrival Time: tip Departure Time: County: C-NDF_(L_ Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Onsite Representative: C-Aal? 2rt zDG r,>J Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Certification Number:
Certification Number:
Longitude:
Swine
Wean to Finish
Design
Capacity
Current
Pop.
Design Current
Wet Poultry Capacity Pop.
C►attle
DairyCow
Design
Capacity
Current
Pop.
Wean to Feeder
"INon-Layer
I
El
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Design Current
MDRIC•a -0 P,o ,
Layers
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
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?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes No
❑ Yes [:]No
[:]Yes ❑ No
[:]Yes [:]No
❑ Yes dNo
0 Yes [-]No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ONE
Page I of 3 21412011 Continued

Ficili Number: - Date of Inspection:
Waste Collection & Treatment
4. M forage 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?
Structure 1
Identifier: (AGjoA%
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): P
Structure 2 Structure 3
❑ Yes ❑ No ❑ NA ❑ NE
Structure 4 Structure 5 Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
❑ Yes No ❑ NA ❑ NE
❑ Yes [,%(No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environment threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ YesVNo ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require [—]Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ZNo ❑ NA ❑ NE
maintenance or improvement?
I I - 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 No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes VNo
'' ❑ NA ❑ NE
lb. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a tack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑WUP ❑Checklists [:]Design ❑ Maps ❑ Lease Agreements
❑ Yes 0 No ❑ NA ❑ NE
[-]Yes YNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA NE
❑ Yes [] No ❑ NA FTNE
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ Nc
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes ❑ No
[:]Yes [:]No
❑ NA
❑ Weather Code
[]Sludge Survey
❑ NA E(NE
❑ NA [v3 NE
Page 2 of 21412011 Continued

Facili Npmber: I j Date of Inspection:
24tR7id thecfacili fail to calibrate waste application equipment as re required b the erm ? Yes No NA
tY PPq Y P ❑ ❑ ❑
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑ No ❑ NA gE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey [:]Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
[:]Yes [—]No ❑ NA
d
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes ❑ No ❑ NA
gYNE
Other issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes No , ❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes 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 the 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?
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 o4o ❑ NA
❑ Yes C3 N ❑ NA
❑ Yes No ❑ NA
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or airy other comments::_
Use drawings ofafacility to better explain situations (use-additiogal pages as necessary):I :
❑ NE
❑ NE
❑ NE
�) Mta.�trlt-E c.RtLE 0 R �� C in►�i} NouSC5 �Lf3CEr� vr•J �cf In/AC air t-AC7x�i
W XT A RAI►.1 t JA sTC; N A S 67004 ' NTo D=rt`IG_q MIJ ec TI,J4- L r✓ -rGj,, t ra G,>r..f,5
DisPaSr ,sF " LPtL�" 1�6ZoP��•-l.� Nd� To �uu.ol�/.
Reviewer/Inspector Name: � d� +A� LZ
Reviewer/Inspector Signature:
Page 3 of 3
Phone: o D) —m
Date: L
21412011

Type of Visit d
Compliance Inspection
0 Structure Evaluation
0 Operation Revi;/Referral
0 Technical Assistance
Reason for Visit
0 Routine 0 Complaint
0 Follow up 0 Emergency
0 Other ❑ Denied Access
Date of Visit: g v Arrival Time: Departure Time: County: &Dta_ „_ Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Owner Email:
Phone:
Onsite Representative: GRtif l-mDGEfaw! Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone No:
Operator Certification Number:
Back-up Certification Number:
Latitude: 0 c 0 ` 0 " Longitude: = ° = d =
16
Design Current Design Current Design
Swine Capacity Population ItPoultry Capacity Population Cattle Capacity
Current
Population
❑ Wean to Finish
10 Layer I
I
❑ Dairy Cow
❑ Wean to Feeder
❑ Non -Layer I
❑ Dairy Calf
® Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
/Uc"
17-1-Y
❑ Dairy Heifer
Dry Poultry ❑ Dry Cow
ElNon-Dairy
❑ Layers
❑ Beef Stocker
❑ Farrow to Finish
❑ Non -Layers
❑Beef Feeder
❑ Gilts
El Pullets
❑ Beef Brood Co
El Boars
❑ Turkeys
❑Turke PouIts
❑ Other
Number of Structures:
Other
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Yes ❑ No ❑ NA ❑ NE
❑ Yes VNo
K ❑ NA ❑ NE
❑ Yes ❑ NA ❑ NE
❑ Yes ElNA ElNE
ElYes �No ❑ NA ❑ NE
❑ Yes WNo ❑ NA ❑ NE
Page 1 of 3 12128104 Continued

Facility Number: �] — Date of Inspection S 0
i
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ' No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure Structure 3 Structure 4 Structure 5 Structure 6
Identifier: (A "d-P-) i �A &174rN/L
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 31 T3
5. Are there any immediate threats to the integrity of any of the structures observed? ❑yes No [INA [INE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes ZNo ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental thy�at, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes �WNo
/o ❑ NA El NE
8. Do any of the stuctures lack adequate markers as required by the permit? El Yes ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes dNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ENo ❑ NA ❑ NE
maintenance/improvement?
H. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes dNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
0 No ❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
El NA
❑ NE
16. Did the facility fail to secure and/or. operate per the irrigation design or wettable acre determination?[] Yes
,_(eNo
o ❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
El Yes
Zo ❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
WN o ❑ NA
❑ NE
r) RCLgctf, Lr,uF Lo sr F AkJf PitE AN D
FLAT✓ L-Aue(P 6N G2oU09 8E SzM"
Ga,,"Ns oii Gl-ourJ.0, fAajvnrcn 'T6
oarixP1= 4 A6& PoUSIL pIDPno,c.>rrv+r9r�1,r �o
CUT ZWr6 GI -AV To ?Q.�,vtat FtomJ,
Reviewer/Inspector Name [ (J o 0 �� Phone: D 6' i� 88
Reviewer/Inspector Signature: Date: S o
Page 2 of 3 12128104 Continued

t Facility Number: — y Date of Inspection 6
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ❑ No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ❑ No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design El maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
Cl No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
❑ No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
❑ No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
❑ No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
❑ No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
❑ No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss reviewtinspection with an on -site representative?
❑ Yes
❑ No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
❑ No
❑ NA
❑ NE
X
Additional Comments and/or Drawings, k ...
Page 3 of 3 12128104

r T JVDivision of Water Quality
Facility Number O Division of Soil and Water Conservation
O Other Agency &Z 11
Type of Visit P Compliance Inspection O Operation Review O Structure Evaluation Q Technical Assistance
Reason for Visit Routine 0 Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: (Oho _ Arrival Time: r Q Departure Time: County: Region:
Farm Name: /`2Z,C�%.-��✓ 6 /Z, Owner Email:
Owner Name: - /�_A 2c/ ZCr /`� Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: Ll
Certified Operator: A_A2j,1__ Z-dQQC=:J-lt)
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
Phone No:
Integrator•
Operator Certification Number:
Back-up Certification Number:
Latitude: = o �, Longitude: = o = & "
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Laver
❑ Non -Layer
Dry Poultry
Pullets
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?
Cattle
Design Current I
Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifej
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes oNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes Y No ❑ NA ❑ NE
❑ Yes �O No ❑ NA ❑ NE
12128104 Continued

r
Facility Numbim: VLJ Date of Inspection D
"Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes ;ZNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ElYes ❑ No ❑ NA ❑ NE
S cture 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: uo /d
Spillway?: 4ho f 10
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes PdNo ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ONo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? Yes ❑ No ElNA ❑ 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 YNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes Y(No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes �No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside ol,Axca
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes /JVNo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
No
❑ Yes A
❑NA
ElNE
18. is there a lack of properly operating waste application equipment?
❑ Yes YNo
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
vF>:D /-, 0 ;.J 0&0
Je
L
er/Inspector Name � �/f O Phone:er/Inspector Signature: Date: O
121281041 Continued

