990007_INSPECTIONS_20171231

- -Division of Water Resources
❑ Division of Soil and Water Conservation
❑ Other Agency
Facility Number: 990007 Facility Status: Active Permit: AWC990007
Inpsectlon Type: Compliance Inspection Inactive Or Closed Date:
Reason for Visit: Routine County: Yadkin Region:
Date of Visit: 08/15/2017 Entry Time: 09:30 am Exit Time: 11:10 am Incident #
Farm Name: Shore Bros Dairy Owner Email:
Owner: Jack Shore Phone:
❑ Denied Access
Winston-Salem
336-679-8463
Mailing Address: 2220 Shore Rd Yadkinville NC 27055
Physical Address: 2220 Shore Rd Yadkinville NC 27055
Facility Statue: Compliant ❑ Not Compliant Integrator:
Location of Farm: Latitude: 36° 10' 60" Longitude: 80° 40' 00"
Take Hwy 601 North out of Yadkinville. Turn right onto Shore Road (SR1374). The farm is on the left just before the Milk House
Dairy Farm, which is on the right.
Question Areas:
Dischrge & Stream Impacts Waste Col, Star, & Treat Waste Application
Records and Documents Other Issues
Certified Operator: Louis M Shore Operator Certification Number: 25634
Secondary OIC(s):
On -Site Representative(s): Name Title Phone
24 hour contact name Louis M Shore Phone: [phone]
On -site representative Louis M Shore Phone: [phone]
Primary Inspector:
Inspector Signature:
Secondary Inspector(s):
Phone: Date: 33(o 7 (a- q to 9 `7
08/1s/a-01 -1
Inspection Summary:
Only 10 cattle remain on the east sie of Shore Road and have access to well -vegetated pasture. Cattle on well -vegetated pasture
on the west side of the road are only fenced -out of the stream on one side, but NO water quality issues are expected due to the
low number of cattle.
4 Waste.sla ge.p d was recently closed.per NRCS standards. Mr: Share to request'his"permit,be rescinded---�
21. Could not locate the allowable PAN in any of the waste plans, including closure, sin~ e`pl ins lisftract-and fields
rather than pulls for the irrigation. No overapplication of PAN expected since owners records document only 6-40 lbs. PAN applied
per acre.
24. No calibration performed in 2016 or 2017. No overapplication of waste expected due to low nitrogen rate in the waste analysis
result (1.27 and 0.25 lbs. N11000gals.).
page: 1

i
E
Permit: AWC990007 Owner- Facility : Jack Shore Facility Number: 990007
Inspection Date: 08/15/17 - • inppection Type: Compliance Inspection Reason for Visit: Routine
Regulated Operations
Cattle
Design Capacity Current promotions
Cattle - Beef Brood Cow
134
10
Cattle - Beef Feeder
80
Cattle - Beef Stocker Calf
75
Total Design Capacity: 289
Total SSLW: 239,260
Waste Structures
Dlalgnated Observed
Type Identifier Closed Data Start Date Freeboard Freeboard
Waste Pond WSP 29.41
page: 2

Permit: AWC990007 Owner - Facility : Jack Shore Facility Number: 990007
lrispectibri Date: -08/15/17 Inpsection Type: -Compliance Inspection '-"Re&son forVisit: Routine
Discharges & Stream Impa.cts
Yea No Na No
1. Is any discharge observed from any part of the operation?
❑
❑
❑
Discharge originated at:
Structure
❑
Application Field
❑
Other
❑
a. Was conveyance man-made?
❑
❑
❑
b. Did discharge reach Waters of the State? (if yes, notify DWQ)
❑
M ❑
0
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?
❑
0 ❑
❑
3. Were there any observable adverse impacts or potential adverse impacts to Waters of the
❑
0 ❑
❑
State other than from a discharge?
Waste Collection, Storage & Treatment
Yes
No Na No
4. Is storage capacity less than adequate?
❑
❑ ■
❑
If yes, is waste level into structural freeboard?
❑
5. Are there any immediate threats to the integrity of any of the structures observed (I.e./ large
❑
❑
❑
trees, severe erosion, seepage, etc.)?
6. Are there structures on -site that are not properly addressed and/or managed through a
❑
❑ M
❑
waste management or closure plan?
7. Do any of the structures need maintenance or improvement?
❑
❑ 0
❑
8. Do any of the structures lack adequate markers as required by the permit? (Not applicable
❑
❑
❑
to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑
❑
❑
maintenance or improvement?
Waste Application
Yea No Ka No
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ 0 ❑ ❑
maintenance or improvement?
11. Is there evidence of incorrect application?
❑ ❑ ❑
If yes, check the appropriate box below.
Excessive Ponding?
❑
Hydraulic Overload?
❑
Frozen Ground?
❑
Heavy metals (Cu, Zn, etc)?
❑
PAN?
❑
Is PAN > 10%/10 lbs.?
❑
Total Phosphorus?
❑
Failure to incorporate manure/sludge into bare soil?
❑
Outside of acceptable crop window?
❑
Evidence of wind drift?
❑
Application outside of application area?
❑
page: 3

•
Permit: AWC990007
Owner - Facility: Jack Shore
Facility Number: 990007
Inspection Date: - 08/15/17 Inppection Type: Compliance Inspection Reason for Visit: .. Routine
Waste Application )ram Na No No
Crop Type 1 Fescue (Hay, Pasture)
Crop Type 2
Crop Type 3
Crop Type 4
Crop Type 5
Crop Type 6
Soil Type 1
Soil Type 2
Soil Type 3
Soil Type 4
Soil Type 5
Soil Type 6
14. Do the receiving crops differ from those designated in the Certified Animal Waste
❑
❑
❑
Management Plan(CAWMP)?
15. Does the receiving crop and/or land application site need improvement?
❑
0 ❑
❑
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre
❑
❑
❑
determination?
17. Does the facility lack adequate acreage for land application?
[]
0 ❑
❑
18. Is there a lack of properly operating waste application equipment?
❑
❑ E
❑
Records and Documents
v
No Na No
19. Did the facility fail to have Certificate of Coverage and Permit readily available?
❑
E ❑
❑
20. Does the facility fail to have all components of the CAWMP readily available?
❑
❑
❑
If yes, check the appropriate box below.
WUP?
❑
Checklists?
❑
Design?
❑
Maps?
❑
Lease Agreements?
❑
Other? i
❑
If Other, please specify
21. Does record keeping need improvement?
❑
0 ❑
❑
If yes, check the appropriate box below.
Waste Application?
❑
Weekly Freeboard?
❑
Waste Analysis?
❑
Soil analysis?
❑
Waste Transfers?
❑
Weather code?
❑
Rainfall?
❑
Stocking?
❑
page: 4

•
0
Permit: AWC990007
Owner - Facility : Jack Shore
Facility Number: 990007
--Inspection Date: 08/15117- - Inspection Type: Compliance Inspection Reason for Visit: Routine
Records and Documents
Yes
No Na No
Crop yields?
❑
120 Minute inspections?
❑
Monthly and 1" Rainfall Inspections
❑
Sludge Survey
❑
22. Did the facility fail to install and maintain a rain gauge?
❑
0 ❑
❑
23. If selected, did the facility fail to install and maintain a rainbreaker on irrigation equipment
❑
❑ 0
❑
(NPDES only)?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
0
❑ ❑
❑
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check the
❑
❑
❑
appropriate box(es) below:
Failure to complete annual sludge survey
❑
Failure to develop a POA for sludge levels
❑
Nora -compliant sludge levels in any lagoon
❑
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
❑
E ❑
❑
27. Did the facility fail to secure a phosphorous loss assessment (PLAT) certification?
❑
E ❑
❑
Other Issues
Yea
No Na No
28. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑
❑
❑
and report mortality rates that exceed normal rates?
29. At the time of the inspection did the facility pose an odor or air quality concern? If yes,
❑
0 ❑
❑
contact a regional Air Quality representative immediately.
30. Did the facility fail to notify regional DWQ of emergency situations as required by Permit?
❑
❑
❑
(i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility?
❑
❑
❑
If yes, check the appropriate box below.
Application Field
❑
Lagoon 1 Storage Pond
❑
Other
❑
If Other, please specify
32. Were any additional problems noted which cause non-compliance of the Permit or
❑
E ❑
❑
CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑
❑
❑
34. Does the facility require a follow-up visit by same agency?
❑
❑
❑
page: 5

Type of Visit: U[Compliance Inspection Q Operation Review Q Structure Evaluation Q Technical Assistance I
Reason for Visit: ► (kRoutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: �7Arrival Time: Z "..ZTI I Departure Time: County: q Region: fit% -SR
Farm Name: S e r .Val r L, Owner Email: Z-SkDN'<<nI o �1aD. C.I3M
Owner Name: �q c7�- Phone: 276
Mailing Address:
Physical Address: tit t
Facility Contact: �dLjf j .Sre Title: Phone:
Onsite Representative: t I Integrator:
Certified Operator: 1 b Certification Number:
Back-up Operator:
Location of Farm:
Certification Number:
` a �f�
Latitude: 3fd /Q , /p /1 Longitude: 46 a / Ot]l
,494 h Go r
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 DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes x<o ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes [:]No
❑ Yes [:]No
❑ Yes E60
❑ Yes IXf No
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 21412015 Continued

Facility Number: Cly - • Date of Inspection: VV I
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes Wo NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): D_
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ❑ No 1% 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 0 Yes [:]No KNA ❑ 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 ❑ NoNA ❑ 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
Vo-
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No VA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
❑ NA
❑ NE
acres determination?
'WNo
17. Does the facility lack adequate acreage for land application?
❑ Yes No
❑ NA
❑ NE
18. is there a lack of properly operating waste application equipment?
❑ Yes ❑ No
VNA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes VNo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes �No
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
2 l .`D%%es record keeping need improvement? If yes, check the appropriate bo below.
^ �]
❑ Yes P No
❑ NA
❑ NE
❑�@l,aste Application Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
wir-.1wwWers-
❑ Weather
Code
Inspections
❑ Raid ❑ Stockilq(❑ Crop Yield ❑ 120 Minute Inspeqo(ns ❑ Monthly and VRainfall Inspections
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 ❑ No
KNA
❑ NE
Page 2 of 3
21412015 Continued

Facili Number: - • Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? Yes ❑ No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [:]No ;YNA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes XNo ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? if yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes XNo
❑ Yes [(No
❑ Yes XNo
❑ Yes No
❑ Yes No
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑NA ❑NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes XNo ❑ NA ❑ NE
omments (refer to question #): Explain any YES answers and./or any, additional recommendations or any other comments.
se drawings of facility to tier explain situations (useadditional pages as necessary).
n
�' �a5re ��o.Pec�ed
Reviewer/Inspector Name:
c2ol (0 o r X01TO
d vim=& low M
ovp ra..1aPl16m+ion
PAN vu_I W U P ,
P-L.-I° [\Jo
DAM
Reviewer/inspector Signature:
Date:
Page 3 of 3 2/4,'201 S

Type of Visit: 9Q Compliance Inspection V Operation Review 0 Structure Evaluation Q Technical Assistance I
Reason for Visit: (Routine 0 Complaint 0 Fallow -up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Q b Arrival Time: Departure Time: ® County: Region: of S p-6
Farm Name: `�lhprP_ �f-A S Oct f Owner Email: 76 -7q — y q A _j
Owner Name: �r�L S h O r'e-- Phone: L.'S h e— 6 r IV a- hao , G 6M
Mailing Address: �r C�bor e V &A 1Z r li'1 Ur jre 1 NG a 74 5
Physical Address:
Facility Contact: Lo U l S 4ba r e, _ Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
C ;zYY—W.y3?f
Phone: J_ 6 `19 — ' zel -4 f
Integrator:
Certification Number:
Certification Number:
O /
Latitude: 3(p 0166
16 f �I Longitude: _ � qad
lbw 1(6d 1 P L S h o re Pa. I- M o n L-
Design Current
Design
Current
Design Current
Swine Capacity Pop.
Wet Poultry
Capacity
Pop.
Cattle
Capacity Pop.
Wean to Finish
La er
DairyCow
'
Wean to Feeder
Non -La er
"'
Dairy Calf
Feeder to Finish
f
Dairy Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
Dr. P■oultr,
Ca aCi
Pv _.
Nan -Dairy
Farrow to Finish
Layers
Beef Stocker
'-j
t
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
j
Turkeys
Other
Turkey Poults
Other I
Other
Discharp_es and Stream Impacts ,
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes 9 No ❑ NA ❑ NE
[:)Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes No
❑ Yes No
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
Page I of 3 21412015 Continued

I.
Facili Number: - • Date of Inspection: 0410
waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
` `1- a. If yes, is waste level into the structural freeboard?
�ee4- Structure I Structure 2 Structure 3 Structure 4
10 Identifier: onA
❑ Yes N
❑ Yes ❑ No
❑ NA ❑ NE
❑ NA ❑ NE
Structure 5 Structure 6
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes X 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 KNo ❑ 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 ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ;<No ❑ NA ❑ NE
maintenance or improvement`?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes //////`"``�������No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes P�No NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑ Yes
gNo
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
XNo
❑ NA
❑ NE
❑ Yes
)RfNo
❑ NA
❑ NE
❑ Yes
XNo
❑ NA
❑ NE
❑ Yes
XNo
❑ NA
❑ NE
❑Other:
�Zaste
es record keeping need improvement`? ❑Yes o ❑ NA ❑ NE
Application Weekly Freebo�120
Waste Analysis�Soilnalysis ��+ter*use. ❑ Weather Code
Rainfall Stocking Minute Inspections DOVIonthly and I" Rainfall Inspections
22. Did the facility fail to Xf14and ma tain a rain gauge? Ai' dr4o* ❑ Yes *] No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [:]No NfNA ❑ NE
Page 2 of 3 21412015 Continued

Facility Number: - 4D jDate of Inspection: jQq *�Q
A Did the facility fail to calibrate waste application equipment as required by the permit? ❑Yes No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? if yes, check ❑ Yes ❑ No 5(NA ❑ NE
t the appropriate box(es) below.
❑ Failure to complete annual sludge survey [:]Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes �No
❑ Yes Nf No
❑ Yes gNo
❑ Yes i No
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑NA ❑NE
❑ Yes WNo ❑ NA 0 NE
❑ Yes A No ❑ NA ❑ NE
❑ Yes C ❑ NA ❑ NE
❑ Yes A No ❑ NA ❑ NE
❑ Yes 06 No ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or ariy other comments.
Used wings of facility to better explain situations (use additional pages as necessary).
briAnd u
4ih s yaA r (z4ol f.
toa) d oLppl I'C,(Jf~s�ior'l 511) c.e FaI owl 3 ?`VC%_ � Mom _ s+e►r .
-- 6 K I I 4 L e&Wl✓ a nee.. &M t of }� tl WQ,�' -. O w r-V 44- �, e�o�c
�C�,os� 4 u-� w s P, NVW h U_4'+ .1- e 4 to+
;iro++�1, w5 P. por+1_6n. ` -fPl uut�Le, d m� U e,�' U_m' rez_
5
ntiIJOL,k-�%p
a5 e- 5&MA pI-P, VOL-5 tO-6& n Sy,-t- -�'a �r 01- &A � 5! 5 -- C�iJh
v p 19 � . 2-o 110 Vole-ords ( 2'R-R. Q'� -r,e, �0 %J re. d� 4L c v e, re-3.1 j
a I So 5 &NA-p le's n q-& be- +01L_� -r o o ,
Reviewer/Inspector N
Reviewer/Inspector S
Page 3 of 3
Phone: 71 % -- 96 12
Date:
21412015
•

(Type of Visit: j5 Compliance Inspection U Operation Review Q Structure Evaluation 0 Technical Assistance
Reason for Visit: 0 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access 1[
Date of Visit: J 5 Arrival Time: Departure Time: LSD County:,�,P11 Region: 05
Farm Name: +f`P� �05 . �Q.1 V L1 Owner Email: L5 t`10 FNiV' to y "` ho 0 - Cc 1-4
Owner Name: � vlY 5U10(-e- Phone: �Q V fjy �j
Mailing Address: o� a- a� Inajre- d • r l� 6Ld yj n V C
Physical Address:
Facility Contact: 1,6 U (5 S �b tr-e Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone: jf ((1 - 3631
Integrator:
Certification Number:
Certification Number:
Latitude: 36 n r 66 tf Longitude: goo qboll
Design C►urrent Design Eurrent Design Current
Swine Capacity Pop. Wet Poultry Capacity Pop. Iattle Capacity Pop.
Wean to Finish I JLayer IDai Cow
Wean to Feeder
Non -La er
I EEJ
Dairy Calf
Feeder to Finish
Design Current
Dai_ry Heifer
D Cow
Farrow to Wean
Farrow to Feeder
D F $oultr, Ca aci P.o
Layers
Non -Dairy
Beef Stocker
Farrow to Finish
Gilts
Non -Layers
Beef Feeder
90.
Boars
Pullets
Beef Brood Cow
Other
Other
LJOther
Turke s
Turkey Poults
=_�l
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes QX No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR) ❑ Yes ❑ No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes [XNo [] NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters [:]Yes ® No ❑ NA ❑ NE
of the State other than from a discharge? J�
Page 1 of 3 21412014 Continued

Facility Number: - Q Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus'heavy rainfall) less than adequate? ❑ Yes [ No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes [ No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes 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 $j No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes 1XNo ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes �6 No ❑ NA ❑ NE
maintenance or improvement?
Waste Application K
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes �No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload [] Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): CK'5TV jr
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 ❑ Yes Wo ❑NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application? ❑ Yes lNo ❑ NA ❑ NE
18. Is there a lack of property operating waste application equipment? ❑ Yes YNo ❑ NA ❑ NE
Required Records & Documents ❑ ❑
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? 3 I Yes No NA NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes PNo ❑ NA ❑ NE
the appropriate box.
❑WUP []Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping ne;Zekly.Freeboard
'rovement? =Analysis
❑ Yes jeNo ❑ NA ❑ NE
Waste Application Analysis �� D-Weather Code
L]Q nainfall [Stocking Ii Lrop Yield �0 Minuy and 1" Rainfall Inspections 8i adge 8 arvey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes JZ(N o ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No t'NA ❑ NE
Page 2 of 3 21412014 Continued

Facility Number: q- '� • Date of Inspection:
low
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑ No [5(NA ❑ NE
the appropriate boxes) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
3 1. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
omments (refer to question #): Explain any YES answers and/or any add
sgArawings of facility to better explain situations (use additional pages a
610 t Soy -ej�+) t eC
F& Lt aoo ?
CAI
❑ Yes No
❑ Yes No
❑ NA ❑ NE
❑NA ❑NE
❑ Yes �4 No ❑ NA ❑ NE
❑ Yes `% No ❑ NA ❑ NE
❑ Yes LM 4 No ❑ NA ❑ NE
❑ Yes [XNo ❑ NA ❑ NE
❑ Yes P No
❑ Yes o
❑ Yes 0No
recommendations or
❑NA ❑NE
❑NA ❑NE
❑ NA . ❑ NE
comments.
NJ ,
t-, U-) hen Mou') urn 0-fp1i<
"Pited to roVVIVK4's Nq
. _ 2 —1-- A PIG
1 err a�o.��-r, e►1 pl tAsl� o+r� VaAk -Lo l'-4 7 N D
d u t° 10 h "
ak-fr < < C coo o v1 pc c u rs 6L)
I � w
Reviewer/Inspector Name: Phone: 9 J
Reviewer/Inspector Signature: Date: 41
Page 3 of 3 21412014