S
r
Facility Number: — Date of Inspection �Q
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20.
Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
VNo
❑ NA
❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design [I Maps ❑Other
2l.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
[/No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and l"
Rain Inspections
❑
Weather
Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
1p�No
❑ No
NA
ElNE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
ElYes
X No
9NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
XNA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
Yes
❑ No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
16 No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
[ No
❑ NA
El NE
If yes, contact a regional Air Quality representative immediately
/
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
� No
[I 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
,.,/
L� No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
VfNo
❑ NA
❑ NE
Additional Comments and/or Drawings: '
,sin c oNr /p G, / v� 5 Aloo
�wT
I`'
��n � � J�i��c-off � �o� ���� Cf_�` ✓� L `�D•v--

Frim. lity Nl
Type of Visit Cr7Routine
pliance inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: 71a o S Arrival Time: tnCiO Departure Time: County: REAM -_- Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: GA6ze� �R�G�
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
Boars
Owner Email:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: 0 0 = 4 Longitude: = o =
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -La et
Other
❑ Other ----- -- --- ... ---
Dry Poultry
❑ La ers
❑ 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 Heifer
ElDry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes ['�No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
3 No
❑ NA
❑ NE
❑ Yes O No ❑ NA ❑ NE
12128104 Continued

Facility Number: -7 Date of Inspection 7 oS
Waste Collection & Treatment
/No
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
❑ 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: GA[,oacJ t L A(. 00M 'L
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
N
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
No
❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental notify DWQ
threat,
7. Do any of the structures need maintenance or improvement?
❑ Yes
E No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
[TNo
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
ETNo
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
El Yes
,,_/
IT No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
,,��,,//
L_uf No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside
of Area
12. Crop type(s) rAsL'_CT LJ(A CAT
13. Soil type(s) (:, tz
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
EfNNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
53 No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination',[]
Yes
93 No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
P No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
`i N10
❑ NA
❑ NE
WON-- - ON C>00ft- A&Zk_%_C T S-rAND L-0
7 0;3-rA:rt'1 r3E9_t-6'0
00 V rJ �zAz i1.1. tasile C 1 . J i'OAjE
Reviewer/Inspector Named Phone: An)) ?9�-7 �-b
Reviewer/Inspector Signature: Date:
1212FI04 Continued

Facility Number: Date of Inspection a5
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CA7Design
P readily available? If yes, check El Yes El No El NA ❑ NE
❑
the appropirate box. WLrP ❑Checklists El Maps El Other
2I . Does record keeping need improvement? If yes, check the appropriate box below. 0Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Wee Freeboard ElWaste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
ElRainfall ElStocking Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections El Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes E: No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes E No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ❑ No EINA ❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit? ❑ Yes ❑l No BNA ElNE
26. Did the facility fail to have an actively certified operator in charge? ElYes eNo El NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? El Yes El No LI NA ❑ NE
Other Issues
28. Were anv additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
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
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes O No ❑ NA ❑ NE
❑ Yes L" No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes 2No ❑ NA ❑ NE
❑ Yes L -14 ❑ NA ❑ NE
❑ Yes Rio ❑ NA ❑ NE
Additio"naI Cornmeiitsaaad/or Drwl s `
ag_r
"}�
ap�4�
12128104

Facility Number 71 43 Date of Visit: 3/17/2004 Time: 1520
O Not Operational O Below Threshold
® Permitted ® Certified 0 Conditionally Certified 13 Registered Date Last Operated or Above Threshold:.............
Farm Name: P.ddzca.Farm.Site.#.2.................... County: F.911der ............................................... WjR0 .........
Owner Name: G.ary...W.................................... Pjrjft.0 ................................................. Phone No: 9�0-22-S2QQ.�t�l.l�0-S1.7.X..(lYtl....................
Mailing Address: bS.l�Qxs�. �aJLl�hl.l a�d.................................................................... um:gaw..NC........................................................... 20.4Z5 .............
Facility Contact: .....
Onsite Representative:...
Certified Operator:.Gay.Aay e..
Location of Farm:
Title:................................................................ Phone No:
Integrator: Hurpity. :amlly.Fums...........................
Pridgm............................................ Operator Certification Number: 27.2Q,7..............................
Vest of Burgaw & Rhyne Crossroads. On North side of SR 1216 approx. 1 ndle West of SR 1336. �
® Swine ❑Poultry ❑ Cattle ❑Horse Latitude 34 • 346 F 35 u Longitude 78 • �4p
Design Current
Swine Canacity .Ponulation
❑ Wean to Feeder
® Feeder to Finish
1800
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Number of Lagoons I
Discharges & Stream Impacts
Design Current Design Current
Poultry Canacity Population Cattle- Capacity Population
❑ Layer _:::]❑Dairy
❑ NoLayer I I JE1 Non -Dairy
❑ Other
Total Design Capacity 1,800
Total SSLW
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 gai/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes ® No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes to No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ® Yes ❑ No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ..............Old.............. ............. Mew ............ ---.....................................---............................................................... ...................................
Freeboard (inches): 16 -
12/12/03 Continued

Yucilik; Number: 71-43
Date of Inspection 3/17/2004
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenancelimprovernent?
11. Is there evidence of over application? If yes, check the appropriate box below.
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes ❑ No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes []No
b) Does the facility need a wettable acre determination? ❑ Yes ❑ No
c) This facility is pended for a wettable acre determination? ❑ Yes ❑ No
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge attor below
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours?
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional
Air Quality representative immediately.
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
Comments (refer to question #) ^Explain -any YES answers and/or any; recommendations or any other.,comments_= _
W
Use cli awmgseof facility to: 6 er'explam=situations (use-addrti6nal pages as necessary) ❑ Field Copy [I Final Notes
- Inspection conducted to check on progress at the farm.
) Marker not present in new lagoon.
Fields had been disked a little more. The shelter at the end of one of the sprayfields had been
moved.
Reviewer/Inspector Name chest obb
Reviewer/Inspector Signature: / Date: Z_
12112103

,Facjligy Number: 71-43 Date of Inspection 3/17/2004
Required Records & Documents
21.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
❑ No
22.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(iel WUP, checklists, design, maps, etc.)
❑ Yes
❑ No
23.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
❑ No
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
24.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
❑ No
25.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
❑ No
26.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
❑ No
27.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
® Yes
❑ No
28,
Does facility require a follow-up visit by same agency?
® Yes
❑ No
29.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
❑ No
NPDES Permitted Facilities
30.
Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
❑ Yes
❑ No
31.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
32.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ No
33.
Did the facility fail to conduct an annual sludge survey?
❑ Yes
❑ No
34.
Did the facility fail to calibrate waste application equipment?
❑ Yes
❑ No
35.
Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below.
❑ Yes
❑ No
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After 1" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
12112103

Type of Visit JO Compliance Inspection O Operation Review O Lagoon Evaluation i
Reason for Visit 0 Routine O Complaint Q Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Date of Visit: 2 Tune:
0 Not Operational 0 Below Threshold
10 Permitted © Certified 0 Conditionally Certified U Registered Date -Last Operated or Above Threshold:
Farm Name: __ ...FARM . _ - . County: E R.... . _.____._._ _.._...
Owner Name: _ , _ , .. Phone No:
Mailing Address:
Facility Contact: ._ -Title: Phone No: .
Onsite Representative: , ! A �Q Integrator. q — -� 0
Certified Operator: , , , r , _. _ _ Operator Certification Number:
Location of Farm:
L
J6 Swine ❑ Poultry ❑ Cattle ❑ Norse Latitude ' " Longitude • 6 (.4
Ihs' char es & Strewn Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes JVNo
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 XNo
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./No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 5
\ Identifier:
Freeboard (inches):
12112103 Continued

Facilio Number: — Date of Inspection ! 2
5. Are there any immediate threats to the integrity of any of the structures observed? (iTe/ trees, severe erosion, ❑ yes JZ No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑ Yes No
closure plan?
{U any of questions 4-6 was answered yes, and the situation poses an JZ
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes [A No
8. Does any part of the waste management system other than waste structures require maintenancelimprovement? X Yes ❑ No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
❑ Yes
;6 No
elevation markings?
Waste Application
10. Are there any buffers that need maintsnancelimprovement?
❑ Yes
J3 No
11. Is there evidence of over application? If yes, check the appropriate box below.
❑ Yes
No
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type 2 "ew
13. Do the receiving crops differ with those designated in the Certified Anima] Waste Management Plan (CAWMP)?
❑ Yes
No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
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
jff No
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge attor below
[] Yes
PfNo
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours?
❑ Yes
No
19_ Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
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 representative immediately.
Field CoDv ❑ Final Notes
'� RoPv5E,0 iel�Z�' A7 zQ.J Sy 3 I j'j cgs /1% Afeiv
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A TrDiJ
ReviewerAnspector Name
Reviewer/.luspector Signature:
Date:
1L/1L/U3 Go u muca

Faciifty Nuidber:
Date of Inspection
Required Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
Oe/ WUP, checklists, design, maps, etc.)
23_ Does record keeping need improvement? If yes, check the appropriate box below.
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
25. Did the facility fail to have a actively certified operator in charge?
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
27. Did Reviewer/lnspector fail to discuss review/inspection with on -site representative?
28. Does facility require a follow-up visit by same agency?
29. Were any additional pizblems noted which cause noncompliance of the Certified AWMP?
NPDES Permitted Facilities
30. Is the facility covered under a NPDFS Permit? (If no, skip questions 31-35)
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
32. Did the facility fail to install and maintain a rain gauge?
33. Did the facility fail to conduct an annual sludge survey?
❑ Yes XNo
❑ Yes gNo
Yes ❑ No
❑ Yes 0 No
jYesVNo
Yes
Yes
❑ Yes )dNo
❑ Yes O No
❑ Yes XNo
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
34. Did the facility fail to calibrate waste application equipment? ❑ Yes ❑ No
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate boa below. ❑ Yes ❑ No
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After 1 " Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
0 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
24o) fiU4ex0j9A0 1eXAOZAJa-5 i,/le56-5 &
/o9 5o ©
" 15,
y
Ot
Gras A, ! CCAm2
IV12(03

Type of Visit XCompliance Inspection 0 Operation Review O Lagoon Evaluation
Reason for Visit O Routine O Complaint Qj Follow up O Emergency Notification 0 Other © Denied Access
Facility Number
Date of Visit: 2 Time: I
Not O erational 0 Below Threshold
0 Permitted [3 Certified [3 Conditionally Certfjed 0 Registered Date Last Operated r Above Threshold:
Farm Name: �� f F County: _ a, Z)",
Owner Name:y Phone No:
Mailing Address:
Facility Contact: Title: F Phone No:
Onsite Representative: Lj�/�f2 Integrator:
Certified Operator:
Location of Farm:
Operator Certification Number:
Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 0 ` Ou Longitude 0 & Du
Design Current Design Current Design Current
Swine Capacitv Population Poultry: Capacity Population Cattle :. : Ca achy Population'
❑ Wean to Feeder 10 Layer ❑ Da'ry
Feeder to Finish 0� ❑Non -La Non -Layer ❑ Non-Dai
Ej Farrow to Wean -
El Farrow to Feeder ❑Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ Boars Total SSLW
Number of Lagoons ❑ Subsurface Drains Present ❑ La 000 Area ❑ S ra Field Area
yHolding Ponds= Solyd Traps- �� . ❑ No . Li uid Waste Mgement Svstem
.-.
lk�
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes )KNo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. is there evidence of past discharge from any part of the operation? ❑ Yes Vfo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes Cl No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway Yes ❑ No
SActure I �S"cture 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard (inches):
05103101 Continued

Facility Number: — Date of Inspection 4
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑yes ❑ No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or mana%:1 through a waste management or
closure plan? ❑ Yes ❑ No
(If anyof questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do anv of the structures need maintenance/improvement? ❑ Yes ❑ No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes ❑ No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes ❑ No
Waste Apiication
10. Are there any buffers that need maintenance/improvement? ❑ Yes ❑ No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes ❑ No
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes ❑ No
34. a) Does the facility lack adequate acreage for land application? ❑ Yes ❑ No
b) Does the facility need a gettable acre determination? ❑ Yes ❑ No
c) This facilin• is pended for a wettable acre determination? ❑ Yes ❑ No
15_ Does the receiving crop need improvement? ZYes ❑ No
16. Is there a lack of adequate waste application equipment? ❑ Yes ❑ No
Re uired Records & Doc ments
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 terrified operator in charge? ❑ Yes ❑ No
22_ Fail to notifi regional D,-%--Q of :mergency situations as required by General Permit?
Oef discharge. freeboard problems, over application) Oyes ❑ No
23. Did Reviewer1rispector fail to discuss review/inspection with on -site representative? ❑ Yes o
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
0 No violations or deficiencies were noted during this visit You will receive no further correspondence about this visit.
_.�.—sr a..�.w:,s'z"C'.�""tyy3'�_.:L%-®'. m-.:w'!—�
CiimiiieSts'. fefer to giiesbiin .:Ezplam:any YES answers-abdfohany.recoaimendidins Qr any ut er comments.�w _ s , :,
Use drawings of facility, to better exphttn situations: (use adds Fnal pages.as m3tc ssary)� ❑l Field Copy ❑ Final Notes
s...rs:br.^/j7....:m"";-..:^"_.w.,R:.�.,;.� yz/%/,»�,,.3.......,R-.�.�...
/
fjE") z'+'-Vo'j /fQw')o /� �' A,o LF V L
Reviewer/Inspector Name ^-'00 16—z
Reviewer/Inspector Signature: Date: ! 2
OSIV3101 �r Continued

Facility lumber: 11 — Date of Inspection !
Odor Issues
26_ Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge atior 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, buildin, structure. and/or public property)
39. is the land application spray system intake not located near the liquid surface of the lagoon?
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.)
31. Do the animals feed storage bins fail to have appropriate cover?
32. Do the flush tanks lack a submerged fill pipe or a permanentitemporary cover?
mments
2-7] ai,efso
--tTf -z'
Ago o (0 0t n L k" O o WA -zee- WIE-
T U) z u, 6Ct�F,-DuUF
WS7r� Go
F#25 FAP'M ,
Wc0ye-t.
❑ Yes ❑ No
Ayes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
FROG N C-L')
L'j (4ze GR e.
La -�r-H �Rk�
O OL,D L/}- Oe r✓
05103101

4 `
IType of Visit rR Compliance Inspection O Operation Review O Lagoon Evaluation I
Reason for Visit O Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number 1)ate of Visit:
Permitted 0 Certified 39 Conditionally Certified [3 Registered
Farm Name: Z e"/#
Owner Name: R
Mailing Address:
Time:
Date Last Operate"r Above Threshold -
County: IW
Phone No:
Facility Contact: Title: Phone No:
Onsite Representative: Integrator:
Certified Operator: Operator Certification Number:
Location of Farm:
iff Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 0' 0° 0« Longitude 0' 6 �u
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes ONO
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 gai/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes ❑ No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes �No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ZfNo
St cr re I �Sreture 2 Structure 3 Structure 4 Structure 5 Structure b
Identifier: 4j// /'G,e
Freeboard (inches):����25
05103101 Continued