FIELD INSPECTION
Waste Storage
* Waste Pond(s)
o Observed Freeboard(s):
c Vegetated, Free of Woody Plants, No burrow holes?
c No Erosion, Slumping, or Seeping?
�r Waste Lagoon(s)
c Observed Freeboard(s):
o Vegetated, Free of Woody Plants, No burrow holes?
a No Erosion, Slumping, or Seeping?
* Waste Piles
arc Dry Stacks
o Roof intact?
o Rainwater excluded?
o Leaks'in block/wooden walls?
* Wet Stacks
o Roof intact?
o Rainwater excluded?
® Leaks in block/wooden walls?
Discharges or Surface Water Impacts
* Structure (leaking walls, seeping, etc.)
* Drains and Ditches j„1
al= AAgAult M inu-wr.�
Pasture/Stock Lanes (stream crossings, water holes, etc.) wrf
* Application Fields
* Irrigation Supply
* Silage Facilities
Were discharge conveyances man-made?
lJ91�e oHWL low'" 401&f oFf�c�c
J.'A"i :114 J,, n , J"
❑ Yes ❑ No ❑ NIA

f/a11Z-1ll = (a4
31 j rl � L - 1 5 'r� •
�2 3 f zdl y 3 INSPECTION OF RE
* Verify current contact information.
19) Permit? Yes ❑ No
19) Certificate of coverage? Yes
S/,zrc
rzc
1A, [�l @'��✓Twe, e
❑ No
26) Operator Certification? AYes ❑ No Hours needed?
20) Waste Management Plan Available? Yes ❑ No
21) Weekly Freeboard Records? Yes ❑ No
21) Precipitation Records (with initials by?1" event)? Yes
22) Rain Gauge on site? Yes ❑ No
❑ No
21) Animal stocking records? Yes ❑ No or DHI for Dairy
�►r Current Population (including poorly vegetated lots)?
Record details on inspection form
WY, 29) How are dead animals disposed of (within 24 hours)?
i"'K� 21) Soil Analysis Results? ❑ Yes ❑ No ,_,_ pH 5.5 - 7.0
Cul: < 60ppm 0R -NCDA < 3,0Q0 — Zn: < 120 ppm OR NCDA < 3,00
21) Waste Analysis Results? ❑ Yes . ❑ No
a Within 60 days of applications (multiple test)?
Dates: Q/zol3 = -J,3c I b J N
N Levels: Bcast:
21) Waste Application Records (with weather code)? ❑ Yes ❑ No
Applications within window for crops?
t^ '
Were there any commercial fertilizers or other sources used? ❑ Yes
What was the N levels applied?
Does the total PAN match up with WMP? 1 ❑ Yes
21) What crops are being grown (are they in the WMP)?
jok Are they harvested? ❑ Yes ❑ No
--- 21) Crop yield records? (3 Yes ❑ No ❑ NIA
7 1.
❑ No
24) Has waste application equipment been calibrated? ❑ Yes ❑ No ❑ NIA
Are gauges & equipment in good repair and working order?
31) Were there any emergency situations that need discussion (date occurred)?
13 Yes ❑ No
7 ti p

i
Date of Visit: z.3 Arrival Time: : 00 Departure Time: 2; Q County: Y"dkRegion: i/ 590
Farm Name: S Nai�`G `jt��, pa�fy Owner Email: L5rwft 61Q y44dgp
—, [�l►�!
Owner Name: Q ., S I+L o re Phone: (jr
22 20 - j S� o .'
Mailing Address: i� �� , 7 4d�ls-�n ✓� � 1� , �G
Physical Address: oLmt?
C Z •— S`3g
Facility Contact: Lott 1J S 1-1cr>! Title: Phone: Lq) 6 7g 3031
Onsite Representative: Integrator:
Certified Operator: Certification Number:
Back-up Operator:
` Certification Number:
Location of Farm: Latitude: '36C0 (4d Longitude: 6D lfi7 B
Rw7 Gol N/ )z skee Rd, / rM OA LWA
Swine
Wean to Finish
11111111 Design Current Design Current
Capacity Pop. Wet Paultry Capacity Pop.
Ai
Layer
El
Design Current
Cattle Capacity Pop.
Dai Cow
Wean to Feeder
Non -La er
DairyCalf
Feeder to Finish
DairyHeifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Design Current
Dr. l;oultr, C•.a aci Ro
I Layers
D Cow
Non -Dairy
Beef Stocker
7
Gilts
Non -Layer
Beef Feeder
D p
Boars
Pullets
Beef Brood Cow
3
Other
Other
Turke s
Turke Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes P No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes ANo
❑ Yes o No
❑ NA ❑ NE
❑NA ❑NE
❑NA ❑NE
Page 1 of 3 21412011 Continued

ti
Facili Number: - . Date of Inspection: �3
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes X No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3
Identifier: W 5
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
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
XNo
❑ NA
❑ NE
❑ Yes
X No
❑ NA
❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes [ No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks) ]�
9. Does any part of the waste management system other than the waste structures require ❑ Yes I YI No ❑ NA ❑ NE
maintenance or improvement? Ti
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
lb. 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
❑ Yes ,[ No
❑ Yes No
❑ Yes No
❑ Yes No
❑ Yes No
❑ Yes No
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. Yes ❑ Nc
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis Soil Analysis
❑ Rainfall D Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
Page 2 of 3
❑ Yes gNo
❑ Yes ❑No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA CD NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ Weather Code
91 IV"
[DNA ❑ NE
9NA ❑ NE
21412011 Continued

ti
Fa cility Number: IDate of Inspection: Z 3
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes OdNo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [:]Yes ❑ No NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes t4 No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes X No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes No
❑ Yes No
❑ Yes No
❑ Yes No
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
OgNo
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes
No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes
No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
V 3.{JI`�� or. an7 1643% t,v,
r6J -z V)� -7 0
0 L ] ff j}}
oihQ C /Q- 6zcsaJl /ere'd �r'br'+ LJS{� !06ki 5ddC1.
Pk- to u C1 ,%
yiE Jhk J �ee,. ` �"r 111 aI �, f? I�ev 7 Drja t Y ►t 11 CAv< 1V Xr axv?
712613
Reviewer/Inspector Name: �q 4-,(,r k I y t '71c�-P� j Phone: 63.6.)'7�l��J�?��
Reviewer/Inspector Signature: Date: 2 7-3 Z20
Page 3 of 3 21412011

i •
Permit: AWC990007 Owner - Facility: Jack Shore Facility Number: 990007
Inspection Date: 09/24/2013 Inspection Type: Compliance Inspection Reason for Visit: Routine
Inspection Summary:
3) Manure is collecting in the low area on the stock trail across the road from the WSP, and is resulting in some minor runoff.
Requested OIC to cleanout manure from this area to prevent possible discharges. NOTE: Manure appears to be remaining in the field
with no evidence of discharge. *CHECK NEXT VISIT*
3/7) Waste is collecting outside the lower corner of the stock lots across the road from the WSP and is washing into the drain under
the stock trail. Requested OIC to cleanout manure from this area to prevent possible discharges. NOTE: Waste appears to be
remaining in the field with no evidence of discharge. *CHECK NEXT VISIT*
21) The 2012/2013 crop yield records were unavailable for review during the inspection. Requested OIC to maintain these records and
have available for future inspections. *CHECK NEXT VISIT*
21) The 2012 and 2013 soil analysis results were unavailable for review during the inspection. Requested OIC to maintain these
records and have available for future inspections. *CHECK NEXT VISIT*
21) Commercial fertilizers were not recorded/reported in PAN application records. Requested OIC to record and include commercial
fertilizers in records. NOTE: The estimated PAN application, including estimated commercial N, appears to be within max PAN rates.
*CHECK NEXT VISIT*
24) Calibration was completed for the irrigation in September 2013; appears to be accurate. Directed OIC to transfer info onto the
appropriate Division calibration form. Irrigation next due by October 2015. - Reportedly the broadcast equipment has not been used
and will be calibrated at the next use.
a( rNly.
30) Onsite facility records indicate that the maximum waste level in the WSP was reached and exceeded in July 2013. Notification to
the RO was NOT made. Reminded OIC that notification must be made to the RO any time the waste level reaches and/or exceeds the
max level in the WSP. NOTE: No evidence of waste release was observed during the inspection.
OTHER NOTES:
- Freeboard markers were visible in the WSP during inspection; they were underneath the waste during the previous visit.
WASTE ANALYSIS:
9/2013 = 3.32 Ibs N
PC - 6 V7
Page: 2

!Type of Visit: 19 Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance j
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access I
Date of Visit: 2 Arrival Time: j.'00pAij Departure Time: 2: 30 M County: YAJ a<1let Region: 0 5 & d
Farm Name: tare, fDS. ��1i�t, Owner Email: L S�wK-(o ® y4k00, CoM
Owner Name: _Jr a S re- Phone: C 7 q - F7' ( -3
Mailing Address: Z 2 2- v 5k re. IW , A d" V ►" r N G 2Y1 o 5_3—
Physical Address: Je
(L Z'/�%'— G.S�3s,
Facility Contact: �.-0VI'S S1-1a fz Title: Phone: I4) (orJq ,— 36 31
Onsite Representative: Integrator:
elf-
Certified Operator: Certification Number: �oZ.1 /2 p j 3
Back-up Operator: Certification Number:
Location of Farm: Latitude: (d
iQ Q Longitude: g pa �fQ QQ
4w� ('01 0/K 5" r4Kj •/ fArwt OA LarF4;
Design Current
Design
Current
Design
Current
Swine C*apacity. Pop.
Wet Poultry
Capacity
Pop.
Cattle
Capacity
Pop.
Wean to Finish
Layer
Dai Cow
Wean to Feeder
Non -La er
I
Calf
Feeder to Finish
Dai Heifer
Farrow to Wean
Design
Current
Pry Cow
Farrow to Feeder
D , P,oultr.
Ca aci
P,o
Non -Dairy
Farrow to Finish
Layers
Beef Stocker a14
IS
Gilts
Non -Layers
Beef Feeder
Q
Boars
Pullets
Beef Brood Cow
3
Turke s
Other
TurkeyPouets
Other
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)?
❑ Yes M No ❑ NA ❑ NE
❑ Yes
[] No
❑ NA
❑ NE
❑ Yes
[] No
❑ NA
❑ NE
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 XNo
Yes [:]No
[DNA ❑NE
[DNA ❑NE
❑NA ❑NE
Page 1 of 3 21412011 Continued

W. .
+ Facility Number: 99 - • Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes X No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: W4A, a
Spillway?: t {f
Designed Freeboard (in):
Observed Freeboard (in): ,5
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 X No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes o
❑ NA
❑ NE
8. Do any of the structures 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 ❑ No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10.Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes No
X
❑ NA
❑ NE
maintenance or improvement?
1 l . Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes *o
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable
}Crop Window
U. Crop Type(s): i r! [�t , f0k
❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
�t t 4- 6, r6 g r *
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
❑ Yes No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes J&No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes 9 No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes X No
❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes DPI No ❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists [3 Design ❑ Maps ❑ Lease Agreements []Other:
kee ing need improvement? If yes, check the appropriate box belo Yes [:]No ❑ NA ❑ NE
Waste Application ❑ Weekly Freeboard ❑ Waste Analysi Soil Analysis ❑ Weather Code
❑ Rainfall Stockin Crop Yield ❑ 120 Minute Inspections on y an 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes 10"No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No X NA ❑ NE
Page 2 of 3 21412011 Continued

• Facility Number: - 0771 • Date of Inspection: Z
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
XNo ❑ NA
❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
❑ No NA
❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge
levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
❑ Yes
o ❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
tNo❑ NA
❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
No ❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
XNo
❑ 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
XYes
❑ No
❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
3 1. Do subsurface tile drains exist at the facility? if yes, check the appropriate box below.
❑ Yes
❑ No
❑ NA NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or GAWMP?
❑Yes
1
❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
No
[DNA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
c-�yticc�oard M�f kc�t�1 ('GSPr�-? Mar�caJ'� �ftJe�v�'- +nx.1ti tcti�le✓�►tr•F�.W�f-ltuell
�� moo.► �!� 6 �, �
� , �v r 3 ,4+�, 6.11k, �n
� ��
aN7t/ i�wTa ar�7a �R!/�rer�`ib✓r �tM� sl A�C n4- 44, 6v1,,cat -', �
�YIJe� 7- rill
PlIr,� /4 fin;,,
CoM�746MOV
2Iarmi=t ✓Soy-1 R����l�✓✓la o;w1ls. MJa/�erstirl 1� !ia {Gu.Ok✓td `s �
i,
C11d%le-
AA &t4,e ,�Ad
a:. ✓ 4 /V�i� %
11
e'GIlAb'� ri-012-d2-013r S11Vcr��e�r �e
n✓¢
e'tom leer
Lv J-1tii zal 3,
p Rid. r��t��c -- +� �� N yti� cam-d-N� MAVm'"m Wc,l�� �
9/20,.3" 3, 32 lds ►�
Reviewer/Inspector Name: P�' iGfe Mt 411 Phone: C��7�,5S4SS
Reviewer/Inspector Signature: Date: ILy L2 Q/
Page 3 of 3 21412011

s�
Divign of Water Quality •
Division of Soil and Water Conservation i
❑ Other Agency
Facility Number: 9990007 Facility Status: Agtivg _ . _ Permit: AWC990 07 Denied Access
Inspection Type: Structure Evalua(lon Inactive or Closed bate:
Reason for Visit: Other I County: Yadkin _ Region: Winston-Salem
Date of Visit: 08/06/2013 Entry Time: 12:45 PM Exit Time: 0J:15 PM Incident #:
Farm Name: $pore Eros Qairy Owner Email:
Owner: Jack Shore
Mailing Address: 2220 Shore Rd
Phone: [phone]
Physical Address: 2220 ShorgBd I Yadkinville NC 27055
Facility Status: ❑ Compliant 0 Not Compliant Integrator:
Location of Farm: Latitude: 3-6°10'60" _ Longitude: 80040'00"
Take Hwy 601 North out of Yadkinville. Turn right onto Shore Road (SR1374). The farm is on the left just before the Milk House Dairy
Farm, which is on the right.
Question Areas:
N Dischrge & Stream Impacts Waste Col, Stor, & Treat Other Issues
Certified Operator: Louis M Shore Operator Certification Number: 25634
Secondary OIC(s):
On -Site Representative(s): Name Title Phone
24 hour contact name Louis Shore Phone: [phone]
On -site representative Louis Shore Phone: [phone]
Primary Inspector: Patrick Mitchell Phone:
Inspector Signature:
Secondary Inspector(s):
Date:
Inspection Summary:
On August 6, 2013 WSRO DWR staff visited the subject facility to review the waste storage structure. The waste level in the structure
was found to be at the spillway elevation, but not overflowing at the time of visit. There was evidence suggesting that the waste had
possibly overflowed the spillway previously, but due to recent rainfall this cannot be said with certainty. There was no evidence
observed suggesting that waste had reached surface waters. The structure embankment appeared to be sound.
The freeboard marker was missing or had been knocked over. The Permittee is working with MRCS to have the marker reset.
A follow up is to be conducted in the near future when the routine yearly compliance evaluation is completed.
Page: 1

•
Permit: AWC990007 Owner -Facility; Jack Shore
• Facility Number : 990007
1r j
Inspection Date: O8/d612013 Inspection Type: Structure Evaluation Reason for Visit: Other
Waste Structures i
Type
Identifier
Designed Observed
Closed Date Start Date Freeboard Freeboard
kaste Pond WSP 29.40 .00
Page: 2

Permit: AWC990007 Owner - Facility: Jack Shore
I—]
Facility Number: 990007
Inspection Date, 0810612013 Inspection Type: Structure Evaluation
Reason for Visit: Other
Discharges & Stream Impacts
Yes
No
NA
NE
1. Is any discharge observed from any part of the operation?
❑
■
❑
❑
Discharge originated at:
Structure
❑
Application Field
❑
Other
❑
a. Was conveyance man-made?
❑
■
❑
❑
b. Did discharge reach Waters of the State? (if yes, notify DWQ)
❑
■
Cl
❑
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 observable adverse impacts or potential adverse impacts to Waters of the Stale other than ■ ❑ ❑ ❑
from a discharge?
Waste Collection, Storage & Treatment Yes No NA NE
4. Is storage capacity less than adequate? ■ ❑ ❑ ❑
If yes, is waste level into structural freeboard? ■
5. Are there any immediate threats to the integrity of any of the structures observed (LeJ large trees, severe ❑ ■ ❑ ❑
erosion, seepage, etc.)?
6. Are there structures on -site that are not properly addressed and/or managed through a waste management ❑ ❑ ❑ ■
or closure plan?
7. Do any of the structures need maintenance or improvement? ❑ ■ ❑ ❑
8, Do any of the structures lack adequate markers as required by the permit? (Not applicable to roofed pits, ❑ ■ ❑ ❑
dry slacks and/or wet slacks)
9, Does any part of the waste management system other than the waste structures require maintenance or ODOM
improvement?
Cffhar ICSl1P_S Yes No NA NE
28. Did the facility fail to properly dispose of dead animals within 24 hours and/or document and report ❑ ❑ ❑ ■
mortality rates that exceed normal rates?
29, At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional ❑ IN ❑ ❑
Air Quality representative immediately.
30, Did the facility fail to notify regional DWQ of emergency situations as required by Permit? (Le., discharge, ❑ ■ ❑ ❑
freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility?
If yes, check the appropriate box below.
Application Field
A
Page: 3

i 0
Permit: AWC990007 Owner - Facility: Jack Shore
Inspection Date: 08/06/2013 Inspection Type: Structure Evaluation
Lagoon 1 Storage Pond
Other
If Other, please specify
32. Were any additional problems noted which cause non-compliance of the Permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with on -site representative?
34. Does the facility require a follow-up visit by same agency?
Facility Number : 990007
Reason for Visit: Other
Yes No NA NE
Page: 4

Type of Visit: ompliance Inspection Q Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: Routine 0 Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: 22g Departure Time: Jp; County: Region: WSA0
Farm Name: S `1-DIG f�S1 Dq t Owner Email: LsllorG
✓
Owner Name: o, c,,k .S `'tor'- Phone: i '7� 7' G► 3
Mailing Address: -2- Z Z 0 S 61,c 7 4 �i� /KV' I e i--,v G 2_7 D.57--5—
Physical Address: J a
Facility Contact:
1__0 4 i1 S Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone: (14) 4 7 9 ?0 3
Integrator: -
(f eta Krt
Certification Number: 1OT z�31� La13.
Certification Number:
s
Latitude: 3ro /Q 1 rod Longitude: go / 00
4
w7 (n01Pj
IP S 0tf- g6n lArM On Leif,
Swine
Design C<uri ent
Capacity Pop.
Design Current
Wet Poultry Capacity Pop.
Design Current
Cattle C►apacity Pop.
Wean to Finish
Wean to Feeder
La er
Dairy Cow
Non -La er
Dairy Calf
Feeder to Finish
Design Current
Dr, P,oultr: Ca aci P.o P.
Layers X
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Dry Cow
Non -Dairy
Beef Stocker e^iP %
Z
Gilts
Non -Layers
Beef Feeder 910
�-
Boars
Pullets
Beef Brood Cow '3 11--Z-
Other
Other
Turke s
Turke Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)? _
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes XNo ❑ NA ❑ NE
❑ Yes [:]No
❑ Yes ❑ No
[-]Yes [-]No
❑ Yes ONo
❑ Yes *o
❑ NA ❑ NE
❑NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 21412011 Continued

t
Facili Number: - • Date of inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes �<No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? []Yes ❑ No ❑ NA ❑ NE
'' Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes WNo ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes JNo ❑ 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 XNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need [] Yes No ❑ NA . ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes XNo
❑ 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 [] AP
lication Outside of Approved Area
12. Crop Type(s): GD f I� �f M S MR e� latM Cf,l
v i/
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
❑ Yes No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design [] Maps ❑ Lease Agreements
❑Other:
�21. D es record keeping need improvement?
Weekly
Yes ❑ No
❑ NA
Weather
❑ NE
ste Application Q Freeboard Waste Analysis [Soil Analysis
aste Transfers
0
Code
Q R infall 29'tocking Yield 120 Minute Inspections EDMonthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge?
❑ YesXNo
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes ❑ .No
❑ NE
Page 2 of 3
/JkNA
21412011 Continued

Facilit Number: - • Date of Ins Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes XNo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑ No )rNA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes �No
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes gNo ❑ 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 gNo ❑ 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) 9
31. Do subsurface tilt drains exist at the facility? if yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes ONo ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes 4
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' ages as.iiecessar ). a `€
VL Prri�a•Nn & I ,' b rri I-{ As r zx+ 14, Ak ►�r f- 20I:3 .
Q, � is Ur✓ �v►a rkcrJ �n {`eJj s �-�' i rl wajlt�c �D� dpa ! PS
ye,5, !
Z 1. I /o P r, a 1A>_k�,1 -sly e-e- 1/�! l � � 1 Inc y/° � � L"JY ;
ld e ed f&r Za l 1 A4 �if�t Jet" ► Pw M
a�
,�,k 4,r jexf A<r
�s. '-A� 411,
Reviewer/Inspector Name:
Reviewer/Inspector Signature
Page 3 of 3
7�-
Phone:
Date:
21412011