Facility Number: Date of Inspection +D
5. Are there any immediate threats to the integrity of any of the structures observed? (iel trees, severe erosion. ❑ Yes ❑ No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes ❑ No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notih, DWQ)
7. Do any of the structures need maintenancelimprovement? ❑ Yes ❑ No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes ❑ No
9. Do anv stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes ❑ No
Waste Apollcation
10. Are there any buffers that need maintenanceiimprovement? ❑ Yes ❑ No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes ❑ No
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAV MP)? ❑ 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 & Docyments
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/ VdUP, 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 notifi- regional DIVQ of emergency situations as required by General Permit?
El Yes
El No
(ie% discharge. freeboard problems, over application)
22. Did Reviewer/Inspector fait to discuss rcviewiinspection with on -site representative?
❑ Yes
X/ 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
0 No violations or deficiencies were noted during this visit You will receive no further correspondence about tills visit.
1-3
Goaitnents,{refer tit"'gnes�on}:.Eap7sin:aa* YES answers°sad/or a t etom�aaeadatiens or any otherim�tne�
Use drawings of facility; to better explain situations. (nse additional page as accessary) ❑ Field Copy ❑ Final Notes_
/7
�SPEG' r�on� N,G�u C %�� � D �✓vEKJ .� ✓r' JrLI�� �` �+KF-✓"� i � {�-��4 �!
.�ACi= Lira �oi,-�P�r�9n�. �sP,�'c��a.� �o.✓�o�e.��o �r�.�
�✓�Si
JJ �/) /�/���
f1'�4�,C� • ��lf `i/ / _ Lam/"
Reviewer/Inspector Name`
Reviewer/Inspector Signature: Date:
0510310I �� ` Continued

Facility Number: Date of Inspection
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes ❑ No
29. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes ❑ No
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes ❑ No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes ❑ No
31 _ Do the animals feed storage bins fail to have appropriate cover? ❑ Yes ❑ No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ❑ No
�,QlzzGam}7 �o� �,�lF/YL- 41V'O -y' F ��Gc�TAle
_
�pZ� �O�,p z✓ ©� S, �� �7 /��u/ �i�2z�¢7Zoiv r�
L�/�7P��Hr�C < �.� S�ir�.0 7•�p�J �/�Cy /'� E.,�'
O5103101

of Visit O Compliance Inspection O Operation Review O Lagoon Evaluation
far Visit O Routine O Complaint OO Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number 71 43 Date of Visit: 12-03-2t)03 Tune: 15110
rO Not Operational 0 Below Threshold
Permitted N Certified [3 Conditionally Certified 13 Registered Date Last Operated or Above Threshold: ............
Farm Name: PrWgen.F&rm.SjtejY2...... -.............................. ..... County: Fender .... ......... ........... _....... _....... W. jRD......-.
OwnerName: Gm7....W.................................. Frijun ....................................................... Phone No: ....................
Facility Contact:
Title:
Phone No:
Mailing Address: 65.Horsn3ir=chBnad..................................................................... Bmimm.,NC .......................................................... 28425 .............
Onsite Representative: NOBE.......................................................................................... Integrator. Uumb,j!FamIly.Y tin........................._...........
Certified Operator: GM..Waymn....................... Pridgen..................... ...................... Operator Certification Number: 27207.- ........... I................
Location of Farm: -
West of Burgaw & Rhyne Crossroads. On North side of SR 1216 approx. 1 mile West of SR 1336.
M Swine []Poultry ❑ Cattle ❑ Horse Latitude 34 • 34 ;' 3S " Longitude i 78 * r0 40 "
. P
❑ Gilts
❑ Boars
:..:::..:...........::::....:::....::::: .::.::: Total:SS...... €€
Design;,;; ?Curl
1,800
Number of Lagoons 2 Subsurface Drains Present ELI Lagoon Area L❑ Spray Field Area
Holding Ponds 7 SOud Traps ; [] No Liquid Waste Management System
Diischarhes & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes M No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ® Yes ❑ No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes M No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes M No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ............. QLa............ ............ NEW ............ .................................... ................................... ..----.............. ........................ .................. ...
Freeboard(inches): ...............41...........-----............... 25....... _....... .............. ...... . ..........................................................................................................................

v Hc�
wnunuea on nurx
umber: ' 71-43 Date of Inspection 12-OT2003 printed on- 12/05/2003
5. Are there zn'y immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑ Yes
® No
- seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
❑ Yes
® No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
❑ Yes
❑ No
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
® Yes
❑ No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
® Yes
❑ No
Waste Aimlication
10. Are there any buffers that need rnaintenance/improvement?
❑ Yes
❑ No
11. Is there evidence of over application? ® Excessive Ponding ❑ PAN ® Hydraulic Overload
® Yes
❑ No
12. Crop type NONE
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
❑ No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
© No
b) Does the facility need a wettable acre determination?
❑ Yes
❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes
❑ No
15. Does the receiving crop need improvement?
® Yes
❑ No
16. Is there a lack of adequate waste application equipment?
❑ Yes
❑ No
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available? ❑ Yes ❑ No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.) ❑ Yes ❑ No
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports) ❑ Yes ❑ No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes ❑ No
21. Did the facility fail to have a actively certified operator in charge? ❑ Yes ❑ No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes ❑ No
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? IN Yes ❑ No
24. Does facility require a follow-up visit by same agency? X Yes ❑ No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes ❑ No
No violations or deficiencies were noted during this visit. You will receive no further
corresvondence about this visit.
conducted as a follow-up to a visit by Chester Cobb the previous day and that morning. Mr. Cobb had a previous
iintment, thus he couldn't complete the assessment.
11. Both fields had considerable areas of ponded wastewater both within the potential spray or wetted area, as well as,
areas well outside the system's range of influence. No discharge was observed as ongoing and no evidence of a discharge
o the field or highway Right -of -Way ditches was observed in the ditches themselves. However, soil staining was observing
leading to at least the ROW ditch in one or more areas. It is likely that waste was discharged during the last significant
rainfall event. CONTINUED T
Reviewer/Inspector Name

JNCVJC"Cr11HXpCV9Uf algUi LUM 1Jatc. 5100
Facility Numt;:+r: 71-43 Date of Inspection 12-03-2003 printed on: 12/050003
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 0 No
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes ❑ 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
I observed no spray heads or risers attached to the system in the vicinity of the ponded waste. Either the heads were
re -located to the drier areas of the fields adjacent to the farm structures or the system has several locations with damaged
lateral lines, risers, or leaking riser plug -ins resulting in wastewater loss during operation of the system elsewhere when th
system is pressurized.
. I observed no evidence that control valves are installed to allow the unused laterals to be shut down when not in use to
revent waste loss from faulty plug -ins or broken lines, thus I would assume that the entire field or system is pressurized
,hen any irrigation occurs. Without the isolation valves it is nearly impossible to tell where the leaks may be located due t
ie expansive area where waste is ponded including higher vegetation and saturated soil conditions. One of the following
ction are required to fix the irrigation system other than complete replacement.
eral isolation valves must be installed in this or any new system installed at the facility. AND
Replace every plug-in valve with a fixed riser system that either always has a spray head attached or can have a head
prior to use. OR
Remove and clean every plug-in valve and replace all damaged or leaking valves.
The freeboard level gauge in the newer lagoon has been pushed over probably by the floating pump dock. It is slanted
approximately a 45 degree angle, thus an accurate reading is not possible. A new, easier to read marker needs to be
stalled in a safer location ASAP.
There is NO cover crop currently on either field. Most of the fescue field was deep plowed during the summer
-ording to the owner and no crop is currently present. No evidence that a summer annual was planted in the other field
'year — some of this field has also been deep plowed. The plowing may have damaged the irrigation system. Owner
ted that the farm is too be sprigged with Bermuda in the spring and cattle & fencing have already been removed. If the
,ner wishes to graze or feed cattle in the non -wetted area of the fields, then this is completely acceptable. In order for
rmuda to survive at this "wet" site, field drainage must be improved. 1 observed that the either thereis no culvert under
farm entrance to allow the ROW ditch to drain the fields or it is completely covered up — this must be addressed. The
ginal field ditches along the outside of both fields have not been maintained with numerous trees, roots, snags, and
bris plugging them. These need to be cleaned out and perhaps deepened to help lower the field's water table and
nvey storm water off the field. Appears that additional ditches once lined the farm path which borders the inside of both
Ids, but these have long since been allowed to fill in naturally or was done intentionally. These should be replaced to
silt in lowering the water table an conveying storm water off the field. Prior to sprigging, both fields need to be slightly
)wned to allow storm water to leave the field.