Type of Visit: Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: '"f�""�' Arrival Time: Departure Time: County: K Region: �c} Farm Name: NDOnp h 10A r u Owner Email: L re. (O l® .1b 4 .V\OD ,
Owner Name: TOIL 1- S b.nre- Phone: (p 9
Mailing Address: Z 9-2-O J' heyr p� IL C� ���3�Li.Ll4_�n ji I 1
Physical Address:
Facility Contact: L6 U5 S hor to Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Phone: J -� -- 3031
Integrator:
Certification Number: h r5 . nea
AeJ
Certification Number:
Location of Farm: Latitude: 3 40 IQ 66 Longitude: gd q 6 O
Design
Current._
Design 'C•urrent
Design Current
Swine;
Capacity
Aop
Wet Poulry
Capacity Pop.
Cattle
Capacity Pop.
It4
Wean to Finish
La er
Dairy Cow
Wean to Feeder
Non -La er
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design Current
Dry Cow
Farrow to Feeder
Dr. P,oultr.,
Ca aci 1',0 ..
-Non
-Dairy
Farrow to Finish
Layers
Beef Stocker dal
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cowq
Q
a
Turkeys
°Other&
Turkey Poults
t
Other
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 0 No ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes irntIj No
❑ Yes U"'No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3 21412011 Continued

Facility Number: - Date of Ins ection:
24. Did the facility fail to calibrate waste app tion equipment as required by the permit? ❑ Yes 0 No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [] Yes ❑ No NA - ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes�S(No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [;KNo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes 51 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
�SrNo
❑ 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
�rNo
❑ 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
V No
❑ NA
❑ NE
FApplication Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
ZYes
[]No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
[]Yes
[yNo
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
[]Yes
® No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any:additional recommendations or any othergcomments
.;
Use drawings. of facility to better explain situat€ons (use additional pages as'necessary).
Sml soi 14es+s2 Nc+ -e
so[ i, al l .b ro oLa C as+ + ' r r l atw H' o e'a t [ b ra+e- J , a�
r' r h
L �� u.7 O O�-Q �C3i 2,�" m �1.� 0 f �Z-t ► � Q b n 1+ R O t e 3 e
V
Ltn— U-4
L!
kalu.-)d
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: — S 0199
Date:
21412011

s'a
Facility Number: - Date of Inspection: 9 O�
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [� No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
9Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: Oa!q-�'e_
7 Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes EA 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 DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
Yes
❑ No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
7�
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes]
No
❑ NA
❑ NE
maintenance or improvement?
1 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 No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application? ❑ Yes No ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes No ❑ NA ❑ NE
_Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. oes record keeping need i rovement? y- Yes of'No ❑ ❑ NE
ste Applicat' n�Cgjo
ly Freeboard aste Analysis oil Analysis �aste Transrs Weather Code
2/Rainfall tockingYield 120 Minute Inspections onthly and V Rainfall Inspections ;mwreyr
rQ-r_ onU
22. Did the facility fail to install and maintain a�-ain gauge? ❑ Yes 0 No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No NA ❑ NE
Page 2 of 3 21412011 Continuer/

Type of Visit P Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: U I
Arrival Time:
Time: County:
irl
Farm Name: %�n re-
B ro 5 , .l
IQI
Mai
C u Owner Email:
Region: 165!
Owner Name: �Q �k 5 ha re- Phone: 6 7 9 — 9,43
Mailing Address: o�-O 5 h a t- t? _ _ • _ __ �GL C� t_(� t1 t P t N C. 01 7 `J
Physical Address: S a M Facility Contact: l6 u 17 hoc e. Title: Phone No:µ 6 7 4 —3031
Onsite Representative: L_6 U 1 .5 h6r e— Integrator: - - ,R q7,f ` G 5 3 g
Certified Operator: LI C u'l S h 0 f' e- Operator Certification Number:
Back-up Operator:
Location of Farm:
1p0.rmrm
m or`!- \ t ro
p n lei+o
Latitude:
k�d V ih V i 1 fee
Back-up Certification Number:
0I,
Longitude:
©0®t I 41
Shore RocL ,
Dcsign C•arrent Design
Current
Design
Current
Swine
Capacity Population Wet Poultry C►►opacity
Population
Cattle C++opacity
Population
❑ an to Finish
❑ Layer
Dairy Cow
❑ Wean to Feeder
I JE1 Non -Layer I
I
Dairy Calf
❑ Feeder to Finish
❑ Dairy Heifer
❑ Dry Cow
❑ Farrow to Wean
Dry Poultry
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
❑ N ers
❑on -La on -Layers
El Beef Stocker
❑ Beef Feeder
U
a2
❑ Gilts
❑ Pullets
❑ Turkeys
❑ Beef Brood Caw jjq
❑ Boars
Other
❑Turkey Poults
❑ Other
Number of Structures:
❑ 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 &rNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑Yes
No
9No
❑NA
❑NE
❑ Yes
❑ NA
, ❑ NE
Page 1 of 3
12128104 Continued

Facility Number: q— & Date of Inspection 1151,s7zo .
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
Identifier: e_ >n
❑ Yes No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 5 L
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No El 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 [INE
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 t eat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes �No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes XNo ❑ 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
❑ 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]
No
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
KNo
❑ NA
❑ NE
18.
Is there a lack of properly operating.waste application equipment?
❑ Yes
9 No
❑ NA
❑ NE
Ile
,Comments: refer to uesttoq # : Ex lain an .;YES answers and/or an ,recommendations or an' other comments
Use drawin s of facilityto=Better explain situations.(use addtional agyes asnecessarY)-
q- ow 5 pots In Pas+ure.
I
?at I
•
a
�
- -xE17
, Ph.ReviewerllnspectorName
Sot
one:
Reviewer/Inspector Signatur
Date:
$ O
Page 2 of 3
r k , a V — 12128104 Continued

CH
Facility Number: — Sof Inspection •
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes J�4No
No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ❑ NA ElNE
El❑ Design ❑Maps ❑Otherthe appropriate box. ❑ WUP Checklists
,,.�(
21. Do record keeping need i provement?elf yee; s e-he e}var. ❑ Yes *o ❑ NA ❑ NE
aste Application [�W ekly Freeboard Waste Analysis oil Analysis [ n
14 ,�,/ f t�►sfe�
Rainfall Stocking [Crop Yield G 120 Minute Inspections LI Monthly and 1" Rain Inspections 7cather Code .
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?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any 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 XNo
❑ Yes ❑ No
❑ Yes %No
❑ Yes ❑ No
❑ Yes �No
❑ Yes t%No
❑ NA ❑ NE
D(NA ❑ NE
❑ NA ❑ NE
ZNA ❑ NE
El NA El NE
❑ NA ❑ NE
Yes ❑ No ❑ NA ❑ NE
Yes DiNo ❑ NA ❑ NE
❑ Yes two ❑ NA ❑ NE
❑ Yes
�No
❑ NA
❑ NE
❑ Yes
0 No
❑ NA
❑ NE
❑ Yes
�J o
❑ NA
❑ NE
Additional Comments'andlor Drawings4aY i krffi _ 3 '* t
i zv�.:.'.-#}�_, �. �. alto
aA60$ q- a6O9 Sol Js? a010 ZOO c 4- aoCade+-ej ,
hec, n l I In �Q_ ,
L'a11 brA-1 Orl 4;r a016 ? �50I'l ►Vo, 1, a '►r+r� a t�n<* torvo-A
- l�l 0-41 - -01 o w aS f e an a) s i s � S" 10 2 - S Q ��e r
'�� W IsLS� fah 5fa-des `Aoc+ l- 9S62 F- 1 S
b
+ l QA fI_LL&UVzk A9 �) Joz- art
Page 3 of 3n U F [- �c.f— II Ch" I (.ij U -P _ a Sad rarzsio4F _ 5 0-1 s p d

Facility Number
Division of Water Quality -
Division of Soil and Water Conservation
Q Other Agency
Type of Visit
Compliance Inspection
0 Operation Review O Structure Evaluation
O Technical Assistance
Reason for Visit
xRoutine () Complaint
0 Follow up 0 Referral 0 Emergency
0 Other ❑ Denied Access
Date of Visit: �V Arrival Time: Departure Time: County: 1Ll yk Region: 5�
Farm Name: nre - r0 5 1C3, l tr' \4 Owner Email:
Owner Name: 'J Ol-tV— S inb C"f Phone:
Mailing Address: `Z a`10 S b 0 re V a-d l n V Q { � C, a % C3S'f --
Physical Address:
Facility Contact: (,O L] 15 S�M f f_ Title: Phone o
Onsite Representative: _ U ��_ Or _ Integrator:
rS • ��
Certified Operator: LoU l S S h0 f Operator Certification Number: J
Back-up Operator:
Location of Farm:
1
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Latitude: ®O G
lb J\
Back-up Certification Number:
10 " Longitude: ® ° Fq—()-1 � 0 10 64
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -La cr
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
Design Current
Cattle Capacity Population
D iry Cow
I cj,5_()
❑ Dairy Calf
Q
❑ Dairy Heifei
❑ D Cow
❑ Non-Dai
❑ Beef Stocket
❑ Beef Feeder
❑ Beef Brood Cow
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures: n
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
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
ANo
❑ NA
❑ NE
❑ Yes LXNo ❑ NA ❑ NE
12128104 Continued

Facility Number: q-- 0 Date of Inspection o�� •
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure Structure 2 Structure 3 Structure 4
Identifier: W Q, e
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes * No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes �No ❑ NA ❑ NE
❑ Yes Lj[No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes *o ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ 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 L] No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No El NA El NE
maintenance/improvement?
1. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes o ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drifl ❑ Application Outside of Area
D�12. Crop type(s) �.�/J , Al 4- ® �,� �-L _ ..
13. Soil type(s) I
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
❑ No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
X
❑ NA
ElNE
18. Is there a lack of properly operating waste application equipment?
ElYes
(No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (.use additional pages as necessary):
Reviewer/Inspector Name Phone:
ReviewerlInspector Signature Date: .20
nue

0 r Facility Number: — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes No [DNA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box. ❑ WUp ❑ Checklists ❑ Design El Maps El Other
21. Does record keeping need improvement? e*el'avA ❑ Yes No ❑ NA ❑ NE
�aSte Applic con 1Ve ly Free7120
aste Analysis ❑ Soil Analysis aste Transfers iar�
lJ Rainfall Stocking Crop YieMinute Inspections Monthly and ]" Rain Inspections �Wea__
de
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No IV 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 XNA ❑ NE
26. Did the facility fail to have an actively certified operator in charge? ❑ Yes A No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ❑ Yes XNo ElNA ElNE
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 KNo ❑ 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 lZU No ❑ NA ❑ NE
General Permit? (iel discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes No ❑ NA ❑ NE
33. Does facility require a follow-up visit by same artery? El Yes No [I NA El NE
Additional Comments and/or Drawings:"
9007 sad 's ? C 00N o reco 0 io idi V) 1 0
Cali bray t-� o io
1)k p5 c off" cal
Q11—
s_
Page 3 of 3 12128104

Type of Visit ? Compliance Inspection Q Operation Review O Structure Evaluation O Technical Assistance
Reason far Visit (ARoutine O Complaint O Follow up 0 Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: I f��f Arrival Time: �� Departure Time: County: VOA V-11 h Region: 10-5 tZd
Farm Name: 5nr� ro5 ��1 r 11 Owner Email: p f!
Owner Name: tT Dream_ Phone:
Mailing Address: rZ oZ ;"�, f` K t rl it.1 11e. t NCB,.,..,. -a `Sys
Physical Address:
Facility Contact: i��V 1p{-P_ Title: Phone NoOof -1�
Onsite Representative: " [�Lj!s,_ �11�V Integrator: _ _ __ _ H 3 361 tall- 3031
Certified Operator: _ . ���Ui _<1pf�e Operator Certification Number:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Back-up Certification Number:
Latitude: ® o ®` Longitude: ® o FW © "
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -Layer
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Design Current
Cattle Capacity Population
airy Cow
Dairy Calf
❑ Dairy Heifej
E]Dry Cow
❑ Non -Dairy
❑ Beef Stocker -
El Beef Feeder
❑ Beef Brood Cow
—
Number of Structures:
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-m e?
b. Did the discharge reach aters of the State? (If yes, notify DWQ)
c. What is the estimatedivolume that reached waters of the State (gallons)?
1
d. Does discharge bypass the waste management system? (]f yes, notify DWQ)
2, Is there evidence of a past discharge fr m 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
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
1 12128104 Continued

Facility Number: — {� . Date of Inspection 141,241
1 L it
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
�io
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
o
❑ NA
❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
�6o
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
No
❑ NA
❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance/improvement? �No
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ElYes ❑ 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? XYes
15. Does the receiving crop and/or land application site need improvement? ❑ Yes
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
17. Does the facility lack adequate acreage for land application? ❑ Yes
18. Is there a lack of properly operating waste application equipment? ❑ Yes
El No El NA El NE
No ❑ NA ❑ NE
No ❑ NA ❑ NE
XNo ❑ NA ❑ NE
KNo ❑ NA ❑ NE
Comments (refer to question ##): Explain any YES answers and/or any recommendations or any other comments
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Page 2 of 3
Phone:
Date:
12128104 Continued

all
Facility Number: — d Oteof Inspection
Required Records & Documents V
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 v ❑ Yes $No ❑ NA ❑ NE
the appropiiate box. r
❑ N UP ❑Checklists El Design ❑Maps ❑Other
21. Does record keeping need impr vement? If yes, check the appropriate box b low. - ❑ Yes L_`(No ❑ NA ❑ NE
[Waste Application Weekly Freeboard ❑'Waste Analysis oil Analysis
tainfall Stocking 2/crop Yield N 20 Minute Inspections �Ionthly and I" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
�No
❑ NA
❑ NE
23.
If selected, did the Facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
[(NA
❑ 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
XNA
❑ 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
I 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 review/inspection with an on -site representative?
❑ Yes
XNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
*0
❑ NA
El NE
Additional Comments and/qr Drawings:
o��e vZ�� Sot�S
a I i b ra+on uer
e
and 3) FouJ nale L�Pm),
roeess of be -'In re o5eJ peer f ec.h s pecial1'5t,
en. W u p 'l s ,Prib�I
) (ILC e eS---�i eU5 tb be rivi so4
i. f jo o su s fe- a-.n0-1 s s� - al d 5. 3
1 N% TOM � � �
1�5. N J ldoo 3rr�► ��ton e
a I M0 WCk
12128104

Division of Water Quality cap
Facility Number Q Division of Soil and Water onservation ��
.. L l
1 0 Other Agency
Type of Visit
Compliance Inspection
Q Operation Review O Structure Evaluation
0 Technical Assistance
Reason for Visit
YRoutine 0 Complaint
0 Follow up 0 Referral Q Emergency
0 Other ❑ Denied Access
Date of Visit: LJQ_JfArrival Time: Departure Time: County: C , Region:
Farm Name: Le ro Owner mail:
Owner Name: a a a �5 h n �' VFif h�r�
Mailing Address: ,. _--+.57L ] k o r�,
Physical Address:
j,QQ2�e` — Facility Contact: Title: sag o ar3 1
Onsite Representative: ex) S integrator: c 3
Certified Operator: Operator Certification Number: t
Back-up Operator: Back-up Certification Number:
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
Latitude: mo OBA Fold
Longitude: � ° 04
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -Layer
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
Dairy Cow
Dairy Calf
❑
Dairy Heifer
❑
Dry Cow
El
Non -Dairy
rp
Beef Stocker
Beef Feeder
10
Beef Brood Co
Number of Structures: FF
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
❑ NL
❑ NA
❑ NE
❑ Yes
❑ No
[--]Yes
,NrNo
❑ NA
❑ NE
❑ Yes
* o
❑ NA
❑ NE
12128104 Continued

Facility Number: — • Date of Inspection I _725 14*
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
0 No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5 Structure 6
In Identifi6r: 1� �[li.�
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): Z
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No El NA El NE
(ie/ large trees, severe erosion, seepage, etc.)
T�
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
qNo ❑ 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?
j Yes
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
,❑/No
No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
I
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
P No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
IgNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 101bs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drill ❑ Application Outside of Area
12. Crop type(s) lbr
—
13. Soil type(s) v
14. Do the receiving crops differ from those designated in the CAWMP?
XYes
❑ 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
No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
ElNA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
X No
❑ NA
❑ NE
Comments (refer to question ##): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
W u5 k� �o�n�at n
lob e s
55 ?
l
wer/lnspec ame
( Phone: —
ReviewerlInspector Signature.
Date: 16
Continue
r
�iI

4-
Facility Number: — 10ate of Inspection 7
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? El Yes )e [I NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check []Yes Xo ❑NA ElNE
❑ Design ❑Maps ❑Otherthe appropriate box. ❑ WUP ❑ Checklists 21. iwa'tc
record keeping nee=Freeboard
ent? If yes, check the appropriate box be w. ❑ Yes ❑ No ❑ NA ❑ NE ZAp��ing
' Waste Analysis �zy
is
fall ❑ Crop Yield 1 0 Minute Inspections and 1" Rain Inspections ❑ Weather Code
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?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any 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, fr6eeboard 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
0 No
❑ NA
❑ NE
❑ Yes
❑ No
[(NA
❑ NE
❑ Yes
,X(No
❑ NA
❑ NE
❑ Yes
(No
❑ NA
❑ NE
❑ Yes
Xl `
ElNA
ElNE
❑ Yes
t5kNo
❑ NA
❑ NE
Yes ❑ No ❑ NA ❑ NE
Yes AKo ❑ NA ❑ NE
❑ Yes [No ❑ NA ❑ NE
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes N<o ❑ NA ❑ NE
❑ Yes j No ❑ NA ❑ NE
• ddg—T.
AAVF
r
I f
el
�y
12128104

■ Division of Water Quality
❑ Division of Soil and Water Conservation
❑ Other Agency
Facility Number: 990007 _ Facility Status: Active Permit: AWC990007 ❑ Denied Access
Inspection Type: Compliance lnsUection Inactive or Closed Date:
Reason for Visit: Routine County: Yadkin Region: Winston-Salem
Date of Visit: 031Q2/2006 Entry Time:10710 AM Exit Time: 11:45 AM Incident #:
Farm Name: Shore Bros Dairy Owner Email:
Owner: Jack Shore
Mailing Address: 2220 Shore Rd _
Physical Address:
FacilityStatus: ❑ Compliant ❑ Not Compliant Integrator:
Phone: [phone]
a 44
Location of Farm: Latitude: 36010'60" Longitude: 80°40'00"
Take Hwy 601 North out of Yadkinville. Turn right onto Shore Road (SR1374). The farm is on the left just before the Milk House Dairy
Farm, which is on the right.
Question Areas:
Discharges & Stream Impacts Waste Collection & Treatment Waste Application
Records and Documents © Other Issues
Certified Operator: Louis M Shore Operator Certification Number: 25634
Secondary OIC(s):
On -Site Representative(s): Name Title Phone
On -site representative Louis Shore Phone: [phone]
24 hour contact name Louis Shore Phone: [phone]
Primary Inspector: Melissa Rosebrock Phone:
Inspector Signature:
Secondary Inspector(s):
Date:
Inspection Summary:
7. Must contain the waste on the concrete lot across the road. To be completed by May 2006.
18. Need pressure gauge for irrigation gun prior to next application event.
21, Waste sample for Jan./Feb, 2006 applications was sent to Raleigh this week. Check PAN balances next visit.
21. Soil test results were obtained late for 2005 but were completed. Don't forget to obtain samples for 2006.
28. WUP states that T-2528 F-1 &2 has 8 acres of usable land. Operator has more acreage in his records. Check with technical
specialist to confirm.
Page: 1

•
Permit: AWC990007 Owner - Facility: Jack Shore
Inspection Date: 03/02/2006 Inspection Type: Compliance Inspection
Faclltty, Number: 990007
Reason for Vlaft: Routine
Regulated Operations Design Capacity Current Population
Cattle
Q Cattle - Milk Cow 250 218
Total Design Capacity: 250
Total SSLW: 350,000
Waste Structures
Type Identlfler Closed Date Start Date Designed Freeboard Observed Freeboard
�aste Pond WSP 29.40 22.00
Page: 2

•
�J
Permit: AWC990007 Owner - Facility: Jack Shore Facility Number: 990007
Inspection Hate: 03/02/2006 Inspection Type: Compliance inspection Reason for Visit: Routine
Discharges & Stream Impacts
Yea
No
NA
NE
1. Is any discharge observed from any part of the operation?
❑
■
❑
❑
Discharge originated at:
Structure
❑
Application Field
❑
Other
❑
a. Was conveyance man-made?
❑
■
❑
❑
b. Did discharge reach Waters of the Slate? (if yes, notify DWQ)
❑
■
❑
❑
c, Estimated volume reaching surface waters?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
❑
01111
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 Waters of the State other than from a
❑
■
❑
❑
discharge?
Waste Collection, Storage & Treatment
Yes
No
NA
NE
4. Is storage capacity less than adequate?
❑
■
❑
❑
If yes, is waste level into structural freeboard?
❑
5. Are there any immediate threats to the integrity of any of the structures observed (Le./ large trees, severe
❑
■
❑
❑
erosion, seepage, etc,)?
6. Are there structures on -site that are not properly addressed and/or managed through a waste management ❑
■
❑
❑
or closure plan?
7. Do any of the structures need maintenance or improvement?
❑
■
❑
❑
8, Do any of the structures lack adequate markers as required by the permit? (Not applicable to roofed pits,
❑
■
❑
❑
dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require maintenance or
■
❑
❑
❑
improvement?
Waste Application
Yes
No
NA
NE
10. Are there any required buffers, setbacks, or compliance alternatives that need maintenance or
❑
■
❑
❑
improvement?
11. Is there evidence of incorrect application?
❑
■
❑
❑
If yes, check the appropriate box below.
Excessive Ponding?
❑
Hydraulic Overload?
❑
Frozen Ground?
❑
Heavy metals (Cu, Zn, etc)?
❑
Page: 3

Permit: AWC990007 Owner- Facility: Jack Shore Facility Number: 990007
Inspection Date: 03/02/2006 Inspection Type: Compliance Inspection Reason far Visit: Routine
Waste Application Yes No NA NE
PAN? ❑
Is PAN > 10%/10 lbs.? ❑
Total P205? ❑
Failure to incorporate manurelsludge into bare soil? ❑
Outside of acceptable crop window? Cl
Evidence of wind drift? ❑
Application outside of application area? ❑
Crop Type 1
Crop Type 2
Crop Type 3
Crop Type 4
Crop Type 5
Crop Type 6
Soil Type 1
Soil Type 2
Soil Type 3
Soil Type 4
Soil Type 5
Soil Type 6
14. Do the receiving crops differ from those designated in the Certified Animal Waste Management
❑ ■
❑
❑
Plan(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 acre determination?
❑ ■
❑
❑
17. Does the facility lack adequate acreage for land application?
❑ ■
❑
❑
18. Is there a lack of properly operating waste application equipment?
■ ❑
❑
❑
Records and Documents
Yes No
NA
NE
19. Did the facility fail to have Certificate of Coverage and Permit readily available?
❑ ■
❑
❑
20. Does the facility fail to have all components of the CAWMP readily available?
❑ ■
❑
❑
If yes, check the appropriate box below.
WUP?
❑
Page: 4

Permit: AWC990007 Owner - Facility: Jack Shore
Facility Number: 990007
Inspection Date: 03/02/2006 Inspection Type: Compliance Inspection
Reason for Visit: Routine
Records and Documents
Yes
No NA
NE
Checklists?
❑
Design?
❑
Maps?
❑
Other?
❑
21. Does record keeping need improvement?
❑
■ ❑
❑
If yes, check the appropriate box below.
Waste Application?
❑
120 Minute inspections?
❑
Weather code?
❑
Weekly Freeboard?
❑
Transfers?
Q
Rainfall?
❑
Inspections after > 1 inch rainfall & monthly?
❑
Waste Analysis?
❑
Annual soil analysis?
❑
Crop yields?
❑
Stocking?
❑
Annual Certification Form (NPDES only)?
❑
22. Did the facility fail to install and maintain a rain gauge?
❑
■ ❑
Q
23, If selected, did the facility fail to install and maintain a rainbreaker on irrigation equipment (NPDES
only)? ❑
❑ ■
❑
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑
■ ❑
❑
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑
❑ ■
❑
26. Did the facility fail to have an actively certified operator in charge?
❑
■ ❑
❑
27. Did the facility fail to secure a phosphorous loss assessment (PLAT) certification?
❑
Cl ■
❑
Other Issues
Yes
No NA
NE
28. Were any 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 those ❑ ■ ❑ ❑
mortality rates that exceed normal rates?
30. At the time of the inspection did the facility pose an air quality concern? If yes, contact a regional Air ❑ ■ ❑ ❑
Quality representative immediately.
Page: 5

Permit: AVVC990007 Owner- Facility: Jack Shore
Facility Number:
990007
Inspection Date: 03/02/2006 Inspection Type: Compliance Inspection
Reason for Via It: Routine
Otherlssues
Yes No
NA
NE
31. Did the facility fail to notify regional DWQ of emergency situations as required by Permit?
❑ ■
❑
❑
32. Did ReviewerAnspector fail to discuss review/inspection with on -site representative?
❑ ■
❑
❑
33. Does facility require a follow-up visit by same agency?
❑ ■
❑
❑
Page: 6

Division of Water Quality
Facility Number `] Division of Soil and Water Conservation
- o
Q Other Agency
Type of Visit Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: - 0 Arrival Time: d D Departure Time:FFf County: K t n Region: s r�
Farm Name: :4%nirP Bros. A 1 rV -- Owner Email:
Owner Name: N-acAL 5bone- Phone: tr2 `[ �
Mailing Address: g a d hn re 1 V to k4,I n -y I( lQ-_t r1jL1 a 7 0 5S
Physical Address:
Facility Contact: Louis Shore Title: Phone No:
Onsite Representative: �[^b Q I SAS bQ CC, Integrator:
Certified Operator: LDU L,� S bore, Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: [Do i d ` �" Longitude:
�O b l�o
M kLj rl/1l i 2 R► on S �1or2
Design.' Current Design Current . '. Design" " Current
Swine Capacity Population` Wet Poultry capacity Population Cattle. Capacity pop' . at-
❑ Wean to Finish
❑ Wean to Feeder
I
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other ..
❑ Other
❑ La er
❑ Non -Layer
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
Dairy Cow
0
r
Dairy Calf
EI_Dairy Heifer
EjDa Cow
❑ Non -Dairy
❑ Beef Stocker
ElBeef Feeder
❑ Beef Brood Cow
c. What is the estimated volume that reached waters of the State (gallons)?
� sI
Number of Structures
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes
4No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
El Yes
El No
El NA
[I NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
ElNA
ElNE
I212104
Continued
Ina

Facility Number: � I* Date of Inspection •
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes ANo ❑ NA [I NE
El Yes ❑No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes YNo ❑ NA ❑ NE
❑ Yes XNo ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes o ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
4. Does any part of the waste management system other than the waste structures require yes ❑ No ❑ NA ❑ NE
maintenance or improvement?
Waste Anplication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 4No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes o ❑ NA ❑ NE
❑ Excessive Ponding El Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.) I _
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Croptype(s) ue //ar0Ze) Corr, 5Ka-1 9c ra15n 12 V-0,S ha.,
13. Soil type(s)
"
V
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
*o
[I NA
[I NE
15. Does the receiving crop and/or land application site need improvement?
Yes
❑```"`No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
No
El NA
❑ NE
17. Does the facility lack adequate acreage for land application?
El Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
-9Yes
❑ No
❑ NA
❑ NE
Comments (refer to'question.#): Explain any YES answers and/or any recommendations or any othertomments
Use drawings of facility to.better explain situations. (use additional pages as•necessary):
F1. 5 5 o r coos 2
AL
e
�
V 1 d 6. Not Lop v olp k e-M e+ .
Reviewer/Inspector Name e— b, r I Phone: - S
Reviewer/Inspector Signature Date: ,3
Page 2 of 3
12128104 Continued

Facility Number: — 0e of Inspection oL t7 •
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes *o ElNA ElNE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 6N o ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design El Maps El Other
21. Does record keeping need�im�rovement? ,
need
El Yes
❑ No
❑ NA
❑ NE
❑ Waste Application Freeboard []/Waste Analysis oil alysis
Rainfall6tocking [Crop Yield ❑ 120 Minute Inspections onthly and 1"
Rain Inspections Lt}'Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
?<O
❑NA
ElNE
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?4W
n b ❑ Yes
0 No
NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No
XNA
❑ 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
r `No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
o
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
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 review/inspection with an on -site representative?
❑ Yes
*o
[INA
ElNE
33. Does facility require a follow-up visit by same agency?
❑ Yes
WTo
❑ NA
❑ NE
Additional Comments and/or Drawings:
i
i
WAI
air -
'IF
W-.0-0 ru

Division of Water Quality
❑ Division of Soil and Water Conservation
❑ Other Agency
Facility Number: 990007 Facility Status: Active — Permit: AWC9900Q7 ❑ Denied Access
Inspection Type: Compliance Inspection _ Inactive or Closed Date:
Reason for.Vislt: Routine County: Region: Winston-Salem
Date of Visit: 09/22/2005 Entry Tlme: 09:30 AM Exit Time: 11:20 AM Incident #:
Farm Name: Shore Bros Dairy Owner Email:
Owner: ,sack Shore
Phone: [phone]
Mailing Address: 2220 ShorLIW Yadkinville NC 27055
Physical Address:
Facility Status: ❑ Compliant ❑ Not Compliant Integrator:
Location of Farm: Latitude: -21QJ0'60" Longitude: 80040'00"
Take Hwy 601 North out of YadkinviIle. Turn right onto Shore Road (SR1374). The farm is on the left just before the Milk House
Dairy Farm, which is on the right.
Question Areas:
Discharges & Stream Impacts 0 Waste Collection & Treatment Waste Application
Records and Documents ® Other Issues
Certified Operator: Louis M Shore Operator Certification Number: 25634
Secondary OIC(s):
On -Site Representative(s): Name Title Phone
On -site representative Louis Shore Phone: [phone]
24 hour contact name Louis Shore Phone: [phone]
Primary Inspector: Me •ssa Rgsebrock Phone: [phone]
Ex1.383
Inspector Signature: Date:
Secondary Inspector(s):
Phone:
Phone:
Inspection Summary:
7. Need to establish permanent vegetation on embankment of WSP.
21. Don't forget to obtain 2005 soil test results.
21. Records look great!
9/16/05 waste analysis:
Beef scraped=4.5 Ibs. Nlton and WSP was sampled and tested twice= 5.2 and 5.3 lbs. N/1000 gal.
Page: 1

Permit: AWC990007 Owner- Facility: Jack Shore Facility Number: 990007
Inspection Date: 09/22/2005 Inspection Type: Compliance Inspection Reason for Vlslt: Routine
Regulated Operations Design Capacity Current Population
Cattle
Cattle - Milk Cow 250 223
Total Design Capacity: 250
Total SSLW: 350,000
We Identliier Closed Date Start Date Designed Frosboard Observed Freeboar
Vaste Pond WSP 29.40 36.00
Page: 2

Penult: AWC990007 Owner -Facility: Jack Shore Facility Number: 990007
Inspection Date: 09/2212005 Inspection Type: Compliance Inspection Reason for Visit: Routine
f}isrhargPs R Stream Imparts
1. Is any discharge observed from any part of the operation?
Yes —No
❑
NA NE
❑ ❑
Discharge originated at:
Structure
❑
Application Field
❑
Other
❑
a. Was conveyance man-made?
❑
❑ ❑
b. Did discharge reach Waters of the State? (if yes, notify DWQ)
❑
❑ ❑
c. Estimated volume reaching surface waters?
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 Waters of the State other than from a discharge?
❑
Yes
M ❑ ❑
No NA NE
Waste Collertion_ Storage & Treatment
4. Is storage capacity less than adequate?
❑
0 ❑ ❑
If yes, is waste level into structural freeboard?
❑
5. Are there any immediate threats to the integrity of any of the structures observed (Le./ large trees, severe erosion,
❑
M ❑ ❑
seepage, etc.)?
6, Are there structures on -site that are not properly addressed and/or managed through a waste management or
❑
❑ ❑
closure plan?
7. Do any of the structures need maintenance or improvement?
❑ ❑ ❑
B. Do any of the structures lack adequate markers as required by the permit? (Not applicable to roofed pits, dry stacks
❑
0 ❑ ❑
and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require maintenance or
❑
❑ ❑
improvement?
Yes
No NA NF
WactP Application
10. Are there any required buffers, setbacks, or compliance alternatives that need maintenance or improvement?
❑
❑ ❑
11. Is there evidence of incorrect application?
❑
❑ ❑
If yes, check the appropriate box below.
Excessive Ponding?
❑
Hydraulic Overload?
❑
Frozen Ground?
❑
Heavy metals (Cu, Zn, etc)?
❑
PAN?
❑
Is PAN n 10%110 lbs.?
❑
Total P205?
❑
Failure to incorporate manurelsludge into bare soil?
❑
Outside of acceptable crop window?
❑
Evidence of wind drift?
❑
Application outside of application area?
❑
Crop Type 1
Corn (Silage)
Crop Type 2
Fescue (Hay)
Crop Type 3
Small Grain (Wheat,
Barley,
Oats)
Crop Type 4
Crop Type 5
Page: 3

• 0
Permit: AWC990007 Owner -Facility: Jack Shore
Facility Number: 990007
Inspection Date: 09/22/2005 Inspection Type: Compliance Inspection
Reason for Visit: Routine
Waste Appflyafinn
Crop Type 6
Yec
No NA
NE
Soil Type 1
Soil Type 2
Soil Type 3
Soil Type 4
Soil Type 5
Soil Type 6
14. Do the receiving crops differ from those designated in the Certified Animal Waste Management Plan(CAWMP)? ❑
s ❑
❑
15. Does the receiving crop and/or land application site need improvement?
❑
E ❑
❑
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?
❑
0 ❑
❑
17. Does the facility lack adequate acreage for land application?
❑
■ ❑
❑
1B. Is there a lack of properly operating waste application equipment?
❑
Yes
0 ❑
No NA
❑
NE
Records and Documents
19. Did the facility fail to have Certificate of Coverage and Permit readily available?
❑
0 ❑
❑
20. Does the facility fail to have all components of the CAWMP readily available?
❑
0 ❑
❑
If yes, check the appropriate box below
WUP?
❑
Checklists?
❑
Design?
❑
Maps?
❑
Other?
❑
21, Does record keeping need improvement?
❑
E ❑
❑
If yes, check the appropriate box below.
Waste Application?
❑
120 Minute inspections?
❑
Weather code?
❑
Weekly Freeboard?
❑
Transfers?
❑
Rainfall?
❑
Inspections after > 1 inch rainfall & monthly?
❑
Waste Analysis?
❑
Annual soil analysis?
❑
Crop yields?
❑
Stocking?
❑
Annual Certification Form (NPDES only)?
❑
22. Did the facility fail to install and maintain a rain gauge?
❑
❑
❑
23, If selected, did the facility fall to install and maintain a rainbreaker on irrigation equipment (NPDES only)?
❑
❑
❑
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑
❑
❑
25, Did the facility tail to conduct a sludge survey as required by the permit?
❑
a ❑
❑
26. Did the facility fail to have an actively certified operator in charge?
❑
❑
❑
27, Did the facility fail to secure a phosphorous loss assessment (PLAT) certification?
❑
❑
❑
Page: 4

C�
•
Permit: AWC990007 Owner -Facility: Jack Shore Facility Number :' 990007
Inspection Date: 09/22/2005 Inspection Type: Compliance Inspection Reason for Visit: Routine
26. Were any additional problems noted which cause non-compllanoe of the Permit or CAWMP? ❑ 0 ❑ ❑
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document and report those mortality ❑ a ❑ ❑
rates that exceed normal rates?
30. At the time of the Inspection did the facility pose an air quality concern? If yes, contact a regional Air Quality ❑ 0013
representative immediately.
31. Did the facility fail to notify regional DWQ of emergency situations as required by Permit? ❑ M ❑ ❑
32. Did Reviewer/Inspector fail to discuss roviewlinspection with on -site representative? ❑ ■ ❑ ❑
33. Does facility require a follow-up visit by same agency? ❑ M ❑ ❑
Page: 5

Type of Visit pliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit rRoutine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: g0— Departure Time: 1 a County: �1 t' _ Region:
Farm Name: Sho r _ - ro s • Yr y Owner Email: f
Owner Name: - �0.e �°E' LC]u l5 5 h O Y2� Phone: l: 7Q _ $ 7 �
a a ao S h-e 1v C ��aSI~
Mailing Address: b
Physical Address: }_&MW - _7q „
Facility Contact: V 1 S �O r e Title: Phone No:
Onsite Representative: t.,n t�;VSMJ I0 re- Integrator:
Certified Operator: , t _0 to l j ! ' t ' Spre=i (9perator Certification Number:
Back-up Operator:
Location of Farm:
Certification Number:
Latitude: ®c M:] ` [0" Longitude: ®o ®1 OD "
1 uo I. D i n o .out 0V lad K I n v 1 I I e. , p 4to S bore
Swine
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -La er
Dry Poultry
Non-L
Puilets
Poults
Design Current
Cattle Capacity Population
Dai Cow
C-Dairy
Calf
❑
Dairy Heifei
❑
Dry Cow
❑
Non -Dairy
❑
Beef Stocker
❑
Beef Feeder
❑
Beef Brood Cow
Number of Structures:
Discharees & 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 qkNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes KNo ❑ NA ❑ NE
❑ Yes 19 No ❑ NA ❑ NE
12128104 Continued

Facility Number: — . . Date of Inspection 4�90A
Waste Collection & 'Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes KNo ❑ NA El NE
a. If yes, is waste level into the structural freeboard? El Yes ❑ No ❑ NA ❑ NE
Structure �} I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: 1paa4le T`phQ
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes �k<o
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes No
❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement? k-Yes ❑ No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes SrNo
❑ 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 );�Ro
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
❑ NA ❑ NE
maintenance/improvement? ,(�No
/
11. Is there evidence of incorrect application? If yes, check the appropriate box below. El Yes L1d'No
El NA El NE
El Excessive Ponding [I Hydraulic Overload ❑ Frozen Ground [I Heavy Metals (Cu, zn, etc.) /,
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Window [I Evidence of Wind Drift [I Application Outside of Area
,Crop
12. Croptype(s) l ". J L�4.412 — h- 4 4 `t
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No
ElNA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
El Yes
No
El NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination; ❑ Yes
No
El NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
Y'No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
'eNo
❑ NA
❑ NE
9 l icy 05 11j aSke'a l Lt'� 6 a
beze = L}.S LA-a5 Pao = S Z WS Pl b = S; 3
Reviewer/Ins ector Name r �-
P Ics
F
Reviewer/Inspector Signatur : Date:
12/28/04 Continued

Facility Number: D10f Inspection I —r ! IV 10
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
❑ Yes XNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes N No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps ❑Other
21. Do record keeping need im rovement? lfyes, the the appropriate box below. ikk 4"E' ❑ Yes ;No ❑ NA ❑ NE
Waste Ap21tock-ing
ion need
Freeboard Waste Analysis Soil Analysis �s—
�Rainfall Becrop Yield �20 Minute Inspections Qti'Mon[hly and I "'Rain Inspections �eather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes �No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No XNA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit? 0�5k•� b ❑ Yes 1�,No ❑ NA ❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit'? ❑ Yes ❑ No XNA ❑ NE
26. Did the facility fail to have an actively certified operator in charge? ❑ Yes �(No ❑ NA ❑ NE
27. Did the facility tail 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 bO.�o ❑ 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
T!$e<o
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
XNo
ElNA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
XNo
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency`?
❑ Yes
XNo
❑ NA
❑ NE
Additional Comments and/or Drawings:
'Re ny\ Fo r cD. e_ "m 2 --
VicP ressu�'2 au on u n?
UP,
d6o5 Soi, Sues 7 L�oln} f"ovc e-} 1
as U-) uIP re- -v'kSea A;:rar &_e v-e5 , �Ie_[ S + e roes
e
12128104

.iAlll�s;.' is .f0
i uO!.,:i tvherK,i.Pel nc
y!, i i.€ '.i tI,i i
� tiI,
I !2l- i u
€
Type of Visit O Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit O• Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Facility Number 99 Date of Visit: 1ZIZ12Q04 Time: 0925
Not O erational C Below Threshold
IN Permitted ® Certified [3 Conditionally Certified © Registered Date Last Operated or Above Threshold: ...............
Farm Name: Shan.B.ros..DAix:......................................................................................... County: YAs1M.............................................. W.5RQ........
Owner Name:JA9lisXt.LQ.W59.................... ShQr:c........................................................... Phone No: 33G-671-.0. 3.41asad............................
Mailing Address: ZZZO.SbQrre.Rd...................................................................................... yAdURyA1gJ4.0 .................................................... Z7.055 .............
Facility Contact: Lo.W.&S1b.QIlr.
Title:..........
Phone No: 679„ Q,3J .(,k1.9mg)...............
Onsite Representative: LQMiS..5hloxQ ........................... .................... .... Integrator:................
Certified Operator:LQmis.X................................. S.11Qla<................................................. Operator Certification Number:2%3.4.....................
Location of Farm:
Take Hwy 601 North out of Yadkinville. Turn right onto Shore Road (SR1374). The farm is on the left just before the Milk
House Dairy Farm, which is on the right.
❑ Swine ❑ Poultry ® Cattle ❑ Horse Latitude 36 • 11 00 Longitude 80 •F 40 1, F 00
Design Current.
Design Current
Design Current
Swine Capacity, Population
Poultry
Capacity Population Cattle
Capacity Population
❑ Wean to Feeder
JE1 Layer
❑ Dairy
250
60
❑ Feeder to Finish
❑ Non -Layer
1 -
❑ Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Other
❑ Farrow to Finish
Total Design Capacity
250
❑ Gilts
Total 'SkLW
350,000
El Boars
Number of Lagoons 0
JE-
" 1
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes ® No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes ® No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ® Yes ❑ No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ® Spillway ❑ Yes ® No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ......Wasle.Pund......................................................................................................................................................................................
Freeboard (inches): 30
12112103 Continued