1
Type of Visit is Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit O Routine O Complaint 0 Follow up O Emergency Notification J9 Other ❑ Denied Access
Facility Number Date of Visit: 3 S Time:
rO Not Operational Q Below Threshold
13 Permitted IRCertified 0 Connd'itionally/Certified D Registered Date Last Operated or Above Threshold:
Farm Name: / risdri'��7 TGri� >i� County:i1��'�
Owner Name:
Mailing Address:
Facility Contact:
Onsite Representative:
Certified Operator:
Location of Farm:
Title:
Phone No:
Phone No:
Integrator:
Operator Certification Number:
❑ Swine ❑ Poultry ❑ Cattle ❑ Harse Latitude a ' 0 " Longitude ' 9 u
Swine
Design Current _ 1) se �gn Current ` Design Current
Ca acity P,o'pu ation P,oult_, Ca aci Po ulation Cattle Ca aci P,o elation
❑ Layer ❑Dai
❑Non -Layer Non -Dairy I
❑ Other❑
Total Design Capaci❑
Total 55LW
❑ We11oeeder
Feeinish
❑ FarWean❑ FarFeeder
FarFinish
Gil❑ Bo
Number of Lagoons ❑ESubsurface Drains Present ❑ Lagoon Area ❑ 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?
Discharge originated at: ❑ Lagoon CRSprayField ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. if discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure 1 Structure 2 Structure 3 Structure 4 Structure S
identifier:
Freeboard (inches): .�.
05103101
.Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
Structure 6
Continued

5
Facility Number: & - 3
Date of Inspection ZSli7
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 anv of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do anv stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Awlication
10. Are there any buffers that need maintenancelimprovement?
11. Is there evidence of over application? ❑ Excessive Pending ❑ PAN ❑ Hydraulic Overload
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAVL'MP)?
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?
Reouired Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(iel WUP, checklists, design. maps, etc.)
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?
(W discharge. freeboard problems. over application)
23. Did ReviewerlInspector fail to discuss reviewlinspection with on -site representative?
24. Does facility require a follow-up visa by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
El Yes El No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes [:]No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
El Yes [:]No
❑ Yes ❑ No
Yes ❑ No
❑ Yes ❑ No
13 No violations or deficiencies were noted daring this visit. You will receive no further correspondence about this visit.
Commegts,(refer to question#): `Eiply= an- YES saswers andlor any recommendaEtotts or a :ot�er.rnmmarfs. , �_ -`-
Use drawmgs of facility to better ezplam sitnahosis (use addteonai pages az necessary)
t. -ram ;_- ii _ s Field Copy ❑ Final Notes
I ZAPre aot avl7-l- 07` �O/l�E/L /✓,tA ✓ `r 45 Al T1'4e,,l u— �X02�/�/r
r of �€ h ,c r ! 414�n Ae /ham aril
�e air o 4e A o A ,, *0,04% �,
a �S 7�,- Ali 3 C11 I'•Ei�e L✓a�t✓, /ff7wrvG✓ a G a�t eta
j AaA . -le C
..
Reviewer/Inspector Name
Reviewer/inspector Signature: Date:
05103101 of v
Continued

a
Facility Number: 7/ — Date of inspection
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lad*oon fail to dischars c 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?
2& is there anv evidence of Find drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, buildin- structure. and/or public property)
29. is the land application spray system intake not located near the liquid surface of the lagoon?
30. N ere 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.)
31. Do the animals feed storage bins fail to have appropriate cover?
32. Do the flush tanks lack a submerged fill pipe or a permanenthemporary cover?
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑Yes ❑No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
C ise/z -,<!Y a Co.' d "i 40A O7' 5,0i1i8 S�IST�i�i rc �P✓ Lt!✓�i�.4 7�71,� -tz'9161/w -/O
Jruise e --A#le-, 74 ck�-/c eAlVel Q �•-�k%L d� �e mar-aM/4#'
O 4 3 SOD 4 QS 79 '5 G/4S 2`eQtG
5mZo� GP/'C.I
fin✓ w� We 3'IAle.
ef9 a,!� O-I "'f
ew
f{rattd sy Ae- /ems,4 7;'tc fle brO�4oi YrtSI� 4hd
Vke,°ld wxs ^)nAvet1
05103101

Type of Visit 7 Compliance Inspection 0 Operation Review 0 Lagoon Evaluation
Reason for Visit Routine 0 Complaint 0 Follow up 0 Emergency Notification 0 Other El
❑ Denied Access
Facilitv Number Date of Visit: Time: T
Not Operational Below Threshold
Permitted © Certifie © Con ' 'onalllly^Ceertified p Reregistered Date Last Operated Above Threshold:
!Farm Dame: IWEf County: 4!Fx
Owner Name: �� Phone No:
Mailing Address:
Facility Contact: Title:
Onsite Representative: _� f r2
Certified Operator:
Location of Farm:
Phone No:
integrator:
Operator Certification Number:
Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude Longitude
Design';: -Current Design _ . Cnrrenf- _ Design = w Current
W
Swine_-.. Ca aeiitv�Po uiatton Poultry _ °Ga add=Pa"clarion Cattle_.: Ca actor. Pa^ulatton
❑ Wean to Feeder # ❑ Layer ci[ _ 4 � ❑ Dairy I
Feeder to Finish ILI Non -Laver I❑Non-Dairy
Farrow to Wean _..
ElFarrow to Feeder
t' ❑ Other
❑ Farrow to Finish To#al Design Capsett�
❑ Gilts m
W�
❑Boars - mTotsI--SSLW
- '.
~na�ncngrranas°r.�crua r. i
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 gaUmin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes A No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ElYes No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes No
Strure I structure 2 Structure 3 Structure 4 Structure 5 Structure
Identifier: �f
Freeboard (inches):
05103101 Continued

r � �
Facility Number: — Date of Inspection
! '
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑ Yes
/No
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 4-6was answered yes, and the situation poses an
El Yes
No
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
xyes
❑ No
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
/
- elevation markings?
El Yes
No
Waste Application
10. Are there any buffers that need maintenance/improvcment?
❑ Yes
No
11. Is there evidence of over applica 'on? El Excessive Ponding ❑ P El Hydraulic O erload
El Yes
No
A-
12. Crop type J)�
13. Do the receiving crops differ with those des4nated in the Certified Anima( Waste Management Plan (CAWMP)?
❑ Yes
No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
No
b) Does the facility need a wettable acre determination?
❑ Yes
No
c) This facility is pended for a wettable acre determination?
❑ Yes
El No
15. Does the receiving crop need improvement?
❑ Yes
ILJ No
16. is there a lack of adequate waste application equipment?
❑ Yes
XNo
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
Xyes
❑ 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
j2fNo
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
X—Yes
❑ No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
Yes
21. Did the facility fail to have a actively certified operator in charge? t
El yes
1XfNo
V 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
X No
24. Does facility require a follow-up visit by same agency?
ElYes
No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
XNo
0 No violations or deficiencies were noted during this visit. You will receive no further correspondence about. this visit
Coaimeats"(refer W. uestmon #f) ;Ex lain i nv YES'ansysers and/©r an W W
q p i recommendations.or anv o er comuma ".
Ilse drawipgs of facdtty tolietteir ezplaua srtuattct. (mmse addmaomtsl pages as necessary) m Field Cop, ❑ Final Notes, I-
RF.�.�S S/�l �i��S FAO � � �'//'1��� �/r�- �•�
Reviewer/Inspector Name 47
ReviewerlInspector Signature: Date:
05103107 �T Continued