Facility Number: 99-7 0 Date of Inspection 12/2/2004 .
ti
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 0 Yes ® No
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need 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 ❑ Yes ® No
elevation markings?
Waste ADDlication
10. Are there any buffers that need maintenance/improvement? ❑ Yes ® No
11. Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes ® No
❑ Excessive Pond ing []PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc > 3000
12. Crop type Fescue (Graze) Corn (Silage & Grain) Small Grain (Wheat, Barley,
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?
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?
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours?
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional
Air Quality representative immediately.
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes ®No
® Yes ❑ No
❑ Yes ❑ No
❑ Yes ® No
❑ Yes ® No
❑ Yes ®No
CO Ex lain` an Y me
or any other-comments'.4�
„
mmawing of fact
q y to 6 tt !' p (use additional p ges as n' cessary)'ns �❑Feld Copy ® Final Notes
Use drawings Of faClht to better explain situations.v
3.DWQ observed a severely eroded and denuded area of the creek (600 linear feet?) in the pasture with the charlais. Must begin cattle
exclusion by January 2005. Contact SWCD/NRCS for assistance.
8. Must install an 8-10" berm on the lower side of the cattle barn lot to control waste run-off from the lot. Must complete this by January
15. Matua that was planted in the fall of 2003 did not come up. These fields have been re -planted in fescue.
16. Need permanent of prtable pressure gauge on irrigation gun.
3. Don't forget to obtain soil samples for 2004. Check next visit.
3. Operator stated that he took waste samples (irrigation and slurry) to the Yadkin Co. field office yesterday. Check PAN balances for
Fall `04 next visit. Jan. `04 records (IRR-2) utilized the 4/24/03 analysis.
3. Some applications in 2004 were outside the 60-day waste analysis window.
13. and 29. Need to revise CAWMP to include fescue instead of/in addition to matua.
H�nr 7 + r iris >>
Reviewer/In
spector Name Melissa 116ebrock i�il t
Reviewer/Inspector Signature: Date:
12112103 Continued

Facility Number: 99-7 Iof .Inspection 12/2/2004
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?
(ie/ WUP, checklists, design, maps, etc.)
❑Yes
®No
23. Does record keeping need improvement? If yes, check -the appropriate box below.
® Yes
❑ No
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
® No
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 ;) Cgmpliance inspection O Operation Review O Lagoon Evaluation - -
Reason for visii 0 Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Date of Visit:
YPermitted 13Cerdfied © Conditionally Certified ❑ Registered
Farm Name: .....64v. ce_.13 LQ5... r ......_ _............... ._......
Owner Name • _ ,jr-eD
Marling Add.ress:.. a �?... », . � ice!` '» }• �1 Vl
Facility Contact: ........4 v i„�" .... .L�.X�.i�.i°....._._.. Title: .. . ...... ..... _...,
Onsite Representative:._. l„� �__ _......._..... ». _....
Certified Operator:.
Location of Farm:
Time:
Not Operational iD Below Threshold
Date Last Operated oristbqvS Threshold:......
County: ..».. ..»......1L .............»..».......» ... .. _.
'Phone No: 7
Phone No:. [g-
Intor:„,_W.»...._.»._......_._.»....»»...............».................»_..
22
Operator Certification Number:.
❑ Swine ❑ Poultry b(Cattle ❑ Horse Latitude Longitude ®• �"
Non -Layer
Other
Total Design
...Total's
Discharges - Stream impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man -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
Structure Structure 2 Structure 3 / Structure 4 Structure 5
Iden6 FvPr• � v
4- as
❑ Yes ® No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes No
Yes No
❑ Yes No
Structure 5
Freeboard(inches): .. __ � _...»._.�........»._....._.........»......_......_.... »...... ._..».._.»... ». _._..._......... _»....._»...»..._......»...
12112103 Continued

Facility Number: qq — Date of Inspection.
5. Are there any immediate threats to the 91grity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑ Yes No
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes �No
8. Does any part of the waste management system other than waste structures require maintenancelimprovement? 1Yes ❑ No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes No
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes IgNo
11. Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes XNo
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload 4)Frozen Ground ❑ Copper and/or Zinc
12. Crop type l) Q 'rt ZC. }
13. Do the receiving crops differ with tPose desijnated in the Certified Animal Waste Manage -mint 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 o
Does the receiving crop need improvement? El Yes o
16. s there a lack of adequate waste application equipment?'T R? .rjSU re— fla.41
�jt� C-71— es No Y
or Issues P'c' P 7 (J
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? ❑ Yes o
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.
)3.
ek6
AM r
Reviewer/Inspector Dame
41
' \ ReviewerAkopector Signature:
b
6""
Field Copy ❑ Final Notes
Date:
12/12/03

Facility Number: — D to of Inspection
Required Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit t readily available? ❑ Yes o
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP eklis !design, maps, etc.) ❑ Yes o
23. Doevrrecord keeping need i�provearont? appropriate box below. Yes ❑ No
Waste Application Freeboard Waste Anal " " /
PP � Y � ❑Soil Sampling Q�.�i�t�.� � �
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 o
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes o
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? X'Ies ❑ No
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35) ❑ Yes ��O
31. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [IYes ❑ 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
] No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
AL
a Soled �.xt,5tc records? (�
5 1% z
3!F'211�

Technical Assistance Site Visit Rencwt
• ion of Soil and Water Conservatio
O Na ural Resources Conservation Service
O Soil and Water Conservation District
O Other...
Facility Number 99 - 7� Date: 9/9104 Time: 1 9:15 j Time On Farm: WSRO
Farm Name Shore Bros Dairy County Yadkin Phone:
Mailing Address 2220 Shore Rd.
Yadkinville NC
Onsite
Representative Louis Shore Integrator
Type Of Visit Purpose Of Visit
Operation Review
Compliance Inspection (pilot only)
Technical Assistance
Confirmation for Removal
❑ No Animals -Date Last Operated:
❑ Operating below threshold
❑ Swine ❑ Poultry ® Cattle ❑ Horse
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
O Response to DWQ/DENR referral
• Response to DSWCISWCD referral
O Response to complaint/local referral
O Requested by prod ucerlintegrator
O Follow-up
O Emergency
O Other...
Design Current Design Current
Capacity Population
❑ Layer
❑ Non -Layer
IR Dairy
® Non -Dairy
so
F_L52
so
❑ Other
336-679-8463
27055
GENERAL QUESTIONS:
1. Is waste discharging from any part of the operation and reaching surface waters or wetlands? ❑ yes ® no
2. Is there evidence of a past waste discharge from any part of the operation that waste reached ❑ yes ® no
surface waters or wetlands?
3. Does any problem pose an immediate threat to the integrity of the waste structure (large trees, ❑ yes ® no
seepage, severe erosion, etc.)?
4. Is there evidence of nitrogen over application, hydraulic overloading or excessive ponding ❑ yes ® no
requiring DWQ notification?
5. Is there evidence of improper dead animal disposal that poses a threat to the environment ❑ yes ® no
and/or public health?
6. Is the waste level within the structural freeboard elevation range for any waste structure? ❑ yes ® no
Structurel Structure 2 Structure 3 Structure 4 Structure 5
Identifier WSP
Level (Inches) 30
CROP TYPES Fescue- raze I ISmall grain silage
SPRAYFIELD
SOIL TYPES CfB
CO2
7. What type of technical assistance does the onsite representative feel is needed? (list in comment section)
03/10/03

•
r-l�
Facility Number 99 - 7 Date:
9/9/04
PARAMETER
O No assistance provided/requested
❑ 8. Waste spill leaving site
TECHNICAL ASSISTANCE Needed
Provided
❑ 9. Waste spill contained on site
❑ 10. Level in structural freeboard
25. Waste Plan Revision or Amendment
❑
❑
❑ 11. Level in storm storage
26• Waste Plan Conditional Amendment
❑
❑
27. Review or Evaluate Waste Plan w/producer
❑
❑
❑ 12. Waste structure integrity compromised
❑ 13. Waste structure needs maintenance
28. Forms Need (fist in comment section)
19
29. Missing Components (list in comments)
❑
❑
❑ 14. Over application >= 10% & 10 lbs.
El
❑ 15. Over application < 10% or < 10 lbs.
30.2H.0200 re -certification
[116. Hydraulic overloading
31. Five & Thirty day Plans of Action (PoA)
❑
❑
32. Irrigation record keeping assistance
❑
❑
❑ 17. Deficient irrigation records
1918. Late/missing waste analysis
33. Organizelcomputerization of records
❑
❑
[119. Late/missing lagoon level records
34. Sludge Evaluation
❑
❑
❑ 20. Late/missing soils analysis
❑ 21. Crop needs improvement
35. Sludge or Closure Plan
❑
❑
❑ 22. Crop inconsistent with waste plan
36. Sludge removal/closure procedures
❑
❑
37. Waste Structure Evaluation
❑
❑
❑ 23. Irrigation maintenance deficiency
❑ 24, Deficient sprayfeld conditions
38. Structure Needs Improvement
❑
❑
39. Operation & Maintenance Improvements
❑
❑
40. Marker check/calibration
❑
❑
Reaulatory Referrals
41. Site evaluation
❑
❑
❑ Referred to DWQ Date:
42. Irrigation Calibration
❑
❑
❑ Referred to NCDA Date:
El
El
El Other...
43. Irrigation system designlinstallation
Date:
44. Secure irrigation information (maps, etc.)
❑
❑
LIST IMPROVEMENTS
45. Operating improvements (pull signs, etc.)
❑
❑
MADE BY OPERATION
46. Wettable Acre Determination
❑
❑
1 • Stock trail, fencing, grading and water box
47. Evaluate WAD certificationlrechecks
❑
❑
48. Crop evaluation/recommendations
❑
❑
installed for the beef cattle across the road.
2•
49. Drainage worklevaluation
❑
❑
The waste plan was revised for crop changes.
50. Land shaping, subsoiling, aeration, etc.
51. Runoff control, stormwater diversion, etc.
❑
❑
❑
❑
3
52. Buffer improvements
❑
❑
53. Field measurements(GPS, surveying, etc.)
❑
❑
4•
54. Mortality BMPs
❑
❑
55. Waste operator education (NPDES)
❑
❑
5.
56. Operation & maintenance education
❑
❑
57. Record keeping education
❑
❑
6.
58. Crop/forage management education
❑
❑
59. Soil and/or waste sampling education
❑
❑
03/10/03

9
IFacility Number 99 - 0 Date:
MENTS:
Waste analysis: 12-12-03 SSB 4.3 Ibs.N/ton
Soil samples dated 1-22-04
The stock trail, fencing and water box looks good on the beOffeediea. Some runoff of solids noted
'ter heavy rains the last two days.
# 18. Mr. Shore could not locate a waste sample to cover thrigation applications.
Remember to get your sample in to cover the July and Ses.
TECHNICAL SPECIALIST lRocky Durham
SIGNATURE
Date Entered: 9/10/04
Entered By: lRocky Durham
03/10/03

JWe of Visit *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 99 7 Date of Visit: 11/2612003 Time: t300
0 Not Operational G Below Threshold
E Permitted NCertifled (3 Conditionally Certified [3Registered Date Last Operated or Above Threshold: ..... ........
Farm Name: Sltax1rJOKAIJ?air ..... County: J(.4dkjR ...................................
Owner Name: ,[Srki&.L.Auis------_-_--t19r� .-------------------------- - Phone No: 3Ct_Ct?94G3._._--------------------------
MailingAddress: 2,z2Q.;5ft.re.Rd.....................................................................................)(AdkWy!1k.N.0 .................................................... Z7.0.55 ..............
Facility Contact: �ou'IS.Skt41 e........................................Title:............................................... Phone No: 33b.6.7.9,303.1..................
Onsite Representative:luiY,�b9XR----------_._---.__._------------------- lntegrator:------------------------------- -----•
Certified Operator: Lauii;tX................................$h9jr.c ................................................. Operator Certification Number: 25.63.4 ............................
Location of Farm:
fake Hwy 601 North out of Yadkinville. Turn right onto Shore Road (SR1374). The farm is on the left just before the Milk
House Dairy Farm, which is on the right.
[]Swine []Poultry ® Cattle []Morse Latitude 1 36 • 11 00 Longitude $0 " 40 00 u
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)
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?
Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
ste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ® Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier: __._ Vymm.pomJi................_.......__.__._ --------------------------
Freeboard (inches): 24
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ® No
❑Yes ®No
❑ Yes ® No
Structure 6
----------------------
05103101 _-JtF inued

Facility Number: 99-7 Date of Inspection 11/26/2003
5. Are there any immediate threats to toegrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
® No
❑ Yes
®NV
❑ Yes
® No
[:]Yes
® No
❑ Yes
® No
Waste Ammlicalion
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 Fescue (Graze) Matua (grazed) Wheat (grazed)
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
IN No
Required
Records & Documents
17.
Fail to have Certificate of Coverage & Genera! 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?
No
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
®
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
® Yes
❑ No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
® No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
® No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
® No
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
® No
24.
Does facility require a follow-up visit by same agency?
❑ Yes
® No
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
IN Yes
❑ No
No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Field Copy ® Final Notes
18. New fencing/stocktrails/water boxes looks great! Cattle are fenced from the creek and new grass is coming up (fescue, 1-2").
19. No solid waste records from the beef cattle operation at Wiley Shore's. Per CAWMP, Louis Shore is to keep these records.
19. No soil test results for 2002 (see also, NOV regarding no soil test results for 2000).
19. Keep fescue or matua on same form for 12 months.
13. and 25. Per records, waste applications (irrigation) were on wheat in March 2003. CAWMP only lists matua as an acceptable crop
for the irrigated fields. Need to revise CAWMP.
19, Operator had not been keeping any freeboard records. Need to record weekly.
Waste analvsis- 4/24/1)1 = I () lhc_ N/1000 oal_
Reviewer/Inspector Name Me sl. Rosebrock
Reviewer/Inspector Signature: Date:
05103101 l Continued
i

Facility Number: 99-7 I)a Inspection10 40
1]12612003
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
4Pliquid level of lagoon or storage pond with no agitation?
. 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?
❑ Yes ❑ No
❑ Yes ® No
❑ Yes ® No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
05103101

I P
Type of Visit Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit VRoutine 0 Complaint 0 Follow up Q Emergency Notification O Other ❑ Denied Access
Facility Number Date of Visit: ime:
- Not O erational Below T reshold
YN
Permitted LICertified Lj Conditionally CertifiieedU Registered Date Last Operated or Above Threshold:
Farm Name: �lntrp rns �I.Jat Ir11 � County: a �l h
Owner Name:
Mailing Addre
Facility Contact:
Phone No . D
ILI 2 lv ?79,57_
Phone o. 33 to • (b ! / • 30,31
Onsite Representative: �id f Ztjp l,^P Integrator:
Certified Operator: LO U `t S S bn t -e- Operator Certification Number:
Location of Farm:
Title:
❑ Swine ❑ Poultry YCattle ❑ Horse Latitude [�' I 1 ,AIL 0 11 Longitude • r1qtU` Lam`
Design
, : Current Design
Current
Design Current
Swine Capacity
Population PoultryCaDacitV
Po ulation C the
Capacitv Po ulation
❑ Wean to Feeder
❑ Layer
Dairy5O
❑ Feeder to Finish
❑ Non -Layer
jIV Non -Dairy
Farrow to Wean
❑ Farrow to Feeder
❑ Other
❑ Farrow to Finish
L.
Total Design Capacity
Z sa
❑ Gilts
❑ Boars
.:
)Total SSLW
Q QQQ
on
Number�ofLago '� s'
s
10 Subsurface Drains Present JEDLsgoonAre. 10 Spray Field Area
Holdin Ponds I Solid 'sra s
g _ p
❑ No Liquid Waste Management System
Discharges & Stream Impacts ��//
I. Is any discharge observed from any part of the operation? Elk 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 gallmin?
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 Xto
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes A No
st Collection & Treatment
Is storage capacity (freeboard plus storm storage) less than adequate? Spillway ❑ Yes
Strut ure Structure 2 Structure 3 Structure 4 Structure 5 Structure 6 A<O
Identifier:
Freeboard (inches):
05103101 Continued

Facility Number: — Date of Inspection
�5. Are there any immediate threats to the integrity of any of the structures observed? (iel 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? El Yes DNo
(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 WO
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes T�(No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes N410
Waste Annlication
10. Are there any buffers that need maintenance/improvement? ❑ Yes No
11. Is there i ne a 1' tion? ❑ Excessive onding El ❑ Hy uIic Overlo ❑ Yes W-N
o
12. Crop pe
11 Do the receiving cr s differ with thos esign ed in th ified Animal aste Management Plan WM Yes El
14. a) Does the facility lack adequate acreage for land application? ❑ Yes XNo
b) Does the facility need a wettable acre determination? ❑ Yes Dk-�o
c) This facility is pended for a wettable acre determination? ❑ Yes XNo
15, Does the receiving crop need improvement? ❑ Yes rNO
16. Is there a lack of adequate waste application equipment? El Yes /� No
Reauired Records & Documentg
17, Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes No
018. Does the facility fail to have all components of the C rtified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.) �� ❑ Yes No
19. Does record keeping need improvement? (iel irrigatio reeboar wad, analysis oil mple repo s all Yes No
20. Is facility not in compliance with any applicable setback cn cria in effect at the time of design? YesJTR
21. Did the facility fail to have a actively certified operator in charge? ❑ Yes WO
22 F A* tify re ion I DWQ f er enc situations as- euired b General Permit?
ai ono 5 a o cm g y q y
❑ Yes
N-No
(ie/ discharge, freeboard problems, over application)
23.
Did Reviewer/inspector fail to discuss review/inspectionn with on -site representative?
❑ Yes
4 o
24.
Does facility require a follow-up visit by same agency?
❑ Yes
Yes
,rNo
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
X
❑ No
No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
5}•;� - YR g.. t d`L6 "x Fh _�1'�34-
Cotzimet►ts (refer to;question#) Explain'any YE5 answers°andlorany recommendations°vr)'aa o her comments ..
rr � E_---'_r e___ir�_r._t_..__��we�-..r.___�r _-=.. r"---,_iaf.t_,_�'�w» �",.: _- �----_......�: •
e°
. Y'4�p�•mr T
_ :�.4',
i
Reviewer/inspector Name
Reviewer/inspector Signature:
Field Cot)v ❑ Final Notes
Date:
05103101 . I. ' V Continued

Facility number: 4qDate of Inspection
dnr Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes XNo
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes ,0
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? =re--
32. Do the flush tanks lack a submerged fill pipe or a permanentitemporary cover?
1 Additional Comments and/or Drawinss: I:
/ktriw —. uh
`�q^toL2a'
moo—
P'bOa'= ' NO.
qpqlo3'
3 o l Los . ►v/ 1000 yro-P — wa4):e "A-Aj'`
U
iu� eAWN
liu
a
05103101

nicall Assistance Site Visit
DWn of Soil and Water ConservatiorM
Natural of
Conservation Service
Soil and Water Conservation District
Other...
Facility Number 99 - �7 Date: 122103 Time: 1 11:40 1 Time On Farm: 90 WSRO
Farm Name Shore Bros Dairy County Yadkin
Mailing Address 2220 Shore Rd.
Onsite
Representative Louis Shore
Type Of Visit
® Operation Review
❑ Compliance Inspection (pilot only)
❑ Technical Assistance
❑ Confirmation for Removal
❑ No Animals -Date Last Operated:
❑ Operating below threshold
❑ Swine ❑ Poultry ® Cattle ❑ Horse
Yadkinville NC
Integrator
Phone: [phone]
Purpose Of Visit
© Routine
O Response to DWQ/DENR referral
O Response to DSWC/SWCD referral
O Response to complaint/local referral
Q Requested by producer/integrator
O Follow-up
O Emergency
O Other...
Design Current Design Current
Capacity Population Capacity Population
❑ Layer
El
❑ Non -Layer
Wean to Feeder
El Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
® Dairy
® Non -Dairy
® Dairy
® Non -Dairy
211
100
400
❑ Other
27055
GENERAL QUESTIONS:
1. Is waste discharging from any part of the operation and reaching surface waters or wetlands? ❑ yes ® no
2. Is there evidence of a past waste discharge from any part of the operation that waste reached ❑ yes ® no
surface waters or wetlands?
3. Does any problem pose an immediate threat to the integrity of the waste structure (large trees, ❑ yes ® no
seepage, severe erosion, etc.)?
4. Is there evidence of nitrogen over application, hydraulic overloading or excessive ponding ❑ yes ® no
requiring DWQ notification?
6• Is there evidence of improper dead animal disposal that poses a threat to the environment ❑ yes ® no
and/or public health?
6. Is the waste level within the structural freeboard elevation range for any waste structure? ❑ yes ® no
Structure1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier WSP
Level (Inches) 36 ir
CROP TYPES Fescue -graze Vrnall grain
SPRAYFIELD
SOIL TYPES Cf13 CO2
7. What type of technical assistance does the onsite representative feel is needed? (list in comment section)
03/10/03

r
Facility Number 99 - 7 Date:
4/22/03
PARAMETER
Q No assistance provided/requested
❑ 8. Waste spill leaving site
TECHNICAL ASSISTANCE Needed
Provided
❑ 9. Waste spill contained on site
25. Waste Plan Revision or Amendment
El
El❑
10. Level in structural freeboard
Waste Plan Conditional Amendment
❑
❑
❑ 11. Level in storm storage
26.
27. Review or Evaluate Waste Plan w/producer
❑
❑
[112. Waste structure integrity compromised
❑ 13. Waste structure needs maintenance
28. Forms Need (list in comment section)
29. Missing Components (list in comments)
❑
❑
❑ 14. Over application >= 10% & 10 lbs.
30. 2H.0200
❑
❑
[115. Over application a 10% or < 10 lbs.
re -certification
❑ 16. Hydraulic overloading
31. Five & Thirty day Plans of Action (PoA)
❑
❑
32. Irrigation record keeping assistance
❑
❑
1917. Deficient irrigation records
❑ 18. Late/missing waste analysis
33. Organize/computerization of records
❑
❑
❑ 19. Late/missing lagoon level records
34. Sludge Evaluation
❑
❑
❑ 20. Late/missing soils analysis
[121. Crop needs improvement
35. Sludge or Closure Plan
❑
❑
❑ 22. Crop inconsistent with waste plan
36. Sludge removallclosure procedures
❑
❑
37. Waste Structure Evaluation
❑
❑
❑ 23. Irrigation maintenance deficiency
❑ 24. Deficient sprayfiefd conditions
38. Structure Needs Improvement
❑
❑
39. Operation & Maintenance Improvements
❑
❑
40. Marker check/calibration
❑
❑
Regulatory Referrals
41. Site evaluation
❑
❑
❑ Referred to DWQ Date:
42. Irrigation Calibration
❑
❑
❑ Referred to NCDA Date:
43. Irrigation designlinstalEation
El
El
El Other...
system
Date:
44. Secure irrigation information (maps, etc.)
❑
❑
LIST IMPROVEMENTS
45. Operating improvements (pull signs, etc.)
❑
❑
MADE BY OPERATION
46. Wettable Acre Determination
❑
❑
1
47. Evaluate WAD certificationlrechecks
❑
❑
48. Crop oval uati onlrecommendations
❑
❑
2
49. Drainage worklevaluation
❑
❑
50. Land shaping, subsoiling, aeration, etc.
51. Runoff control, stormwater diversion, etc.
❑
❑
❑
❑
3
52. Buffer improvements
❑
❑
53. Field measurements(GPS, surveying, etc.)
❑
❑
4.
54. Mortality BMPs
❑
❑
55. Waste operator education (NPDES)
❑
5.
56. Operation & maintenance education
❑
❑
57. Record keeping education
❑
❑
6
58. Croplforage management education
❑
❑
59. Soil and/or waste sampling education
❑
❑
03/10/03

IFacility Number 99 - Date: 4122103
MMENTS:
The beef operation across the road from 99-7 still needs to have a WUP and the cost -share contract
:ms completed. Mr. Shore stated that as soon as the weather permitted, work would begin.
Need to have solid waste application records available for the beef cattle.
A waste sample has been sent in and Mr. Shore is awaiting the analysis to complete his Irrigation
;cords for the Spring applications.
According to the freeboard from the 11/18/02 inspection there appears to be some application of waste
gat did not get recorded and no corresponding waste analysis.
Irr-I, Irr-11, Solid-1, Solid-11 and freeboard forms were given to Mr. Shore.
TECHNICAL SPECIALIST lRocky Durham
SIGNATURE
Date Entered: 125103 I Entered By: lRocky Durham
3 03/10/03

Type of Visit O Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit O Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number 99 7 Date or visit. 11/18J2002 Time: 0900
0 Not Operational O Below Threshold
Permitted a Certified [3 Conditionally Certified 13 Registered Date Last Operated or Above Threshold: ...............
Farm Name: Sitorr.ftoa. ?ai y.......................................................................................... County: YAtiacitn............................................... WSRO ........
Owner Name: dackA.l. oWs....................... SIIQx.................................................... Phone No: 336-6.7.9..446...........................................................
Mailing Address: 222U,$,kQKg.Kd..................................................................................... YAd,WAYWP,..N.C.................................................... 2.7.055 .............
Facility Contact: Lo.1 k.Shm....................................................Title:................................................................ Phone No: 336,67-9,3.03.1 ............
Onsite Representative:Loajs.Share..............:................................... . Integrator: ......................................................................
Certified Operator: Lautis.M................................. Slwrc ................................................ Operator Certification Number: 2504 ..............................
Location of Farm:
rake Hwy 601 North out of Yadkinville. Turn right onto Shore Road (SR1374). The farm is on the left just before the Milk A
Souse Dairy Farm, which is on the right.
❑ Swine ❑ Poultry ® Cattle ❑ Horse Latitude 36 • 11 00 Longitude F 80 • 40 ' 00
D� gn
;Swine Ca aeit
�r
Current Design Current
P,o ulation Poultry Ca acit P,o ulation Cattle
Design C►urgent
Ca acit P,o ulation
❑ Wean to Feeder
❑Layer
® Dairy
250
150
❑ Feeder to Finish
❑Non -Layer
1110 Non -Dairy
80
❑ Farrow to Wean
�s
❑ Farrow to Feeder
❑Other
❑Farrow to Finish
Total Design Capacity
r . Total SS,LW
350,000
�F
❑ Gilts
❑ Boars
ns
Number o�Sofid
JHolding )Ponds Traps
10 ❑ Subsurface Drains Present ❑ Lagoon Area ❑ Spray Field Area
0❑ No Liquid Waste Management System
Discharm & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes ® No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system'? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes ® No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ® No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ® Spillway ® Yes ❑ No }
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ...... Y.asle.Rond................................................................................................................................................... ......................
Freeboard (inches): 12
05103101 q Continued
�7
V/!f�

Facility Number: 99-7 go
Date of Inspection F —1/1-8/20-0-21 •
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
® No
❑ Yes
® No
❑ Yes
® No
❑ Yes
® No
❑ Yes
® No
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes ® No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes ® No
12. Crop type Fescue (Graze)
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 or other Permit readily available?
❑ Yes
❑ No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
® No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
® Yes
❑ No
20,
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
® No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
® No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
® No
23,
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
® No
24.
Does facility require a follow-up visit by same agency?
® Yes
❑ No
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
® No
0 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
+ mments e e tti:o i n Explain any •S a e and/or any ecommendations or any other comments.
awin of aci t better explain situations. a additional pa es as necessary : ® Field Copy ❑ Final Notes
4. WSP is about an inch above the maximum liquid mark but is still 12 inches below the spillway. Is to be pumped this week.
_
24. DWQ to check liquid level again within a week.
8.Operator has signed a contract with NRCS for construction of a stocktrail and installation of water boxes and fencing on pasture/lots
across the road. Operator stated that he plans to complete construction before putting any cattle back onto this area. The sloped lots are
completely denuded. If vegetation cannot be maintained here, the cattle in this area would have to count towards the total confined
umber.
* 19. Need to take solid waste sample and keep application records on animal waste generated by confined beef finished/slaughter cattle
across the road.
er/Inspector Name Mel' Rosebrock
E
er/Inspector Signature`•= ! Date:
05103101 1 r ` Continued

Facility Number: 99--7 1 D 0 f Inspection 11/1$12002 0
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes .0 No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes ® No
28, Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes ® No
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes ❑ No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes ® No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes ❑ No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
19. Need to obtain soil samples by December 31, 2002. Don't forget to take waste sample for Fall WSP applications.
❑ Yes ❑ No
19, Waste has not been irrigated from the WSP since the Spring so no Fall irrigation records were required for this visit. Check
time.
need to add in a statement in the CAWMP stating that part of the confined cattle operation is beef cattle as well as milk cows,
animal waste from this operation (lot -scrape across the road and irrigated waste from the WSP) is applied by Louis to fields
rained in the CAWMP for the Shore Bros. Dairy.
Buis Shore also owns and keeps beef cattle on a dry lot on property owned by Wiley Shore (The Milk House #99-11). Per Louis
V Walter/Wiley Shore, any animal waste generated on this lot is applied by Louis onto fields contained in his CAWMP (Shore
-os. Dairy #99-7). 1 instructed Louis to keep tract of all waste that he applies on his fields whether it's generated at his farm or
Wiley's so as to not accidently over -apply on afield. All of the animal waste generated by cattle that Louis owns is applied only
fields that are in his CAWMP.
instructed Walter/Wiley Shore (#99-7) to just record the amount that Louis removes from the dry lot at #99-7.
J
05103101

a q,9m
Dlvisioa of Water QnaElh'
°;
u,��
division'ofSpll and Water Conservation
€' Y ! 4� EaY iai Sif
A6f i (rp?x t� E�
'4
OtiLLe•M�t{�ry f IW f i# E{ i I (i i p,. w¢E I i tti [3
It� i
t ait
h az��E +I VIE
,� (r
r } �I.
I ., If
77"r
i Id. li 0 .;�i i i'yf
_ 3 N 9�". SE�ef
Type of Visit A Compliance Inspection 0 Operation Review 0 Lagoon Evaluation
Reason for Visit Routine (D Complaint 0 Follow up 0 Emergency Notification 0 Other ❑ Denied Access
Facility Number date of Visit: 'Time:
Not O erati nal Below Threshold
©Permitted 0Certified Q Conditionally Certified D Registered Date Last Operated or Abov Threshold:
Farm Name: no_r 1 r County: `
Owner Name: ��� eAL.5� Lo r Phone No:
^1
Mailing Address: f.,r1f a h S �0 c� PA 1 VaAn �
Facility Contact: o U r� Title• Phone No: � 21. 30 1
Onsite Representative: �Integrator:
Certified Operator: r.-_ Operator Certification Number: 0'� Ll
Location of Farm:
TF in ELL 20: us y � no 05 y (ao1 mr j2r o o .
Shores PA rot rrr1 on ��.
❑ Swine ❑ Poultry, Cattle ❑ Horse Latitude Longitude ' �• ®�
Swine Ca acJt E Po eiilai�on' Poultry . ,..,. ;, }Ga
Design Current Design Current , Design Curren! ,
actty. Po ulatioit C itle �,t, _I '..:Ca acttvE " % illationE .°
❑ Wean to Feeder [] Layer Dai ,
ElFeeder to Finish i""
6,'' ❑ Non -La er Non -Dai
❑ Farrow to Wean
E I
❑ Farrow to Feeder ` ❑Other
❑ n r
Farrow to Finish
Totald Designi Capacit)'
❑ Gilts
❑ Boars k Tota!_SSLW Q QQ h
....t€t e
'i
❑ $ rav Field Area
Number of Lagoons P ; ; ❑ Subsurface Drains Present ❑ on Area La
'Holding Ponds/.Solld'Tra s � . g`
, p �t. E � : ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. if discharge 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 Collecti2n &'Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? {� Spillway
Structure 1 tructure 2 Structure 3 ! ` Structure 4 Structure 5
identifier: 'NA av r) J
❑ Yes XNo
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes
❑ No
❑ Yes
ElYes§No
No
AYes
❑ No
Structure 6
Freeboard (inches):
05103101 Continued
0
0

Facility Number: — Date of Inspection
S. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes XNO
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? (If any of questions 4-6 was answered yes, and the situation poses an ❑ Yes XNo
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 ANo
Waste Anolication
10. Are there any buffers that need maintenance/improvement? ❑ Yes No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes o
12. Crop type
13. Do the receiving c ops differ with t se designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes jNo
o
b) Does the facility need a wettable acre determination? El Yes
c) This facility is pended for a wettable acre determination? ❑ Yeso
15. Does the receiving crop need improvement? ❑ YesXNo
o
16. is there a lack of adequate waste application equipment? ❑ Yes
Refluired Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available? r-1 B m,
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 o
21. Did the facility fail to have a actively certified operator in charge? ❑ YesfNo
22. Fail to notify regional DWQ of emergency situations as required b Ge it.
(ie/ discharge, freeboard problems, over application) ❑ Yeso
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes )KNo
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 XNo
No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
i-. i{: .�.� -:.e Vt ::E"r F.#.-..-' �y
Comments,{reer.ito question, fI) ,Explain anyfYS answers'and/orany recomutiendations or any'o r cocttmerits:' ` ts'i',I `�E
r
t€ � 93d; .r. ..,..:-:..:io..s�:i.ss�. �.:k-..�..,E.1s3.iSMi11b17
Use drawings of facility to better, explain situations. (use additiaaal.puges as necessary) r _: ❑i l
Fteld CQry Final Notes
f
do
Reviewer/Inspector Name -,- w k^ „r
Reviewer/Inspector Signature: ro r Date: Q �-
05103101 Continued

r+a
Facility lumber: — Ote of Inspecliun d
i
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes 'IN
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes 0
roads, building structure; and/or public property) , `
29. Is the land application spray system intake not located near the liquid surface of the lagoon? - ri *
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 '20� o
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? NO
Additional Comments an Mr, . ra ings._
Ao-� A.,ueyo;.,, ✓—,�f 4t�v.-G�-
-dtRA /d.�'4ZL &4 ✓mod �
CVpt'�"#°� -Gt°a a S�na+P E(�.rn.�et u��FUeCS.
w �pka"�a � PM�w et �9�l�n,a ta/O
'-Piacf� �
05103101

�ld� �„,, tom,, m� ,� ?d�f� c�✓yr�
�id2a add. J)az
„

(Type of Visit O Compliance Inspection *Operation Review O Lagoon Evaluation
Reason for Visit *Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number 99 7 Daic of Visit: 6/13/2002 Time: lU:2t1
Not Operational O Below Threshold
Q Permitted A Certified 13 Conditionally Certified 0 Registered . Date Last Operated or Above Threshold: .........................
Farm Name: Sitar.Bros..Djtiry.......................................................................................... County: Yadkiril............................................... W.SRQ........
Owner Name: daitch.&Lwis....................... shoxx ........................................................... Phone No: 33.6.479. 46.3.....................................
MailingAddress: 222.0..Stor.e_.dt.................................................................................... YAdWnyUJr,..N.0 .................................................... 2.7.05.5 .............
FacilityContact: ..............................................................................Title:................................................................ Phone No:...................................................
OnsiteRepresentative: Louis.Shore................................................................................. Integrator:..................................................................... .................
Certified Operator: Lauds.M.. ............................... Skiorc................................................ Operator Certification Number: 2,5#34.............................
Location of Farm:
rake Hwy 601 North out of Yadkinville. Turn right onto Shore Road (SR1374). The farm is on the left just before the Milk A
!-louse Dairy Farm, which is on the right. w
❑ Swine ❑ Poultry ® Cattle ❑ Horse Latitude F-36--1 • 11 6 00 {f Longitude $0 • 40 ' 00 44
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes ® No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? []Yes []No
b. If discharge is observed, did it reach Water of the State? (if yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
❑ Yes ❑ No
❑ Yes ® No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ® No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ® No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:...................................................................................................................................................................................................................
Freeboard (inches): 60
05103101
Continued

Facility Number. 99-7 Date of Inspection 6/13/2002 "
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ treere erosion, ❑ Yes ® No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑Yes ®No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes ® No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ® Yes ❑ No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes ® No
Waste Application
10. Are there any buffers that need maintenance/improvement? [:]Yes ® No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes ® No
12. Crap type Fescue/Orchard grass
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 or other Permit readily available?
❑ Yes
❑ No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
® No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
® No
20,
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
IN No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
® No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
® No
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
® No
24.
Does facility require a follow-up visit by same agency?
❑ Yes
® No
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
® No
0 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
►omments refer to 'on #): Explain n—n VAMnsWerMnd/or any ecommendations or any other comments.
s drawings of faei i� to better explain situations. u additional pages as necessary : ❑ Field Copy ® Final Notes
8. The local soil and water conservation district is working with Mr. Shore to design and install a stock -trail and possibly a water tank
or stream access. The local district is awaiting approval from Raleigh on the cost share contract.
IV I
Reviewer/Inspector Name lRocky Durham ~
Reviewer/Inspector Signature: Date:
05103101 Continued

Facility Number: 99-7 Dgf Inspection 6/13/2002
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours?
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon?
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan bladc(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?
aste analysis: 12-t9-01 LSD 5.8 Ibs.N/1000 gals. B, 5.4 Ibs.N/1000 gals. I
ail analysis dated 3-01-02 & 4-17-02
❑ Yes ❑ No
❑ Yes ® No
❑ Yes ® No
❑ Yes ®No
❑ Yes ® No
❑ Yes ® No
❑ Yes ❑ No
J
05103101

Type of Visit O Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit O Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number
Date or visit: 71/5/2001 Time: lUSo Printed on: 11/5/2001
99 7
O Not O erational 0 Below Threshold
0 Permitted 0 Certified 13 Conditionally Certified [3 Registered Date Last Operated or Above Threshold: .........................
FarmName: Shm.B.ztvakaury........................................................................................ . County: a,'Adi4llft.............................................. E' .SRQ........
Owner Name: 1ack.A.Jj quis....................... shom ........................................................... Phone No: 33.6,4794463 ..........................................................
MailingAddress: 2220.Shafr Adh.................................................................................... YMdkxr yMv..N.C.................................................... 2.OS.5.....
Facility Contact: UIIh.S:harc....................................................Title:................................................................ Phone No: .......................
Onsite Representative: LemjS.1jhoj e................................................................................. Integrator:...................... .......... ......................................................
Certified Operator:L%js....................................... SIMM ................................................ Operator Certification Number:..........................................
Location of Farm:
fake Hwy 601 North out of Yadkinville. Turn right onto Shore Road (SR1374). The farm is on the left just before the Milk A
House Dairy Farm, which is on the right. .�
❑ Swine ❑ Poultry ® Cattle ❑ Horse Latitude F 36 ' 114F 00 « Longitude
Design Current.,
De rstn urreni
ult } Ca acit Pn
,o ulaPoulattonSwincati�u �
❑ Wean to Feeder ❑Layer ®Dairy 250 175
❑ Feeder to Finish ❑Nan -Layer ❑Nan-Dairyi
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Other r... at
❑ Farrow to Finish Total Design Capacity 250
❑ Gilts
❑ Boars Total S$L�V 350,000L1V.s .
Number of Lagoons 0 ❑Subsurface Drains Present ❑ Lagoon Area ❑ Spray Field Area
Holdiing Ponds / Solid Traps 0 ❑ No Liquid Waste Management Systemin
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (if yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system'? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
❑ Yes ® No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ® No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ® Yes ❑ No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ® Spillway ❑ Yes ® No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ...... Wasie.Ptxnd................................................................................................................................................... .......................
Freeboard (inches): 42
05103101 _6 3 3 /Continued