Facility Number: Date of inspection
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge atior 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 major 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?
Additional Gomments`andlnr.Drawings:
GfPflP
05103101
❑ Yes ❑ No
❑ Yes o
❑ Yes No
❑ Yes �blo
❑ Yes /!//!/r�'
No
❑ Yesio
❑ Yes rio

PR Davision of -Water Quality L7- Y
Q Dmsion of Soil and, Water Conservat><on , r
0bibiA eri c x T
er g. y.- -
Type of Visit 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 Date. of Visit: Tirne: � Printed on; 7/21/2000
Q Not O erational Q Below Threshold
'Permitted [] Certified [:j Conditionally Certified ❑ Registered Date Last Oper ed or Above Threshold:
Farm Name:G...S CI-5.a.`..........County:
..................................................... ...... .. '.............................................
Owner Name:
Facility Contact:
Mailing Address:
Title:
Onsite Representative: 0_i�-fti-�2r
........................................................................................
Certified Operator:
Location 'of Farm:
Phone No:
Phone No:
......................_..-.................................-.-.............-....... ....... I.......
Integrator: _.. '.........,
Operator Certification Number: ...............................
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude �• �� « Longitude �• ��«
Design Current Design Current Design'. Current
-- - Capacity Population
Wean to Feeder
Feeder to Finish
GO
Farrow to Wean
Farrow to Feeder
i Farrow to Finish
Gilts
Boars
Poultry Capacity Population Caere
❑ Layer ❑ Dairy
❑ Non -Layer I 1 10 Non -Dairy
❑ Other
Total Design Capacity. C
Total SSL W - . C
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at_ ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the convcyancc man -trade?
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
Stru c lure I Structure 2 Structure 3 Structure 4 Structure 5
Identi Fier:
/.......-•....................-.................... .................................... .................................... .............................
Freeboard (inches):
5100
❑ Yes KNo
❑ Yes []No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes No
❑ Yes �NO
❑ Yes O�lo
Structure 6
Continued on back

Date of Inspection Printed on: 7/21/2000
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes KNo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes Ig No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes gNo
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes CKNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes PfNo
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes 0No
11. Is there evidence of over application? ❑ Excessive Ponding KPAN ❑ Hydraulic Overload Yes ❑�No
12. Crop type 4-1k\ek /V P-- . dam_?CL_
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes 04 No
14.
a) Does the facility lack adequate acreage for land application?
[:]Yes
XNo
b) Does the facility need a wettable acre determination?
Kyes
❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes
❑ No
15.
Does the receiving crop need improvement?
❑ Yes
kNo
16.
Is there a lack of adequate waste application equipment?
❑ Yes
XNo
Required
Records & Documents
17.
Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
k'No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
WYes
XNook
(ie/ WUP, checklists, design, maps, etc.)
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
4No
21.
Did the facility fail to have a actively certified operator in charge?
Yes
N
00,
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes
&No
(ie/ discharge, freeboard problems, over application)
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
,M No
24.
Does facility require a follow-up visit by same agency?
❑ Yes
gNo
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
[:]Yes
ff No
; ; �'Vo •yiolatiq�is;or• d�fcienc{es vwere nofee�• dix:ing �his;viset; - Y;oix will •i•eeeiye tiEo #'ucther • ; • ; •
coriesporidence: albout. this visit. .: ::
'any -YES answers and/or airy-recomme>d
tu srattroms {use addrtronal pages as neees
Reviewer/Inspector Name t ^ k " W
Reviewer/Inspector Signature: \ ( I Date: L) — 16 '�1i 5100

Facility Number: — Date of Inspection
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below WYes [:]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 CIO
No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes �hT0
roads, building structure, and/or public property) / r
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes INo
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes j No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes M No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes JeNo
Additional omments an orDrawings:
A- C l��'r� Gam`'-�-pQ )1-�-�� �� �✓\�`
14
5/00

Facility Number Date of Inspection
Time of inspection ©24 hr. (hh:mm)
Permitted ❑Certified Conditionally Certified ❑Registered Not O rational Date Last Operated:
Farm Name: ..... G� I . ...:5 a ................................................. County ... .............................................................
....
OwnerName............................................................................................................................ Phone No: ............................. ............. .................. -.........................
Facility Contact: .............................................................................. Title: ... Phone No:
.............................................................
MailingAddress: .......................... ........--- ..... .......................
Onsite Representative:...�.Wknej........................................................................... Integrator:.......-�------..............................................
Certified Operator: ....... I ............................................. ...... I ......... I ....................... I ......... I .......... Operator Certification Number:.........................................
Location of Farm:
Latitude 9 6 4& Longitude 0 & 44
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes O'No
Discharge originated at: ❑ Lagoon ❑ Spray Field [3 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) El Yes ❑ No
c. if discharge is observed, what is the estimated flow in ga]/min?
d. Does discharge bypass a lagoon system'? (If ycs, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes j)�No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes C 'No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ff No
Struc ure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: Q1d KQ2k.1
Freeboard (inches): ..............a 36
............................................................................................................................................................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, []Yes XNo
seepage, etc.)
3/23/99 Continued on back

c Facility Number: — Date of Inspection
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidencp,,of over application? ❑ Excessive Ponding ❑ PAN
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coveragc & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
0: Nd Mblatidiis br deficiencies were noted- d&ihii #bis:visit: - Ybir will-to&0*16 Rio further - : .
.. • rorres�biidence. abouh this .visit:
❑ Yes )f No
❑ Yes XNo
❑ Yes ,< No
❑ Yes ONo
❑ Yes No
❑ Yes �No
❑ Yes ONo
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes gNo
❑ Yes 9No
❑ Yes t�No
❑ Yes KNo
r
,ZdYes V No
❑ Yes gNo
❑ Yes RNo
❑ Yes No
❑ Yes KNo
❑ Yes 9No
❑ Yes XNo
Comiments`(refer tq question #}=Explaiti'any YE5 answers'and/or any reconrimenda,lions ocaay-other comments
Use drawings'of facility tg better -explain situations (use:addrtional pages asiwkessarv)
CAvL�1
T� C 1
C& *`. dam � We,51,cQ ��.� �,,� ��e ✓r c reJ G�� s�����e.
Ay. P,
Reviewer/Inspector Name 3qf ,' �j q0 x a .
Reviewer/Inspector Signature: Date: -GO

Facility Dumber: r7 — Date of Inspection G
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below xYes ❑ 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 MNo
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes NX No
roads, building structure, and/or public property) ff
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes eNo
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 P No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes Po
Additional Comments, mw or rawings:.,.
��� . C�,� +�C►�G� � S G �1 ��j" �C,' �� 1 +� �Ct-..Q: � � , .�';1�.t2, q„Q�1
t��ley �L �1 c�d.e.-�"�-�;s �e1��c�se-. �-1s��f y� b.��-- -�f��e �•e
- �. -►-� - �--�� >-� CIA W1,1W ire 1-�41 4(1z. y aL'-
3/23/99