Facility Number: 99-7 Date of Inspection 11/5/2001 Printed on: 11/5/2001
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ tree%evere 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 maintenancelimprovemen t?
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 maintenancelimprovemen t?
11. Is there evidence of over application? []Excessive Ponding ❑ PAN ❑ Hydraulic Overload
12. Crop type Orchard, graze Fescue (Graze)
❑ 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
M. 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?
Required rd & DggUments
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
❑ Yes ® No
❑ Yes ® No
❑ Yes ❑ No
❑ Yes ® No
® Yes ❑ No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ® Yes ❑ No
113 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
❑ Field Copy ® Final Notes
3. Operator has beef cattle on denuded pasture across the road. Cattle have are fenced out of creek except for short section for drinking.
This area needs BMPs. The beef cattle will have to be permitted either with the dairy or as a seperate operation if vegetation can't be
established and maintained on this pasture. This was noted on 2001 SWCD operational review.
11. Can't verify PAN over or underapplication since operator has not been keeping track of PAN balance on IRR-2. Need to have
irrigation design revised and then have WUP revised by technical specialist. This was noted on 2000 DWQ inspection and NOV.
14. Can't verify based on current waste application patterns. Noted on DWQ 2000 inspection and NOV.
19. No waste samples taken in 2000 and 2001. Need to obtain soil samples for 2001. No soil samples for 2000. Noted on 2000 DWQ
inspection and NOV and 2001 operational review.
Reviewer/Inspector Name
Reviewer/Inspector Signal
Rosebrock %1
Date:
05103101 _ Continued

Facilit; Number: 99-7 6 of Inspection 1115/200I 0 Printed on: 11/5/2001
Odor ISsucs
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours?
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon?
30. Were any 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?
❑ Yes ❑ No
❑ Yes ® No
❑ Yes ® No
❑ Yes ❑ No
❑ Yes ® No
❑ Yes ❑ No
❑ Yes ❑ No
24. Follow-up correspondence from operator is needed, no visit required.
25. Again, WUP acres don't match irrigation design. Need to contact Gra-Mac to have irrigation design revised since irrigation
-icres and design don't match pull patterns. This was also noted on 2000 DWQ inspection.
Z7. One dead beef calf noted on pasture across the road. Per operator, this is to go to landfill today.
6
J
05103101

Type of Visit Compliance Inspection O Operation Review O Lagoon Evaluation I
Reason for Visit (A Routine O Complaint. O Follow up O Emergency Notification O Other 1 ❑ Denied Access
Facility Number Date of Visit: ti Time:
Q Not Operational 0 Below Threshold
Permitted # Cerdfied [3 Conditionally Certified 13 Registered Date Last Operated or Above Threshold: .........................
Farm Name: ...shar:.:.....DI??s.,......��r. County: ..4.0-d. 14.rl .............................. ......................
OwnerName:.... 1 ..�#'...�-(.t4? �.... ... i�r......................................... Phone No:...........�J................................................... ».....»»:.
Facility Contact: ........t :ar� b.......�:T..1ac.q.:......1.rt`..: .... iL�.i1.Ut�f2t.. L'....... fie -hie:... 05 ...................
ailing Address:........L au....Jr........�,►..I..�.�........................................................ .....................�;�1.3....(0. 7.......36.3.1.............................
Onsite Representative:.........
Certified Operator:
Location of Farm:
Integrator:.................................................... ............ ...........
Operator Certification Number:.. ' ..................................
❑ Swine ❑ Poultry dCattle ❑ Horse Latitude • ©& 6t Longitude • ®6 ©69
0
Design,, Current Design Current:, Design
o ulaHon , Capacity )P
Swine Ca aci Po ulatfon Poultry Ca aci P Cattle
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
❑ Layer
Dairy
❑ Non -Layer
" `
Non -Dairy
❑ Other
Total Design Capacity : L
Total SSLW . E
aso ,
• 16
< < Nuinbei of Lagoons ❑ Subsurface Drains Present ❑ Lagoon❑ Spray F Area she
Area geld
HaldidgPoinds Solid:Traps. ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
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 4 No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? Nyes []-No
Waste Collection &-Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? Spillway ❑ Yes ANo
StructuN I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: .................................................................... ........
..........................................................................................
Freeboard (inches):
5/00 Continued on back

Facility Number: 94? — -7 1 91grity
Date of Inspection / , 05Are there any immediate threats to the 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 A No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes X"o
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes INo
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes VNo'
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload Q Yes ❑ No
12. Crop type
13. Do the receiving cro) rsdiffer with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes KNo
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 XNo
16. Is there a lack of adequate waste application equipment? ❑ Yes 9No
Required Records _&_Documents
17. Fail to have Certificate of Coverage & General Permit readily available? E3 Yes $I+le
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.) Z ❑ Yes No
19. Does record keeping need improvement? (i irr'gatio , irbeari ast analysis sail mple reports) IV Yes ❑ No
20. Is facility not in compliance with any applicab a setback criteria in effect at the time of design? ❑ Yes Wo
21. Did the facility fail to have a actively certified operator in charge? ❑ Yet XNo
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes ANo
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes `JeNo
24. Does facility require a follow-up visit by same agency? ❑ Yes No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? 19Yes ❑ No
N4 •Yl#1;atH1iis'o� dgfc}enele . i... .Pt: 1H`l4>P this;vis�t� Yoh wild t�ee$iY�
cor'resporideike: athis visit: ................................... .
>... ....., i .,�.. _ ... t „F •in , ! ,,t •t .,.! --}• c ts. s !t 1 t^-:� t - ISI tGi,it- t — +,
Use draWitt ;af facility�to;bt?tter�explain sltrxadans. (ttse`additianal pary)
aq, fatlmo-up Urre5po knue -From opP,f'a�or.'rs need , no vi51 �lu're-df
-VAI
Awl. _aA-e VtA'C6&j &�Aqzm�,
— E,,='a � f ' t _t Y ! C ll -�
Reviewer/Inspector Name tE :,..,. s, ...t.! 1 tl { , I .. u' I`t'
'h i ��' i.14� „fi0.La,�t���
Reviewer/Inspector Signature: Date: 5100

S
Facility Number: 29— 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 B-ifcs$Irlo
Iiquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes [ No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes No
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon?
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 A No
31. Do the animals feed storage bins fail to have appropriate cover? -B*es--B o
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?9406-�o
g,4noiro
oil
SAM
Po
a
5100

(Type of Visit O 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 99 Date of Visit: 6/14/2001 'Tune: 14:30 Printed on: 10/25/2001
Not Ojgerational Q Below Threshold
Permitted M Certified [3 Conditionally Certified 0 Registered Date Last Operated or Above Threshold: .........................
Farm Name: Sl Qre.D.r9..Ddry................................
Owner Name: JACk.fit.LRt1 5...................... Mon..
Mailing Address: 222Q.Sh9r.P.Rd.............................
Facility Contact:............................................................
Onsite Representative: Lomb.Shoxe........................
.. County: Yjadkin............................................... WSRQ........
....................................... Phone No: 33.6:479.4463 ...........................................................
.............................. :........ XAt%1G fKVi119.N.C.................................................... 2.7.00 ..............
Title:................................................................ Phone No:....................................... .......
....................................... Integrator:.........................................................................
Certified Operator:.W..Wsex.................................... ShQre ................................................ Operator Certification Number:21.44.0 .............................
Location of Farm:
Cake, Hwy 601 North out of Yadkinville. Turn right onto Shore Road (SR1374). The farm is on the left just before the Milk
House Dairy Farm, which is on the right. V
I-
[] Swine ❑ Poultry ® Cattle ❑ Norse . Latitude 36 • 11 6 ®66 Longitude $0 • 40 ° 00 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 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. 1s storage capacity (freeboard plus storm storage) less than adequate? ® Spillway
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier: .........................
❑ Yes ❑ No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
Structure b
Freeboard (inches): 48
05103101
Continued

Facility Number: 99-7 Date of Inspection 6/19/2001 Printed on: 10/25/2001 1 0 +-.o
W
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ treed severe erosion, rl Yes 10 No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑Yes ®No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes ® No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes ® No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes ® No
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes ® No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes ® No
12. Crop type Fescue (Graze) Fescue (Hay) Matua Grass (grazed)
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_&J)ocuments
IT
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
❑ No
I&
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
® No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
® Yes
❑ No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
® No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
® No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
® No
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
® No
24.
Does facility require a follow-up visit by same agency?
❑ Yes
® No
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
® No
0 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
en f x lain an. an o nn. ommendatio or any he >ommeits.
ra n o a o ette ex lain 'tuat' 't'o a s ne a y ❑ Field Copy ® Final Notes
# 13. Need to have matua grass added to the WUP. Mr. Shore was using the N rate for Fescue which should be ok.
19. Missing a waste analysis for the Spring applications. Will need to get a 2001 soil analysis.
r. Shore has taken and passed the certified operator's exam and had his card on site. I left a designation form for Mr. Shore to send in.
r. Shore had some beef cattle across the road that he is back -grounding. I recommended he contact the local soil and water officefor
technical assistance to possibly to install BMP's.
Reviewer/Inspector Name ;Rocky Durham
Reviewer/lnspector Signature: Date:
05103101 Continued

,>+acifity Number: 99-7 1) A Inspection F6/T9/20011
0 Printed on: 10/25/2001
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours?
28. Is there any evidence of wind drift during land application'? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon?
30. Were any 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?
❑ Yes ❑ No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes ❑ No
J
05103101

r
JJ�l
ti�° Ilttln li3E1o3lPIf IIIW, i,, iP€iaJi, �r;,
10, (d,<3i]...,Uu+uEI an+I llll>�€t€.€y€tE1Y� I l€E�I 6e
'' ofi So>I,andIWater€ C;€ oiIt,fjj
iII Y;i I YYi€
0I:III�l Iri
�)theAgency i
#}
:.
i ��gq
€ !!"Id 1pl ' ! "'H !7i ii
I i tl
flii!;
Type of Visit O Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit O Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number 99 07 'late of Visit: 9/26/2000 Titne: 1Z45 Printed on: 9/27/2000
0 Not Operational 0 Below Threshold
0 Permitted ® Certified 0 Conditionally Certified [3 Registered Date bast Operated or Above Threshold:
Farm Name: :....................................................... County: Yafdklin.............................................. 1?l'5 ........
Owner Name: JA&&,Calms....................... sbYS?1C.t~........................................................... Phone No: 334-519.4463...........................................................
Facility Contact: lag.uh.S.h.m .....................................................Title:................................:............................... Phone No: 33.0,.4713,03.1........................
Mailing Address: z220.Slwrv..Rd. .................................................................................... yAdXt1y111R.NC .................................................... Z7.05.5 .............
Onsite Representative: 1,QmjN,,$h9jr.r..............
Certified Operator: 1,tQ>A1S.M,.........................
Location of Farm:
Integrator: ......................................................................................
Operator Certification Number:2.1.4.3.7. fps-d..............
rake Hwy 601 North out of Yadkinville. Turn right onto Shore Road (SR1374), The farm is on the left just before the Milk A
Souse Dairy Farm, which is on the right. #
❑ Swine ❑ Poultry 0 Cattle ❑ Horse Latitude F 36 • Longitude 80 • 40 00 ��
Design Current
Swine Canaeity Poni lation
❑ 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 IN Dairy 250
❑ Non -Layer I JE1 Non -Dairy
❑ Other
Total Design! Capacity. 250
Total SSLW 350,000
Number'of Lagoons 0 ❑ Subsurface Drains Present ❑ Lagoon Area ❑ Spray Field Area
Holding Ponds 1 Solid Traps 1 ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge 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?
Structure I Structure 2 Structure 3
Identifier: ....... aswRond..................................
Freeboard (inches): 30
5100
❑ Yes ® No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes 0 No
❑ Yes 0 No
® Spillway ❑ Yes ® No
Structure 4 Structure 5 Structure 6
:..........................................................................................................
Continued on back

Facility Number: 99—D7 Date of Inspection 9l2612flflfl Printed on: 9/27/2000 ,
5. Are there any immediate threats to the Grity of any of the structures observed? (ie/ treevere erosion, ❑ Yes N 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 N No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
❑ Yes
N No
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
N No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
N No
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes
N No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload.
❑ Yes
N No
12. Crop type Fescue (Graze)
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
N No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
® No
b) Does the facility need a wettable acre determination?
❑ Yes
N No
c) This facility is pended for a wettable acre determination?
❑ Yes
N No
15. Does the receiving crop need improvement?
® Yes
❑ No
16. Is there a lack of adequate waste application equipment?
❑ Yes
N 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
N 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
N No
21.
Did the facility fail to have a actively certified operator in charge?
N Yes
❑ No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
N No
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
N No
24.
Does facility require a follow-up visit by same agency?
❑ Yes
N No
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
N No
::Nlti
-lreNtofaoaions;or&ces•Weenodn•hiA-uwich-r
fnr"ther ;
]
.
.d -,u.ti. .g,tisvt'
:: ::: :. : : :orrespondncenbaut this:visit: -. • . ': • " - - ' . • .. . :. .: • - • , ... '' - -
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):
14. Operator wants to add additional irrigation land to WUP. Suggest contacting SWCD to amend WUP. +
15. Continue efforts to cintrol pigweed on pastures.
19. WUP acres do not match irrigation design. Irrigation acres and design do not match pull patterns. No waste samples were taken
for March and July 2000 applications. Need to transfer information to IRR 2 form.
21. Operator did not have certification card on hand. Per Training and Certification Group in Raleigh (Beth Buffington), operator did
not pay renewal fee for 2000.
Soil samples to be taken this Fall.
Reviewer/Ins ector Name
p �Meli
5/00
Reviewer/Inspector Signatur . Date: ,-,2 7 �d

t
Number: 99-07 Dot f Inspection 9/26/2000 Printed
on: 9/27/2000
Tacility
0
Odor Issues ;
26.
Does the discharge pipe from the confinement building to the storage pond or lagoon fail to -discharge at/or below
❑ Yes
❑ No
liquid level of lagoon or storage pond with no agitation?
27.
Are there any dead animals not disposed of properly within 24 hours?
❑ Yes
® No
28.
Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
® No
roads, building structure, and/or public property)
29.
Is the land application spray system intake not located near the liquid surface of the lagoon?
❑ Yes
® No
30.
Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
❑ Yes
®No
31.
Do the animals feed storage bins fail to have appropriate cover?
Cl Yes
❑ No
32.
Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes
❑ No
Additional Comment s att or,ravings. f F' u r
-I u' .,�.r•al iE i �, dels a i!. f� i ,
.1116
7
5100

vision of Water Quality
vision of Soil and Water Conservation s rvation
0 Other Agency
33
Type of Visit Compliance Inspection () Operation Review 0 Lagoon Evaluation
Reason for Visit ),Routine OComplaint OFollow up 0 Emergency Notification 00ther El Denied Access
Date of Visit. hinted on: 7/21/2000
Facility NurnberEjRD—C= .1 10 , Not Operational 0 Below Threshold I
Permitted Certified (3 Conditionally Certified [3 Registered Date Last Operated or Above Threshold: .........................
FarmName: ...... Shore . .....�.r.o.�........r. ................... County: ...... ................................................
o Phone No: ....... .. 6.-7.q
.y&.,5 ..........
Name .......... ......... ....... ..............................
Owner N, .........
Facility Contact: ..... L-6-U.1,5 ..... ................................................................ Phone No: .........
Mailing Address: .......�..a.....sqC
......... Rd ...................................................... ..........................
Onsite Representative: .......�PiA0 ....... ZShare . ......................................... I ....... Integrator: ......................................................................................
Certified Operator:..... �)h.o
..... ........... ..... ........M ....... . ............ ...................... Operator Certification Number:...
.............
Location of FaTm:
of tj f'j-6 AA jL1W'1jJe . Tum r!jh+ 6in-to F"
F
E]Swine ElPoultry 4Cattle []Horse Latitude a Longitude 01
Design Current
Swine canneitv Pa"Idatinn
E] Wean to Feeder
E] Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
JE1 Boars
Design Current Design Current
Poultry Capacity Population Cattle
Capacity Population
❑ Layer Dairy DTb I
❑ Nan -La
yer ❑ Non -Dairy
❑ Other I I I
Total Design Capacity 2s—o
Total SSLW
Number of Lagoons 1 FE—ISubsurface Drains Present 11[3 Lagnibn Area 1[] Spray Field Area
Holding Ponds / Solid Traps ❑ No Liquid Waste Management System
Discharges & Stream Impacts
I. Is any discharge observed from any part of the operation? ❑ Yes VNo
Discharge originated at, [] Lagoon El Spray Field E] Other
a. If discharge is observed, was the conveyance man-made? I El Yes 0 No
1), If discharge is ohserved, did it reach Water of the State'? (If yes, notify DWQ) El Yes El No
c. lfdischar�,e is observed. what is the estimated flow in gal/min?
d. Mies discharge bypass a lagoon system? (If yes, notify DWQ) El Yes [I No
2. Is there evidence of past discharge from any part of the operation? E] Yes No
I Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? C] Yes No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate'?
Structur,p I l -uCture 2 Structure 3
Identifier: ..... . ...... ............. .......... .............................
Freeboard (inches): Jv
5100
Spillway El Yes No
Structure 4 Structure 5 Structure �
.... .................................... ... I ............................ .... I ............... I ...............
Continued on back

Facility Number: — 1)aac of Inspection � Printed on: 7/21/2000
5. Are there any immediate threats to the i grity of any of the structures observed'? (ie/ tre , severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan'?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application'? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
12. Crop type
13. Do the receiving crops differ with those I#signated in fife Certified Animal Waste
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettahle acre determination?
15. Does the receiving crop need improvement?
16. Is there'a lack of adequate waste application equipment?
Reuuired Records & Documents
❑ Yes YNo
❑ Yes )No
❑ Yes No
❑ Yes No
❑ Yes No
❑ Yes X,
40
❑ Yes 'j�No
n
w oil
Plan (CAWMP)? ❑ Yes
No PtJS
❑ Yes
No f
❑ Yes
No
❑ Yes
I
Yes
❑ No
❑ Yes
)KNo
17. Fail to have Certificate of Coverage & General Permit readily available'? N
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily availa le?
(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?
: 10 yioEaticjris;or deficiencies -were further ;
cor'res} 6tideii& abuut. this :visit
❑ Yes gNo
gJ Yes [] No
Yes jKNa
Yes ❑ No
❑ Yes No
❑ Yes I
❑ Yes No
❑ Yes )(No
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
IS con At, Ue eS
u
o P
ReviewerfInspector Name
Reviewer/Inspector Signature. Date: 4 52 Z 7 60 5100

A Facility Number: 4qCJ— I of Inspection • Printed on: 7/21/2000
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge AL/or below E3 Yes-- -ISO
liquid level of lagoon or storage pond with no agitation? �jn j T- tLOCZ
27. Are there any dead animals not disposed of properly within 24 hours?�,`p ❑ Yes No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes `INo
roads, building structure, and/or public property) /�
29. is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes XNo
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes.19�No
31. Do the animals feed storage bins fail to have appropriate cover? -ET t`es- U No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cove '? ) 4 ff rMr—ETNo
lnay.� ieme.r ? V'
Pi Weed or) P2,- m s . ✓
-1 eg- 5 r 7
5a t is ?
Oa5-k 4,1a-1y5J'5 ?
k-) L)P atAA- d. o r) d-f ma4a�h i rr i 'an
Trrt a4lor) de 5 1 Y? mA9J
�J
P''�1�f�rhs�
P
, a000 ,
MAX.anJ `� L P--2 MO Y�
a ,
0
uj�
'y
5100
J

er
I ,.,1.
C'ei+EI'II 3 [ I€>.1 .I;,i: "Al' slon,or,W yuyasiiWofSoi}andWater„•Coiisevati'on
nAi'I. i l
they
,
Type of Visit O Compliance Inspection O+ Operation Review O Lagoon Evaluation
Reason for Visit O Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number 99 7 Date of Visit: 7/b12000 'Time: 900 -1 Printed on: 9/25/2000
Not O erational 0 Below Threshold
U Permitted ®Certified 0 Conditionally Certified 0 Registered Date Last Operated or Above Threshold:. ........................
, - r
FarmName: ....................................................................................... . County: Valid ida................... ........................... WSRO.........
OwnerName: dAdA.LQ-ui5....................... 5hon ........................................................... Phone No: ...........................................................
FacilityContact:..............................................................................Title:................................................................ Phone No:...................................................
Mailing Address: Z.R. ixRxG.tid.................................................................. ... Y.Ad7RYMP.M........................... Z7.053 .............
................. .........................
Onsite Representative: LgUjfi.$bQXfi ............................... ...................... Integrator:
..................................................................
Certified Operator: LelailX.. ................................ shug ................................................ Operator Certification Nurnber:2.1.4.3.7 .............................
Location of Farm:
rake Hwy 601 North out of Yadkinville. Turn right onto Shore Road (SR1374). The farm is on the left just before the Milk A
Souse Dairy Farm, which is on the right.
❑ Swine ❑ Poultry ® Cattle ❑ Horse Latitude Longitude $0 • 40 00
Design , Current
Swine Capacity Ponulation
❑ 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 ® Dairy 250 220
❑ Non -Layer ❑ Non -Dairy
❑ Other
Total Design Capacity 250
Total SSLW 350,000
Number of Lagoons
Holding` Ponds / Solid Traps€ 1
10 Subsurface Drains Present
❑ Lagoon Area
ID Spray Field Area
❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
® No
Discharge originated at: ❑ Lagoon ❑ Spray Field . ❑ Other
a, if discharge is observed, was the conveyance man-made?
❑ Yes
❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
❑ Yes
❑ No
c. If discharge is observed, what is the'estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
❑ Yes
❑ No
2. Is there evidence of past discharge from any part of the operation?
❑ Yes
®No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes
® No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
❑ Yes
® No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Structure 6
Identifier: .......................................................................................................................................................................................................................
Freeboard (inches): 12
5100
Continued on back