;.., D Division of Soil and Water Conservation - Operation Review
©Division of Soil and Water Conservation - Compliance Inspection
Division of Water Quality Compliance Inspection
Other Agency - Operation Review
Routine 0 Complaint 0 Follow-up of DWQ inspection 0 Follow-up of DSWC review 0 Other
Facility Number Dniv of Inspection1 2: S
Time of Inspection 24 hr. (hh:mm)
© Permitted O(Certifred I3 Conditionally Certified I❑ Registered JE3 Not OLerationall Date Last Operated:
Farm Name: L I�1... Q!-�.a- ................ County: _.... �.�
. .. .. ..
Owner Name: ...................---. Phone No:
FacilityContact: .............................................................................. Title :................................................. ............... Phone No: ........................ ...........................
MailingAddress- ............................................................................................................................................................(_.........._....}.........._.................... ............."...........
Onsite Representative: V..L'.'-. 2"............................. ................................................... Integrator:.....
....... .... . .. . .......... •Etc'• v�.!................................................
Certified Operator: ................................................... ............................................................. Operator Certification Number:..........................................
Location of Karin: I-- & t t t f} n _— .a . _ _ A ,1
r........................... R ......1,11—.................................... ..............._......................_........_.........._..._............................._.........._.
Latitude r �' �44 Longitude r 4 r'
Design Current
Swine Capacity Population
❑ Wean to Feeder
Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Design Current Design Current
Poultry Capacity Population Cattle Capacity Population
❑ Layer I I ::::]❑Dairy
❑ Non -Layer ❑ Non -Dairy
❑ Other
Total Design Capacity
Total SSLW
Number of Lagoons JE1 Subsurface Drains Present ❑ Lagoon Area ❑ Spray Field Area
Holding Ponds / Solid Traps JE1 No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation (If yes, notify DWQ)?
Discharge originated at: []Lagoon ❑ Spray Field []Other
a. If discharge is observed, was the conveyance man-tnade"
b. If discharge is observed. did it reach: ❑ Surface Waters ❑ Waters of the State
c. If dischar_e is observed. what is the estimated flow in «alhnin'?
d. Does discharge bypass a lagoon system?
2_ Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts to the waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure I Structure 2 Structure 3 Structure 4
Identifier:
Freeboard (inches): • ................................... .... ..?...1....... ,.......
1 /6/99
❑ Yes KNo
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes
❑ No
❑ Yes
XNo
❑ Yes
XNo
❑ Yes A No
Structure S Structure 6
.................................................................
Continued on back

Facility Number:. — 3 Date of Inspection
•5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
S. Does any pact of the waste management system other than waste's tructures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with requircd top of dike, maximum and minimum
liquid level elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? Ponding ❑ Nitrogen
• 12. Crop typc ..... k1�2�........... � `...... i� 3........................................................................
0
❑ Yes UfNo
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. Does the facility lack wettable acreage for land application? (footprint)
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 certified operator in responsible charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
Oe/ discharge, freeboard problems, over application)
❑ Yes tq No
❑ Yes 1No
❑ Yes X No
❑ Yes EYNo
❑ Yes 0 No
❑ Yes 0 No
❑ Yes C4 No
❑ Yes 0 No
❑ Yes OtNo
❑ Yes 5yNo
❑ Yes 14 No
❑ Yes ZNo
❑ Yes ONo
❑ Yes KNo
❑ Yes �No
❑ Yes 1(No
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes NfNo
24. Does facility require a follow-up visit by same agency? ElYes C�No
X. N:o:vialatioits :or. defciencit'si a n .weofe'd, dtiring:Nis i:visit:. Yoti will.rerceive nar ftiriiier...:.
• correSDiHidehice; abort: this ;visit..... . . ` .. ........ ... . .. .. ....: . .
Comments.(refer to question#): Explain any YES answers and/or any--recommendafioris or any__o'ther comments a:
Use drawin s'of facillt to b 4 f
eater ex laimsi ry) g y _ . p tuations. (use additional pages as_necessa ,• v , , _ M ,.
! t"P W' k �.QL rest ��!: �r — a� f.� r,.��e� �,0
iQ
p �
Reviewer/Inspector Name
Reviewer/Inspector Signature: ( �, ��Date: d f 7 I1 1/6/99

Division of Soil and Water Conservation 0 Other Agency
Division of Water Quality
JI[Routine O Complaint O Follow-up of DWQ inspection O Follow-up of DSWC review O Other
Dale of Inspection
Facility Number Time of (inspection d ! 24 hr. (hh:mm)
© Registered Certified © Applied for Permit © Permitted [y Not Operational Date Last Operated:
Farm Name: .. r r 4 �-�► irn ..5� l c .2 County: �� y,cf�................................... P ...
-------------- • ---...----.. ............... ✓ c,
�............... Phone ZsOKner Name: .......G� .........................(.......s ................ ..------ ........
Facility Contact:
........ Title:
Mailing Address: .......... L5 ..........Hn! 8r`:1........ 12,,l
Onsite Representative:...........................................................................................................
Certified Operator. ......... 6 T �Y`: c%5.....................................................
............................
Location of Farm:
........ ....y................ P/h//o'ne No: ........................................ ..
Integrator: ..... .y rp.y................................................
Operator Certification Number;...1 '—
0
"o
Latitude '646 Longitude • 4 "
General
1. Are there any buffers that need maintenancelimprovement?
❑ Yes
'O(No
2. Is any discharge observed from any part of the operation?
❑ Yes
�NO
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
❑ Yes
No
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
❑ Yes
V'No
c. If discharge is observed, what is the estimated flow in gal/min?
AA
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
❑ Yes
j]9 No
3. Is there evidence of past discharge from any part of the operation?
❑ Yes
K((No
4. Were there any adverse impacts to the waters of the State other than from a discharge?
El Yes
L� No
5. Does any part of the waste management system (other than lagoons/holding ponds) require
❑ Yes
XNo
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?
ElYesXNo
7/25/97

r- 5itcilitfWuinber: —
8. Are there lagoons or storage ponds on site which need to be properly closed? ❑ Yes p No
Structures (Lagoons,Holding Ponds, Flush Pits, etc.)//(
9. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes 00
Structure i Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
------ �........... ........ . Z....... ................................................---------.............................----...................................................
Freeboard(ft):......... ��...5 ...................................................................................................................................................:......
10. Is seepage observed from any of the structures? ❑ Yes JVNO
11. Is erosion, or any other threats to the integrity of any of the structures observed? ❑ Yes VNo
12. Do any of the structures need maintenance/improvement? XYes ❑ No
(If any of questions 9-12 was answered yes, and the situation poses
an inunediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
❑ Yes WNo
Waste Application
14. Is there physical evidence of over application? ❑ Yes )dNo
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type ......... !f1..i. � A? V.. �-------------------------•-----..............................................-.-----------------.------.................................................................................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)? ❑ Yes � No
17. Does the facility have a lack of adequate acreage for land application? ❑ Yes VNo
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 reviewlinspection with on -site representative?
22. Does record keeping need improvement?
For Certified or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
25. Were any additional problems noted which cause noncompliance of the Permit?
[3-No.vialations,ordeficiencies.were-noted-during this:visit. Yau:vKill receive-no•fu:rilier�
:.correspondence dboid Als:visit:: - :::: :. ; . , . =
1Z —e.e,-L1frz_.*J rlac �j�(J�L �GSOJ �'1 L4 rt f
��,� `�Gr�e.�L�-K� �c.�,�c1rL`-'y �tr�✓"� 145.dc�v�
k4 _ � r r�, �s :�0e . ; l �e-� r..• : Gia�1, - 12t- &,a;j 4 �
Gar r4— IL,G
❑ Yes VNo
❑ Yes VNo
❑ Yes VNo
❑ Yes �fNo
Yes ❑ No
❑ Yes KNo
❑ Yes �No
❑ Yes KNO
I -ZZ, 14 Lep L.4G1C'��r �rGe.lp:�i.�� ✓C CO rG5 0 h 5 e 1'�i
1 7I25197