�i
Facility Number: 99-7 Date of Inspection 7/6/2000 Printed on: 9/25/2000
5. Are there any immediate threats to thewity of any of the structures observed? (ie/ troevere 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 IN No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
❑ Yes
® No
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
®No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
® Yes
❑ No
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes
®No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
❑ Yes
®No
12. Crop type Fescue (Graze) Orchard grass (Graze)
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
Renuired Records & Documents
17.
Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes [I No
18.
I
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes ® No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
® Yes ❑ No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes ® No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes ® No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes ®No
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes ®No
24.
Does facility require a follow-up visit by same agency?
❑ Yes ® No
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
® Yes ❑ No
Nd Ablatiogs;or de#ieiencies •were;noted iwing•this visit.- N u'Will tec6V& fto•fu;rt1(er• ; - ;
comes ondence: about this .visit.
Comments (refer to uestion' # x lain' ari YES answers "and/oi an 'recoitimendatio is;or a" `
q ) P Y Y ny otFiei• comments.
Use drawings of facility to better,. situations. (use additional,.pages as necessary):.
V 4. Waste storage pond is over the max. liquid level, but not in the structural freeboard. Needs to pump as soon as possible. Planning
)n pumping Monday according to Mr. Shore.
V 15. Continue efforts to get rid of pig weed and other weeds in pastures.
� 19. Had IrrI form, no IrrII, soil samples or waste analysis. Records were not adequate on last years review as well.
V 25. The WUP acres do not match the irrigation design. Need to also change irrigation design and acres to match operators pull pattern
jr go by current design.
Reviewer/Inspector Name Rock Y..Dmurha
Reviewer/Inspector Signature: Date: 5100

Facility Number: 99-7 Da Lispection 71b/2000 Printed on: 9/25/2000
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes ® No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboringvegetation, asphalt, ❑ Yes ®No
roads, building structure, and/or public property) n
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
5100

Facility Number 99 07 Date of Inspection 12/8/99
Time of Inspection � 24 hr. (hh:mm)
0 Permitted ® Certified 0 Conditionally Certified 13 Registered 113 Not Opera Date Last Operated: ..........................
Farm Name., S1rr....rA&D,Ai1C3:....................................... ................ ................. County: Yadkiti .............................................. WSRQ........
Owner Name: lArk, 9iG.LOUIS.....................
Facility Contact: Lauh.S.h tre................
.. Mon.............
Mailing Address: 222R.5ha r.mAd...........
Onsite Representative: RQUis-Shots:.......
Certified Operator:
Location of Farm:
Latitude F-3-6­1 ' =1 0011
Phone No: 33.6-fi7.9.4463......
...................... Title:................................................................ Phone No:................................ .........
............................................................. YAdk aY..ikl>rAC..................................................... V055..............
.............................................................. Integrator:........................................................ ..............................
shm................................................. Operator Certification Number: 21437.............................
Longitude EK10 40 , =11
- `
Swine
Design
Ca acit
�.� �,.� <4' to ;' t Desih Current
Current s Design Cnrrent a
P.o elution Poultry Ca acit Po utation` C tt aCa, act Po elation
❑ Layer ®Dairy 250 200
k ;
❑ Non -Layer ❑Non Dairy
Other c t
❑ �.:F a a
i 'tom`
Total Designt1Capactty, 250
� MEW,
Total-SSLW ; =350,000
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Number of Lagoons
Holding Ponds 1 Solid Traps
❑ Subsurface Drains Present ❑ Lagoon Arcs ❑ Spray Field Area
❑ No Liquid Waste Management System
Discharggs & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes ® No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made'? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State'? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min'?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes ® No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ® No
Waste Collection & Treatenent
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 h
Identifier:
Freeboard(inches): ..............3.0............... .................................... ................................... .................................... ....................................
..
5. Are there any immediate threats to the integrity of any of the structures observed'? (ie/ trees, severe erosion,
seepage, etc.)
3/23/99
...............................
❑ Yes ® No
Continued on back
Printed on 12/16/99

Facility Number: 99-07 rf Inspection
6. Are there structures on -site which are noperly addressed and/or managed through a management or
closure plan?
(If any of questions 4.6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7.,Do any of the structures need maintenance/improvement'?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN
12. Crop type Fescue (Graze) Corn (Silage & Grain) Small Grain (Wheat, Barley,
12/8199
❑ 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?
Reauired Records & Documents
17, Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
0: �No•yiblations:or deficiencies •wetre;noted ;duri>ng•this; visit.• :You:will'receive•no•furth;er• ; • ;
correspondence: about this :visit::
❑ Yes ® No
❑ Yes ® No
❑ Yes ❑ No
❑ Yes OR No
® Yes ❑ No
❑ Yes ® No
❑ Yes ® No
❑ Yes ❑ No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
- Need to install "start pump" marker on lagoon; contact tech. specialist.
19 - Records are being kept of irrigation information, though not all columns on the form are being filled out; need to fill out
impletely. No yearly soil analysis performed. No waste analysis was performed within 60 days of application.
'OTE: The above deficiencies notwithstanding, from a surface water quality standpoint, the farm is in excellent shape.
tock trails, fencing, and water boxes have been installed, and animals are completely isolated from surface waters.
Reviewer/Inspector Name .Abner Braddy Melissa Rosebrock
Reviewer/Inspector Signature: Date:
w
11
on 12/16/99

<a! P , .v ,.�... f �; pi A [rI 4 `' 1�I k) ., i , i 1 t t ['Division ofnd`Water Conservation -Operation Re ' ��
Dtvisionof nil Water Conservation' -.Compliance _ 1oAV.
of Water Quality - Cnmpliance Inspection
Other Agency.- Operattoi>7
Oth
13
r
100koutine O Complaint 0 Follow-up of DWQ inspection 0 Follow-up of DSWC review 0 Other
II.
Facility Number Date of Inspection
Ti me of Inspection 24 hr. (hh:mm)
[3Permitted Certified © Conditionally Certified © Registered JE3 Not O erational Date Last Operated:
FarmName:.............................................................................................................. county: .....................................................................
OwnerName:........................................................................................................................... Phone No:................................................................
.......................
FacilityContact: .............................................................................. Title:................................................................ Phone No:'
...................................................
MailingAddress: ........................................::............................................. ..........................
Onsite Representative: ............................................................................................................ lntegrator:...............................,......................................................
Certified Operator: ................................................... ............................................................. Operator Certification Number:..........................................
Location of Farm:
A
...................................... ......................... ....................................... .. w
Latitude Longitude • �` �"
De acgity Population' Poultry:' f ..1 . Ce ag t Po ulataon',v' .Caftic Ceactt Po ulaton lr
Swine i . g;
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts,
❑ Boars
�4.
❑ Layer ❑ Dairy
❑ Non -Layer 1 10 Non -Dairy
❑ Other
Total De igh: Capacity <i'
!;j
l-557[ �`I
ii f �3 i !�. ill tJJ � TotaLW�.
Number of Lagoons, ❑ Subsurface Drains Present ❑ Lagoon Area ❑ Spray Field Area
Hol�n'P g 0 I "
�.i
g
onds / Solid Traps ❑ No Liquid Waste Management System
Discharges & Stream Impacts
l.'Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system'? (If ycs, notify DWQ)
2.' Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Freeboard(inches): .....5iv.......................................................................................................................................................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
❑ Yes WNo
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes XNo
❑ Yes �No
❑ YesXNo
Structure 6
❑ Yes jJ�No
on bac Continued k
3/23/99

Facility Number: — of Inspection
6. Are there structures on -site which are no�roperly addressed and/or managed through a waste management or
closure plan? ❑ Yes 'XNo
(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 ro
S. Does any part of the waste management system other than waste structures require maintenance/improvement? El Yes /XNO
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation. markings? Yes []No
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes 111rNo
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Yes XNo
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes IyNo
14. a) Does the facility lack adequate acreage for land application? ❑ Yes �io
b) Does the facility need a wettable acre determination? El Yes /❑ No
c) This facility is pended for a wettable acre determination? []Yes ❑ No
15. Does the receiving crop need improvement? ❑ Yes IWNo
16. Is there a lack of adequate waste application equipment? ❑ Yes prNO
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 WIo
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)�4e/❑ No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes P140
21. Did the facility fail to have a actively certified operator in charge? ❑ Yes XNo
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 ANo
24. Does facility require a follow-up visit by same agency? ❑ Yes XNo
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes �'iVo
10 yiolaiicjns or dOf dencies -mere )10 ed- d(Wing NS'visit.' • Y:oit will-teceiye fid fu>G-thgr . /�
cor;res• ofide"e: abbot_ this .visit. • ... • . • .. •
t t .<._. . ii r , E. r,. s;¢ , ,E .. .. �, - , " ' u i, i�ae€E g r tr A. r
Comments` (refer to question #) . Explain' any YES answers and/or any recommendations nr:any other, comments
Use drawings of facility to better explain situations (use'addittonal `bages as necessary) ' 3is , t , r ,o 'x p , ' i : ' ' ''
:{ ` ,t i 1 i
74
# !9 o�0� ' �/� �>orr� a� t6/ Gila i� r�40—ZZ, f� �
5W-0
is
Reviewer n5 n1J}�'t ,:% s: sn�! F `ifN.ki, (JC E �1�. �'rQ%/ I
6�// Y
Reviewer/Inspector Signature:Offi
�«
3123/99

Facility Number Date ofinspection 7/29/99
'I'ivac of Inspection 9:15 24 hr. (hh:mm)
0 Permitted ®Certified 0 Conditionally Certified 0 Registere193 d Not O erational Date Last Operated; ,,,,,,,,,,,,,,,,,,,,,,,,,,
Farm Name: S1tArtr.l3tro..Daix .. County: YmdkAtx .............................
Owner Name: JudiA.Ltatais....................... Sfxture............................................................ Phone No:
Facility Contact:.............................................................................. Title:......
Mailing Address: 2220.Stht9lie..Rd. ................................................................. ................................
Onsite Representative:
Certified Operator- Louls..M................................. Shuc ..............................
Location of Farm:
................:...........................
Phone No:
...... Y»t"xiA a-K............................................
......, Integrator: .......................................
......... 2.7.QS.5 .............
Operator Certification Number:2143..7............................•
Latitude 36 • 11 , 0011 Longitude =0 =1 =11
i ,vi'y'...o- Design
Swine
Current Design Gur�ent
4
P,o Poultry. Ca
y
Cattle
Design Current
xix. f5 .
Ca P:o
@a acit
ulation acit Po ulation
actt ulation ;
®Dairy
250 200
i
`'
❑Layer
}❑Non
-Layer
❑Non -Dairy
� ��
❑Other
"''
�
Total Designx Capacity
250
q
r
Total'SSLW
350,000
Number of Lagoons
❑ Subsurface Drains Present ❑ Lagoon Area
❑ Spray Field Arcs
Holding Ponds /Solid Traps
0
❑ No Liquid Waste Management System
Feeder
FFeederto
Finisharrow
to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑Gilts
❑ Boars
Discharges 8�Stream-Impacts
I. Is any discharge observed from any part of the operation? ❑ Yes ® No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made'? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State'? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min'?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes ® No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ® No
Wye Collection -. Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate'? ® Spillway ❑ Yes ® No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard(inches) 1.Q.. .............................................. ............................................................. ..................................................................
5. Are there any immediate threats to the integrity of any of the structures observed? (ic/ trees, severe erosion,
seepage, etc.)
❑ Yes ®No ,
Continued on hack
Printed on 1218/99
3/23/99

Facility Number: 99-7 Smanagement
)r inspection
6. Are there structures on -site which are ncoperly addressed and/or managed through a or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste —Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application'? ❑ Excessive Ponding ❑ PAN
12. Crop type Fescue/Orchard grass(Graze)
7/29/99
❑ 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?
® Yes
❑ No
16.
Is there a lack of adequate waste application equipment?
❑ Yes
® No
Required
Records & Documents
17.
Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
❑ No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
® No
19,
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
® Yes
❑ No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
® No
21,
Did the facility fail to have a actively certified operator in charge?
❑ Yes
® No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
® No
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
® No
24.
Does facility require a follow-up visit by same agency?
❑ Yes
® No
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
® No
No violations;or deficiencies were noted during this: visit. ;You:will receive i�o further : ;
correspondence, about this.visit. : : : : : : : : : : : : : : : : : : : :
9 Owner stated that a black pipe from a drop box was the max. liquid level. This needs to be stated in the plan or have a marker
stalled. Suggested that the owner install a gauged marker since weekly freeboard readings would be require by the general
rrmit.
4 Need to pump WSP as soon as possible.
15 Need to get rid of pig weed in the pastures. Also, continue efforts to reduce erosion.
xlked to Mr. Shore about the General permit and informed him that the database showed he needed to supply additional
formation to DWQ before he could get permitted.
Reviewer/Inspector Name lRocky Durham
Reviewer/Inspector Signature: Date:
w
IV
Printed on 1

Facility Number: 99-7 1)1&f InsprCtion 7129/99
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes IN No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes ® No
28. Is there any evidence of wind drift during land application?' (i.e. 'residue on neighboring vegetation, asphalt, ❑ Yes ® No
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes IN 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
Printed on 12/8/99

DSWC AnMl Feedlot Operation Review
,-A5TbWQ Animal Feedlot Operation Site Inspection
lGrRoutine OCounpfaint OFollf),,%7-up_ofl)N�-Qins paction 0 Follow-up of DS%VC review 00ther
Date of Inspect ion
Facility Number Time of Inspection E= 24 hr. (hh:mm
®"Registered 0 Certified 0 Applied for Permit E3 Permitted E3 Not Operational j Date Last Operated: ­ -­ — ------- Farm Name. 5�VQVRe .... ....................... County:....Nhf,-�;\ ......................... .. .....................
.
Owner Name: 75,4,-.4,.4..e ...... V--t4,A5 .......... Gt,C ......................... Phone No: ... . ........... _Jf
Facility Contact: .................. Title: ................................................................ Phone Nok1AUJA-.101\
IMailing Address:.. ....... KV %.r ................... ....................... P e
Onsite Representative:.. ......... .............................................. Integrator...................................................................... ................
Certified ....................... ......................... Operator Certification Number-.,-
............
[,ocation of Farm.
............ A
............
.... . b.4 ..... . . .... x .... zx'
Latitude 11(�] a U7, E=,, Longitude * W,
Design Current Design Current Design Current.
Swine Capacity Population Poultry Capacity Population Cale:"Capacity Populatibi
0 Wean to Feeder
0 Feeder to Finish
0 Farrow to Wean
0 Farrow to Feeder
0 Farrow to Finish
0 Gilts
0 Boars
Number of Lagoons Holding Ponds
10 Layer I L[KDairy 7 Arj
ID Non -Layer 10 Non-Dairyj
FEI —Other
Total Design Capacity]
Total SSLW
FE1 —subsurface Drains Present J] Lagoon Area 10 Spray Field Areaj
10 No Liquid Waste Management System
General
1. Are there any buffers that need IllliTItenance/irliproveiiietit?
2. Is any discharge observed from any part of the operation'!
Discharge originated ak [:1 Lagoon [I Spray Field D Other
M -1 0
a. If discharge is observe was the conveyance man-made?
t he b. IIdischar-c is observed. it reach Surface Water'? (If yes. notify DWQ)
c. If-discharcre is observed, observe
- the, estimated flow in i1allmin?
d. Does discharge bypass a lagoon sNeni? (If yes, notify DWQ)
3. Is there evidence of past discharge from any part of the operation?
4. Were there any adverse impacts to the waters of the State other than from a discharge?
5. Does any part of the waste management system (other than lagoons/holding ponds) require
maintenance/improvement?
6. Is facility not in compliance with any applicable setbackcriteria in effect at the time of design?
7. Did the facility fail to have a certified operator in responsible charge!
7/25/97
El Yes ff <
El Yes VNo
0 Yes [I No
El Yes 0 No
0 Yes
0 No
0 Yes
GRINO
0 Yes
[if No
0 Yes
W40
El Yes
eN o
El Yes
[2'Ko
Continued on back VIV\­

Facility Number: —
8. Are there lagoons or storage ponds on site which need to be properly closed? ❑ Yes EPCO'
Structures (Lagoons,11olding, Ponds Flush fits etc.
9. Is storage capacity (Freeboard plus storm storage) less than adequate? ❑ Yes 2-10 4
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard(ft):.........L.�.............. ............................... ...... .............. ..................... Y
10. Is seepage observed from any of the structures? ❑ Yes 4EM
11. Is erosion, or any other threats to the integrity of any of the structures observed? ❑ Yes ❑ No
12.
Do any of the structures need maintenance/improvement?
❑ Yes
a"KO
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13.
Do any of the structures lack adequate minimum or maximum liquid level markers'?
CNN*
❑ Yes
[7 No
Ak
Waste Application \ \
14.
Is there physical evidence of over application?
❑ Yes
,,.�.,,
Wff o
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15.
Crap type ...................... .................................................................................................
���C>��,r...�..�OC.n.��..'.A4Q��..�...........�.:!�\�
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?
El Yes
[❑
93 0
18.
Does the receiving crop need improvement?
❑ Yes
EKo
19.
Is there a lack of available waste application equipment?
❑ Yes
R<o
20.
Does facility require a follow-up visit by same agency?
❑ Yes
[R<'o
21.
Did Reviewer[[nspector fail to discuss review/inspection with on -site representative?
El Yes
�'lsio
22.
Does record keeping need improvement?
❑ Yes
❑ No
For Certified or Permitted Facilities Only
23.
Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑ Yes
❑ No
24.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
❑ No
25.
Were any additional problems noted which cause noncompliance of the Permit?
❑ Yes
❑ No
No.violations or deficiencies were-notedduring this.visit..You4ill receive no further
correspondence about this'visit:,:.
Gamments (i efer to question #) . Explai&any YES answers,and/or anyrecom` mendations or.any other comments:,
Use drawrgs of fucility.ta better exglatn s�tuahons: (use additional pages asenecessary)
S\ \A\1 Ci\\)J"
7/25/97
Reviewer/Inspector Name
Reviewer/Inspector Signature:
M
Date: S"`�'' 6

OPERATIONS BRANCH - WO F8x:919-r15-60a8 3u.1 20 ' 95 11; 05 P. 15/I8
` 'r �. 5�e r9qulres immediate ati�r5ai
r"adl�y number ,
SITE 14SITATiaN RECORD
Oats: _ 1 ,1995
cwrlL,r: �k_... � ___ _---- Fan., 5 47�,
Agent VISi'irg site-, S z etea_de ty-
_L
On-'S;t.- ,- .Vssentative: Phcne: _
Fry3icdi AdCr.ss: �,.
Tyre of Swine - pou!!ry "` l altte
Cesi�n C2c�Ci`�: Number of Ar:rnas wi S: e: c2l-�D
Type Of
Girc!e Yes or No
Decs :�a r. mai Waste L grxr, have suilcj�ent freeCcwl of i Foot - 25 yasr 4 lc!jr ayent
rl-�.6rlala;y 1 FCCt + ! inC a �`e5 Lr Nc
lkiiti" more than v e ;ag:cn, ;ease addre-cS to the
sc-de 1,
:Val"j' S89YGvgSciti':Yes or
r�s 1he'n rosion cf',he daM? Yes or t%ac
s aacL:a` 'ar.d avaitaole far land appiiea},,on? F
or :No
16 irli: wCC.,aP ade-'Ja!?i :r tic
Sign
P.:( ?c GI ) 71!-v5:_
_ I l

, =- ,
13
V tom, 4 ♦ .
NILz
i
y
f
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x y"�-'�. �. Lei � -A �.� "t, •
a
_
_ '-.�... � �yq ,.'per*„ � a .. �•r ' .'y;:� ^►�,�" W ' f • •' -ti-..
Y
1 Y
si �, �+s:.11: 1�p't, ��Lc�F'pS[• "'*tee"
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