M aDSWC Animal FeediofOperation Review
®DWO"Animal Feedlot 4pel:=atlon Site. InspectlonY
.�T V
o Routine O Complaint O Follow-up of DWO inspection O Follow-uo of DSWC reviciv O Other
Date of Inspection J
Facility number -11 I _j Time of Inspection I : Zo Use 24 hr. time
Farm Status:... -
Total Time (in hours) Spent onReview. .
or Inspection (includes travel and processing)
Farm Flame: ?r4)PV\ J.l - --- County
Owner Name: r1It=iS E Phone No: _ �QI O�___Z__S -_•S� v
Mailing Address: („S- 40t-a _LR+rc R� _ gi ah) L
Onsite Representative: 601n, Wick,, Integrator:
Certified Operator: _ S? ._3L rJag.,, — Operator Certification number:
Location of Farm:
r �. �.� �+�a�w��.l.�•w r,�trl�RfLi r . r � . Al �. r ►1
11�
Latitude[ • �� ®` Longitude �• & ®°°
© Not Operational Date Last Operated:
rype of Operation and Design Capacity
Sr�tne
- s :Poultry �� Cattle77
�..
. .. ,:... ...:.
Q Wean to Feeder
.
• . -°°Number �. ._-� ----.. .-number
z" Q Laver
R ❑ Dairy
® Feeder to Finish
$i}G £ ❑ Non Laver
J JE] Beef !
Farrow to Wean
Y
a M x
Farrow to Feeder
�
Farrow to Finish
�Livestock--N�-
� � ❑ Other Type of
�
1\umbet` of LaQooas ! HoldttsgPonds: I ❑Subsurface Drains Present—
�:. ❑Lagoon Area ❑Spray Field Area
General
1. Are there any buffers that need maintenance/improvement? ❑ Yes kNo
2. Is any discharge observed from any part of the operation? ❑ Yes 0 No
& If discharge is observed, was the conveyance man-made? ❑ Yes 9 No
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ) ❑ Yes ® No
tl
c. If discharge is observed, what is the estimated flow in aaLimia?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑Yes No
Is there evidence of past discharge from any part of the operation? ❑ Yes 14 No
4. Was there any adverse impacts to the waters of the State other than from a discharge? ❑ Yes [Q No
5. Does any part of the waste management system (other than lagoons/holding ponds) require ❑ Yes [A No
traintenance,improvemeni?
Continfled on bank-

b. Is facility aot in compliance with any applicable setback criteria?
7. Did the facility fail to have a certified operator.in responsible charge (if inspection after 111197)?
8. Are there Iagoons or storage ponds on site which need to be properly closed?
Structures (Lagoons and/or Holding Ponds)
9. Is structural freeboard less than adequate?
Freeboard (ft): Lagoon 1 Lagoon 2 Lagoon 3
� _2-
10. Is seepage observed from any of the structures?
I I. 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 strd6t&es lack adquate markers to identify start and stop pumping levels?
Waste Applicatiun
14. Is there physical evidence of over application?
(if in excess of WMP, or runoff entering waters of the State, notify DWQ)
IS. Crop type .CM
16. Do the active crops differ with those designated in the Animal Waste Management PIan?
17. Does the facility have a lack of adequate acreage for land application?
18. Does the cover crop need improvement?
19. Is there a lack of available irrigation equipment?
For Certified Facilities 0131v- .
20. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
21. Does the facility fail to comply with the Animal. Waste Management Plan in any way?
22. Does record keeping need improvement?
23. Does. facility require a follow-up visit by same agency?
24. Did Reviewedimpector fail to discuss reviewlinspection with owner or operator in charge?
❑ Yes g[No
❑ Yea EQ No - .
❑ Yes VI No
❑ Yes EgNo
Lagoon 4
❑ Yes 04 No
❑ Yes [R No
❑ Yes Z No
❑ Yes IR No
❑ Yes R No
❑ Yes ® No
❑ Yes Lallo
❑ Yes [9 No
❑ Yes 5No
❑ Yes ® No
❑ Yes (4 No
55 Yes - ❑ No
❑ Yes [R No
❑ Yes �&No
irn�rM
Ss6vjb
beSIA usi
im'�OlT16n Cof� {oG -4 lRA-( .J
17R-Z� a i xv.cEvdG
k)kilt'
�'►e�r�s
&J 15rir,V6
s
►J re. use .
Rerdewer/inspectorNgme
Reviwer/Inspector Signature: Date:
cc. Division of Water Quaiiry, YVater Qualitp Section, FaciliT Assessment Unit 11114196

CJ 7: 1'tii 13�.J 1G: 2 J1 1 rCi"IL+ is l_I—II_�i' CriI -C�; PAGE 0
0
•
0
Site Requires Immediate Attention
Facility Number: _.T 4
j 0 SITE VISITATION RECORD
L DATE: jjit y 1_„ 7 _ , 1995
l
Owner: _('era Pri drrPn - � Farm Name: #1
County-
Agent Visiting Site: —SM & .M - _ - - — Phone: -[phone]
Operator. Cary Rridrygn Phone: [phone]
On Site Representative: Not available Phone:
Physical Address: Horse Branch Road and Malpass Corner Road - .1 mile SW of the
intersection of SR 1120 and SR 1336. Farm is on the right,
Mailing Address: 65 Horse Branch Road,
Burgaw, N.C. 2 4 5
Type of Operation: -Swine x
Design Capacity: unknown
Poultry Cattle
Number of Animas on Site: 1800 f inishing
Latitude: ° Longitude: a "
Type of Inspection: Ground x Aeriai
Circle Yes or No
Does the Animal Waste Lagoca have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately I Foot + 7 inches) G or No Actual Freeboard: --i-- Feet 3 Inches
For facilities with more than one lagoon, please address the other lagoons' freeboard under the
comments section.
Was any seepage observed from the lagoon(s)? Yes oG Was there erosion of the dash?: Yes or
Is adequate land available for land application? G. or No Is the cover crop adequate? A or No
Additional Comments: Freeboard on side of dam just opposite pipes had only
11311 --tom2rary stoKyM full. Probably needs to
1
Fax to [phone] Signature of Agent

Site Requires Immediate Attention: Ale
Facility No. 7 / - cam
DIVISION OF ENVIRONMENTAL MANAGEMENT , l
ANIMAL FEEDLOT OPERATION SITE VISITATION RECORD
DATE: , 1995
Time:
ors a ,
Mailing
County:
Integrator:
On Site Representative: if f eRx A21 A 1
Physical Address/Location:��
Phone:
Phone: "
e_ Or -
Type of Operation: Swine �_ Poultry Cattle
Design .Capacity: AVP Number of Animals on Site: 9' leew
DEM Certification ACE DEM Certification Number: ACNEW
d
Latitude: `t° �1 Z' &V " Longitude: �° Q� 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) Yes or No Actual Freeboard: �C —Ft. Inche
Was any seepage observed from the lagoon(s)? Yes t6r No as any erosion observed? Yes r No
Is adequate land available for spray? Yes or No Is the cover crop adequate9 Yes or No
Crop(s) being utilized:
Does the facility meet SCS minimum setback criteria? •200 Feet from Dwellings �er
100 Feet from Wells? es r No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or No
•
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes or No
Is animal waste discharged into waters of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes r o If Yes, Please Explain. .
Does the facility maintain adequate was a management records (volumes of manure, land applied,
spray irrigated on speciIm
acreage with cover crop) es r��No
Additional Comments: 4/'L S/'�'&Lfd (�r'-C��/�/ ' s
Zy/tP--UP f S 6tLfWi1 A,, 15 ",ee W16 ter1 IF;' TD1�rJ,
Ta -- &/j,0t/C1_ 9LzId6t-- t S W A1-ee
a� 1 AA -C, A4e9eWZh�Ei � � —
A41
Inspector Name Si e
cc: Facility Assessment Unit Use Attachments if Needed.